Healthcare Utilization and Emotional Distress in Coronary Artery Disease Patients

Hospital Utilization for Coronary Artery Disease, 1997-2014

BACKGROUND

Coronary artery disease (CAD) is the leading cause of cardiovascular morbidity, mortality, and healthcare costs in the United States. There are few reports on how public health and payment reforms might have influenced inpatient hospital use among patients with CAD.

OBJECTIVE

This study describes trends in hospital discharges, hospital charges, and discharge destinations in a national sample of patients with CAD between 1997 and 2014.

METHODS

This was a longitudinal study with descriptive analysis of the Healthcare Cost and Utilization Project of National Inpatient Sample data.

FINDINGS

During this study period, the total number of discharges was 1 333 996. Patients with CAD between 65 and 84 years old were among the highest users of inpatient hospital services, followed by those in the 45- to 64-year age group. The death rate increased from 5961 to 7217 per 10 000 patients during this time. The mean charge increased more than 5 times, from $9100 to $49 643. There was a large difference in mean hospital charges in urban ($51 666) and rural ($25 548) locations in 2014. Coronary artery disease patients with private insurance paid more than those with Medicaid and Medicare plans. The discharge to home and healthcare costs increased by 4.1% and 4.8%, respectively.

CONCLUSION AND IMPLICATIONS

Future researchers should use data sets, such as Medicare claims/Medical Expenditure Panel Study, that can provide comprehensive insights into patient-level factors influencing the use of inpatient care services among patients with CAD. Healthcare providers in posthospital settings should be well skilled in providing advanced cardiac rehabilitation and education to patients with CAD.

[Comprehensive conservative care of stage 5-CKD: A practical guide]

In French-speaking countries, the anglicism "traitement conservateur" is commonly used in clinical practice for CKD 5 patients, meaning comprehensive conservative care. In 2015, the publication of KDIGO controversies put forward this "new" therapeutic option at the same level as dialysis or transplantation. However, its detailed contents remain heterogeneous due to cultural and ethical considerations, varying with regional or national health systems. This is the reason why the French-speaking society of Nephrology, Dialysis, Transplantation (SFNDT) set up an international debate to publish clinical guidelines in French.

Communication principles and practices for making shared decisions about renal replacement therapy: a review of the literature

PURPOSE OF REVIEW

To provide an overview of the skill set required for communication and person-centered decision making for renal replacement therapy (RRT) choices, especially conservative kidney management (CKM).

RECENT FINDINGS

Research on communication and decision-making skills for shared RRT decision making is still in infancy. We adapt literature from other fields such as primary care and oncology for effective RRT decision making.

SUMMARY

We review seven key skills: (1) Announcing the need for decision making (2) Agenda Setting (3) Educating patients about RRT options (4) Discussing prognoses (5) Eliciting patient preferences (6) Responding to emotions and showing empathy, and (7) Investing in the end. We also provide example sentences to frame the conversations around RRT choices including CKM.

Verona Coding Definitions of Emotional Sequences (VR-CoDES): Conceptual framework and future directions

OBJECTIVE

To discuss the theoretical and empirical framework of VR-CoDES and potential future direction in research based on the coding system.

METHODS

The paper is based on selective review of papers relevant to the construction and application of VR-CoDES.

RESULTS

VR-CoDES system is rooted in patient-centered and biopsychosocial model of healthcare consultations and on a functional approach to emotion theory. According to the VR-CoDES, emotional interaction is studied in terms of sequences consisting of an eliciting event, an emotional expression by the patient and the immediate response by the clinician. The rationale for the emphasis on sequences, on detailed classification of cues and concerns, and on the choices of explicit vs. non-explicit responses and providing vs. reducing room for further disclosure, as basic categories of the clinician responses, is described.

CONCLUSIONS

Results from research on VR-CoDES may help raise awareness of emotional sequences. Future directions in applying VR-CoDES in research may include studies on predicting patient and clinician behavior within the consultation, qualitative analyses of longer sequences including several VR-CoDES triads, and studies of effects of emotional communication on health outcomes.

PRACTICE IMPLICATIONS

VR-CoDES may be applied to develop interventions to promote good handling of patients' emotions in healthcare encounters.

Direct Cost and Complications Associated With Total Joint Arthroplasty in Patients With Preoperative Anxiety and Depression

INTRODUCTION

The outcome of total joint arthroplasty (TJA) may be affected by numerous factors including the mental health status of patients and the presence of psychological disorders Therefore, the present study was designed and conducted to determine the impact of concomitant psychiatric disorders on the hospitalization charges and complications in patients with preoperative depression or anxiety undergoing TJA.

MATERIALS AND METHODS

International Classification of Diseases, Ninth Revision, codes were used to identify perioperative complications in patients with and without concomitant diagnosis of depression or anxiety who underwent TJA at our institution during 2009. Hospitalization charges and complications were compared for patients with and without depression or anxiety undergoing TJA.

RESULTS

Respectively, 12.7% and 6.4% of knee and the hip arthroplasty patients had concomitant depression or anxiety. In the knee but not the hip group, the charge was $3420 higher in patients with depression/anxiety (P < .001). Anxiety and depression and higher American Society of Anesthesiologists score were independent predictors of complications.

DISCUSSION

Depression or anxiety was a predictor of increased complications after TJA. Therefore, patients with depression or anxiety undergoing TJA need to be counselled appropriately, and all efforts need to be invested to minimize complications and the added cost in these patients.