Journal articles: 'Healthcare utilization outcomes'

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Akinbami, Lara J., Sean D. Sullivan, Jonathan D. Campbell, Robert W. Grundmeier, Tina V. Hartert, Todd A. Lee, and Robert A. Smith. "Asthma outcomes: Healthcare utilization and costs." Journal of Allergy and Clinical Immunology 129, no. 3 (March 2012): S49—S64. http://dx.doi.org/10.1016/j.jaci.2011.12.984.

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Encinosa, William E., Didem M. Bernard, Chi-Chang Chen, and Claudia A. Steiner. "Healthcare Utilization and Outcomes After Bariatric Surgery." Medical Care 44, no. 8 (August 2006): 706–12. http://dx.doi.org/10.1097/01.mlr.0000220833.89050.ed.

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Kramer, David. "Intensive care unit outcomes: Healthcare utilization versus physiology." Critical Care Medicine 28, no. 8 (August 2000): 3117–18. http://dx.doi.org/10.1097/00003246-200008000-00092.

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EDOUMIEKUMO, SAMUEL GOWON, and TARI MOSES KARIMO. "INEQUITY IN HEALTHCARE UTILISATION AND HEALTH OUTCOMES AMONG HOUSEHOLDS IN BAYELSA STATE, NIGERIA." WILBERFORCE JOURNAL OF THE SOCIAL SCIENCES 7, no. 1 (June 30, 2022): 1–14. http://dx.doi.org/10.36108/wjss/2202.70.0110.

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This study examines inequity in the use of health care and health outcomes in Nigeria with specific focus on Bayelsa State. The study is based on 426 households who were administered with questionnaire. Health care utilization for general purposes and antenatal care are used as proxy for health care utilization, while maternal death, under-5 death and infant deaths are proxy for health outcomes. Results from concentration index estimates show more concentration of health care utilization for general purposes among the poor which is surprising, and more concentration of use of antenatal services among the rich. The study also found pro-rich inequity in all three health outcome indicators. The study concludes that health care utilization and health outcomes are inequitably distributed among households in Bayelsa: while the rich and poor have similar health needs, the rich enjoy better access to health services and health outcomes.

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Mezuk, Briana, Weidi Qin, Linh Dang, and Rodlescia Sneed. "CARE COORDINATION, HEALTH OUTCOMES, AND HEALTHCARE UTILIZATION AMONG ADULTS WITH MULTIMORBIDITY." Innovation in Aging 6, Supplement_1 (November 1, 2022): 22. http://dx.doi.org/10.1093/geroni/igac059.082.

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Abstract Care coordination is a vehicle for improving patient-provider and provider-provider communication to improve outcomes and reduce unnecessary healthcare utilization, particularly for adults with multimorbidity. However, the clinical effectiveness of coordination at the population level remains unknown. This study examined the association between experiences of care coordination with subsequent health and healthcare outcomes among US adults over age 50. The analytic sample (n=695) included respondents from the Health and Retirement Study who had at least two chronic conditions, completed an Experimental Module on Coordinated Care in 2016, and were re-interviewed in 2018. Three domains of care coordination were examined as predictors: perceptions of coordination; using tangible supports (e.g., seeing a care coordinator); and using technical supports (e.g., patient portal). A range of outcomes related to health (i.e., self-rated health, functioning, pain) and healthcare (i.e., medication adherence, visits, hospitalizations, care satisfaction) were assessed in 2018. Weighted linear and logistic regression models, adjusted for demographic and socioeconomic characteristics, were fit for each lagged outcome. Higher engagement with tangible supports was positively associated with subsequent hospitalization (OR: 1.08, 95%CI: 1.01-1.15), greater pain (OR: 1.11 , 95%CI: 1.03-1.20), and marginally worse self-rated health (B=-0.02, p< 0.063). Better perceptions of coordination were also positively associated with care satisfaction (B=0.03, p< 0.020). Care coordination was not associated with functioning, adherence, or number of medical visits. Findings indicate the salience of tangible support for coordination among older adults with multi-morbidity, and that positive perceptions of coordination contribute to healthcare satisfaction.

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Toolan, Shane, Mark Griffin, Mark Coyne, Kate O'Mahony, Joy Lewis, Chandan D'Souza, Daniel G. Connaghan, et al. "Predictors of Healthcare Utilization in Newly Diagnosed Myeloma." Blood 136, Supplement 1 (November 5, 2020): 37–38. http://dx.doi.org/10.1182/blood-2020-138857.

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Introduction The introduction of novel therapies has significantly improved outcomes in myeloma. However, the economic burden of enhanced healthcare utilization is significant and cannot be discounted. This study sought to identify baseline characteristics that may influence outcomes and subsequent healthcare utilization. Patients were also stratified by induction therapy to determine the impact newer combinations have on healthcare utilization. Methods This retrospective single-center study enrolled all newly diagnosed patients with myeloma between 2005 and 2020. Three outcome measures were used to determine healthcare utilization - total inpatient length of stay (LOS), number of admissions, and day ward attendances. Univariate and multivariable analyses were performed to identify significant covariates related to overall survival (OS) and healthcare utilization. Outcomes were subsequently adjusted for duration of follow-up and per patient year. Results There were 113 patients included; 60 (53.1%) female; median age at diagnosis was 67 years (IQR 62, 73 years) and 22.1% were high risk International Staging System (ISS). Further baseline demographics are presented in Table 1. Median duration of follow up was 3.2 years (IQR 1.50, 6.55). Sixty patients (53.1%) died, 91.7% attributable to myeloma or its treatment. Predictors of OS by multivariable analysis were advanced stage [ISS III (p<0.001)] and IgA idiotype [(IgA vs IgG) (p=0.0002)]. Stem cell transplant eligibility was associated with improved OS (p=0.003). The total number of admissions to hospital was 547 (median 4; IQR 2, 7), with 55.4% unplanned. In the multivariable analysis, younger age (p=0.020), higher paraprotein levels (p=0.045), dialysis (p=0.037), and SCT eligibility (p=0.0012) were predictive of greater number of admissions. During the study period, there were 7000 inpatient bed occupancy days (median 46; IQR 26, 80). Only younger age remained significant (p=0.0028) in the multivariable analysis. There were a total of 5987 day care attendances during the study period. Multivariable analysis identified younger age at diagnosis (p<0.0001), WBC (p=0.0072), and light chain (kLC vs lLC) (p=0.0027) as predictive of increased day ward attendance. Healthcare utilization correlated with increased survival, as depicted in figure 1. There was no significant relationship between treatment type and LOS (p=0.055); this remained unchanged when adjusted per patient year (p=0.24). There was significant relationship between treatment type and total number of admissions (p=0.015). Patients receiving anthracycline based therapy (p=0.003), Immunomodulatory (IMiD)/Proteasomal Inhibition (PI)/Steroid (p=0.020), or PI/Steroid (p=0.021) were more likely to have a greater number of admissions. However, when adjusted per patient year, this association was no longer evident (p=0.19). A highly significant relationship between treatment type and day ward attendances was identified (p<0.0001). Alkylator based (pp=0.005), alkylator/PI/Steroid (p=0.006), anthracycline based (p=0.0002), IMiD/PI/Steroid (p=0.0007), or PI/Steroid (0.0002) were more likely to have greater day ward attendance. When adjusted per patient year, this significant association between treatment type and day ward attendance remained (p=0.0002). Conclusion Studies assessing healthcare utilization in patients with myeloma are mostly limited to relapsed refractory setting. In this population, younger age at presentation was a significant predictor for all three measures of healthcare utility. Whilst treatment type did not demonstrate a significant impact of LOS, we did determine that novel triplet therapy combinations were associated with increased number of admissions and day care attendances. We also showed that healthcare utilization increased with survival time. While survival outcomes with novel agents have improved, given current financial and capacity limitations within which the majority of health systems function, resource demand implications must be considered when planning future service provision and novel treatment strategies. Disclosures No relevant conflicts of interest to declare.

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Shireman, Theresa I., Pamela C. Heaton, Wendy E. Gay, Robert J. Cluxton, and Charles J. Moomaw. "Relationship between Asthma Drug Therapy Patterns and Healthcare Utilization." Annals of Pharmacotherapy 36, no. 4 (April 2002): 557–64. http://dx.doi.org/10.1345/aph.1a067.

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BACKGROUND AND OBJECTIVE: Asthma drug therapy problems contribute significantly to preventable hospitalizations and increased healthcare use in asthmatics. Since asthma patients often require >1 medication for control of symptoms, concurrent asthma drug therapies may be important in predicting excessive healthcare utilization. The purpose of this study was to link inappropriate asthma drug therapy patterns and selected patient demographics to healthcare utilization. METHODS: This study was a retrospective, cross-sectional analysis of Ohio Medicaid medical, institutional, and prescription claims. We included ambulatory patients aged 15–65 years who had ≥2 claims for asthma (493.x) and who were continuously enrolled in the Medicaid fee-for-service program for the 12-month period from April 1998 through March 1999. We examined age, race, gender, metropolitan residence, presence of gastroesophageal reflux disease, and the usage patterns of inhaled corticosteroids, short-acting β2-agonists, long-acting β2-agonists, theophylline, and leukotriene receptor modifiers to identify asthma drug therapy problems based on national guidelines. The primary outcomes included the number of asthma-related hospitalizations, asthma-related emergency department visits, and oral steroid bursts. RESULTS: Among 10 959 asthma patients, only 46.8% of the study patients received >1 puff of inhaled corticosteroid per day. Forty-four percent of the patients received >3 puffs of short-acting β2-agonists per day. The most common outcome was an oral steroid burst (46.5%). Patients on high doses of short-acting β2-agonists had the greatest odds of receiving an oral steroid burst and were most likely to be hospitalized. African Americans were more likely to incur a hospitalization or emergency department visit. Women had greater odds of any undesirable asthma outcome. Higher use of short-acting β2-agonists led to higher odds of receiving a steroid burst or being hospitalized. Leukotriene receptor modifier use was related to higher levels of all outcomes. CONCLUSIONS: A large percentage of Ohio Medicaid patients were not receiving asthma medications in compliance with the National Heart, Lung, and Blood Institute guidelines. Despite nearly a decade of national efforts, asthma drug therapy patterns still have substantial room for improvement and continue to be associated with excess healthcare utilization.

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Killingmo, Rikke Munk, Kjersti Storheim, Danielle van der Windt, Zinajda Zolic-Karlsson, Ørjan Nesse Vigdal, Lise Kretz, Milada Cvancarova Småstuen, and Margreth Grotle. "Healthcare utilization and related costs among older people seeking primary care due to back pain: findings from the BACE-N cohort study." BMJ Open 12, no. 6 (June 2022): e057778. http://dx.doi.org/10.1136/bmjopen-2021-057778.

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ObjectivesTo describe healthcare utilization and estimate associated costs during 1 year of follow-up among older people seeking primary care due to a new episode back pain and to describe healthcare utilization across patients with different risk profiles stratified using the StarT Back Screening Tool (SBST).DesignProspective cohort study.Participants and settingA total of 452 people aged ≥55 years seeking Norwegian primary care with a new episode of back pain were included.Outcome measuresThe primary outcome of this study was total cost of healthcare utilization aggregated for 1 year of follow-up. Secondary outcomes included components of healthcare utilization aggregated for 1 year of follow-up. Healthcare utilization was self-reported and included: primary care consultations, medications, examinations, hospitalisation, rehabilitation stay, and operations. Costs were estimated based on unit costs collected from national pricelists. Healthcare utilization across patients with different SBST risk profiles was compared using Kruskal-Wallis test, post hoc Mann-Whitney U tests and Bonferroni adjustment.ResultsIn total, 438 patients were included in the analysis. Mean (BCa 95% CI) total cost per patient over 1 year was €825 (682-976). Median (BCa 95% CI) total cost was €364 (307-440). The largest cost category was primary care consultations, accounting for 56% of total costs. Imaging rate was 34%. The most commonly used medication was paracetamol (27%–35% of patients). Medium- and high-risk patients had a significantly higher degree of healthcare utilization compared with low-risk patients (p<0.030).ConclusionThis study estimated a 1 year mean and median cost of healthcare utilization of €825 and €364, respectively. Patients within the top 25th percentile accounted for 77% of all costs. Patients classified as medium risk and high risk had a significantly higher degree of healthcare utilization compared with patients classified as low risk.Trial registration numberClinicalTrials.gov NCT04261309, results

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Ray, Emily Miller, Richard F. Riedel, Christel N. Rushing, and Anthony N. Galanos. "Healthcare utilization among cancer patients prior to hospice." Journal of Clinical Oncology 34, no. 26_suppl (October 9, 2016): 135. http://dx.doi.org/10.1200/jco.2016.34.26_suppl.135.

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135 Background: The integration of palliative medicine in oncologic care has become increasingly recognized and supported. We have previously reported improved health system and quality of care outcomes for solid tumor patients admitted to our novel, fully-integrated palliative care (PC) and medical oncology inpatient service at Duke University Medical Center (DUMC). In this study, we explored healthcare utilization in patients specifically discharged to hospice pre- and post-PC integration. Methods: We conducted a retrospective cohort study of hospitalized patients on the solid tumor unit at DUMC who were discharged to hospice care between September 1, 2009-June 30, 2010 (pre-PC integration) and September 1, 2011-June 30, 2012 (post-PC integration). Cohorts were compared on the following outcome variables occurring within 30 days prior to discharge to hospice: number of hospitalizations, ICU days, ED visits, invasive procedures, subspecialty consultations, radiologic studies, medical oncology clinic visits, and use of chemotherapy or radiation. Wilcoxon rank-sum and Chi square tests were used for statistical analyses. Results: A total of 296 patients were included (133 pre-PC integration; 163 post-PC integration) in the analyses. Patient characteristics were well matched between cohorts. The overall mean age was 63 years (range 25-96), 62% were Caucasian, 51% were male, and 98% of patients had recurrent or metastatic disease. Of particular note, there were no significant differences noted between cohorts with regards to the resource utilization outcome variables assessed. Conclusions: Understanding healthcare utilization in this patient population is of great interest to clinical providers and policymakers alike. While we have previously demonstrated the benefit of integrating palliative care and medical oncology for reducing hospital readmissions and length of stay, this study shows no significant impact of an integrated approach on the utilization of healthcare resources measured within the 30 days prior to discharge to hospice. This may reflect the aggressive approach to management of symptoms for end-of-life patients, which often involves invasive procedures, use of imaging, and other resources to meet their needs.

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Dewland, Thomas A., David V. Glidden, and Gregory M. Marcus. "Healthcare Utilization and Clinical Outcomes after Catheter Ablation of Atrial Flutter." PLoS ONE 9, no. 7 (July 1, 2014): e100509. http://dx.doi.org/10.1371/journal.pone.0100509.

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Lauring, Julianne R., Allen R. Kunselman, Jaimey M. Pauli, John T. Repke, and Serdar H. Ural. "Comparison of healthcare utilization and outcomes by gestational diabetes diagnostic criteria." Journal of Perinatal Medicine 46, no. 4 (May 24, 2018): 401–9. http://dx.doi.org/10.1515/jpm-2017-0076.

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Abstract Objective: To compare healthcare utilization and outcomes using the Carpenter-Coustan (CC) criteria vs. the National Diabetes Data Group (NDDG) criteria for gestational diabetes mellitus (GDM). Methods: This is a retrospective cohort study. Prior to 8/21/2013, patients were classified as “GDM by CC” if they met criteria. After 8/21/2013, patients were classified as “GDM by NDDG” if they met criteria and “Meeting CC non-GDM” if they met CC, but failed to reach NDDG criteria. “Non-GDM” women did not meet any criteria for GDM. Records were reviewed after delivery. Results: There was a 41% reduction in GDM diagnosed using NDDG compared to CC (P=0.01). There was no significant difference in triage visits, ultrasounds for growth or hospital admissions. Women classified as “Meeting CC non-GDM” were more likely to have preeclampsia than “GDM by CC” women [OR 11.11 (2.7, 50.0), P=0.0006]. Newborns of mothers “Meeting CC non-GDM” were more likely to be admitted to neonatal intensive care units than “GDM by CC” [OR 6.25 (1.7, 33.3), P=0.006], “GDM by NDDG” [OR 5.56 (1.3, 33.3), P=0.018] and “Non-GDM” newborns [OR 6.47 (2.6, 14.8), P=0.0003]. Conclusion: Using the NDDG criteria may increase healthcare costs because while it decreases the number of patients being diagnosed with GDM, it may also increase maternal and neonatal complications without changing maternal healthcare utilization.

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Bassey, Uduak E., Mary I. Akinyemi, and Kelechi F. Njoku. "On Zero inflated models with applications to maternal healthcare utilization." International Journal of Mathematical Analysis and Optimization: Theory and Applications 7, no. 2 (March 28, 2022): 65–75. http://dx.doi.org/10.52968/28309288.

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We consider the problem of modelling count data with excess zeros and over-dispersion which are commonly encountered in various disciplines that limit the use of traditional models for count outcomes. Our research work applies the Zero-inflated Poisson and Negative Binomial models in modelling Maternal Health Care (MHC) utilization in Nigeria, employing the Andersen’s behavioural model to examine the effect of predisposing, enabling, and need factors on MHC utilization. The performance of these models are compared to the traditional Poisson and negative binomial models. The Vuong test and AIC suggests that the Zero-inflated Negative Binomial model provided the most significant improvement over traditional models for count outcomes.

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Gunturu, Krishna S., Timothy T. Pham, Sonali Shambhu, Michael J. Fisch, John J. Barron, and David Debono. "Immune checkpoint inhibitors: immune-related adverse events, healthcare utilization, and costs among commercial and Medicare Advantage patients." Supportive Care in Cancer 30, no. 5 (January 21, 2022): 4019–26. http://dx.doi.org/10.1007/s00520-022-06826-9.

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Abstract Background Immune checkpoint inhibitors (ICI) are increasingly used across multiple cancer types and stages and little is known about real-world outcomes. This study sought to determine healthcare utilization, costs, immune-related adverse events (irAEs), and all-cause mortality of single-agent versus combination ICI in the USA. Materials and methods This is a retrospective study conducted with 2016–2018 data from the HealthCore Integrated Research Database, consisting of commercial and Medicare-insured adult patients with a cancer diagnosis using ICI in the USA. Outcomes were healthcare utilization, costs, and irAEs (FDA-recognized and others) up to 1-year post-index between patients using ICI monotherapy (mono, PD-1/PD-L1 inhibitor) and combination therapy (combo, PD-1/PD-L1 with CTLA-4 inhibitors). Results In total, 9084 patients received monotherapy and 904 patients received combo therapy. Mean age 65 years for mono and 58 years for combo. Overall, the combo arm had higher rates of FDA-recognized irAEs (67.4% vs. 45.9%), especially endocrinopathies (27.7% vs 14.7%) and dermatitis (25.9% vs. 12.4%). All-cause mortality over 1-year follow-up was similar, 30.7% in mono vs 30.8% in combo arms. The combo group had higher rates of all-cause inpatient hospitalizations (55.4% mono vs 65.6% combo) and emergency department (ED) visits (33.7% mono vs 41.4% combo). IrAE-related hospitalizations were higher in combo (55.2% vs 42.1%). IrAE-related ED visits were 15.7% mono vs 22.7% combo. This increased toxicity and health care utilization was reflected in significant differences in healthcare costs. Stark differences were seen in all-cause medical costs as well as costs related to inpatient and ED utilization and costs attributed to irAEs. Conclusions Higher rates of irAEs, healthcare utilization, and costs occur with combination immunotherapy. As further indications are approved for combination ICI, our study highlights the real-world tradeoffs involved with combination therapy regarding burdens of toxicity and increased healthcare utilization.

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Moya-Alarcón, Carlota, Guiomar Piera, Ángel Callejo, and Amaya Gascó. "Real-world treatment patterns and outcomes in platinum-sensitive recurrent high-grade serous ovarian cancer patients." Journal of Comparative Effectiveness Research 11, no. 1 (January 2022): 13–27. http://dx.doi.org/10.2217/cer-2021-0135.

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Aim: To describe the overall cancer-related healthcare utilization patterns, treatment patterns and outcomes in women diagnosed with platinum-sensitive recurrent high-grade serous ovarian cancer. Patients & methods: Subanalysis of the Spanish sample of a retrospective, noninterventional, multinational, observational study. Results: BRCA-mutated patients had better outcomes in terms of progression-free survival and overall survival than patients who were BRCA wild-type. It was observed that patients’ treatment outcomes after the first recurrence progressively worsened as the patient underwent subsequent chemotherapy lines. Healthcare resource utilization when accounting for the follow-up time did not substantially differ between BRCA1/ 2-mutated and BRCA wild-type patients. Conclusion: BRCA1/2 mutation carriers have better treatment outcomes, including longer survival, without a negative impact on the use of healthcare resources.

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Kim, Myung Ja, and Eunhee Lee. "How to Reduce Excessive Use of the Health Care Service in Medical Aid Beneficiaries: Effectiveness of Community-Based Case Management." International Journal of Environmental Research and Public Health 17, no. 7 (April 6, 2020): 2503. http://dx.doi.org/10.3390/ijerph17072503.

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Community-based case management for medical aid beneficiaries was implemented in Korea to promote the rational use of medical care and stabilize the financial system. This study investigated the economic impact of community-based case management on reductions in healthcare utilization and costs. This was a program study using a national database to evaluate the effectiveness of community-based case management in changing not only healthcare utilization and costs but also client-centered outcomes using the NHI database and 198 regional databases. A total of 1741 case management clients were included in this study. The case management clients were categorized into three targeted groups and were provided individualized services according to the groups. Client-centered outcomes, such as health-related quality of life (QOL), self-care ability, and having a support system, increased after case management. Healthcare utilization and costs decreased significantly after case management. However, there was no significant difference in the decrease between the groups. An increase in healthcare utilization among medical aid beneficiaries has been observed due to the aging population and an increase in the number of recipients. To reduce healthcare utilization and costs while maintaining the health status of the beneficiaries, it is necessary to expand targeted case management.

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Alghamdi, A., T. Alsubait, A. Baz, and H. Alhakami. "Healthcare Analytics: A Comprehensive Review." Engineering, Technology & Applied Science Research 11, no. 1 (February 6, 2021): 6650–55. http://dx.doi.org/10.48084/etasr.3965.

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Big data have attracted significant attention in recent years, as their hidden potentials that can improve human life, especially when applied in healthcare. Big data is a reasonable collection of useful information allowing new breakthroughs or understandings. This paper reviews the use and effectiveness of data analytics in healthcare, examining secondary data sources such as books, journals, and other reputable publications between 2000 and 2020, utilizing a very strict strategy in keywords. Large scale data have been proven of great importance in healthcare, and therefore there is a need for advanced forms of data analytics, such as diagnostic data and descriptive analysis, for improving healthcare outcomes. The utilization of large-scale data can form the backbone of predictive analytics which is the baseline for future individual outcome prediction.

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Barba, Cheyanne, Brian Downer, Olivio J. Clay, Richard Kennedy, Erin Ballard, and Michael Crowe. "Healthcare utilization among pre-frail and frail Puerto Ricans." PLOS ONE 18, no. 1 (January 12, 2023): e0280128. http://dx.doi.org/10.1371/journal.pone.0280128.

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Frailty is associated with adverse health outcomes and greater healthcare utilization. Less is known about the relationship between frailty and healthcare utilization in Puerto Rico, where high rates of chronic conditions and limited healthcare may put this group at a higher likelihood of using healthcare resources. This study examined the association between pre-frailty and frailty with healthcare utilization at baseline and 4-year follow-up among a cohort of community dwelling Puerto Ricans living on the island. We examined data from 3,040 Puerto Ricans (mean age 70.6 years) from The Puerto Rican Elderly: Health Conditions (PREHCO) study between 2002–2003 and 2006–2007. We used a modified version of the Fried criteria defined as 3 or more of the following: shrinking, weakness, poor energy, slowness, and low physical activity. Pre-frailty was defined as 1–2 components. The number of emergency room visits, hospital stays, and doctor visits within the last year were self-reported. Zero-inflated negative binomial regression models were used for ER visits and hospital stays. Negative binomial models were used for doctor visits. Pre-frailty was associated with a higher rate of doctor visits with a rate ratio of 1.11 (95% CI = 1.01–1.22) at baseline. Frailty was associated with a higher rate of ER visits (1.48, 95% CI = 1.13–1.95), hospital stays (1.69, 95% CI = 1.08–2.65), and doctor visits (1.24, 95% CI = 1.10–1.39) at baseline. Pre-frailty and frailty were not associated with any healthcare outcomes at follow-up. Pre-frailty and frailty are associated with an increased rate of healthcare services cross-sectionally among Puerto Rican adults, which may cause additional burdens on the already pressured healthcare infrastructure on the island.

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Roman, Youssef M. "Pathway to Ascertain the Role of Pharmacogenomics in Healthcare Utilization Outcomes [Letter]." Pharmacogenomics and Personalized Medicine Volume 14 (March 2021): 379–80. http://dx.doi.org/10.2147/pgpm.s309038.

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Vaughn, Ivana A., Nicole M. Marlow, Kalyani Sonawane, Roger B. Fillingim, and Rebecca J. Beyth. "EXAMINING LONGITUDINAL HEALTHCARE UTILIZATION, OUTCOMES, AND SATISFACTION IN PRE-FRAIL OLDER ADULTS." Innovation in Aging 3, Supplement_1 (November 2019): S689—S690. http://dx.doi.org/10.1093/geroni/igz038.2541.

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Abstract Frailty is a medical syndrome occurring in nearly 60% community dwelling older adults and could have insidious origins in middle-adulthood that manifest predominantly as decline and multi-morbidity. Identification of pre-frail states in adults could potentially reduce its impact in late-life. The study used data from the Health and Retirement Study (HRS) to: 1) compare long-term healthcare utilization between pre-frail and non-frail patients, 2) compare risk of pain progression, functional decline, and mortality between pre-frail and non-frail patients, and (3) compare satisfaction with healthcare, self-perceptions of aging and satisfaction with life between pre-frail and non-frail patients. The primary predictor, pre-frailty phenotype, was based on the Paulson-Lichtenberg Frailty Index (PLFI), a validated HRS-version of the Fried criteria. Additional covariates included sociodemographics, comorbidities, smoking status, sleep quality, health status, and body mass index. Statistical analyses consisted of descriptive statistics, univariate analysis, negative binomial regression with log-link function, logistic regression, generalized linear modeling and Cox regression. Pre-frailty status increased the incidence of hospitalizations (IRR: 1.23; 95%CI: 1.18-1.28) and doctor’s visits (IRR: 1.18; 95%CI: 0.15-1.22); increased the risk of pain progression (HR: 1.61, 95%CI: 1.53-1.69), functional decline (HR: 1.77, 95%CI: 1.67-1.87), and all-cause mortality (HR: 1.09, 95%CI:1.03-1.16); lowered odds of healthcare satisfaction (OR: 0.79, 95%CI: 0.62-0.99) and lowered satisfaction with aging ((β: -0.23 95%CI: -0.36- (-0.10)) and satisfaction with life (β: -0.27 95%CI: -0.44- (-0.11)). Frailty syndrome is highly prevalent and having a better understanding of its influence on health outcomes at intermediate pre-frail states could provide insight into reducing manifestations in later life.

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MAYNARD, CHARLES, NATHAN R. EVERY, MICHAEL K. CHAPKO, and JAMES L. RITCHIE. "Improved Outcomes Associated with Stenting in the Healthcare Cost and Utilization Project." Journal of Interventional Cardiology 14, no. 2 (April 2001): 159–63. http://dx.doi.org/10.1111/j.1540-8183.2001.tb00728.x.

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Leeds, Ira L., Joseph K. Canner, Faiz Gani, Patrick M. Meyers, Elliott R. Haut, Jonathan E. Efron, and Fabian M. Johnston. "Increased Healthcare Utilization for Medical Comorbidities Prior to Surgery Improves Postoperative Outcomes." Annals of Surgery 271, no. 1 (January 2020): 114–21. http://dx.doi.org/10.1097/sla.0000000000002851.

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Axelrad, Jordan E., Daniel E. Freedberg, Susan Whittier, William E. Greendyke, Benjamin Lebwohl, and Daniel A. Green. "978 – Impact of Gastrointestinal Pathogen Panel Implementation on Healthcare Utilization and Outcomes." Gastroenterology 156, no. 6 (May 2019): S—205—S—206. http://dx.doi.org/10.1016/s0016-5085(19)37310-x.

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Lowe, Timothy John, Mark Hibberd, Paula Miller, Teresa Davis, and Gajanan Bhat. "IMPACT OF CONTRAST ECHOCARDIOGRAPHY ON ICU PATIENT OUTCOMES AND HEALTHCARE RESOURCE UTILIZATION." Journal of the American College of Cardiology 59, no. 13 (March 2012): E1133. http://dx.doi.org/10.1016/s0735-1097(12)61134-6.

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Sharplin, Kirsty, Li Yan A. Wee, Suzanne Edwards, Silke Danner, Agnes S. Yong, Deepak Singhal, and Devendra Hiwase. "Outcomes and Healthcare Utilization in Older Patients with Acute Myeloid Leukemia (AML)." Clinical Lymphoma Myeloma and Leukemia 19 (September 2019): S224. http://dx.doi.org/10.1016/j.clml.2019.07.101.

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Jones, Scott A., Katharine Hegerty, Carla Scuderi, Jessica Eglington, Ben Green, and Andrew Mallett. "Clinical and Healthcare Utilization Outcomes of Parathyroidectomy in CKD and Dialysis Patients." Kidney International Reports 5, no. 7 (July 2020): 1086–89. http://dx.doi.org/10.1016/j.ekir.2020.04.026.

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Wood, G. Craig, Lisa Bailey-Davis, Peter Benotti, Adam Cook, James Dove, Jacob Mowery, Abhilasha Ramasamy, et al. "Effects of sustained weight loss on outcomes associated with obesity comorbidities and healthcare resource utilization." PLOS ONE 16, no. 11 (November 3, 2021): e0258545. http://dx.doi.org/10.1371/journal.pone.0258545.

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Objective Determine the impact of long-term non-surgical weight loss maintenance on clinical relevance for osteoarthritis, cancer, opioid use, and depression/anxiety and healthcare resource utilization. Methods A cohort of adults receiving primary care within Geisinger Health System between 2001–2017 was retrospectively studied. Patients with ≥3 weight measurements in the two-year index period and obesity at baseline (BMI ≥30 kg/m2) were categorized: Obesity Maintainers (reference group) maintained weight within +/-3%; Weight Loss Rebounders lost ≥5% body weight in year one, regaining ≥20% of weight loss in year two; Weight Loss Maintainers lost ≥5% body weight in year one, maintaining ≥80% of weight loss. Association with development of osteoarthritis, cancer, opioid use, and depression/anxiety, was assessed; healthcare resource utilization was quantified. Magnitude of weight loss among maintainers was evaluated for impact on health outcomes. Results In total, 63,567 patients were analyzed including 67% Obesity Maintainers, 19% Weight Loss Rebounders, and 14% Weight Loss Maintainers; median follow-up was 9.7 years. Time until osteoarthritis onset was delayed for Weight Loss Maintainers compared to Obesity Maintainers (Logrank test p <0.0001). Female Weight Loss Maintainers had a 19% and 24% lower risk of developing any cancer (p = 0.0022) or obesity-related cancer (p = 0.0021), respectively. No significant trends were observed for opioid use. Weight loss Rebounders and Maintainers had increased risk (14% and 25%) of future treatment for anxiety/depression (both <0.0001). Weight loss maintenance of >15% weight loss was associated with the greatest decrease in incident osteoarthritis. Healthcare resource utilization was significantly higher for Weight Loss Rebounders and Maintainers compared to Obesity Maintainers. Increased weight loss among Weight Loss Maintainers trended with lower overall healthcare resource utilization, except for hospitalizations. Conclusions In people with obesity, sustained weight loss was associated with greater clinical benefits than regained short-term weight loss and obesity maintenance. Higher weight loss magnitudes were associated with delayed onset of osteoarthritis and led to decreased healthcare utilization.

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Noor, Rafat, and Aumeo Rushdi Saif. "Access to Maternal Healthcare in Rural Bangladesh: A literature-based Analysis on Factors Affecting Maternal Healthcare Utilization in Bangladesh." Journal of Armed Forces Medical College, Bangladesh 16, no. 1 (June 7, 2021): 69–75. http://dx.doi.org/10.3329/jafmc.v16i1.53848.

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In the last decade, Bangladesh has made substantial improvements of maternal and newborn mortality, such the maternal mortality ratio (MMR) had dropped from 574 per thousand live births in 1990 to 170 per thousand live births in 2013. Despite these improvements, Bangladesh is still lagging in achieving equity in service utilization. Literature manifested significant healthcare inequities across different socio-demographic factors and religious and cultural views. The primary aims of this analysis are – i) to assess the disparities in the quality and availability of maternal healthcare in Bangladesh and its relation to the service utilization in rural Bangladesh, ii) to identify demand-side interventions implemented in developing countries and relevant considerations to promote maternal healthcare utilization in rural Bangladesh. A narrative literature review was conducted using Rudolph Matas Library, Tulane University online resources, Google Scholar and PUBMED. Articles published between January 1st, 2015 and December 31st, 2018 describing quality, availability and utilization of maternal healthcare services; existing disparities and barriers in healthcare utilization in rural Bangladesh are included in the analysis. This analysis also includes articles describing the impact of demand-side interventions on healthcare utilization in developing countries. A total of 10 articles met the selection criteria. Bibliographies of selected articles were also searched to include additional information in this analysis. Reviews of the literature revealed a significant healthcare equity gap according to place of residences, wealth status, age at birth, and parity of mothers in Bangladesh. According to available study findings, the level of mothers’ education, cultural and social views, women’s employment status, distance of health facility, and perceived quality of care act as significant factors influencing maternal healthcare utilization in rural Bangladesh. Studies have shown that demand-side interventions considering cultural context and other existing barriers result in improved uptake of maternal healthcare and improved health outcome. Only availability of services cannot translate into better outcomes, unless those services are of acceptable quality and the population irrespective of their socio-demographic status can attain those services without any perceived barrier. The analysis suggested, along with ensuring availability and quality of healthcare, the need for demand-side interventions addressing existing barriers make services accessible to the rural communities in Bangladesh. JAFMC Bangladesh. Vol 15, No 1 (June) 2020: 848

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Shaffer, Kelly M., and Chandylen L. Nightingale. "Comparison of Healthcare Utilization Between Informal Caregivers and Non-Caregivers: An Analysis of the Health Information National Trends Survey." Journal of Aging and Health 32, no. 5-6 (February 22, 2019): 453–61. http://dx.doi.org/10.1177/0898264319830262.

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Objective: The demands of providing unpaid care for someone with a disabling health condition (i.e., informal caregiving) can limit attention to one’s own health needs. Using a nationally representative survey, this study examines whether caregivers report different healthcare utilization relative to non-caregivers. Method: Participants in the Health Information National Trends Survey 5, Cycle 1 reported whether they provided unpaid care and healthcare utilization outcomes. Logistic regressions and chi-square tests with jackknife variance estimation were used. Results: Caregivers ( N = 391) did not differ from non-caregivers ( N = 2,894) in time since routine checkup or number of healthcare appointments in the past year ( p values > .25). Among caregivers, number of healthcare appointments differed according to caregivers’ relationship to the care recipient ( p = .04). Discussion: Findings suggest that informal caregivers access routine healthcare at a frequency similar to non-caregivers. Further research should determine whether this utilization is optimal, or whether increased utilization during caregiving might help attenuate caregivers’ longer term morbidity.

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Sutphen, Rebecca, Joseph E. Bauer, Katherine S. Virgo, Carolina Casares, Gregg Walker, Marc D. Schwartz, Joanne Armstrong, et al. "American BRCA outcomes and utilization of testing (ABOUT) study." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 1608. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.1608.

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1608 Background: An estimated 100,000 individuals currently undergo genetic testing for hereditary susceptibility to breast and ovarian cancer annually in the U.S., yet little is known about their characteristics, testing experience or outcomes. Research in this high-risk group has been limited to patients recruited at academic medical centers where case ascertainment, health services delivery, decision-making and, quite likely, outcomes are different from those in the community setting where the majority of individuals currently receive healthcare services. Methods: Eligible subjects include 10,000 consecutive individuals requesting BRCA testing through the nation’s third-largest health insurer, Aetna, beginning in December, 2011. De-identified data are analyzed from each test request form submitted by the ordering provider. Each eligible subject is mailed a study packet inviting them to complete a questionnaire (by mail, online or telephone) designed to investigate informational and healthcare services, test results, knowledge, risk perception and medical intentions. Results: Of 442 subjects contacted during the first two weeks of accrual, 143 (32%) have completed the questionnaire to date. Similar to Aetna member demographics, 7% are African-American and 7% report Hispanic ethnicity. Based on Chi-Square tests, there were no differences between respondents and non-respondents with regard to age (51% under age 50), race, ethnicity or personal history of cancer (58%). Among respondents, deleterious mutations were identified in 8%. Testing for a known familial mutation was performed in 8%. Among women with breast cancer, 13% were undergoing testing prior to initial surgical treatment. Updated results from 3000 eligible subjects will be presented. Conclusions: This innovative, academic-industry collaboration enables an unprecedented investigation of significant issues surrounding individuals at increased risk for hereditary breast and ovarian cancer and undergoing genetic testing in the U.S. The results will guide the development and dissemination of more targeted decision-support tools and strategies to improve medical outcomes for such individuals.

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Rishel, Chris A., Martin S. Angst, and Eric C. Sun. "Preoperative Opioid Utilization Patterns and Postoperative Opioid Utilization: A Retrospective Cohort Study." Anesthesiology 135, no. 6 (November 9, 2021): 1015–26. http://dx.doi.org/10.1097/aln.0000000000004026.

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Background Among chronic opioid users, the association between decreasing or increasing preoperative opioid utilization and postoperative outcomes is unknown. The authors hypothesized that decreasing utilization would be associated with improved outcomes and increasing utilization with worsened outcomes. Methods Using commercial insurance claims, the authors identified 57,019 chronic opioid users (10 or more prescriptions or 120 or more days supplied during the preoperative year), age 18 to 89 yr, undergoing one of 10 surgeries between 2004 and 2018. Patients with a 20% or greater decrease or increase in opioid utilization between preoperative days 7 to 90 and 91 to 365 were compared to patients with less than 20% change (stable utilization). The primary outcome was opioid utilization during postoperative days 91 to 365. Secondary outcomes included alternative measures of postoperative opioid utilization (filling a minimum number of prescriptions during this period), postoperative adverse events, and healthcare utilization. Results The average age was 63 ± 13 yr, with 38,045 (66.7%) female patients. Preoperative opioid utilization was decreasing for 12,347 (21.7%) patients, increasing for 21,330 (37.4%) patients, and stable for 23,342 (40.9%) patients. Patients with decreasing utilization were slightly less likely to fill an opioid prescription during postoperative days 91 to 365 compared to stable patients (89.2% vs. 96.4%; odds ratio, 0.323; 95% CI, 0.296 to 0.352; P < 0.001), though the average daily doses were similar among patients who continued to utilize opioids during this timeframe (46.7 vs. 46.5 morphine milligram equivalents; difference, 0.2; 95% CI, –0.8 to 1.2; P = 0.684). Of patients with increasing utilization, 93.6% filled opioid prescriptions during this period (odds ratio, 0.57; 95% CI, 0.52 to 0.62; P < 0.001), with slightly lower average daily doses (44.3 morphine milligram equivalents; difference, –2.2; 95% CI, –3.1 to –1.3; P < 0.001). Except for alternative measures of persistent postoperative opioid utilization, there were no clinically significant differences for the secondary outcomes. Conclusions Changes in preoperative opioid utilization were not associated with clinically significant differences for several postoperative outcomes including postoperative opioid utilization. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Zhang, Xiangjun, Roy Oman, Trudy Larson, Elizabeth Christiansen, Michelle Granner, Minggen Lu, and Yueran Yang. "Healthcare Utilization, Unmet Service Needs, and HIV Treatment Outcomes among Racial/Ethnic Groups." Health Behavior and Policy Review 7, no. 6 (2020): 584–95. http://dx.doi.org/10.14485/hbpr.7.6.7.

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Objectives: In this study, we aimed to investigate possible racial/ethnic differences regarding service utilization, linkage to care, and medication adherence among people living with HIV/AIDS (PLWHA). Methods: PLWHA (N = 142) 18 years or older were recruited from a needs assessment project conducted in Nevada in 2016. Participants completed a self-administered questionnaire. The study variables included participants’ race/ethnicity (Caucasian, African-American, and Hispanic), service utilization, unmet service needs, linkage to care, and medication adherence. Significant between-group (race/ethnicity) differences regarding service utilization, linkage to care, and medication adherence were assessed. Results: There were no statistically significant between-group differences regarding utilized services, unmet service needs, linkage to care, and medication adherence (p > .05). However, there were statistically significant between-group differences for 4 individual utilized services. For example, African-American participants were 72% less likely to have utilized medical care services than Caucasians (AOR = 0.28, 95% CI = 0.10-0.74) and Hispanics were 84% less likely to have utilized mental health services than Caucasians (AOR = 0.16, 95% CI = 0.04-0.60). Conclusions: Health disparities among racial/ethnic groups exist, specifically regarding certain individual medical and support services. Federal and regional programs must allocate funding to address specific service needs and improve healthcare services for certain racial/ethnic groups.

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Delaney, Rebecca K., Brittany Sisco-Taylor, Angela Fagerlin, Peter Weir, and Elissa M. Ozanne. "A systematic review of intensive outpatient care programs for high-need, high-cost patients." Translational Behavioral Medicine 10, no. 5 (October 2020): 1187–99. http://dx.doi.org/10.1093/tbm/ibaa017.

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Abstract Five percent of the patient population accounts for 50% of U.S. healthcare expenditures. High-need, high-cost patients are medically complex for numerous reasons, often including behavioral health needs. Intensive outpatient care programs (IOCPs) are emerging, innovative clinics which provide patient-centered care leveraging multidisciplinary teams. The overarching goals of IOCPs are to reduce emergency department visits and hospitalizations (and related costs), and improve care continuity and patient outcomes. The purpose of this review was to examine the effectiveness of IOCPs on multiple outcomes to inform clinical care. A systematic search of the literature was conducted to identify articles. Six studies were included that varied in rigor of research design, analysis, and measurement of outcomes. Most studies reported results on healthcare utilization (n = 4) and costs (n = 3), with fewer reporting results on patient-reported and health-related outcomes (n = 2). Overall, there were decreasing trends in emergency department visits and hospitalizations. However, results on healthcare utilization varied based on time of follow-up, with shorter follow-up times yielding more significant results. Two of the three studies that evaluated costs found significant reductions associated with IOCPs, and the third was cost-neutral. Two studies reported improvements in patient-reported outcomes (e.g., satisfaction, depression, and anxiety). Overall, these programs reported positive impacts on healthcare utilization and costs; however, few studies evaluated patient characteristics and behaviors (e.g., engagement in care) which may serve as key mechanisms of program effectiveness. Future research should examine patient characteristics, behaviors, and clinic engagement metrics to inform clinical practice.

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Warholak, T., and A. Hincapie. "The Impact of Health Information Exchange on Health Outcomes." Applied Clinical Informatics 02, no. 04 (2011): 499–507. http://dx.doi.org/10.4338/aci-2011-05-r-0027.

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Summary Background and Objective: Healthcare professionals, industry and policy makers have identified Health Information Exchange (HIE) as a solution to improve patient safety and overall quality of care. The potential benefits of HIE on healthcare have fostered its implementation and adoption in the United States. However,there is a dearth of publications that demonstrate HIE effectiveness. The purpose of this review was to identify and describe evidence of HIE impact on healthcare outcomes. Methods: A database search was conducted. The inclusion criteria included original investigations in English that focused on a HIE outcome evaluation. Two independent investigators reviewed the articles. A qualitative coding approach was used to analyze the data. Results: Out of 207 abstracts retrieved, five articles met the inclusion criteria. Of these, 3 were randomized controlled trials, 1 involved retrospective review of data, and 1 was a prospective study. We found that HIE benefits on healthcare outcomes are still sparsely evaluated, and that among the measurements used to evaluate HIE healthcare utilization is the most widely used. Conclusions: Outcomes evaluation is required to give healthcare providers and policy-makers evidence to incorporate in decision-making processes. This review showed a dearth of HIE outcomes data in the published peer reviewed literature so more research in this area is needed. Future HIE evaluations with different levels of interoperability should incorporate a framework that allows a detailed examination of HIE outcomes that are likely to positively affect care.

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Bui, Thi My, Huyen Chu, and Quynh Pham. "Current situation of human resource for health and the outcomes of healthcare workforce policies on the healthcare indicators among ethnic minorities." Journal of Health and Development Studies 04, no. 02 (June 28, 2020): 115–22. http://dx.doi.org/10.38148/jhds.0101skpt20-014.

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A descriptive study was employed by using desk-studyapproach, focused on the reports and policies of the human resources for health in Vietnam, especially for the ethnic minority group. This study aimed to describe the status of the healthcare workforce in Vietnam and some outcomes of implementating the health workforce policies on the healthcare indicators among the ethnic minority group. The results of this study based on the data of health indicators for the period of 2013-2018. The main findings showed that the quantity and quality of the health workforce had increased gradually and also the health status and healthcare services utilization in the ethnic people had improved. However, the health workforce still had an imbalance in both quantitative and qualitative dimensions. While comparing to the general population, the inequity in healthcare services utilization and health indicators of ethnic minorities group still remained. Therefore, the Government and Ministry of Health need to review and develop the specific policies of the healthcare workforce to attract and maintain the health workers in the remote areas for ethnic minorities group. At the local health level, it is necessary to take the initiative in advising on develop the policies of the healthcare workforce; Strengthen the collaboration with all the stakeholders in the policy implementation; Monitoring and evaluation of the policy implementation to suggest the appropriate recommendations and solutions in the upcoming period. Keywords: Health workforce, human resources for health, ethnic minorities, health policy, health care, healthcare service utilization,…

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Dang, Nhu, Soryan Kumar, Michelle Kwon, Michael Cradeur, Katherine Zeven, Mihir Khunte, Daniel Marino, et al. "EFFECTS OF ACTIVE PATIENT PARTICIPATION IN AN INFLAMMATORY BOWEL DISEASE QUALITY IMPROVEMENT PROGRAM ON HEALTHCARE UTILIZATION OUTCOMES." Inflammatory Bowel Diseases 29, Supplement_1 (January 26, 2023): S53. http://dx.doi.org/10.1093/ibd/izac247.103.

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Abstract BACKGROUND Although previous studies have shown that participating in a structured national quality improvement program improves healthcare utilization for patients with inflammatory bowel disease (IBD), it is not known whether the extent of active participation influences health outcomes. Patients in the IBD Qorus Learning Health System self-report symptoms and treatment goals prior to clinic visits via electronic surveys, which facilitates disease surveillance and patient-provider co-production of care. This study assesses the relationship between active patient participation and IBD-related healthcare utilization outcomes. METHODS We reviewed electronic health records and surveys of patients with IBD from a private community gastrointestinal practice participating in Qorus for two years after they submitted the first pre-clinic survey. The study period was from 2016 to 2021. Primary outcomes were times from the first survey to an IBD-related ED visit/hospitalization, urgent message*, and CT-scan use. Participation score was calculated as a ratio of eligible surveys (submitted within two weeks prior to clinic visits) to the number of clinic visits, with a ratio <0.5 representing inactive participation and ≥0.5 representing active participation. Cox proportional hazards regression was performed to determine the relationship between active participation and healthcare utilization, controlling for potential confounders such as IBD subtype, baseline clinical disease activity, steroid use, and six-months-prior IBD-related ED visit/hospitalization and CT scan use. The “survival time” was defined as the time from the first survey to IBD-related healthcare utilization events, loss of follow-up in the electronic health records, or two years, whichever occurred earliest. RESULTS Out of 244 patients, 122 were inactive participants and 122 were active participants. Among inactive participants, 23.8% experienced an IBD-related ED visit/hospitalization, 27.9% sent an urgent message, and 12.3% received a CT scan. Among active participants, 18.9 % experienced an IBD-related ED visit/hospitalization, 21.3% sent an urgent message, and 12.3% received a CT scan (Table 1). Active and inactive (reference) Qorus participants were not statistically different in their healthcare utilization: ED visit/hospitalization (HR 0.61[95% CI 0.34-1.09]), sending an urgent message (HR 0.68 [95% CI 0.40-1.15]), and CT scan use (HR 1.00 [95% CI 0.47-2.13]), after adjusting for confounders (Table 2). CONCLUSION Although active participants show numerically less frequent ED visit/hospitalization and urgent message than inactive participants, there was not a statistically significant association between participation and healthcare utilization. A greater sample size is needed to draw further conclusions to inform future strategies to engage patients and optimize health outcomes.

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Haruna, Umar, Gordon Dandeebo, and Sylvester Z. Galaa. "Improving Access and Utilization of Maternal Healthcare Services through Focused Antenatal Care in Rural Ghana: A Qualitative Study." Advances in Public Health 2019 (July 1, 2019): 1–11. http://dx.doi.org/10.1155/2019/9181758.

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Improved access to and utilization of various maternal healthcare services have been seen as the panacea to poor maternal and child health outcomes characterizing many developing countries. Focused Antenatal Care (FANC) replaced the regular antenatal care model about a decade and a half ago. This study sought to document empirical outcomes of how the FANC approach translates access and utilization of maternal health services into positive maternal health outcomes. We utilized a descriptive qualitative design and analysis. We applied key informant interviewing to collect data from 206 respondents consisting of 140 women in their fertility age and 66 health workers across 14 communities in the study district. We found that FANC has been widely implemented across the district with most of the required services integrated into the existing healthcare delivery system. Overall, there has been successful implementation of FANC in the district, resulting in several benefits including the increased utilization of maternal healthcare services, acceptance of family planning, increased skilled delivery, and utilization of postnatal care (PNC) services. This notwithstanding, a number of issues need to be addressed to improve FANC services. These include provision of adequate infrastructure, essential supplies, communication and transportation systems, and manpower and adoption of positive sociocultural practices. No effort should be spared in providing these to sustain the successes and ensure sustainability of FANC.

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Vo, Daniel, and Yasir Hamad. "596. Clinical outcomes and healthcare utilization in uninsured patients requiring long-term antibiotic therapy." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S360—S361. http://dx.doi.org/10.1093/ofid/ofaa439.790.

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Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) is frequently indicated in the management of severe bacterial infections. Uninsured patients may more have difficulties accessing OPAT services (compared to those with a payer source) which can lead to prolonged hospitalizations or early discharge with potentially suboptimal therapy. We sought to assess disparities in the care of hospitalized, uninsured patients who had an OPAT indication and to examine subsequent clinical outcomes. Methods We performed a retrospective analysis of consecutive patients admitted to an academic hospital from 09/01/2018-12/31/2018 who received an infectious diseases consultation and had an index diagnosis of endocarditis (IE), Staphylococcus aureus BSI, or bone and joint infection including osteomyelitis, prosthetic joint infection, and septic arthritis identified by ICD-10 code. Clinical data were collected during index admission; outcomes were followed for up to 30 days after discharge. We examined differences in length of stay (LOS), discharge against medical advice (AMA), and composite outcome of death and readmission at 30 days in uninsured and privately insured patients. Results Of 104 patients, 66 (63.5%) were privately insured and 38 (36.5%) were uninsured. Baseline clinical characteristics are presented in Table 1. Uninsured patients were younger (40.9 versus 51.4 years, p< 0.001) and more likely to be African American (55.3% versus 19.7%, p< 0.001). Uninsured patients were more likely to leave AMA (18.4% versus 0%, p=0.001), complete shorter duration of IV antibiotics (p=0.001), and receive oral antibiotics at discharge (15.8% versus 3.0%, p=0.049). Length of stay was numerically longer in this group although not significant (15.5 days versus 10 days, p=0.053). Composite outcome of readmission or death from all cause at 30 days was lower in the uninsured group; however, after adjusting for age, the results were not significant (aOR 0.372, 95% CI 0.106-1.297, p=0.121). Table 1. Demographic and clinical characteristics of privately insured and uninsured patients Conclusion Uninsured patients were more likely to leave AMA, complete shorter duration of IV antibiotics, and receive oral antibiotics at discharge compared with privately insured patients. Thirty-day readmission and death rates were not significantly different among the two groups. Disclosures All Authors: No reported disclosures

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Zullow, Samantha, Barathi Sivasailam, Jonathan S. Galati, Takahiro Nakamura, Lisa Malter, and Jordan E. Axelrad. "Su1023: DISPARITIES IN HEALTHCARE UTILIZATION AND OUTCOMES IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE." Gastroenterology 162, no. 7 (May 2022): S—484. http://dx.doi.org/10.1016/s0016-5085(22)61150-8.

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Chesover, Alexander D., Antoine Eskander, Rebecca Griffiths, Jesse D. Pasternak, Jason D. Pole, Nikolaus E. Wolter, and Jonathan D. Wasserman. "The Impact of Hospital Surgical Volume on Healthcare Utilization Outcomes After Pediatric Thyroidectomy." World Journal of Surgery 46, no. 5 (February 3, 2022): 1082–92. http://dx.doi.org/10.1007/s00268-022-06456-6.

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Mallow, P., K. Belk, L. Clark, R. Banuelos, and C. Martin. "POSC244 Racial Disparities in Healthcare Utilization Outcomes Among Patients with Duchenne Muscular Dystrophy." Value in Health 25, no. 1 (January 2022): S167. http://dx.doi.org/10.1016/j.jval.2021.11.811.

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Oliveira, C., P. Redondo, M. J. Fonseca, J. Oliveira Gomes, S. Sousa, and D. Pereira. "PCN27 Treatment Outcomes and Healthcare Resources Utilization of Palbociclib in Advanced Breast Cancer." Value in Health 23 (December 2020): S425. http://dx.doi.org/10.1016/j.jval.2020.08.164.

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Kort, Smadar, Mark G. Hibberd, Timothy J. Lowe, Paula E. Miller, and Gajanan Bhat. "IMPACT OF CONTRAST ECHOCARDIOGRAPHY ON OBESE ICU PATIENT OUTCOMES AND HEALTHCARE RESOURCE UTILIZATION." Journal of the American College of Cardiology 61, no. 10 (March 2013): E953. http://dx.doi.org/10.1016/s0735-1097(13)60953-5.

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Hughes, Tasha M., Katiuscha Merath, Qinyu Chen, Steven Sun, Elizabeth Palmer, Jay J. Idrees, Victor Okunrintemi, Malcolm Squires, Eliza W. Beal, and Timothy M. Pawlik. "Association of shared decision-making on patient-reported health outcomes and healthcare utilization." American Journal of Surgery 216, no. 1 (July 2018): 7–12. http://dx.doi.org/10.1016/j.amjsurg.2018.01.011.

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Wiegand, Jared G., Sarah E. Messiah, Samir Ramesh Pandya, and Faisal Ghulam Qureshi. "Predicting Outcomes of Pediatric Traumatic Brain Injury Based on Healthcare Utilization at Diagnosis." Journal of the American College of Surgeons 231, no. 4 (October 2020): e180-e181. http://dx.doi.org/10.1016/j.jamcollsurg.2020.08.477.

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Williams, Zaria, Steven J. Hardy, Carly Berger, Danielle Griffin, Hannah Weisman, Hua Liang, and Deepika S. Darbari. "Cognitive and Emotional Factors and Pain-Related Outcomes in Youth with Sickle Cell Disease." Blood 136, Supplement 1 (November 5, 2020): 11. http://dx.doi.org/10.1182/blood-2020-141969.

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Children with sickle cell disease (SCD) experience acute episodes of pain that may require visits to emergency department (ED) or hospitalizations. SCD is associated with cognitive deficits that are particularly evident in domains of executive functioning (e.g., attention, working memory). Many patients/parents also report emotional concerns related to SCD. It is not known the degree to which these concerns impact disease self-management and healthcare utilization. This study investigated cognitive and emotional factors as contributors to pain-related healthcare utilization (visits to ED and hospitalizations) in children with SCD. The cohort included 112 youth with SCD (all genotypes) between ages 7-16 years who received care at Children's National Hospital in Washington, DC. Measures of socioeconomic status (e.g., parent education, family income, 1- vs. 2-parent households), cognitive abilities, and emotional functioning were extracted from an existing database of participants who had previously enrolled in the IRB approved study of computerized working memory training. Cognitive measures included the Wechsler Intelligence Scale for Children (WISC-V) Full Scale IQ and attention, working memory, and executive functioning tests from Cogstate, a computerized cognitive assessment. Emotional functioning was measured using the Worry 1 (i.e., anxiety about SCD) and Emotions (i.e., frustration and anger about SCD) domains of both the child- and parent-rated Pediatric Quality of Life Inventory Sickle Cell Disease Module. Healthcare utilization was measured through chart review, separated into ED visits for pain and hospitalizations for pain 1 year and 3 years after enrollment. The mean age of participants was 10.61 (SD=2.91) year with majority being females (n=65; 58%). Eighty-three (74%) had sickle cell anemia (HbSS or HbSβ0 thalassemia). The median number of ED visits for pain was 1 visit (IQR=2) across 1 year after enrollment and 3 visits (IQR=6) across 3 years after enrollment. The median number of hospital admissions for pain was 0 admissions (IQR=1) across 1 year after enrollment and 1 admission (IQR=4) across 3 years after enrollment (pain hospitalizations = 1; IQR=4). Linear regression models were applied to explore whether cognitive and emotional variables were predictive of healthcare utilization for pain. Variables included in the final model were selected by using the Akaike information criterion. Results indicated that attentional abilities were significantly associated with ED visits and hospitalizations for pain, both at 1 year and 3 years after enrollment (p's<.009), such that better performance on the Cogstate attention task was associated with fewer ED visits and hospitalizations. Child-rated emotional quality of life significantly predicted ED visits for pain over 1 year (b=-0.004, p=.049) and hospitalizations for pain over 3 years (b=-0.006, p=.013), such that higher emotional quality of life was predictive of fewer ED visits and hospitalizations. Parent-rated child emotional quality of life was also predictive of hospitalizations for pain over 3 years (b=-0.007, p=.020). Neither SCD genotype nor socioeconomic status significantly impacted healthcare utilization. Results demonstrate that children's cognitive and emotional functioning play an important role in pain management and should be an integral part of comprehensive pain management plans for children with SCD. Attentional abilities emerged as a reliable predictor of pain-related healthcare utilization and may signal that poor attention makes it difficult to implement strategies to distract from pain. It could also suggest that children with poor attention have greater difficulty with behavioral aspects of disease self-management (e.g., medication adherence, avoiding pain triggers). These are important considerations, given that youth with SCD are at risk for disease-related neurological sequelae including reduced attentional abilities. Emotional functioning (specifically, frustration and anger about SCD) also predicted healthcare utilization for pain, highlighting the potential impact of stress on pain onset and management. Clinicians and researchers should consider cognitive and emotional factors when evaluating risk for pain in SCD and incorporate these factors when developing strategies to reduce healthcare utilization and costs. Disclosures Darbari: Hilton Publishing: Consultancy, Other: Expert advisory board for developing gaming app for SCD; Global blood therapeutics: Consultancy, Honoraria, Other: participated in advisory board meeting ; Novartis: Consultancy, Honoraria, Other: steering committee for SPARTAN study .

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AGHDASSI, ELAHEH, STACEY MORRISON, CAROLINA LANDOLT-MARTICORENA, JIANDONG SU, CHRISTIAN A. PINEAU, DAFNA GLADMAN, MURRAY UROWITZ, et al. "The Use of Micronutrient Supplements Is Not Associated with Better Quality of Life and Disease Activity in Canadian Patients with Systemic Lupus Erythematosus." Journal of Rheumatology 37, no. 1 (December 1, 2009): 87–90. http://dx.doi.org/10.3899/jrheum.090761.

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Objective.Associations between the use of micronutrient supplements (MS) and disease activity, quality of life (QOL), and healthcare resource utilization were studied in a Canadian population of patients with systemic lupus erythematosus (SLE).Methods.QOL was assessed by the Medical Outcomes Study 36-item Short Form. Healthcare resource utilization and disease activity/damage were determined.Results.Of the 259 subjects studied, 53% were MS users and 34% used only calcium/vitamin D. MS users had a higher Systemic Lupus International Collaborating Clinics score and utilized more healthcare resources. Disease activity and QOL were similar between MS users and nonusers.Conclusion.MS are frequently used by patients with SLE and are not associated with concomitant benefit on QOL. MS users utilized more healthcare resources.

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Salerno, Stephen, Yuming Sun, Emily L. Morris, Xinwei He, Yajing Li, Ziyang Pan, Peisong Han, Jian Kang, Michael W. Sjoding, and Yi Li. "Comprehensive evaluation of COVID-19 patient short- and long-term outcomes: Disparities in healthcare utilization and post-hospitalization outcomes." PLOS ONE 16, no. 10 (October 6, 2021): e0258278. http://dx.doi.org/10.1371/journal.pone.0258278.

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Background Understanding risk factors for short- and long-term COVID-19 outcomes have implications for current guidelines and practice. We study whether early identified risk factors for COVID-19 persist one year later and through varying disease progression trajectories. Methods This was a retrospective study of 6,731 COVID-19 patients presenting to Michigan Medicine between March 10, 2020 and March 10, 2021. We describe disease progression trajectories from diagnosis to potential hospital admission, discharge, readmission, or death. Outcomes pertained to all patients: rate of medical encounters, hospitalization-free survival, and overall survival, and hospitalized patients: discharge versus in-hospital death and readmission. Risk factors included patient age, sex, race, body mass index, and 29 comorbidity conditions. Results Younger, non-Black patients utilized healthcare resources at higher rates, while older, male, and Black patients had higher rates of hospitalization and mortality. Diabetes with complications, coagulopathy, fluid and electrolyte disorders, and blood loss anemia were risk factors for these outcomes. Diabetes with complications, coagulopathy, fluid and electrolyte disorders, and blood loss were associated with lower discharge and higher inpatient mortality rates. Conclusions This study found differences in healthcare utilization and adverse COVID-19 outcomes, as well as differing risk factors for short- and long-term outcomes throughout disease progression. These findings may inform providers in emergency departments or critical care settings of treatment priorities, empower healthcare stakeholders with effective disease management strategies, and aid health policy makers in optimizing allocations of medical resources.

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Wong, E. T. "Improving laboratory testing: can we get physicians to focus on outcome?" Clinical Chemistry 41, no. 8 (August 1, 1995): 1241–47. http://dx.doi.org/10.1093/clinchem/41.8.1241.

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Abstract Managed care is changing the financing of healthcare and replacing open-ended reimbursement with fixed pricing schemes. Clinical laboratory tests will remain an important part of medical practice because laboratory information is essential for diagnosis and management of patients. The relative role of the hospital-based clinical laboratory, however, remains to be determined because healthcare organizations are reevaluating their services and attempting to drive down costs through reducing unit costs, decreasing utilization of services, and improving patient outcomes. The challenge for the clinical laboratory in managed care is to achieve appropriate utilization of laboratory tests so that clinical outcomes are optimized. The clinical laboratory at this medical center has used a number of approaches to improve utilization of thyroid function tests, isoenzyme tests for myocardial infarction, beta-human chorionic gonadotropin tests, and stat laboratory services for the emergency department. These experiences suggest that the laboratory can contribute to optimizing utilization of laboratory tests. This goal will require mutual cooperation of both the clinician and the clinical laboratory physician and (or) scientist.

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P, Dr Arul Valan. "Utilization of AI Technology To Rapidly Synthesize Information, Complete Work, Assist with Clinical Decisions and Improve Patient Outcomes." Journal of Nursing Practices and Research 1, no. 2 (January 11, 2022): 22–26. http://dx.doi.org/10.36647/jnpr/01.02.a005.

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The study sheds light on the concept of AI technology in healthcare and its importance to improve the patient’s conditions. Artificial intelligence and its usage in healthcare is the main focus of the research article. It is identified that most healthcare institutions are using AI-based devices nowadays to enhance sustainability and provide better healthcare service to the patients. The AI-based machines or devices that help the nurses to gain basic medical information about the patients are presented in the research article. Apart from that, the usage of published journals and articles helped to gain data and information about AI technology in healthcare.

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Cazeau-Bandoo, Stephanie I. V., and Ivy K. Ho. "The Role of Structural Gendered Racism in Effective Healthcare Utilization among Black American Women with Herpes Simplex Virus." Journal of Prevention and Health Promotion 3, no. 1 (November 25, 2021): 3–29. http://dx.doi.org/10.1177/26320770211049257.

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The sexual health of Black women has been compromised by racial and discriminatory healthcare practices from slavery through current medical and institutional barriers to care. This paper proposes a conceptual framework that identifies the link between stigma, gendered racism, and historical underpinnings that contribute to ineffective healthcare utilization of Black women diagnosed with the chronic sexually transmitted infection (STI), genital herpes. This paper also draws attention to different social factors that act as barriers to effective healthcare utilization and influence the health outcomes of Black women beyond individual factors. Using a socio-ecological framework, this paper reviews multi-level (i.e., individual, interpersonal, community, and institutional/policy) influences of the experience of genital herpes among Black women. Recommendations are provided to improve the ability of health systems and medical providers to deliver appropriate services to diverse populations, thereby improving healthcare utilization and reducing disparities for Black women.

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Journal articles on the topic 'Healthcare utilization outcomes'

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