scholarly journals The impact of targeted therapy on healthcare resource use in patients with metastatic renal cell carcinoma: The University of Sherbrooke experience

2018 ◽  
Vol 12 (9) ◽  
pp. E373-7
Author(s):  
Hugo Simard ◽  
Robert Sabbagh ◽  
Simon Ouellet ◽  
Patrick Richard ◽  
Claudio Jeldres
Keyword(s):  
Emergency Department ◽  
Renal Cell Carcinoma ◽  
Targeted Therapy ◽  
Resource Use ◽  
Targeted Therapies ◽  
Healthcare Resource ◽  
Therapy Group ◽  
Emergency Department Visits ◽  
Healthcare Resource Use ◽  
The Impact

Introduction: We assessed the impact of targeted therapies on healthcare resource use and compared treatment regimens used in patients diagnosed with metastatic renal cell carcinoma (mRCC).Methods: Clinicopathological and administrative data of patients with mRCC from our institution were retrospectively collected from January 2000 to August 2014. Patients were divided into two groups based on the use of targeted therapies. Healthcare resource use (HCRU) data included non-scheduled total number of hospitalizations, total days hospitalized, emergency department visits, and healthcare professional consultations. Each variable was presented with absolute and relative values (i.e., per month of survival). Statistics relied on the use of t-student and Chi-square tests.Results: Ninety-nine patients were included in the study; 60 were treated with targeted therapy. There were no statistically significant differences between the two groups for demographic features and clinicopathological stage. HCRU analysis revealed an absolute increase in the median number of healthcare consultants (6 vs. 4; p<0.01) and emergency department visits (1 vs. 0; p=0.02) for the targeted therapy group. However, analysis per month of survival showed the targeted therapy group had fewer consultants (0.33 vs. 0.40; p=0.04) and hospitalizations (0.09 vs. 0.13; p=0.03) than their counterpart. Population size, non-randomization, treatment selection bias, and heterogeneity were the main limitations of this study.Conclusions: Monthly use of HCRU is lower in mRCC patients treated with targeted therapies. However, because of a greater overall survival, their absolute total HCRU will be higher than those not exposed to targeted agents.

scholarly journals Nutrition Care for Poorly Nourished Outpatients Reduces Resource Use and Lowers Costs

2021 ◽  
Vol 12 ◽  
pp. 215013272110170
Author(s):  
Kurt Hong ◽  
Suela Sulo ◽  
William Wang ◽  
Susan Kim ◽  
Laura Huettner ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Resource Use ◽  
Healthcare Resource ◽  
Community Dwelling ◽  
Emergency Department Visits ◽  
Nutritional Risk ◽  
Healthcare Resource Use ◽  
Improvement Program ◽  
Poor Nutritional Status ◽  
The Impact

Background and Objectives: Over 25% of United States (US) community-dwelling, older adults are at nutritional risk. Health and cost burdens of poor nutrition can be lowered by nutrition programs for hospital inpatients, but few studies have looked at the impact on outpatients. The objective of our study was to assess outcomes of a nutrition focused quality improvement program (QIP) on healthcare resource use and costs in poorly nourished outpatients. Methods: This pre-post QIP study was implemented at 3 US healthcare system clinics. Included patients (n = 600) were ≥45 years old, had ≥2 chronic conditions, and were enrolled over a 15-month interval. For comparison, historical (n = 600) and concurrent control (n = 600) groups were used. Assessment of poor nutritional status was performed during each patient’s baseline visit. Healthcare resource use (hospitalizations, emergency department visits, and outpatient clinic visits), medication use, and costs were determined for a 90-day interval. Results: QIP patients (mean age 61.6 years) were predominantly female (62.5%) and overweight/obese (81.7%). The proportion of QIP outpatients presenting for healthcare services was significantly reduced compared to both historical and concurrent controls—relative risk reduction (RRR) versus historical (11.6%, P < .001) and versus concurrent (8.9%, P = .003). Of those who presented, RRR for healthcare resource use by QIP was significant in comparison with historical (12.9%, P = .022) but not concurrent controls. No significant differences were observed for medication usage. Lower resource use among QIP patients yielded total cost savings of $290 923 or per-patient savings of $485. Conclusions: Nutrition QIPs in outpatient clinics are feasible and can reduce healthcare resource use and cut costs. Such findings underscore benefits of nutritional interventions for community-dwelling outpatients with poor nutritional status.

scholarly journals LO67: Alcohol-related emergency department visits by youth aged 12-24: demographics and resource utilization at Kingston Health Sciences Centre

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S32-S32
Author(s):  
H. Murray ◽  
L. Erlikhman ◽  
T. Graham ◽  
M. Walker
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Resource Use ◽  
Standard Form ◽  
Emergency Department Visits ◽  
Acute Intoxication ◽  
Mental Health Issue ◽  
Male Predominance ◽  
Ed Visits ◽  
The Impact

Introduction: Recent evidence shows an increase in alcohol-related emergency department (ED) visits among youth. We sought to quantify the impact of ED visits (type and frequency, patient characteristics and resource use) related to alcohol in our centre. Methods: This was a chart review of patients aged 12-24 with alcohol-related ED visits between Sept 2013-Aug 2017. The National Ambulatory Care Reporting System (NACRS) database was searched for visits alcohol related ICD-10 codes. The Canadian Hospital Injury Reporting and Prevention Program (CHIRPP) database was also searched using the keyword alcohol. Duplicate visits were removed. Visits were excluded if patients had a history of psychosis, were held in the ED for psychiatric assessment, were homeless, were inmates from a correctional institute, if alcohol use was not mentioned and for complaints of sexual assault/intimate partner violence. Data was abstracted by two reviewers using a standard form with predetermined variables. Differences were resolved with third party adjudication. Interrater reliability of the reviewers was assessed with Kappa scores through duplicate review of 10% of randomly selected charts. A further 10% were assessed by a 3rd reviewer for extraction accuracy. Results: 3,256 ED visits were identified with 777 removed via predefined exclusion criteria. 2,479 visits were reviewed with a male predominance (54.3%). More than half of all patients (50.9%) arrived via ambulance. Assigned CTAS levels were Resuscitation: 1% Emergent: 9.9% Urgent: 48.2% Less Urgent: 35.7% Non-Urgent: 4.2% (missing 1%). The median LOS was 2.9 hrs (IQR 1.8-4.6). All visits were subclassified into mutually exclusive categories: injury (51.8%), acute intoxication (45.1%) and mental health issue (3.2%). Males were more likely to present with injury (62.4% vs 42.6%, p < 0.01). Females were more likely to present with acute intoxication (53.3% vs 46.7%, p <0.01) and mental health issues (59.5% vs 40.5%, P = 0.01). ED resource use was notable: 483 (19.4%) had imaging tests and 1216 (49.1%) had some medical intervention (blood test, fluids or medication). 57 (2.3%) patients were admitted and there was one death from an alcohol related MVC. Conclusion: Alcohol-related ED visits by youth are common in our centre and utilize substantial prehospital and in-hospital resources. Identification of effective harm reduction strategies should be a research priority.

Healthcare resource use and costs associated with renal impairment in US patients with bone metastases from solid tumors

2016 ◽  
Vol 23 (3) ◽  
pp. 195-202 ◽  
Author(s):  
Yi Qian ◽  
Jorge Arellano ◽  
Debajyoti Bhowmik ◽  
Erin Thomson ◽  
David M Smith ◽  
...  
Keyword(s):  
Renal Impairment ◽  
Bone Metastases ◽  
Solid Tumors ◽  
Resource Use ◽  
Hospital Admissions ◽  
Healthcare Resource ◽  
The United States ◽  
Emergency Department Visits ◽  
Administrative Claims ◽  
Healthcare Resource Use

Introduction During cancer progression, more than half of patients develop renal insufficiency, including chronic kidney disease. The primary and secondary objectives of this study were to estimate healthcare resource use and costs, respectively, associated with renal impairment in patients with bone metastases from solid tumors in the United States. Methods and materials This was a retrospective, observational cohort study conducted using administrative claims data for individuals with solid tumors and bone metastases. Control patients were matched to renal impairment patients using propensity scores (ratio up to 3:1) based on demographics, clinical characteristics, and baseline costs. Average per-patient per-year healthcare resource utilization and costs (total costs and cost components; 2013 dollars) were reported. Results In total, 2616 renal impairment patients were matched to 7211 control patients. Renal impairment patients had greater healthcare resource use compared with controls, including a greater mean number of hospital admissions (4.4 versus 2.1), longer average stay per hospital admission (7.4 versus 6.5 days), as well as greater mean number of physician office visits (22.9 versus 18.8), emergency department visits (3.1 versus 2.0), and hospital-based outpatient visits (18.8 versus 16.0) compared with control patients. Total costs were > $50,000 higher among renal impairment patients ($142,267 versus $88,839; P < 0.001), with hospital costs accounting for $72,557 for renal impairment patients, and $27,858 for control patients ( P < 0.001). Conclusion The healthcare resource use and costs associated with renal impairment in patients with bone metastases from solid tumors is high; efforts to reduce renal impairment in this population, including the potential avoidance of nephrotoxic agents, are warranted.

Annual Medical Costs and Healthcare Resource Use in Patients with Systemic Sclerosis in an Insured Population

2012 ◽  
Vol 39 (12) ◽  
pp. 2303-2309 ◽  
Author(s):  
DANIEL E. FURST ◽  
ANCILLA W. FERNANDES ◽  
SERBAN R. IORGA ◽  
WARREN GRETH ◽  
TIM BANCROFT
Keyword(s):  
Systemic Sclerosis ◽  
Resource Use ◽  
Healthcare Resource ◽  
Medical Costs ◽  
Geographic Region ◽  
Emergency Department Visits ◽  
Care Plan ◽  
Healthcare Resource Use ◽  
Hospital Stays ◽  
Serious Disease

Objective.Systemic sclerosis (SSc) is a chronic autoimmune disease. The objective of our study was to estimate the medical costs and healthcare resource use of subjects with SSc in a large US managed care plan.Methods.Subjects at least 18 years of age and with claims-based evidence of SSc (ICD-9-CM code 710.1x) were identified from a health plan database from 2003 through 2008. Subjects were matched to unaffected controls, based on index date, age, sex, geographic region, time on insurance, and comorbidity score. Costs and resource use were identified during the 12-month postindex period. A generalized linear model (GLM) was used to estimate costs, controlling for demographic and clinical characteristics.Results.In this study, 1648 subjects with SSc were matched to 4944 controls. Mean overall annual medical costs were higher among SSc subjects than controls ($17,365 vs $5,508; p < 0.001). A GLM model supported these results. Evidence of lung disease, gastrointestinal bleeding, or renal disease increased costs (all p < 0.001). Compared to controls, significantly higher proportions of SSc subjects had postindex ambulatory visits, emergency department visits, and inpatient hospital stays (all p < 0.001).Conclusion.Our findings suggest that the medical costs and resource use associated with treating SSc are high (compared to matched controls), and as expected, subjects with serious disease complications experience the highest costs.

scholarly journals Kidney involvement in tuberous sclerosis complex: the impact on healthcare resource use and costs

2015 ◽  
Vol 18 (12) ◽  
pp. 1060-1070 ◽  
Author(s):  
Francis Vekeman ◽  
Matthew Magestro ◽  
Paul Karner ◽  
Mei Sheng Duh ◽  
Timothy Nichols ◽  
...  
Keyword(s):  
Tuberous Sclerosis ◽  
Tuberous Sclerosis Complex ◽  
Resource Use ◽  
Healthcare Resource ◽  
Healthcare Resource Use ◽  
Kidney Involvement ◽  
The Impact
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