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Objective: Gout is a progressive form of arthritis that causes significant pain and disability. Patients with treatment-refractory (or uncontrolled) gout experience a higher prevalence and severity of comorbidities than those whose gout is controlled. Pegloticase is a recombinant PEGylated uricase indicated for the treatment of gout in patients refractory to conventional therapy. We evaluated the treatment journey of patients with chronic uncontrolled gout before initiation of pegloticase therapy. Methods: Using IQVIA's PharMetrics® Plus database, we conducted a retrospective observational analysis of adults with ≥ 1 pegloticase claim between April 1, 2011, and August 31, 2020. Demographics were assessed at baseline. Clinical outcomes, health care resource utilization (HCRU), and associated costs were compared over two 12-month periods (months 13–24 and 1–12) prior to the first pegloticase claim (index date). Results: The study included 408 patients. Prevalence of all gout-associated conditions increased between months 1–12 and 13–24 (P < 0.05 for all). The percentage of patients with tophi increased from 15.4% to 61.5%, the percentage with ≥ 1 flare increased from 49% to 84%, and mean number of flares per patient increased from 1.0 to 2.1 (P < 0.0001 for all). The frequency of all categories of HCRU except emergency department visits also increased (P < 0.0001 for all), as did gout-related healthcare utilization (P£0.005). Conclusions: Patients with uncontrolled gout experienced an increase in the clinical burden of disease and HCRU in the 2 years before the initiation of pegloticase. Earlier patient identification and initiation of potentially effective therapy may help alleviate these burdens. Plain Language Summary: Gout is a progressive and painful form of arthritis. Patients with uncontrolled gout have a higher risk of other health problems, including high blood pressure, heart disease, and kidney disease, compared to those whose gout is well controlled. Pegloticase is a medication for patients whose gout has not responded to other treatments. In this study, we used health claims data to understand the treatment journey of 408 patients with gout who were treated with pegloticase. In the 2 years before starting pegloticase, patients experienced increasingly severe gout symptoms as well as an increase in other conditions such as high blood pressure and kidney disease. As a result, these patients required progressively more medication, including opioids, and health care resources. These findings confirm that gout is a progressive condition, and that earlier identification of patients whose gout is not controlled is important to relieving the burden of this disease. [ABSTRACT FROM AUTHOR]

Background: The Veterans Affairs Nebraska Western Iowa Health Care System (VA‐NWIHCS) uses teleoncology and remote systemic cancer therapy services to expand care to veterans in rural Nebraska via remote sites in Lincoln and Grand Island. This study compares clinical outcomes in patients receiving care at these remote sites to those at the primary site in Omaha. Methods: Data were retrospectively reviewed for 151 patients who received first‐line systemic therapy at VA sites in Omaha, Lincoln, or Grand Island between January 1, 2018, and December 31, 2020. This included patient demographics, malignancy type and stage, survival, systemic therapy received, treatment intent and toxicities, missed or delayed cycles, and frequency of hospitalizations or emergency department visits. SAS version 9.4 was used for analysis. Results: The study population included 108 patients who received their systemic therapy in Omaha, whereas 43 received therapy at the remote sites. The demographic of both populations was predominantly male with a median age of 69 years and Eastern Cooperative Oncology Group Performance Status of 0 to 1. The two groups were comparable in terms of comorbidities. Both populations had a similar distribution of cancer types, proportion of patients with stage IV disease, and treatment with curative intent. There was no difference in 1‐ and 2‐year survival, systemic therapy‐related toxicity classification and prevalence, number of delayed/missed cycles, and hospitalization/emergency department visits. Conclusion: Evaluated outcomes in patients treated in Omaha versus remote sites via teleoncology under the same providers were similar. Effective oncology care, including systemic therapy, can be provided via teleoncology, and this model can help mitigate issues with access to care. Disparities in the delivery of high‐quality, cancer‐directed systemic therapy arise from a variety of factors including patient proximity to treatment centers. Use of teleoncology and remote systemic therapy administration can help to alleviate these barriers to cancer‐directed therapies. [ABSTRACT FROM AUTHOR]

Background: This study sought to characterize the incidence of, timing of, predictive factors for, and reasons for emergency department (ED) visits within 90 days of single-level posterior cervical foraminotomy (PCF). These visits, after PCF, have received limited attention. Materials and Methods: The 2010–2022 M161 PearlDiver database was queried for elective single-level PCFs, excluding multilevel procedures, midline laminectomies, fusions, or other posterior/anterior procedures, as well as indications of trauma, infection, or neoplasm. Patient age, sex, Elixhauser Comorbidity Index (ECI), insurance, and region were extracted. Weekly ED use after PCF was calculated. Multivariate analyses were used to identify predictive factors for ED use, and primary ED diagnoses were categorized. Results: Of 10,588 PCF patients, 9.09% (n=962) visited the ED within 90 days after surgery, mostly in the first 4 weeks. Multivariate analysis identified that predictors included younger age (odds ratio [OR], 1.02 per decade decrease), female sex (OR, 1.19), higher ECI (OR, 1.28 for ECI 1–2; OR, 1.41 for ECI 3–4; OR, 1.51 for ECI ≥5), Midwest (OR, 1.16) or Northeast (OR, 1.19) region, and Medicare (OR, 1.09) or Medicaid (OR, 1.57) coverage. In the first 4 weeks, 69.9% of ED visits were related to the surgical site; this decreased to 27.1% thereafter. Conclusion: Almost one-tenth of PCF patients visited the ED within 90 days after surgery. Specific patient characteristics were associated with ED visits, with surgical site-related diagnoses predominating in the acute postoperative period. Tailoring health care interventions based on timing of, risk factors for, and causes of ED visits may enhance outcomes and reduce costs. [Orthopedics. 2025;48(1):51–56.] [ABSTRACT FROM AUTHOR]

Background: Dyspnoea is one of the emergency department's (ED) most common and deadly chief complaints, but frequently misdiagnosed and mistreated. We aimed to design a diagnostic decision support which classifies dyspnoeic ED visits into acute heart failure (AHF), exacerbation of chronic obstructive pulmonary disease (eCOPD), pneumonia and "other diagnoses" by using deep learning and complete, unselected data from an entire regional health care system. Methods: In this cross-sectional study, we included all dyspnoeic ED visits of patients ≥ 18 years of age at the two EDs in the region of Halland, Sweden, 07/01/2017–12/31/2019. Data from the complete regional health care system within five years prior to the ED visit were analysed. Gold standard diagnoses were defined as the subsequent in-hospital or ED discharge notes, and a subsample was manually reviewed by emergency medicine experts. A novel deep learning model, the clinical attention-based recurrent encoder network (CareNet), was developed. Cohort performance was compared to a simpler CatBoost model. A list of all variables and their importance for diagnosis was created. For each unique patient visit, the model selected the most important variables, analysed them and presented them to the clinician interpretably by taking event time and clinical context into account. AUROC, sensitivity and specificity were compared. Findings: The most prevalent diagnoses among the 10,315 dyspnoeic ED visits were AHF (15.5%), eCOPD (14.0%) and pneumonia (13.3%). Median number of unique events, i.e., registered clinical data with time stamps, per ED visit was 1,095 (IQR 459–2,310). CareNet median AUROC was 87.0%, substantially higher than the CatBoost model´s (81.4%). CareNet median sensitivity for AHF, eCOPD, and pneumonia was 74.5%, 92.6%, and 54.1%, respectively, with a specificity set above 75.0, slightly inferior to that of the CatBoost baseline model. The model assembled a list of 1,596 variables by importance for diagnosis, on top were prior diagnoses of heart failure or COPD, daily smoking, atrial fibrillation/flutter, life management difficulties and maternity care. Each patient visit received their own unique attention plot, graphically displaying important clinical events for the diagnosis. Interpretation: We designed a novel interpretable deep learning model for diagnosis in emergency department dyspnoea patients by analysing unselected data from a complete regional health care system. [ABSTRACT FROM AUTHOR]

Background: Gallstone disease is one of the most resource-intensive surgical conditions. Despite the significant burden of emergency cholecystectomy on healthcare system, there is lack of research assessing the risk factors predisposing scheduled elective cholecystectomy patients to emergency surgery. Characterization of patients with gallstones helps to prioritize delivery of health care to avoid urgent surgery. The objective of the present study is to analyze risk factors associated with emergency cholecystectomy and assess the impact of delay on electively scheduled patients. Methods: This retrospective cohort study at a tertiary care center in Jeddah, Saudi Arabia, between January 2018 and June 2022. Net total of 823 patients.The study has collected data retrospectively from an electronic health record system. The data were entered and coded in excel sheet. All statistical tests were 2-sided and were conducted using SAS statistical software version 9.4 (SAS Institute Inc. Cary, NC). Results: A total of 823 patients met the inclusion criteria and enrolled in the analysis. Among them, 129 patients (15.67%) underwent emergency cholecystectomy, while 694 patients (84.33%) underwent elective cholecystectomy. The waiting time in days was significantly longer for patients undergoing emergency cholecystectomy (mean of 362 days) compared to those undergoing elective cholecystectomy (mean of 305 days). Patients with more than two previous ED visits were over five times more likely to undergo emergency cholecystectomy compared to those who had never visited the ED previously (p-value < 0.0001) Moreover, patients diagnosed with acute cholecystitis and pancreatitis were more likely to undergo emergency cholecystectomy compared to those not diagnosed with these conditions (p-value < 0.0001; p-value 0.02). Conclusion: Analysis of risk factors and delay in patients with gallstones scheduled for elective cholecystectomy demonstrates that long waiting times, severity of the initial visit setting, Hemolytic anemia, and male gender were significantly related to emergency cholecystectomy. Independent risk factors for emergency cholecystectomy were frequency of ED visits, acute cholecystitis, pancreatitis, and CBD stone. Patients with these risk factors should be given priority on the waiting list to avoid emergency surgery. Future research is required to design a scoring system or specific criteria for elective patients at risk of developing acute cholecystitis. Highlights: •Highlight the impact of surgery delay on electively scheduled patients with gallstone •To identify the risk factor leading to emergency cholecystecomy •To measure the rate of emergency cholecystectomy among electively scheduled patients [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Methods Data Sources Results Conclusion Implications for the Profession and/or Patient Care Impact Patient or Public Contribution Synthesise evidence on advanced practice nurses' impact on health services utilisation, healthcare costs, access and quality of care globally.Scoping review.A scoping review guided by the Joanna Briggs Institute Manual for Evidence Synthesis and the PRISMA‐ScR checklist.PubMed, CINHAL and Embase for articles between 2016 and 2023.Eighteen studies were included (14 from the United States, two from the Netherlands and one from Australia and New Zealand each). Outcomes included health services utilisation, healthcare costs, access, and quality of care. Most studies reported advanced practice nursing patients had fewer emergency department (9 of 11 studies), fewer hospital (re‐)admissions (9 of 10 studies) and primary care visits (3 of 3 studies). Seven (of eight) studies found advanced practice nursing care was associated with significantly lower healthcare costs. For access and quality of care, advanced practice nursing care was associated with lower consultation rates, similar mean number of patients seen, higher protocol adherence, more rural patient care and lower‐to‐similar quality delivery of chronic disease management.Majority of the studies reported that advanced practice nursing care was associated with lower emergency department visits, hospital readmissions and costs. Access to care outcomes varied under advanced practice nursing care.Advanced practice nursing care can improve patient outcomes, reduce costs and impact access and quality of care. Practices need supportive work environments for advanced practice nurses to deliver high‐quality, effective care.Addressing the need for a synthesis of up‐to‐date evidence, this review highlights the importance of advanced practice nurses in primary care. Findings can inform global workforce development strategies to address health inequalities through effective advanced practice nursing integration.No patient or public contribution is required for this study. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the quantity and quality of medical care provided by the Western NSW Local Health District Virtual Rural Generalist Service (VRGS). Design: Retrospective cohort study; analysis of emergency department and administrative hospital data. Setting: Twenty‐nine rural or remote hospitals in the Western NSW Local Health District at which the VRGS was providing medical care in the emergency department (ED) and/or inpatient setting. The VRGS was providing predominantly virtual medical support when local doctors needed relief or were unavailable, typically for lower acuity ED presentations and scheduled inpatient ward rounds. Patients: All patients who presented or were admitted to a Western NSW Local Health District hospital serviced by the VRGS between 1 July 2021 and 30 June 2022. Main outcome measures: Treatment completions, transfers, ED departure within 4 hours, length of stay, and hospital mortality. Results: During 2021–22, 34% of ED presentations (13 660/39 701) and 40% of admissions (2531/6328) involved VRGS care. For ED presentations, after adjusting for socio‐demographic and clinical factors, patients attended by VRGS doctors had higher odds of not waiting (adjusted odds ratio [aOR], 3.69; 95% CI, 2.79–4.89), lower odds of transfer to another hospital (aOR, 0.66; 95% CI, 0.60–0.72) and slightly lower odds of ED departure within 4 hours (aOR, 0.92; 95% CI, 0.86–0.98) when compared with patients not attended by VRGS doctors (ie, those provided usual care). For admissions, after adjusting for socio‐demographic and clinical factors, inpatients attended exclusively by VRGS doctors had higher odds of discharging at their own risk (3.33; 95% CI, 1.98–5.61) and lower odds of being a long stay outlier (aOR, 0.51; 95% CI, 0.35–0.74) when compared with inpatients not attended by VRGS doctors. The odds of inpatient mortality were equivalent when comparing VRGS and non‐VRGS care (aOR, 0.78; 95% CI, 0.48–1.28) and when comparing combined (VRGS and non‐VRGS) and non‐VRGS care (aOR 1.21; 95% CI, 0.91–1.61). Conclusions: In the current environment of rural medical workforce shortages, the VRGS achieved similar outcomes on routinely collected measures of quality of care. It is demonstrably an option for complementing and enhancing the delivery of medical care in rural and remote communities with limited or no local medical services. [ABSTRACT FROM AUTHOR]

Objective: To explore variation in rates of acute care utilization for mental health conditions, including hospitalizations and emergency department (ED) visits, across high‐income countries before and during the COVID‐19 pandemic. Data Sources and Study Setting: Administrative patient‐level data between 2017 and 2020 of eight high‐income countries: Canada, England, Finland, France, New Zealand, Spain, Switzerland, and the United States (US). Study Design: Multi‐country retrospective observational study using a federated data approach that evaluated age‐sex standardized rates of hospitalizations and ED visits for mental health conditions. Principal Findings: There was significant variation in rates of acute mental health care utilization across countries. Among the subset of four countries with both hospitalization and ED data, the US had the highest pre‐COVID‐19 combined average annual acute care rate of 1613 episodes/100,000 people (95% CI: 1428, 1797). Finland had the lowest rate of 776 (686, 866). When examining hospitalization rates only, France had the highest rate of inpatient hospitalizations of 988/100,000 (95% CI 858, 1118) while Spain had the lowest at 87/100,000 (95% CI 76, 99). For ED rates for mental health conditions, the US had the highest rate of 958/100,000 (95% CI 861, 1055) while France had the lowest rate with 241/100,000 (95% CI 216, 265). Notable shifts coinciding with the onset of the COVID‐19 pandemic were observed including a substitution of care setting in the US from ED to inpatient care, and overall declines in acute care utilization in Canada and France. Conclusion: The study underscores the importance of understanding and addressing variation in acute care utilization for mental health conditions, including the differential effect of COVID‐19, across different health care systems. Further research is needed to elucidate the extent to which factors such as workforce capacity, access barriers, financial incentives, COVID‐19 preparedness, and community‐based care may contribute to these variations. What is known on this topic: Approximately one billion people globally live with a mental health condition, with significant consequences for individuals and societies.Rates of mental health diagnoses vary across high‐income countries, with substantial differences in access to effective care.The COVID‐19 pandemic has exacerbated mental health challenges globally, with varying impacts across countries. What this study adds: This study provides a comprehensive international comparison of hospitalization and emergency department visit rates for mental health conditions across eight high‐income countries.It highlights significant variations in acute care utilization patterns, particularly in countries that are more likely to care for people with mental health conditions in emergency departments rather than inpatient facilitiesThe study identifies temporal and cross‐country differences in acute care management of mental health conditions coinciding with the onset of the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Background and objectives: Falls are a leading cause of injury-related emergency department (ED) visits and hospitalizations across Canada and can result in decline in function and quality of life for an older adult. The COVID-19 pandemic placed severe strain on EDs and hospitals across Canada. This study aimed to understand the experience of older adults who presented to the ED as a result of having a fall during a COVID-19 surge. This may help generate hypotheses and ideas about how to provide optimal care in the midst of pandemic-related healthcare system disruption. Methods: A purposive sampling strategy identified nine participants over age 65 in a medium population centre in Northern Ontario, Canada. Qualitative semi-structured interviews sought information regarding patient demography and function prior to their fall, the circumstances and communication surrounding their fall, and information about their post-fall recovery. Qualitative thematic analysis of the data was completed. Results: Three main themes were identified: patients minimized their fall risk; the challenge of interacting with the healthcare system in a time of limited resources; and complex care navigation and fragmentation within the healthcare system. Discussion: Participants were uncertain about the significance of a fall. Post-fall care was directed by the participant, and little coordination or education was provided at the point of contact with the health care system. Participants were hesitant to present to the ED. Participants expressed vulnerability when reflecting on their experience and acknowledged the systemic pressures experienced by their healthcare workers during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Objective To examine the real-world clinical and healthcare resource burden of familial hypophosphatemia (FH). Methods In a retrospective, observational cohort study using MarketScan claims data from 2017 to 2021, clinical characteristics and healthcare resource utilization (HCRU) and costs were compared between burosumab-naïve pediatric and adult patients with ≥ 1 FH diagnosis code and matched controls without FH. Patient characteristics were evaluated at baseline, and disease characteristics, HCRU, and costs were evaluated over a 12-month follow-up period. Outcomes were analyzed descriptively. Costs were additionally analyzed using multivariate regression models. Results Overall, 570 patients with FH and 1710 non-FH matched controls were included. Approximately 10% of study participants were aged < 18 years. Patients with FH had 7.8-fold higher mean baseline comorbidity (Charlson Comorbidity Index). The prevalence of morbidities over the 12-month follow-up period was higher in patients with FH than controls, including renal disease (33% vs 3%), arthralgia (25% vs 10%), osteoarthritis (17% vs 6%), and delayed growth/walking difficulty (16% vs 2%; all P <.001). All-cause HCRU was significantly greater for patients with FH than controls over follow-up, including the proportion of patients with at least one inpatient admission (60% vs 4%), outpatient emergency room visit (52% vs 16%), and outpatient pharmacy prescription (96% vs 71%; all P <.001). The mean annual total healthcare cost per patient was also 22.6-fold higher for patients with FH than controls (adjusted cost difference = $129 643; P <.001). Differences were apparent across all age groups. Conclusion Compared with non-FH matched controls, burosumab-naïve patients with FH experienced multiple morbidities and had substantially higher HCRU and costs. [ABSTRACT FROM AUTHOR]

\nIntroduction: Emergency department (ED) screening for cognitive impairment (CI) is crucial for early intervention, yet guidance on dementia screening protocols remains limited. Our objective was to assess the concordance between the Ascertain Dementia 8 (AD8) tool, a brief screening tool for CI, administered to ED patients and their informants. Methods: We conducted a prospective observational study of dyads, including patients ≥65 years without a diagnosis of dementia seeking care in the ED and their informants (e.g., family, friend with close contact). Trained research assistants used the 4AT to exclude patients with concern for delirium. The AD8 was then administered to blinded patients (pAD8) and informants (iAD8), with scores ranging from 0 to 8 and scores of ≥2 indicating CI. We used the intraclass correlation coefficient (ICC) to calculate the level of agreement between AD8 scores. Results: Our analytic sample included 538 dyads, of which 63.3% of patients were female with a mean age of 73.5 years. A total of 131 (24.3%) patients without a diagnosis of dementia self-identified as having CI using the pAD8, in comparison to 110 (20.4%) informants using the iAD8. The ICC of 0.519 (95% CI 0.454–0.578) indicated moderate agreement between pAD8 and iAD8 scores. Conclusions: When seeking emergency care, one in four older adults without a diagnosis of dementia and approximately 20% of informants indicated that patients were cognitively impaired. Our finding of moderate agreement between the pAD8 and iAD8 has important implications for clinicians providing care to patients with suspected CI and investigators conducting dementia-related studies. Older adults frequently visit the emergency department (ED) for urgent medical care, but can often have underlying cognitive impairment (CI) that goes unnoticed. CI can affect an older adult’s ability to understand and follow medical advice in the ED, and therefore, detecting CI is crucial to providing appropriate care for these patients. The Ascertain Dementia 8 (AD8) is a quick screening tool typically administered to an informant, such as a patient’s family member, friend, or caregiver. However, no prior studies have compared the AD8 responses between patients and their informants. Exploring the agreement of AD8 scores between patients and informants may offer the opportunity to directly administer the AD8 to patients, allowing for cognitive screening in the ED to be more feasible. This study examined whether AD8 scores provided by older adults matched those given by their informants in the ED. Patients with a prior history of dementia and those without an available informant were excluded. The study consisted of 538 pairs of patients and informants. The findings showed that 24.3% of patients identified themselves as having CI, while 20.4% of informants identified patients as having CI. There was moderate agreement between the patient-completed and informant-completed AD8 scores. [ABSTRACT FROM AUTHOR]

The article discusses the issue of polypharmacy, particularly central nervous system-active polypharmacy, in older adults with dementia. It highlights the risks associated with multiple medications, including cognitive decline, falls, and mortality. The study emphasizes the importance of communication among prescribers and the need for deprescribing efforts to reduce medication burden. It also suggests potential solutions, such as involving patients and caregivers in the deprescribing process and addressing barriers faced by primary care providers. The findings aim to inform future interventions to manage medication use in older adults with dementia. [Extracted from the article]

There is limited evaluation of approaches to identify patients with new onset bipolar affective disorder (BPAD) when using administrative datasets. Using the Massachusetts All-Payer Claims Database (APCD), we identified individuals with a 2016 diagnosis of bipolar disorder with mania and examined patterns of psychiatric and medical care over the preceding 48 months. Among 4806 individuals aged 15–35 years with a 2016 BPAD with mania diagnosis, 3066 had 48 months of historical APCD data, and of those, 75 % involved information from ≥2 payors. After excluding individuals with historical BPAD or mania diagnoses, there were 583 individuals whose 2016 BPAD with mania diagnosis appeared to be new (i.e., 34 new diagnoses per 100,000 individuals aged 15–35 years). Most individuals received medical care, e.g., 98 % had outpatient visits, 76 % had Emergency Department (ED) visits, and 50 % had mental health-related ED visits during the 48 months prior to their first mania diagnosis. One-third (37.2 %) had a depressive episode before their initial BPAD with mania diagnosis. Study was conducted in one state among insured individuals. We used administrative data, which permits evaluation of large populations but lacks rigorous, well-validated claims-based definitions for BPAD. There could be diagnostic uncertainty during illness course, and clinicians may differ in their diagnostic thresholds. Careful examination of multiple years of patient history spanning all payors is essential for identifying new onset BPAD diagnoses presenting with mania, which in turn is critical to estimating population rates of new disease and understanding the early course of disease. • The rate of new mania diagnoses was 34 per 100,000 individuals. • 97.6 % with new mania had ≥1 outpatient visits in the 48 months prior to diagnosis. • 76.3 % had ED visits, 50.1 % had mental health-related ED visits during that time. • 37.2 % had a depressive episode in the 48 months prior to a new mania diagnosis. [ABSTRACT FROM AUTHOR]

Background/Objective: We sought to understand healthcare utilization and barriers to care among youth with chronic illness who interact frequently with the healthcare system. Methods: This was a retrospective analysis of healthcare utilization for youth ≤25 years of age with chronic illness during one calendar year (1 January 2021–31 December 2021) in a single urban academic healthcare system. Inclusion criteria were (1) having at least one healthcare encounter in the calendar year of 2021 and (2) having at least six healthcare encounters over the preceding 3-year period or having a qualifying chronic illness. Demographic and clinical characteristics were collected along with self-reported and derived social determinants of health. Univariable and multivariable regression models were created to identify predictors of missed clinic visits, telehealth use, and activated patient portal accounts. Results: The cohort (N = 14,245) was demographically, clinically, and socioeconomically diverse. The youth had frequent clinic visits (median 9, IQR 4–18), multiple subspecialty care referrals (median 4, 1–8), were prescribed multiple medications (median 6, 3–10), and a high proportion received emergency department (18%) or inpatient treatment (15%). Race and public insurance were significant predictors of missed clinic visits and telehealth use. Primary language was a significant predictor of patient portal activation. Conclusions: Youth with chronic illness who are high users of the healthcare system face a high burden of clinic, emergency room, and hospital visits, referrals, and medications. Systematic efforts to lower the healthcare burden and improve care access should address existing racial and socioeconomic disparities affecting this patient population, who are likely to need frequent healthcare over their lifetime. [ABSTRACT FROM AUTHOR]

INTRODUCTION: To assess prevalence of outpatient care received before and after emergency department (ED) visits for pediatric patients with inflammatory bowel disease (IBD). METHODS: Using commercial claims, we identified patients 2-18 years old with IBD and a related ED visit (2015-2018). We identified outpatient visits in 2 weeks before and after ED visits, then used logistic regression to assess relationships between care received and patient characteristics. RESULTS: Forty-one percent received care in 2 weeks before an IBD-related ED visit and 51% in 2 weeks after. High-risk medications and outpatient continuity were associated with higher odds of outpatient care. DISCUSSION: Gaps in preceding and follow-up care signal opportunities to improve care quality. [ABSTRACT FROM AUTHOR]

Effective patient-provider communication is a critical component of optimal patient care, but its potential impact on the delivery of healthcare services remains unclear. This study examines the association of patient-provider communication with access to care, healthcare utilization, and financial burden of care. Using the 2013–2021 Medical Expenditure Panel Survey longitudinal data, the level of patient-provider communication was measured across four domains (attentive listening, clear explanation, respectfulness, and time allocation) as a primary independent variable, categorized into low, moderate, and high. A lagged dependent model was employed to examine the associations of patient-provider communication at baseline with subsequent access to care, healthcare utilization, and financial burden of care, controlling for baseline sample characteristics and outcomes measured at the baseline. Analysis was conducted in February 2024. Among 28,955 analytic samples (representing 709,547,678 U.S. adults), 5.3%, 50.2%, and 44.3% reported low, moderate, and high levels of patient-provider communication. Marginalized populations, including racial/ethnic minorities, those with low education and income, and those lacking insurance, were more likely to report low patient-provider communication. Compared with adults with high patient-provider communication, those with low patient-provider communication were more likely to encounter difficulties in accessing medical care (2.6 percentage points; 95% CI: 1.2–3.9), experience delays in obtaining necessary medical care (2.8 percentage points; 1.3–4.4), have emergency room visits (4.2 percentage points; 1.9–6.4), and face difficulties paying medical bills (4.0 percentage points; 2.2–5.8) in the subsequent year. Encouraging effective patient-provider communication is essential for advancing patient-centered care and mitigating health inequities. [ABSTRACT FROM AUTHOR]

Background: Postoperative visits to the emergency department (ED) generate additional costs on health care systems and consume already limited resources. We sought to determine the rate and reasons why patients who underwent primary knee arthroplasty returned to the ED within 90 days of postoperative discharge, which could guide the development of preventative measures. Methods: We identified patients who underwent primary knee arthroplasty at 2 hospitals in Nova Scotia, Canada, between April 2021 and March 2022 and who had an ED visit within 90 days of postoperative discharge. We reviewed data for timing and reason for ED visits. Results: Of 687 patients who had primary knee arthroplasty surgeries, 145 (21.1%) patients visited the ED within 90 days of postoperative discharge. Most visits occurred in the early postoperative period, predominantly for surgical reasons (94.7% within 7 days) and shifting toward medical reasons over time. Pain was the most common surgical reason for ED visits (15.9%), followed by swelling (9.7%), and hematoma drainage (9.7%). Conclusion: Understanding the reasons for postoperative ED visits after knee arthroplasty is important in developing strategies to reduce ED overcrowding and improve patient outcomes. Implementing targeted interventions, such as enhanced pain management and patient education, may help alleviate the burden on EDs, reduce costs, and improve overall health care delivery for patients undergoing knee arthroplasty. [ABSTRACT FROM AUTHOR]

The article "Impact of COVID-19 pandemic on healthcare provision in youth with systemic lupus erythematosus" discusses the effects of the pandemic on healthcare for children and young people with systemic lupus erythematosus (SLE). The study conducted a retrospective analysis on 115 patients under 21 years old with SLE, comparing healthcare delivery and access before, during, and after the pandemic. The study found that there were disruptions in healthcare provision, with an increase in appointment rescheduling and reliance on emergency room visits post-pandemic. Telemedicine emerged as a valuable tool in maintaining care continuity for this vulnerable population. [Extracted from the article]

The Asia Pacific Journal of Clinical Oncology published oral abstracts on various cancer care topics, including health disparities, telehealth interventions, and cultural competency. The research aimed to address disparities in cancer care and promote equity for diverse populations. A study in Australia explored pain management for Aboriginal and Torres Strait Islander peoples with cancer, emphasizing the importance of culturally safe care and involving family and community in decision-making. Healthcare professionals highlighted challenges in providing care for patients with brain tumour-related cognitive impairment, emphasizing the need for ongoing education and individualized support. A symposium in London will discuss the integration of Artificial Intelligence in healthcare, focusing on personalized treatment optimization and the transformative potential of AI in revolutionizing healthcare practices. [Extracted from the article]

Background: Cluster randomized trials (CRTs) are increasingly important for evaluating interventions embedded in health care systems. An essential parameter in sample size calculation to detect both overall and heterogeneous treatment effects for CRTs is the intra-cluster correlation coefficient (ICC) of both outcome and covariates of interest. However, obtaining advance estimates for the ICC can be challenging. When trial outcomes will be obtained from routinely collected data sources, there is an opportunity to obtain reliable ICC estimates in advance of the trial. Using USA national Medicare data, we estimated ICCs for a range of outcomes to inform the design of CRTs for people living with Alzheimer's and related dementias (ADRD). Method: Data from 2018 Medicare Fee-for-Service beneficiaries, specifically, 1,898,812 individuals (≥ 65 years) with diagnosis of ADRD within 3436 hospital service areas (treated as clusters) and 306 hospital referral regions (treated as fixed strata), were used to calculate unadjusted and adjusted ICC estimates for three outcomes: death, any hospitalizations, and any emergency department (ED) visits and three covariates: age, race and sex. We present both overall and stratum-specific ICC estimates. We illustrate their use in sample size calculations for overall treatment effects as well as detecting treatment effect heterogeneity. Results: The unadjusted overall ICCs for death, hospitalizations, and ED visits were 0.001, 0.010, and 0.017 respectively. Stratum-specific ICCs varied widely across the 306 HRRs: median 0.001, 0.010 and 0.025 for death, hospitalizations, and ED visits respectively and 0.007, 0.001, and 0.080 for age, sex and race. An interactive R Shiny app is provided that allows users to retrieve estimates overlayed on a map of the USA. Conclusions: We presented both adjusted and unadjusted ICCs for outcomes as well as unadjusted ICCs for covariates of potential interest from population-level data in the USA and demonstrated how the estimates may be used in sample size calculations for CRTs in ADRD. [ABSTRACT FROM AUTHOR]

Background: Telemedicine use expanded greatly during the COVID-19 pandemic. More data is needed to understand how this shift may impact other venues of acute care delivery. Objective: We evaluate the association of visit modality (telephone, video, or office) and downstream emergency department (ED) and hospital visits among primary care visits for acute, time-sensitive conditions. Design: Observational study of patient-scheduled primary care telemedicine and office visits for acute conditions (cardiac, gastrointestinal, neurologic, musculoskeletal, and head and neck) in a large, integrated healthcare delivery system. Participants: Adults with a new self-booked primary care appointment for an eligible acute condition from January 1, 2022, to December 31, 2022 (with no primary care, ED, or hospital visits in prior 30 days). Interventions: Visit modality, including office, video, or telephone. Main Measures: Seven-day ED and hospital utilization, adjusted for patient and visit characteristics. Key Results: Among 258,958 primary care visits by 239,240 adult patients, 57.7% were telemedicine visits; of these, 72.4% were telephone and 27.6% were video. Telephone visits were the timeliest, with over 70% of visits scheduled within 1 day of booking. Rates of 7-day ED utilization were low, and varied by condition group, with cardiac visits having the highest rates (4.8%) and musculoskeletal visits having the lowest (0.8%). There was less than a 1% absolute difference in ED use by visit modality for all condition types; however, telephone visits were associated with slightly higher rates than video visits. The 7-day hospitalization rate was less than 1% and observed between visit type differences varied by clinical condition. Conclusions: Among office, telephone, and video visits in primary care for potentially high-risk, time-sensitive conditions, downstream ED and hospital use were uncommon. ED utilization was lower for video visits than telephone visits, although telephone visits were timelier and may offer a safe and accessible option for acute care. [ABSTRACT FROM AUTHOR]

Background Cancer care coordinators (CCCs) are recognized as having an important role in patients' and carers' cancer journey. However, there are no studies investigating the impact of CCCs on quantitative outcomes. We performed a retrospective cohort study investigating the impact of brain cancer care coordinators (BCCCs) on health service resource use and survival in patients with glioblastoma. Methods All patients diagnosed with glioblastoma between 2012 and 2019 in Hunter New England Local Health District, Australia (HNELHD) were included and the patients were divided into 2 cohorts: before and after the introduction of the BCCC. Any patient diagnosed in 2016, during the introduction of the BCCC, were excluded. The main outcomes assessed were overall survival, health service resource use, odds of being admitted to hospital after the emergency presentation, and cost-offset analysis to examine the economic implications of BCCCs. Results A total of 187 patients were included. There were no significant differences in overall survival between the 2 groups (mOS 12.0 vs 11.16 months, HR 0.95). However, there was a reduction in the number of ED presentations and admissions. This was associated with a 24% reduction in aggregate length of stay with the BCCC. There was no statistically significant difference in mean patient costs, however our hospital may have saved over AUD$500 000 with BCCCs. Conclusions The introduction of BCCC did not improve survival but appeared to be associated with reduced health resource utilization. This study provides economic justification, in addition to the established quality of life improvements, to support the presence of BCCCs. [ABSTRACT FROM AUTHOR]

Background Maccabi-RED is a new service developed in Israel that allows primary care staff to direct urgent cases to specialists in the community for evaluation in their local clinics on the same day as an alternative to an emergency department (ED) visit. A primary care physician or a nurse can activate the service, and all nearby specialists receive "a call" and can decide if they are willing to accept it, thus allowing the patient to avoid an unnecessary visit to the ED. Aim To quantify and characterize the medical care provided by this service in a large national healthcare system. Design and Setting Multicenter, community-based, retrospective cohort study. Methods All Maccabi-RED visits recorded between September 2021 and August 2022 were included. Patient characteristics were compared to national demographics. Descriptive statistics were used to present data regarding recorded diagnoses, treating physicians, treatments or referrals provided, and subsequent emergency department admissions or hospitalizations. Results 31831 visits were recorded. Most frequent diagnoses were musculoskeletal pain (12.1%), otitis or otalgia (7.8%), contusions (7.6%), fractures (7.1%), foreign body (6.7%), pregnancy-related symptoms (6.3%), and upper-respiratory or unspecified viral infection (6.3%). The most common treatments reported were foreign body removal (5%) and cast application (3.5%). Only 7.8% of visits resulted in emergency department admission within seven days (any cause). The average time from patient request to physician treatment was 91 min. Conclusions Maccabi-RED is being widely used by patients nationwide. Additional studies are needed to investigate whether Maccabi-RED reduces emergency department visits and costs. [ABSTRACT FROM AUTHOR]

Objectives: Dravet syndrome (DS) is a rare form of refractory epilepsy that begins in the first year of life. Approximately 85% of patients have a mutation in the SCN1A gene, which encodes a voltage‐gated sodium channel. The main objective of the present work was to assess the degree of knowledge of DS among Spanish primary care (PC) professionals, the communication flow between them and the pediatric neurologists (PNs), and the services available and resources offered to patients in Spain when searching for a diagnosis and adequate treatment. Methods: Two anonymized online surveys on DS diagnosis and patient management in PC were conducted with Spanish PC pediatricians (PCPs) and caregivers of DS patients in Spain. Results: Most PCPs are aware of genetic epilepsy but lack full knowledge of DS and patient advocacy groups (PAGs). Access to epilepsy treatments varies among regions, with many referrals to hospitals and pediatric neurologists. Diagnosis is often delayed, with misdiagnoses and frequent emergency room (ER) visits. Treatment involves multiple drugs, and sodium channel blockers are used, which are contraindicated in DS treatment. Improved training, resources, and communication are needed for early diagnosis. Significance: To improve the care and treatment of DS patients in Spain, early diagnosis is required and, possibly, specific efforts aimed at identifying patients in adulthood, generating socio‐sanitary structures that integrate social and health services to provide comprehensive care, taking into account the different features and comorbidities of the disease. Plain Language Summary: Dravet syndrome (DS) is a form of genetic epilepsy that starts within the first year of life. We present a study showing that, while family doctors are aware of genetic epilepsies, many don't have a complete understanding of DS. Unfortunately, getting the right diagnosis can take a long time, leading to unnecessary visits to the emergency room. Patients often need several medications, and sometimes they're given drugs that aren't recommended for DS. The takeaway is that training for doctors, more resources, and improved communication could help creating better healthcare systems and therefore give easier access to the right therapies. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Emergency department (ED) visits at end‐of‐life may cause financial strain and serve as a marker of inadequate access to community services and health care. We sought to examine end‐of‐life ED use, total healthcare spending, and out‐of‐pocket spending in a nationally representative sample.Using Medicare Current Beneficiary Survey data, we conducted a pooled cross‐sectional analysis of Medicare beneficiaries aged 65+ years with a date of death between July 1, 2015 and December 31, 2021. Our primary outcomes were ED visits, total healthcare spending, and out‐of‐pocket spending in the 7, 30, 90, and 180 days preceding death. We estimated a series of zero‐inflated negative binomial models identifying patient characteristics associated with the primary outcomes.Among 3812 older adult decedents, 610 (16%), 1207 (31.7%), 1582 (41.5%), and 1787 (46.9%) Medicare beneficiaries had ED visits in the final 7, 30, 90, and 180 days, respectively, of life. For Medicare beneficiaries with at least one ED visit in the final 30 days of life, the median total and out‐of‐pocket costs were, respectively, $12,500 and $308, compared, respectively, with $278 and $94 for those without any ED visits (p < 0.001 for both comparisons). Having a diagnosis of dementia (odds ratio [OR] 0.71; 95% confidence interval [CI] 0.51–0.99; p = 0.04) and being on hospice status during the year of death (OR 0.56; 95% CI 0.48–0.66; p = <0.001) were associated with a decreased likelihood of having an ED visit. Having dementia was associated with a decreased likelihood of having any healthcare spending (OR 0.50; 95% CI 0.36–0.71; p = 0.001) and any out‐of‐pocket spending (OR 0.51; 95% CI 0.36–0.72; p = <0.001).One in three older adults visit the ED in the last month of life, and approximately one in two utilize ED services in the last half‐year of life, with evidence of associated considerable total and out‐of‐pocket spending. [ABSTRACT FROM AUTHOR]

Background: Telehealth has emerged as a vital alternative to traditional healthcare delivery, particularly for rural and underserved populations. While efforts to enhance telehealth accessibility have primarily focused on technological solutions, the effectiveness of its telehealth and the role of physician training in bridging racial and ethnic disparities in telehealth usage remains underexplored. This study evaluates the impact of a trained-physician-delivered, age-friendly telehealth model on healthcare accessibility and outcomes. Methods: A retrospective analysis was conducted on 214 older patients (60+) at an urban primary care facility in Nevada, USA. Patients received telehealth services from either trained or non-trained physicians, with the trained group utilizing a 4M-based telehealth model focusing on Medication, Mentation, Mobility, and What Matters. Results: Findings revealed lower exposure to both general and 4M-based telehealth among Hispanic and Asian patients compared to their white counterparts. Telehealth usage did not significantly reduce hospital or emergency department visits overall. However, certain types of 4M-based telehealth, such as What Matters and Medications, reduced hospital and ED visits. Implications: The development and implementation of telehealth education curricula for healthcare providers could make telehealth more accessible to minority patients, potentially reducing unnecessary emergency department visits and addressing disparities in telehealth access. [ABSTRACT FROM AUTHOR]

Objective: Investigate the association between Telemental Health (TMH) uptake and sociodemographic characteristics, and how TMH uptake relates to health care resource utilization and Medicaid expenditures among Mississippi Medicaid enrollees with major depression. Methods: A retrospective cohort study was conducted (2019–2020), comparing those who utilized TMH and those who did not. Results: Among the 21,239 identified enrollees, 806 (3.79%) utilized TMH. The TMH cohort was more likely to be of older age, non-Hispanic White, comprehensive managed care organization enrollees, rural residents, and from areas with a higher area deprivation index, and have higher Charlson comorbidity index scores. The TMH cohort also exhibited higher mental health-related and all-cause outpatient and emergency department utilization, along with higher Medicaid expenditures. Conclusion: As the first study investigating telehealth utilization among Mississippi Medicaid enrollees, this study highlights sociodemographic disparities in telehealth adoption. Addressing barriers hindering telehealth adoption among vulnerable populations and ensuring the availability of quality data are vital for future research. [ABSTRACT FROM AUTHOR]

Rationale: Existing work suggests that patients with chronic obstructive pulmonary disease (pwCOPD) presented less frequently to the emergency department and were less likely to be hospitalized during the coronavirus disease (COVID-19) pandemic, but it is unclear if this was due to improved health and disease management or to increased barriers and/or avoidance of health care. Objectives: The objective of this study was to determine the impact of the pandemic on inpatient and outpatient healthcare use, disease incidence, and mortality rates in pwCOPD. Methods: A retrospective population-based analysis using linked administrative datasets from Alberta, Canada 18 months before and after March 12, 2020 was conducted to measure hospitalization, emergency department and outpatient visits, and COPD outpatient exacerbations during these time periods. Mortality data were also analyzed before versus after the pandemic, taking confirmed COVID-19 infection within 30 days into account. Subgroup analysis based on COPD exacerbation risk stratification was undertaken to determine if healthcare use differed based on exacerbation risk. Finally, sex-based analysis of healthcare use during the pandemic was also completed. Results: Hospitalization or emergency department visits and outpatient treatment for acute exacerbations of COPD dropped, whereas total outpatient COPD visits, including both virtual and in person, increased during the pandemic for pwCOPD. The mortality rate increased even after adjusting for COVID-19–associated deaths. Sex-based subgroup analysis showed a greater drop in acute care use for females, but the rise in mortality was seen for both sexes, with men experiencing a greater rate of mortality than women. Conclusions: Overall, pwCOPD accessed acute care resources less during the pandemic, which may have contributed to a rise in non–COVID-19 all-cause mortality. [ABSTRACT FROM AUTHOR]

Purpose: Hospitals are increasingly the target of cybersecurity threats, including ransomware attacks. Little is known about how ransomware attacks affect care at rural hospitals. Methods: We used data on hospital ransomware attacks from the Tracking Healthcare Ransomware Events and Traits database, linked to American Hospital Association survey data and Medicare fee‐for‐service (FFS) claims data from 2016 to 2021. We measured Medicare FFS volume and revenue in the inpatient, outpatient, and emergency room setting—at the hospital‐week level. We then conducted a stacked event study analysis, comparing hospital volume and revenue at ransomware‐attacked and nonattacked hospitals before and after attacks. Findings: Ransomware attacks severely disrupted hospital operations—with comparable effects observed at rural versus urban hospitals. During the first week of the attack, inpatient admissions volume fell by 14.7% at rural hospitals (P =.04) and 16.9% at urban hospitals (P =.01)—recovering to preattack levels within 2‐3 weeks. Outpatient visits fell by 35.3% at rural hospitals (P<.01) and 22.0% at urban hospitals (P =.03) during the first week. Emergency room visits fell by 10.0% at rural hospitals (P =.04) and 19.3% at urban hospitals (P =.01). Travel time and distance to the closest nonattacked hospital was 4‐7 times greater for rural ransomware‐attacked hospitals than for urban ransomware‐attacked hospitals. Conclusions: Ransomware attacks disrupted hospital operations in rural and urban areas. Disruptions of similar magnitudes may be more detrimental in rural areas, given the greater distances patients must travel to receive care and the outsized impact that lost revenue may have on rural hospital finances. [ABSTRACT FROM AUTHOR]

Background: A left ventricular assist device (LVAD) is a life-saving but intensive therapy for patients with end-stage heart failure. We evaluated the healthcare consumption in a cohort of LVAD patients in our centre over 6 years. Methods: All patients with a primary LVAD implantation at the University Medical Centre Utrecht in Utrecht, the Netherlands from 2016 through 2021 were included in this analysis. Subsequent hospital stay, outpatient clinic visits, emergency department visits and readmissions were recorded. Results: During the investigated period, 226 LVADs were implanted, ranging from 32 in 2016 to 45 in 2020. Most LVADs were implanted in patients aged 40–60 years, while they were supported by or sliding on inotropes (Interagency Registry for Mechanically Assisted Circulatory Support class 2 or 3). Around the time of LVAD implantation, the median total hospital stay was 41 days. As the size of the LVAD cohort increased over time, the total annual number of outpatient clinic visits also increased, from 124 in 2016 to 812 in 2021 (p = 0.003). The numbers of emergency department visits and readmissions significantly increased in the 6‑year period as well, with a total number of 553 emergency department visits and 614 readmissions. Over the years, the annual number of outpatient clinic visits decreased by 1 per patient-year follow-up, while the annual numbers of emergency department visits and readmissions per patient-year remained stable. Conclusion: The number of patients supported by an LVAD has grown steadily over the last years, requiring a more specialised healthcare in this particular population. [ABSTRACT FROM AUTHOR]

The article "Taking CMS Back to HCFA: Harnessing Private Innovation to Secure and Enhance Medicare" by Richard G. Stefanacci discusses the evolution and challenges of the Medicare system. The author advocates for returning CMS to its original role as HCFA and empowering private health plans to manage Medicare. The article highlights the benefits of transitioning to Medicare Advantage (MA) to reshape incentives, improve care quality, and reduce costs. It also addresses the need for risk adjustment reform, drug price negotiations, and eliminating the Center for Medicare and Medicaid Innovation (CMMI) to drive innovation and improve care delivery. [Extracted from the article]

The article discusses the practice of involuntary commitment in psychiatric services, focusing on differing opinions regarding patient autonomy, legal parameters, and behavioral services care delivery. Authors present arguments both for and against involuntary commitment, highlighting concerns about patient autonomy, treatment effectiveness, and ethical considerations. The article also addresses the implementation of involuntary commitment for individuals with substance use disorders, emphasizing the need for well-considered guidelines and data-informed approaches to balance benefits and harms. Overall, the article explores the complex ethical and practical considerations surrounding involuntary commitment in mental health care. [Extracted from the article]

The article discusses the controversies surrounding involuntary commitment for individuals with treatment-resistant mental illness and grave disability. Different viewpoints are presented, with some arguing against involuntary commitment due to its ineffectiveness and negative outcomes, while others advocate for its use to ensure patients receive lifesaving treatments. The article also addresses the implementation of involuntary commitment for substance use disorders, highlighting the need for well-considered guidelines and data-informed approaches to minimize harm and maximize benefits. The authors emphasize the importance of balancing patient autonomy with the necessity of involuntary commitment in certain cases. [Extracted from the article]

Background: The COVID-19 pandemic has had a major impact on the access and delivery of healthcare services, posing unprecedented challenges to healthcare staff worldwide. Frontline healthcare staff faced unique stressors and challenges that impact their well-being and patient care. This qualitative study aimed to explore the experiences and perspectives of frontline ED healthcare staff on emergency care services during the COVID-19 pandemic, providing valuable insights into the challenges, adaptations, and lessons learned in delivering emergency care. Methods: This study utilized a qualitative approach. In-depth semi-structured interviews were conducted with 30 ED healthcare staff from three different hospitals located in Turkey between 15/03/2022 and 30/04/2022. Convenience sampling was used to recruit participants. The duration of the interviews ranged from 28 to 37 min. Data saturation was reached as no new information was gathered. The data were analyzed using the thematic analysis method. NVivo software was used to manage the data analysis process. Member check was carried out to ensure that the generated themes conformed to the participants' views. Results: 15 sub-themes under three themes emerged: (1) the impact of COVID-19 on emergency care services, including sub-themes of "introducing a COVID-19 unit in the ED", "changes in the routine functioning of EDs", "changes in the number of ED visits", "quality of care", "resources", and "increased workload"; (2) the psychological effects of COVID-19 on ED healthcare staff, including sub-themes of "staying away from family", "fear", "society's perspective on healthcare professionals", "morale-staff burnout", "psychological and emotional effects", and "unable to receive sufficient support"; and (3) the difficulties faced by ED healthcare staff, including sub-themes of "difficult working conditions", "community-based effects difficulties", and "COVID-19 is an unknown situation". Conclusion: Staff burnout threatens the quality of patient care and staff retention, and therefore this should be addressed by ED directors and leaders. This study could inform appropriate stakeholders regarding lessons learned from COVID-19 to better manage future pandemics. Learning from such lived experiences and developing appropriate interventions to minimize the difficulties faced during COVID-19 would allow better management of future pandemics. This study calls for a reform to address the challenges faced by healthcare staff, improve the overall response to public health crises, and enhance the resilience of healthcare systems for future crises. [ABSTRACT FROM AUTHOR]

Objective Data Sources and Study Setting Study Design Data Collection/Extraction Methods Principal Findings Conclusions To determine whether availability of behavioral health crisis care services is associated with changes in emergency department (ED) utilization.We used longitudinal panel data (2016–2021) on ED utilization from the Healthcare Cost and Utilization Project's State ED Databases and a novel dataset on crisis care services compiled using information from the Substance Abuse and Mental Health Services Administration's National Directories of Mental Health Treatment Facilities. A total of 1002 unique zip codes from Arizona, Florida, Kentucky, Maryland, and Wisconsin were included in our analyses.To estimate the effect of crisis care availability on ED utilization, we used a linear regression model with zip code and year fixed effects and standard errors accounting for clustering at the zip code‐level. ED utilization related to mental, behavioral, and neurodevelopmental (MBD) disorders served as our primary outcome. We also examined pregnancy‐related ED utilization as a nonequivalent dependent variable to assess residual bias in effect estimates.We extracted data on crisis care services offered by mental health treatment facilities (n = 14,726 facility‐years) from the National Directories. MBD‐related ED utilization was assessed by applying the Clinical Classification Software Refined from the Healthcare Cost and Utilization Project to the primary ICD‐10‐CM diagnosis code on each ED encounter (n = 101,360,483). All data were aggregated to the zip code‐level (n = 6012 zip‐years).The overall rate of MBD‐related ED visits between 2016 and 2021 was 1610 annual visits per 100,000 population. Walk‐in crisis stabilization services were associated with reduced MBD‐related ED utilization (coefficient = −0.028, p = 0.009), but were not significantly associated with changes in pregnancy‐related ED utilization.Walk‐in crisis stabilization services were associated with reductions in MBD‐related ED utilization. Decision‐makers looking to reduce MBD‐related ED utilization should consider increasing access to this promising alternative model. [ABSTRACT FROM AUTHOR]

Summary: Obstructive sleep apnea (OSA) is a highly prevalent yet underdiagnosed disease that creates a large economic burden on the United States healthcare system. In this retrospective study, we tested the hypothesis that adherence to positive airway pressure (PAP) therapy, the 'gold standard' treatment for OSA, is associated with reduced healthcare resource utilisation and costs. We linked de‐identified payer‐sourced medical claims and objective PAP usage data for patients newly diagnosed with OSA. Inverse probability of treatment weighting was used to create balanced groups of patients who were either adherent, intermediately adherent, or non‐adherent to PAP therapy. From a sample of 179,542 patients (average age 52.5 years, 61% male), 37% were adherent, 40% intermediate, and 23% non‐adherent. During the first year, PAP adherence was significantly associated with fewer emergency room visits (mean [SD] adherent: 0.39 [1.20] versus intermediate: 0.47 [1.30], p < 0.001; versus non‐adherent: 0.54 [1.44], p < 0.001), all‐cause hospitalisations (mean [SD] adherent: 0.09 [0.43] versus intermediate: 0.12 [0.51], p < 0.001; versus non‐adherent: 0.13 [0.55], p < 0.001), and lower total costs (mean [SD] adherent $5874 [8045] versus intermediate $6523 [9759], p < 0.001; versus non‐adherent $6355 [10,517], p < 0.001). Results were similar in the second year of PAP use. These results provide additional evidence from a large, diverse sample to support the diagnosis and treatment of OSA and encourage long‐term adherence to PAP therapy. [ABSTRACT FROM AUTHOR]

Background and objective Children with medical complexity (CMC) have chronic and severe conditions leading to medical fragility. CMC represent less than 1% of children but account for one-third of paediatric healthcare expenditures. Enrollment to a complex care program (CCP) decreases health care resource utilization while improving parental satisfaction. An in-depth understanding of how these changes operate in real-world setting is needed to further support CMC and their families. This study aimed at assessing the possible reasons for a decrease in emergency department (ED) visits and hospitalization length of stay related to enrollment to a CCP, based on parental perspectives. Study design Using a qualitative approach, data were collected using in-depth, semi-structured interviews with parents of CMC enrolled in a CCP from a university hospital centre in Montreal, Canada. The interview guide was co-constructed by an interdisciplinary team, including a parent partner and a clinical nurse coordinator. Themes have been identified inductively, using thematic analysis. Results Parents identified personalized care , family empowerment and guidance as enablers arising from the CCP that contributed to the decrease in hospital-delivered care utilization. Improvement in medical baseline condition was also identified as a contributing factor, while not necessarily related to program's support. Conclusions In this study, we identified personalized care, parental empowerment, and guidance as three strategies for a CCP to potentially decrease ED visits and hospital length of stay, from the parents' perspective. Parents identified the clinical nurse coordinator as playing a central role in supporting the implementation of these strategies. [ABSTRACT FROM AUTHOR]

Introduction Objective: The purpose of this study was to provide an unprecedented comprehensive examination of work-related safety within a sample of emergency departments in Saudi hospitals. Safety climate is an important human resource management topic because large numbers of victims are drawn to the emergency departments at both public and private hospitals in Saudi Arabia. Subsequently, the staff in these emergency departments are at risk of physical violence, serious verbal and legal consequences, chronic health issues, and psychological issues. Staff affected by violence and injury are usually off work and need short-term and long-term sick leave benefits, which means cost-effective issues would make this study beneficial. The overall aim of this work was to study these effects in emergency departments at public and private hospitals, from the personnel perspective, by comparing general perceived safety. The relationships and effects between trust and safety at work were also robustly tested. Methods The target population consisted of nursing and emergency non-nursing staff employed in six government healthcare hospitals that provide emergency services in the Eastern Province of Saudi Arabia. The head nurses and director of nursing of the selected hospitals granted approval to conduct the study in each hospital. Approval and ethical permission to conduct the study were granted by the Deanship of Research and the Research and Ethical Committee in the College of Nursing. Eligible participants were provided with information for the purpose of the study through a cover page attached to the self-administered questionnaire explaining the purpose of the study, the time required to complete the study, the voluntary basis of participation in the study, and the right to refuse to participate or withdraw without prejudice. Conclusion The findings of this study have implications for the development of policies and protocols for the prevention of workplace violence against nurses, guidance on what to expect and what the job of nursing entails, and how the organizational culture can be modified in such a way as to favorably develop and maintain nursing and retention within this area of nursing. Consequently, effective interventions to reduce violence and change the perceptions of emergency care nursing as acceptable behavior for this role, forming part of the response strategy to violence against nurses, should be considered. The intention here is not to over-dramatize, but to draw attention to an issue that is far more complex than is currently recognized. Workplace violence and the deleterious effect that it has on the minds and bodies of emergency department staff must be appreciated by the wider society and taken up by researchers, managers, policy developers, and educational bodies so that further examination, imperative change, and informed practice in the assessment of current effective measures to address the consequences workplace violence has for the staff being subjected to it. The verbal, emotional, and physical violence directed against the staff in hospital emergency departments for both male and female nurses involved in the profession is both unacceptable and far removed from the workplace environment where practices need to be valued, expanded, and reinforced. Since the task of protecting the patients and staff in hospital emergency departments is so demanding, and as healthcare becomes increasingly complex, education at all levels of nursing--pre-registration, registration, and continuing professional development--is an essential foundation for the development of proactive, empathetic, compliant, roleaware, and decision-making effective practitioners. [ABSTRACT FROM AUTHOR]

Introduction: Hospital nursing staff are often overstretched, particularly in the emergency department, with too many tasks and too little time. This results in an unsatisfactory work environment and, as a consequence, compromises patient care and outcomes. Interventions to reduce unnecessary visits and optimize nursing care are needed to make the healthcare system more sustainable and improve the quality of patient care. Used in the right way, with the right patients and the right infrastructure, mobile applications and sensors might represent such an intervention. The primary aim of the project is to evaluate the effects of a novel mobile intervention designed to reduce the number of patients who visit the emergency department unnecessarily and to provide nurses with situational awareness and decision support using simple visual cues. In this paper, we describe the design of a quasi-experimental study where we have used methods from intervention mapping for the development of the mobile intervention. The evaluation considers the multifaceted nature of the process related to implementation and mechanisms of impact. The study protocol is designed in line with guidance for the development and evaluation of complex interventions. Methods: Building on previous work, we conducted interviews with physicians, oncologists, and caregivers of advanced cancer patients visiting the emergency department. Using content analysis, we developed an intervention based on our previous study, aligned with calls to action in community oncology. Our study explores interventions to reduce ED visits and improve nursing care for advanced cancer patients. The feasibility and potential for our interventions pave the way for large-scale implementation trials. Our research aims to enhance nursing care for better interactions and optimize advanced cancer nursing. Conclusion: Interpretation of each research finding is limited because only one study investigated each comparison. The evidence suggested that examples of interventions that might reduce ED visits and optimize nursing care included minor injury units, particularly for improving waiting times for people with acute conditions of the ear, nose, or throat, and for patients with injuries. These findings are based on evidence of moderate quality. Moderate-quality evidence also suggested that treatments given by pharmacists for people with self-limiting conditions might help to significantly reduce the length of stay among people who are waiting for admission to hospital compared with ED medical staff. There is limited evidence for the effect of these minor injury unit interventions on patient safety, cost and other outcomes. High-quality studies are needed to directly compare these different types of services with the use of existing data or to examine patients' views about introducing or extending the range of services available at these units. It is also important to explicitly examine the themes that are underpinning the different interventions and services. High-quality studies may involve using qualitative and quantitative research that takes a mixed-methods approach, and highly transferable economic evaluations. With either approach, this would require a linked team drawn from the disciplines of strategy, management, nursing and clinical care. These findings are based on data of moderate to low quality. Future investigations should consider differences in the way resources are used and whether one strategy is more resourced than another but also more beneficial in terms of patient care, financial cost savings and the positive aspects experienced by those who contribute clinically. [ABSTRACT FROM AUTHOR]

Effective pain management in the Emergency Department (ED) is a critical concern for healthcare providers, impacting patient satisfaction and overall health outcomes. This study aims to synthesize existing knowledge and identify best practices for optimizing pain management in the ED through an extensive review of secondary data sources, including peer-reviewed articles, clinical guidelines, and statistical reports. The findings reveal persistent challenges such as variability in pain assessment practices, underutilization of pain management protocols, and disparities in treatment related to demographics. The review highlights successful interventions, including standardized pain assessment tools, multimodal analgesia strategies, and educational programs for healthcare providers. Additionally, the study underscores the importance of integrating a patient-centered approach to address subjective pain experiences and cultural competence in treatment plans. The results provide comprehensive insights and actionable recommendations to enhance pain management efficacy and improve patient care in emergency settings. Future research should focus on developing and implementing innovative approaches that address identified gaps and further streamline pain management protocols in the ED. [ABSTRACT FROM AUTHOR]

Introduction: The World Health Organization (WHO) called for the expansion of all nursing roles, including advanced practice nurses (APNs), nurse practitioners (NPs) and clinical nurse specialists (CNSs). A clearer understanding of the impact of these roles will inform global priorities for advanced practice nursing education, research, and policy. Objective: To identify gaps in advanced practice nursing research globally. Materials and methods: A review of systematic reviews was conducted. We searched CINAHL, Embase, Global Health, Healthstar, PubMed, Medline, Cochrane Library, DARE, Joanna Briggs Institute EBP, and Web of Science from January 2011 onwards, with no restrictions on jurisdiction or language. Grey literature and hand searches of reference lists were undertaken. Review quality was assessed using the Critical Appraisal Skills Program (CASP). Study selection, data extraction and CASP assessments were done independently by two reviewers. We extracted study characteristics, country and outcome data. Data were summarized using narrative synthesis. Results: We screened 5840 articles and retained 117 systematic reviews, representing 38 countries. Most CASP criteria were met. However, study selection by two reviewers was done inconsistently and language and geographical restrictions were applied. We found highly consistent evidence that APN, NP and CNS care was equal or superior to the comparator (e.g., physicians) for 29 indicator categories across a wide range of clinical settings, patient populations and acuity levels. Mixed findings were noted for quality of life, consultations, costs, emergency room visits, and health care service delivery where some studies favoured the control groups. No indicator consistently favoured the control group. There is emerging research related to Artificial Intelligence (AI). Conclusion: There is a large body of advanced practice nursing research globally, but several WHO regions are underrepresented. Identified research gaps include AI, interprofessional team functioning, workload, and patients and families as partners in healthcare. PROSPERO registration number: CRD42021278532. [ABSTRACT FROM AUTHOR]

Aims: Oxycodone is the most commonly prescribed strong opioid in Australia. This study describes health service antecedents and sociodemographic factors associated with oxycodone initiation. Methods: Population‐based new user cohort study linking medicine dispensings, hospitalizations, emergency department visits, medical services and cancer notifications from New South Wales (NSW) for 2014–2018. New users had no dispensings of any opioid in the preceding year. We analysed health service use in the 5 days preceding initiation and proportion of people on treatment over 1 year and fitted an area‐based, multivariable initiation model with sociodemographic covariates. Results: Oxycodone accounted for 30% of opioid initiations. Annually, 3% of the NSW population initiated oxycodone, and 5–6% were prevalent users; the new user cohort comprised 830 963 people. Discharge from hospital (39.3%), therapeutic procedures (21.4%) and emergency department visits (19.7%) were common; a hospital admission for injury (6.0%) or a past‐year history of cancer (7.2%) were less common. At 1 year after initiation, 4.6% of people were using oxycodone. In the multivariable model, new use of oxycodone increased with age and was higher for people outside major cities, for example, an incidence rate ratio of 1.43 (95% confidence interval 1.36–1.51) for inner regional areas relative to major cities; there was no evidence of variation in rates of new use by social disadvantage. Conclusion: About half of new oxycodone use in NSW was preceded by a recent episode of hospital care or a therapeutic procedure. Higher rates of oxycodone initiation in rural and regional areas were not explained by sociodemographic factors. [ABSTRACT FROM AUTHOR]

Objectives: As general practice increasingly moves towards large group practices, there is debate about the relative benefits, safety and sustainability of different care delivery models. This study investigates the performance of single-handed practices compared to practices with multiple doctors in England, UK. Methods: Practices in England with more than 1000 patients were included. Workforce data and a quality control process classified practices as single-handed or multiple-handed. Outcomes were (i) GP patient survey scores measuring access, continuity, confidence in health professional and overall satisfaction; (ii) reported diabetes and hypertension outcomes; and (iii) emergency department presentation rates and cancer detection (percentage of cancers diagnosed by a 2-week wait). Generalised linear models, controlling for patient and practice characteristics, compared outcomes in single and multiple-handed practices and assessed the effect of GP age in single-handed practices. Results: Single-handed practices were more commonly found in areas of high deprivation (41% compared to 20% of multiple-handed practices). Single-handed practices had higher patient-reported access, continuity and overall satisfaction but slightly lower diabetes management and cancer detection rates. Emergency department presentations were higher when controlling for patient characteristics in single-handed practices but not when also controlling for practice rurality and size. Increased deprivation was associated with lower performance in seven out of eight outcomes. Conclusions: We found single-handed practices to be associated with high patient satisfaction while performing slightly less well on selected clinical outcomes. Further research is required to better understand the association between practice size, including increasing multidisciplinary working, on patient experience and outcomes. [ABSTRACT FROM AUTHOR]

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Background: Needle and syringe programs (NSP) are effective harm-reduction strategies against HIV and hepatitis C. Although skin, soft tissue, and vascular infections (SSTVI) are the most common morbidities in people who inject drugs (PWID), the extent to which NSP are clinically and cost-effective in relation to SSTVI in PWID remains unclear. The objective of this study was to model the clinical- and cost-effectiveness of NSP with respect to treatment of SSTVI in PWID. Methods: We performed a model-based, economic evaluation comparing a scenario with NSP to a scenario without NSP. We developed a microsimulation model to generate two cohorts of 100,000 individuals corresponding to each NSP scenario and estimated quality-adjusted life-years (QALY) and cost (in 2022 Canadian dollars) over a 5-year time horizon (1.5% per annum for costs and outcomes). To assess the clinical effectiveness of NSP, we conducted survival analysis that accounted for the recurrent use of health care services for treating SSTVI and SSTVI mortality in the presence of competing risks. Results: The incremental cost-effectiveness ratio associated with NSP was $70,278 per QALY, with incremental cost and QALY gains corresponding to $1207 and 0.017 QALY, respectively. Under the scenario with NSP, there were 788 fewer SSTVI deaths per 100,000 PWID, corresponding to 24% lower relative hazard of mortality from SSTVI (hazard ratio [HR] = 0.76; 95% confidence interval [CI] = 0.72–0.80). Health service utilization over the 5-year period remained lower under the scenario with NSP (outpatient: 66,511 vs. 86,879; emergency department: 9920 vs. 12,922; inpatient: 4282 vs. 5596). Relatedly, having NSP was associated with a modest reduction in the relative hazard of recurrent outpatient visits (HR = 0.96; 95% CI = 0.95–0.97) for purulent SSTVI as well as outpatient (HR = 0.88; 95% CI = 0.87–0.88) and emergency department visits (HR = 0.98; 95% CI = 0.97–0.99) for non-purulent SSTVI. Conclusions: Both the individuals and the healthcare system benefit from NSP through lower risk of SSTVI mortality and prevention of recurrent outpatient and emergency department visits to treat SSTVI. The microsimulation framework provides insights into clinical and economic implications of NSP, which can serve as valuable evidence that can aid decision-making in expansion of NSP services. [ABSTRACT FROM AUTHOR]

Background: We aimed to compare anticoagulation control and outcomes between usual medical care (UMC) and pharmacist-led anticoagulation services (PLAS) in patients receiving warfarin at the Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia. Methods: A quasi-experimental study was conducted, including 350 (66.7%) and 175 (33.3%) patients from the UMC and PLAS groups, respectively, from 525 patients. The time in therapeutic range (TTR) was determined using the Rosendaal method, with a TTR ≥ 65% set as the cut-off for optimal anticoagulation. The two-sample Wilcoxon rank-sum (Mann–Whitney U) test was used to compare continuous variables between groups. Categorical variables were compared between groups using Pearson's chi-square test or Fisher's exact test. Logistic regression and negative binomial regression analyses were conducted to identify the factors associated with suboptimal TTR and secondary outcomes, respectively, at the p values < 0.05, and 95% confidence interval (CI). Results: Compared with the UMC group, the patients in the PLAC group showed a significantly higher median (IQR) TTR [60.89% (43.5–74.69%) vs. 53.65% (33.92–69.14%), p < 0.001]. A significantly higher optimal TTR (≥ 65%) was achieved in the PLAC group (41.7% vs. 31.7%) than in the UMC group (p = 0.002). The odds of having a poor TTR were reduced by 43% (AOR = 0.57, 95% CI = 0.36–0.88, p = 0.01) among patients in the PLAC group compared to those in the UMC group. There were no statistically significant differences in the secondary outcomes between the groups, except for all-cause emergency visits (p = 0.003). The incidence of bleeding events decreased by 3% (IRR = 0.97, 95% CI = 0.96–0.99, p < 0.001) for every increase in INR monitoring frequency. The incidence of thromboembolic events increased by a factor of 15.13 (IRR = 15.13, 95% CI = 1.47–155.52, p = 0.02) among patients with a high-risk CHA2DS2-VASc score compared with those with a moderate score. Conclusion: Patients in the PLAC group had a significantly higher median TTR than those in the UMC group did. There were no statistically significant differences in the secondary outcomes between the groups, except for fewer all-cause emergency department visits in the PLAC group. [ABSTRACT FROM AUTHOR]

Background: Telemedicine use increased with the Covid-19 pandemic. The impact of telemedicine on resource use in pulmonary clinics is unknown. Methods: This retrospective cohort study identified adults with pulmonary clinic visits at the University of Miami Hospital and Clinics (January 2018-December 2021). The primary exposure was telemedicine versus in-person visits. Standard statistics were used to describe the cohort and compare patients stratified by visit type. Multivariable logistic regression models evaluated the association of telemedicine with resource use (primarily, computed tomography [CT] orders placed within 7 days of visit). Results: 21,744 clinic visits were included: 5,480 (25.2%) telemedicine and 16,264 (74.8%) in-person. In both, the majority were < 65-years-old, female, and identified as Hispanic white. Patients seen with telemedicine had increased odds of having CT scans ordered within 7 days (adjusted odds ratio [aOR] 1.34, [95% confidence interval 1.04–1.74]); and decreased odds of chest x-rays (aOR 0.37 [0.23–0.57]). Telemedicine increased odds of contact of any kind with our healthcare system within 30-days (aOR 1.56 [1.29–1.88]) and 90-days (aOR 1.39 [1.17–1.64]). Specifically, telemedicine visits had decreased odds of emergency department visits and hospitalizations (30 days: aOR 0.54 [0.38–0.76]; 90 days: aOR 0.68 [0.52–0.89]), but increased odds of phone calls and electronic health record inbox messages (30 days: aOR 3.44 [2.73–4.35]; 90 days: aOR 3.58 [2.95–4.35]). Conclusions: Telemedicine was associated with an increased odds of chest CT order with a concomitant decreased odds of chest x-ray order. Increased contact with the healthcare system with telemedicine may represent a larger time burden for outpatient clinicians. [ABSTRACT FROM AUTHOR]

Objective: Opioid stewardship interventions promote appropriate use of opioids. We synthesized evidence from recent studies on the effectiveness of opioid stewardship interventions in United States healthcare settings on opioid prescribing and clinical outcomes. Methods: We followed the Evidence-based Practice Center Program's rapid review processes. We searched PubMed and Cochrane for original studies meeting specified inclusion criteria from January 2016 (correlating with the Centers for Disease Control and Prevention Pain Guidelines) to April 2023, supplemented by gray literature searches. Findings: Our search identified 13 randomized controlled trials and 6 nonrandomized studies. Randomized controlled trials addressed interventions involving multiple components (typically combining prescriber education, care management, and facilitated access to resources), clinical decision support (CDS) or electronic health records (EHR), and patient education and engagement, mainly in ambulatory chronic pain. Multicomponent interventions and opioid stewardship practices involving CDS or EHR were associated with decreased opioid prescribing or reduced doses and no increases in pain, emergency department visits, or hospitalizations (low strength of evidence for all outcomes). Patient engagement and education interventions had mixed results for opioid prescribing outcomes (insufficient strength of evidence) and no increases in pain, emergency department visits, or hospitalizations (low strength of evidence). Conclusions: Selected opioid stewardship interventions may be effective for reducing opioid prescribing without adversely affecting clinical outcomes. Interventions to reduce opioid prescribing should monitor unintended consequences and include access to nonpharmacological pain management resources with patient education and engagement. [ABSTRACT FROM AUTHOR]