scholarly journals Clinical outcomes and health care utilization pre- and post-laparoscopic radiofrequency ablation of symptomatic fibroids and laparoscopic myomectomy: a randomized trial of uterine-sparing techniques (TRUST) in Canada

2018 ◽  
Vol Volume 10 ◽  
pp. 201-212 ◽  
Author(s):  
Darrien D Rattray ◽  
Laura Weins ◽  
Lexy C Regush ◽  
James M Bowen ◽  
Daria O'Reilly ◽  
...  
Keyword(s):  
Health Care ◽  
Radiofrequency Ablation ◽  
Health Care Utilization ◽  
Randomized Trial ◽  
Clinical Outcomes ◽  
Laparoscopic Myomectomy ◽  
Care Utilization ◽  
Laparoscopic Radiofrequency Ablation

Telemedicine, the effect of nurse-initiated telephone follow up, on health status and health-care utilization in COPD patients: A randomized trial

Respirology ◽  
2014 ◽  
Vol 20 (2) ◽  
pp. 279-285 ◽  
Author(s):  
Farida F. Berkhof ◽  
Jan W.K. van den Berg ◽  
Steven M. Uil ◽  
Huib A.M. Kerstjens
Keyword(s):  
Health Care ◽  
Health Status ◽  
Health Care Utilization ◽  
Randomized Trial ◽  
Care Utilization ◽  
Copd Patients

Negative Pressure Wound Therapy After Abdominal Body Contouring: A Comparative Matched Analysis of Outcomes and Cost

2021 ◽  
pp. 229255032110196
Author(s):  
Martin P. Morris ◽  
Adrienne N. Christopher ◽  
Viren Patel ◽  
Ginikanwa Onyekaba ◽  
Robyn B. Broach ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Clinical Outcomes ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Body Contouring ◽  
Emergency Department Visits ◽  
Smoking History ◽  
Care Utilization ◽  
Wound Therapy

Background: Studies that have previously validated the use of incisional negative pressure wound therapy (iNPWT) after body contouring procedures (BCP) have provided limited data regarding associated health care utilization and cost. We matched 2 cohorts of patients after BCP with and without iNPWT and compared utilization of health care resources and post-operative clinical outcomes. Methods: Adult patients who underwent abdominoplasty and/or panniculectomy between 2015 and 2020 by a single surgeon were identified. Patients were propensity score matched by body mass index (BMI), gender, smoking history, diabetes mellitus, hypertension, and incision type. Primary outcomes included time to final drain removal, outpatient visits, homecare visits, emergency department visits, and cost. Secondary outcomes included surgical site occurrences (SSO), surgical site infections, reoperations, and revisions. Results: One hundred sixty-six patients were eligible, and 40 were matched (20 with iNPWT and 20 without iNPWT) with a median age of 47 years and BMI of 32 kg/m2. There were no differences in demographics or intraoperative details (all P > .05). No significant differences were found between the cohorts in terms of health care utilization measures or clinical outcomes (all P > .05). Direct cost was significantly greater in the iNPWT cohort ( P = .0498). Inpatient length of stay and procedure time were independently associated with increased cost on multivariate analysis (all P < .0001). Conclusion: Consensus guidelines recommend the use of iNPWT in high-risk patients, including abdominal BCP. Our results show that iNPWT is associated with equivalent health care utilization and clinical outcomes, with increased cost. Additional randomized controlled trials are needed to further elucidate the cost utility of this technique in this patient population.

scholarly journals Approaches to Evaluations of Virtual Care in Primary Care

2022 ◽  
Vol 2 (1) ◽  
pp. es0358
Author(s):  
Daphne Hui ◽  
Bert Dolcine ◽  
Hannah Loshak
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Utilization ◽  
Clinical Outcomes ◽  
Care Utilization ◽  
Cost Analyses ◽  
Virtual Care ◽  
Primary Care Health ◽  
Guidance Documents ◽  
Care Health

A literature search informed this Environmental Scan and identified 11 evaluations of virtual care in primary care health settings and 7 publications alluding to methods, standards, and guidelines (referred to as evaluation guidance documents in this report) being used in various countries to evaluate virtual care in primary care health settings. The majority of included literature was from Australia, the US, and the UK, with 2 evaluation guidance documents published by the Heart and Stroke Foundation of Canada. Evaluation guidance documents recommended using measurements that assess the effectiveness and quality of clinical care including safety outcomes, time and travel, financial and operational impact, participation, health care utilization, technology experience including feasibility, user satisfaction, and barriers and facilitators or measures of health equity. Evaluation guidance documents specified that the following key decisions and considerations should be integrated into the planning of a virtual care evaluation: refining the scope of virtual care services; selecting an appropriate meaningful comparator; and identifying opportune timing and duration for the evaluation to ensure the evaluation is reflective of real-world practice, allows for adequate measurement of outcomes, and is comprehensive, timely, feasible, non-complex, and non–resource-intensive. Evaluation guidance documents highlighted that evaluations should be systematic, performed regularly, and reflect the stage of virtual care implementation to encompass the specific considerations associated with each stage. Additionally, evaluations should assess individual virtual care sessions and the virtual care program as a whole. Regarding economic components of virtual care evaluations, the evaluation guidance documents noted that costs or savings are not limited to monetary or financial measures but can also be represented with time. Cost analyses such as cost-benefit and cost-utility estimates should be performed with a specific emphasis on selecting an appropriate perspective (e.g., patient or provider), as that influences the benefits, effects, and how the outcome is interpreted. Two identified evaluations assessed economic outcomes through cost analyses in the perspective of the patient and provider. Evidence suggests that, in some circumstances, virtual care may be more cost-effective and reduces the cost per episode and patient expenses (e.g., travel and parking costs) compared to in-person care. However, virtual care may increase the number of individuals treated, which would increase overall health care spending. Four identified evaluations assessed health care utilization. The evidence suggests that virtual care reduces the duration of appointments and may be more time-efficient compared to in-person care. However, it is unclear if virtual care reduces the use of medical resources and the need for follow-up appointments, hospital admissions, and emergency department visits compared to in-person care. Five identified evaluations assessed participation outcomes. Evidence was variable, with some evidence reporting that virtual care reduced attendance (e.g., reduced attendance rates) and other evidence noting improved attendance (e.g., increased completion rate and decreased cancellations and no-show rates) compared to in-person care. Three identified evaluations assessed clinical outcomes in various health contexts. Some evidence suggested that virtual care improves clinical outcomes (e.g., in primary care with integrated mental health services, symptom severity decreased) or has a similar effect on clinical outcomes compared to in-person care (e.g., use of virtual care in depression elicited similar results with in-person care). Three identified evaluations assessed the appropriateness of prescribing. Some studies suggested that virtual care improves appropriateness by increasing guideline-based or guideline-concordant antibiotic management, or elicits no difference with in-person care.

scholarly journals Association between clinical outcomes and metformin use in adults with sickle cell disease and diabetes mellitus

2019 ◽  
Vol 3 (21) ◽  
pp. 3297-3306
Author(s):  
Sherif M. Badawy ◽  
Amanda B. Payne
Keyword(s):  
Diabetes Mellitus ◽  
Health Care ◽  
Sickle Cell Disease ◽  
Health Care Utilization ◽  
Clinical Outcomes ◽  
Care Utilization ◽  
Cell Disease ◽  
Clinical Events ◽  
Key Points ◽  
Clinical Benefits

Key Points Metformin use was associated with significantly fewer SCD-related health care utilization encounters and clinical events. Our findings provide the first evidence to suggest potential clinical benefits associated with metformin use in patients with SCD.

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