Visit Rates Research Articles

Visits to Health Centers Among Adults, by Selected Characteristics: United States, 2022.

This report describes care received at health centers in the United States in 2022. Estimates are presented for selected characteristics. The data presented in this report are from the 2022 National Ambulatory Medical Care Survey Health Center Component. Data were collected from federally qualified health centers and federally qualified health center look-alikes and weighted to produce nationally representative estimates of visits to health centers from all 50 U.S. states and the District of Columbia. During 2022, an estimated 89.5 million visits were made by adults to health centers in the United States, an overall rate of 349.4 visits per 1,000 adults. The visit rate among women was higher than for men. Differences in visit rates by age were not significant. Adults who were not married accounted for 48.2% of visits, and adults who were married accounted for 37.6% of visits. More than one-half of health center visits were disease-related (61.4%). Symptoms-related diagnoses accounted for 22.0% of visits. Screenings (12.6%) and examinations (10.2%) were also frequent reasons for health center visits. Social determinants of health were listed as a reason for the visit at 2.0% of health center visits. Endocrine diseases represented the most frequently mentioned disease category (29.1%), overall and among adults age 45 and older. Mental disorders represented the most common disease category among adults ages 18-44. Women visited health centers at a higher rate than men. In addition, patient and visit characteristics, including marital status and diagnoses, differed by age.

Differences in Utilization of Preventive Services for Primary Care Clinicians Participating in MIPS and ACOs.

Value-based payment programs link payments to the performance of providers on cost and quality of care to incentivize high-value care. To improve quality and lower costs, the Centers for Medicare and Medicaid Services (CMS) implemented the Quality Payment Program (QPP) for clinicians in 2017. Under the Medicare QPP, most eligible clinicians participate in one of the payment models: (a) Advanced Alternative Payment Models (A-APMs) through eligible APMs like Accountable Care Organizations (ACOs) or (b) the Merit-based Incentive Payment System (MIPS). ACO and MIPS clinicians participating in QPP differ in quality reporting requirements, and these differences are likely to affect the utilization of different quality measures, including preventive services. This study evaluated the differences in the utilization of preventive services by primary care clinicians participating in MIPS and ACOs. We use difference-in-difference regressions to compare preventive services in MIPS versus ACOs. Since preventive services like immunization and certain cancer screening are mandatory reporting measures for ACOs and voluntary measures for MIPS, the treatment group for this study is ACO clinicians and the comparison group is non-ACO MIPS clinicians. We obtained the rates of influenza immunization, pneumonia vaccination, tobacco use cessation intervention, depression screening, colorectal cancer screening, breast cancer screening, and wellness visits per 10000 Medicare beneficiaries from Medicare Provider Utilization and Payment Public Use File (2012-2018). We had 508144 total observations (ACO=25.78% and MIPS=74.22%) from 72592 unique primary care clinicians. Compared to MIPS clinicians, ACO clinicians had significantly higher rates of pneumonia vaccination (incidence rate ratio [IRR] 1.25; 95% confidence interval [CI], 1.10-1.43) but lower rates of colorectal cancer screening (IRR 0.69; 95% CI, 0.50-0.96). Similarly, clinicians in ACO shared savings-only models had significantly higher rates of pneumonia vaccination (IRR 1.28; 95% CI, 1.11-1.48), depression screening (IRR 1.72; 95% CI, 1.09-2.71), and wellness visits (IRR 1.27; 95% CI, 1.09-1.47) compared to MIPS clinicians. There were no differences between ACO and MIPS clinicians on the utilization of breast cancer screening procedures and tobacco use cessation interventions. ACO clinicians may have prioritized relatively low-cost services such as pneumonia vaccination, depression screening, and wellness visits to improve their performance under QPP. Policymakers may need to alter incentives in performance-based payment programs to ensure that clinicians are improving all types of quality measures, including cancer screening.

Emergent cesarean section during active labor-does cervical dilatation matter?

To compare the immediate and late complications associated with emergent cesarean sections (CS) performed during the first and second stages of active labor. We conducted a retrospective analysis of electronic medical records from a single academic center, including data from 577 patients who underwent emergent cesarean sections at 4cm or more of cervical dilatation. Patients were divided into two groups: those who had CS during the first stage of labor (4-9cm dilatation) and those who had CS at complete dilatation (10cm). Maternal and neonatal outcomes were compared, including rates of complications such as uterine atony, post-partum hemorrhage, infection, and neonatal intensive care unit (NICU) admission. Of the 577 patients, 352 underwent CS during active labor and 255 at complete dilatation. The complete dilatation group exhibited significantly higher rates of uterine atony (19.6% vs. 11.6%, p = 0.009) and uterine incision extension (34.2% vs. 16.5%, p = 0.0001). In addition, they had longer hospital stays (4.8 vs. 4.25days, p = 0.003) and higher outpatient clinic visit rates (21.3% vs. 9.9%, p = 0.0001). Infection-related complications on readmission were more common in the complete dilatation group (20% vs. 9.7%, p = 0.001). Neonatal outcomes, including APGAR scores and NICU admissions, did not differ significantly between the groups. Emergent cesarean sections performed at complete cervical dilatation are associated with increased intra-operative and post-operative complications compared to those performed during active labor. These findings highlight the importance of considering the stage of labor when planning cesarean delivery to minimize risks and optimize outcomes for both mother and neonate.

Factors associated with Antenatal care among the Reproductive age of Women in Madhesh Province, Nepal

Antenatal care (ANC) is essential for maternal and neonatal health, where ANC acceptance varies significantly across different socioeconomic and demographic groups. This study aims to dissect the factors influencing ANC visits Madhesh Province, Nepal, using data from the 2022 Nepal Demographic and Health Survey (NDHS). The NDHS provides a rich dataset, the women of reproductive age who had at least one live birth in the preceding five years. The study focuses on a range of variables such as age, education, household wealth, and proximity to healthcare facilities, analyzing their impact on ANC visits, with the World Health Organization recommending a minimum of four visits for a healthy pregnancy. This study indicates that while age, religion, caste/ethnicity, and rural versus urban residency do not significantly impact ANC attendance, educational attainment shows a non-significant trend towards higher ANC visit rates among better-educated women. Interestingly, economic status does not generally affect ANC attendance except in the wealthiest group, which shows a near-significant increase in visit. Furthermore, significant negative relationship between birth order and ANC visits, suggesting that women with subsequent pregnancies are less likely to seek frequent antenatal care. The dynamics of ANC attendance targeted interventions aimed at improving maternal health services. By identifying the specific barriers and facilitators to ANC access, policymakers and healthcare providers can develop more effective strategies to boost ANC interest and improve pregnancy results. This study highlights the necessity of addressing both socio-economic differences and educational needs to ensure inclusive maternal health coverage.

Access to urban community mental health services: does geographical distance play a role?

Mental health challenges are a pressing concern in Australia, which account for a significant portion of the disease burden and economic costs, yet a substantial number of those affected do not utilise necessary professional support. This study evaluates distance decay effect on adults' community mental health services in North Metropolitan Western Australia and explores factors influencing service use. Data were extracted from the Mental Health Information Data Collections including the records of consumers receiving face-to-face services from the Community Mental Health Clinics in the North Metro Health Service during March 2022 to March 2023. Additionally, socio-demographic information for each suburb and population data were obtained from the Australian Bureau of Statistics. The distance between residential suburbs and clinic locations was calculated. Descriptive statistics were used to describe the characteristics of the study population. A hierarchical linear regression analysis was used to explore whether the distance of suburb to the nearest community clinic was related to service utilisation. A total of 3,453 consumers received direct services across the North Metro Health Service Community Mental Health Clinics. Findings highlighted the impact of proximity to clinics on service utilisation, with suburbs closer to clinics exhibiting higher visit rates (p = 0.004). The data also showed a strong positive correlation between gender (percentage of females in the suburb) and living in socially and economically disadvantaged areas with consumer visits per thousand residents. These findings underscore the importance of addressing accessibility barriers and tailoring mental health services to meet the diverse needs of the community.

Examining the Link Between Delivery Method, Sleep Quality, and Postpartum Depression: Insights from a Prospective Study

This study investigates the prevalence of postpartum depression (PPD) among 200 women who delivered at Government Women’s Hospital, Dharashiv, from October 2023 to March 2024. The findings reveal a half-year prevalence of PPD at 13% for vaginal deliveries and 26% for cesarean deliveries, resulting in a pooled prevalence of 22% in India. This figure is notably higher than the 12.9% reported in high-income countries and aligns with the 19.2% prevalence found in low- and middle-income nations. The study highlights the challenges faced by mothers in accessing adequate postpartum care, especially given the short hospital stays and low rates of follow-up visits, which contribute to undetected mental health issues. Urban mothers exhibited higher rates of PPD, potentially due to factors such as overcrowding and increased stress. The mean age of affected mothers was 28.05 years, with no significant associations found between PPD and socio-demographic variables like family type or maternal education. Notably, a prior history of depression was linked to higher prevalence rates. These findings underscore the urgent need for enhanced screening and intervention strategies for PPD in India, particularly for vulnerable populations, to improve maternal mental health outcomes and overall family well-being.

Real-world perioperative treatment patterns and burden of recurrent disease in patients with high-risk endometrial cancer: a SEER-Medicare study

Objectives To elucidate unmet needs in high-risk endometrial cancer (EC), this study described perioperative treatment patterns in Medicare beneficiaries with high-risk EC and quantified the impact of disease recurrence on clinical and economic outcomes among patients receiving adjuvant therapy. Methods Patients aged ≥66 years with high-risk EC (stage I/II EC of non-endometrioid histology or stage III/IVA EC of any histology) receiving hysterectomy with bilateral salpingo-oophorectomy from SEER-Medicare data (2007–2019) were identified; perioperative treatment patterns were described. Post-operative treatment patterns were described among patients receiving adjuvant therapy; overall survival (OS), all-cause and EC-related healthcare resource utilization and costs were evaluated from recurrence date (using a claims-based algorithm developed with clinical input) for recurrent patients and from a frequency-matched date for non-recurrent patients. Results Of 2,279 patients receiving EC surgery, 3.1% received neoadjuvant therapy and 55.3% received adjuvant therapy. Among 1,199 patients receiving adjuvant therapy, systemic adjuvant therapy with radiation (38.9%) was most common. Median OS was 1.4 years among 378 (31.5%) recurrent patients identified over a median follow-up of 3.7 years. Recurrent patients had significantly higher per-patient-year rates of all-cause outpatient visits (37.7 vs. 22.6), EC-related outpatient visits (14.5 vs. 3.0), and all-cause hospitalizations (1.3 vs. 0.4) than non-recurrent patients, and an excess of $84,562 and $62,128 in all-cause and EC-related annual costs, predominantly driven by hospitalizations. Conclusions Our findings highlight the considerable clinical and economic burden experienced by patients with high-risk EC experiencing recurrence and emphasize the unmet need for novel therapies in early settings to mitigate this burden.

Antihypertensive therapy and unplanned maternal postpartum healthcare utilization in patients with mild chronic hypertension

ObjectiveTo test whether treatment of mild chronic hypertension (CHTN) in pregnancy is associated with lower rates of unplanned maternal healthcare utilization postpartum. MethodsThis was a secondary analysis of the CHTN and pregnancy study, a prospective, open-label, pragmatic, multicenter, randomized treatment trial of pregnant people with mild CHTN. All patients with a postpartum follow-up assessment were included. The primary outcome was unplanned healthcare utilization, defined as unplanned postpartum clinic visits, Emergency Department (ED) or triage visits, or unplanned hospital admissions within 6 weeks postpartum. Differences in outcomes were compared between study groups (Active Group: blood pressure goal of<140/90 mm Hg, and Control Group: blood pressure goal of <160/105 mm Hg), and factors associated with outcomes were examined using logistic regression. ResultsA total of 2293 patients were included with 1157 (50.5%) in the active group and 1136 (49.5%) in the control group. Rates of unplanned maternal postpartum healthcare utilization did not differ between treatment and control groups, (20.2% vs 23.3%, P=.07, aOR 0.84, 95% CI 0.69–1.03). However, ED or triage/maternity evaluation unit visits were significantly lower in the Active group (10.2% vs 13.2%, P=.03, aOR 0.76, 95% 0.58–0.99). Higher BMI at enrollment and cesarean delivery were associated with higher odds of unplanned postpartum healthcare utilization. ConclusionWhile treatment of mild CHTN during pregnancy and postpartum was not significantly associated with overall unplanned healthcare resource utilization, it was associated with lower rates of postpartum ED and triage visits.

Weighing the risks and benefits of flowering early in the spring for the woody perennial Prunus pumila.

There are advantages to flowering early in the spring, including greater pollinator fidelity and longer fruit maturation time. But plant phenology has advanced in recent years, making many plants vulnerable to freezing damage from late frosts. To determine the costs and benefits of flowering early in the growing season, we exposed Prunus pumila plants to two freezing treatments and a delayed flowering treatment in subsequent years. Data were collected on ovary swelling, fruit production, and pollinator visitation on hand- and open-pollinated plants in all treatments. We also measured tissue damage after freeze events. Our results suggest that flowering time and temperature affect reproductive success, with fewer fruits produced after hard freezes. The same was not true for light freezes, which had minimal impact on reproduction. Freezing damage to plants after a hard freeze did affect the number of dipteran pollinators but not the overall pollinator visitation rate. Despite the clear impact of freezing temperatures on plant reproduction, flowering early provided an advantage in that reproductive output decreased with delayed flowering. Our findings suggest that Prunus pumila will retain the ability to attract pollinators and produce viable seeds if exposed to false spring conditions that involve a light freeze, but hard freezes may reduce yield by an order of magnitude. Although the advantages to flowering early may outweigh the risk of freezing damage under current conditions, it is possible that flower viability may be constrained under continued climate warming.

30-Month Impact of Medications for Opioid Use Disorder on Acute Care Utilization in Rural Communities.

To assess both the short- and longer-term impact of offering medications for opioid use disorder (MOUD, ie, methadone, buprenorphine, or naltrexone) on rates of all-cause emergency department (ED) visits and acute inpatient admissions (IP) over a 30-month period among Medicaid enrollees with opioid use disorder (OUD) residing in rural communities. A quasi-experimental retrospective analysis of longitudinal Medicaid claims data among continuously enrolled adult patients with OUD residing in 71 predominantly rural counties in the United States between 2018 and 2020. A cohort of patients receiving MOUD treatment was compared against a contemporaneous propensity score-matched comparison group consisting of those who received no MOUD during the period. The sample included 5370 patients with OUD in each group. At the index period (ie, the month in which any MOUD was used for the first time), buprenorphine was the most commonly used MOUD (82% of the MOUD treatment group). By the eighth month since the index period, MOUD use dropped below 60% among the MOUD treatment group. Over the 30-month post-MOUD period, MOUD treatment was associated with 24% (112 vs 148 per 1000 per month) and 52% (21 vs 44) lower rates of ED visit and IP admission rates, respectively (P < 0.001), relative to the comparison group. Moreover, the reductions persisted well after the 18th month period. Receipt of MOUD was associated with both immediate- and long-term lower rates in acute care utilization rates among adult Medicaid beneficiaries with OUD residing in rural communities despite significant treatment discontinuation.

Vegetative traits, floral biology, and mutualistic interactions in the tropical mountain shrub Ribes ciliatum (Grossulariaceae)

Plant species in tropical mountain ecosystems experience significant environmental variation across short spatial distances. These systems offer an opportunity to assess geographic variation in plant traits in relation to biotic and abiotic environments. We examined plant vegetative and reproductive traits in the shrub R. ciliatum across two native conifer forests in central Mexico. We measured plant height, number of branches, leaf size, flower production, floral morphology, floral longevity, and plant reproductive success in R. ciliatum populations found in fir forests (3100 m) and Hartweg's pine forests (subalpine habitat, 3700 m). We also quantified the level of pollinator dependence, pollinator visitation rates, and fruit consumption rates by frugivorous birds in both populations. Plants were shorter and had smaller leaves in the subalpine forest than in the fir forest. Floral longevity decreased in the subalpine forest, but flower production, flower size, and fruit weight remained similar across populations. Fruit set and pollinator visitation rates were higher in the subalpine forest; however, seed weight and fruit consumption rates did not differ between sites. Hummingbirds and bumblebees were the primary pollinators of R. ciliatum, and the bird Ptiliogonys cinereus was the most important fruit consumer at both sites. Fruit set was entirely dependent on pollinators. Reduced plant size in the subalpine forest coincides with a general pattern associated with high mountain environments. In contrast, reproductive characters had a closer relationship to the pollination environment. The absence of variation in flower size and shape was consistent with the similarity in the composition of the pollinator community. Meanwhile, compared to lower-elevation forests, the subalpine forest exhibited shorter-lived flowers and increased fruit set, associated with higher pollinator visitation rates. Ribes ciliatum is a key resource for pollinators and frugivores at a time of year when few other floral resources are available in these high-elevation mountain forests.

Respiratory phenotype and health care utilization patterns by adults with sickle cell disease

AbstractAdults with sickle cell disease (SCD) and asthma have increased mortality and health care utilization; however, there are individuals with respiratory symptoms (including cough and wheeze) without asthma. These individuals may have similar patterns of increased mortality and health care utilization. To characterize the association between respiratory phenotype and health care utilization by adults with SCD. Cross-sectional study of adults with SCD presenting for emergency and inpatient hospital care from 2012 to 2014 in Florida, Iowa, and New York using state-level health care utilization databases. Outcomes of interest include all-cause, SCD-related, painful episode, and acute chest syndrome–related care. Respiratory phenotype was defined as SCD + asthma, SCD + respiratory symptoms, and SCD + none. We built multivariable logistic regression and negative binomial regression models to evaluate the association adjusting for demographics, social determinant of health proxies, year of care, and state. Of 29 952 identified individuals, 3.4% had intermittent respiratory symptoms, and a larger proportion (15.6%) had asthma. There was a high rate of inpatient hospitalizations (43%) and ED visits (60%). Individuals with asthma had a higher annual risk of inpatient hospitalizations (48% vs 37%) but lower annual risk of an ED visit (62% vs 86%) than individuals with intermittent respiratory symptoms. The pattern of increased health care utilization among individuals with intermittent respiratory symptoms was consistent across each utilization type. In this large cohort of adults with SCD, we identified some with intermittent respiratory symptoms who had significantly increased health care utilization. This warrants further evaluation to understand potential etiologies and interventions.

Application of the Clinical Outcomes, Healthcare Resource Utilization, and Related Costs Model in Chronic Obstructive Pulmonary Disease Patients

Introduction: The change in prevalence and management of chronic obstructive pulmonary disease (COPD) led to changes in outcomes and costs. We aimed to assess current clinical outcomes, resource utilisation, and costs in COPD. Methods: Retrospective, observational study of a cohort of consecutive COPD patients who visited the emergency department (ED) of a large tertiary hospital in 2018. The study measured baseline characteristics, 30-day and 1-year mortality, readmission, re-ED visit rates, and costs using the Clinical Outcomes, HEalthcare REsource utilisatioN, and relaTed costs (COHERENT) model, validated for heart failure. This model, featuring a colour graphic system, tracks time spent in different clinical situations (home, ED, hospital), considering vital status, healthcare resource use, and related costs. Results: In 2018, 2,384 patients with a primary COPD diagnosis visited the ED. The average age was 76 years, with 40% women. Observed mortality rates were 7.6% in-hospital, 8.5% at 30 days, and 23.4% at 1 year. The readmission rates were 9.9% and 36.1%, respectively. The cohort’s 1-year cost was approximately EUR 14.6 million (USD 15.95 million), with a median cost per patient of EUR 3,298 (USD 3,603.96). Hospitalisation incurred the highest costs, with initial hospitalisation and readmissions accounting for 44.7% and 42.6% of expenditures, respectively. Conclusion: One-year mortality and readmission rates for patients with COPD visiting the ED remain high with a significant economic impact on the health system. This burden justifies special programs to improve their care.

Suicide and self-injury-related emergency department visits and homelessness among adults 25–64 years old from 2016 to 2021 in the USA

BackgroundDespite pronounced increases in homelessness and mental health problems in the USA over the past decade, further exacerbated during the pandemic, and the higher prevalence of mental health conditions among...

High waterhole visitation rate by a breeding female snow leopard in summer

Water is a limiting resource in arid environments where space use of animals is often driven by access to water during the dry times of the year. Here we report on a breeding female snow leopard visiting a waterhole 37 times in June and July in 2015. These observations show that space use of snow leopards can be driven strongly by access to water during certain times of the year such as when lactating and the need for water is increased. Strong dependence on water during certain times of the year suggest that climate change and high human pressure on limited water sources may have negative impact on snow leopards and other wildlife in the mountains of High Asia.

Evaluating the role of insect pollinators in the viability of true seeds of shallot in tropical agroecosystems

Pollen transfer in tropical agroecosystems to increase seed production has received limited research, notably on shallot pollination and insect pollinators. This study evaluated how insect pollinators optimize shallot seed production in tropical agroecosystems, i.e. Batu and Malang Districts in Indonesia. This study was conducted from June to October in 2023. We examined pollinator diversity, foraging behavior, and the effectiveness of dominating insect pollinators during umbel flower anthesis, as well as visiting insect foraging and visiting patterns. We assessed pollinator effectiveness by comparing visitation rates under four treatments. A total of 21 insect species belonging to three orders visited the shallot flowers, of which 14 species have the potential to act as pollinators. Apis cerana Fabricius, 1793 (Hymenoptera: Apidae) and Lucilia sericata (Meigen, 1826) (Diptera: Calliphoridae) emerged as potentially effective pollinators. Air temperature significantly influenced pollinator activity in visiting anthesis umbels. Evaluations of pollinator efficiency showed that A. cerana was more efficient than L. sericata in promoting the production of true shallot seed and has a significant role in ensuring high-quality pollination. This highlights the necessity of comprehending the specialized contributions of pollinators for shallot seed production.

Impact of COVID-19 Pandemic on Emergency Department Visits for Opioid Use Disorder Across University of California Health Centers

Introduction: Coronavirus 2019 (COVID-19) has had a devastating impact on mental health and access to addiction treatment in the United States, including in California, which resulted in the highest rates of emergency department visits (ED) for opioid poisoning in 2020. As California slowly returns to pre-pandemic normalcy, it remains uncertain whether the rates of opioid-related events have slowed down over time. We hypothesized that the number of opioid-related ED visits were exacerbated after the period of the COVID-19 pandemic and continue at a high rate in the present. Methods: In this analysis we searched the University of California (UC) Health Data Warehouse—a database of electronic health records from six UC health centers—for opioid-related ED visits, identifiying using the following International Classification of Diseases, 10th Ed, Clinical Modification codes: F11 codes, and T40.0*, T40.1*, T40.2*, T40.3*, T40.4*, T40.6*. Opioid overdose-associated visits were classified by types of opioids involved: heroin (T40.1*); prescription opioids (T40.2* or T40.3*); and synthetic opioids (T40.4*). We performed interrupted time analysis to estimate the immediate (level) change and change-in-time trend (trend change), from before (January 2018–October 2019) and during the pandemic (April 2020–December 2022). Monthly visit rates were evaluated with negative binomial regression adjusted for first-order autoregression and using all-cause ED counts as the offset. We present effect sizes as rate ratios (RR) and 95% confidence intervals (CI), tested at α = .05. Results: Before COVID-19, a steadily increasing trend in ED visit rates was observed for all outcomes (P &amp;lt; 0.05) except synthetic opioids. Total opioid-related ED visit rates increased by 15% (RR 1.15, 95%CI 1.02–1.29, P = 0.20) immediately after March 2020 before decreasing by 0.5% every month, albeit without statistical significance (RR .995, 95% CI .991–1.00, P = 0.06). Similar trends were observed with prescription opioid overdoses, with a step increase of 44% (RR 1.44, 95% CI 1.10–1.89, P = .008) before plateauing after March 2020 (RR 1.01, 95% CI .998–1.02, P = 0.12). After March 2020, ED visit rates for synthetic opioid overdoses were increasing steadily by 4% every month (RR 1.04, 95% CI 1.02–1.06, P = .001), unlike with heroin, which was observed with an 8% monthly reduction (RR .92, 95% CI .90–.93, P &amp;lt; .001). No immediate increase in visit rates was observed for either opioid. Conclusion: While opioid-related ED admissions among the UC health centers showed an overall decrease, prescription and synthetic opioid overdoses remained significantly higher than pre-pandemic trends as of December 2022. A multilevel approach to improve awareness of new opioid health policies could ameliorate these alarming rises in the post-pandemic era.

The association between fracture and short-term adverse health outcomes among children with cerebral palsy

BackgroundChildren with cerebral palsy (CP) have a high risk of fracture; yet, little is known about their post-fracture health outcomes. A fracture is an unplanned event in contrast to surgeries or procedures where there is a pre-operative period to optimize body composition and health and planned post-operative follow-up care. Fractures may be associated with significant outcomes due to the unplannable nature and reactionary care. The objective of this study was to determine if fractures were associated with an increased rate of short-term adverse health outcomes among children with CP, and if these associations were dependent on age. MethodsThis retrospective cohort study used commercial claims from 01/01/2001–12/31/2018. The primary cohort was children 2–18 years old with CP and an incident fracture (CP + Fx). Comparison cohorts were propensity score matched 1:1 to CP + Fx on demographic and health-related indicators: CP without fractures (CPw/oFx); without CP with (w/oCP + Fx) or without (w/oCPw/oFx) a fracture. The incidence rate (IR) and IR ratios (IRR) of 30-day and 31–90-day pneumonia and 90-day emergency department (ED) visit were estimated. Cox regression tested for effect modification by age and sex. ResultsThe CP + Fx cohort (n = 1670) had higher IRs of 30-day pneumonia (IRR range, 1.53–4.54) and 90-day ED visit (IRR range, 1.45–2.37) (all P < 0.05), and higher IRs of 31–90-day pneumonia but this did not reach statistical significance (IRR, 1.41 to 2.32, all P > 0.05). Notably, there was evidence of effect modification by age. The rate of 30-day pneumonia became more problematic for CP + Fx with older age relative to comparison cohorts and for 90-day ED visit compared to CPw/oFx. The rate of 90-day ED visit for CP + Fx was more problematic at younger ages compared to w/oCP + Fx. ConclusionsFractures among children with CP were associated with an increased rate of short-term pneumonia and ED visit, which was more problematic with older age.

Outpatient Upper Extremity Fracture Surgery Is Associated with Increased Post-operative Emergency Department Visits.

This study aimed to determine if outpatient upper extremity fracture surgery was associated with increased post-operative ED visits and identify related risk factors. Design: Retrospective cohort. This multi-center study was conducted within a single academic institution, encompassing two level 1, two level 2, and one level 3 trauma center. All patients >18 years of age that underwent upper extremity fracture surgery from 2015-2021 were included. Risk factors for postoperative ED visit that were investigated included age, sex, tobacco use, alcohol abuse, psychiatric diagnosis, Elixhauser comorbidity score, race, location of upper extremity fracture, surgical setting (inpatient vs. outpatient), upper extremity block, surgical specialty, and Area Deprivation Index. Variables with a p<0.1 in bivariate analysis were included in a multivariable logistic regression to determine factors associated with a postoperative ED visit at 30 and 90-days. A total of 6,315 patients with an average age of 51±19 years were identified of which 52% were female and 65% had outpatient surgery. Post-operatively, 188 patients (3.0%) presented to the ED within 30 days and 304 (4.8%) presented within 90 days. Thirty-seven percent of ED visits were directly related to the procedure, most commonly for pain (20%), cast issues (4.3%), and swelling (3.9%). At 30 days postoperatively, 2.8% of patients who underwent surgery in an outpatient setting and 3.4% of those who underwent inpatient surgery returned to the ED, with these rates increasing to 4.4% and 5.6%, respectively, by 90 days. In multivariable analysis, outpatient surgery (OR:1.5, p=0.030), tobacco use (OR:2.1, p<0.001), higher Elixhauser Comorbidity scores (OR:1.2, p<0.001), non-White race (OR:1.9, p<0.001) elbow fractures (OR:1.8, p=0.016), and hand fractures (OR: 1.6, p=0.046) were associated with 30-day ED visits. Outpatient surgery was associated with increased rate of 30-day ED visits. Patients that smoke, had increased number of comorbidities or were non-White presented to the ED more frequently. III.

Enhanced Primary Care for Severe Mental Illness Reduces Inpatient Admission and Emergency Room Utilization Rates.

Cardiovascular disease (CVD) is a leading cause of premature mortality among patients with severe mental illness (SMI). Effective care delivery models are needed to address this mortality gap. This study examines the impact of an enhanced primary care (PC) program that specializes in the treatment of patients with SMI, called Medicine in Psychiatry Service-Primary Care (MIPS-PC). Using multipayer claims data in Western New York from January 1, 2016 to December 31, 2021, patients with SMI and CVD were identified using International Classification of Diseases, Tenth Revision codes. National Provider Identification numbers of MIPS-PC providers were then used to identify those patients who were treated by MIPS-PC during the period. These MIPS-PC-treated patients were compared against a cohort of one-to-one propensity score matched contemporaneous comparison group (ie, patients receiving PC from providers unaffiliated with MIPS-PC). A difference-in-difference approach was used to identify the treatment effects of MIPS-PC on all-cause emergency department (ED) visits and hospitalization rates. The MIPS-PC group was associated with a downtrend in the acute care utilization rates over a 3-year period following the index date (ie, date of first MIPS-PC or other PC provider encounter), specifically a lower hospitalization rate in the first year since the index date (25%; P < 0.001). ED visit rate reduction was significant in the third-year period (18%; P = 0.021). In summary, MIPS-PC treatment is associated with a decreasing trend in acute care utilization. Prospective studies are needed to validate this effect of enhanced PC in patients with SMI and CVD.