scholarly journals 3580 What percent of unnecessary ED visits for chronic conditions can be reduced by extant telemedicine devices?

2019 ◽  
Vol 3 (s1) ◽  
pp. 62-62
Author(s):  
Simeon Abiola ◽  
Kimberly Arcoleo
Keyword(s):  
Chronic Conditions ◽  
Chronic Condition ◽  
Healthcare Research ◽  
Full Potential ◽  
Principal Diagnosis ◽  
On Demand ◽  
Transitive Property ◽  
Ed Visits ◽  
Condition Indicator ◽  
Management Services

OBJECTIVES/SPECIFIC AIMS: This study will elucidate what percent of unnecessary ED visits for chronic conditions can be reduced by extant telemedicine devices, and which telemedicine devices can yield the greatest reduction in unnecessary ED visits for chronic conditions. METHODS/STUDY POPULATION: We intend to use the Nationwide Emergency Department Sample (NEDS) to estimate the percent of ED visits, with a chronic condition as the principal diagnosis, were only evaluation and management services were rendered. The NEDS is the largest publicly available, all-payer ED database, providing national estimates of ED visits. The NEDS contains information on patient demographics, principal diagnosis (captured by ICD-9-CM codes and defined as the main reason for bringing the patient to the hospital), and procedure codes using Current Procedural Terminology, Fourth Edition (CPT-4). Patients with a chronic condition will be identified using Chronic Condition Indicator developed by the Agency for Healthcare Research and Quality and, from them, patients who only received “evaluation and management” services will be extracted using the CPT-4 codes 99281–99283 and G0380–G0383. Then using our previously developed database, wherein FDA-approved OTC medical devices were allied to chronic conditions by applying the transitive property of equality between telemedicine devices – measurement and measurement – conditions pairs, we will elucidate what percent of unnecessary ED visits for chronic conditions which can be reduced by extant telemedicine devices. RESULTS/ANTICIPATED RESULTS: We anticipate multiple OTC telemedicine devices will be necessary to evaluate and manage common principal conditions. DISCUSSION/SIGNIFICANCE OF IMPACT: Telemedicine is seen as a potentially powerful tool for improving healthcare and reducing cost. UnitedHealthcare, the largest US insurance provider, has partnered with Doctors on Demand, the largest players in the telemedicine app space, and other app-based telemedicine services to provide on-demand access to physicians. However, to reach the full potential of telemedicine, and more specifically towards reducing unnecessary ED visits for chronic conditions, telemedicine services need to include capabilities that will allow for the evaluation and management of chronic conditions. This study is a pragmatic first step towards understanding what telemedicine devices would best augment existing telemedicine services to reduce unnecessary ED utilization.

The role of chronic disease in the costs of potentially preventable emergency department use during treatment: A regional study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6505-6505 ◽  
Author(s):  
Laura Elizabeth Panattoni ◽  
Catherine R. Fedorenko ◽  
Karma L. Kreizenbeck ◽  
Stuart Greenlee ◽  
Julia Rose Walker ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chronic Disease ◽  
Chronic Conditions ◽  
Healthcare Research ◽  
Future Research ◽  
Regional Study ◽  
Diagnosis Codes ◽  
Ed Visits ◽  
One Year

6505 Background: The Centers for Medicare and Medicaid Services (CMS) released a quality metric for potentially preventable chemotherapy-associated emergency department (ED) use, effective in 2020. This metric excludes diagnoses with emerging evidence for outpatient management, such as proactive symptom management (PSM) and those for ambulatory care sensitive chronic conditions. Little is known about the intersection between potentially preventable ED visits due to cancer vs. other chronic disease. This study characterized the number and costs of ED visits during treatment. Methods: Western Washington cancer registry records from 2011- 2015 were linked with claims from two commercial insurers. Patients with newly diagnosed solid tumors undergoing initial treatment with chemotherapy or radiation were eligible. ED use was tracked one year post treatment initiation. ED diagnosis codes for fields 1-10 from the CMS metric and the PSM literature were labeled “Potentially Preventable” (Pp). Codes from the Agency for Healthcare Research and Quality’s Prevention Quality Indicators (PQI) for Chronic Conditions were labeled “Potentially Preventable-Chronic Disease” (PpChronic). Costs were adjusted to $2016. Results: Of the 7,053 eligible patients, 2,543 (36.1%) visited the ED (median # visits [IQR]: 1 [1-2]). The most commonly listed codes included Pain (1,054 visits) and Dyspnea (279 visits) for Pp, Hypertension-PQI (652 visits) and COPD-PQI (206 visits) for PpChronic, and Diabetes (247 visits) and Hyperlipidemia (181 visits) for the other codes. Spending on ED visits including both potentially preventable cancer and chronic disease diagnoses totalled $706,552 (20% of ED costs). Conclusions: One fifth of ED costs potentially resulted from simultaneous poor cancer symptom and chronic disease management. Future research should explore the role of chronic illness in categorizing which ED visits are potentially preventable during cancer treatment. [Table: see text]

scholarly journals Swāsthya, an integrated chronic condition management programme for families of patients with hypertension and diabetes mellitus: a study protocol for a randomised controlled trial

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
M D Saju ◽  
Bindiya M Varghese ◽  
Lorane Scaria ◽  
Anuja Maria Benny ◽  
Shilpa V Yohannan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Randomised Controlled Trial ◽  
Social Cohesion ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Controlled Trial ◽  
Risk Groups ◽  
Care Model ◽  
Randomised Controlled

Abstract Background Kerala is known as the diabetes mellitus (DM) and hypertension (HTN) capital of the world, thus compelling health professionals to model strategies, addressing their social, behavioural, and cognitive risk factors and eliminating various barriers to management. This paper describes the protocol of our study that aims to examine the effectiveness and sustainability of an integrated care model for the management of chronic conditions and their risk factors through a family-based intervention. The proposed care model targets to modify systems and processes that predispose to chronic conditions by enhancing social cohesion and social networks, preventing lifestyle risks, developing iterative cognitive interventions, and engaging the family into customised treatment adherence strategies navigated by community health social workers (CHSWs). Methods A cluster randomised controlled trial (RCT) in selected participants will be conducted involving additional assessments prior to the baseline assessment. The assessment will identify and categorise patients into four risk groups, namely behavioural, social, cognitive, and multiple, based on dominant risks identified. Eligible participants will be randomly allocated (at a ratio of 1:1) into the intervention or control arm. The intervention arm will receive social, behavioural, and cognitive or multiple interventions corresponding to the identified risk groups, whereas the control arm will receive general intervention. Both the groups will be followed up at 6 months and 12 months post baseline to measure outcomes. The primary outcome will be the control of HTN and DM, and secondary outcomes include decreased depression and anxiety and improved functioning, social cohesion, and social network linkages. The sustainability and scalability of this intervention will be assessed through cost effectiveness, acceptability, and user friendliness of the integrated approach by performing a qualitative evaluation. Discussion This RCT will inform the potential paradigm shift from a medical model of chronic condition management to a multidimensional, multisystem, and multidisciplinary convergence model navigated by CHSWs. Such a model is not currently considered in the management of chronic conditions in Kerala. Trial registration Trial has been prospectively registered on Clinical Trial Registry of India- CTRI/2020/12/029474 on 1st December 2020.

scholarly journals Disease-related disability burden: a comparison of seven chronic conditions in middle-aged and older adults

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chieh-Ying Chou ◽  
Ching-Ju Chiu ◽  
Chia-Ming Chang ◽  
Chih-Hsing Wu ◽  
Feng-Hwa Lu ◽  
...  
Keyword(s):  
Older Adults ◽  
Physical Disability ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Disease Diagnosis ◽  
Rate Of Change ◽  
Middle Aged ◽  
Rates Of Change ◽  
Depression Status ◽  
Stage Disease

Abstract Background Although previous studies have explored the effect of chronic conditions on physical disability, little is known about the levels and rates of change in physical disability after a chronic condition diagnosis in middle-aged and older adults in the Asian population. The aim of this study is to ascertain the average levels and rates of change in the development of disability after disease diagnosis, as well as to determine the influences of sociodemographic and health-related correlates in the development of disability. Methods This is a retrospective cohort study analyzing data of nationally representative participants aged 50 and over with a chronic condition or having developed one during follow-ups based on data from the 1996–2011 Taiwan Longitudinal Study on Aging (TLSA) (n = 5131). Seven chronic conditions were examined. Covariates included age at initial diagnosis, gender, education level, number of comorbidities, and depression status. Physical disability was measured by combining self-reported ADL, IADL, and strength and mobility activities with 17 total possible points, further analyzed with multilevel modeling. Results The results showed that (1) physical disability was highest for stroke, followed by cancer and diabetes at the time of the initial disease diagnosis. (2) The linear rate of change was highest for stroke, followed by lung disease and heart disease, indicating that these diseases led to higher steady increases in physical disability after the disease diagnosis. (3) The quadratic rate of change was highest in diabetes, followed by cancer and hypertension, indicating that these diseases had led to higher increments of physical disability in later stage disease. After controlling for sociodemographic and comorbidity, depression status accounted for 39.9–73.6% and 37.9–100% of the variances in the physical disability intercept and change over time, respectively. Conclusions Despite the fact that a comparison across conditions was not statistically tested, an accelerated increase in physical disabilities was found as chronic conditions progressed. While stroke and cancer lead to disability immediately, conditions such as diabetes, cancer, and hypertension give rise to higher increments of physical disability in later stage disease. Mitigating depressive symptoms may be beneficial in terms of preventing disability development in this population.

Approach to the Patient with Abdominal Pain

2020 ◽  
Author(s):  
Dana Sajed
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Chronic Conditions ◽  
Acute Abdominal Pain ◽  
Point Of Care ◽  
Abdominal Ultrasonography ◽  
Pediatric Populations ◽  
Ed Visits ◽  
Point Of Care Ultrasonography

Abdominal pain is the most common presenting complaint in the emergency department (ED), accounting for nearly 8% of ED visits. Although many chronic conditions may cause pain in the abdomen, acute abdominal pain, defined as undiagnosed pain present for less than 1 week, is of greatest concern to the emergency practitioner. For many reasons, acute abdominal pain is often diagnostically challenging. Abdominal pain may be due to numerous causes, including gastrointestinal, genitourinary, cardiovascular, pulmonary, and other sources. Symptoms may fluctuate or change in nature, and the quality of pain can be difficult for the patient to describe. Physical examination findings, although important, are variable and can even be misleading. Despite being such a common presenting complaint, misdiagnosis is not uncommon and results in a high percentage of medicolegal actions in both and adult and pediatric populations. This review contains 5 figures, 8 tables, and 92 references Key words: abdominal computed tomography, abdominal pain, abdominal ultrasonography, pain management, point-of-care ultrasonography

scholarly journals Medication understanding and health literacy among patients with multiple chronic conditions: a study conducted in Bangladesh

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Fahad Imtiaz Rahman ◽  
Farina Aziz ◽  
Sumaiya Huque ◽  
Sadia Afruz Ether
Keyword(s):  
Health Literacy ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Healthcare Providers ◽  
Poor Health ◽  
Multiple Chronic Conditions ◽  
Multiple Chronic Condition ◽  
Convenience Sample ◽  
Individual Interviews ◽  
Reduce Medication Error

Objectives: Medication understanding is critical for patients who suffer from multiple chronic conditions in order to reduce medication error and is often associated with poor health outcomesand low adherence. This study aims to identify the gap of medication knowledge among multiple chronic condition patients in Bangladesh, in order to aid physicians and other healthcare providers in improving health literacy.Methods: Individual interviews of a convenience sample of multiple chronic condition patients in Bangladesh were heldwhere they were asked a number of questions for assessing medication related literacy.Results: More than 26% patients failed to cite the brand name of all their prescribed medications while the rate of patients not knowing the generic names was far worse (88.1%). Nearly 1 out of every 4 patients did not know the purpose of all their medications and more than half of the participants (55%) did not know the strengths of their drugs. While knowledge about medication routes and regimen was satisfactory, awareness regarding risk factors of medicine was lowest of all. Only 1 out of every 4 patients had a habit of reading drug information leaflet. Patient’s ability to correctly state the purpose of their medication seemed to be positively associated with age (p=0.004) and negatively associated with number of medicines taken (p=0.03).Conclusions: Many patients demonstrated poor health literacy regarding medication. Routine review of medications from physician or health provider can significantly improve their health literacy, leading to better treatment outcome and medication adherence.

scholarly journals What do patients experience? Interprofessional collaborative practice for chronic conditions in primary care: an integrative review

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Alexandra R. Davidson ◽  
Jaimon Kelly ◽  
Lauren Ball ◽  
Mark Morgan ◽  
Dianne P. Reidlinger
Keyword(s):  
Primary Care ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Collaborative Practice ◽  
Integrative Review ◽  
Patient Role ◽  
Interprofessional Collaborative Practice ◽  
Sharing Space ◽  
Patients Experience

Abstract Background Improving the patient experience is one of the quadruple aims of healthcare. Therefore, understanding patient experiences and perceptions of healthcare interactions is paramount to quality improvement. This integrative review aimed to explore how patients with chronic conditions experience Interprofessional Collaborative Practice in primary care. Methods An integrative review was conducted to comprehensively synthesize primary studies that used qualitative, quantitative, and mixed methods. Databases searched were Medline, Embase, CINAHL and Web of Science on June 1st, 2021. Eligible studies were empirical full-text studies in primary care that reported experiences or perceptions of Interprofessional Collaborative Practice by adult patients with a chronic condition, in any language published in any year. Quality appraisal was conducted on included studies using the Mixed Method Appraisal Tool. Data on patients’ experiences and perceptions of Interprofessional Collaborative Practice in primary care were extracted, and findings were thematically analyzed through a meta-synthesis. Results Forty-eight (n = 48) studies met the inclusion criteria with a total of n = 3803 participants. Study quality of individual studies was limited by study design, incomplete reporting, and the potential for positive publication bias. Three themes and their sub-themes were developed inductively: (1) Interacting with Healthcare Teams, subthemes: widening the network, connecting with professionals, looking beyond the condition, and overcoming chronic condition collectively; (2) Valuing Convenient Healthcare, subthemes: sharing space and time, care planning creates structure, coordinating care, valuing the general practitioner role, and affording healthcare; (3) Engaging Self-care, subthemes: engaging passively is circumstantial, and, engaging actively and leading care. Conclusions Patients overwhelmingly had positive experiences of Interprofessional Collaborative Practice, signaling it is appropriate for chronic condition management in primary care. The patient role in managing their chronic condition was closely linked to their experience. Future studies should investigate how the patient role impacts the experience of patients, carers, and health professionals in this context. Systematic review registration PROSPERO: CRD42020156536.

The Effectiveness of a Healthcare Application and Human Coaching Program in Primary Care Clinics: A Non-randomized Controlled Trial (Preprint)

2021 ◽  
Author(s):  
HyoRim Ju ◽  
EunKyo Kang ◽  
YoungIn Kim ◽  
HyunYoung Ko ◽  
Belong Cho
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Sleep Quality ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Intervention Group ◽  
Self Management ◽  
Control Group ◽  
Primary Care Clinics ◽  
Healthcare Application

BACKGROUND As the global burden of chronic conditions increases, effective management for these are a concern. There is an increasing need for chronic condition management using mobile self-management healthcare applications. OBJECTIVE This study evaluated the effectiveness of a mobile self-management healthcare application combined with human coaching for primary care services in patients with chronic conditions. METHODS A total of 110 patients with hypertension, diabetes, dyslipidemia, and/or metabolic syndrome who visited one of 17 participating primary care clinics from September 2020 to November 2020 were included in this study. Data regarding changes in body weight, sleep conditions, quality of life, depression, anxiety, stress, body mass index, waist circumference, blood sugar levels, blood pressure, and blood lipids levels were recorded. The intervention group (N=65) used a mobile self-management healthcare application with human coaching for 12 weeks, and the control group (N=45) underwent conventional, self-managed health care. RESULTS Patients in the intervention group reported significantly more weight loss than those in the control group (P=.002). The weight loss was markedly greater after using application for nine weeks than using it for four weeks or five to eight weeks (P=.002). Patients in the intervention group reported better sleep quality (P=.04) and duration (P=.004) than those in the control group. CONCLUSIONS The combination of a mobile self-management healthcare application and human coaching in primary care clinics results in better management of chronic conditions. The observed weight loss was greater and sleep quality improved than conventional primary care for patients with at least one chronic condition.

The effect of household wealth on financial debt after cancer diagnosis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18552-e18552
Author(s):  
Syed Hussaini ◽  
Mia Dana ◽  
Lauren Nicholas
Keyword(s):  
Heart Disease ◽  
Cancer Diagnosis ◽  
Chronic Conditions ◽  
Credit Card ◽  
Chronic Condition ◽  
Household Wealth ◽  
Credit Card Debt ◽  
Home Equity ◽  
Diagnosis Of Cancer ◽  
New Diagnosis

e18552 Background: Cancer is the 2nd most common cause of death in the country, eclipsed only by heart disease. Cancer care is increasingly characterized by financial toxicity related to high-cost treatments, though it is unknown whether other chronic conditions impose similar financial harms. Methods: We conducted a retrospective analysis of the Health and Retirement Study participants interviewed between 2012-2018. This is a national, longitudinal survey conducted every two years of adults 50 and older and their spouses. We used fixed effect regression models to compare changes in financial debt among households with new diagnosis of cancer, other major chronic conditions (diabetes, stroke, or heart disease), and no new health diagnosis (or health shock). Since more affluent households may respond to health shocks differently, we estimated separate comparisons for households above versus below median wealth in 2012, prior to new health conditions. We assessed use of any non-housing financial debt, credit card debt, and home equity lines of credit among the subset of homeowning households. Results: In this study of 14,153 households, average age at interview was 62 years, with 43% male, 70% White, 22% Black, 13% Hispanic, and 70% with up to high school education. Of this population, 25% held credit card debt, 70% owned a home, 18% had a home equity line of credit, and 9% used a home equity line of credit. Among households with below median wealth when they entered the study in 2012 ( < $23,000 in $2016), a new cancer diagnosis was associated with a 4.7 percentage point increase in financial debt (12.5% effect size, p < 0.05). Participants diagnosed with a chronic condition (heart condition, stroke or diabetes) were 3.6 percentage points more likely to develop financial debt (9.6%, p < 0.05) compared to households that did not develop a new chronic condition. Such differences were eliminated in participants in a house with above median wealth. There was no difference in credit card debt, availability of home equity line of credit, or use of home equity line of credit for participants with a new diagnosis. Conclusions: New diagnosis of cancer or a chronic condition were associated with increased financial debt for older Americans living in a household that were below median wealth.

Chinese Herbal Medicine in the Management of Atherosclerosis-Related Chronic Conditions in an Aging Population

2019 ◽  
pp. 593-615
Author(s):  
Enoch Chan ◽  
Sai Wang Seto ◽  
Tsoi Ming Au Yeung ◽  
Gabriel Hoi Huen Chan
Keyword(s):  
Herbal Medicine ◽  
Chinese Herbal Medicine ◽  
Heart Attack ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Healthy Aging ◽  
The Elderly ◽  
Chinese Herbal ◽  
Mainstream Healthcare ◽  
The Cost

Chronic conditions are important problems for an aging society. They impede on healthy aging and increases the cost of living due to increased medical cost. The most prevalent chronic conditions faced by the elderly population are hypertension, high cholesterol and diabetes mellitus. They increase the risk of developing atherosclerosis, a chronic condition which causes heart attack and stroke. This chapter provides a review on existing therapeutics for the treatment of cardiovascular disease, and briefly discusses their side effects. This chapter also provides a brief introduction to Traditional Chinese Medicine (TCM), and its development in ancient China. This will be followed by a discussion on the recent research on the use of Chinese herbal medicine (CHM) in the treatment of cardiovascular diseases, and the potentials and challenges of incorporating CHM in mainstream healthcare system.

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