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Russell-Smith A, Murphy L, Nguyen A, Blauer-Peterson C, Terpenning M, Cao F, Li S, Bancroft T, Webb N, Dorman S, Shah R. Real-world use of inotuzumab ozogamicin is associated with lower health care costs than blinatumomab in patients with acute lymphoblastic leukemia in the first relapsed/refractory setting. J Comp Eff Res 2024; 13:e230142. [PMID: 38099517 PMCID: PMC10842295 DOI: 10.57264/cer-2023-0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
Aim: To compare all-cause and acute lymphoblastic leukemia (ALL)-related healthcare resource utilization (HCRU) and costs among patients receiving inotuzumab ozogamicin (InO) and blinatumomab (Blina) for ALL in the first relapsed/refractory (R/R) setting. Patients & methods: We studied retrospective claims for adult commercial and Medicare Advantage enrollees with ALL receiving InO (n = 29) or Blina (n = 23) from 1 January 2015 to 16 February 2021. Mean per-patient-per-month (PPPM) HCRU and total costs were described and multivariable-adjusted PPPM total all-cause and ALL-related predicted costs were calculated. Results: Mean monthly ALL-related hospitalizations were the same for patients receiving InO and Blina (PPPM = 0.8 stays); however, the length of ALL-related hospital stay was almost twice as long among patients receiving Blina versus InO (ALL-related: InO = 7.6 days; Blina = 14.1 days; p = 0.346). In multivariable models, total ALL-related costs were 43% lower for InO compared with Blina (PPPM costs: InO = $93,767; Blina = $163,470; p = 0.021). Conclusion: In the first R/R setting, patients who used InO had significantly lower all-cause and ALL-related costs compared with patients who used Blina, in part driven by hospitalization patterns.
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Affiliation(s)
| | - Louise Murphy
- Optum, Eden Prairie, MN 55344, USA
- Author for correspondence: Tel;
| | | | | | | | - Feng Cao
- Optum, Eden Prairie, MN 55344, USA
| | | | | | | | - Stephanie Dorman
- Global Medical Affairs, Pfizer Inc, Kirkland QC, H9J 2M5, Canada
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Kim H, Shulman LM, Shakya S, Gruber-Baldini A. The effects of medical comorbidity, cognition, and age on patient-reported outcomes in Parkinson's disease. Parkinsonism Relat Disord 2023; 116:105892. [PMID: 37837675 PMCID: PMC10841750 DOI: 10.1016/j.parkreldis.2023.105892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/05/2023] [Accepted: 10/08/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVE The purpose of this cross-sectional study was to compare the independent contributions of medical comorbidity, cognition, and age on patient-reported outcomes in Parkinson's disease (PD). METHODS 572 PD patients completed the Patient-Reported Outcome Measurement Information System (PROMIS®)-29 v2.0 Profile (physical function, anxiety, depression, fatigue, sleep disturbance, satisfaction with participation in social roles, pain interference) and PROMIS Global Health (mental health and physical health) scales. Comorbidity was measured with the Cumulative Illness Rating Scale-Geriatric (CIRS-G) and cognition with the Montreal Cognitive Assessment (MoCA). Multiple regression models examined the 9 PROMIS measures as predicted by comorbidity, cognition, and age, adjusting for demographic and clinical characteristics (UPDRS and disease duration). RESULTS Comorbidity was associated with poorer outcomes in all nine PROMIS domains. Cognition was associated with two of nine domains: physical function and anxiety. Age was associated with five domains: anxiety, depression, sleep disturbance, satisfaction with participation in social roles, and global mental health. Comorbidity showed greater effects on all nine domains than cognition or age (higher standardized beta coefficients). CONCLUSION Medical comorbidity, cognition, and age have different impacts on patient-reported outcomes in PD. Medical comorbidity has a greater impact than either cognition or age on a range of patient-reported physical and mental health domains. Medical comorbidity is an important contributor to the patient's perspective of their physical and mental health.
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Affiliation(s)
- Haesung Kim
- Division of Gerontology, Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lisa M Shulman
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sunita Shakya
- Division of Gerontology, Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ann Gruber-Baldini
- Division of Gerontology, Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
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Loggers SAI, Nijdam TMP, Folbert EC, Hegeman JHH, Van der Velde D, Verhofstad MHJ, Van Lieshout EMM, Joosse P. Prognosis and institutionalization of frail community-dwelling older patients following a proximal femoral fracture: a multicenter retrospective cohort study. Osteoporos Int 2022; 33:1465-1475. [PMID: 35396653 PMCID: PMC9187528 DOI: 10.1007/s00198-022-06394-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/30/2022] [Indexed: 11/24/2022]
Abstract
UNLABELLED Hip fractures are a serious public health issue with major consequences, especially for frail community dwellers. This study found a poor prognosis at 6 months post-trauma with regard to life expectancy and rehabilitation to pre-fracture independency levels. It should be realized that recovery to pre-trauma functioning is not a certainty for frail community-dwelling patients. INTRODUCTION Proximal femoral fractures are a serious public health issue in the older patient. Although a significant rise in frail community-dwelling elderly is expected because of progressive aging, a clear overview of the outcomes in these patients sustaining a proximal femoral fracture is lacking. This study assessed the prognosis of frail community-dwelling patients who sustained a proximal femoral fracture. METHODS A multicenter retrospective cohort study was performed on frail community-dwelling patients with a proximal femoral fracture who aged over 70 years. Patients were considered frail if they were classified as American Society of Anesthesiologists score ≥ 4 and/or a BMI < 18.5 kg/m2 and/or Functional Ambulation Category ≤ 2 pre-trauma. The primary outcome was 6-month mortality. Secondary outcomes were adverse events, health care consumption, rate of institutionalization, and functional recovery. RESULTS A total of 140 out of 2045 patients matched the inclusion criteria with a median age of 85 (P25-P75 80-89) years. The 6-month mortality was 58 out of 140 patients (41%). A total of 102 (73%) patients experienced adverse events. At 6 months post-trauma, 29 out of 120 (24%) were readmitted to the hospital. Out of the 82 surviving patients after 6 months, 41 (50%) were unable the return to their home, and only 32 (39%) were able to achieve outdoor ambulation. CONCLUSION Frail community-dwelling older patients with a proximal femoral fracture have a high risk of death, adverse events, and institutionalization and often do not reobtain their pre-trauma level of independence. Foremost, the results can be used for realistic expectation management.
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Affiliation(s)
- S A I Loggers
- Department of Surgery, Northwest Clinics Alkmaar, P.O. Box 501, 1800 AM, Alkmaar, The Netherlands
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - T M P Nijdam
- Department of Surgery, St. Antonius Ziekenhuis, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands
| | - E C Folbert
- Department of Trauma Surgery, Ziekenhuisgroep Twente, P.O. Box 7600, 7600 SZ, Almelo, The Netherlands
| | - J H H Hegeman
- Department of Trauma Surgery, Ziekenhuisgroep Twente, P.O. Box 7600, 7600 SZ, Almelo, The Netherlands
| | - D Van der Velde
- Department of Surgery, St. Antonius Ziekenhuis, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands
| | - M H J Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - E M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - P Joosse
- Department of Surgery, Northwest Clinics Alkmaar, P.O. Box 501, 1800 AM, Alkmaar, The Netherlands
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Health Economics in Speech-Language Pathology. Semin Speech Lang 2022; 43:173-175. [PMID: 35858603 DOI: 10.1055/s-0042-1748191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Smith TO, Parsons S, Ooms A, Dutton S, Fordham B, Garrett A, Hing C, Lamb S. Randomised controlled trial of a behaviour change physiotherapy intervention to increase physical activity following hip and knee replacement: the PEP-TALK trial. BMJ Open 2022; 12:e061373. [PMID: 35641012 PMCID: PMC9157340 DOI: 10.1136/bmjopen-2022-061373] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To test the effectiveness of a behaviour change physiotherapy intervention to increase physical activity compared with usual rehabilitation after total hip replacement (THR) or total knee replacement (TKR). DESIGN Multicentre, pragmatic, two-arm, open, randomised controlled, superiority trial. SETTING National Health Service providers in nine English hospitals. PARTICIPANTS 224 individuals aged ≥18 years, undergoing a primary THR or TKR deemed 'moderately inactive' or 'inactive'. INTERVENTION Participants received either six, 30 min, weekly, group-based exercise sessions (usual care) or the same six weekly, group-based, exercise sessions each preceded by a 30 min cognitive behaviour discussion group aimed at challenging barriers to physical inactivity following surgery (experimental). RANDOMISATION AND BLINDING Initial 75 participants were randomised 1:1 before changing the allocation ratio to 2:1 (experimental:usual care). Allocation was based on minimisation, stratifying on comorbidities, operation type and hospital. There was no blinding. MAIN OUTCOME MEASURES Primary: University of California Los Angeles (UCLA) Activity Score at 12 months. Secondary: 6 and 12-month assessed function, pain, self-efficacy, kinesiophobia, psychological distress and quality of life. RESULTS Of the 1254 participants assessed for eligibility, 224 were included (139 experimental: 85 usual care). Mean age was 68.4 years (SD: 8.7), 63% were women, 52% underwent TKR. There was no between-group difference in UCLA score (mean difference: -0.03 (95% CI -0.52 to 0.45, p=0.89)). There were no differences observed in any of the secondary outcomes at 6 or 12 months. There were no important adverse events in either group. The COVID-19 pandemic contributed to the reduced intended sample size (target 260) and reduced intervention compliance. CONCLUSIONS There is no evidence to suggest attending usual care physiotherapy sessions plus a group-based behaviour change intervention differs to attending usual care physiotherapy alone. As the trial could not reach its intended sample size, nor a proportion of participants receive their intended rehabilitation, this should be interpreted with caution. TRIAL REGISTRATION NUMBER ISRCTN29770908.
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Affiliation(s)
- Toby O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Scott Parsons
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Alexander Ooms
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Susan Dutton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Beth Fordham
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Angela Garrett
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Caroline Hing
- Trauma and Orthopaedic Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sarah Lamb
- College of Medicine and Health, University of Exeter, Exeter, UK
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Islim AI, Millward CP, Piper RJ, Fountain DM, Mehta S, Kolamunnage-Dona R, Ali U, Koszdin SD, Georgious T, Mills SJ, Brodbelt AR, Mathew RK, Santarius T, Jenkinson MD. External validation and recalibration of an incidental meningioma prognostic model - IMPACT: protocol for an international multicentre retrospective cohort study. BMJ Open 2022; 12:e052705. [PMID: 35042706 PMCID: PMC8768908 DOI: 10.1136/bmjopen-2021-052705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Due to the increased use of CT and MRI, the prevalence of incidental findings on brain scans is increasing. Meningioma, the most common primary brain tumour, is a frequently encountered incidental finding, with an estimated prevalence of 3/1000. The management of incidental meningioma varies widely with active clinical-radiological monitoring being the most accepted method by clinicians. Duration of monitoring and time intervals for assessment, however, are not well defined. To this end, we have recently developed a statistical model of progression risk based on single-centre retrospective data. The model Incidental Meningioma: Prognostic Analysis Using Patient Comorbidity and MRI Tests (IMPACT) employs baseline clinical and imaging features to categorise the patient with an incidental meningioma into one of three risk groups: low, medium and high risk with a proposed active monitoring strategy based on the risk and temporal trajectory of progression, accounting for actuarial life expectancy. The primary aim of this study is to assess the external validity of this model. METHODS AND ANALYSIS IMPACT is a retrospective multicentre study which will aim to include 1500 patients with an incidental intracranial meningioma, powered to detect a 10% progression risk. Adult patients ≥16 years diagnosed with an incidental meningioma between 1 January 2009 and 31 December 2010 will be included. Clinical and radiological data will be collected longitudinally until the patient reaches one of the study endpoints: intervention (surgery, stereotactic radiosurgery or fractionated radiotherapy), mortality or last date of follow-up. Data will be uploaded to an online Research Electronic Data Capture database with no unique identifiers. External validity of IMPACT will be tested using established statistical methods. ETHICS AND DISSEMINATION Local institutional approval at each participating centre will be required. Results of the study will be reported through peer-reviewed articles and conferences and disseminated to participating centres, patients and the public using social media.
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Affiliation(s)
- Abdurrahman I Islim
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Christopher P Millward
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Rory J Piper
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Daniel M Fountain
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - Shaveta Mehta
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Clinical Oncology, The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK
| | - Ruwanthi Kolamunnage-Dona
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Usama Ali
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | - Samantha J Mills
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Andrew R Brodbelt
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Ryan K Mathew
- Leeds Institute of Medical Research at St James's, University of Leeds School of Medicine, Leeds, UK
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Thomas Santarius
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK
- Division of Neurosurgery, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Michael D Jenkinson
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
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Abner S, Gillies CL, Shabnam S, Zaccardi F, Seidu S, Davies MJ, Adeyemi T, Khunti K, Webb DR. Consultation rates in people with type 2 diabetes with and without vascular complications: a retrospective analysis of 141,328 adults in England. Cardiovasc Diabetol 2022; 21:8. [PMID: 35012531 PMCID: PMC8744247 DOI: 10.1186/s12933-021-01435-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/13/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To assess trends in primary and specialist care consultation rates and average length of consultation by cardiovascular disease (CVD), type 2 diabetes mellitus (T2DM), or cardiometabolic multimorbidity exposure status. METHODS Observational, retrospective cohort study used linked Clinical Practice Research Datalink primary care data from 01/01/2000 to 31/12/2018 to assess consultation rates in 141,328 adults with newly diagnosed T2DM, with or without CVD. Patients who entered the study with either a diagnosis of T2DM or CVD and later developed the second condition during the study are classified as the cardiometabolic multimorbidity group. Face to face primary and specialist care consultations, with either a nurse or general practitioner, were assessed over time in subjects with T2DM, CVD, or cardiometabolic multimorbidity. Changes in the average length of consultation in each group were investigated. RESULTS 696,255 (mean 4.9 years [95% CI, 2.02-7.66]) person years of follow up time, there were 10,221,798 primary and specialist care consultations. The crude rate of primary and specialist care consultations in patients with cardiometabolic multimorbidity (N = 11,881) was 18.5 (95% CI, 18.47-18.55) per person years, 13.5 (13.50, 13.52) in patients with T2DM only (N = 83,094) and 13.2 (13.18, 13.21) in those with CVD (N = 57,974). Patients with cardiometabolic multimorbidity had 28% (IRR 1.28; 95% CI: 1.27, 1.31) more consultations than those with only T2DM. Patients with cardiometabolic multimorbidity had primary care consultation rates decrease by 50.1% compared to a 45.0% decrease in consultations for those with T2DM from 2000 to 2018. Specialist care consultation rates in both groups increased from 2003 to 2018 by 33.3% and 54.4% in patients with cardiometabolic multimorbidity and T2DM, respectively. For patients with T2DM the average consultation duration increased by 36.0%, in patients with CVD it increased by 74.3%, and in those with cardiometabolic multimorbidity it increased by 37.3%. CONCLUSIONS Annual primary care consultation rates for individuals with T2DM, CVD, or cardiometabolic multimorbidity have fallen since 2000, while specialist care consultations and average consultation length have both increased. Individuals with cardiometabolic multimorbidity have significantly more consultations than individuals with T2DM or CVD alone. Service redesign of health care delivery needs to be considered for people with cardiometabolic multimorbidity to reduce the burden and health care costs.
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Affiliation(s)
- Sophia Abner
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK
| | - Clare L Gillies
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK
| | - Sharmin Shabnam
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK
| | - Samuel Seidu
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Melanie J Davies
- Leicester Diabetes Centre, National Institute for Health Research Biomedical Research Centre, Leicester, LE5 4PW, UK
| | | | - Kamlesh Khunti
- Leicester Diabetes Centre, National Institute for Health Research (NIHR) Applied Research Collaboration - East Midlands (ARC-EM), Leicester, LE5 4PW, UK
| | - David R Webb
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, LE5 4PW, UK.
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Charlson ME, Wells MT. Comorbidity: From a Confounder in Longitudinal Clinical Research to the Main Issue in Population Management. PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 91:145-151. [PMID: 35196663 PMCID: PMC9064932 DOI: 10.1159/000521952] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Mary E. Charlson
- Department of Medicine, Weill Cornell Medicine, New York, New York
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Zhong X, Wang DL, Xiao LH. Research on the economic loss of hospital-acquired pneumonia caused by Klebsiella pneumonia base on propensity score matching. Medicine (Baltimore) 2021; 100:e25440. [PMID: 33847646 PMCID: PMC8052027 DOI: 10.1097/md.0000000000025440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/27/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Hospital-acquired pneumonia (HAP) caused by Klebsiella pneumonia (KP) is a common nosocomial infection (NI). However, the reports on the economic burden of hospital-acquired pneumonia caused by Klebsiella pneumonia (KP-HAP) were scarce. The study aims to study the direct economic loss caused by KP-HAP with the method of propensity score matching (PSM) to provide a basis for the cost accounting of NI and provide references for the formulation of infection control measures. METHODS A retrospective investigation was conducted on the hospitalization information of all patients discharged from a tertiary group hospital in Shenzhen, Guangdong province, China, from June 2016 to August 2019. According to the inclusion and exclusion criteria, patients were divided into the HAP group and noninfection group, the extended-spectrum beta-lactamases (ESBLs) positive KP infection group, and the ESBLs-negative KP infection group. After the baselines of each group were balanced with the PSM, length of stay (LOS) and hospital cost of each group were compared. RESULTS After the PSM, there were no differences in the baselines of each group. Compared with the noninfection group, the median LOS in the KP-HAP group increased by 15 days (2.14 times), and the median hospital costs increased by 7329 yuan (0.89 times). Compared with the ESBLs-negative KP-HAP group, the median LOS in the ESBLs-positive KP-HAP group increased by 7.5 days (0.39 times), and the median hospital costs increased by 22,424 yuan (1.90 times). CONCLUSION KP-HAP prolonged LOS and increased hospital costs, and HAP caused by ESBLs-positive KP had more economic losses than ESBLs-negative, which deserves our attention and should be controlled by practical measures.
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Affiliation(s)
- Xiao Zhong
- Department of Nosocomial Infection, University of Chinese Academy of Sciences, Shenzhen Hospital
| | - Dong-Li Wang
- Inspection Center, Guangming District Center for Disease Control and Prevention, Shenzhen, Guangdong, China
| | - Li-Hua Xiao
- Department of Nosocomial Infection, University of Chinese Academy of Sciences, Shenzhen Hospital
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Blumenthal KG, Oreskovic NM, Fu X, Shebl FM, Mancini CM, Maniates JM, Walensky RP. High-cost, high-need patients: the impact of reported penicillin allergy. AMERICAN JOURNAL OF MANAGED CARE 2021; 26:154-161. [PMID: 32270982 DOI: 10.37765/ajmc.2020.42832] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES More than 90% of patients who report a penicillin allergy have the allergy disproved when tested. Unnecessary use of alternative (non-beta-lactam) antibiotics can result in more treatment failures and adverse reactions. We described the prevalence and impact of a reported penicillin allergy in high-cost, high-need (HCHN) patients. STUDY DESIGN Retrospective cohort. METHODS We identified HCHN patients in a care management program of an urban academic medical center (January 1, 2014, to December 31, 2016). We used multivariable logistic regression models to determine the association between a reported penicillin allergy and antibiotic use. We used multivariable Poisson regression models to determine the association between a reported penicillin allergy, with or without multiple drug intolerance syndrome (MDIS; ≥3 reported drug allergies), and healthcare resource utilization (HRU). RESULTS Of 1870 HCHN patients, 383 (20%) reported penicillin allergy, 835 (45%) had MDIS, and 290 (16%) had both. HCHN patients reporting penicillin allergy had an increased odds of beta-lactam alternative antibiotic use (adjusted odds ratio, 3.84; 95% CI, 2.17-6.80). HRU was significantly higher for patients reporting a penicillin allergy alone (adjusted relative risk [aRR], 1.13; 95% CI, 1.03-1.25) and with concurrent MDIS (aRR, 1.20; 95% CI, 1.08-1.34). CONCLUSIONS HCHN patients had a high burden of reported drug allergy. A reported penicillin allergy conferred a 4-fold increased odds of beta-lactam alternative antibiotic use. Reporting penicillin allergy, with and without MDIS, was associated with significantly more HRU. HCHN care management programs should consider systematic drug allergy evaluations to optimize antibiotic use in these fragile patients.
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Affiliation(s)
- Kimberly G Blumenthal
- Division of Rheumatology, Allergy, and Immunology, The Medical Practice Evaluation Center, The Mongan Institute, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA 02114.
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Islim AI, Kolamunnage-Dona R, Mohan M, Moon RDC, Crofton A, Haylock BJ, Rathi N, Brodbelt AR, Mills SJ, Jenkinson MD. A prognostic model to personalize monitoring regimes for patients with incidental asymptomatic meningiomas. Neuro Oncol 2021; 22:278-289. [PMID: 31603516 PMCID: PMC7032634 DOI: 10.1093/neuonc/noz160] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Asymptomatic meningioma is a common incidental finding with no consensus on the optimal management strategy. We aimed to develop a prognostic model to guide personalized monitoring of incidental meningioma patients. METHODS A prognostic model of disease progression was developed in a retrospective cohort (2007-2015), defined as: symptom development, meningioma-specific mortality, meningioma growth or loss of window of curability. Secondary endpoints included non-meningioma-specific mortality and intervention. RESULTS Included were 441 patients (459 meningiomas). Over a median of 55 months (interquartile range, 37-80), 44 patients had meningioma progression and 57 died (non-meningioma-specific). Forty-four had intervention (at presentation, n = 6; progression, n = 20; nonprogression, n = 18). Model parameters were based on statistical and clinical considerations and included: increasing meningioma volume (hazard ratio [HR] 2.17; 95% CI: 1.53-3.09), meningioma hyperintensity (HR 10.6; 95% CI: 5.39-21.0), peritumoral signal change (HR 1.58; 95% CI: 0.65-3.85), and proximity to critical neurovascular structures (HR 1.38; 95% CI: 0.74-2.56). Patients were stratified based on these imaging parameters into low-, medium- and high-risk groups and 5-year disease progression rates were 3%, 28%, and 75%, respectively. After 5 years of follow-up, the risk of disease progression plateaued in all groups. Patients with an age-adjusted Charlson comorbidity index ≥6 (eg, an 80-year-old with chronic kidney disease) were 15 times more likely to die of other causes than to receive intervention at 5 years following diagnosis, regardless of risk group. CONCLUSIONS The model shows that there is little benefit to rigorous monitoring in low-risk and older patients with comorbidities. Risk-stratified follow-up has the potential to reduce patient anxiety and associated health care costs.
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Affiliation(s)
- Abdurrahman I Islim
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,School of Medicine, University of Liverpool, Liverpool, UK.,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | - Midhun Mohan
- School of Medicine, University of Liverpool, Liverpool, UK.,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Richard D C Moon
- School of Medicine, University of Liverpool, Liverpool, UK.,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Anna Crofton
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Brian J Haylock
- Department of Clinical Oncology, The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK
| | - Nitika Rathi
- Department of Neuropathology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Andrew R Brodbelt
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Samantha J Mills
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Michael D Jenkinson
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
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12
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Journeay W, Marquez M, Kowgier M. Hemodialysis is Not Associated With Pre-prosthetic Inpatient Rehabilitation Outcomes After Dysvascular Lower Extremity Amputation: A Retrospective Cohort Study. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 2020; 3:34471. [PMID: 37614403 PMCID: PMC10443487 DOI: 10.33137/cpoj.v3i2.34471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/30/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Lower extremity amputation due to complications from peripheral vascular disease and/or diabetes are common and these patients often have multiple comorbidities. Patients with end-stage renal disease receiving hemodialysis (ESRD/HD) are a particularly vulnerable group at risk for amputation. After lower extremity amputation (LEA) surgery, many patients undergo post-operative inpatient rehabilitation to improve their pre-prosthetic functional independence. Given the increased complexity of dysvascular patients living with ESRD/HD compared to those without ESRD/HD, the association of HD with pre-prosthetic inpatient functional outcomes warrants further study. OBJECTIVE The objective of this study was to compare the pre-prosthetic functional outcomes and Length of Stay (LOS) among patients with recent dysvascular LEA with and without ESRD/HD. METHODOLOGY A retrospective cohort design was used to analyze a group of 167 patients with unilateral, dysvascular limb loss who were admitted to inpatient rehabilitation with 24 of these patients in the ESRD/HD group. Age, gender, amputation level, amputation side, length of stay (LOS), time since surgery, Functional Independence Measure (FIM) scores (admission and discharge), and Charlson Comorbidity Index (CCI) were collected. FINDINGS There was no difference between patients with dysvascular amputation with and without ESRD/HD in the association of functional outcomes or LOS in this cohort and rehabilitation model. The CCI score was higher in the ESRD/HD group. Multivariate analysis indicated an inverse relationship with age and FIM scores, where increased age was associated with lower Total and Motor FIM at admission and discharge. There were no associations with FIM change. Age was positively associated with LOS. Being female was inversely associated to motor FIM scores at admission and discharge. CONCLUSION Among patients with recent dysvascular LEA, ESRD/HD is not associated with different functional outcomes or LOS in the pre-prosthetic inpatient rehabilitation setting. This suggests that despite added comorbidity that patients with ESRD/HD may still benefit from inpatient rehabilitation to optimize pre-prosthetic function.
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Affiliation(s)
- W.S. Journeay
- Providence Healthcare – Unity Health Toronto, Toronto, ON, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada
| | - M.G. Marquez
- Department of Anatomy and Cell Biology, McGill University, Montreal, Canada
| | - M. Kowgier
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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13
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Kwon CS, Wong B, Agarwal P, Lin JY, Mazumdar M, Dhamoon M, Jetté N. Nonelective hospital admissions, discharge disposition, and health services utilization in epilepsy patients: A population-based study. Epilepsia 2020; 61:1969-1978. [PMID: 32808690 DOI: 10.1111/epi.16642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/24/2020] [Accepted: 07/20/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Identifying adverse outcomes and examining trends and causes of nonelective admissions among persons with epilepsy would be beneficial to optimize patient care and reduce health services utilization. We examined the association of epilepsy with discharge status, in-hospital mortality, length-of-stay, and charges. We also examined 10-year trends and causes of hospital admissions among those with and without epilepsy. METHODS Nonelective hospital admission in persons with epilepsy was identified in the 2005-2014 National Inpatient Sample (NIS) using a validated International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) case definition. The NIS is the largest US all-payer database including patient and hospital-level variables, and represents hospitalizations in the general population. Descriptive statistics on trends and causes of admissions and multivariable regression analysis summarizing the association of epilepsy with the outcomes of interest are presented. RESULTS Of 4 718 178 nonelective admissions in 2014, 3.80% (n = 179 461) were in persons with epilepsy. Admissions in persons with epilepsy increased from 14 636 to 179 461 (P < .0001) between 2005 and 2014. As compared to persons without epilepsy, hospital admissions in persons with epilepsy had higher odds of transfer to other facilities (odds ratio [OR] = 1.77, 95% confidence interval [CI]: 1.72-1.81, P < .0001), being discharged against medical advice (OR = 1.48, 95% CI: 1.38-1.59, P < .0001), and incurring 4% greater total charges (P < .0001). Epilepsy, convulsions, pneumonia, mood disorders, cerebrovascular disease, and septicemia were the top causes for admissions in those with epilepsy. SIGNIFICANCE Future research should focus on designing targeted health care interventions that decrease the number of hospital admissions, reduce health services utilization, and increase the odds of discharge home in people with epilepsy.
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Affiliation(s)
- Churl-Su Kwon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Division of Health Outcomes & Knowledge Translation Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bonnie Wong
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Parul Agarwal
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jung-Yi Lin
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Madhu Mazumdar
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mandip Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nathalie Jetté
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Division of Health Outcomes & Knowledge Translation Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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14
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Saad AB, Loued L, Joobeur S, Migaou A, Mhamed SC, Rouatbi N, Fahem N. [Influence of co-morbidities on the progression and prognosis of patients with chronic obstructive pulmonary disease in a Tunisian Hospital]. Pan Afr Med J 2020; 36:76. [PMID: 32774635 PMCID: PMC7386274 DOI: 10.11604/pamj.2020.36.76.21511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/15/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction la broncho-pneumopathie chronique obstructive (BPCO) s’associe fréquemment avec des comorbidités. L’objectif de notre travail est d'étudier l'impact des comorbidités sur l’évolution et le pronostic de la BPCO. Méthodes il s’agit d’une étude rétrospective incluant des patients porteurs de BPCO hospitalisés et/ou suivis à la consultation de Pneumologie au Centre Hospitalo-Universitaire Fattouma Bourguiba de Monastir entre Janvier 2000 jusqu’à Décembre 2017. Les patients ont été répartis initialement en deux groupes, le groupe G0: BPCO isolée et le groupe G1: au moins une comorbidité. Nous avons divisé les patients du groupe G1 en deux sous-groupes: Groupe A: patients ayant 1-2 comorbidités et Groupe B: ≥ 3 comorbidités associées. Nous avons comparé les différents paramètres de sévérité de la BPCO entre les différents groupes. Résultats en tout 1152 patients BPCO ont été inclus. Soixante-dix-neuf pourcent des patients avaient au moins une pathologie chronique associée à leur BPCO. La présence d’au moins une comorbidité était associée à l'augmentation du nombre des exacerbations sévères (p = 0,004), avec plus de recours à l’oxygène longue durée (p = 0,006) et à une survie réduite (p = 0,001). De même, un nombre de comorbidités plus important (≥ 3 comorbidités) était associé à une inflammation systémique plus importante, à un recours plus fréquent à la ventilation mécanique ou la ventilation non invasive (p = 0,04) et à une survie réduite (p = 0,05). Conclusion la présence de comorbidités au cours de la BPCO s’associe à une sévérité plus importante et un pronostic plus sombre de la maladie. Abstract
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Affiliation(s)
- Ahmed Ben Saad
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, Monastir, Tunisie
| | - Lobna Loued
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, Monastir, Tunisie
| | - Samah Joobeur
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, Monastir, Tunisie
| | - Asma Migaou
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, Monastir, Tunisie
| | - Saousen Cheikh Mhamed
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, Monastir, Tunisie
| | - Naceur Rouatbi
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, Monastir, Tunisie
| | - Nesrine Fahem
- Service de Pneumologie et d'Allergologie, Hôpital Universitaire Fattouma Bourguiba, Rue 1er juin, Monastir, Tunisie
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15
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How comfortable are primary care physicians and oncologists prescribing medications for comorbidities in patients with cancer? Res Social Adm Pharm 2020; 16:1087-1094. [DOI: 10.1016/j.sapharm.2019.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 12/21/2022]
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16
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Smith TO, Parsons S, Fordham B, Ooms A, Dutton S, Hing C, Barber VS, Png ME, Lamb S. Behaviour change physiotherapy intervention to increase physical activity following hip and knee replacement (PEP-TALK): study protocol for a pragmatic randomised controlled trial. BMJ Open 2020; 10:e035014. [PMID: 32690503 PMCID: PMC7371148 DOI: 10.1136/bmjopen-2019-035014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION While total hip replacement (THR) and total knee replacement (TKR) successfully reduce pain associated with chronic joint pathology, this infrequently translates into increased physical activity. This is a challenge given that over 50% of individuals who undergo these operations are physically inactive and have medical comorbidities such as hypertension, heart disease, diabetes and depression. The impact of these diseases can be reduced with physical activity. This trial aims to investigate the effectiveness of a behaviour change physiotherapy intervention to increase physical activity compared with usual rehabilitation after THR or TKR. METHODS AND ANALYSIS The PEP-TALK trial is a multicentre, open-labelled, pragmatic randomised controlled trial. 260 adults who are scheduled to undergo a primary unilateral THR or TKR and are moderately inactive or inactive, with comorbidities, will be recruited across eight sites in England. They will be randomised post-surgery, prior to hospital discharge, to either six, 30 min weekly group-based exercise sessions (control), or the same six weekly, group-based, exercise sessions each preceded by a 30 min cognitive behaviour approach discussion group. Participants will be followed-up to 12 months by postal questionnaire. The primary outcome is the University of California, Los Angeles (UCLA) Physical Activity Score at 12 months. Secondary outcomes include: physical function, disability, health-related quality of life, kinesiophobia, perceived pain, self-efficacy and health resource utilisation. ETHICS AND DISSEMINATION Research ethics committee approval was granted by the NRES Committee South Central (Oxford B - 18/SC/0423). Dissemination of results will be through peer-reviewed, scientific journals and conference presentations. TRIAL REGISTRATION NUMBER ISRCTN29770908.
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Affiliation(s)
- Toby O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Scott Parsons
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Beth Fordham
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Alexander Ooms
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Oxford Clinical Trials Unit, University of Oxford, Oxford, UK
| | - Susan Dutton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Oxford Clinical Trials Unit, University of Oxford, Oxford, UK
- CSM, University of Oxford, Oxford, UK
| | - Caroline Hing
- University of London St George's Molecular and Clinical Sciences Research Institute, London, UK
| | - Vicki S Barber
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Oxford Clinical Trials Unit, University of Oxford, Oxford, UK
| | - May Ee Png
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Oxford Clinical Trials Unit, University of Oxford, Oxford, UK
| | - Sarah Lamb
- College of Medicine and Health Sciences, University of Exeter, Exeter, Devon, UK
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Marquez M, Kowgier M, Journeay W. Comorbidity and Non-prosthetic Inpatient Rehabilitation Outcomes After Dysvascular Lower Extremity Amputation. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 2020; 3:33916. [PMID: 37614663 PMCID: PMC10443504 DOI: 10.33137/cpoj.v3i1.33916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 05/08/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Dysvascular amputations arising from peripheral vascular disease and/or diabetes are common. Patients who undergo amputation often have additional comorbidities that may impact their recovery after surgery. Many individuals undergo post-operative inpatient rehabilitation to improve their non-prosthetic functional independence. Thus far, our characterization of comorbidity in this population and how it is associated with non-prosthetic inpatient functional recovery remains relatively unexplored. OBJECTIVE The objective of this study was to describe comorbidities, using the Charlson Comorbidity Index (CCI), and to examine associations between comorbidity and functional outcomes in a cohort of patients with dysvascular limb loss undergoing non-prosthetic inpatient rehabilitation. METHODOLOGY A retrospective cohort design was used to analyze a group of 143 patients with unilateral, dysvascular limb loss who were admitted to inpatient rehabilitation. Age, sex, amputation level, amputation side, length of stay (LOS), time since surgery, Functional Independence Measure (FIM) scores (Total and Motor at admission and discharge), and CCI scores were collected. FINDINGS The data showed that neither total or specific comorbidities were associated with functional outcomes or LOS in this cohort and rehabilitation model. Multivariate analysis demonstrated an inverse relationship with age and FIM scores, where increased age was associated with lower Total and Motor FIM at admission and discharge. Comorbidities were not associated with functional outcomes. Dementia was negatively associated with FIM scores, however this requires more study given the low number of patients with dementia in this cohort. CONCLUSION These data suggest that regardless of burden of comorbidity or specific comorbidities that patients with dysvascular limb loss may derive similar functional benefit from post-operative non-prosthetic inpatient rehabilitation.
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Affiliation(s)
- M.G Marquez
- Department of Anatomy and Cell Biology, McGill University, Montreal, Canada
| | - M Kowgier
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - W.S Journeay
- Providence Healthcare – Unity Health Toronto, Toronto, ON, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada
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18
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Islim AI, Mohan M, Moon RDC, Rathi N, Kolamunnage-Dona R, Crofton A, Haylock BJ, Mills SJ, Brodbelt AR, Jenkinson MD. Treatment Outcomes of Incidental Intracranial Meningiomas: Results from the IMPACT Cohort. World Neurosurg 2020; 138:e725-e735. [PMID: 32200011 DOI: 10.1016/j.wneu.2020.03.060] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Incidental findings such as meningioma are becoming increasingly prevalent. There is no consensus on the optimal management of these patients. The aim of this study was to examine the outcomes of patients diagnosed with an incidental meningioma who were treated with surgery or radiotherapy. METHODS Single-center retrospective cohort study of adult patients diagnosed with an incidental intracranial meningioma (2007-2015). Outcomes recorded were postintervention morbidity, histopathologic diagnosis, and treatment response. RESULTS Out of 441 patients, 44 underwent treatment. Median age at intervention was 56.1 years (interquartile range [IQR], 49.6-66.5); patients included 35 women and 9 men. The main indication for imaging was headache (25.9%). Median meningioma volume was 4.55 cm3 (IQR, 1.91-8.61), and the commonest location was convexity (47.7%). Six patients underwent surgery at initial diagnosis. Thirty-eight had intervention (34 with surgery and 4 with radiotherapy) after a median active monitoring duration of 24 months (IQR, 11.8-42.0). Indications for treatment were radiologic progression (n = 26), symptom development (n = 6), and patient preference (n = 12). Pathology revealed World Health Organization (WHO) grade 1 meningioma in 36 patients and WHO grade 2 in 4 patients. The risk of postoperative surgical and medical morbidity requiring treatment was 25%. Early and late moderate adverse events limiting activities of daily living occurred in 28.6% of patients treated with radiotherapy. Recurrence rate after surgery was 2.5%. All meningiomas regressed or remained radiologically stable after radiotherapy. CONCLUSIONS The morbidity after treatment of incidental intracranial meningioma is not negligible. Considering most operated tumors are WHO grade 1, treatment should be reserved for those manifesting symptoms or demonstrating substantial growth on radiologic surveillance.
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Affiliation(s)
- Abdurrahman I Islim
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; School of Medicine, University of Liverpool, Liverpool, United Kingdom; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.
| | - Midhun Mohan
- School of Medicine, University of Liverpool, Liverpool, United Kingdom; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Richard D C Moon
- School of Medicine, University of Liverpool, Liverpool, United Kingdom; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Nitika Rathi
- Department of Neuropathology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Anna Crofton
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Brian J Haylock
- Department of Clinical Oncology, The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Samantha J Mills
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Andrew R Brodbelt
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Michael D Jenkinson
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
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19
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Monterde D, Vela E, Clèries M, Garcia-Eroles L, Roca J, Pérez-Sust P. Multimorbidity as a predictor of health service utilization in primary care: a registry-based study of the Catalan population. BMC FAMILY PRACTICE 2020; 21:39. [PMID: 32066377 PMCID: PMC7026948 DOI: 10.1186/s12875-020-01104-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 01/31/2020] [Indexed: 12/29/2022]
Abstract
Background Multimorbidity is highly relevant for both service commissioning and clinical decision-making. Optimization of variables assessing multimorbidity in order to enhance chronic care management is an unmet need. To this end, we have explored the contribution of multimorbidity to predict use of healthcare resources at community level by comparing the predictive power of four different multimorbidity measures. Methods A population health study including all citizens ≥18 years (n = 6,102,595) living in Catalonia (ES) on 31 December 2014 was done using registry data. Primary care service utilization during 2015 was evaluated through four outcome variables: A) Frequent attendants, B) Home care users, C) Social worker users, and, D) Polypharmacy. Prediction of the four outcome variables (A to D) was carried out with and without multimorbidity assessment. We compared the contributions to model fitting of the following multimorbidity measures: i) Charlson index; ii) Number of chronic diseases; iii) Clinical Risk Groups (CRG); and iv) Adjusted Morbidity Groups (GMA). Results The discrimination of the models (AUC) increased by including multimorbidity as covariate into the models, namely: A) Frequent attendants (0.771 vs 0.853), B) Home care users (0.862 vs 0.890), C) Social worker users (0.809 vs 0.872), and, D) Polypharmacy (0.835 vs 0.912). GMA showed the highest predictive power for all outcomes except for polypharmacy where it was slightly below than CRG. Conclusions We confirmed that multimorbidity assessment enhanced prediction of use of healthcare resources at community level. The Catalan population-based risk assessment tool based on GMA presented the best combination of predictive power and applicability.
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Affiliation(s)
- D Monterde
- Sistemes d'Informació, Institut Català de la Salut, Barcelona, Catalonia, Spain
| | - E Vela
- Unitat d'informació i Coneixement, Servei Català de la Salut, Barcelona, Spain
| | - M Clèries
- Unitat d'informació i Coneixement, Servei Català de la Salut, Barcelona, Spain
| | - L Garcia-Eroles
- Gerència de Sistemes d'informació, Servei Català de la Salut, Barcelona, Spain
| | - J Roca
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERES, Universitat de Barcelona, Villarroel, 170, 08036, Barcelona, Spain.
| | - P Pérez-Sust
- Sistemes d'Informació, Institut Català de la Salut, Barcelona, Catalonia, Spain.,Coordinació de les Tecnologies de la Informació i la Comunicació del Sistema de Salut. Generalitat de Catalunya, Barcelona, Spain
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20
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Joosse P, Loggers SAI, Van de Ree CLPM, Van Balen R, Steens J, Zuurmond RG, Gosens T, Van Helden SH, Polinder S, Willems HC, Van Lieshout EMM. The value of nonoperative versus operative treatment of frail institutionalized elderly patients with a proximal femoral fracture in the shade of life (FRAIL-HIP); protocol for a multicenter observational cohort study. BMC Geriatr 2019; 19:301. [PMID: 31703579 PMCID: PMC6839183 DOI: 10.1186/s12877-019-1324-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/18/2019] [Indexed: 12/21/2022] Open
Abstract
Background Proximal femoral fractures are strongly associated with morbidity and mortality in elderly patients. Mortality is highest among frail institutionalized elderly with both physical and cognitive comorbidities who consequently have a limited life expectancy. Evidence based guidelines on whether or not to operate on these patients in the case of a proximal femoral fracture are lacking. Practice variation occurs, and it remains unknown if nonoperative treatment would result in at least the same quality of life as operative treatment. This study aims to determine the effect of nonoperative management versus operative management of proximal femoral fractures in a selected group of frail institutionalized elderly on the quality of life, level of pain, rate of complications, time to death, satisfaction of the patient (or proxy) and the caregiver with the management strategy, and health care consumption. Methods This is a multicenter, observational cohort study. Frail institutionalized elderly (70 years or older with a body mass index < 18.5, a Functional Ambulation Category of 2 or lower pre-trauma, or an American Society of Anesthesiologists score of 4 or 5), who sustained a proximal femoral fracture are eligible to participate. Patients with a pathological or periprosthetic fractures and known metastatic oncological disease will be excluded. Treatment decision will be reached following a structured shared decision process. The primary outcome is quality of life (Euro-QoL; EQ-5D-5 L). Secondary outcome measures are quality of life measured with the QUALIDEM, pain level (PACSLAC), pain medication use, treatment satisfaction of patient (or proxy) and caregivers, quality of dying (QODD), time to death, and direct medical costs. A cost-utility and cost-effectiveness analysis will be done, using the EQ-5D utility score and QUALIDEM score, respectively. Non-inferiority of nonoperative treatment is assumed with a limit of 0.15 on the EQ-5D score. Data will be acquired at 7, 14, and 30 days and at 3 and 6 months after trauma. Discussion The results of this study will provide insight into the true value of nonoperative treatment of proximal femoral fractures in frail elderly with a limited life expectancy. The results may be used for updating (inter)national treatment guidelines. Trial registration The study is registered at the Netherlands Trial Register (NTR7245; date 10-06-2018).
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Affiliation(s)
- Pieter Joosse
- Department of Surgery, Noordwest Ziekenhuisgroep, P.O Box 501, 1800 AM, Alkmaar, The Netherlands
| | - Sverre A I Loggers
- Department of Surgery, Noordwest Ziekenhuisgroep, P.O Box 501, 1800 AM, Alkmaar, The Netherlands.,Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - C L P Marc Van de Ree
- Department Trauma TopCare, Elisabeth-TweeSteden Ziekenhuis, P.O. Box 90151, 5000 LC, Tilburg, The Netherlands
| | - Romke Van Balen
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Jeroen Steens
- Department of Orthopaedic Surgery, Dijklander Ziekenhuis (location Westfriesgasthuis), P.O. Box 600, 1620 AR, Hoorn, The Netherlands.,Department of Orthopaedic Surgery, Dijklanders Ziekenhuis (location Waterland Ziekenhuis), P.O. Box 250, 1440 AG, Purmerend, The Netherlands
| | - Rutger G Zuurmond
- Department of Orthopaedic Surgery, Isala, P.O. Box 10400, 8000 GK, Zwolle, The Netherlands
| | - Taco Gosens
- Department of Orthopaedic Surgery, Elisabeth-TweeSteden Ziekenhuis, P.O. Box 90151, 5000 LC, Tilburg, The Netherlands
| | - Sven H Van Helden
- Department of Surgery, Isala, P.O. Box 10400, 8000 GK, Zwolle, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Hanna C Willems
- Geriatrics Section, Department of Internal Medicine, Amsterdam UMC location AMC, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Valizadeh R, Vali L, Bahaadinbeigy K, Amiresmaili M. The Challenges of Iran's Type 2 Diabetes Prevention and Control Program. Int J Prev Med 2019; 10:175. [PMID: 32133093 PMCID: PMC6826765 DOI: 10.4103/ijpvm.ijpvm_371_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/13/2017] [Indexed: 11/29/2022] Open
Abstract
Background: Incidence and prevalence of type 2 diabetes are one of the major challenges of Iran health system. Despite policies on diabetes prevention and control, Iran is faced with many problems in prevention and control of this disease at the executive level. This study seeks to identify the problems of Type 2 diabetes prevention and control program in Iran. Methods: In this qualitative study, 17 participants were interviewed purposefully. The semi-structured interview guide was designed based on literature review and four initial in-depth interviews. Framework analysis method was used for the analysis of qualitative data. Results: Six themes and 29 subthemes explaining the problems of type 2 diabetes prevention and control program were identified: Referral system, human resources, infrastructure, cultural problems, access, and intersectoral coordination issues. Conclusions: Despite the well-developed policy of type 2 diabetes prevention and control, the implementation is faced with some problems which endangers the effectiveness of the plan. Any attempt to improve the successful implementation of the type 2 diabetes prevention and control program requires effective measures, deep understanding of the problems and solving them.
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Affiliation(s)
- Reza Valizadeh
- Department of health management, policy and economics, school of management and medical informatics, Kerman University of Medical Sciences, Kerman, Iran
| | - Leila Vali
- Environmental Health Engineering Research center, Kerman University of Medical Sciences, Kerman, Iran
| | - Kambiz Bahaadinbeigy
- Department of health management, policy and economics, school of management and medical informatics, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammadreza Amiresmaili
- Department of health management, policy and economics, school of management and medical informatics, Kerman University of Medical Sciences, Kerman, Iran
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22
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Premji S, McDonald SW, Metcalfe A, Faris P, Quan H, Tough S, McNeil DA. Examining postpartum depression screening effectiveness in well child clinics in Alberta, Canada: A study using the All Our Families cohort and administrative data. Prev Med Rep 2019; 14:100888. [PMID: 31193116 PMCID: PMC6517566 DOI: 10.1016/j.pmedr.2019.100888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 04/28/2019] [Accepted: 05/02/2019] [Indexed: 12/20/2022] Open
Abstract
Affecting 10-15% of women, postpartum depression (PPD) can be debilitating and costly. While early identification has the potential to improve timely care, recommendations regarding the implementation of routine screening are inconsistent. In Alberta, screening is completed using the Edinburgh Postnatal Depression Scale during public health well child clinic visits. The objective of this study was to examine the effectiveness of screening in identifying, diagnosing and treating women at increased risk for PPD over the first year postpartum, compared to those unscreened. The All Our Families prospective pregnancy cohort was linked to public health, inpatient, outpatient, physician claims and community pharmaceutical data over the first year postpartum. Descriptive statistics and bivariate analyses examined differences in sample characteristics and PPD and non-PPD related utilization by screening category. Odds ratios and 95% confidence intervals for PPD diagnosis and mental health drugs dispensed were generated using crude and multivariable logistic regression models. Within our sample, 87% of the eligible population were screened, with 3% receiving a high-risk score, and 13% were unscreened. Compared to those unscreened, women screened high-risk had higher odds of being diagnosed with PPD (OR: 3.88, 95% CI: 2.18-6.92) and women screened low/moderate-risk had reduced odds of receiving a diagnosis (OR: 0.51, 95% CI: 0.35-0.74). High-risk women had an increased likelihood of diagnosis, higher PPD-related utilization and drugs dispensed compared to those unscreened. This information suggests that screening was effective at streamlining resources in Alberta. Future work should focus on evaluating the cost-effectiveness of PPD screening.
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Key Words
- 1H2P, 1 hospitalization, 2 physician claims
- ANOVA, analysis of variance
- AOF, All Our Families
- CI, confidence interval
- EPDS, Edinburgh Postnatal Depression Scale
- Evaluation
- IQR, interquartile range
- OR, odds ratio
- PPD, postpartum depression
- Perinatal depression
- Public health
- SD, standard deviation
- Screening
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Affiliation(s)
- Shainur Premji
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada.,Alberta Health Services, 10101 Southport Road SW, Calgary, AB T2W3N2, Canada
| | - Sheila W McDonald
- Alberta Health Services, 10101 Southport Road SW, Calgary, AB T2W3N2, Canada.,Department of Paediatrics, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada
| | - Amy Metcalfe
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada.,Department of Obstetrics and Gyneacology, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada
| | - Peter Faris
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada.,Alberta Health Services, 10101 Southport Road SW, Calgary, AB T2W3N2, Canada
| | - Hude Quan
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada
| | - Suzanne Tough
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada.,Department of Paediatrics, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada
| | - Deborah A McNeil
- Alberta Health Services, 10101 Southport Road SW, Calgary, AB T2W3N2, Canada.,Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB T2N1N4, Canada
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23
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Rakesh N, Boiarsky D, Athar A, Hinds S, Stein J. Post-stroke rehabilitation: Factors predicting discharge to acute versus subacute rehabilitation facilities. Medicine (Baltimore) 2019; 98:e15934. [PMID: 31145364 PMCID: PMC6709303 DOI: 10.1097/md.0000000000015934] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to examine predictors of discharge of hospitalized stroke patients to either an acute inpatient rehabilitation facility (IRF) or subacute skilled nursing facility (SNF).A retrospective cohort study was done in a large multicampus urban academic medical center of individuals hospitalized for stroke between January 1, 2015 and December 31, 2015 and who were discharged to either an IRF (n = 84) or SNF (n = 59). A set of characteristics and scales were collected on each patient and assessed using univariate and multivariate regression analyses.Although univariate analyses revealed multiple measures were associated with discharge destination, the most predictive multivariate logistic regression model for discharge to SNF incorporated age (odds ratio [OR] = 1.09, 95% confidence interval [CI], 1.05-1.13), premorbid physical disability (OR 7.52, 95% CI 1.66-34.14), and inability to ambulate before discharge (OR 5.84, 95% CI 2.01-16.92) with an overall c-statistic of 0.85.Increasing age, premorbid physical disability, and inability to ambulate increase the overall likelihood of discharge to a SNF. These findings need to be replicated in larger samples to determine whether they are generalizable.
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Affiliation(s)
- Neal Rakesh
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons
- Department of Rehabilitation Medicine, Weill Cornell Medical College
- NewYork-Presbyterian Hospital, New York, NY
| | - Daniel Boiarsky
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons
| | - Ammar Athar
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons
| | - Shaliesha Hinds
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons
| | - Joel Stein
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons
- Department of Rehabilitation Medicine, Weill Cornell Medical College
- NewYork-Presbyterian Hospital, New York, NY
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24
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Monterde D, Vela E, Clèries M, García Eroles L, Pérez Sust P. Validez de los grupos de morbilidad ajustados respecto a los clinical risk groups en el ámbito de la atención primaria. Aten Primaria 2019; 51:153-161. [PMID: 29433758 PMCID: PMC6836969 DOI: 10.1016/j.aprim.2017.09.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/19/2017] [Accepted: 09/18/2017] [Indexed: 11/05/2022] Open
Abstract
Objetivo Comparar el rendimiento referente a la bondad de ajuste y el poder explicativo de 2 agrupadores de morbilidad en el ámbito de la atención primaria (AP): los grupos de morbilidad ajustados (GMA) y los clinical risk groups (CRG). Diseño Estudio transversal. Emplazamiento Ámbito de la AP del Instituto Catalán de la Salud (ICS), Cataluña, España. Participantes Población asignada a centros de AP del ICS para el año 2014. Mediciones principales Se analizan 3 indicadores de interés, como son el ingreso urgente, el número de visitas y el gasto en farmacia. Se aplica un análisis estratificado por centros ajustando modelos lineales generalizados a partir de las variables edad, sexo y agrupador de morbilidad para explicar cada una de las 3 variables de interés. Las medidas estadísticas para analizar el rendimiento de los distintos modelos aplicados son el índice de Akaike, el índice de Bayes y la seudovariabilidad explicada mediante cambio de deviance. Resultados Los resultados muestran que en el ámbito de la AP del ICS el poder explicativo de los GMA es superior al ofrecido por los CRG, especialmente para el caso de las visitas y el gasto en farmacia. Conclusiones El rendimiento de los GMA en el ámbito de la AP del ICS es superior al mostrado por los CRG.
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25
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Effects of Different Comorbidities on Health-Related Quality of Life among Respiratory Patients in Vietnam. J Clin Med 2019; 8:jcm8020214. [PMID: 30736474 PMCID: PMC6406871 DOI: 10.3390/jcm8020214] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/31/2019] [Accepted: 02/05/2019] [Indexed: 12/21/2022] Open
Abstract
Comorbidities are common in respiratory disease patients and have been well-known to impact their quality of life. The objective of this study is to estimate the minimal clinically important difference (MCID) of the health-related quality of life (HRQOL) among respiratory disease patients with different comorbidities in a Vietnamese tertiary hospital. We performed a cross-sectional study from October to November 2016 at the Respiratory Center of Bach Mai Hospital, Hanoi, with a total of 508 participants. Information about socio-economic characteristics, HRQOL and comorbidities of participants was collected. ANOVA was used to identify MCID between patients with and without specific comorbid conditions. Tobit regression was used to explore the associations between comorbidities and the HRQOL. Results showed that the prevalence of cardiovascular comorbidities was 23.8%, followed by musculoskeletal diseases (12.0%), digestive diseases (11.8%), endocrine diseases (10.0%), kidney diseases (5.1%) and ear, nose, and throat diseases (4.5%). Regarding HRQOL, having a problem in pain/discomfort was observed in 61.0% of participants, followed by anxiety/depression (48.2%). Mean EQ-5D index was 0.66 (SD (Standard Deviation) = 0.31). The significant MCID (p < 0.05) was found between patients with and without cardiovascular diseases, musculoskeletal diseases, kidney diseases, and endocrine diseases. The multivariate regression model showed that only musculoskeletal diseases were found to be related with the marked decrement of EQ-5D index score (Coef. = -0.13; 95% CI (Confident Interval) = -0.23; -0.02). Suffering at least one chronic illness was correlated to the marked decrease of EQ-5D index score (Coef. = -0.09; 95%CI = -0.17; -0.01). These results underline the importance of appropriate pain management as well as the provision of an interprofessional care approach to patients in order to alleviate the burden of comorbidities to their treatment outcomes and HRQOL.
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26
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Arnautovic J, Mazhar A, Souther B, Mikhijan G, Boura J, Huda N. Cardiovascular Factors Associated with Septic Shock Mortality Risks. Spartan Med Res J 2018; 3:6516. [PMID: 33655132 PMCID: PMC7746094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/15/2018] [Indexed: 09/16/2024] Open
Abstract
CONTEXT The presence of at least one underlying chronic health condition, such as long-term care facility residence, malnutrition, immunosuppression, or prosthetic device use, are well known factors increasing infection risks and progression to severe sepsis. Furthermore, some degree of cardiovascular dysfunction occurs in the majority of septic patients and this prognostic significance has become increasingly recognized. Since septic shock carries the highest mortality risk on the sepsis spectrum, it is important to evaluate the cardiovascular risk impact on mortality in this subset of patients. METHODS The retrospective parent study contributing these electronic health record data was IRB approved and conducted across four hospital intensive care units within the authors' Michigan healthcare system. Patients with cardiopulmonary arrest or transfers from an outside facility were excluded. The authors evaluated the presence of modifiable and non-modifiable cardiovascular risk factors in septic shock patients upon admission to an emergency department. RESULTS The authors' final analytic sample included n = 109 adults who were discharged alive compared to those who died during hospitalization. Those patients who died were more often male with an underlying history of hypertension, congestive heart failure, coronary artery disease, or peripheral arterial diseases, were taking pre-admission beta-blocker medications, and had higher APACHE II scores at admission compared to the patients who survived to discharge. Significantly higher mortality risks were found in sample patients with increased troponin levels on admission and atrial fibrillation. CONCLUSIONS Appropriate triage and prompt treatment of these patient groups with tailored therapy to stabilize and improve cardiac dysfunction in the emergency department could potentially lead to improved survival outcomes. Clinicians need more studies to determine therapeutic targets most impacting underlying pathophysiologic mechanisms such as elevated troponin and atrial fibrillation that greatly increase mortality risks.
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Affiliation(s)
- Jelena Arnautovic
- St. John Macomb, Department of Cardiovascular Medicine, Faculty, Warren MI
| | - Areej Mazhar
- Henry Ford Macomb, Department of Internal Medicine, PGY 3 Resident, Clinton Township, MI
| | - Britni Souther
- Henry Ford Macomb, Department of Internal Medicine, PGY 3 Resident, Clinton Township, MI
| | - Gary Mikhijan
- Henry Ford Macomb, Department of Emergency Medicine, PGY1 Resident, Clinton Township, MI
| | - J Boura
- St. John Macomb, Department of Cardiovascular Medicine, Statistician, Warren, MI
| | - Najia Huda
- Henry Ford, Department of Critical Care Medicine, Attending Faculty, Detroit, MI
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27
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Ogunsanya ME, Nduaguba SO, Brown CM. Incremental health care services and expenditures associated with depression among individuals with cutaneous lupus erythematosus (CLE). Lupus 2018. [DOI: 10.1177/0961203318762604] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objectives The objective of this paper is to describe the annual direct medical expenditures for cutaneous lupus erythematosus (CLE) patients, and to estimate the incremental health care expenditures and utilization associated with depression among adults with CLE, while controlling for covariates. Methods Using the 2014 Medical Expenditure Panel Survey (MEPS), we compared CLE patients with and without depression to determine differences in: (a) health care utilization—inpatient, outpatient, office-based and emergency room (ER) visits, and prescriptions filled; and (b) expenditures—total costs, inpatient, outpatient, office-based, ER, and prescription medication costs, and other costs using demography-adjusted and comorbidity-adjusted multivariate models (age, gender, race/ethnicity, marital status, education, perception of health status, poverty category, smoking status, and Charlson Comorbidity Index). Results The total direct medical expenditure associated with CLE is estimated at approximately $29.7 billion in 2014 US dollars. After adjusting for covariates, adults with CLE and depression had more hospital discharges (utilization ratio (UR) = 1.13, 95% confidence interval (CI) (1.00–1.28)), ER visits (UR = 1.17, 95% CI (1.09–1.37)), and prescribed medicines (UR = 2.15, 95% CI (1.51–3.05)) than those without depression. Adults with CLE and depression had significantly higher average annual total expenditure that those without depression ($19,854 vs. $9735). Conclusions High health care expenditures are significant for patients with CLE, especially among those with depression. Prescription drugs, inpatient visits, and ER visits contributed most to the total expenditures in CLE patients with depression. Early diagnosis and treatment of depression in CLE patients may reduce total health care expenditures and utilization in this population.
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Affiliation(s)
- M E Ogunsanya
- College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - S O Nduaguba
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - C M Brown
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
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28
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Feudtner C, Schall T, Nathanson P, Berry J. Ethical Framework for Risk Stratification and Mitigation Programs for Children With Medical Complexity. Pediatrics 2018; 141:S250-S258. [PMID: 29496976 DOI: 10.1542/peds.2017-1284j] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2017] [Indexed: 11/24/2022] Open
Abstract
Those in hospitals and health care systems, when designing clinical programs for children with medical complexity, often talk about needing to develop and implement a system of risk stratification. In this article, we use the framework of an ethical evaluation of a health care program to examine what this task of risk stratification might entail by identifying specific and detailed issues that require particular attention and making a series of recommendations to help ensure that programs for children with medical complexity avoid potentially ethically problematic situations and practices.
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Affiliation(s)
- Chris Feudtner
- Department of Medical Ethics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; .,Departments of Pediatrics and Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Theodore Schall
- Department of Medical Ethics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Pamela Nathanson
- Department of Medical Ethics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jay Berry
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; and.,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
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29
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Monterde D, Vela E, Clèries M. [Adjusted morbidity groups: A new multiple morbidity measurement of use in Primary Care]. Aten Primaria 2016; 48:674-682. [PMID: 27495004 PMCID: PMC6879171 DOI: 10.1016/j.aprim.2016.06.003] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/11/2016] [Accepted: 06/03/2016] [Indexed: 11/04/2022] Open
Abstract
The Adjusted Morbidity Groups (GMA) is a new morbidity measurement developed and adapted to the Spanish healthcare System. It enables the population to be classified into 6 morbidity groups, and in turn divided into 5 levels of complexity, along with one healthy population group. Consequently, the population is divided into 31 mutually exclusive categories. The results of the stratification in Catalonia are presented. GMA is a method for grouping morbidity that is comparable to others in the field, but has been developed with data from the Spanish health system. It can be used to stratify the population and to identify target populations. It has good explanatory and predictive results in the use of health resources indicators. The Spanish Ministry of Health is promoting the introduction of the GMA into the National Health System.
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Affiliation(s)
- David Monterde
- Instituto Catalán de la Salud, Departamento de Salud, Generalidad de Cataluña, Barcelona, España.
| | - Emili Vela
- Servicio Catalán de la Salud, Departamento de Salud, Generalidad de Cataluña, Barcelona, España
| | - Montse Clèries
- Servicio Catalán de la Salud, Departamento de Salud, Generalidad de Cataluña, Barcelona, España
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30
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McPhail SM. Multimorbidity in chronic disease: impact on health care resources and costs. Risk Manag Healthc Policy 2016; 9:143-56. [PMID: 27462182 PMCID: PMC4939994 DOI: 10.2147/rmhp.s97248] [Citation(s) in RCA: 283] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Effective and resource-efficient long-term management of multimorbidity is one of the greatest health-related challenges facing patients, health professionals, and society more broadly. The purpose of this review was to provide a synthesis of literature examining multimorbidity and resource utilization, including implications for cost-effectiveness estimates and resource allocation decision making. In summary, previous literature has reported substantially greater, near exponential, increases in health care costs and resource utilization when additional chronic comorbid conditions are present. Increased health care costs have been linked to elevated rates of primary care and specialist physician occasions of service, medication use, emergency department presentations, and hospital admissions (both frequency of admissions and bed days occupied). There is currently a paucity of cost-effectiveness information for chronic disease interventions originating from patient samples with multimorbidity. The scarcity of robust economic evaluations in the field represents a considerable challenge for resource allocation decision making intended to reduce the burden of multimorbidity in resource-constrained health care systems. Nonetheless, the few cost-effectiveness studies that are available provide valuable insight into the potential positive and cost-effective impact that interventions may have among patients with multiple comorbidities. These studies also highlight some of the pragmatic and methodological challenges underlying the conduct of economic evaluations among people who may have advanced age, frailty, and disadvantageous socioeconomic circumstances, and where long-term follow-up may be required to directly observe sustained and measurable health and quality of life benefits. Research in the field has indicated that the impact of multimorbidity on health care costs and resources will likely differ across health systems, regions, disease combinations, and person-specific factors (including social disadvantage and age), which represent important considerations for health service planning. Important priorities for research include economic evaluations of interventions, services, or health system approaches that can remediate the burden of multimorbidity in safe and cost-effective ways.
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Affiliation(s)
- Steven M McPhail
- Centre for Functioning and Health Research, Metro South Health; Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
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31
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Les facteurs de comorbidités et BPCO. Rev Mal Respir 2016. [DOI: 10.1016/j.rmr.2015.10.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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32
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Brinchault G, Diot P, Dixmier A, Goupil F, Guillais P, Gut-Gobert C, Leroyer C, Marchand-Adam S, Meurice JC, Morel H, Person C, Cavaillès A. [Comorbidities of COPD]. REVUE DE PNEUMOLOGIE CLINIQUE 2015; 71:342-349. [PMID: 26585876 DOI: 10.1016/j.pneumo.2015.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 09/08/2015] [Indexed: 06/05/2023]
Abstract
COPD is a slowly progressive chronic respiratory disease causing an irreversible decrease in air flow. The main cause is smoking, which provokes inflammatory phenomena in the respiratory tract. COPD is a serious public health issue, causing high morbidity, mortality and disability. Related comorbidities are linked to ageing, common risk factors and genetic predispositions. A combination of comorbidities increases healthcare costs. For instance, patients with more than two comorbidities represent a quarter of all COPD sufferers but account for half the related health costs. Our review describes different comorbidities and their impact on the COPD prognosis. The comorbidities include: cardiovascular diseases, osteoporosis, denutrition, obesity, ageing, anemia, sleeping disorders, diabetes, metabolic syndrome, anxiety-depression and lung cancer. The prognosis worsens with one or more comorbidities. Clinicians are faced with the challenge of finding practical and appropriate ways of treating these comorbidities, and there is increasing interest in developing a global, multidisciplinary approach to management. Managing this chronic disease should be based on a holistic, patient-centred approach and smoking cessation remains the key factor in the care of COPD patients.
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Affiliation(s)
- G Brinchault
- Service de pneumologie, CHU Pontchaillou, 2, rue Henri-le-Guilloux, 35033 Rennes cedex, France
| | - P Diot
- Service de pneumologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - A Dixmier
- Service de pneumologie et oncologie thoracique, centre hospitalier régional d'Orléans, 14, avenue de l'Hôpital, 45067 Orléans cedex 2, France
| | - F Goupil
- Service de pneumologie, CH Le Mans, 194, avenue Rubillard, 72037 Le Mans cedex, France
| | - P Guillais
- CHP Saint-Martin, 18, rue des Roquemonts, 14000 Caen, France
| | - C Gut-Gobert
- Département de pneumologie et médecine interne, CHRU la Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest cedex 2, France
| | - C Leroyer
- UBO, EA3878 (GETBO) IFR 148, département de médecine interne et de pneumologie, CHU de la Cavale-Blanche, université européenne de Bretagne, 29609 Brest, France
| | - S Marchand-Adam
- UMR 1100, service de pneumologie et explorations fonctionnelles respiratoires, université François-Rabelais, CHRU de Tours, 37032 Tours, France; UMR 1100/EA6305, Inserm, centre d'étude des pathologies respiratoires, 37032 Tours, France
| | - J-C Meurice
- Service de pneumologie du CHU de Poitiers, faculté de médecine et pharmacie de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - H Morel
- Service de pneumologie et oncologie thoracique, centre hospitalier régional d'Orléans, 14, avenue de l'Hôpital, 45067 Orléans cedex 2, France
| | - C Person
- Département de pneumologie, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - A Cavaillès
- Service de pneumologie, l'institut du thorax, CHU de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex 1, France.
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Kuluski K, Tracy CS, Upshur RE. Perceived risk factors of health decline: a qualitative study of hospitalized patients with multimorbidity. Risk Manag Healthc Policy 2015; 8:63-72. [PMID: 25960683 PMCID: PMC4412483 DOI: 10.2147/rmhp.s79720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Effectively preventing and managing chronic illness are key goals for health systems worldwide. A growing number of people are living longer with multiple chronic illnesses, accompanied by a high degree of treatment burden and heavy use of health care resources. People with multimorbidity typically have to manage their care needs for a number of years, and from this experience may offer valuable perspectives on factors that influenced their health outcome. Purpose The purpose of this study was to explore factors that may serve as tipping points into poor health from the perspective of hospitalized patients with multimorbidity. Participants and methods Patient interview data were analyzed from 43 hospitalized patients with multimorbidities who indicated that something could have been done to either avoid or slow down their health decline. The study used qualitative description as the analytic method to generate themes from a specific question collected through one-on-one interviews. Two reviewers independently analyzed and thematically coded the data and reached consensus on the final themes after a series of meetings. Results According to patient accounts, factors at the personal level (eg, personal behaviors), provider level (eg, late diagnoses), and health care system level (eg, poor care transitions) contributed to their health decline. Conclusion This paper focuses on prevention in the context of multimorbidity. While some respondents indicated personal behaviors that impacted health, many pointed to factors outside themselves (providers and the broader health system). The orientation of health care systems, historically designed to support acute and episodic care and not multimorbidity, places patients, at least in some cases, at additional risk of decline. The patient accounts suggest that the notion of prevention should evolve throughout the course of illness. A successful health system would embrace this notion and see the goal as forestalling not only mortality (as achieved for the most part in high socioeconomic nations) but morbidity as well. High rates of multimorbidity and health system challenges suggest that we have not yet achieved this latter aim.
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Affiliation(s)
- Kerry Kuluski
- Bridgepoint Collaboratory for Research and Innovation, Bridgepoint Active Healthcare, Toronto, ON, Canada ; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - C Shawn Tracy
- Bridgepoint Collaboratory for Research and Innovation, Bridgepoint Active Healthcare, Toronto, ON, Canada
| | - Ross E Upshur
- Bridgepoint Collaboratory for Research and Innovation, Bridgepoint Active Healthcare, Toronto, ON, Canada ; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada ; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Krishnan JA, Gussin HA, Prieto-Centurion V, Sullivan JL, Zaidi F, Thomashow BM. Integrating COPD into Patient-Centered Hospital Readmissions Reduction Programs. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2015; 2:70-80. [PMID: 25927076 PMCID: PMC4410712 DOI: 10.15326/jcopdf.2.1.2014.0148] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/02/2014] [Indexed: 12/21/2022]
Abstract
About 1 in 5 patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD) in the United States are readmitted within 30 days. The U.S. Centers for Medicare and Medicaid Services has recently expanded its Hospital Readmissions Reduction Program to financially penalize hospitals with higher than expected all-cause 30-day readmission rates following a hospitalization for COPD exacerbation. In October 2013, the COPD Foundation convened a multi-stakeholder National COPD Readmissions Summit to summarize our understanding of how to reduce hospital readmissions in patients hospitalized for COPD exacerbations. Over 225 individuals participated in the Summit, including patients, clinicians, health service researchers, policy makers and representatives of academic health care centers, industry, and payers. Summit participants recommend that programs to reduce hospital readmissions: 1) Include specific recommendations about how to promote COPD self-management skills training for patients and their caregivers; 2) Adequately address co-existing disorders common to COPD in care plans during and after hospitalizations; 3) Include an evaluation of adverse events when implementing strategies to reduce hospital readmissions; and 4) Develop a strategy (e.g., a learning collaboratory) to connect groups who are engaged in developing, testing, and implementing programs to reduce hospital readmissions for COPD and other conditions.
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Affiliation(s)
- Jerry A. Krishnan
- Population Health Sciences Program. University of Illinois Hospital and Health Sciences System, Chicago
- Department of Medicine, Section of Pulmonary, Critical Care, Sleep and Allergy Medicine, University of Illinois at Chicago
| | - Hélène A. Gussin
- Department of Medicine, Section of Pulmonary, Critical Care, Sleep and Allergy Medicine, University of Illinois at Chicago
| | - Valentin Prieto-Centurion
- Department of Medicine, Section of Pulmonary, Critical Care, Sleep and Allergy Medicine, University of Illinois at Chicago
| | | | - Farhan Zaidi
- Department of Medicine, Section of Pulmonary, Critical Care, Sleep and Allergy Medicine, University of Illinois at Chicago
| | - Byron M. Thomashow
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, New York
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Cohen CJ, Flaks-Manov N, Low M, Balicer RD, Shadmi E. High-Risk Case Identification for Use in Comprehensive Complex Care Management. Popul Health Manag 2015; 18:15-22. [DOI: 10.1089/pop.2014.0011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Chandra J. Cohen
- Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
| | - Natalie Flaks-Manov
- Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
| | - Marcelo Low
- Health Policy and Planning, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
| | - Ran D. Balicer
- Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
- Epidemiology Department, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Efrat Shadmi
- Health Policy and Planning, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
- Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Steppuhn H, Langen U, Keil T, Scheidt-Nave C. Chronic disease co-morbidity of asthma and unscheduled asthma care among adults: results of the national telephone health interview survey German Health Update (GEDA) 2009 and 2010. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2014; 23:22-9. [PMID: 24346826 PMCID: PMC6442275 DOI: 10.4104/pcrj.2013.00107] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background: Co-morbidities may complicate the clinical management of chronic conditions such as asthma. Aims: To quantify the strength of the relationship between asthma and other chronic diseases and to analyse whether co-morbidities contribute to unscheduled asthma care. Methods: Data from two consecutive national telephone health interview surveys (GEDA 2009 and 2010) including a total of 43,312 adults (≥18 years of age) were analysed. Persons with and without a current diagnosis of asthma were compared with respect to concurrent diagnoses (diabetes mellitus, hypertension, chronic heart failure, depression, osteoarthritis, stroke, coronary heart disease, and cancer). Logistic regression models were applied to assess the strength of the association between asthma and co-morbidities in the total study population and, among persons with asthma, between the number of co-morbidities and unscheduled inpatient (hospital admissions and/or emergency department admissions) or outpatient asthma care in the past 12 months. Results: Overall, 5.3% (95% CI 5.0% to 5.6%) of adults reported current physician-diagnosed asthma. Asthma was significantly associated with most of the conditions considered and 18% of persons with asthma had three or more co-morbidities. Adjusted odds ratios (AOR) of unscheduled asthma care increased with numbers of conditions, with AOR 3.40 (95% CI 1.39 to 8.31) for unscheduled inpatient care and AOR 2.32 (95% CI 1.30 to 4.14) for unscheduled outpatient care comparing those with three or more co-morbidities versus those with none. Conclusions: The magnitude of chronic disease co-morbidity is substantial in asthma, is related to unscheduled asthma care, and implies a significant number of adults with asthma facing complex healthcare needs.
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Affiliation(s)
- Henriette Steppuhn
- Department of Epidemiology and Health Monitoring, Robert Koch Institute Berlin, Berlin, Germany • Institute for Social Medicine, Epidemiology, and Health Economics, Charité - Universitätmedizin Berlin, Berlin, Germany
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Charlson ME, Wells MT, Kanna B, Dunn V, Michelen W. Medicaid managed care: how to target efforts to reduce costs. BMC Health Serv Res 2014; 14:461. [PMID: 25395056 PMCID: PMC4289361 DOI: 10.1186/1472-6963-14-461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 09/15/2014] [Indexed: 09/03/2023] Open
Abstract
Background To be successful, cost control efforts must target Medicaid Managed Care (MMC) beneficiaries likely to incur high costs. The critical question is how to identify potential high cost beneficiaries with simple, reproducible, transparent, auditable criteria. Our objective in this analysis was to evaluate whether the total burden of comorbidity, assessed by the Charlson comorbidity index, could identify MMC beneficiaries who incurred high health care costs. Methods The MetroPlus MMC claims database was use to analyze six months of claims data from 07/07-12/07; the analysis focused on the total amount paid. Age, gender, Charlson comorbidity score, serious mental illness and pregnancy were analyzed as predictors of total costs. Results We evaluated the cost profile of 4,614 beneficiaries enrolled at MetroPlus, an MMC plan. As hypothesized, the comorbidity index was a key correlate of total costs (p < .01). Yearly costs were more related to the total burden of comorbidity than any specific comorbid disease. For adults, in addition to comorbidity (p < .01) both serious mental illness (p < .01) and pregnancy (p < .01) were also related to total costs, while age, drug addiction and gender were not. The model with age, gender, comorbidity, serious mental illness, pregnancy and addiction explained 20% of the variance in total costs. In children, comorbidity (p < .01), serious mental illness (p < .01), addiction (p < .03) and pregnancy (p < .01) were associated with log cost; the model with those variables explained 6% of the variance in costs. Conclusions Comorbidity can be used to identify MMC beneficiaries most likely to have high costs.
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Affiliation(s)
- Mary E Charlson
- Division of Clinical Epidemiology and Evaluative Sciences Research and Center for Integrative Medicine at Weill Cornell Medical College, New York, USA.
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Zhong W, Finnie DM, Shah ND, Wagie AE, St Sauver JL, Jacobson DJ, Naessens JM. Effect of multiple chronic diseases on health care expenditures in childhood. J Prim Care Community Health 2014; 6:2-9. [PMID: 25001922 DOI: 10.1177/2150131914540916] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To examine multiple chronic conditions and related health care expenditures in children. METHODS Retrospective cohort study of all dependents of Mayo Clinic employees aged 0-17 on Jan 1, 2004 with continuous health benefits coverage for 4 years (N=14,727). Chronic conditions, health care utilization, and associated expenditures were obtained from medical and pharmacy claims. RESULTS The most prevalent chronic conditions were asthma/chronic obstructive pulmonary disease (12%), allergic rhinitis (11%), and behavior problems (9%). The most costly conditions were congenital anomalies, asthma/chronic obstructive pulmonary disease, and behavior problems ($9602, $4335, and $5378 annual cost per child, respectively). Annual health care expenditures increased substantially with the number of chronic conditions, and a small proportion of children with multiple chronic conditions accounted for a large proportion of health care costs. In addition, those with multiple chronic conditions were more likely to persist in the top 10th percentile spender group in year-to-year spending. CONCLUSION Children with multiple chronic conditions accounted for a large proportion of health care expenditures. These children were also likely to persist as high spenders in the 4-year time frame. Further research into effective ways to manage the health care delivery for children with multiple chronic conditions is needed.
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Orueta JF, García-Álvarez A, García-Goñi M, Paolucci F, Nuño-Solinís R. Prevalence and costs of multimorbidity by deprivation levels in the basque country: a population based study using health administrative databases. PLoS One 2014; 9:e89787. [PMID: 24587035 PMCID: PMC3937325 DOI: 10.1371/journal.pone.0089787] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 01/27/2014] [Indexed: 11/18/2022] Open
Abstract
Background Multimorbidity is a major challenge for healthcare systems. However, currently, its magnitude and impact in healthcare expenditures is still mostly unknown. Objective To present an overview of the prevalence and costs of multimorbidity by socioeconomic levels in the whole Basque population. Methods We develop a cross-sectional analysis that includes all the inhabitants of the Basque Country (N = 2,262,698). We utilize data from primary health care electronic medical records, hospital admissions, and outpatient care databases, corresponding to a 4 year period. Multimorbidity was defined as the presence of two or more chronic diseases out of a list of 52 of the most important and common chronic conditions given in the literature. We also use socioeconomic and demographic variables such as age, sex, individual healthcare cost, and deprivation level. Predicted adjusted costs were obtained by log-gamma regression models. Results Multimorbidity of chronic diseases was found among 23.61% of the total Basque population and among 66.13% of those older than 65 years. Multimorbid patients account for 63.55% of total healthcare expenditures. Prevalence of multimorbidity is higher in the most deprived areas for all age and sex groups. The annual cost of healthcare per patient generated for any chronic disease depends on the number of coexisting comorbidities, and varies from 637 € for the first pathology in average to 1,657 € for the ninth one. Conclusion Multimorbidity is very common for the Basque population and its prevalence rises in age, and unfavourable socioeconomic environment. The costs of care for chronic patients with several conditions cannot be described as the sum of their individual pathologies in average. They usually increase dramatically according to the number of comorbidities. Given the ageing population, multimorbidity and its consequences should be taken into account in healthcare policy, the organization of care and medical research.
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Affiliation(s)
- Juan F. Orueta
- Centro de Salud de Astrabudua, Osakidetza - Basque Health Service, Erandio, Bizkaia, Spain
- * E-mail:
| | | | - Manuel García-Goñi
- Departamento de Economía Aplicada II, Universidad Complutense de Madrid, Madrid, Spain
| | - Francesco Paolucci
- The Australian National University, Acton, Australia
- University of Northumbria, Newcastle upon Tyne, United Kingdom
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Burgel PR, Clini EM. Multimorbidity in elderly patients with chronic obstructive pulmonary disease: stop smoking! Go exercise? Am J Respir Crit Care Med 2014; 189:7-8. [PMID: 24381987 DOI: 10.1164/rccm.201311-2029ed] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Identification of clinical phenotypes using cluster analyses in COPD patients with multiple comorbidities. BIOMED RESEARCH INTERNATIONAL 2014; 2014:420134. [PMID: 24683548 PMCID: PMC3934315 DOI: 10.1155/2014/420134] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 01/02/2014] [Indexed: 11/17/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation, the severity of which is assessed using forced expiratory volume in 1 sec (FEV1, % predicted). Cohort studies have confirmed that COPD patients with similar levels of airflow limitation showed marked heterogeneity in clinical manifestations and outcomes. Chronic coexisting diseases, also called comorbidities, are highly prevalent in COPD patients and likely contribute to this heterogeneity. In recent years, investigators have used innovative statistical methods (e.g., cluster analyses) to examine the hypothesis that subgroups of COPD patients sharing clinically relevant characteristics (phenotypes) can be identified. The objectives of the present paper are to review recent studies that have used cluster analyses for defining phenotypes in observational cohorts of COPD patients. Strengths and weaknesses of these statistical approaches are briefly described. Description of the phenotypes that were reasonably reproducible across studies and received prospective validation in at least one study is provided, with a special focus on differences in age and comorbidities (including cardiovascular diseases). Finally, gaps in current knowledge are described, leading to proposals for future studies.
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Implications of comorbidity for primary care costs in the UK: a retrospective observational study. Br J Gen Pract 2014; 63:e274-82. [PMID: 23540484 DOI: 10.3399/bjgp13x665242] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Comorbidity is increasingly common in primary care. The cost implications for patient care and budgetary management are unclear. AIM To investigate whether caring for patients with specific disease combinations increases or decreases primary care costs compared with treating separate patients with one condition each. DESIGN Retrospective observational study using data on 86 100 patients in the General Practice Research Database. METHOD Annual primary care cost was estimated for each patient including consultations, medication, and investigations. Patients with comorbidity were defined as those with a current diagnosis of more than one chronic condition in the Quality and Outcomes Framework. Multiple regression modelling was used to identify, for three age groups, disease combinations that increase (cost-increasing) or decrease (cost-limiting) cost compared with treating each condition separately. RESULTS Twenty per cent of patients had at least two chronic conditions. All conditions were found to be both cost-increasing and cost-limiting when co-occurring with other conditions except dementia, which is only cost-limiting. Depression is the most important cost-increasing condition when co-occurring with a range of conditions. Hypertension is cost-limiting, particularly when co-occurring with other cardiovascular conditions. CONCLUSION Three categories of comorbidity emerge, those that are: cost-increasing, mainly due to a combination of depression with physical comorbidity; cost-limiting because treatment for the conditions overlap; and cost-limiting for no apparent reason but possibly because of inadequate care. These results can contribute to efficient and effective management of chronic conditions in primary care.
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Corser WD. Increasing comorbidity with diabetes in the community: diabetes research challenges. Diabetes Res Clin Pract 2013; 100:173-80. [PMID: 23228391 DOI: 10.1016/j.diabres.2012.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 10/29/2012] [Accepted: 11/15/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The purpose of this paper is to discuss the ongoing definitional, measurement and analytic challenges imposed on community-based diabetes researchers examining the experiences and outcomes of home-dwelling adults surviving longer with diabetes and additional comorbid health conditions. When selecting from the still limited number of standard hospital-oriented comorbidity methods, researchers across the world will need to consider a frequently complex series of methodological decisions from their enrolling such adults with increased comorbidity into study samples. CONCLUSIONS Three categories of methodological implications from increasing forms of comorbid diabetes are discussed for diabetes researchers. Six sequenced research design strategies with specific examples are offered regarding how to most rigorously incorporate elements of comorbidity into prospective diabetes study designs.
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Assoziation zwischen Multimorbidität und Krankheitskosten — Eine systematische Übersichtsarbeit. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/bf03320764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Burgel PR, Escamilla R, Perez T, Carré P, Caillaud D, Chanez P, Pinet C, Jebrak G, Brinchault G, Court-Fortune I, Paillasseur JL, Roche N. Impact of comorbidities on COPD-specific health-related quality of life. Respir Med 2013; 107:233-41. [DOI: 10.1016/j.rmed.2012.10.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 09/26/2012] [Accepted: 10/03/2012] [Indexed: 01/31/2023]
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Burgel PR, Mannino D. Systemic inflammation in patients with chronic obstructive pulmonary disease: one size no longer fits all! Am J Respir Crit Care Med 2013; 186:936-7. [PMID: 23155208 DOI: 10.1164/rccm.201209-1634ed] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Gaitatzis A, Sisodiya SM, Sander JW. The somatic comorbidity of epilepsy: A weighty but often unrecognized burden. Epilepsia 2012; 53:1282-93. [DOI: 10.1111/j.1528-1167.2012.03528.x] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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O'Kelly N, Robertson W, Smith J, Dexter J, Carroll-Hawkins C, Ghosh S. Short-term outcomes in heart failure patients with chronic obstructive pulmonary disease in the community. World J Cardiol 2012; 4:66-71. [PMID: 22451854 PMCID: PMC3312233 DOI: 10.4330/wjc.v4.i3.66] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 03/06/2012] [Accepted: 03/13/2012] [Indexed: 02/06/2023] Open
Abstract
AIM To establish the short term outcomes of heart failure (HF) patients in the community who have concurrent chronic obstructive pulmonary disease (COPD). METHODS We evaluated 783 patients (27.2%) with left ventricular systolic dysfunction under the care of a regional nurse-led community HF team between June 2007 and June 2010 through a database analysis. RESULTS One hundred and one patients (12.9%) also had a diagnosis of COPD; 94% of patients were treated with loop diuretics, 83% with angiotensin converting enzyme inhibitors, 74% with β-blockers; 10.6% with bronchodilators; and 42% with aldosterone antagonists. The mean age of the patients was 77.9 ± 5.7 years; 43% were female and mean New York Heart Association class was 2.3 ± 0.6. The mean follow-up was 28.2 ± 2.9 mo. β-blocker utilization was markedly lower in patients receiving bronchodilators compared with those not taking bronchodilators (overall 21.7% vs 81%, P < 0.001). The 24-mo survival was 93% in patients with HF alone and 89% in those with both comorbidities (P = not significant). The presence of COPD was associated with increased risk of HF hospitalization [hazard ratio (HR): 1.56; 95% CI: 1.4-2.1; P < 0.001] and major adverse cardiovascular events (HR: 1.23; 95% CI: 1.03-1.75; P < 0.001). CONCLUSION COPD is a common comorbidity in ambulatory HF patients in the community and is a powerful predictor of worsening HF. It does not however appear to affect short-term mortality in ambulatory HF patients.
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Affiliation(s)
- Noel O'Kelly
- Noel O'Kelly, Community Health Services, Leicestershire Partnership Trust, Melton, Leicestershire, Le13 1SJ, United Kingdom
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Greiner MA, Hammill BG, Fonarow GC, Whellan DJ, Eapen ZJ, Hernandez AF, Curtis LH. Predicting costs among medicare beneficiaries with heart failure. Am J Cardiol 2012; 109:705-11. [PMID: 22154317 DOI: 10.1016/j.amjcard.2011.10.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 10/13/2011] [Accepted: 10/13/2011] [Indexed: 12/14/2022]
Abstract
Disease management programs that target patients with the highest risk of subsequent costs may help payers and providers control health care costs, but identifying these patients prospectively is challenging. We hypothesized that medical history and clinical data from a heart failure registry could be used to prospectively identify patients with heart failure most likely to incur high costs. We linked Medicare inpatient claims to clinical registry data for patients with heart failure and calculated total Medicare costs during the year after the index heart failure hospitalization. We defined patients as having high costs if they were in the upper 5% (>$76,500) of the distribution. We used logistic regression models to identify patient and clinical characteristics associated with high costs. Costs for 40,317 patients in the study varied widely. Patients in the upper 5% of the cost distribution incurred mean costs of $117,193 ± 55,550 during 1 year of follow-up compared to $17,086 ± 17,792 for the lower-cost group. Demographic and clinical characteristics associated with high costs included younger age and black race; history of anemia, chronic obstructive pulmonary disease, ischemic heart disease, diabetes mellitus, or peripheral vascular disease; serum creatinine level; and systolic blood pressure at admission. Mean 1-year Medicare costs for patients whom the model predicted would exceed the high-cost threshold were >2 times the costs for patients below the threshold. In conclusion, a model based on variables from clinical registries can identify a group of patients with heart failure who on average will incur higher costs in the first year after hospitalization.
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Sampalli T, Fox RA, Dickson R, Fox J. Proposed model of integrated care to improve health outcomes for individuals with multimorbidities. Patient Prefer Adherence 2012; 6:757-64. [PMID: 23118532 PMCID: PMC3484525 DOI: 10.2147/ppa.s35201] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Indexed: 12/21/2022] Open
Abstract
Multimorbidity is defined as the coexistence of multiple chronic conditions. Individuals with multimorbidity typically present with complex needs and show significant changes in their functional health and quality of life. Multimorbidity in the aging population is well recognized, but there has been limited research on ways to manage the problem effectively. More recent studies have demonstrated a high prevalence of multimorbidity in the younger demographics aged under 65 years. There is a definite need to develop models of care that can manage these individuals effectively and mitigate the impact of illness on individuals and the financial burden to the health care system. An integrated model of care has been developed and implemented in a facility in Nova Scotia that routinely treats individuals with multiple chronic conditions. This care model is designed to address the specific needs of this complex patient population, with integrated and coordinated care modules that meet the needs of the person versus the disease. The results of a pilot evaluation of this care model are also discussed.
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Affiliation(s)
- Tara Sampalli
- Correspondence: Tara Sampalli, Integrated Chronic Care Service, Primary Health Care, Capital Health, Nova Scotia, Canada, Tel +1 902 860 3107, Fax +1 902 860 2046, Email
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