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Haleem A, Rosenthal Z, Lee DJ. Access to Sudden Hearing Loss Care at Urgent Care Centers. Laryngoscope 2024. [PMID: 38953603 DOI: 10.1002/lary.31596] [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: 01/24/2024] [Revised: 05/11/2024] [Accepted: 06/05/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVES To compare patient access to urgent care centers (UCCs) with a diagnosis of sudden hearing loss based on insurance. METHODS One hundred twenty-five random UCCs in states with Medicaid expansion and 125 random UCCs in states without Medicaid expansion were contacted by a research assistant posing as a family member seeking care on behalf of a patient with a one-week history of sudden, unilateral hearing loss. Each clinic was called once as a Medicaid patient and once as a private insurance (PI) patient for 500 total calls. Each phone encounter was evaluated for insurance acceptance and self-pay price. Secondary outcomes included other measures of timely/accessible care. Chi-square/McNemar's tests and independent/paired sample t-tests were performed to determine whether there were statistically significant differences between expansion status and insurance type. Calls ended before answering questions were not included in the analysis. RESULTS Medicaid acceptance rate was significantly lower than PI (68.1% vs. 98.4%, p < 0.001). UCCs in Medicaid expansion states were significantly more likely to accept Medicaid (76.8% vs. 59.2%, p = 0.003). The mean wage-adjusted self-pay price was significantly greater in states with Medicaid expansion at $169.84 than in states without at $145.34 when called as a Medicaid patient (mean difference: $24.50, 95% Confidence Interval: $0.45-$48.54, p = 0.046). The rates of referral to an emergency department and self-pay price nondisclosure rates were greater for Medicaid calls than for private insurance calls (8.2% vs. 0.4% and 17.4% vs. 5.8%; p < 0.001 for both). CONCLUSION Medicaid patients with otologic emergencies face reduced access to care at UCCs. LEVEL OF EVIDENCE NA Laryngoscope, 2024.
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Affiliation(s)
- Afash Haleem
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
- Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Zachary Rosenthal
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Daniel J Lee
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
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Boyev A, Azimuddin A, Prakash LR, Newhook TE, Maxwell JE, Bruno ML, Arvide EM, Dewhurst WL, Kim MP, Ikoma N, Lee JE, Snyder RA, Katz MHG, Tzeng CWD. Classification of Post-pancreatectomy Readmissions and Opportunities for Targeted Mitigation Strategies. Ann Surg 2024; 279:1046-1053. [PMID: 37791481 DOI: 10.1097/sla.0000000000006112] [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: 10/05/2023]
Abstract
OBJECTIVE Within a learning health system paradigm, this study sought to evaluate reasons for readmission to identify opportunities for improvement. BACKGROUND Post-pancreatectomy readmission rates have remained constant despite improved index hospitalization metrics. METHODS We performed a single-institution case-control study of consecutive patients with pancreatectomy (October 2016 to April 2022). Complications were prospectively graded in biweekly faculty and advanced practice provider meetings. We analyzed risk factors during index hospitalization and categorized indications for 90-day readmissions. RESULTS A total of 835 patients, median age 65 years and 51% (427/835) males, underwent 64% (534/835) pancreatoduodenectomies, 34% (280/835) distal pancreatectomies, and 3% (21/835) other resections. Twenty-four percent (204/835) of patients were readmitted. The primary indication for readmission was technical in 51% (105/204), infectious in 17% (35/204), and medical/metabolic in 31% (64/204) of patients. Procedures were required in 77% (81/105) and 60% (21/35) of technical and infectious readmissions, respectively, while 66% (42/64) of medical/metabolic readmissions were managed noninvasively. During the index hospitalization, benign pathology [odds ratio (OR): 1.8, P =0.049], biochemical pancreatic leak (OR: 2.3, P =0.001), bile/gastric/chyle leak (OR: 6.4, P =0.001), organ-space infection (OR: 3.4, P =0.007), undrained fluid on imaging (OR: 2.4, P =0.045), and increasing white blood cell count (OR: 1.7, P =0.045) were independently associated with odds of readmission. CONCLUSIONS Most readmissions following pancreatectomy were technical in origin. Patients with complications during the index hospitalization, increasing white blood cell count, or undrained fluid before discharge were at the highest risk for readmission. Predischarge risk stratification of readmission risk factors and augmentation of in-clinic resources may be strategies to reduce readmission rates.
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Affiliation(s)
- Artem Boyev
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Dhodapkar MM, Modrak M, Halperin SJ, Gouzoulis MJ, Rubio DR, Grauer JN. Low Back Pain: Utilization of Urgent Cares Relative to Emergency Departments. Spine (Phila Pa 1976) 2024; 49:513-517. [PMID: 37982595 DOI: 10.1097/brs.0000000000004880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/12/2023] [Indexed: 11/21/2023]
Abstract
STUDY DESIGN/SETTING Retrospective study. OBJECTIVE To understand why patients utilize emergency departments (EDs) versus urgent care centers for low back pain (LBP). SUMMARY OF BACKGROUND DATA LBP is a common reason for ED visits. In the setting of trauma or recent surgery, the resources of EDs may be needed. However, urgent care centers may be appropriate for other cases. MATERIALS AND METHODS Adult patients below 65 years of age presenting to the ED or urgent care on the day of diagnosis of LBP were identified from the 2019 PearlDiver M151 administrative database. Exclusion criteria included history of radiculopathy or sciatica, spinal surgery, spinal cord injury, other traumatic, neoplastic, or infectious diagnoses in the 90 days prior, or Medicare insurance. Patient age, sex, Elixhauser comorbidity index, geographic region, insurance, and management strategies were extracted. Factors associated with urgent care relative to ED utilization were assessed using multivariable analysis. RESULTS Of 356,284 LBP patients, ED visits were identified for 345,390 (96.9%) and urgent care visits for 10,894 (3.1%). Factors associated with urgent care use relative to the ED were: geographic region [relative to Midwest; Northeast odds ratio (OR): 5.49, South OR: 1.54, West OR: 1.32], insurance (relative to Medicaid; commercial OR: 4.06), lower Elixhauser comorbidity index (OR: 1.28 per two-point decrease), and higher age (OR: 1.10 per decade), female sex (OR: 1.09), and use of advanced imaging (OR: 0.08) within 1 week ( P <0.001 for all). CONCLUSIONS Most patients presenting for a first diagnosis of isolated LBP went to the ED relative to urgent care. The greatest drivers of urgent care versus ED utilization for LBP were insurance type and geographic region. Utilization of advanced imaging was higher among ED patients, but rates of surgical intervention were similar between those seen in the ED and urgent care.
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Howard DH, David G. Hospital ownership and admission rates from the emergency department, evidence from Florida. Health Serv Res 2024; 59:e14254. [PMID: 37875259 PMCID: PMC10915481 DOI: 10.1111/1475-6773.14254] [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: 10/26/2023] Open
Abstract
OBJECTIVE In light of Department of Justice investigations of for-profit chains for over-admitting patients, we sought to evaluate whether for-profit hospitals are more likely to admit patients from the emergency department. DATA SOURCES We used statewide visit-level inpatient and emergency department records from Florida's Agency for Healthcare Administration for 2007-2019. STUDY DESIGN We calculated differences in admission rates between for-profit and other hospitals, adjusting for patient and hospital characteristics. We also estimated instrumental variables models using differential distance to a for-profit hospital as an instrument. DATA COLLECTION/EXTRACTION METHODS Our main analysis focuses on patients ages 65 and older treated in hospitals that primarily serve adults. PRINCIPAL FINDINGS Adjusted admission rates among patients ages 65 and older were 7.1 percentage points (95% CI: 5.1-9.1) higher at for-profit hospitals in 2019 (or 18.8% of the sample mean of 37.8%). Differences in admission rates have remained constant since 2009. CONCLUSION Our results are consistent with allegations that for-profit hospitals maintain lower admission thresholds to increase occupancy levels.
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Affiliation(s)
- David H. Howard
- Department of Health Policy and ManagementEmory UniversityAtlantaGeorgiaUSA
| | - Guy David
- Department of Health Care ManagementUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Saper JK, Macy ML, Martin-Gill C, Ramgopal S. Pediatric Utilization of Emergency Medical Services from Outpatient Offices and Urgent Care Centers. Acad Pediatr 2024:S1876-2859(24)00107-4. [PMID: 38492632 DOI: 10.1016/j.acap.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/01/2024] [Accepted: 03/10/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE National efforts have highlighted the need for pediatric emergency readiness across all settings where children receive care. Outpatient offices and urgent care centers are frequent starting points for acutely injured and ill children, emphasizing the need to maintain pediatric readiness in these settings. We aimed to characterize emergency medical services (EMS) utilization from outpatient offices and urgent care centers to better understand pediatric readiness needs. METHODS We performed a retrospective cross-sectional analysis of EMS encounters using the National Emergency Medical Services Information System, a nationally representative EMS registry (2019-2022). We included four years of EMS encounters of children (<18 years old) that originated from an outpatient office or urgent care center. We described characteristics, including patient demographics, prehospital clinician impression, therapies, and procedures performed. RESULTS Of 179,854,336 EMS encounters during the study period, 164,387 pediatric encounters originated at an outpatient setting. Most EMS encounters originated from outpatient offices. Evening and weekend EMS encounters more frequently originated from urgent care centers. The most common impressions were respiratory distress (n = 60,716), systemic illness (n = 23,583), and psychiatric/behavioral health (n = 13,273). Ninety-four percent of EMS encounters resulted in transportation to a hospital. CONCLUSIONS EMS encounters from outpatient settings most commonly originate from outpatient offices, relative to urgent care settings, where pediatric emergency readiness may be limited. It is important that outpatient settings and providers are ready for varied emergencies, including those occurring for a behavioral health concern, and that readiness guidelines are updated to address these needs.
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Affiliation(s)
- Jennifer K Saper
- Division of Advanced General Pediatrics and Primary Care (JK Saper), Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Pediatrics (JK Saper, ML Macy, and S Ramgopal), Northwestern University Feinberg School of Medicine, Chicago, IL; Mary Ann and J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center (JK Saper and ML Macy); Stanley Manne Children's Research Institute; Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
| | - Michelle L Macy
- Department of Pediatrics (JK Saper, ML Macy, and S Ramgopal), Northwestern University Feinberg School of Medicine, Chicago, IL; Mary Ann and J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center (JK Saper and ML Macy); Stanley Manne Children's Research Institute; Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Division of Emergency Medicine (ML Macy and S Ramgopal); Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Christian Martin-Gill
- Department of Emergency Medicine (C Martin-Gill), University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Sriram Ramgopal
- Department of Pediatrics (JK Saper, ML Macy, and S Ramgopal), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Emergency Medicine (ML Macy and S Ramgopal); Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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D'Avella C, Whooley P, Milano E, Egleston B, Helstrom J, Patrick K, Edelman M, Bauman J. The impact of an oncology urgent care center on health-care utilization. JNCI Cancer Spectr 2024; 8:pkae009. [PMID: 38377387 PMCID: PMC10946649 DOI: 10.1093/jncics/pkae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/31/2023] [Accepted: 02/08/2024] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Studies suggest that many emergency department (ED) visits and hospitalizations for patients with cancer may be preventable. The Centers for Medicare & Medicaid Services has implemented changes to the hospital outpatient reporting program that targets acute care in-treatment patients for preventable conditions. Oncology urgent care centers aim to streamline patient care. Our cancer center developed an urgent care center called the direct referral unit in 2011. METHODS We abstracted visits to our adjacent hospital ED and direct referral unit from January 2014 to June 2018. Patient demographics, cancer and visit diagnoses, visit charges, and 30-day therapy utilization were assessed. RESULTS An analysis of 13 114 visits demonstrated that increased direct referral unit utilization was associated with decreased monthly ED visits (P < .001). Common direct referral unit visit diagnoses were dehydration, nausea and vomiting, abdominal pain, and fever. Patients receiving active cancer treatment more frequently presented to the direct referral unit (P < .001). The average charges were $2221 for the direct referral unit and $10 261 for the ED. CONCLUSION The association of decreased ED visits with increased direct referral unit utilization demonstrates the potential for urgent care centers to reduce acute care visits. Many patients presented to our direct referral unit with preventable conditions, and these visits were associated with considerable cost savings, supporting its use as a cost-effective method to reduce acute care costs.
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Affiliation(s)
- Christopher D'Avella
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Peter Whooley
- Beth Israel Deaconess Medical Center, Department of Medical Oncology, Boston, MA, USA
| | - Emily Milano
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brian Egleston
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - James Helstrom
- Division of Anesthesiology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Kenneth Patrick
- Department of Medicine, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Martin Edelman
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Jessica Bauman
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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Klein S, Eaton KP, Bodnar BE, Keller SC, Helgerson P, Parsons AS. Transforming Health Care from Volume to Value: Leveraging Care Coordination Across the Continuum. Am J Med 2023; 136:985-990. [PMID: 37481020 DOI: 10.1016/j.amjmed.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 06/26/2023] [Accepted: 06/26/2023] [Indexed: 07/24/2023]
Affiliation(s)
- Sharon Klein
- Department of Medicine, New York University Langone Health, New York
| | - Kevin P Eaton
- Department of Medicine, New York University Langone Health, Brooklyn
| | - Benjamin E Bodnar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Sara C Keller
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Paul Helgerson
- Department of Medicine, University of Virginia School of Medicine, Charlottesville
| | - Andrew S Parsons
- Department of Medicine, University of Virginia School of Medicine, Charlottesville.
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Dhodapkar MM, Gouzoulis MJ, Halperin SJ, Modrak M, Yoo BJ, Grauer JN. Urgent Care Versus Emergency Department Utilization for Foot and Ankle Fractures. J Am Acad Orthop Surg 2023; 31:984-989. [PMID: 37253245 DOI: 10.5435/jaaos-d-22-01097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/22/2023] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION Foot and ankle fractures are common injuries for which patients may need urgent evaluation and care. Many such injuries are managed in emergency departments (EDs), but urgent care facilities may sometimes be an appropriate setting. Understanding which foot and ankle fractures are managed at which facility might help define care algorithms, improve patient experience, and suggest directions for containing costs. METHODS This retrospective cohort study used the 2010 to 2020 M151 PearlDiver administrative database. Adult patients less than 65 years old presenting to EDs and urgent care facilities for foot and ankle fractures were identified using ICD-9 and ICD-10 diagnosis codes, excluding polytrauma, and Medicare patients. Patient/injury variables associated with urgent care utilization relative to ED utilization and utilization trends of urgent care relative to ED were assessed with univariable and multivariable analyses. RESULTS From 2010 to 2020, 1,120,422 patients with isolated foot and ankle fractures presented to EDs and urgent care facilities. Urgent care visits evolved from 2.2% in 2010 to 4.4% in 2020 (P , 0.0001). Independent predictors of urgent care relative to ED utilization were defined. In decreasing odds ratios (ORs), these were insurance (relative to Medicaid, commercial OR 8.03), geographic region (relative to Midwest, Northeast OR 3.55, South OR 1.74, West OR 1.06), anatomic location of fracture (relative to ankle, forefoot OR 3.45, midfoot 2.20, hindfoot 1.63), closed fracture (OR 2.20), female sex (OR 1.29), lower ECI (OR 1.11 per unit decrease), and younger age (OR 1.08 per decade decrease) (P , 0.0001 for all). DISCUSSION A small but increasing minority of patients with foot and ankle fractures are managed in urgent care facilities relative to EDs. While patients with certain injury types were associated with increased odds of urgent care relative to ED utilization, the greatest predictors were nonclinical, such as geographic regions and insurance type, suggesting areas for optimizing access to certain care pathways. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Meera M Dhodapkar
- From the Yale Department of Orthopaedics and Rehabilitation, New Haven, CT
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Liu W, Li J, Dalton CM. Disruptions to in-person medical visits across the United States during the COVID-19 pandemic: evolving disparities by medical specialty and socio-economic status. Public Health 2023; 221:116-123. [PMID: 37441995 PMCID: PMC10250151 DOI: 10.1016/j.puhe.2023.06.011] [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: 03/13/2023] [Revised: 05/29/2023] [Accepted: 06/05/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES This study aimed to investigate how people's health-seeking behaviors evolve in the COVID-19 pandemic by community and medical service category. STUDY DESIGN This is a longitudinal study using mobility data from 19 million mobile devices of visits to all types of health facility locations for all US states. METHODS We examine the variations in weekly in-person medical visits across county, neighborhood, and specialty levels. Different regression models are used for each level to investigate factors that influence the disparities in medical visits. County-level analysis explores associations between county medical visit patterns, political orientation, and COVID-19 infection rate. Neighborhood-level analysis focuses on neighborhood socio-economic compositions as potential determinants of medical visit levels. Specialty-level analysis compares the evolution of visit disruptions in different specialties. RESULTS A more left-leaning political orientation and a higher local infection rate were associated with larger decreases in in-person medical visits, and these associations became stronger, moving from the initial period of stay-at-home orders into the post-lockdown period. Initial reactions were strongest for seniors and those of high socio-economic status, but this reversed in post-lockdown period where socio-economically disadvantaged communities stabilized at a lower level of medical visits. Neighborhoods with more female and young people exhibited larger decreases in in-person medical visits throughout the initial and post-lockdown periods. The evolution of disruptions diverges across medical specialties, from only short-term disruption in specialties such as dentistry to increasing disruption, as in cardiology. CONCLUSIONS Given distinct patterns in visit between communities, medical service categories, and between different periods in the pandemic, policy makers, and providers should concentrate on monitoring patients in disrupted specialties who overlap with the at-risk contexts and socio-economic factors in future health emergencies.
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Affiliation(s)
- W Liu
- Department of Industrial Engineering, Tsinghua University, Beijing 100084, China.
| | - J Li
- School of Business, Wake Forest University, Winston-Salem, NC 27106, United States.
| | - C M Dalton
- Department of Economics, Wake Forest University, Winston-Salem, NC 27106, United States.
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Benjamin P, Bryce R, Oyedokun T, Stempien J. Strength in the gap: A rapid review of principles and practices for urgent care centres. Healthc Manage Forum 2023; 36:101-106. [PMID: 36519425 PMCID: PMC9976643 DOI: 10.1177/08404704221143300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Responding to a provincial government decision to develop two Urgent Care Centres (UCCs) in Saskatchewan, we undertook a rapid review of published literature with the objective of determining best practices for their creation and functioning. Two English-limited PubMed database searches combining "after-hours care," "ambulatory care," "emergency medicine," "urgent care," "minor emergency," "walk-in," and "Canada" over the past 10 years were the sources of articles for our review. Articles were independently reviewed by two authors and synthesized collaboratively. From 833 articles, 44 were utilized in the review. Six considerations in the following areas were subsequently outlined: expected impact, preferred location, healthcare services collaboration, available services, staffing priorities, and community partnerships. These principles were considered against the backdrop of currently successful Canadian UCCs. This review indicates that general principles for the successful development of UCCs exist; these may guide the establishment and functioning of UCCs both in Saskatchewan and elsewhere.
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Affiliation(s)
- Ponn Benjamin
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Rhonda Bryce
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Rhonda Bryce, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. E-mail:
| | | | - James Stempien
- Royal University Hospital, Saskatoon, Saskatchewan, Canada
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Virji AZ, Cheloff AZ, Ghoshal S, Nagle B, Guo TZ, Lev MH, Raja AS, Gee MS, Succi MD. Analysis of self-initiated visits for cervical trauma at urgent care centers and subsequent emergency department referral. Clin Imaging 2022; 91:14-18. [PMID: 35973271 DOI: 10.1016/j.clinimag.2022.08.007] [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: 06/16/2022] [Revised: 07/20/2022] [Accepted: 08/08/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Following trauma involving the cervical spine (c-spine), patients often seek care at urgent care centers (UCCs) or emergency departments (EDs). PURPOSE The purpose was to assess whether UCCs could effectively image acute self-selected c-spine trauma without referral to the ED as well as to estimate costs differences between UCC and ED imaging assessment. MATERIALS AND METHODS This retrospective study identified patients receiving c-spine imaging at UCCs affiliated with a large academic hospital system from 5/1/-8/31/2021. Patients receiving c-spine X-rays with an indication of trauma following low acuity injury, at UCCs were compared to patients receiving any c-spine imaging in the main campus ED. Medical record numbers were cross-referenced to identify patients receiving imaging at both a UCC and ED within 24 h and within 7 days. Work relative value units (wRVUs) for each UCC and ED imaging type were calculated. For the hypothetical scenario of patients presenting to the ED in the absence of UCC, patients were assumed to receive c-spine computed tomography (CT) without contrast per "usually appropriate" designation by the American College of Radiology Appropriateness Criteria®. RESULTS Among 143 self-selected, low acuity, patients who received c-spine X-rays at UCCs with an indication of trauma, one required referral to the ED within 24 h and two required referrals to the ED within 7 days. During the 4-month study period, 105.94 wRVUs ($3696.25) were saved by performing a c-spine X-ray in an UCC instead of a CT in the ED, extrapolated to 317.82 wRVUs ($11,088.74) per year. Using the average total costs of an UCC visit versus an ED visit, a total $145,976 was estimated to be saved during the study period or $437,928 per year. CONCLUSION Offering access for patient-initiated visits at UCCs for low-acuity c-spine trauma may help reduce the need for an ED visit, reducing imaging and healthcare visit costs. SUMMARY STATEMENT Urgent Care Centers (UCCs) reduced the need for an Emergency Department (ED) referral visit in nearly 100% of self-selected, low acuity, patients with cervical trauma. KEY RESULTS
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Affiliation(s)
- Azan Z Virji
- Harvard Medical School, Boston, MA, United States; Department of Radiology, Massachusetts General Hospital, Boston, MA, United States; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, United States
| | - Abraham Z Cheloff
- Harvard Medical School, Boston, MA, United States; Department of Radiology, Massachusetts General Hospital, Boston, MA, United States; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, United States
| | - Soham Ghoshal
- Harvard Medical School, Boston, MA, United States; Department of Radiology, Massachusetts General Hospital, Boston, MA, United States; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, United States
| | - Baily Nagle
- Harvard Medical School, Boston, MA, United States; Department of Radiology, Massachusetts General Hospital, Boston, MA, United States; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, United States
| | - Teddy Z Guo
- Harvard Medical School, Boston, MA, United States; Department of Radiology, Massachusetts General Hospital, Boston, MA, United States; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, United States
| | - Michael H Lev
- Harvard Medical School, Boston, MA, United States; Department of Radiology, Massachusetts General Hospital, Boston, MA, United States; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, United States
| | - Ali S Raja
- Harvard Medical School, Boston, MA, United States; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Michael S Gee
- Harvard Medical School, Boston, MA, United States; Department of Radiology, Massachusetts General Hospital, Boston, MA, United States; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, United States
| | - Marc D Succi
- Harvard Medical School, Boston, MA, United States; Department of Radiology, Massachusetts General Hospital, Boston, MA, United States; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, United States.
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Hurt J, Graf A, Dawes A, Toston R, Gottschalk M, Wagner E. Winter sport musculoskeletal injuries: epidemiology and factors predicting hospital admission. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03322-y. [PMID: 35943590 DOI: 10.1007/s00590-022-03322-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/15/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Participation in winter sports such as skiing, snowboarding and snowmobiling is associated with risk of musculoskeletal injury. The purpose of our study was to describe and quantify emergency department encounters associated with these sports. METHODS The National Electronic Injury Surveillance System (NEISS) was queried for skiing-, snowboarding- and snowmobiling-related injuries from 2009 to 2018. Patient demographics and disposition data were collected from emergency department encounters. Descriptive statistics were utilized to describe the trends in injuries from each sport and factors associated with the sports-specific injuries. RESULTS From 2009 to 2018, there were an estimated 156,353 injuries related to snowboarding, skiing, or snowmobiling. Estimated injury incidence per 100,000 people decreased over time for skiing (3.24-1.23), snowboarding (3.98-1.22,) and snowmobiling (0.71-0.22,). The most common injury location by sport was shoulder for skiing (29.6%), wrist for snowboarding (32.5%) and shoulder for snowmobiling (21.9%), with fractures being the most common diagnosis. Only 4.5% required admission to the hospital. Fracture or dislocation was associated with highest likelihood of hospital admission (OR 42.34; 95% CI 22.59-79.37). Snowmobiling injuries (OR 1.63; 95% CI 1.20-2.22) and white race (OR 1.42; 95% CI 1.17-1.72) were also both associated with increased risk of hospital admission. CONCLUSIONS Upper extremity injuries, particularly those involving fractures, were more common than lower extremity injuries for all three sports, with the shoulder being the most common location of injury for skiing and snowmobiling. This study can serve as the foundation for future research in sports safety and health policy to continue the declining trend of musculoskeletal injuries in the future. LEVEL OF EVIDENCE III.
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Affiliation(s)
- John Hurt
- Division of Upper Extremity Surgery, Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Alexander Graf
- Division of Upper Extremity Surgery, Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Alex Dawes
- Division of Upper Extremity Surgery, Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Roy Toston
- Division of Upper Extremity Surgery, Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael Gottschalk
- Division of Upper Extremity Surgery, Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Eric Wagner
- Division of Upper Extremity Surgery, Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA.
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Wardrop R, Ranse J, Chaboyer W, Crilly J. Profile and outcomes of emergency department presentations based on mode of arrival: A state-wide retrospective cohort study. Emerg Med Australas 2021; 34:519-527. [PMID: 34908237 DOI: 10.1111/1742-6723.13914] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/02/2021] [Accepted: 12/05/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Understanding how people arrive to the ED assists in planning health services' response to fluctuating ED demand. The present study aimed to describe and compare demographics, clinical characteristics and health service outcomes of adult ED patient presentations based on mode of arrival: brought in by police (BIBP)/brought in by ambulance (BIBA)/privately arranged transport (PAT). METHODS A retrospective cohort study of ED patient presentations made between 1 January 2018 and 31 December 2020 from all public hospital EDs across Queensland, Australia. Descriptive and inferential analyses were performed to ascertain presentation characteristics and predictors of health service outcomes. RESULTS From 4 707 959 ED presentations, 0.9% were BIBP, 34.8% were BIBA and 64.0% were PAT. Presentations BIBP were younger and comprised a higher proportion of mental health problems and Emergency Examination Authority orders compared to presentations BIBA or PAT. Compared to presentations BIBP or PAT, presentations BIBA were more likely to be assigned more urgent triage scores, be admitted to hospital, and have a longer ED length of stay (LOS). Compared to other modes of arrival, presentations arriving by PAT were more likely to be discharged and have a shorter ED LOS. CONCLUSION Presentations BIBA and BIBP encountered a longer ED LOS and higher admission rates than PAT, suggesting more complex care needs than those from PAT. Clinical care pathways for specific modes of arrival that support pre-hospital providers and patients and are considerate of the throughput and output stages of ED care may be needed.
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Affiliation(s)
- Rachel Wardrop
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Jamie Ranse
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Julia Crilly
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
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14
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Allen L, Cummings JR, Hockenberry JM. The impact of urgent care centers on nonemergent emergency department visits. Health Serv Res 2021; 56:721-730. [PMID: 33559261 PMCID: PMC8313962 DOI: 10.1111/1475-6773.13631] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To estimate the impact of urgent care centers on emergency department (ED) use. DATA SOURCES Secondary data from a novel urgent care center database, linked to the Healthcare Cost and Utilization Project State Emergency Department Databases (SEDD) from six states. STUDY DESIGN We used a difference-in-differences design to examine ZIP code-level changes in the acuity mix of emergency department visits when local urgent care centers were open versus closed. ZIP codes with no urgent care centers served as a control group. We tested for differential impacts of urgent care centers according to ED wait time and patient insurance status. DATA COLLECTION/EXTRACTION METHODS Urgent care center daily operating times were determined via the urgent care center database. Emergency department visit acuity was assessed by applying the NYU ED algorithm to the SEDD data. Urgent care locations and nearby emergency department encounters were linked via zip code. PRINCIPAL FINDINGS We found that having an open urgent care center in a ZIP code reduced the total number of ED visits by residents in that ZIP code by 17.2% (P < 0.05), due largely to decreases in visits for less emergent conditions. This effect was concentrated among visits to EDs with the longest wait times. We found that urgent care centers reduced the total number of uninsured and Medicaid visits to the ED by 21% (P < 0.05) and 29.1% (P < 0.05), respectively. CONCLUSIONS During the hours they are open, urgent care centers appear to be treating patients who otherwise would have visited the ED. This suggests that urgent care centers have the potential to reduce health care expenditures, though questions remain about their net cost impact. Future work should assess whether urgent care centers can improve health care access among populations that often experience barriers to receiving timely care.
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Affiliation(s)
- Lindsay Allen
- School of Public HealthWest Virginia UniversityMorgantownWest VirginiaUSA
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15
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Williams CA, Haffizulla F. Factors Associated With Avoidable Emergency Department Visits in Broward County, Florida. Cureus 2021; 13:e15593. [PMID: 34277214 PMCID: PMC8272918 DOI: 10.7759/cureus.15593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background Improper utilization of emergency departments (EDs) in the United States is an issue that places a large burden on the healthcare system. Previous studies have shown that differences in race, gender, and income level have been associated with avoidable ED visits. Broward County, Florida, is diverse with people from many different socioeconomic backgrounds. The objective of this study is to determine the impact that race/ethnicity, gender, and payment methods have on the rates of avoidable ED visits at hospitals in Broward County, Florida. Methods This study utilized a dataset from the Broward Regional Health Planning Council that included ED visits in Broward County in 2019. Secondary data analysis was conducted utilizing a one-way analysis of variance (ANOVA) with post-hoc analysis to compare the proportions of non-emergent, emergent primary care-treatable, and emergent preventable ED visits amongst different race/ethnicities, genders, and payment/insurance methods. Results Compared to non-Hispanic white patients, non-Hispanic black and Hispanic patients had higher mean rates of non-emergent ED visits. Women had greater mean rates compared to men for non-emergent ED visits; males had higher mean rates than females for emergent primary care-treatable and emergent preventable. Patients covered by Medicaid had greater mean rates of non-emergent and emergent primary care-treatable visits compared to patients using other payment or insurance methods. Conclusions This study identified demographics within Broward County associated with avoidable ED visits. To reduce the burden of ED overutilization on the healthcare system, healthcare providers must better educate the at-risk populations about proper ED use. In addition, a comprehensive assessment of social determinants of health in patients overutilizing the ED will allow for better alignment of resources and policy changes to improve healthcare access and community health.
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Affiliation(s)
- Caitlin A Williams
- Emergency Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Farzanna Haffizulla
- Internal Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
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