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Xu Zheng E, Zhu X, Zhu Y, Qin Z, Zhang J, Huang Y. Impact of Insurance on Readmission Rates, Healthcare Expenditures, and Length of Hospital Stay among Patients with Chronic Ambulatory Care Sensitive Conditions in China. Healthcare (Basel) 2024; 12:1798. [PMID: 39273822 PMCID: PMC11395110 DOI: 10.3390/healthcare12171798] [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: 07/22/2024] [Revised: 08/31/2024] [Accepted: 09/05/2024] [Indexed: 09/15/2024] Open
Abstract
Background: The disparities in healthcare access due to varying insurance coverage significantly impact hospital outcomes, yet what is unclear is the role of insurance in providing care once the patient is in the hospital for a preventable admission, particularly in a weak gatekeeping environment. This study aimed to investigate the association between insurance types and readmission rates, healthcare expenditures, and length of hospital stay among patients with chronic ambulatory care sensitive conditions (ACSCs) in China. Methods: This retrospective observational study utilized hospitalization data collected from the Nanhai District, Foshan City, between 2016 and 2020. Generalized linear models (GLMs) were employed to analyze the relationship between medical insurance types and readmission rates, lengths of hospital stay, total medical expenses, out-of-pocket expenses, and insurance-covered expenses. Results: A total of 185,384 records were included. Among these, the participants covered by urban employee basic medical insurance (UEBMI) with 44,415 records and urban and rural resident basic medical insurance (URRBMI) with 80,752 records generally experienced more favorable outcomes compared to self-pay patients. Specifically, they had lower readmission rates (OR = 0.57, 95% CI: 0.36 to 0.90; OR = 0.59, 95% CI: 0.42 to 0.84) and reduced out-of-pocket expenses (β = -0.54, 95% CI: -0.94 to -0.14; β = -0.41, 95% CI: -0.78 to -0.05). However, they also experienced slightly longer lengths of hospital stay (IRR = 1.08, 95% CI: 1.03 to 1.14; IRR = 1.11, 95% CI: 1.04 to 1.18) and higher total medical expenses (β = 0.26, 95% CI: 0.09 to 0.44; β = 0.25, 95% CI: 0.10 to 0.40). Conclusions: This study found that different types of health insurance were associated with varying clinical outcomes among patients with chronic ambulatory care sensitive conditions (ACSCs) in China. Since the hospitalization of these patients was initially avoidable, disparities in readmission rates, lengths of hospital stay, and medical expenses among avoidable inpatient cases exacerbated the health gap between different insurance types. Addressing the disparities among different types of insurance can help reduce unplanned hospitalizations and promote health equity.
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Affiliation(s)
- Esthefany Xu Zheng
- School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou 510030, China
| | - Xiaodi Zhu
- School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou 510030, China
| | - Yi Zhu
- School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou 510030, China
| | - Zhenhua Qin
- School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou 510030, China
| | - Jiachi Zhang
- School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou 510030, China
| | - Yixiang Huang
- School of Public Health, Sun Yat-sen University, 74, Zhongshan 2nd Road, Guangzhou 510030, China
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Zhang W, Watson LR, Johnson KR. Racial Disparities in Hospitalization Due to Ambulatory Care Sensitive Conditions Among U.S. Children with Autism. J Autism Dev Disord 2024; 54:2430-2439. [PMID: 37142910 DOI: 10.1007/s10803-023-05995-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE This study was to investigate the factors associated with preventable hospitalization due to ambulatory care sensitive conditions (ACSCs) in children with autism. METHODS Using secondary data from the U.S. Nationwide Inpatient Sample (NIS), multivariable regression analyses were conducted to determine the potential effect of race and income level on the likelihood of inpatient stays for ACSCs among autistic children. Pediatric ACSCs included three acute conditions (dehydration, gastroenteritis, and urinary infection) and three chronic conditions (asthma, constipation, and diabetes short-term complications). RESULTS In this analysis, there were 21,733 hospitalizations among children with autism; about 10% were hospitalized due to pediatric ACSCs. Overall, the odds of ACSCs hospitalization were greater among Hispanic and Black autistic children versus White autistic children. Both Hispanic and Black autistic children from the lowest income level had the highest odds to be hospitalized for chronic ACSCs. CONCLUSION Inequities of access to health care among racial/ethnic minorities were most notable for autistic children with chronic ACSC conditions.
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Affiliation(s)
- Wanqing Zhang
- Department of Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Linda R Watson
- Department of Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Khalilah R Johnson
- Division of Occupational Science and Occupational Therapy, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Cho M, Kim W, Kim M, Ye R, Hwang Y, Lee DW, Shin J. The Effect of Telehealth on Patterns of Health Care Utilization and Medication Prescription in Patients with Diabetes or Hypertension During COVID-19: A Nationwide Study. Telemed J E Health 2024; 30:1297-1305. [PMID: 38206789 DOI: 10.1089/tmj.2023.0466] [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] [Indexed: 01/13/2024] Open
Abstract
Background: In response to the coronavirus disease-19 pandemic, audio-based telehealth services for consultation and medication prescription were temporarily introduced in Korea. This study investigated the impact of telehealth services on patterns of health care utilization and medication prescription in patients with hypertension or diabetes. Methods: The 2019 to 2021 Health Insurance Review and Assessment Service claims data were used. The difference-in-difference approach was used to investigate the effect of telehealth services between the case and control group before and after the intervention period. The pre-intervention period was from February 24, 2019, to February 23, 2020, and the post-intervention period from February 24, 2020, to February 23, 2021. The control group included individuals who used in-person outpatient services and the case group those who utilized both telehealth and in-person services. Results: A total of 250,640 patients with hypertension and 154,212 patients with diabetes were included. The use of telehealth services was associated with an increase in outpatient visits in those with hypertension (0.07, p = 0.0027) and diabetes (0.32, p < 0.0001). A decrease in hospitalizations (-0.2%, p = 0.0007) and emergency department visits (-0.11%, p = 0.0016) was found in individuals with hypertension. Policy implementation also resulted in an increase in medication possession ratio (MPR) and the proportion of appropriate prescription in patients with hypertension (MPR: 3.0%, p < 0.0001, prescription: 3.1%, p < 0.0001) and diabetes (MPR: 3.4%, p < 0.0001, prescription: 1.7%, p < 0.0001). Conclusions: The findings confirm a relationship between implementing telehealth services and improved patterns of health care utilization and medication prescription, suggesting the potential benefit of telehealth in managing chronic diseases.
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Affiliation(s)
- Minho Cho
- Health Insurance Review & Assessment Research Institute, Health Insurance Review & Assessment Service, Wonju-si, Republic of Korea
| | - Woorim Kim
- National Hospice Center, National Cancer Control Institute, National Cancer Center, Goyang-si, Republic of Korea
- Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang-si, Republic of Korea
| | - Myunghwa Kim
- Health Insurance Review & Assessment Research Institute, Health Insurance Review & Assessment Service, Wonju-si, Republic of Korea
| | - Ryemi Ye
- Health Insurance Review & Assessment Research Institute, Health Insurance Review & Assessment Service, Wonju-si, Republic of Korea
| | - Yungi Hwang
- Health Insurance Review & Assessment Research Institute, Health Insurance Review & Assessment Service, Wonju-si, Republic of Korea
| | - Dong Woo Lee
- Bureau of Healthcare Policy, Ministry of Health and Welfare, Sejong-si, Republic of Korea
| | - Jaeyong Shin
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Aronowitz T, Peterson KS, Morris NS. Moving the Disparity Needle: Resourcing Care Delivery for Those With Greatest Needs. Med Care 2024; 62:213-216. [PMID: 38315884 DOI: 10.1097/mlr.0000000000001986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Affiliation(s)
- Teri Aronowitz
- Department of Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, MA
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Marasović Šušnjara I, Mijaković M, Jurčev Savičević A. The Influence of the COVID-19 Pandemic on Hospitalizations for Ambulatory Care-Sensitive Conditions in Split-Dalmatia County, Croatia. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:523. [PMID: 38674169 PMCID: PMC11052272 DOI: 10.3390/medicina60040523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: We aimed to explore whether the COVID-19 pandemic influenced hospitalizations for ambulatory care-sensitive conditions (ACSCs) in Split-Dalmatia County, Croatia. Materials and Methods: We performed a cross-sectional comparative study using two different time periods, the pre-pandemic (from March 2019 to February 2020) and the pandemic period (from March 2020 to February 2021), to explore the possible influences that the COVID-19 pandemic had on hospitalizations for ACSCs. The ACSCs were classified into the categories of vaccine-preventable, chronic, and acute disease. The indicators were statistically analyzed. Results: During the pandemic, a decrease in the total number of hospitalizations and ACSC hospitalizations was recorded. The relative risk for having any ACSC hospitalization in the pandemic period compared to the pre-pandemic period was 0.67 (95% CI, 0.64-0.71; p = 0). The risk reduction was seen in all three categories of vaccine-preventable ACSCs, chronic disease, and acute disease. Large reductions were found in the relative risk of hospitalization for COPD and asthma. Considering the mode of discharge, there was a statistically significantly higher risk of ACSCs with fatal outcomes during the pandemic than in the pre-pandemic period (relative risk 1.31; 95% CI, 1.01-1.7; p = 0.0197). Conclusions: The results of this study show that the COVID-19 pandemic influenced the total number of hospitalizations as well as hospitalizations relating to ACSCs. Certainly, one of the reasons for these changes was due to organizational changes in the working of the entire health system due to the COVID-19 pandemic.
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Affiliation(s)
- Ivana Marasović Šušnjara
- Teaching Public Health Institute of Split-Dalmatia County, 21000 Split, Croatia; (I.M.Š.); (M.M.)
- University Department of Health Studies, University of Split, 21000 Split, Croatia
| | - Marijana Mijaković
- Teaching Public Health Institute of Split-Dalmatia County, 21000 Split, Croatia; (I.M.Š.); (M.M.)
| | - Anamarija Jurčev Savičević
- Teaching Public Health Institute of Split-Dalmatia County, 21000 Split, Croatia; (I.M.Š.); (M.M.)
- University Department of Health Studies, University of Split, 21000 Split, Croatia
- School of Medicine, University of Split, 21000 Split, Croatia
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Chumbler NR, Ogunsanmi DO, Surbhi S. Impact of the COVID-19 Pandemic on Healthcare Utilization among Medically Underserved Patients with Ambulatory Care Sensitive Conditions. Health Serv Res Manag Epidemiol 2024; 11:23333928241283367. [PMID: 39314671 PMCID: PMC11418340 DOI: 10.1177/23333928241283367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024] Open
Abstract
Introduction This study aims to examine (1) the impact of the pandemic phases on overall and preventable hospitalizations and emergency department (ED) visits, and (2) the effect of the pandemic on these outcomes within subgroup populations including gender, race, patients' residence in health professional shortage areas (HPSA), and residence in a federal poverty level. Study Design We used electronic medical record (EMR) data for the year 2019 and 2020 from a large health system predominantly serving medically underserved patients in the South. We used a difference-in-differences approach to examine changes in weekly rates of overall and preventable hospitalizations and ED visits in the pandemic phase 1 (Mid-March to June of 2020) and phase 2 (July-September of 2020) compared to the same period in 2019 after adjusting for weekly outcome rates in the baseline period (January to Mid-March of 2020) compared to the same period in 2019. Results The study sample included 1.4 million hospitalizations and ED encounters. In phase 1 of the pandemic, there were significant reductions in overall (-108) and preventable (-75.3) hospitalizations, and overall (-408) and preventable (-306) ED visits when compared to the same period in 2019. In phase 2 of the pandemic, there were significant reductions in overall (-60) and preventable (-43) hospitalizations and in overall (-360) and preventable (-258) ED visits as compared to 2019. We found greater reductions in ED visits, both overall and preventable, during the early pandemic phases among Black patients than among White patients. Similar patterns in the reduction of ED visits were found in Black versus White patients within subgroups of women, men, and those residing in a HPSA and low-income areas. Discussion Substantial reductions in utilization were observed in Black patients in comparison to white patients and these differences persisted among men, women, and those living in underserved and low-income areas.
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Affiliation(s)
- Neale R. Chumbler
- Department of Diagnostic and Health Sciences, College of Health Professions, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Deborah O. Ogunsanmi
- Center for Health System Improvement, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Satya Surbhi
- Center for Health System Improvement, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
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Agarwal G, Siriwardena AN, McLeod B, Spaight R, Whitley GA, Ferron R, Pirrie M, Angeles R, Moore H, Gussy M. Development of indicators for avoidable emergency medical service calls by mapping paramedic clinical impression codes to ambulatory care sensitive conditions and mental health conditions in the UK and Canada. BMJ Open 2023; 13:e073520. [PMID: 38086589 PMCID: PMC10729076 DOI: 10.1136/bmjopen-2023-073520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 11/19/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE Paramedic assessment data have not been used for research on avoidable calls. Paramedic impression codes are designated by paramedics on responding to a 911/999 medical emergency after an assessment of the presenting condition. Ambulatory care sensitive conditions (ACSCs) are non-acute health conditions not needing hospital admission when properly managed. This study aimed to map the paramedic impression codes to ACSCs and mental health conditions for use in future research on avoidable 911/999 calls. DESIGN Mapping paramedic impression codes to existing definitions of ACSCs and mental health conditions. SETTING East Midlands Region, UK and Southern Ontario, Canada. PARTICIPANTS Expert panel from the UK-Canada Emergency Calls Data analysis and GEospatial mapping (EDGE) Consortium. RESULTS Mapping was iterative first identifying the common ACSCs shared between the two countries then identifying the respective clinical impression codes for each country that mapped to those shared ACSCs as well as to mental health conditions. Experts from the UK-Canada EDGE Consortium contributed to both phases and were able to independently match the codes and then compare results. Clinical impression codes for paramedics in the UK were more extensive than those in Ontario. The mapping revealed some interesting inconsistencies between paramedic impression codes but also demonstrated that it was possible. CONCLUSION This is an important first step in determining the number of ASCSs and mental health conditions that paramedics attend to, and in examining the clinical pathways of these individuals across the health system. This work lays the foundation for international comparative health services research on integrated pathways in primary care and emergency medical services.
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Affiliation(s)
- Gina Agarwal
- Department of Family Medicine, Hamilton, Hamilton, Ontario, Canada
| | | | - Brent McLeod
- Hamilton Paramedic Service, Hamilton, Ontario, Canada
| | | | | | - Richard Ferron
- Niagara Emergency Medical Services, Niagara, Ontario, Canada
| | - Melissa Pirrie
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ricardo Angeles
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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Neri DT, da Costa Miranda AL, Botelho EP, Valois RC, Dias GAR, Parente AT, da Cunha Araújo E, Ferreira GRON. Hospitalizations for congenital syphilis in children under one year old in the state of Pará, Brazilian Amazon: ecological study. BMC Pediatr 2023; 23:581. [PMID: 37986154 PMCID: PMC10658822 DOI: 10.1186/s12887-023-04409-z] [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: 04/24/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND The high incidence of congenital syphilis shows flaws in the resolution of primary health care, being a predictor of greater use of hospital services, whose regional differences in access to health actions and services may be reflected in health inequalities. OBJECTIVE to investigate hospitalizations due to congenital syphilis in children under one year of age, in the state of Pará, Brazilian Amazon. METHODS an ecological study was carried out, using hospitalization, lethality and mortality rates related to congenital syphilis in children under one year of age. Temporal analysis and mapping of hospitalization flows were carried out using Joinpoint®, version 4.7.0.0, Terraview 4.2.2, Tabwin 4.1.5. RESULTS A total of 6,487 hospitalizations were recorded. For the ten years of the study period (2009 to 2018), the lethality rate showed a decreasing trend of - 13.5% (p = 0.01). The crude hospitalization rate showed an increasing trend of 12.8% (p < 0.000. The regression analysis demonstrated that there was a change point in the trend with a significant growth of 12.8% until 2016 (p = 0.0006). In the mortality rate the trend was stable (p = 0.56). The analysis of hospitalization care flows made it possible to identify that most hospitalizations due to congenital syphilis occurred in the municipalities of residence, but 1,378 (21.2%) had to move. Two large care gaps were highlighted in Metropolitan health regions II and III, belonging to macroregion II. The hospitalizations of residents of these regions were carried out by the assistance networks of Belém (capital) and Marituba, both of which are part of Metropolitana I. Residents of macroregions III and IV had the greatest distances traveled to access hospital care. CONCLUSIONS The increase in the rate of hospitalizations with an increasing trend demonstrates the impact that syphilis still causes in Brazil, not being resolved even after national government interventions in primary health care, but there was a decreasing trend in the fatality rate. The results demonstrate a heterogeneous organization of health care networks in the state's health regions and macroregions.
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Affiliation(s)
- Débora Talitha Neri
- Programa de Pós Graduação em Enfermagem, Federal University of Para, Rua Augusto Correa, 01 - Setor Saúde. Guamá, 66075-110, Belém, PA, Brazil
| | - Amanda Loyse da Costa Miranda
- Programa de Pós Graduação em Enfermagem, Federal University of Para, Rua Augusto Correa, 01 - Setor Saúde. Guamá, 66075-110, Belém, PA, Brazil
| | - Eliã Pinheiro Botelho
- Programa de Pós Graduação em Enfermagem, Federal University of Para, Rua Augusto Correa, 01 - Setor Saúde. Guamá, 66075-110, Belém, PA, Brazil
| | | | - Geyse Aline Rodrigues Dias
- Programa de Pós Graduação em Enfermagem, Federal University of Para, Rua Augusto Correa, 01 - Setor Saúde. Guamá, 66075-110, Belém, PA, Brazil
| | - Andressa Tavares Parente
- Programa de Pós Graduação em Enfermagem, Federal University of Para, Rua Augusto Correa, 01 - Setor Saúde. Guamá, 66075-110, Belém, PA, Brazil
| | - Eliete da Cunha Araújo
- Programa de Pós Graduação em Enfermagem, Federal University of Para, Rua Augusto Correa, 01 - Setor Saúde. Guamá, 66075-110, Belém, PA, Brazil
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Ferreira-Batista NN, Teixeira AD, Diaz MDM, Postali FAS, Moreno-Serra R, Love-Koh J. Is primary health care worth it in the long run? Evidence from Brazil. HEALTH ECONOMICS 2023; 32:1504-1524. [PMID: 37010114 DOI: 10.1002/hec.4676] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 02/15/2023] [Accepted: 03/03/2023] [Indexed: 06/04/2023]
Abstract
This paper assesses whether Brazilian primary health care is worth it in the long-run by estimating the accumulated costs and benefits of its flagship, the Family Health Strategy program (ESF). We employ an alternative strategy centered on years of exposure to the program to incorporate its dynamics. We also account for the program's heterogeneity with respect to the remuneration of ESF health teams and the intensity of coverage across Brazilian municipalities, measure by the number of people assisted by each ESF team, on average. To address heterogeneity in professional earnings, this paper employs, for the first time, a dataset containing the remuneration of professionals allocated to all ESF teams nationwide. The benefits are measured by the avoided deaths and hospitalizations due to causes sensitive to primary care. Results suggest that the net monetary benefit of the program is positive on average, with an optimum time of exposure of approximately 16 years. Significant heterogeneities in cost-benefit results were found since costs outweigh benefits in localities where the coverage is low intensive. On the other hand, the benefits outweigh the costs by 22.5% on average in municipalities with high intensive coverage.
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Affiliation(s)
| | | | | | | | | | - James Love-Koh
- Centre for Health Economics, University of York, York, UK
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Gwon YG, Han SJ, Kim KH. Trends in the Quality of Primary Care and Acute Care in Korea From 2008 to 2020: A Cross-sectional Study. J Prev Med Public Health 2023; 56:248-254. [PMID: 37287202 PMCID: PMC10248101 DOI: 10.3961/jpmph.23.015] [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: 01/09/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVES Measuring the quality of care is paramount to inform policies for healthcare services. Nevertheless, little is known about the quality of primary care and acute care provided in Korea. This study investigated trends in the quality of primary care and acute care. METHODS Case-fatality rates and avoidable hospitalization rates were used as performance indicators to assess the quality of primary care and acute care. Admission data for the period 2008 to 2020 were extracted from the National Health Insurance Claims Database. Case-fatality rates and avoidable hospitalization rates were standardized by age and sex to adjust for patients' characteristics over time, and significant changes in the rates were identified by joinpoint regression. RESULTS The average annual percent change in age-/sex-standardized case-fatality rates for acute myocardial infarction was -2.3% (95% confidence interval, -4.6 to 0.0). For hemorrhagic and ischemic stroke, the age-/sex-standardized case-fatality rates were 21.8% and 5.9%, respectively in 2020; these rates decreased since 2008 (27.1 and 8.7%, respectively). The average annual percent change in age-/sex-standardized avoidable hospitalization rates ranged from -9.4% to -3.0%, with statistically significant changes between 2008 and 2020. In 2020, the avoidable hospitalization rates decreased considerably compared with the 2019 rate because of the coronavirus disease 2019 pandemic. CONCLUSIONS The avoidable hospitalization rates and case-fatality rates decreased overall during the past decade, but they were relatively high compared with other countries. Strengthening primary care is an essential requirement to improve patient health outcomes in the rapidly aging Korean population.
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Affiliation(s)
- Yeong Geun Gwon
- Review and Assessment Research Division, Health Insurance Review & Assessment Service, Wonju, Korea
| | - Seung Jin Han
- Primary Care Improvement Division, Health Insurance Review & Assessment Service, Wonju, Korea
| | - Kyoung Hoon Kim
- International Policy Research Division, Health Insurance Review & Assessment Service, Wonju, Korea
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Park H, Son MJ, Jung DW, Lee H, Lee JY. National Trends in Hospitalization for Ambulatory Care Sensitive Conditions among Korean Adults between 2008 and 2019. Yonsei Med J 2022; 63:948-955. [PMID: 36168248 PMCID: PMC9520050 DOI: 10.3349/ymj.2022.0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/27/2022] [Accepted: 08/02/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study aimed to examine 12-year trends in hospitalization rates for ambulatory care sensitive conditions (ACSC) and factors affecting hospitalization. MATERIALS AND METHODS This study used data on Korean National Health Insurance and Medical Aid patients aged 19 and over who used medical services at least once between January 2008 and December 2019 with an ACSC as their major diagnosis. As of 2019, a total of 12324071 patients were included. To check for any changes in hospitalization, age- and sex-standardized hospitalization rates were obtained for each condition and insurance type, and multiple logistic regression was performed to identify factors affecting hospitalization. RESULTS The collective average ACSC hospitalization rate decreased from 5.0% in 2008 to 4.2% in 2019. Specifically, hospitalization rates for hypertension (1.4% in 2008; 0.8% in 2019), diabetes (5.8% in 2008; 3.3% in 2019), and chronic obstructive pulmonary disease and asthma (4.1% in 2008; 3.2% in 2019) decreased, while rates for pneumonia (24.5% in 2008; 28.1% in 2019) and urinary tract infection (UTI) (5.7% in 2008; 6.4% in 2019) increased. The rate for heart failure decreased 2.3% between 2008 and 2012 and then rebounded. The odds of hospitalization among Medical Aid patients were 1.45-4.20 times higher than those of National Health Insurance patients. CONCLUSION Differences in trends were confirmed for ACSC hospitalization rates among different conditions and insurance types in Korea. These results suggest the need for policy reforms aimed at reducing hospitalization for heart failure, pneumonia, and UTI, especially among Medical Aid patients.
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Affiliation(s)
- Hyeki Park
- HIRA Research Institute, Health Insurance Review and Assessment Service, Wonju, Korea
- Department of Public Health, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Jung Son
- HIRA Research Institute, Health Insurance Review and Assessment Service, Wonju, Korea
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Da Won Jung
- HIRA Research Institute, Health Insurance Review and Assessment Service, Wonju, Korea
- Department of Health Administration, Yonsei University Graduate School, Wonju, Korea
| | - Hyejin Lee
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Jin Yong Lee
- HIRA Research Institute, Health Insurance Review and Assessment Service, Wonju, Korea
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea.
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12
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Chao YH, Huang WY, Tang CH, Pan YA, Chiou JY, Ku LJE, Wei JCC. Effects of continuity of care on hospitalizations and healthcare costs in older adults with dementia. BMC Geriatr 2022; 22:724. [PMID: 36056303 PMCID: PMC9438333 DOI: 10.1186/s12877-022-03407-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/25/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION People with dementia have high rates of hospitalization, and a share of these hospitalizations might be avoidable with appropriate ambulatory care, also known as potentially preventable hospitalization (PAH). This study investigates the associations between continuity of care and healthcare outcomes in the following year, including all-cause hospitalization, PAHs, and healthcare costs in patients with dementia. METHODS This is a longitudinal retrospective cohort study of 69,658 patients with dementia obtained from the Taiwan National Health Insurance Research Database. The Continuity of Care Index (COCI) was calculated to measure the continuity of dementia-related visits across physicians. The PAHs were classified into five types as defined by the Medicare Ambulatory Care Indicators for the Elderly (MACIEs). Logistic regression models were used to examine the effect of COCI on all-cause hospitalizations and PAHs, while generalized linear models were used to analyze the effect of COCI on outpatient, hospitalization, and total healthcare costs. RESULTS The high COCI group was significantly associated with a lower likelihood of all-cause hospitalization than the low COCI group (OR = 0.848, 95%CI: 0.821-0.875). The COCI had no significant effect on PAHs but was associated with lower outpatient costs (exp(β) = 0.960, 95%CI: 0.941 ~ 0.979), hospitalization costs (exp(β) = 0.663, 95%CI: 0.614 ~ 0.717), total healthcare costs (exp(β) = 0.962, 95%CI: 0.945-0.980). CONCLUSION Improving continuity of care for dementia-related outpatient visits is recommended to reduce hospitalization and healthcare costs, although there was no statistically significant effect of continuity of care found on PAHs.
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Affiliation(s)
- Yung-Hsiang Chao
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Wen-Yen Huang
- Department of Public Health, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan
| | - Chia-Hong Tang
- Department of Public Health, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan
- Department of Psychiatric, Tainan Hospital, Ministry of Health and Welfare, Tainan City, Taiwan
| | - Yu-An Pan
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jeng-Yuan Chiou
- School of Health Policy and Management, Chung Shan Medical University, Taichung, Taiwan
| | - Li-Jung Elizabeth Ku
- Department of Public Health, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan.
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
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Loureiro da Silva C, Rocha JV, Santana R. Economic and financial crisis based on Troika's intervention and potentially avoidable hospitalizations: an ecological study in Portugal. BMC Health Serv Res 2021; 21:506. [PMID: 34039326 PMCID: PMC8152149 DOI: 10.1186/s12913-021-06475-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 05/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hospitalisations for Ambulatory Care Sensitive Conditions (ACSC) cause harm to users and to health systems, as these events are potentially avoidable. In 2009, Portugal was hit by an economic and financial crisis and in 2011 it resorted to foreign assistance ("Memorandum of Understanding" (2011-2014)). The aim of this study was to analyse the association between the Troika intervention and hospitalisations for ACSC. METHODS We analysed inpatient data of all public NHS hospitals of mainland Portugal from 2007 to 2016, and identified hospitalisations for ACSC (pneumonia, chronic obstructive pulmonary disease, hearth failure, hypertensive heart disease, urinary tract infections, diabetes), according to the AHRQ methodology. Rates of hospitalisations for ACSC, the rate of enrollment in the employment center and average monthly earnings were compared among the pre-crisis, crisis and post-crisis periods to see if there were differences. A Spearman's correlation between socioeconomic variables and hospitalisations was performed. RESULTS Among 8,160,762 admissions, 892,759 (10.94%) were classified as ACSC hospitalizations, for which 40% corresponded to pneumonia. The rates of total hospitalisations and hospitalisations for ACSC increased between 2007 and 2016, with the central and northern regions of the country presenting the highest rates. No correlations between socioeconomic variables and hospitalisation rates were found. CONCLUSIONS During the period of economic and financial crisis based on Troika's intervention, there was an increase in potentially preventable hospitalisations in Portugal, with disparities between the municipalities. The high use of resources from ACSC hospitalisations and the consequences of the measures taken during the crisis are factors that health management must take into account.
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Affiliation(s)
- Cristina Loureiro da Silva
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisbon, Portugal
| | - João Victor Rocha
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Rui Santana
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
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