scholarly journals 4269 Frequent emergency department use among homeless individuals seen in emergent care: High risks of opioid-related diagnoses and adverse health services utilization outcomes

2020 ◽  
Vol 4 (s1) ◽  
pp. 133-133
Author(s):  
Ayae Yamamoto ◽  
Lillian Gelberg ◽  
Yusuke Tsugawa ◽  
Gerald Kominski ◽  
Jack Needleman
Keyword(s):  
Emergency Department ◽  
Mechanical Ventilation ◽  
Alcohol Abuse ◽  
Health Services ◽  
Hospital Mortality ◽  
Health Services Utilization ◽  
The State ◽  
Opioid Overdose ◽  
Services Utilization ◽  
Ed Visits

OBJECTIVES/GOALS: Using multi-state discharge data, to identify predictors of frequent emergency department (ED) use among the homeless patients seen in emergent care, and to compare frequent versus less frequent homeless ED users for their risk of serious health services utilization outcomes. METHODS/STUDY POPULATION: Based on the State Emergency Department Database and the State Inpatient Database, homeless individuals (n = 88,541) who made at least one ED visit in four states (Florida, Maryland, Massachusetts, and New York) in 2014. In this retrospective cross-sectional analysis, patient-level demographic and clinical factors were assessed as predictors for increased ED use. Risks of opioid overdose, opioid-related hospital admission/ED visit, in-hospital mortality, mechanical ventilation, and number of hospitalizations were compared between individuals with 4 or more vs. 2-3 vs. 1 ED visit(s), adjusting for potential confounders including hospital fixed effects (allowing for within hospital comparisons). RESULTS/ANTICIPATED RESULTS: Higher rates of ED use were associated with Medicare coverage <65; primary diagnosis of alcohol abuse, asthma, or abdominal pain; and co-morbidity of alcohol abuse, psychoses, or chronic pulmonary disease. Individuals with ≥4 visits had significantly higher adjusted risk of opioid overdose (3.7% vs. 1.2% vs. 1.0%), opioid-related hospitalizations/ED visits (17.9% vs. 8.5% vs. 6.6%), mechanical ventilation (9.8% vs. 7.0% vs. 4.7%), and greater # of hospitalizations (3.2 vs. 1.3 vs. 0.8) compared to individuals with 2-3 or 1 ED visit. Individuals with ≥4 and 2-3 ED visits had similar but increased risks of in-hospital mortality compared to individuals with 1 ED visit (2.8% vs. 2.8% vs. 2.3%). DISCUSSION/SIGNIFICANCE OF IMPACT: Homeless patients who were high ED users were more likely to be hospitalized and have other adverse outcomes. These findings encourage targeted interventions (i.e. housing) for the high-utilizer homeless population to reduce the burden of serious outcomes and costs for the patient and society.

scholarly journals Patterns of respiratory health services utilization from birth to 5 years of children who experienced adverse birth outcomes

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0247527
Author(s):  
Jesus Serrano-Lomelin ◽  
Anne Hicks ◽  
Manoj Kumar ◽  
David W. Johnson ◽  
Radha Chari ◽  
...  
Keyword(s):  
Health Services ◽  
Birth Outcomes ◽  
Gestational Age ◽  
Health Services Utilization ◽  
Respiratory Health ◽  
Adverse Birth Outcomes ◽  
Services Utilization ◽  
Appropriate For Gestational Age ◽  
Ed Visits ◽  
Respiratory Conditions

Introduction Adverse birth outcomes have important consequences for future lung health. We evaluated patterns of respiratory health services utilization in early childhood among children born preterm (PTB), small and large for gestational age at term (SGA and LGA, respectively), and appropriate-for-gestational age at term. Materials and methods We conducted a population-based retrospective cohort study using administrative health data of all singleton live births in Alberta, Canada between 2005–2010. Data on hospitalizations and emergency department (ED) visits from birth to 5 years were collected for asthma, bronchitis, bronchiolitis, croup, influenza, pneumonia, and other acute upper and lower respiratory tract infections (other URTI and other LRTI, respectively). Adjusted rate ratios were estimated for respiratory ED visits and hospitalizations for adverse birth outcomes using the appropriate-for-gestational age at term group as reference. Age-specific trajectories of total respiratory health services utilization rates for each group were estimated in Poisson models. Results A total of 293,764 episodes of respiratory care from 206,994 children were analyzed. Very PTB children had the highest rates of health services use for all respiratory conditions, particularly for asthma, pneumonia, and bronchiolitis hospitalizations. Moderate/late PTB children also had elevated ED visits and hospitalizations for all respiratory conditions. Children born SGA showed high rates of ED visits for other LRTI, and of hospitalizations for bronchitis, bronchiolitis, and other URTI. Children born LGA had high rates of croup and other URTI ED visits, and of bronchiolitis and bronchiolitis hospitalizations. Age-specific trajectories showed a decreasing trend in the rates of total respiratory health service utilization from birth to five years of age for all groups studied. Children born PTB and LGA at term significantly required more respiratory health services over time compared to the reference group. Conclusion Patterns of paediatric respiratory health services utilization vary according to gestational age and fetal growth.

scholarly journals Opioid Misuse in Missouri: Analyzing Emergency Department Use in Urban/Rural Areas

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Evan Mobley ◽  
Andrew Hunter ◽  
Whitney Coffey
Keyword(s):  
Emergency Department ◽  
Rural Areas ◽  
Urban Areas ◽  
The State ◽  
Opioid Overdose ◽  
Metro Area ◽  
Urban Rural ◽  
Ed Visits ◽  
Changes Over Time ◽  
Over Time

ObjectiveCompare rate changes over time for Emergency Department (ED) visits due to opioid overdose in urban versus rural areas of the state of Missouri.IntroductionLike many other states in the U.S., Missouri has experienced large increases in opioid abuse resulting in hundreds dying each year and thousands of ED visits due to overdose. Missouri has two major urban areas, St. Louis and Kansas City and a few smaller cities, while the remainder of the state is more rural in nature. The opioid epidemic has impacted all areas in the state but the magnitude of that impact varies as well as the type of opioid used. Missouri Department of Health and Senior Services (MODHSS) maintains the Patient Abstract System (PAS) which contains data from hospitals and ambulatory surgical centers throughout the state. PAS includes data from ED visits including information on diagnoses, patient demographics, and other information about the visit. MODHSS also participates in the Enhanced State Surveillance of Opioid-involved Morbidity and Mortality project (ESOOS). One major aspect of this surveillance project is the collection of data on non-fatal opioid overdoses from ED visits. Through this collection of data, MODHSS analyzed opioid overdose visits throughout the state, how rates compare across urban and rural areas, and how those rates have changed over time.MethodsThe 115 counties in Missouri were organized into the six-level urban-rural classification scheme developed by the National Center for Health Statistics (NCHS). The attached table shows the breakout of counties into the six different categories. The data years analyzed were 2012 through 2016. ED visits due to opioid overdose were identified using case definitions supplied by ESOOS. Overdoses were analyzed in three different categories—all opioids, heroin, and non-heroin opioids. The all opioid category combines heroin and non-heroin opioids. Non-heroin opioids includes prescription drugs such as oxycodone, hydrocodone, fentanyl, and fentanyl analogues. Annual rates per 10,000 were calculated for each county classification using population estimates. Confidence intervals (at 95%) were then calculated using either inverse gamma when the number of ED visits was under 500, or Poisson when the number was 500 or more. Changes over time were calculated using both a year over year method and a 5 year change method.ResultsOverall opioid rates have increased in all geographic areas during the 5 year period analyzed. Large Central Metro and Large Fringe Metro counties had the highest rates of ED visits due to opioid overdose. These two classifications also saw the largest increases in rates. The Large Central Metro counties collectively increased over 125%, while the Large Fringe Metro area increased 130%. Both areas experienced statistically significant increases year-to-year between 2014 and 2016 in addition to the overall 5 year period of 2012-2016.Analysis was also conducted for heroin and non-heroin subsets of opioid abuse. There were important differences in these two groups. For heroin ED visits, the highest rates were found in the Large Central Metro and Large Fringe Metro regions. However, the largest increase in percentage terms were found in the Medium Metropolitan, Micropolitan and Noncore regions which all saw increases of over 300%. Notably, every region experienced increases of over 150%. The Medium Metro had two consecutive years (2013/2014 and 2014/2015) where the heroin ED rate more than doubled.In contrast, non-heroin ED visits did not experience such a large increase over time. Most areas saw small fluctuations year-to-year with moderate overall increases over the 5-year time period. The exception to this trend is the Large Fringe Metro area, which saw increases every year most notably between 2014 and 2015 and had by far the largest 5 year increase at 82%.ConclusionsThe urban areas in Missouri continue to have the highest rates of opioid overdose, however all areas within the state have experienced very large increases in heroin ED visits within the past five years. The increase in heroin ED visits in the rural areas suggests the abuse of heroin has now spread throughout the state, as rates were much lower in 2012. The steady increase in non-heroin opioids unique to the Large Fringe Metro may be due to the availability of fentanyl in urban areas especially the St. Louis area. This possible finding would correspond with the increased deaths due to fentanyl experienced in and around the St. Louis urban area that has been identified through analysis of death certificate data. 

Effects of a standardized Emergency Department asthma care pathway on health services utilization

2018 ◽  
Author(s):  
Chanel Kwok ◽  
Katherine Lajkosz ◽  
Carole Madeley ◽  
Mona Jabbour ◽  
Teresa To ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health Services ◽  
Health Services Utilization ◽  
Care Pathway ◽  
Asthma Care ◽  
Services Utilization

Nonelective hospital admissions, discharge disposition, and health services utilization in epilepsy patients: A population‐based study

Epilepsia ◽  
2020 ◽  
Vol 61 (9) ◽  
pp. 1969-1978
Author(s):  
Churl‐Su Kwon ◽  
Bonnie Wong ◽  
Parul Agarwal ◽  
Jung‐Yi Lin ◽  
Madhu Mazumdar ◽  
...  
Keyword(s):  
Health Services ◽  
Hospital Admissions ◽  
Health Services Utilization ◽  
Population Based ◽  
Population Based Study ◽  
Services Utilization ◽  
Discharge Disposition

scholarly journals Does the implementation of a national oral health policy reduce inequalities in oral health services utilization? The Brazilian experience

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maria Helena Rodrigues Galvão ◽  
Angelo Giuseppe Roncalli
Keyword(s):  
Health Policy ◽  
Oral Health ◽  
Health Services ◽  
Health Services Utilization ◽  
Age Groups ◽  
Public Access ◽  
Services Utilization ◽  
Index Of Inequality ◽  
Oral Health Services ◽  
Oral Health Policy

Abstract Background This study aimed to assess the trend in income-related inequalities in oral health services utilization by the Brazilian population from 1998 to 2013. This period represents a timeline that includes different stages of implementation of the National Oral Health Policy. Methods The design was based on repeated cross-sectional surveys using secondary data from household-based studies carried out in Brazil in 1998, 2003, 2008, and 2013. The dependent variable was “having access to a dentist appointment at least once in a lifetime (yes/no).” Monthly household per capita income, based on Brazil’s minimum wage, was included as the main independent variable. To measure the inequalities in oral health access related to economic position, the following complex indexes based on regression were used: (a) the slope index of inequality (SII) and (b) the relative index of inequality (RII). Results There was a reduction in the percentage of individuals who never had a dentist appointment for all age groups and income classifications. In general, there was a reduction trend in absolute inequality for all age groups (p < 0.001). The relative inequality and reduction trend were different between the age groups studied. Conclusions The National Oral Health Policy was very important for expanding free of charge, public access to dental appointment. However, despite policy implementation, there continues to be high levels of inequality in access to dental consultation. Assessing which strategies are necessary to overcome this challenge is discussed.

Sign in / Sign up

Export Citation Format

Share Document