scholarly journals Cross‐sectional Analysis of Emergency Department and Acute Care Utilization Among Medicare Beneficiaries

2020 ◽  
Vol 27 (7) ◽  
pp. 570-579
Author(s):  
Arjun K. Venkatesh ◽  
Hao Mei ◽  
Liu Shuling ◽  
Gail D’Onofrio ◽  
Craig Rothenberg ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Care ◽  
Care Utilization ◽  
Medicare Beneficiaries ◽  
Cross Sectional ◽  
Cross Sectional Analysis ◽  
Acute Care Utilization ◽  
Sectional Analysis

scholarly journals Post-discharge Acute Care and Outcomes in the Era of Readmission Reduction

2019 ◽  
Author(s):  
Rohan Khera ◽  
Yongfei Wang ◽  
Susannah M. Bernheim ◽  
Zhenqiu Lin ◽  
Harlan M. Krumholz
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Acute Care ◽  
Care Utilization ◽  
Post Discharge ◽  
Readmission Rates ◽  
Risk Of Death ◽  
Observation Units ◽  
Acute Care Utilization ◽  
Significant Change

ABSTRACTBackgroundWith incentives to reduce readmission rates, there are concerns that patients who need hospitalization after a recent hospital discharge may be denied access, which would increase their risk of mortality.ObjectiveWe determined whether patients with hospitalizations for conditions covered by national readmission programs who received care in emergency department (ED) or observation units but were not hospitalized within 30 days had an increased risk of death. We also evaluated temporal trends in post-discharge acute care utilization in inpatient units, emergency department (ED) and observation units for these patients.Design, Setting, and ParticipantsIn this observational study, national Medicare claims data for 2008-2016, we identified patients ≥65 years hospitalized with heart failure (HF), acute myocardial infarction (AMI), or pneumonia, conditions included in the HRRP.Main Outcomes and MeasuresPost-discharge 30-day mortality according to patients’ 30-day acute care utilization. Acute care utilization in inpatient and observation units, and the ED during the 30-day and 31-90-day post-discharge period.ResultsThere were 3,772,924 hospitalizations for HF, 1,570,113 for AMI, and 3,131,162 for pneumonia. The overall post-discharge 30-day mortality was 8.7% for HF, 7.3% for AMI, and 8.4% for pneumonia. Post-discharge mortality increased annually by 0.16% (95% CI, 0.11%, 0.22%) for HF, decreased by 0.15% (95% CI, -0.18%, -0.12%) for AMI, and did not significantly change for pneumonia. Specifically, mortality only increased for HF patients who did not utilize any post-discharge acute care, increasing at a rate of 0.16% per year (95% CI, 0.11%, 0.22%), accounting for 99% of the increase in post-discharge mortality in heart failure. Concurrent with a reduction in 30-day readmission rates, 30-day observation stays and visits to the ED increased across all 3 conditions during and beyond the post-discharge 30-day period. There was no significant change in overall 30-day post-acute care utilization (P-trend >0.05 for all).Conclusions and RelevanceThe only condition with an increasing mortality through the study period was HF; the increase preceded the policy and was not present among those received ED or observation unit care without hospitalization. Overall, during this period, there was not a significant change in the overall 30-day post-discharge acute care utilization.

Factors Influencing Emergency Department Utilization and Hospital Re-Admissions in a Predominantly Obese, Racially Diverse Urban Renal Transplant Population

2020 ◽  
pp. 152692482097859
Author(s):  
Alicia B. Lichvar ◽  
Alisha Patel ◽  
Dana Pierce ◽  
Renee Petzel Gimbar ◽  
Ivo Tzvetanov ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Emergency Department ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
Acute Care ◽  
Body Mass ◽  
Care Utilization ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Acute Care Utilization

Introduction: Early emergency department and hospital re-admissions are common in renal transplant recipients, but data are lacking in unique populations. Study Aim: The purpose of this study was to identify patient risk factors for multiple acute care utilization events within the first year of renal transplantation. Design: This was a single-center, retrospective cohort study of adult renal transplant recipients between 9/2013-9/2016. Patients were compared across number of emergency department visits and by hospital re-admissions. Diagnoses were categorized. Univariate and multivariate logistic regression was used to assess risk for multiple acute care utilization events within the first 12 months post-transplant. Results: A total of 216 patients were analyzed and were on average 50.5 (SD 13.9) years old, redominantly Black (49.77%) with an average body mass index of 33.33 (9.8) and were recipients of deceased donor renal transplants (61.11%). A total of 105 (48.6%) patients visited the emergency epartment and 119 (55.1%) patients had a hospital readmission. Patients having a body mass index >35 kg/m2 did not differ across emergency department visit or hospitalization groups. Delayed graft function (OR 2.86, 95% CI 1.07-7.65) and previous renal transplant (OR 2.77, 95% CI 1.04-7.39) were significantly associated with multiple acute care utilizations. Discussion: Acute care utilization following renal transplantation was similar to previously reported experiences. Obesity did not impact use of acute care resources or patient outcomes. Strategies addressing potential preventable emergency visits and hospital re-dmissions should be promoted.

scholarly journals Trends in Emergency Department Visits and Charges for Gout in the United States between 2006 and 2012

2016 ◽  
Vol 43 (8) ◽  
pp. 1589-1592 ◽  
Author(s):  
Sadao Jinno ◽  
Kohei Hasegawa ◽  
Tuhina Neogi ◽  
Tadahiro Goto ◽  
Maureen Dubreuil
Keyword(s):  
United States ◽  
Emergency Department ◽  
Temporal Trends ◽  
The United States ◽  
Emergency Department Visits ◽  
Cross Sectional ◽  
Cross Sectional Analysis ◽  
Ed Visits ◽  
Sectional Analysis

Objective.To examine temporal trends in the rate of gout emergency department (ED) visits and charges in the United States between 2006 and 2012.Methods.A serial cross-sectional analysis of the Nationwide Emergency Department Sample.Results.The rate of ED visits for gout in adults overall increased from 75.0 to 85.4 per 100,000 persons over the study period (14% increase, p < 0.001), and increased 29% for those aged 45–54 years. Nationwide ED charges increased from $156 million to $281 million (80% increase, p < 0.001).Conclusion.Between 2006 and 2012, the rate of gout ED visits increased among US adults, most notably in those aged 45–54 years.

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