scholarly journals Distinguishing Features of AAA-Healthcare Partnerships: Business Acumen Is Necessary but Not Sufficient

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 501-502
Author(s):  
Leslie Curry ◽  
Emily Cherlin ◽  
Adeola Ayedun ◽  
Chris Rubeo ◽  
Traci Wilson ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Health Care Organizations ◽  
Service Providers ◽  
Comparative Method ◽  
Visionary Leadership ◽  
Health Care Use ◽  
Care Utilization ◽  
Total N ◽  
Business Acumen

Abstract Stronger relationships among service providers in the health care and social service sectors may contribute to positive outcomes such as lower health care use and spending. Such partnerships have grown in recent years, including Area Agencies on Aging (AAAs) contracting with health care organizations, and their impact on health care utilization has been demonstrated. Nevertheless, knowledge about how AAAs establish and manage successful collaborations is limited. This study was designed to understand how AAAs in regions with low levels of avoidable health care utilization develop and sustain partnerships with health care organizations. We conducted an explanatory sequential mixed-methods, positive deviance study. In the quantitative phase, we identified 8 AAAs with multiple health care partners serving areas with little utilization of nursing homes by residents with low-care needs, and 3 with few partners and high utilization for comparison. In the qualitative phase, we identified key informants within AAAs and their partners for in-depth interviews (total n = 123). We used the constant comparative method of analysis to identify 5 factors that characterized partnerships in the highly-partnered, low-utilization sites: 1) Regional context (e.g., breadth of health care provider market, cross-sectoral coalitions), 2) AAA human resource assets (e.g., community expertise, business acumen), 3) AAA organizational culture (e.g., visionary leadership, risk taking), 4) Interdependence among organizations (e.g., mutual benefit, alignment), and 5) Interpersonal dynamics (e.g., trust, relationships). The importance of these regional, organizational, and relational factors suggests that AAA business acumen is necessary but not sufficient to build and sustain robust cross-sectoral partnerships.

scholarly journals Understanding Patients’ Decisions to Obtain Unplanned, High-Resource Health Care After Colorectal Surgery

2021 ◽  
pp. 104973232110024
Author(s):  
Stephanie T. Lumpkin ◽  
Eileen Harvey ◽  
Paul Mihas ◽  
Timothy Carey ◽  
Alessandro Fichera ◽  
...  
Keyword(s):  
Health Care ◽  
Colorectal Surgery ◽  
Health Care Utilization ◽  
Care Coordination ◽  
Health Care Use ◽  
Care Utilization ◽  
Discharge Instructions ◽  
Care Needs ◽  
High Resource ◽  
Optimal Health

Readmissions and emergency department (ED) visits after colorectal surgery (CRS) are common, burdensome, and costly. Effective strategies to reduce these unplanned postdischarge health care visits require a nuanced understanding of how and why patients make the decision to seek care. We used a purposefully stratified sample of 18 interview participants from a prospective cohort of adult CRS patients. Thirteen (72%) participants had an unplanned postdischarge health care visit. Participant decision-making was classified by methodology (algorithmic, guided, or impulsive), preexisting rationale, and emotional response to perceived health care needs. Participants voiced clear mental algorithms about when to visit an ED. In addition, participants identified facilitators and barriers to optimal health care use. They also identified tangible targets for health care utilization reduction efforts, such as improved care coordination with streamlined discharge instructions and improved communication with the surgical team. Efforts should be directed at improving postdischarge communication and care coordination to reduce CRS patients’ high-resource health care utilization.

Attachment and Health Care Utilization Among Middle-Aged and Older African-Descent Men

2013 ◽  
Vol 7 (5) ◽  
pp. 382-393 ◽  
Author(s):  
Nathan S. Consedine ◽  
Natalie L. Tuck ◽  
Katherine L. Fiori
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Prostate Specific Antigen ◽  
African Descent ◽  
Small Body ◽  
Specific Antigen ◽  
Health Care Use ◽  
Care Utilization ◽  
Prostate Specific Antigen Testing ◽  
Antigen Testing

Although health care utilization occurs in interpersonal contexts, little is known regarding how interpersonal preferences or styles among patients may be relevant. A small body of work has identified links between attachment—a dispositional style of relating to others—and patterns of health care use. The current report examined how attachment characteristics predicted the frequency of digital rectal exam and prostate-specific antigen testing in a sample of African-descent men. Four hundred and fourteen African-descent men aged 45 to 70 years completed measures of prostate screening and attachment, together with measures of traditional predictors of screening (demographics, insurance, family history, physician variables, knowledge, perceived risk, and accessibility). Consistent with predictions, dismissiveness—the most common relational style among older men—predicted less frequent prostate-specific antigen testing and digital rectal examination. However, attachment security—a comfort with intimate relationships—also predicted lower screening frequency. Identifying the interpersonal characteristics predicting screening may help identify men at risk of suboptimal health care use and guide the development of interventions suited to the normative relational preferences of current cohorts of older, African-descent men.

scholarly journals Health Care Utilization Is High Amongst Adults Who Relapse Following Allogeneic Hematopoietic Cell Transplantation

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4778-4778
Author(s):  
Jessica Langston ◽  
Vandana Sundaram ◽  
Vyjeyanthi Periyakoil ◽  
Lori S Muffly
Keyword(s):  
Health Care ◽  
Treatment Group ◽  
Cell Therapy ◽  
Health Care Utilization ◽  
Research Funding ◽  
Poor Prognosis ◽  
Hematopoietic Cell Transplantation ◽  
Health Care Use ◽  
Care Utilization ◽  
Relapse Treatment

Abstract Background: Leukemia relapse is the leading cause of death for patients who undergo allogeneic hematopoietic cell transplantation (HCT). Relapse post-HCT is associated with poor prognosis; however, the in-hospital health care utilization of this population is unknown. Using a cohort of patients who relapsed post-HCT for acute leukemia (AL) and myelodysplastic syndrome (MDS), we describe survival, intensity of health care utilization, and characteristics associated with high resource utilization at the end-of-life (EOL). Methods: Adult patients with AL/MDS who underwent HCT at a large regional referral center with subsequent relapse between 2005 and 2015 were included in this retrospective study. We created a composite score for EOL health care utilization intensity summing the presence of any of the following criteria: death in the hospital, the use of chemotherapy, emergency department (ED), hospitalization, intensive care unit (ICU), intubation, cardiopulmonary resuscitation, or hemodialysis in the last month of life. Higher scores indicate more intense health care use at EOL. Chi-square and t-tests were used to assess differences in the distribution of health care utilization by post-relapse treatment. Log-rank test statistic and Kaplan Meier curves were used to evaluate differences in survival. Multivariable linear regression analysis was used to determine variables (demographic characteristics, advance directives documentation, palliative care referral, time to relapse) associated with EOL health care utilization intensity. Results: 154 patients were included; median age was 55 years (IQR 38-62), 55% were male, 79% had AL. Following relapse, 28% did not undergo any treatment, 50% received chemotherapy only, and 22% received chemotherapy plus cell therapy (either donor lymphocyte infusion (DLI), second HCT, or DLI plus second HCT). With the exception of age, baseline characteristics (gender, race, graft versus host disease, year of treatment) did not significantly differ by post-relapse treatment group. 140 (91%) patients died within two years of relapse; survival differed significantly by post-relapse treatment group (Figure 1). Health care utilization in AL/MDS patients following post-HCT relapse is described in Table 1. Overall utilization was high with 44% visiting the ED at least once (22% >= 2 times), 92% hospitalized (55% >= 2 times; 16% >= 5 times), and 38% using the ICU (median length of stay 5 days; IQR 3-10 days). Utilization was high even among those receiving no additional therapy (Table 1). For those patients who died, the median (range) intensity score for EOL health care use was 2 (0-8). Most (70%) had a marker of high-intensity health care utilization at the EOL or died in hospital. In multivariable analysis, post-relapse chemotherapy plus cell therapy (estimate (95% CI): 1.41 (0.45-2.37) compared to no treatment was associated with more intense EOL health care use; no other variables were associated with intensity of EOL health care use. Conclusions: Health care utilization following post-HCT relapse is associated with receipt of disease-directed therapy, but remains high across all groups despite known poor prognosis. Interventions are needed to minimize non-beneficial treatments and promote goal-concordant EOL care in this seriously ill patient population. Disclosures Muffly: Adaptive Biotechnologies: Research Funding; Shire Pharmaceuticals: Research Funding.

scholarly journals Perceived Need for Care and Health Care Utilization Among Depressed and Anxious Patients With and Without Suicidal Ideation

Crisis ◽  
2013 ◽  
Vol 34 (3) ◽  
pp. 192-199 ◽  
Author(s):  
Barbara Stringer ◽  
Berno van Meijel ◽  
Merijn Eikelenboom ◽  
Bauke Koekkoek ◽  
Peter F. M. Verhaak ◽  
...  
Keyword(s):  
Health Care ◽  
Suicidal Ideation ◽  
Health Care Utilization ◽  
Health Care Use ◽  
Background Information ◽  
Care Utilization ◽  
Perceived Needs ◽  
Axis I ◽  
Met Needs ◽  
Almost All

Background: Information is scarce concerning the perceived needs and the amount of health-care utilization of persons with suicidal ideation (SI) compared to those without SI. Aims: To describe the needs and health care use of persons with and without SI and to investigate whether these differences are associated with the severity of the axis-I symptomatology. Method: Data were obtained from 1,699 respondents with a depressive and/or anxiety disorder who participated in the Netherlands Study of Depression and Anxiety. Persons with and without SI were distinguished. Outcome variables were perceived needs and health-care utilization. We used multivariate regression in two models: (1) adjusted only for sociodemographic variables and (2) adjusted additionally for severity of axis-I symptomatology. Results: Persons with SI had higher odds for both unmet and met needs in almost all domains and made more intensive use of mental-health care. Differences in needs and health-care utilization of persons with and without SI were strongly associated with severity of axis I symptomatology. Conclusions: Our results validate previous findings about perceived needs and health-care use of persons with SI. The results also suggest that suicidal persons are more seriously ill, and that they need more professional care, dedication, and specialized expertise than anxious and depressed persons without SI, especially in the domains of information and referral.

scholarly journals Patterns of health care utilization among people who overdosed from illegal drugs: a descriptive analysis using the BC Provincial Overdose Cohort

2018 ◽  
Vol 38 (9) ◽  
pp. 328-338 ◽  
Author(s):  
Michael C. Otterstatter ◽  
Alexis Crabtree ◽  
Sabina Dobrer ◽  
Brooke Kinniburgh ◽  
Salman Klar ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Health Care Utilization ◽  
Descriptive Analysis ◽  
Health Care Use ◽  
Care Utilization ◽  
Poison Control ◽  
Illegal Drugs ◽  
Health Related ◽  
Using Data

Introduction British Columbia (BC) declared a public health emergency in April 2016 in response to a rapid rise in overdose deaths. Further understanding of health care utilization is needed to inform prevention strategies for individuals who overdose from illegal drugs. Methods The Provincial Overdose Cohort includes linked administrative data on health care utilization by individuals who experienced an illegal drug overdose event in BC between 1 January 2015 and 30 November 2016. Overdose cases were identified using data from ambulance services, coroners’ investigations, poison control centre calls and hospital, emergency department and physician administrative records. In total, 10 455 overdose cases were identified and compared with 52 275 controls matched on age, sex and area of residence for a descriptive analysis of health care utilization. Results Two-thirds (66%) of overdose cases were male and about half (49%) were 20–39 years old. Over half of the cases (54%) visited the emergency department and about one-quarter (26%) were admitted to hospital in the year before the overdose event, compared with 17% and 9% of controls, respectively. Nevertheless, nearly onefifth (19%) of cases were recorded leaving the emergency department without being seen or against medical advice. High proportions of both cases (75%) and controls (72%) visited community-based physicians. Substance use and mental health–related concerns were the most common diagnoses among people who went on to overdose. Conclusion People who overdosed frequently accessed the health care system in the year before the overdose event. In light of the high rates of health care use, there may be opportunities to identify at-risk individuals before they overdose and connect them with targeted programs and evidence-based interventions. Further work using the BC Provincial Overdose Cohort will focus on identifying risk factors for overdose events and death by overdose.

Health Care Utilization after NICU Discharge and Neurodevelopmental Outcome in the First 2 Years of Life in Preterm Infants

2017 ◽  
Vol 35 (05) ◽  
pp. 441-447 ◽  
Author(s):  
Michelle Greene ◽  
Kousiki Patra
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Neurodevelopmental Outcome ◽  
Health Care Use ◽  
High Rate ◽  
Care Utilization ◽  
Abnormal Head

Objective The objective of this study was to determine predictors of health care utilization and its association with neurodevelopmental outcome in a recent cohort of preterm infants. Study Design A total of 405 infants (born 2008–2011) seen in neonatal intensive care unit (NICU) follow-up were compared for use of hospitalizations (hosps), emergency room (ER), subspecialties (SS), and results of the Bayley-III. High rate of use was defined as having >1 hosp, ER, or SS. Multiple regression adjusted for the effect of risk factors on high health care use. Results High hosp rate was associated with public health insurance (PHI; p = 0.021), severely abnormal head ultrasound (SAHUS; p = 0.04) at 1 year, and PHI (p = 0.011), younger gestational age (GA) (p = 0.029) at 2 years. High ER use was associated with PHI, younger GA at 1 year (p = 0.007 and 0.012) and 2 years (p = 0.010 and 0.005). High SS was associated with NICU morbidities including small for GA (p = 0.005), retinopathy of prematurity (p = 0.001), necrotizing enterocolitis (p = 0.03), and SAHUS (p = 0.045). At 20 months, infants with high hosp and SS had higher rates of cerebral palsy and significantly lower mean cognitive, language, and motor scores. Conclusion Health care utilization is high among preterm infants in recent years and significantly associated with worse neurodevelopmental outcome. Further research is needed to determine if health care utilization after NICU discharge is an independent predictor of poor outcome.

Randomized trial of remote cancer symptom monitoring during COVID-19: Impact on symptoms, QoL, and unplanned health care utilization.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12000-12000
Author(s):  
Kathi Mooney ◽  
Eli Iacob ◽  
Christina M. Wilson ◽  
Jennifer Lloyd ◽  
Heidi Nielson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Health Care Utilization ◽  
Symptom Burden ◽  
Mixed Effects ◽  
Health Care Use ◽  
Mixed Effects Models ◽  
Care Utilization ◽  
Symptom Monitoring

12000 Background: Unplanned health care utilization due to poorly controlled cancer symptoms is common and important to avoid during the Covid-19 pandemic. In a randomized trial we evaluated whether remote symptom monitoring and management utilizing Symptom Care at Home (SCH), would reduce symptom burden, improve quality of life, and decrease unplanned health care use in cancer patients receiving active treatment. Methods: Patients (n = 252) receiving chemotherapy and/or radiation therapy were randomized to the SCH intervention (n = 128) or usual care (UC) (n = 124). Daily, those in the intervention group, utilized the SCH system to report the presence and severity of 9 common symptoms during treatment. For symptoms endorsed, SCH participants received immediate, tailored automated self-management coaching. Symptoms at moderate to severe levels were automatically reported to oncology nurse practitioners who called the SCH patients to improve symptom management based on a decision support dashboard. Participants from both groups were assessed at baseline and monthly for up to 5 months on symptom burden (MDASI), mental health well-being and social isolation (PROMIS; HADS) and Health-related Quality of Life (HRQoL) (Penedo Covid-19 HRQoL subscale). Unplanned health care use was extracted from the EHR. Descriptive statistics examined equivalency between groups. Mixed effects models with random intercepts were utilized to examine group differences over time with post-hoc analyses to determine specific timepoint differences. Results: Participants did not differ on demographic or baseline measures. On average participants were 61 years of age, predominantly female (61%) and white (93%). A variety of cancers were represented with colon, breast and ovarian most common and 60% had stage 3 or 4 disease. Longitudinal mixed effects models found significant effects for lower symptom burden (p =.018) and better HRQoL (p =.007) for SCH participants versus UC at months 1 and 2 with improvements subsiding over the remaining months. Mental health wellbeing and social isolation were not significantly different. There were a total of 71 unplanned health care episodes with 28 for SCH and 43 for UC. Unplanned episode types included: unplanned clinic visit- 3 SCH vs 2 UC; ED visit- 10 SCH vs 16 UC and unplanned hospitalizations-15 SCH vs 25 UC. More SCH participants had no unplanned health care episodes than UC participants (χ2 4.08; p =.04). Conclusions: Remote monitoring and management of patients’ cancer and treatment-related symptoms during the Covid-19 pandemic reduced symptom burden and improved quality of life during the first two months of monitoring. Unplanned health care utilization trended lower for those remotely monitored. Extending care to the home during the pandemic can decrease demand on the health care system and improve cancer patients’ symptom experience. Clinical trial information: NCT04464486.

Residential Segregation, Neighborhood Health Care Organizations, and Children's Health Care Utilization in the Phoenix Urbanized Area

2020 ◽  
Vol 19 (3) ◽  
pp. 771-801
Author(s):  
Kathryn Freeman Anderson
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Residential Segregation ◽  
Health Care Organizations ◽  
Children's Health ◽  
Care Utilization ◽  
Urbanized Area ◽  
Racial Ethnic ◽  
Children’S Health Care ◽  
The Phoenix

Research has demonstrated health care consequences of racial/ethnic residential segregation. Here, I test one possible mechanism—the distribution of community health care organizations and service providers across urban communities. Using data from a 2013 survey on children's health care utilization in the Phoenix urbanized area combined with data on a 2013 census of health care organizations, I estimate a series of statistical models in order to test this relationship. I find that Latino and Native American segregation is related to a lower density of health care organizations. Furthermore, the lack of these resources increases the odds of a family using a clinic, versus a physician's office, which is a more ideal source of care. Finally, a higher rate of racial/ethnic clustering is also related to greater utilization of a clinic, as opposed to a physician's office, and this association is partially mitigated by distribution of health care organizations.

scholarly journals Changes in Health Care Use by Mexican American Medicare Beneficiaries Before and After a Diagnosis of Dementia

2020 ◽  
Author(s):  
Brian Downer ◽  
Soham Al Snih ◽  
Lin-Na Chou ◽  
Yong-Fang Kuo ◽  
Mukaila Raji ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Mexican Americans ◽  
Mexican American ◽  
Health Care Use ◽  
Care Utilization ◽  
Medicare Beneficiaries ◽  
Physician Visits ◽  
Piecewise Regression ◽  
Before And After

Abstract Background Evidence from predominantly non-Hispanic White cohorts indicates health care utilization increases before Alzheimer’s disease and related dementias (ADRD) is diagnosed. We investigated trends in health care utilization by Mexican American Medicare beneficiaries before and after an incident diagnosis of ADRD. Methods Data came from the Hispanic Established Populations for the Epidemiological Study of the Elderly that has been linked with Medicare claims files from 1999 to 2016 (n = 558 matched cases and controls). Piecewise regression and generalized linear mixed models were used to compare the quarterly trends in any (ie, one or more) hospitalizations, emergency room (ER) admissions, and physician visits for 1 year before and 1 year after ADRD diagnosis. Results The piecewise regression models showed that the per-quarter odds for any hospitalizations (odds ratio [OR] = 1.62, 95% CI = 1.43–1.84) and any ER admissions (OR = 1.40, 95% CI = 1.27–1.54) increased before ADRD was diagnosed. Compared to participants without ADRD, the percentage of participants with ADRD who experienced any hospitalizations (27.2% vs 14.0%) and any ER admissions (19.0% vs 11.7%) was significantly higher at 1 quarter and 3 quarters before ADRD diagnosis, respectively. The per-quarter odds for any hospitalizations (OR = 0.88, 95% CI = 0.80–0.97) and any ER admissions (OR = 0.89, 95% CI = 0.82–0.97) decreased after ADRD was diagnosed. Trends for any physician visits before or after ADRD diagnosis were not statistically significant. Conclusions Older Mexican Americans show an increase in hospitalizations and ER admissions before ADRD is diagnosed, which is followed by a decrease after ADRD diagnosis. These findings support the importance of a timely diagnosis of ADRD for older Mexican Americans.

scholarly journals Prevalence of Post-Concussion-Like Symptoms in the General Injury Population and the Association with Health-Related Quality of Life, Health Care Use, and Return to Work

2021 ◽  
Vol 10 (4) ◽  
pp. 806
Author(s):  
Marjolein van der Vlegel ◽  
Suzanne Polinder ◽  
Hidde Toet ◽  
Martien J.M. Panneman ◽  
Juanita A. Haagsma
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Health Care Utilization ◽  
Return To Work ◽  
Health Care Use ◽  
Care Utilization ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

Little is known about post-concussion-like symptoms in the general injury population and the association of these symptoms with outcome after injury. This study aimed to assess the prevalence of post-concussion-like symptoms in a general injury population and describe the association between post-concussion syndrome (PCS) and health-related quality of life (HRQL), health care use, and return to work. In this longitudinal study of a cohort of injury patients, data were collected 6 and 12 months after their Emergency Department visit. Questionnaires included socio-demographics, health care utilization, return to work and the five-level version of the EuroQol five-dimensional descriptive system (EQ-5D-5L) to measure HRQL. The 12-month questionnaire included the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). In total, 282 (22.0%) of the 1282 patients met the criteria for PCS. Apart from the high prevalence of PCS in patients with head injuries (29.4%), a considerable proportion of non-head injury patients also had PCS (20.6%) a year after injury. Patients with PCS had lower HRQL, lower return to work rates, and higher health care utilization, compared to patients without PCS. This underlines the importance of developing strategies to prevent post-concussion-like symptoms among injury patients, raising awareness among patients and physicians on the occurrence of PCS, early detection of PCS in the general injury population, and development of strategies to optimize recovery in this group of injury patients, ultimately leading to lower the individual and economic burden of injury.

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