scholarly journals Elevated post-delivery blood pressure and acute care utilization

2022 ◽  
Vol 226 (1) ◽  
pp. S637
Author(s):  
Alison M. Stuebe ◽  
Clara Busse ◽  
Emily Patterson ◽  
Kristin P. Tully
Keyword(s):  
Blood Pressure ◽  
Acute Care ◽  
Care Utilization ◽  
Acute Care Utilization

scholarly journals Effect of Psychiatric Illness on Acute Care Utilization at End of Life From Serious Medical Illness

2017 ◽  
Vol 54 (2) ◽  
pp. 176-185.e1 ◽  
Author(s):  
Kyle Lavin ◽  
Dimitry S. Davydow ◽  
Lois Downey ◽  
Ruth A. Engelberg ◽  
Ben Dunlap ◽  
...  
Keyword(s):  
End Of Life ◽  
Acute Care ◽  
Psychiatric Illness ◽  
Care Utilization ◽  
Medical Illness ◽  
Acute Care Utilization

The Association of Antibiotic (ATB) exposure prior to immune checkpoint inhibitor (ICI) treatment on early emergency room and hospitalization utilization: A population-based study.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 304-304
Author(s):  
Lawson Eng ◽  
Rinku Sutradhar ◽  
Yue Niu ◽  
Ning Liu ◽  
Ying Liu ◽  
...  
Keyword(s):  
Emergency Room ◽  
Acute Care ◽  
Therapeutic Option ◽  
Population Based ◽  
Dose Effect ◽  
Care Utilization ◽  
Comorbidity Score ◽  
Logistic Regression Models ◽  
Acute Care Utilization ◽  
The Impact

304 Background: ICIs are becoming a common therapeutic option for many solid tumors. Prior studies have shown that ATB exposure can negatively impact ICI outcomes through gut microbiome changes leading to poorer overall survival; however, less is known about the potential impact of ATB exposure on toxicities from ICI. We undertook a population-based retrospective cohort study in patients receiving ICIs to evaluate the impact of ATB exposure on early acute care use, defined as emergency department visit or hospitalization, within 30 days of initiation of ICI therapy. Methods: Administrative data was utilized to identify a cohort of cancer patients > 65 years of age receiving ICIs from June 2012 to October 2018 in Ontario, Canada. We linked databases deterministically to obtain socio-demographic and clinical co-variates, ATB prescription claims and acute care utilization. Patients were censored if they died within 30 days of initiating ICI therapy. The impact of ATB exposure within 60 days prior to starting ICI on early acute care use was evaluated using multi-variable logistic regression models, adjusted for age, gender, rurality, recent hospitalization within 60 days prior to starting ICI and comorbidity score. Results: Among 2737 patients (median age 73 years), 43% received Nivolumab, 41% Pembrolizumab and 13% Ipilimumab, most commonly for lung cancer (53%) or melanoma (34%). Of these patients, 19% had ATB within 60 days prior to ICI with a median ATB treatment duration of 9 days (SD = 13). 647 (25%) patients had an acute care episode within 30 days of starting ICIs; 182 (7%) patients passed away within 30 days without acute care use and were censored from further analyses. Any ATB exposure within 60 days prior to ICI was associated with greater likelihood of acute care use (aOR = 1.34 95% CI [1.07-1.67] p = 0.01). A dose effect was seen based on weeks of ATB exposure within 60 days prior to ICI (aOR = 1.12 per week [1.04-1.21] p = 0.004) and early acute care use. ATB class analysis identified that exposure to penicillins (aOR = 1.54 [1.11-2.15] p = 0.01) and fluoroquinolones (aOR = 1.55 [1.11-2.17] p = 0.01) within 60 days of starting ICIs were associated with a greater likelihood of acute care use, while there was no significant association between cephalosporin exposure and early acute care use (p > 0.05). Conclusions: Exposure to ATBs, specifically fluoroquinolones and penicillins, prior to ICI therapy is associated with greater likelihood of hospitalization or emergency room visits within 30 days after initiation of ICIs, even after adjustment for relevant co-variates including age, comorbidity score and recent hospitalization prior to ICI initiation. Further studies are required to better understand the mechanisms of recent ATB exposure on early acute care use among patients receiving ICIs.

Acute care utilization risk among older adults living undiagnosed or unaware of dementia

2021 ◽  
Author(s):  
Halima Amjad ◽  
Quincy M. Samus ◽  
Jin Huang ◽  
Sneha Gundavarpu ◽  
Julie P. W. Bynum ◽  
...  
Keyword(s):  
Older Adults ◽  
Acute Care ◽  
Care Utilization ◽  
Acute Care Utilization

Pediatric stroke: clinical characteristics, acute care utilization patterns, and mortality

2010 ◽  
Vol 27 (4) ◽  
pp. 565-573 ◽  
Author(s):  
Kimberly D. Statler ◽  
Li Dong ◽  
Denise M. Nielsen ◽  
Susan L. Bratton
Keyword(s):  
Acute Care ◽  
Clinical Characteristics ◽  
Care Utilization ◽  
Pediatric Stroke ◽  
Utilization Patterns ◽  
Acute Care Utilization

scholarly journals Retrospective Study Evaluating Effect of Voxelotor Treatment on Acute Care Utilization during the Peak of COVID-19

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4179-4179
Author(s):  
Shivani Rao ◽  
Nicole K. Yun ◽  
James L. Coggan ◽  
Peter Wu ◽  
Teresa O'Brien ◽  
...  
Keyword(s):  
Acute Care ◽  
Statistical Significance ◽  
Advisory Board ◽  
Urgent Care ◽  
Care Utilization ◽  
Novel Therapies ◽  
Care Clinic ◽  
Acute Care Utilization ◽  
Urgent Care Clinic ◽  
Acute Medical Care

Abstract Introduction In sickle cell disease (SCD), the polymerization of deoxygenated HbS fundamentally alters the structure of the erythrocyte, producing the sickle cell that is characteristic of the disease. Clinical manifestations often perceived in patients suffering from SCD include vaso-occlusion, anemia, and hemolysis. Due to these sequelae, patients frequent the emergency room (ER), urgent care clinic, and hospital. Voxelotor, an oral medication approved by the Food and Drug Administration (FDA) in 2019 for the treatment of SCD, directly targets the pathophysiology of SCD by inhibiting deoxygenated HbS polymerization. Results of the Phase III HOPE trial indicate that the drug can increase hemoglobin levels and reduce markers of hemolysis as well as the incidence of worsening anemia in patients with SCD (Vichinsky et al. N Engl J Med 2019). The COVID-19 pandemic has posed several challenges for patients with SCD in 2020. Amid the pandemic, patients continued to seek out acute medical care, including care in the ER, urgent care clinics, and hospital. The aim of this study was to determine whether utilization of acute medical care differed for patients who received voxelotor before and after therapy in 2020. We also evaluated the utilization of healthcare through telemedicine platforms to facilitate access to novel therapies such as voxelotor for patients with SCD. Methods 13 patients (≥18 years of age as of January 1, 2020) with SCD who had begun treatment with voxelotor between January 1, 2020 and December 31, 2020 were included in the initial analysis. Six patients were excluded from final analysis: three discontinued treatment due to side effects, one was noncompliant with treatment, and two were lost to follow-up. Acute care utilization, measured by the number of times each patient visited the ER, urgent care clinic, and hospital was compared for each patient in the period six months prior to their first dose of voxelotor and in the period six months after their last dose of the drug in 2020 using paired t-tests and Wilcoxon matched-pairs signed rank tests. Demographic information and the type of visit at which patients agreed to proceed with voxeletor was recorded for each patient. Simple linear regressions and multiple regressions controlled for covariates, defined as sex, BMI, age, type of insurance coverage, and duration of treatment. Results All seven (100%) patients discussed voxelotor treatment with their provider during a telehealth video visit. In the period before initiating treatment, patients frequented the ER an average of 2.71 (SD=6.75) times. In the six months after their last dose, patients visited the ER less than they had in the period prior to treatment, on average 0.57 (SD=0.79) times. This difference did not achieve statistical significance (p>0.9999). The mean number of visits to the urgent care clinic in the six months before treatment was 2.71 (SD=6.75) compared to 2 (SD=4) in the period after patients' last dose in 2020. This finding was not statistically significant (p>0.9999). Hospitalizations, on average, decreased significantly from 5.14 (SD=2.34) in the six months before starting treatment to 1.57 (SD=0.98) after ending therapy for 2020 (p=0.0015). Covariates did not have an effect on the differences in acute care utilization before treatment and after last treatment in 2020. Conclusions The findings of this study imply that treatment with voxelotor was associated with a decrease in the frequency of hospitalizations for the seven patients analyzed. This finding can potentially be attributed to the efficacy of voxelotor in improving anemia and reducing complications associated with SCD. While the difference between ER visits and urgent care visits before treatment and after the last dose in 2020 did not achieve statistical significance, likely due to small sample size, the data does suggest a reduction in both outcomes. In addition, the observation that all visits in which patient and provider discussed and initiated treatment were virtual support the use of telemedicine technology to improve access to multidisciplinary care and novel therapies for SCD patients. The impact of voxelotor treatment will continue to be assessed in SCD patients at our institution, and more data from clinical encounters will lead to a greater understanding of the efficacy of voxelotor. Figure 1 Figure 1. Disclosures Jain: GBT: Speakers Bureau; Novartis: Speakers Bureau; Sanofi: Other: advisory board; Argenx: Other: advisory board; DOVA: Other: advisory board.

Post-Acute Care Utilization and Episode of Care Payments Following Common Elective Operations

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Anne P Ehlers ◽  
Ryan Howard ◽  
Yen-ling Lai ◽  
Jennifer F. Waljee ◽  
Lia D. Delaney ◽  
...  
Keyword(s):  
Acute Care ◽  
Care Utilization ◽  
Episode Of Care ◽  
Acute Care Utilization ◽  
Post Acute Care

scholarly journals The Association Between Patient-reported Clinical Factors and 30-day Acute Care Utilization in Chronic Heart Failure

Medical Care ◽  
2020 ◽  
Vol 58 (4) ◽  
pp. 336-343 ◽  
Author(s):  
Jinying Chen ◽  
Rajani Sadasivam ◽  
Amanda C. Blok ◽  
Christine S. Ritchie ◽  
Catherine Nagawa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Acute Care ◽  
Care Utilization ◽  
Clinical Factors ◽  
Patient Reported ◽  
Acute Care Utilization

scholarly journals Association of Positive Airway Pressure Use With Acute Care Utilization and Costs

2019 ◽  
Vol 15 (09) ◽  
pp. 1243-1250 ◽  
Author(s):  
Douglas B. Kirsch ◽  
Hongmei Yang ◽  
Andréa L. Maslow ◽  
Michael Stolzenbach ◽  
Andrea McCall
Keyword(s):  
Acute Care ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Care Utilization ◽  
Acute Care Utilization
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