scholarly journals Associations between primary care continuity and acute care utilization among adult inpatients

2019 ◽  
Vol 19 (4) ◽  
pp. 438
Author(s):  
Shelly Vik ◽  
Colin Weaver ◽  
Ceara Cunningham ◽  
Robin Walker ◽  
Rob Skrypnek ◽  
...  
Keyword(s):  
Primary Care ◽  
Acute Care ◽  
Care Utilization ◽  
Care Continuity ◽  
Acute Care Utilization

Social Risk Screening in Pediatric Primary Care Anticipates Acute Care Utilization

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Victoria M. Wurster Ovalle ◽  
Andrew F. Beck ◽  
Nicholas J. Ollberding ◽  
Melissa D. Klein
Keyword(s):  
Primary Care ◽  
Acute Care ◽  
Pediatric Primary Care ◽  
Care Utilization ◽  
Social Risk ◽  
Risk Screening ◽  
Acute Care Utilization

scholarly journals Acute Care Utilization by Dementia Caregivers Within Urban Primary Care Practices

2008 ◽  
Vol 23 (11) ◽  
pp. 1736-1740 ◽  
Author(s):  
Cathy C. Schubert ◽  
Malaz Boustani ◽  
Christopher M. Callahan ◽  
Anthony J. Perkins ◽  
Siu Hui ◽  
...  
Keyword(s):  
Primary Care ◽  
Acute Care ◽  
Care Utilization ◽  
Dementia Caregivers ◽  
Acute Care Utilization ◽  
Care Practices ◽  
Primary Care Practices

scholarly journals Acute Care Utilization by Patients After Graduation of Their Resident Primary Care Physicians

2015 ◽  
Vol 30 (11) ◽  
pp. 1611-1617 ◽  
Author(s):  
Sonja R. Solomon ◽  
Holly C. Gooding ◽  
Harry Reyes Nieva ◽  
Jeffrey A. Linder
Keyword(s):  
Primary Care ◽  
Acute Care ◽  
Primary Care Physicians ◽  
Care Utilization ◽  
Acute Care Utilization

scholarly journals No-shows to primary care appointments: subsequent acute care utilization among diabetic patients

2012 ◽  
Vol 12 (1) ◽  
Author(s):  
Lynn A Nuti ◽  
Mark Lawley ◽  
Ayten Turkcan ◽  
Zhiyi Tian ◽  
Lingsong Zhang ◽  
...  
Keyword(s):  
Primary Care ◽  
Acute Care ◽  
Care Utilization ◽  
Diabetic Patients ◽  
Acute Care Utilization

scholarly journals Interruption in Care Continuity during Healthcare Transition from Pediatric to Adult Care Increases Acute Care Utilization

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2226-2226
Author(s):  
Pradeep S. B. Podila ◽  
Vikki Nolan ◽  
Anjelica Christina Saulsberry ◽  
Sheila Anderson ◽  
Jason R Hodges ◽  
...  
Keyword(s):  
Health Care ◽  
Acute Care ◽  
Sickle Cell ◽  
Pediatric Care ◽  
Care Utilization ◽  
Latency Time ◽  
Adult Care ◽  
Care Continuity ◽  
Centered Care ◽  
Acute Care Utilization

Abstract Background: Among youth with sickle cell disease (SCD), morbidity and mortality substantially increase following departure from pediatric care. Care continuity following transfer from pediatric to adult-centered care is paramount to ensure maintenance of health care delivery and reduce the risk of poor clinical outcomes. The American Academy of Pediatrics recommends matriculation in adult care within 6 months from leaving pediatric care for patients with special health care needs. Failure to transition from pediatric to adult care among youth with SCD may contribute to frequent disease complications and early death. No formal analysis has been conducted to quantify the risk of care interruption as youth transition from pediatric to adult care on the rate of acute health care utilization. We tested the hypothesis that patients who interrupted care for more than 6 months as they moved from the pediatric to the adult-centered care setting would have higher frequency of acute health care utilization. Methods: With IRB approval, we conducted a retrospective review of the rate of acute care utilization among patients with SCD who were transitioned from the pediatric sickle cell program at St. Jude Children's Research Hospital to the adult sickle cell program at Methodist University Hospital, Memphis TN between January 2014 and December 2017. We compared the rates of emergency department (ED) and inpatient utilization among those who established care >6 months from completing pediatric care (interrupted care continuity) and those who established adult care within 6 months from completing pediatric care (uninterrupted care continuity). We used person-time rates to compare the rates of emergency department and inpatient encounters per patient between the two care continuity groups. Results: Between January 2014 and December 2017 there were 172 patients with SCD who completed pediatric care and established adult care: 63 of them had a latency time from pediatric to adult care >6 months and 109 had a latency time from pediatric to adult care ≤6 months. Their follow-up since matriculation in adult care was 2245 and 2197 person-years for interrupted and uninterrupted care continuity groups, respectively The median (range) age upon establishing adult care was 20 (range, 20 to 24) years and 18 (range, 18 to 19) years for the interrupted and uninterrupted care continuity groups, respectively. Patients who interrupted care >6 months after leaving pediatric care had an incidence rate of 0.18 ED visits/person-year compared to 0.09 ED visits/person-year among those who completed the first visit within 6 months from leaving pediatric care (IRR 0.48, 95%CI 0.40-0.57, p<0.0001) (Figure panels A and B). Patients who interrupted care >6 months after leaving pediatric care had an incidence rate of 0.09 inpatient visits/person-year compared to 0.04 inpatient visits/person-year among those who completed the first visit within 6 months from leaving pediatric care (IRR 0.42 (95%CI 0.32-0.54, p<0.0001) (Figure panels C and D). Conclusions: The latency time from pediatric to adult care may impact the frequency of acute care utilization among youth with SCD. Patients who do not establish adult care within 6 months from leaving pediatric care, as recommended by the American Academy of Pediatrics, are at risk of experiencing greater ED and inpatient visits than those who establish care within 6 months from leaving pediatric care. Efforts to avoid care interruptions during the health care transition period are important to ensure optimal health outcomes among youth with SCD. Disclosures Hankins: NCQA: Consultancy; bluebird bio: Consultancy; Novartis: Research Funding; Global Blood Therapeutics: Research Funding.

scholarly journals Effect of Psychiatric Illness on Acute Care Utilization at End of Life From Serious Medical Illness

2017 ◽  
Vol 54 (2) ◽  
pp. 176-185.e1 ◽  
Author(s):  
Kyle Lavin ◽  
Dimitry S. Davydow ◽  
Lois Downey ◽  
Ruth A. Engelberg ◽  
Ben Dunlap ◽  
...  
Keyword(s):  
End Of Life ◽  
Acute Care ◽  
Psychiatric Illness ◽  
Care Utilization ◽  
Medical Illness ◽  
Acute Care Utilization

The Association of Antibiotic (ATB) exposure prior to immune checkpoint inhibitor (ICI) treatment on early emergency room and hospitalization utilization: A population-based study.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 304-304
Author(s):  
Lawson Eng ◽  
Rinku Sutradhar ◽  
Yue Niu ◽  
Ning Liu ◽  
Ying Liu ◽  
...  
Keyword(s):  
Emergency Room ◽  
Acute Care ◽  
Therapeutic Option ◽  
Population Based ◽  
Dose Effect ◽  
Care Utilization ◽  
Comorbidity Score ◽  
Logistic Regression Models ◽  
Acute Care Utilization ◽  
The Impact

304 Background: ICIs are becoming a common therapeutic option for many solid tumors. Prior studies have shown that ATB exposure can negatively impact ICI outcomes through gut microbiome changes leading to poorer overall survival; however, less is known about the potential impact of ATB exposure on toxicities from ICI. We undertook a population-based retrospective cohort study in patients receiving ICIs to evaluate the impact of ATB exposure on early acute care use, defined as emergency department visit or hospitalization, within 30 days of initiation of ICI therapy. Methods: Administrative data was utilized to identify a cohort of cancer patients > 65 years of age receiving ICIs from June 2012 to October 2018 in Ontario, Canada. We linked databases deterministically to obtain socio-demographic and clinical co-variates, ATB prescription claims and acute care utilization. Patients were censored if they died within 30 days of initiating ICI therapy. The impact of ATB exposure within 60 days prior to starting ICI on early acute care use was evaluated using multi-variable logistic regression models, adjusted for age, gender, rurality, recent hospitalization within 60 days prior to starting ICI and comorbidity score. Results: Among 2737 patients (median age 73 years), 43% received Nivolumab, 41% Pembrolizumab and 13% Ipilimumab, most commonly for lung cancer (53%) or melanoma (34%). Of these patients, 19% had ATB within 60 days prior to ICI with a median ATB treatment duration of 9 days (SD = 13). 647 (25%) patients had an acute care episode within 30 days of starting ICIs; 182 (7%) patients passed away within 30 days without acute care use and were censored from further analyses. Any ATB exposure within 60 days prior to ICI was associated with greater likelihood of acute care use (aOR = 1.34 95% CI [1.07-1.67] p = 0.01). A dose effect was seen based on weeks of ATB exposure within 60 days prior to ICI (aOR = 1.12 per week [1.04-1.21] p = 0.004) and early acute care use. ATB class analysis identified that exposure to penicillins (aOR = 1.54 [1.11-2.15] p = 0.01) and fluoroquinolones (aOR = 1.55 [1.11-2.17] p = 0.01) within 60 days of starting ICIs were associated with a greater likelihood of acute care use, while there was no significant association between cephalosporin exposure and early acute care use (p > 0.05). Conclusions: Exposure to ATBs, specifically fluoroquinolones and penicillins, prior to ICI therapy is associated with greater likelihood of hospitalization or emergency room visits within 30 days after initiation of ICIs, even after adjustment for relevant co-variates including age, comorbidity score and recent hospitalization prior to ICI initiation. Further studies are required to better understand the mechanisms of recent ATB exposure on early acute care use among patients receiving ICIs.

Acute care utilization risk among older adults living undiagnosed or unaware of dementia

2021 ◽  
Author(s):  
Halima Amjad ◽  
Quincy M. Samus ◽  
Jin Huang ◽  
Sneha Gundavarpu ◽  
Julie P. W. Bynum ◽  
...  
Keyword(s):  
Older Adults ◽  
Acute Care ◽  
Care Utilization ◽  
Acute Care Utilization
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