Health-care utilization and costs with fluticasone propionate and fluticasone propionate/salmeterol in asthma patients at risk for exacerbations

2014 ◽  
Vol 35 (1) ◽  
pp. 54-62 ◽  
Author(s):  
May Hagiwara ◽  
Thomas E. Delea ◽  
Richard H. Stanford
Keyword(s):  
Health Care ◽  
At Risk ◽  
Fluticasone Propionate ◽  
Health Care Utilization ◽  
Care Utilization ◽  
Asthma Patients ◽  
Patients At Risk

Evaluating goals of care meetings for hospitialized cancer patients at risk for critical care.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 134-134
Author(s):  
Colleen C. Apostol ◽  
Julie Waldfogel ◽  
Elizabeth Pfoh ◽  
Donald C. List ◽  
Lynn Billing ◽  
...  
Keyword(s):  
Health Care ◽  
At Risk ◽  
Critical Care ◽  
Health Care Utilization ◽  
Cancer Patients ◽  
Cancer Center ◽  
Care Utilization ◽  
Refractory Disease ◽  
Comfort Care ◽  
Goals Of Care

134 Background: Communication about care preferences is vital for care of cancer patients with advanced and refractory disease, particularly when they become ill enough to be at risk for critical care interventions potentially inconsistent with their preferences. It is vital to describe the use of goals of care discussions in patients with advanced/refractory cancer at risk for critical care and evaluate associations between these discussions and outcomes. Methods: Cohort study describing patient/families’ perceptions of goals of care meetings and comparing health care utilization outcomes of patients who did and who did not have discussions. Inpatient units of an academic cancer center included patients who had metastatic solid tumors or relapsed/refractory lymphoma or leukemia and were at risk for critical care (defined as requiring supplemental oxygen and/or a cardiac monitor). Results: Of 86 patients enrolled, 34 (39%) had a reported goals of care discussion. Patients/families reported their needs and goals were addressed moderately to quite a bit during the meetings. Patients with reported discussions were less likely to receive critical care (0% vs 22%, p=0.003) and more likely to be discharged to hospice (48% vs 30%, p=0.04). Only one patient with a goals of care discussion died during the index hospitalization (on comfort care) (3%) compared with 9% among those without discussions (p=0.08). Conclusions: Goals of care meetings should be incorporated into usual care for cancer patients with advanced or refractory disease at risk for critical care during a hospitalization, in order to improve concordance between care received and patient and family preferences. Goals of care meetings for advanced/refractory cancer inpatients at risk for critical care can address patient and family goals and needs and improve health care utilization outcomes. These meetings should be part of routine care in this patient population.

scholarly journals Health Care Utilization Among Homeless Veterans in Chicago

2019 ◽  
Vol 185 (3-4) ◽  
pp. e335-e339
Author(s):  
Jason H Raad ◽  
Elizabeth Tarlov ◽  
Abel N Kho ◽  
Dustin D French
Keyword(s):  
Health Care ◽  
At Risk ◽  
Health Care Utilization ◽  
Health Care Providers ◽  
The United States ◽  
Chronic Health Conditions ◽  
Health Conditions ◽  
Care Utilization ◽  
Care Providers ◽  
Chronic Health

Abstract Introduction The U.S. Department of Veterans Affairs (VA), the single largest health care system in the United States, provides comprehensive medical and behavioral health services to more than 9 million Veterans. The size and scope of the VA’s system of care allow health care providers, policymakers, and community stakeholders to conduct detailed analyses of health care utilization among Veterans; however, these analyses do not include health care encounters that occur outside VA. Although many Veterans obtain care in non-VA settings, understanding health care utilization among vulnerable populations of Veterans, including those who are homeless or at risk of becoming homeless, is needed to identify potential opportunities to enhance access and reduce fragmentation of care. Materials and Methods VA administrative data were merged with data from the Chicago HealthLNK Data Repository to identify Veterans eligible for VA services who were homeless, or at risk of becoming homeless, in the greater Chicago metropolitan area for the years 2010–2012. Results During the 3-year study period, about 208,554 Veterans were registered for care at two VA medical centers located in the City of Chicago and an adjacent suburb. Of those, 13,948 were identified as homeless or at risk of becoming homeless. Results suggest that 17% (n = 2,309) of Veterans in this sample received some or all of their care in the community. Much of the care these Veterans received was for chronic health conditions, substance use, and mental health disorders. Conclusions Veterans eligible for VA servicers who are homeless, or at risk of becoming homeless, frequently sought care in the community for a variety of chronic health conditions. Health information exchanges and partner-based registries may represent an important tool for identifying vulnerable Veteran populations while reducing duplication of care.

scholarly journals Association of goals of care meetings for hospitalized cancer patients at risk for critical care with patient outcomes

2014 ◽  
Vol 29 (4) ◽  
pp. 386-390 ◽  
Author(s):  
Colleen C Apostol ◽  
Julie M Waldfogel ◽  
Elizabeth R Pfoh ◽  
Donald List ◽  
Lynn S Billing ◽  
...  
Keyword(s):  
Health Care ◽  
At Risk ◽  
Critical Care ◽  
Health Care Utilization ◽  
Cancer Patients ◽  
Care Utilization ◽  
Control Group ◽  
Study Group ◽  
Comfort Care ◽  
Goals Of Care

Background: Caring for cancer patients with advanced and refractory disease requires communication about care preferences, particularly when patients become ill enough to be at risk for critical care interventions potentially inconsistent with their preferences. Aim: To describe the use of goals of care discussions in patients with advanced/refractory cancer at risk for critical care interventions and evaluate associations between these discussions and outcomes. Design: Cohort study describing patients/families’ perceptions of goals of care meetings and comparing health care utilization outcomes of patients who did and did not have discussions. Setting/participants: Inpatient units of an academic cancer center. Included patients had metastatic solid tumors or relapsed/refractory lymphoma or leukemia and were at risk for critical care, defined as requiring supplemental oxygen and/or cardiac monitor. Results: Of 86 patients enrolled, 34 (39%) had a reported goals of care discussion (study group). Patients/families reported their needs and goals were addressed moderately to quite a bit during the meetings. Patients in the study group were less likely to receive critical care (0% vs 22%, p = 0.003) and more likely to be discharged to hospice (48% vs 30%, p = 0.04) than the control group. Only one patient in the study group died during the index hospitalization (on comfort care) (3%) compared with 9(17%) in the control group ( p = 0.08). Conclusion: Goals of care meetings for advanced/refractory cancer inpatients at risk for critical care interventions can address patient and family goals and needs and improve health care utilization. These meetings should be part of routine care for these patients.

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