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Andrew S Hwang, Steven J Atlas, Johan Hong, Jeffrey M Ashburner, Adrian H Zai, Richard W Grant, Clemens S Hong
BACKGROUND: A better understanding of the attributes of patients who require more effort to manage may improve risk adjustment approaches and lead to more efficient resource allocation, improved patient care and health outcomes, and reduced burnout in primary care clinicians. OBJECTIVE: To identify and characterize high-effort patients from the physician's perspective. DESIGN: Cohort study. PARTICIPANTS: Ninety-nine primary care physicians in an academic primary care network...
October 21, 2016: Journal of General Internal Medicine
I-Shiang Tzeng, Su-Hsun Liu, Kuan-Fu Chen, Chin-Chieh Wu, Jih-Chang Chen
To reduce patient boarding time at the emergency department (ED) and to improve the overall quality of the emergent care system in Taiwan, the Minister of Health and Welfare of Taiwan (MOHW) piloted the Grading Responsible Hospitals for Acute Care (GRHAC) audit program in 2007-2009.The aim of the study was to evaluate the impact of the GRHAC audit program on the identification and management of acute myocardial infarction (AMI)-associated ED visits by describing and comparing the incidence of AMI-associated ED visits before (2003-2007), during (2007-2009), and after (2009-2012) the initial audit program implementation...
October 2016: Medicine (Baltimore)
Larisa M Strawbridge, Jennifer T Lloyd, Ann Meadow, Gerald F Riley, Benjamin L Howell
BACKGROUND: Diabetes is highly prevalent among Medicare beneficiaries, resulting in costly health care utilization. Strategies to improve health outcomes, such as disease self-management, could help reduce the increasing burden of diabetes. OBJECTIVES: Short-term benefits of diabetes self-management training (DSMT) are established; however, longer-term impacts among Medicare beneficiaries are unknown. RESEARCH DESIGN: Claims-based observational study with 1-year follow-up beginning 6 months after diabetes diagnosis...
October 6, 2016: Medical Care
Leila Heidari, Andrea Winquist, Mitchel Klein, Cassandra O'Lenick, Andrew Grundstein, Stefanie Ebelt Sarnat
Identification of populations susceptible to heat effects is critical for targeted prevention and more accurate risk assessment. Fluid and electrolyte imbalance (FEI) may provide an objective indicator of heat morbidity. Data on daily ambient temperature and FEI emergency department (ED) visits were collected in Atlanta, Georgia, USA during 1993-2012. Associations of warm-season same-day temperatures and FEI ED visits were estimated using Poisson generalized linear models. Analyses explored associations between FEI ED visits and various temperature metrics (maximum, minimum, average, and diurnal change in ambient temperature, apparent temperature, and heat index) modeled using linear, quadratic, and cubic terms to allow for non-linear associations...
October 2, 2016: International Journal of Environmental Research and Public Health
Misty D Humphries, Ann Brunson, Chin-Shang Li, Joy Melnikow, Patrick S Romano
OBJECTIVE: This study reports all-payer amputation rates using state-based administrative claims data for high-risk patients with lower extremity (LE) ulcers and concomitant peripheral artery disease (PAD), diabetes mellitus (DM), or combination PAD/DM. In addition, we characterize patient factors that affect amputation-free survival. We also attempted to create a measure of a patient's ability to manage chronic diseases or to access appropriate outpatient care for ulcer management by accounting for hospital and emergency department (ED) visits in the preceding 60 days to determine how this also affects amputation-free survival...
September 23, 2016: Journal of Vascular Surgery
Renee Carter, Jean-Frédéric Lévesque, Sam Harper, Amélie Quesnel-Vallée
The Family Medicine Group (FMG) model of primary care in Quebec, Canada, was driven by the voluntary implementation of family physicians. Our main objective was to measure the effect of FMG enrolment on avoidable use of the emergency department (ED) by diabetic patients. We also sought to determine if effects differed according to whether patients were infrequent or frequent users of the ED and according to high- versus low-regional levels of enrolment. We used data from provincial health administrative databases to identify the diabetic patient population over the age of 20 years for each fiscal year between 2003-2004 and 2011-2012...
August 30, 2016: Journal of Evaluation in Clinical Practice
Jing Feng, Joseph P Iser, Wei Yang
BACKGROUND: Despite today's heightened concern over opioid overdose, the lack of population-based data examining clinical and contextual factors associated with opioid use represents a knowledge gap with relevance to prevention and treatment interventions. We sought to quantify rates of emergency department (ED) visits and inpatient hospitalizations for harmful opioid effects and their sociodemographic differentials as well as clinical correlates in Southern Nevada, using ED visit and hospital inpatient discharge records from 2011 to 2013...
2016: BMC Health Services Research
Geoffrey Law, Nawaaz A Nathoo, Ethan Reiner, Jonathan Berkowitz, Simon J Warner, Frederick S Mikelberg
PURPOSE: To examine the association between open-angle glaucoma and erectile dysfunction (ED), and investigate the correlation in severity between these 2 conditions. METHODS: Cross-sectional study with patient questionnaire and retrospective chart review. A total of 167 male patients over 40 years of age who attended ophthalmology clinic visits in Vancouver, British Columbia, Canada, participated in the study by providing written consent and responding to the survey...
September 2016: Journal of Glaucoma
David C Lee, Vibha K Gupta, Brendan G Carr, Sidrah Malik, Brandy Ferguson, Stephen P Wall, Silas W Smith, Lewis R Goldfrank
OBJECTIVE: To evaluate the acute impact of disasters on diabetic patients, we performed a geospatial analysis of emergency department (ED) use by New York City diabetic adults in the week after Hurricane Sandy. RESEARCH DESIGN AND METHODS: Using an all-payer claims database, we retrospectively analyzed the demographics, insurance status, and medical comorbidities of post-disaster ED patients with diabetes who lived in the most geographically vulnerable areas. We compared the patterns of ED use among diabetic adults in the first week after Hurricane Sandy's landfall to utilization before the disaster in 2012...
2016: BMJ Open Diabetes Research & Care
Jasvinder A Singh, Shaohua Yu
BACKGROUND: Hypertension is one of the commonest chronic diseases, yet limited data are available for related health care utilization. Our study objective was to describe the emergency department (ED) and subsequent hospitalization related health care utilization and charges due to hypertension in the U.S. METHODS: We used the National ED sample (NEDS) to study hypertension-related utilization and charges. Multivariable-adjusted linear or logistic regression was used to assess hypertension-associated ED and hospitalization outcomes (disposition, length of stay, charges), adjusted for patient demographic, comorbidity and hospital characteristics...
2016: BMC Health Services Research
Lisa Tokuda, Lenora Lorenzo, Andre Theriault, Tracey H Taveira, Lynn Marquis, Helene Head, David Edelman, Susan R Kirsh, David C Aron, Wen-Chih Wu
AIM: To explore whether Video-Shared Medical Appointments (video-SMA), where group education and medication titration were provided remotely through video-conferencing technology would improve diabetes outcomes in remote rural settings. METHODS: We conducted a pilot where a team of a clinical pharmacist and a nurse practitioner from Honolulu VA hospital remotely delivered video-SMA in diabetes to Guam. Patients with diabetes and HbA1c ≥7% were enrolled into the study during 2013-2014...
September 2016: International Journal of Medical Informatics
Elisavet Ntountoulaki, Elspeth Guthrie, Konstantinos Kotsis, Vassiliki Paika, Athina Tatsioni, Barbara Tomenson, Konstantinos N Fountoulakis, Andre F Carvalho, Thomas Hyphantis
BACKGROUND: Suicidal risk is often unrecognized in emergency department (ED). We aimed to assess its prevalence in patients with long-term conditions (LTCs) attending an ED and to test whether gender differences influence suicidal risk assessment, using the diagnostic accuracy properties of the Risk Assessment Suicidality Scale (RASS). METHODS: The RASS was administered to 349 patients with diabetes, COPD and rheumatic diseases visiting an ED. The MINI interview was used as the criterion standard...
August 2016: Comprehensive Psychiatry
Brian Petullo, Byron Noble, Kathleen M Dungan
BACKGROUND: Electronic messaging (EM) is increasingly utilized among patients with diabetes, but it is unclear whether it is associated with improved glycemic control, hospital admissions, or emergency visits. METHODS: Patients who were seen over a 1 year period at an academic endocrinology clinic with a diagnosis of diabetes were categorized according to portal activation and whether EMs were actually sent. The association between EM and HbA1c and inpatient or emergency department (ED) visits was further characterized using multivariable (MV) linear or logistic regression models...
September 2016: Diabetes Technology & Therapeutics
Jungwoo Sohn, Seng Chan You, Jaelim Cho, Yoon Jung Choi, Boyoung Joung, Changsoo Kim
Many epidemiological studies have reported associations between ambient particulate matter (PM) and cardiovascular diseases. However, the effects associated with PM that promote cardiovascular events among susceptible populations who may respond differently than the general population to the same ambient air pollutants remain unclear. We conducted a time-series study with generalized additive models to assess the association between ambient PM10 and emergency department (ED) visits for ischemic heart disease (IHD) in Seoul, Republic of Korea from 2005 to 2009...
October 2016: Environmental Science and Pollution Research International
Marianne D Harris, Susan Kirsh, Patricia A Higgins
Managing diabetes poses substantial challenges to the over 29.1 million Americans afflicted, and is financially overwhelming to the US health care system. One potential strategy is utilizing a group approach to care delivery or shared medical appointment (SMA). The purpose of this 3-year retrospective VA study was to investigate differences in clinical and quality outcome measures in veterans with type 2 diabetes who used SMAs and those who received only usual care (UC) one-on-one with their doctor. This observational, 2-group cohort study used abstracted medical records from a large Midwestern Veterans Administration hospital...
July 2016: Quality Management in Health Care
Brian E Driver, Travis D Olives, Johanna E Bischof, Marcus R Salmen, James R Miner
STUDY OBJECTIVE: Hyperglycemia is frequently encountered in the emergency department (ED), and there is no consensus on optimal care before discharge. The importance of glucose reduction in the ED is unknown. We seek to determine whether an association exists between discharge glucose and 7-day adverse outcomes. METHODS: A cohort design with retrospective chart review was conducted at a high-volume urban ED. Patients were included if any glucose level was greater than or equal to 400 mg/dL and they were discharged from the ED...
June 25, 2016: Annals of Emergency Medicine
Jinmyoung Cho, Laurel A Copeland, Eileen M Stock, John E Zeber, Marcos I Restrepo, Andrea A MacCarthy, Marcia G Ory, Paul A Smith, Alan B Stevens
OBJECTIVES: To characterize physical and mental diseases and use of healthcare services and identify factors associated with mortality in the oldest individuals using the Veterans Health Administration (VHA). DESIGN: Retrospective study with 5-year survival follow-up. SETTING: VHA, system-wide. PARTICIPANTS: Veterans using the VHA aged 80 and older as of October 2008 (N = 721,588: n = 665,249 aged 80-89, n = 56,118 aged 90-99, n = 221 aged 100-115)...
June 2016: Journal of the American Geriatrics Society
Joe Burton, Barry Eggleston, Jeffrey Brenner, Aaron Truchil, Brittany A Zulkiewicz, Megan A Lewis
Stakeholders often expect programs for persons with chronic conditions to "bend the cost curve." This study assessed whether a diabetes self-management education (DSME) program offered as part of a multicomponent initiative could affect emergency department (ED) visits, hospital stays, and the associated costs for an underserved population in addition to the clinical indicators that DSME programs attempt to improve. The program was implemented in Camden, New Jersey, by the Camden Coalition of Healthcare Providers to address disparities in diabetes care...
June 7, 2016: Population Health Management
Wei-Hsuan Lo-Ciganic, Julie M Donohue, Bobby L Jones, Subashan Perera, Joshua M Thorpe, Carolyn T Thorpe, Zachary A Marcum, Walid F Gellad
BACKGROUND: Numerous interventions are available to boost medication adherence, but the targeting of these interventions often relies on crude measures of poor adherence. Group-based trajectory models identify individuals with similar longitudinal prescription filling patterns. Identifying distinct adherence trajectories may be more useful for targeting interventions, although the association between adherence trajectories and clinical outcomes is unknown. OBJECTIVE: To examine the association between adherence trajectories for oral hypoglycemics and subsequent hospitalizations among diabetes patients...
September 2016: Journal of General Internal Medicine
Stephanie S Crossen, Darrell M Wilson, Olga Saynina, Lee M Sanders
OBJECTIVE: To identify patterns of outpatient care associated with diabetic ketoacidosis (DKA) among pediatric patients with type 1 diabetes (T1D). METHODS: Retrospective cohort study using Medicaid claims data from 2009 to 2012 for children with T1D enrolled ≥365 consecutive days in California Children's Services, a Title V program for low-income children with chronic disease. Outcome was DKA hospitalization >30 days after enrollment. Outpatient visits to primary care, endocrinology, pharmacies, and emergency departments (EDs) were assessed during the 6 months before an index date: either date of first DKA hospitalization or end of enrollment for those without DKA...
June 2016: Pediatrics
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