1
|
Progovac AM, Mullin BO, Yang X, Kibugi L(T, Mwizerwa D, Hatfield LA, Schuster MA, McDowell A, Cook BL. Despite Higher Rates of Minimally Recommended Depression Treatment, Transgender and Gender Diverse Medicare Beneficiaries with Depression Have Poorer Mental Health Outcomes: Analysis of 2009–2016 Medicare Data. Transgend Health 2023. [DOI: 10.1089/trgh.2022.0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
|
2
|
Dev S, Goldstick J, Peterson T, Brenner J, Abir M. Quantifying Ambulatory Care Use Preceding Emergency Department Visits and Hospitalizations for Ambulatory Care Sensitive Conditions. Am J Med Qual 2022; 37:285-289. [PMID: 34803133 DOI: 10.1097/jmq.0000000000000029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ambulatory Care Sensitive Conditions (ACSC) represent a significant source of health care spending in the United States. Existing literature is largely descriptive and there is limited information about how an emergency department (ED) visit or hospitalization for ACSCs is related to prior ambulatory care visits. A retrospective, observational study was conducted using health records from a large midwestern health system during a 20-month period between 2012 and 2014. Our primary variables were (1) type of care setting (i.e., ED visit or hospitalization) and (2) whether the patient received ambulatory care services in the 14, 30, and 60 days before the ED visit or hospital admission. Of patients seen in the ED for ACSCs, 11.9%, 16.3%, and 21.67% were seen in ambulatory care in the 14, 30, and 60 days prior, respectively. Of those hospitalized for ACSCs, 29.1%, 39.9%, and 53% were seen in ambulatory care in the 14, 30, and 60 days prior, respectively. These results highlight a potential lost opportunity to address ACSCs in the ambulatory care setting. Such knowledge can inform interventions to reduce avoidable ACSC-related acute care use and health care costs, and improve patient outcomes.
Collapse
Affiliation(s)
- Sharmistha Dev
- Department of Emergency Medicine, Indiana University, Indianapolis, IN
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN
- Roudebush VA Medical Center, HSR&D Center for Health Information and Communication (CHIC), Indianapolis, IN
| | - Jason Goldstick
- Acute Care Research Unit, Department of Emergency Medicine, University of Michigan, Ann Arbor, MI
| | - Timothy Peterson
- Acute Care Research Unit, Department of Emergency Medicine, University of Michigan, Ann Arbor, MI
| | | | - Mahshid Abir
- Acute Care Research Unit, Department of Emergency Medicine, University of Michigan, Ann Arbor, MI
- RAND Corporation, Santa Monica, CA
| |
Collapse
|
3
|
Ryskina KL, Shultz K, Zhou Y, Lautenbach G, Brown RT. Older adults' access to primary care: Gender, racial, and ethnic disparities in telemedicine. J Am Geriatr Soc 2021; 69:2732-2740. [PMID: 34224577 DOI: 10.1111/jgs.17354] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/16/2021] [Accepted: 06/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In 2020, primary care practices adopted telemedicine as an alternative to in-person visits. Little is known about whether access to telemedicine was equitable, especially among older patients. Our objectives were to (1) examine older adults' use of telemedicine versus in-person primary care visits and (2) compare hospitalization for ambulatory care sensitive conditions (ACSCs) between the groups. METHODS In this retrospective cross-sectional study of 17,103 patients aged ≥65 years seen at 32 clinics in the Mid-Atlantic, primary care patients were classified into two groups-telemedicine versus in person-based on the first visit between March and May 2020 and followed up for 14 days. Using multivariable logistic regression, we measured the odds of being seen via telemedicine versus in person as a function of patient demographics, comorbidities, and week of study period. We then measured the odds of ACSC hospitalization by visit modality. RESULTS Mean age was 75.1 years (SD, 7.5), 60.6% of patients were female, 64.6% white, 28.1% black, and 2.0% Hispanic. Overall, 60.3% of patients accessed primary care via telemedicine. Black (vs. white) patients had higher odds of using telemedicine (adjusted odds ratio [aOR], 1.30; 95% CI, 1.14-1.47) and Hispanic (vs. not Hispanic) patients had lower odds (aOR, 0.63; 95% CI, 0.42-0.92). Compared with the in-person group, patients in the telemedicine group had lower odds of ACSC hospitalization (aOR, 0.78; 95% CI, 0.61-1.00). Among patients who used telemedicine, black patients had 1.43 higher odds of ACSC hospitalization (95% CI, 1.02-2.01) compared with white patients. Patients aged 85 or older seen via telemedicine had higher odds of an ACSC hospitalization (aOR, 1.60; 95% CI, 1.03-2.47) compared with patients aged 65-74. CONCLUSIONS These findings support the use of telemedicine for primary care access for older adults. However, the observed disparities highlight the need to improve care quality and equity regardless of visit modality.
Collapse
Affiliation(s)
- Kira L Ryskina
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kaitlyn Shultz
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yi Zhou
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gillian Lautenbach
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rebecca T Brown
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Geriatric Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Geriatrics and Extended Care Program, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA.,Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| |
Collapse
|
4
|
Depression and Uptake of Oral Anticoagulation Therapy in Patients With Atrial Fibrillation: A Danish Nationwide Cohort Study. Med Care 2020; 58:216-224. [PMID: 31876644 DOI: 10.1097/mlr.0000000000001268] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Oral anticoagulation therapy (OAT) in patients with atrial fibrillation (AF) is a highly important preventive intervention, perhaps especially in those with comorbid depression, who have a worse prognosis. However, OAT may pose particular challenges in depressed patients. OBJECTIVES To assess whether AF patients with depression have lower OAT uptake. METHODS This nationwide register-based 2005-2016 cohort study of all Danes with AF and OAT indication (CHA2DS2VASc stroke risk score ≥2) assessed OAT initiation within 90 days in those with incident AF (N=147,162) and OAT prevalence in those with prevalent AF (N=192,656). The associations of depression with both outcomes were estimated in regression analyses with successive adjustment for socioeconomic characteristics and somatic and psychiatric comorbidity. RESULTS Comorbid depression was significantly associated with lower frequency of OAT initiation in incident AF patients {adjusted proportion differences (aPDs): -6.6% [95% confidence interval (CI), -7.4 to -5.9]} and lower prevalence of OAT [aPD: -4.2% (95% CI, -4.7 to -3.8)] in prevalent AF patients. Yet, the OAT uptake increased substantially during the period, particularly in depressed patients [aPD for OAT prevalence in 2016: -0.8% (95% CI, -1.6 to -0.0)]. CONCLUSIONS Comorbid depression was associated with a significantly lower OAT uptake in patients with AF, which questions whether depressed patients receive sufficient support to manage this consequential cardiac condition. However, a substantial increase in the overall OAT uptake and a decrease of the depression-associated deficit in OAT were seen over the period during which OAT was developed through the introduction of new oral anticoagulation therapy.
Collapse
|
5
|
Helmer DA, Dwibedi N, Rowneki M, Tseng CL, Fried D, Rose D, Jani N, Sambamoorthi U. Mental Health Conditions and Hospitalizations for Ambulatory Care Sensitive Conditions Among Veterans with Diabetes. AMERICAN HEALTH & DRUG BENEFITS 2020; 13:61-71. [PMID: 32724500 PMCID: PMC7370828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/12/2019] [Indexed: 06/11/2023]
Abstract
BACKGROUND Veterans with diabetes and mental health conditions have a higher risk for suboptimal care and complications related to their diseases than veterans with diabetes who do not have mental health conditions. We hypothesized that among veterans with diabetes, patients with mental health conditions are more likely to be hospitalized for ambulatory care sensitive conditions (ACSC) than those without mental health conditions. OBJECTIVES To examine the association between depression, anxiety, and serious mental illness and hospitalizations for ACSC among veterans with diabetes after controlling for demographics and comorbidities. METHODS We used a retrospective cohort design with merged Veterans Health Administration (VHA) and Medicare electronic health records from 2008 to 2010. Andersen's Behavioral Model of Health Services Use was used to select the variables associated with hospitalizations for ACSC (ie, predisposing, enabling and need characteristics, personal health practices, and external environment). We used chi-square tests and logistic regressions for our analyses. RESULTS Among the dual VHA/Medicare-enrolled veterans with any hospitalization in 2010, 30% had hospitalizations for ACSC. Veterans with diabetes and co-occurring depression were at increased likelihood to be hospitalized for ACSC, after adjusting for all other covariates (adjusted odds ratio, 1.08; 95% confidence interval, 1.04-1.11). Similar findings were observed for anxiety. Veterans with serious mental illness were as likely as veterans without serious mental illness to be hospitalized for ACSC. CONCLUSION Veterans with depression and anxiety were more likely to be hospitalized for any or acute ACSC than veterans without mental health conditions. Patients hospitalized for acute ACSC were more susceptible than patients hospitalized for chronic ACSC to have mental health conditions. As the VHA continues to evolve from care provider to community care payer (per the Veterans Affairs MISSION Act), our results highlight the ongoing importance of care coordination and communication between payers and providers.
Collapse
Affiliation(s)
- Drew A Helmer
- Director, War Related Illness and Injury Study Center (WRIISC), Veterans Affairs (VA) New Jersey Healthcare System, East Orange
| | - Nilanjana Dwibedi
- Assistant Professor, Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown
| | - Mazhgan Rowneki
- Health Services Data Analyst, WRIISC, VA New Jersey Healthcare System
| | - Chin-Lin Tseng
- Health Services Scientist, WRIISC, VA New Jersey Healthcare System
| | - Dennis Fried
- Epidemiologist, WRIISC, VA New Jersey Healthcare System
| | - Danielle Rose
- Health Research Scientist, Veteran Affairs Greater Los Angeles Healthcare System, Sepulveda, CA
| | - Nisha Jani
- Epidemiologist, WRIISC, VA New Jersey Healthcare System
| | - Usha Sambamoorthi
- Professor, Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy
| |
Collapse
|
6
|
Racial Disparities in Healthcare Utilization Among Individuals with Cardiometabolic Risk Factors and Comorbid Anxiety Disorder. J Racial Ethn Health Disparities 2020; 7:1234-1240. [PMID: 32277365 DOI: 10.1007/s40615-020-00748-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE This study addresses racial/ethnic differences in adverse health care utilization among individuals with comorbid anxiety disorder and cardiometabolic syndrome (CMetS) risk factors. METHODS Utilizing 2011-2015 Medical Expenditure Panel Survey (MEPS) data, logistic regression models were estimated to determine the likelihood of receiving CMetS-related medical treatment in the emergency department (ED) or via inpatient services and to determine if the likelihood is associated with race/ethnicity. Adjusted models controlled for age, sex, and insurance type. RESULTS Significant racial-ethnic differences were observed for utilization (any emergency department and/or inpatient visit). The odds of non-Hispanic Black respondents reporting emergency department and/or inpatient utilization was 2.39 (p < 0.05) times the odds of non-Hispanic White respondents. CONCLUSION Racial-ethnic variation in adverse healthcare utilization suggests an opportunity to improve care and outcomes for persons diagnosed with comorbid anxiety disorder and cardiometabolic syndrome. Integrated interventions could simultaneously improve mental health and facilitate CMetS disease self-management.
Collapse
|
7
|
Hensel JM, Taylor VH, Fung K, Yang R, Vigod SN. Acute Care Use for Ambulatory Care-Sensitive Conditions in High-Cost Users of Medical Care with Mental Illness and Addictions. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:816-825. [PMID: 29347834 PMCID: PMC6309042 DOI: 10.1177/0706743717752880] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The role of mental illness and addiction in acute care use for chronic medical conditions that are sensitive to ambulatory care management requires focussed attention. This study examines how mental illness or addiction affects risk for repeat hospitalization and/or emergency department use for ambulatory care-sensitive conditions (ACSCs) among high-cost users of medical care. METHOD A retrospective, population-based cohort study using data from Ontario, Canada. Among the top 10% of medical care users ranked by cost, we determined rates of any and repeat care use (hospitalizations and emergency department [ED] visits) between April 1, 2011, and March 31, 2012, for 14 consensus established ACSCs and compared them between those with and without diagnosed mental illness or addiction during the 2 years prior. Risk ratios were adjusted (aRR) for age, sex, residence, and income quintile. RESULTS Among 314,936 high-cost users, 35.9% had a mental illness or addiction. Compared to those without, individuals with mental illness or addiction were more likely to have an ED visit or hospitalization for any ACSC (22.8% vs. 19.6%; aRR, 1.21; 95% confidence interval [CI], 1.20-1.23). They were also more likely to have repeat ED visits or hospitalizations for the same ACSC (6.2% vs. 4.4% of those without; aRR, 1.48; 95% CI, 1.44-1.53). These associations were stronger in stratifications by mental illness diagnostic subgroup, particularly for those with a major mental illness. CONCLUSIONS The presence of mental illness and addiction among high-cost users of medical services may represent an unmet need for quality ambulatory and primary care.
Collapse
Affiliation(s)
- Jennifer M Hensel
- Department of Psychiatry, Women's College Hospital and University of Toronto, Toronto, Ontario.,Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, Ontario
| | - Valerie H Taylor
- Department of Psychiatry, Women's College Hospital and University of Toronto, Toronto, Ontario
| | - Kinwah Fung
- Institute for Clinical Evaluative Sciences, Toronto, Ontario
| | - Rebecca Yang
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, Ontario
| | - Simone N Vigod
- Department of Psychiatry, Women's College Hospital and University of Toronto, Toronto, Ontario.,Institute for Clinical Evaluative Sciences, Toronto, Ontario
| |
Collapse
|
8
|
Perceived Stress, Multimorbidity, and Risk for Hospitalizations for Ambulatory Care-sensitive Conditions: A Population-based Cohort Study. Med Care 2017; 55:131-139. [PMID: 27579911 DOI: 10.1097/mlr.0000000000000632] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Psychiatric disorders are associated with an increased risk for ambulatory care-sensitive condition (ACSC)-related hospitalizations, but it remains unknown whether this holds for individuals with nonsyndromic stress that is more prevalent in the general population. OBJECTIVES To determine whether perceived stress is associated with ACSC-related hospitalizations and rehospitalizations, and posthospitalization 30-day mortality. RESEARCH DESIGN AND MEASURES Population-based cohort study with 118,410 participants from the Danish National Health Survey 2010, which included data on Cohen's Perceived Stress Scale, followed from 2010 to 2014, combined with individual-level national register data on hospitalizations and mortality. Multimorbidity was assessed using health register information on diagnoses and drug prescriptions within 39 condition categories. RESULTS Being in the highest perceived stress quintile was associated with a 2.13-times higher ACSC-related hospitalization risk (95% CI, 1.91, 2.38) versus being in the lowest stress quintile after adjusting for age, sex, follow-up time, and predisposing conditions. The associated risk attenuated to 1.48 (95% CI, 1.32, 1.67) after fully adjusting for multimorbidity and socioeconomic factors. Individuals with above reference stress levels experienced 1703 excess ACSC-related hospitalizations (18% of all). A dose-response relationship was observed between perceived stress and the ACSC-related hospitalization rate regardless of multimorbidity status. Being in the highest stress quintile was associated with a 1.26-times insignificantly increased adjusted risk (95% CI, 0.79, 2.00) for ACSC rehospitalizations and a 1.43-times increased adjusted risk (95% CI, 1.13, 1.81) of mortality within 30 days of admission. CONCLUSIONS Elevated perceived stress levels are associated with increased risk for ACSC-related hospitalization and poor short-term prognosis.
Collapse
|
9
|
Atun R, Gurol-Urganci I, Hone T, Pell L, Stokes J, Habicht T, Lukka K, Raaper E, Habicht J. Shifting chronic disease management from hospitals to primary care in Estonian health system: analysis of national panel data. J Glob Health 2017; 6:020701. [PMID: 27648258 PMCID: PMC5017034 DOI: 10.7189/jogh.06.020701] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Following independence from the Soviet Union in 1991, Estonia introduced a
national insurance system, consolidated the number of health care providers, and
introduced family medicine centred primary health care (PHC) to strengthen the
health system. Methods Using routinely collected health billing records for 2005–2012, we examine
health system utilisation for seven ambulatory care sensitive conditions (ACSCs)
(asthma, chronic obstructive pulmonary disease [COPD], depression, Type 2
diabetes, heart failure, hypertension, and ischemic heart disease [IHD]), and by
patient characteristics (gender, age, and number of co–morbidities). The
data set contained 552 822 individuals. We use patient level data to test
the significance of trends, and employ multivariate regression analysis to
evaluate the probability of inpatient admission while controlling for patient
characteristics, health system supply–side variables, and PHC use. Findings Over the study period, utilisation of PHC increased, whilst inpatient admissions
fell. Service mix in PHC changed with increases in phone, email, nurse, and
follow–up (vs initial) consultations. Healthcare utilisation for diabetes,
depression, IHD and hypertension shifted to PHC, whilst for COPD, heart failure
and asthma utilisation in outpatient and inpatient settings increased.
Multivariate regression indicates higher probability of inpatient admission for
males, older patient and especially those with multimorbidity, but protective
effect for PHC, with significantly lower hospital admission for those utilising
PHC services. Interpretation Our findings suggest health system reforms in Estonia have influenced the shift of
ACSCs from secondary to primary care, with PHC having a protective effect in
reducing hospital admissions.
Collapse
Affiliation(s)
- Rifat Atun
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ipek Gurol-Urganci
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Thomas Hone
- Department of Primary Care and Public Health, Imperial College, London, UK
| | - Lisa Pell
- The Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Jonathan Stokes
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Kaija Lukka
- Estonian Health Insurance Fund, Tallinn, Estonia
| | - Elin Raaper
- Estonian Health Insurance Fund, Tallinn, Estonia
| | - Jarno Habicht
- WHO Country Office in Republic of Kyrgyzstan, World Health Organization
| |
Collapse
|
10
|
Racial and Ethnic Disparities in Preventable Hospitalizations for Chronic Disease: Prevalence and Risk Factors. J Racial Ethn Health Disparities 2016; 4:1100-1106. [PMID: 27924622 DOI: 10.1007/s40615-016-0315-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/12/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hospitalizations due to ambulatory care sensitive conditions (ACSCs) result in high morbidity and economic burden on the American healthcare system. Admissions due to chronic ACSCs, in particular, cost the American healthcare system over 30 billion dollars annually. OBJECTIVES AND METHODS This paper presents the current research on racial and ethnic disparities in the burden of hospitalizations due to chronic ACSCs. For this narrative review, we evaluated over 800 abstracts from MEDLINE and Google Scholar and cited 62 articles. RESULTS Since 1998, racial and ethnic disparities in hospitalizations from chronic ACSCs have increased resulting in over 430,000 excess hospitalizations among non-Hispanic Blacks compared to non-Hispanic Whites. CONCLUSIONS Racial disparities in chronic ACSCs hospitalizations are pervasive in the USA. There is need for more research on the pathways through which an individual's race modifies the risk for hospitalizations due to chronic ACSCs.
Collapse
|
11
|
Hibbard JH, Greene J, Sacks RM, Overton V, Parrotta C. Improving Population Health Management Strategies: Identifying Patients Who Are More Likely to Be Users of Avoidable Costly Care and Those More Likely to Develop a New Chronic Disease. Health Serv Res 2016; 52:1297-1309. [PMID: 27546032 DOI: 10.1111/1475-6773.12545] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To explore using the Patient Activation Measure (PAM) for identifying patients more likely to have ambulatory care-sensitive (ACS) utilization and future increases in chronic disease. DATA SOURCES Secondary data are extracted from the electronic health record of a large accountable care organization. STUDY DESIGN This is a retrospective cohort design. The key predictor variable, PAM score, is measured in 2011, and is used to predict outcomes in 2012-2014. Outcomes include ACS utilization and the likelihood of a new chronic disease. DATA Our sample of 98,142 adult patients was drawn from primary care clinic users. To be included, patients had to have a PAM score in 2011 and at least one clinic visit in each of the three subsequent years. PRINCIPAL FINDINGS PAM level is a significant predictor of ACS utilization. Less activated patients had significantly higher odds of ACS utilization compared to those with high PAM scores. Similarly, patients with low PAM scores were more likely to have a new chronic disease diagnosis over each of the years of observation. CONCLUSIONS Assessing patient activation may help to identify patients who could benefit from greater support. Such an approach may help ACOs reach population health management goals.
Collapse
Affiliation(s)
- Judith H Hibbard
- Planning, Public Policy & Management, University of Oregon, Eugene, OR
| | | | | | | | | |
Collapse
|
12
|
Dantas I, Santana R, Sarmento J, Aguiar P. The impact of multiple chronic diseases on hospitalizations for ambulatory care sensitive conditions. BMC Health Serv Res 2016; 16:348. [PMID: 27488262 PMCID: PMC4973077 DOI: 10.1186/s12913-016-1584-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 07/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The high financial burden of avoidable hospitalizations has led to an increase of the study of hospitalizations for ambulatory care sensitive conditions (ACSC). There is limited information on the impact of secondary diagnoses on these hospitalizations, although patients' social and demographic characteristics, as well as the coexistence of multiple diseases are often identified in the literature as risk factors for avoidable hospitalizations. This study explores the impact of chronic conditions on the likelihood of hospitalizations for ACSC. METHODS Data were extracted from the Portuguese hospital discharge database. Avoidable hospitalizations were identified according to the Canadian Institute for Healthcare Information, and chronic conditions were identified according to criteria set by the Agency for Healthcare Research and Quality. A retrospective study analysing all patients hospitalized for an ACSC and all patients hospitalized for non-ACSC was made, using multiple logistic regression models to identify the impact of chronic conditions on the risk of admission. RESULTS The risk of an avoidable hospitalization increases by a factor of 1.35 (95 % CI [1.34;1.35]) for each additional chronic condition, and 1.55 (95 % CI [1.55;1.56]) for each additional body system affected. The respiratory and circulatory systems have the most impact on the risk of ACSC, increasing the risk by 8.72 (95 % CI [8.58;8.86]) and 3.01 (95 % CI [2.95;3.06]), respectively. CONCLUSIONS The number of chronic conditions and the body systems affected increase the risk of hospital admissions for ACSC.
Collapse
Affiliation(s)
- Inês Dantas
- National School of Public Health (ENSP), Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560, Lisbon, Portugal.
| | - Rui Santana
- Department of Health Policy and Systems Management, National School of Public Health (ENSP), Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560, Lisbon, Portugal.,Public Health Research Centre (PHRC), National School of Public Health (ENSP), Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560, Lisbon, Portugal
| | - João Sarmento
- National School of Public Health (ENSP), Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560, Lisbon, Portugal
| | - Pedro Aguiar
- Public Health Research Centre (PHRC), National School of Public Health (ENSP), Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560, Lisbon, Portugal.,Department of Strategies in Health, National School of Public Health (ENSP), Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560, Lisbon, Portugal
| |
Collapse
|
13
|
National Trends in Emergency Department Visits by Adults With Mental Health Disorders. J Emerg Med 2016; 51:131-135.e1. [DOI: 10.1016/j.jemermed.2016.05.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/03/2016] [Accepted: 05/05/2016] [Indexed: 11/23/2022]
|
14
|
Bergamo C, Juarez-Colunga E, Capp R. Association of mental health disorders and Medicaid with ED admissions for ambulatory care-sensitive condition conditions. Am J Emerg Med 2016; 34:820-4. [PMID: 26887865 DOI: 10.1016/j.ajem.2016.01.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/14/2016] [Accepted: 01/18/2016] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Adult Medicaid enrollees are more likely to have mental health disorders (MHDs) than privately insured patients and also have high rates of emergency department (ED) visits for ambulatory care-sensitive conditions (ACSCs). We aimed to evaluate the association of MHD and insurance type with ED admissions for ACSC in the United States. METHODS We conducted a cross-sectional study of ED visits made by adults aged 18 to 64 years using the corrected 2011 National Emergency Department Survey. Using multivariable logistic regression analysis, we controlled for sociodemographics and clinical variables to determine the association between insurance type, MHD, Medicaid, and MHD (as an interaction variable) and ED admissions for ACSC. RESULTS There were 131 million ED visits in 2011; after exclusions, 1.4 million admissions were included in our study. Of all ED visits, 44.7% had an MHD, of which 49.9% were covered by Medicaid and 38.1% were covered by private insurance. A total of 32.6% (95% confidence interval, 32.5%-32.7%) of ED admissions were for an ACSC. Medicaid-covered ED visits were more likely to result in ACSC hospital admission (odds ratio, 1.32; 95% confidence interval, 1.30-1.35) compared with visits covered by private insurance. Among patients with MHD, those with Medicaid insurance had 1.6 times the odds of ACSC admission compared with those privately insured. CONCLUSION Among all ED admissions, patients covered by Medicaid are more likely to be admitted for an ACSC when compared with those covered by private insurance, with a larger association being present among patients with MHD comorbidities.
Collapse
Affiliation(s)
- Cara Bergamo
- Denver Health Emergency Medicine Program, Denver Health Medical Center, Denver, CO.
| | | | - Roberta Capp
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| |
Collapse
|