Assessing the Relationship Between Well-Care Visit and Emergency Department Utilization Among Adolescents and Young Adults

The profile of adolescents assisted by the emergency department of a Brazilian private tertiary hospital

INTRODUCTION

Adolescents represent an important demographic percentage in the studied population and in Emergency Departments (ED). It is imperative that health professionals and services are prepared to address this population. This work aims to characterize adolescents at the ED of a Brazilian private tertiary hospital.

METHODS

The study was an observational, retrospective longitudinal cohort that included 37,450 visits of patients aged 10 to 21 years of age, between January 2018 and June 2022 in the ED of a private tertiary hospital. The study evaluated the reason for the consultation, diagnosis, need for hospitalization, the medical professional responsible for the care, severity, and paying source of care.

RESULTS

53.7% were female. Mean age was 16.2y for girls and 15.6y for boys (p < 0.005). The most common complaints were flu-like symptoms (17.4%), sore throat (8.2%), fever (6.7%) and limb trauma (6.3%). Flu-like symptoms were the main consultations caused in all age groups and genders. 36.8% were attended by a general practitioner, 35.8% by a pediatrician, 15.1% by orthopedics and 5.6% by surgeons. The hospitalization rate was 5.5%. There was a strong correlation between age and hospitalization rate (correlation coefficient [r = 0.93]; p < 0.001). The most prevalent diagnoses in hospitalizations were acute abdomen (12.7%) and trauma (9.4%). 78.2% of the consultations were classified as "not urgent". There was a strong correlation between age and severity (r = 0.86; p < 0.001). 92.7% of the consultations were paid by medical insurance.

CONCLUSION

In this study, flu-like symptoms were the single main reason for adolescents to search for immediate health care, in every age subgroup and gender, but represented a small risk for hospital admission. Limb trauma was more common in younger male teenagers. Acute abdominal pain and trauma were the most frequent causes of hospital admissions. There was a significant and strong correlation between age and both admission rate and severity.

A mobile integrated health program for the management of undifferentiated acute complaints in older adults is safe and feasible

BACKGROUND

Poor care access and lack of proper triage of medical complaints leads to inappropriate use of acute care resources. Mobile integrated health (MIH) programs may offer a solution by providing adaptable on-demand care. There is little information describing programs that manage undifferentiated complaints in the community. The objective of this study was to assess the safety and feasibility of an MIH program that responds to the community to manage medical complaints in older adults.

METHODS

This was a prospective observational study examining a pilot MIH program. Seven ambulatory clinics and their affiliated patients aged 65 and older were oriented to the program and invited to use its services. Visit and follow-up data for all patients who underwent an MIH visit were abstracted, along with 30-day follow-up information. All demographic data and outcomes were reported descriptively.

RESULTS

In 21 months, 153 MIH visits were completed, involving 91 patients (mean age 81 years, 60.4% female). The most common chief complaints were generalized weakness (28.8%) and shortness of breath (18.9%). Electrocardiogram (57.5%) and point-of-care bloodwork (34.6%) were the most common diagnostic tests performed. Sixteen visits (10.4%) were followed by an emergency department (ED) visit within 72 h. In 11 encounters, the patient was referred to the ED; in five cases, the ED visit was unforeseen. Fifteen patients (9.8%) were admitted to the hospital after an MIH visit. There were two deaths within 30 days following an index visit.

CONCLUSIONS

An MIH program designed to address the acute complaints of community-dwelling older adults was feasible and safe, with low rates of unforeseen emergency services utilizations. MIH programs have valuable diagnostic and therapeutic capabilities and may serve to help triage the acute medical needs of patients. Further study is required to validate the efficacy and cost-effectiveness of MIH programs.

Associations Between Mental and Physical Illness Comorbidity and Hospital Utilization

OBJECTIVE

Characterize the prevalence of chronic physical illness types and mental illness and their comorbidity among adolescents and young adults (AYA) and assess the association of comorbidity on hospital utilization.

METHODS

This study features a population-level sample of 61 339 insurance-eligible AYA with an analytic sample of 49 089 AYA (aged 12-21) in Vermont's 2018 all-payer database. We used multiple logistic regressions to examine the associations between physical illness types and comorbid mental illness and emergency department (ED) use and inpatient hospitalization.

RESULTS

The analytic sample was 50% female, 63% Medicaid, and 43% had ≥1 chronic illness. Mental illness was common (31%) and highly comorbid with multiple physical illnesses. Among AYA with pulmonary illness, those with comorbid mental illness had 1.74-times greater odds (95% confidence interval [CI]: 1.49-2.05, P ≤.0005) of ED use and 2.9-times greater odds (95% CI: 2.05-4.00, P ≤.0005) of hospitalization than those without mental illness. Similarly, comorbid endocrine and mental illness had 1.84-times greater odds of ED use (95% CI: 1.39-2.44, P ≤.0005) and 2.1-times greater odds of hospitalization (95% CI: 1.28-3.46, P = .003), comorbid neurologic and mental illness had 1.36-times greater odds of ED use (95% CI: 1.18-1.56, P ≤.0005) and 2.4-times greater odds of hospitalization (95% CI: 1.73-3.29, P ≤.0005), and comorbid musculoskeletal and mental illness had 1.38-times greater odds of ED use (95% CI: 1.02-1.86, P = .04) and 2.1-times greater odds of hospitalization (95% CI: 1.20-3.52, P = .01).

CONCLUSIONS

Comorbid physical and mental illness was common. Having a comorbid mental illness was associated with greater ED and inpatient hospital utilization across multiple physical illness types.

Translation and validation of the STARx questionnaire in transitioning Chinese adolescents and young adults with chronic health conditions

BACKGROUND

Adolescent/young adults (AYAs) with chronic conditions must undergo healthcare transition (HCT) preparation until their mid-twenties. Valid HCT readiness measures are lacking in China.

METHODS

The present study translated, back-translated, and adapted the Self-Management and Transition to Adulthood with Rx = Treatment (STAR_x) Questionnaire. We examined the psychometric properties of this tool in a relatively large in-patient sample of AYAs with various chronic health conditions at a Chinese tertiary general hospital.

RESULTS

We enrolled 624 AYAs aged 10-25 years (19.66 ± 3.64) with various chronic health conditions. The Chinese version of the STAR_x Questionnaire demonstrated excellent internal consistency (Cronbach's alpha = 0.83) and reliability with a two-week test-retest (ICC = 0.88, p < .001). Furthermore, the Chinese version revealed a three-factor structure (self-management, disease knowledge, and provider communication) consistent with the revised English version of the STAR_x Questionnaire. In terms of discriminant validity, the total score of the Chinese STAR_x Questionnaire showed a significant positive correlation with age but no gender differences were found. In terms of predictive validity, the Chinese STAR_x Questionnaire was significantly correlated with shorter length of hospitalization and higher frequency of emergency room visit, but the correlations became insignificant after controlling for age.

CONCLUSIONS

The results suggest that the Chinese version of the STAR_x Questionnaire is a robust HCT readiness tool in AYAs with chronic conditions and clinicians may find it useful to develop individualized interventions.