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BACKGROUND: Given the complexity of arthroscopic rotator cuff repair (ARCR) and increasing prevalence, there is a need for comprehensive, large-scale studies that investigate potential correlations between surgeon-specific factors and postoperative outcomes after ARCR. This study examines how surgeon-specific factors including case volume, career length, fellowship training, practice setting, and regional practice impact two-year reoperation rates, conversion to total shoulder arthroplasty (anatomic or reverse), and 90-day post-ARCR hospitalization. METHODS: The PearlDiver Mariner database was used to collect surgeon-specific variables and query patients who underwent ARCR from 2015 to 2018. Patient outcomes were tracked for two years, including reoperations, hospitalizations, and International Classification of Diseases, Tenth Revision codes for revision rotator cuff repair (RCR) laterality. Hospitalizations were defined as any emergency department (ED) visit or hospital readmission within 90 days after primary ARCR. Surgeon-specific factors including surgeon case volume, career length, fellowship training, practice setting, and regional practice were analyzed in relation to postoperative outcomes using both univariate and multivariate logistic regression. RESULTS: 94,150 patients underwent ARCR by 1489 surgeons. On multivariate analysis, high-volume surgeons demonstrated a higher risk for two-year total reoperation (odds ratio [OR] = 1.06, 95% confidence interval [CI]: 1.01-1.12, P = .03) and revision RCR (OR = 1.06, 95% CI: 1.01-1.12, P = .02) compared to low-volume surgeons. Early-career surgeons showed higher rates of 90-day ED visits (mid-career surgeons: OR = 0.78, 95% CI: 0.73-0.83, P

Revision total hip arthroplasty (THA) and total knee arthroplasty (TKA) tremendously burden hospital resources. This study evaluated factors influencing perioperative costs, including emergency department (ED) visits, readmissions, and total costs-of-care within 90 days following revision surgery. A retrospective analysis of 772 revision TKAs and THAs performed on 630 subjects at a single center between January 2007 and December 2019 was conducted. Cost data were available from January 2015 to December 2019 for 277 patients. Factors examined included comorbidities, demographic information, preoperative Anesthesia Society of Anesthesiologists score, implant selection, and operative indication using mixed-effects linear regression models. Among 772 revisions (425 THAs and 347 TKAs), 213 patients required an ED visit, and 90 required hospital readmission within 90 days. There were 22.6% of patients who underwent a second procedure after their initial revision. Liver disease was a significant predictor of ED readmission for THA patients (multivariable odds ratio [OR]: 3.473, P =.001), while aseptic loosening, osteolysis, or instability significantly reduced the odds of readmission for TKA patients (OR: 0.368, P =.014). In terms of ED visits, liver disease increased the odds for THA patients (OR: 1.845, P =.100), and aseptic loosening, osteolysis, or instability decreased the odds for TKA patients (OR: 0.223, P <.001). Increased age was associated with increased costs in both THA and TKA patients, with significant cost factors including congestive heart failure for TKA patients (OR: $7,308.17, P =.004) and kidney disease for THA patients. Revision surgeries took longer than primary ones, with TKA averaging 3.0 hours (1.6 times longer) and THA 2.8 hours (1.5 times longer). Liver disease increases ED readmission risk in revision THA, while aseptic loosening, osteolysis, or instability decreases it in revision TKA. Increased age and congestive heart failure are associated with increased costs. These findings inform postoperative care and resource allocation in revision arthroplasty. Economic and Decision Analysis, Level IV. [ABSTRACT FROM AUTHOR]

Objective: To assess the correlation between atmospheric pollutants, meteorological factors, and emergency department visits for respiratory diseases in Haikou City. Methods: Daily data on atmospheric pollutants, meteorological factors, and emergency department visits for respiratory diseases in Haikou City from 2018 to 2021 were collected. The Spearman rank correlation test was used to analyze the correlation, and a distributed lag non-linear model was employed to analyze the health effects and lag impacts of environmental factors. Subgroup analyses were conducted based on sex and age. Results: According to the criteria of International Classification of Diseases (ICD-10: J00-J99), a total of 221 913 cases were included, accounting for 21.3% of the total emergency department visits in Haikou City. For every 1 °C increase in temperature, the risk of emergency department visits increased by 1.029% (95% CI 1.016%-1.042%). Relative humidity greater than 80% reduced the risk of visits, while higher atmospheric pressure (>1 010 hpa) also decreased the likelihood of daily emergency department visits. Higher concentrations of PM25 (30-50 μg/m3), PM10 (>60 μg/m3), and O3 (75-125 μg/m3) were associated with increased visits. Higher temperatures (>25 °C) have a greater impact on females and children aged 0-14 years, while males are more sensitive to low atmospheric pressure. Individuals aged 65 and above exhibited increased sensitivity to O3 concentration, and the effects of PM2.5, PM10, and O3 are more pronounced in individuals over 14 years old. Conclusions: Short-term exposure to high temperatures, particulate matter pollutants (PM25 and PM10), and ozone (O3) is associated with increased emergency department visits for respiratory diseases.

Background: Given the complexity of arthroscopic rotator cuff repair (ARCR) and increasing prevalence, there is a need for comprehensive, large-scale studies that investigate potential correlations between surgeon-specific factors and postoperative outcomes after ARCR. This study examines how surgeon-specific factors including case volume, career length, fellowship training, practice setting, and regional practice impact two-year reoperation rates, conversion to total shoulder arthroplasty (anatomic or reverse), and 90-day post-ARCR hospitalization. Methods: The PearlDiver Mariner database was used to collect surgeon-specific variables and query patients who underwent ARCR from 2015 to 2018. Patient outcomes were tracked for two years, including reoperations, hospitalizations, and International Classification of Diseases, Tenth Revision codes for revision rotator cuff repair (RCR) laterality. Hospitalizations were defined as any emergency department (ED) visit or hospital readmission within 90 days after primary ARCR. Surgeon-specific factors including surgeon case volume, career length, fellowship training, practice setting, and regional practice were analyzed in relation to postoperative outcomes using both univariate and multivariate logistic regression. Results: 94,150 patients underwent ARCR by 1489 surgeons. On multivariate analysis, high-volume surgeons demonstrated a higher risk for two-year total reoperation (odds ratio [OR] = 1.06, 95% confidence interval [CI]: 1.01-1.12, P = .03) and revision RCR (OR = 1.06, 95% CI: 1.01-1.12, P = .02) compared to low-volume surgeons. Early-career surgeons showed higher rates of 90-day ED visits (mid-career surgeons: OR = 0.78, 95% CI: 0.73-0.83, P

Background: Supportive oncology (SO) care reduces symptom severity, admissions, and costs in patients with advanced cancer. This study examines the impact of SO care on utilization and costs. Methods: Retrospective analysis of utilization and costs comparing patients enrolled in SO versus three comparison cohorts who did not receive SO. Using claims, the authors estimated differences in health care utilization and cost between the treatment group and comparison cohorts. The treatment group consisting of patients treated for cancer at an National Cancer Institute‐designated cancer center who received SO between January 2018 and December 2019 were compared to an asynchronous cohort that received cancer care before January 2018 (n = 60), a contemporaneous cohort with palliative care receiving SO care from other providers in the Southeastern Pennsylvania region during the program period (n = 86), and a contemporaneous cohort without palliative care consisting of patients at other cancer centers who were eligible for but did not receive SO care (n = 393). Results: At 30, 60, and 90 days post‐enrollment into SO, the treatment group had between 27% and 70% fewer inpatient admissions and between 16% and 54% fewer emergency department visits (p <.05) compared to non‐SO cohorts. At 90 days following enrollment in SO care, total medical costs were between 4.4% and 24.5% lower for the treatment group across all comparisons (p <.05). Conclusions: SO is associated with reduced admissions, emergency department visits, and total costs in advanced cancer patients. Developing innovative reimbursement models could be a cost‐effective approach to improve care of patients with advanced cancer. Patients who received supportive oncology (SO) care had significantly fewer inpatient admissions, emergency department visits, and lower total medical costs compared to three comparison cohorts of cancer patients who did not receive SO care. [ABSTRACT FROM AUTHOR]

Barriers to quality improvement (QI) initiatives in multi-institutional hospital settings are understudied. Here we describe a qualitative investigation of factors negatively affecting a QI initiative focused on reducing avoidable emergency department (ED) visits after bariatric surgery across 17 hospitals. Our goal was to explore participant perspectives and identify themes describing why the program was not effectively implemented or why the program may have been ineffective when correctly implemented. We performed semistructured group interviews with 17 sites (42 interviews) participating in a statewide bariatric QI program. We used descriptive content analysis to identify challenges, facilitators, and barriers to implementation of the QI program. All analyses were conducted using MAXQDA software. Results revealed barriers across hospitals related to four themes: buy-in, provider accessibility, resources at participating hospitals, and patient barriers to care. In particular, the initiative faced difficulty if it was not well-matched to the factors driving increasing ED visits at a particular site, such as lack of patient access to outpatient or primary care. Additional challenges occurred if the initiative was not adapted and customized to the working systems in place at each site, involving employees, surgeons, support staff, and leadership. Overall, findings can direct future focused efforts aimed at site-specific interventions to reduce unnecessary postoperative ED visits. Results demonstrated a need for a nuanced approach that can be adapted based on facility needs and resources. [ABSTRACT FROM AUTHOR]

To address pediatric asthma disparities on the South Side of Chicago, a community health worker (CHW) home visiting intervention was implemented collaboratively by academic institutions and community based health centers. This evaluation assessed the effectiveness of this longitudinal quality improvement CHW intervention in reducing asthma morbidity and healthcare utilization. All patients aged 2–18 who met the high-risk clinical criteria in outpatient settings or those who visited the ED due to asthma were offered the program. A within-subject study design analyzed asthma morbidity and healthcare utilization at baseline and follow-up. Multivariable mixed-effects regression models, adjusted for baseline demographic and asthma characteristics, were used to assess changes over time. Among 123 patients, the average age was 8.8 (4.4) years, and 89.3% were non-Hispanic black. Significant reductions were observed in the average daytime symptoms days (baseline 4.1 days and follow-up 1.6 days), night-time symptoms days (3.0 days and 1.2 days), and days requiring rescue medication (4.1 days and 1.6 days) in the past two weeks (all p < 0.001). The average number of emergency department visits decreased from 0.92 one year before to 0.44 one year after program participation, a 52% reduction (p < 0.001). No significant difference was found in hospital admissions. These results support the use of a collaborative approach to implement the CHW home visiting program as part of standard care for pediatric asthma patients in urban settings. This approach has the potential to reduce asthma disparities and underscores the valuable role of CHWs within the clinical care team. [ABSTRACT FROM AUTHOR]

Objective: The elderly population is increasing worldwide and in Turkish society due to increased life expectancy, decreased mortality rate, and developments in medicine. This situation, together with the aging society, brings with it the need for quality long-term care of geriatric patients and the effective use of ethical principles such as autonomy, justice, and non-maleficence by considering a holistic ethical approach in elderly care. In this study, we aimed to determine the demographic and general characteristics of geriatric patients admitted to the emergency department (ED) and to compare the ED admissions of those who benefit from Home Health Services (HHS) with those who do not use this service. Materials and Methods: The study was conducted as a retrospective file review in the ED of a district state hospital, taking into account that there is only one ED in the district, and HHS patients cannot apply to another emergency department. It was aimed to access the data of all patients aged 65 years and over who applied to the ED within 1 year. Results: It was found that 11.4% (n=13,261) of 116,263 examinations performed in the ED within one year belonged to individuals in the geriatric age group. The median age of the patients admitted to the ED who were registered to HHS was 77 (65-101), while the median age of those who were not registered was 72 (65-107). Conclusion: Many results obtained in this study, especially the fact that the rate of repeated admissions, which is an important indicator for the health system and the ED, is higher in geriatric patients enrolled in HHS, indicate that there is a relationship between HHS and ED admissions. This suggests that making HHS and home care practices more efficient may reduce geriatric patients' ED visits. [ABSTRACT FROM AUTHOR]

Background: Deprescribing is the planned/supervised method of dose reduction or cessation of medications that might be harmful, or no longer be beneficial. Though benefits of deprescribing are debatable in improving clinical outcomes, it has been associated with decreased number of potentially inappropriate medications, which may potentially reduce the risk of adverse events among hospitalized older adults. With unclear evidence for deprescribing in this population, this study aimed to examine time‐to‐first unplanned healthcare utilization, which included 90‐day emergency department (ED) visits or hospital readmission and associated predictors, during a deprescribing intervention. Methods: A secondary data analysis of a clinical trial (Shed‐MEDS NCT02979353) was performed. Cox regression was used to compare the time‐to‐first 90‐day ED visit/readmission/death from hospital discharge for the intervention and control groups. Additionally, we performed exploratory analysis of predictors (comorbidities, functional health status, drug burden index (DBI), hospital length of stay, health literacy, food insecurity, and financial burden) associated with the time‐to‐first 90‐day ED visit/readmission/death. Results: The hazard of first 90‐day ED visits/readmissions/death was 15% lower in the intervention versus the control group (95% CI: 0.61–1.19, p = 0.352, respectively); however, this difference was not statistically significant. For every additional number of comorbidities (Hazard ratio (HR): 1.12, 95% CI: 1.04–1.21) and each additional day of hospital length of stay (HR: 1.04, 95% CI: 1.01–1.07) were significantly associated with a higher hazard of 90‐day ED visit/readmission/death in the intervention group; whereas for each unit of increase in pre‐hospital DBI score (HR: 1.08 and HR 1.16, respectively) was significantly associated with a higher hazard of 90‐day ED visit/readmission/death in the control group. Conclusions: The intervention and control groups had comparable time‐to‐first 90‐day ED visit/readmission/death during a deprescribing intervention. This finding suggests that deprescribing did not result in a higher risk of ED visit/readmission/death during the 90‐day period following hospital discharge. [ABSTRACT FROM AUTHOR]

Background/Aim: Chronic obstructive pulmonary disease (COPD) is a major public health concern, affecting over 200 million people worldwide in 2019. The prevalence of COPD has risen by 40% from 1990 to 2010 and continued to increase by 13% from 2010 to 2019, causing over 3 million deaths globally in 2019, ranking it as the third leading cause of death. This study explored how daily weather changes relate to the number of COPD-related emergency department (ED) visits. Materials and Methods: We collected data on daily COPD-related ED visits in 2017 in Pécs along with corresponding meteorological data to analyze this connection. Results: High diurnal temperature range (DTR) and day-to-day variability in dew point were linked to a 4.5% increased risk of more COPD-related ED visits. Notably, DTR had a stronger impact on males, contributing to a 6.3% increase, while dew point variability significantly affected males with an odds ratio (OR) of 1.083. (OR=1.083). Stratifying by age revealed heightened risks for those aged 30-39 (43.5% increase) and 50-59 (7.6% increase). Females aged 30-39 and 50-59 faced elevated risks of 42.7% and 9.1%, respectively, whereas males aged 60-69 showed a 9.8% increase. Conclusion: Our findings highlight the influence of weather variations on COPDrelated ED visits, with nuanced effects based on age and sex. [ABSTRACT FROM AUTHOR]

Background: Same-day discharge after colorectal surgery in enhanced recovery pathways is increasing. This study aimed to determine if discharge on postoperative days (POD) one or two is associated with increased rates of emergency department (ED) visits and hospital readmissions after left and right colectomy. Methods: Single institution retrospective analysis of prospective institutional colorectal surgery database between 07/01/2018 and 07/15/2022. Primary outcomes were ED visit and readmission rates for enhanced recovery open and minimally invasive right and left colectomy using logistic regressions models. Results: 820 patients met inclusion criteria. There were significant differences in discharge-day by diagnosis—58.5% of patients with Crohn's disease were discharged on POD ≥4 and 21.6% with benign colon neoplasia were discharged on POD-0-1 (P <.001). ED visits occurred in 12.9% of the study population and were not significantly different between discharge-day groups (P =.096). Overall readmission rate was 8.5% and significantly different between discharge-day groups (0% POD-0 vs 8.3% POD-1 vs 5.8% POD-2 vs 6.9% POD-3 vs 12.9% POD ≥4, P =.041). Logistic regression showed that ED visits and readmissions for longer discharge-days (POD-2, POD-3, POD ≥4) were not significantly different than POD-0-1. Readmission diagnoses for the study population were higher for ileus (17.1%) and surgical site infection (SSI) type-III (22.9%) than for acute kidney injury (1.4%) and SSI type-I/II (1.4%). Conclusion: Early discharge after left and right colectomy is not associated with increased rates of ED visits and readmissions. Same-day discharge may be feasible in selected enhanced recovery patients. Standardized post-discharge resources that safely allow same-day discharge require further investigation. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: What is the difference in the frequency of transfers to hospital between German and Dutch nursing home residents? Findings: In German nursing homes, residents are transported to hospital more often than in the Netherlands (e.g., at least one emergency department visit during last year: 26.5% vs. 7.9%, p < 0.0001). General practitioners in Germany are less involved in the transfer decision than elder care physicians in the Netherlands. Message: The differences are probably mainly due to differences in the health and care systems (e.g., very strong gatekeeper function of the general practitioner/elder care physician in the Netherlands). Purpose: Assessing and comparing German and Dutch nursing home perspectives on residents' hospital transfers. Methods: Cross-sectional study among German and Dutch nursing homes. Two surveys were conducted in May 2022, each among 600 randomly selected nursing homes in Germany and the Netherlands. The questionnaires were identical for both countries. The responses were compared between the German and Dutch participants. Results: We received 199 German (response: 33.2%) and 102 Dutch questionnaires (response: 17.0%). German nursing homes estimated the proportion of transfers to hospital during 1 year to be higher than in Dutch facilities (emergency department visits: 26.5% vs. 7.9%, p < 0.0001; hospital admissions: 29.5% vs. 10.5%, p < 0.0001). In German nursing homes, the proportion of transfers to hospital where the decision was made by the referring physician was lower than in the Dutch facilities (58.8% vs. 88.8%, p < 0.0001). More German nursing homes agreed that nursing home residents are transferred to the hospital too frequently (24.5% vs. 10.8%, p = 0.0069). German nursing homes were much more likely than Dutch facilities to believe that there was no alternative to transfer to a hospital when a nursing home resident had a fall (66.3% vs. 12.8%, p < 0.0001). Conclusion: German nursing home residents are transferred to hospital more frequently than Dutch residents. This can probably be explained by differences in the care provided in the facilities. Future studies should, therefore, look more closely at these two systems and examine the extent to which more intensive outpatient care can avoid transfers to hospital. [ABSTRACT FROM AUTHOR]

Abstract Background Although the association between ambient temperature and mortality of respiratory diseases was numerously documented, the association between various ambient temperature levels and respiratory emergency department (ED) visits has not been well studied. A recent investigation of the association between respiratory ED visits and various levels of ambient temperature was conducted in Beijing, China. Methods Daily meteorological data, air pollution data, and respiratory ED visits data from 2017 to 2018 were collected in Beijing. The relationship between ambient temperature and respiratory ED visits was explored using a distributed lagged nonlinear model (DLNM). Then we performed subgroup analysis based on age and gender. Finally, meta-analysis was utilized to aggregate the total influence of ambient temperature on respiratory ED visits across China. Results The single-day lag risk for extreme cold peaked at a relative risk (RR) of 1.048 [95% confidence interval (CI): 1.009, 1.088] at a lag of 21 days, with a long lag effect. As for the single-day lag risk for extreme hot, a short lag effect was shown at a lag of 7 days with an RR of 1.076 (95% CI: 1.038, 1.114). The cumulative lagged effects of both hot and cold effects peaked at lag 0–21 days, with a cumulative risk of the onset of 3.690 (95% CI: 2.133, 6.382) and 1.641 (95% CI: 1.284, 2.098), respectively, with stronger impact on the hot. Additionally, the elderly were more sensitive to ambient temperature. The males were more susceptible to hot weather than the females. A longer cold temperature lag effect was found in females. Compared with the meta-analysis, a pooled effect of ambient temperature was consistent in general. In the subgroup analysis, a significant difference was found by gender. Conclusions Temperature level, age-specific, and gender-specific effects between ambient temperature and the number of ED visits provide information on early warning measures for the prevention and control of respiratory diseases.

Abstract Introduction Estimating respiratory syncytial virus (RSV) burden in adults is challenging because of non-specific symptoms, infrequent standard-of-care testing, resolution of viral shedding before seeking medical care, test positivity that varies by specimen site in the upper airway and lower diagnostic test sensitivity compared to children. Conducting prospective observational studies to assess RSV burden in adults is time- and resource-intensive. Thus, model-based approaches can be applied using existing data to obtain more accurate estimates of RSV burden. This protocol establishes essential elements for estimating RSV incidence rate in adults using a time series model-based approach. It can be tailored to specific databases and applied globally across countries, enabling estimation of local RSV disease burden to inform public health decision-making, including immunization policy. Methods Data are analysed using a quasi-Poisson regression model, considering the effect of baseline trends and pathogen co-circulation, stratified by age and risk status. Pathogen co-circulation is represented by viral proxies defined based on ICD code groupings indicating RSV and influenza-specific hospitalizations, lagged 0 up to 4 weeks based on the model selection. A final model is constructed in two steps: optimization of the time trend (using p-values) and selection of the viral proxy lag time (using test statistics, to prioritize the most biologically plausible option). The yearly incidence rate and percentage of events attributable to RSV are estimated from the final model. Confidence intervals are calculated using residual bootstrapping. Planned Outcomes Outcomes to be modelled are based on administrative ICD code groupings and include the number of cardiorespiratory, respiratory and cardiovascular events in a specific care setting (e.g., general practitioner visit, emergency department visit, hospitalization and death). Cardiovascular events are limited to those for which existing evidence suggests an association with RSV infection. Additional secondary outcomes are constructed as a subset of the primary outcomes based on specific ICD code groups.

ObjectiveTo investigate the differential associations of homelessness with emergency department (ED) visits and hospitalizations by race, ethnicity, and gender.Data sourcesCalifornia Medicaid enrollment and claims.Study designWe identified beneficiaries experiencing homelessness (BEH) and those who did not (NBEH) using diagnosis and place of service codes and residential addresses. Outcomes include four ED visit measures and four hospitalization measures. We compared the use of these services by BEH to NBEH overall and by race, ethnicity, and gender groups in regression models controlling for covariates.Data collectionWe used a sample of Medicaid beneficiaries who met eligibility criteria for a California Medicaid demonstration program in 2017 and 2018 but were not enrolled in the program. We identified 473,069 BEH, and the rest (1,948,422) were considered NBEH. We used the 2018 data for utilization analyses and most covariates. We constructed lagged measures of health conditions using 2017 data.Principal findingsWe found that homelessness was significantly associated with 0.34 more ED visits (p

Background: Although the association between ambient temperature and mortality of respiratory diseases was numerously documented, the association between various ambient temperature levels and respiratory emergency department (ED) visits has not been well studied. A recent investigation of the association between respiratory ED visits and various levels of ambient temperature was conducted in Beijing, China. Methods: Daily meteorological data, air pollution data, and respiratory ED visits data from 2017 to 2018 were collected in Beijing. The relationship between ambient temperature and respiratory ED visits was explored using a distributed lagged nonlinear model (DLNM). Then we performed subgroup analysis based on age and gender. Finally, meta-analysis was utilized to aggregate the total influence of ambient temperature on respiratory ED visits across China. Results: The single-day lag risk for extreme cold peaked at a relative risk (RR) of 1.048 [95% confidence interval (CI): 1.009, 1.088] at a lag of 21 days, with a long lag effect. As for the single-day lag risk for extreme hot, a short lag effect was shown at a lag of 7 days with an RR of 1.076 (95% CI: 1.038, 1.114). The cumulative lagged effects of both hot and cold effects peaked at lag 0–21 days, with a cumulative risk of the onset of 3.690 (95% CI: 2.133, 6.382) and 1.641 (95% CI: 1.284, 2.098), respectively, with stronger impact on the hot. Additionally, the elderly were more sensitive to ambient temperature. The males were more susceptible to hot weather than the females. A longer cold temperature lag effect was found in females. Compared with the meta-analysis, a pooled effect of ambient temperature was consistent in general. In the subgroup analysis, a significant difference was found by gender. Conclusions: Temperature level, age-specific, and gender-specific effects between ambient temperature and the number of ED visits provide information on early warning measures for the prevention and control of respiratory diseases. Highlights: 1. Cold weather had a longer lag time and hot weather had a shorter lag time but a stronger effect. 2. Extreme temperatures had a greater effect on emergency room visits for respiratory disease than moderate temperatures. 3. The elderly population were more sensitive to cold and hot weather. [ABSTRACT FROM AUTHOR]

Introduction: Therapeutic alliance (TA), or the extent to which patients feel a sense of caring and trust with their physician, may have an impact on health care utilization. We sought to determine if TA is associated with: (1) emergency department (ED) visits within 30 days of death and (2) hospice enrollment. Methods and Materials: This is a secondary analysis of data from a randomized clinical trial. We used restricted cubic splines to assess the relationship between TA scores and health care utilization. Results: Six hundred seventy-two patients were enrolled in the study, with 331 (49.3%) dying within 12 months. Patients with higher TA were less likely to have an ED visit in the last 30 days of life, but there was no evidence of a relationship between TA and enrollment in hospice. Conclusions: Higher TA was associated with decreased ED visits within 30 days of death. There was no association between TA and rates of hospice enrollment. Clinical Registration Number: NCT02712229. [ABSTRACT FROM AUTHOR]

Introduction: Estimating respiratory syncytial virus (RSV) burden in adults is challenging because of non-specific symptoms, infrequent standard-of-care testing, resolution of viral shedding before seeking medical care, test positivity that varies by specimen site in the upper airway and lower diagnostic test sensitivity compared to children. Conducting prospective observational studies to assess RSV burden in adults is time- and resource-intensive. Thus, model-based approaches can be applied using existing data to obtain more accurate estimates of RSV burden. This protocol establishes essential elements for estimating RSV incidence rate in adults using a time series model-based approach. It can be tailored to specific databases and applied globally across countries, enabling estimation of local RSV disease burden to inform public health decision-making, including immunization policy. Methods: Data are analysed using a quasi-Poisson regression model, considering the effect of baseline trends and pathogen co-circulation, stratified by age and risk status. Pathogen co-circulation is represented by viral proxies defined based on ICD code groupings indicating RSV and influenza-specific hospitalizations, lagged 0 up to 4 weeks based on the model selection. A final model is constructed in two steps: optimization of the time trend (using p-values) and selection of the viral proxy lag time (using test statistics, to prioritize the most biologically plausible option). The yearly incidence rate and percentage of events attributable to RSV are estimated from the final model. Confidence intervals are calculated using residual bootstrapping. Planned Outcomes: Outcomes to be modelled are based on administrative ICD code groupings and include the number of cardiorespiratory, respiratory and cardiovascular events in a specific care setting (e.g., general practitioner visit, emergency department visit, hospitalization and death). Cardiovascular events are limited to those for which existing evidence suggests an association with RSV infection. Additional secondary outcomes are constructed as a subset of the primary outcomes based on specific ICD code groups. [ABSTRACT FROM AUTHOR]

We estimate the impact of the Affordable Care Act (ACA) on emergency department (ED) visits and the composition of insurance coverage for White, Black, and Hispanic older adults. Our estimation strategy uses changes in the discontinuity of health insurance coverage at age 65 and the variation in state decisions about Medicaid expansion under the ACA. We find that uninsured ED visits decreased for older adults in all three racial and ethnic groups in Medicaid expansion and non-expansion states. The magnitude of the decreases varied from four visits per 1,000 people among White older adults in non-expansion states to 23 visits per 1,000 people among Black and Hispanic older adults in expansion states. The insurance coverage gains came primarily from Medicaid in expansion states and private insurance in non-expansion states, regardless of race or ethnicity. We find suggestive evidence of increased ED visits for Black and Hispanic populations that had low insurance coverage rates before 2014. [ABSTRACT FROM AUTHOR]

More than 1 in 5 older Americans live in rural areas (10.6 million of the 46.2 million aged 65 and older). Long-term care for aging rural populations is a growing challenge in the United States. Research on long-term care services in nonmetro areas has focused almost exclusively on nursing home care, despite growth of residential care alternatives. This paper uses unique facility-level data from the 2020 National Post-acute and Long-term Care Study (NPALS) to examine the relationship of residential care community (RCC) features in metro and nonmetro settings with adverse outcomes (emergency department visits, overnight hospital stays, and falls). Nationally, in 2020, about 13.5% of RCC residents made visits to the emergency department, 8.6% had overnight hospital stays, and 21.3% had falls. Controlling for facility characteristics, RCCs in metro areas had higher risks of overnight hospital stays (p <.001) but lower risks of falls (p =.06). [ABSTRACT FROM AUTHOR]

Abstract Background An integrated practice unit (IPU) that provides a multidisciplinary approach to patient care, typically involving a primary care provider, registered nurse, social worker, and pharmacist has been shown to reduce healthcare utilization among high-cost super-utilizer (SU) patients or multi-visit patients (MVP). However, less is known about differences in the impact of these interventions on insured vs. uninsured SU patients and super high frequency SUs ( $$\ge$$ 8 ED visits per 6 months) vs. high frequency SUs (4–7 ED visits per 6 months). Methods We assessed the percent reduction in ED visits, ED cost, hospitalizations, hospital days, and hospitalization costs following implementation of an IPU for SUs located in an academic tertiary care facility. We compared outcomes for publicly insured with uninsured patients, and super high frequency SUs with high frequency SUs 6 months before vs. 6 months after enrollment in the IPU. Results There was an overall 25% reduction in hospitalizations (p

Background and Objectives: The coronavirus disease 2019 (COVID-19) pandemic has profoundly impacted healthcare systems worldwide. To assess the effects of the pandemic on pediatric emergency department (ED) visits in Taiwan, we conducted a study to evaluate changes in pediatric ED visits during the COVID-19 pandemic. Materials and Methods: This retrospective study included pediatric patients (age ≤ 18) who visited the ED between 21 January 2019 and 30 April 2019, at three hospitals of the Cathay Health System, and compared them with a corresponding period in 2020. Basic information, including mode of arrival, triage level, disposition, chief complaints, and incidence rates, were analyzed before and during the pandemic. Results: A total of 10,116 patients, with 6009 in the pre-pandemic group and 4107 in the pandemic group, were included in this study. The mean number of daily pediatric ED visits decreased from 60.09 before the pandemic to 40.66 during the pandemic, while ambulance use increased significantly by 2.56%. The percentage of patients with high acuity triage levels (levels 1 and 2) was significantly lower during the pandemic period (0.63% and 10.18%, respectively) than the pre-pandemic period (0.7% and 10.9%, respectively). Additionally, a significantly higher proportion of patients were discharged during the pandemic period (89.36%) than during the pre-pandemic period (88.33%). The proportion of COVID-19-related complaints, such as fever and respiratory tract infections, as well as other complaints including gastrointestinal issues, trauma, and psychological problems, significantly increased during the pandemic. Conclusions: In preparation for future pandemics, we recommend increasing emergency medical service capacity, establishing a non-contagious route for obtaining chronic medication prescriptions, optimizing staff allocation in pediatric emergency departments, and increasing the number of hospital social workers for enhanced support. [ABSTRACT FROM AUTHOR]

Using daily variation in wind power generation in the western portion of Texas, we show that the resulting lower fossil fuel generation in the eastern portion of the state leads to air-quality improvements and, subsequently, to fewer emergency department (ED) visits. Spatially, the impact on pollution is widespread, but wind energy reduces ED admission rates more in zip codes closer to coal plants. Using intra-day wind generation and electricity pricing data, we find that more wind generation coming from hours when congestion on the electricity grid is less leads to higher reductions in emissions from east Texas power plants and PM2.5 concentrations and ED admission rates in east Texas. Comparing wind generation effects across low-demand night hours to higher-demand day hours, more NO X and SO 2 is offset by wind from night hours, but the time-dependent effects for PM2.5 concentrations and ED admission rates is much weaker, potentially due to differences in exposure. [ABSTRACT FROM AUTHOR]

Background: An integrated practice unit (IPU) that provides a multidisciplinary approach to patient care, typically involving a primary care provider, registered nurse, social worker, and pharmacist has been shown to reduce healthcare utilization among high-cost super-utilizer (SU) patients or multi-visit patients (MVP). However, less is known about differences in the impact of these interventions on insured vs. uninsured SU patients and super high frequency SUs ( 8 ED visits per 6 months) vs. high frequency SUs (4–7 ED visits per 6 months). Methods: We assessed the percent reduction in ED visits, ED cost, hospitalizations, hospital days, and hospitalization costs following implementation of an IPU for SUs located in an academic tertiary care facility. We compared outcomes for publicly insured with uninsured patients, and super high frequency SUs with high frequency SUs 6 months before vs. 6 months after enrollment in the IPU. Results: There was an overall 25% reduction in hospitalizations (p < 0.001), and 23% reduction in hospital days (p = 0.0045), when comparing 6 months before vs. 6 months after enrollment in the program. There was a 26% reduction in average total direct hospitalization costs per patient (p = 0.002). Further analysis revealed a greater reduction in health care utilization for uninsured SU patients compared with publicly insured patients. The program reduced hospitalizations for super high frequency SUs. However, there was no statistically significant impact on overall health care utilization of super high frequency SUs when compared with high frequency SUs. Conclusions: Our study supports existing evidence that dedicated IPUs for SUs can achieve significant reductions in acute care utilization, particularly for uninsured and high frequency SU patients. Trial Registration: IRB201500212. Retrospectively registered. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the relationship between community-level economic deprivation, as measured by the Distressed Communities Index (DCI) and ED visits on account of firearm injuries (assaults and unintentional). Methods: A retrospective analysis was conducted using the Maryland State Emergency Department Databases (SEDD) from January 2019 to December 2020 to explore the association between the DCI and ED visits because of firearm injuries (assaults and unintentional). The DCI utilizes 7 variables, based on zip codes, generating 5 levels of socioeconomic distress (prosperous, comfortable, mid-tier, at-risk, and distressed). In a multivariate analysis, we adjusted for age, sex, mental conditions, alcohol addiction, substance abuse, smoking, race/ethnicity, insurance type, and median income. Results: Of the 2725 ED visits for firearm injuries, 84.5% were Black and 88.5% male. The median age was 27 (21-35) years, and the mortality rate was 17.7%. A statistically significant association was found between economic deprivation and ED visits for firearm injuries. Compared to prosperous communities, the odds ratios (ORs) were comfortable (OR = 1.33, 95% CI 1.04-1.71, P = .03), mid-tier (OR = 1.69, 95% CI 1.33-2.15, P < .001), at-risk (OR = 1.53, 95% CI 1.17-1.99, P < .001), and distressed (OR = 2.65, 95% CI 2.11-3.33, P < .001). Discussion: The study highlights the significant association between community-level economic deprivation, as measured by the Distressed Communities Index, and the incidence of firearm injuries in Maryland. The findings underscore the importance of addressing socioeconomic disparities and implementing targeted interventions to reduce firearm-related injuries in economically distressed communities. [ABSTRACT FROM AUTHOR]

Background: Research on factors associated with recurrent emergency department (ED) visits and their implications for improving dementia care is lacking. The objective of this study was to examine associations between the individual characteristics of older adults living with dementia and recurrent ED visits. Methods: We used health administrative databases to conduct a population‐based retrospective cohort study among older adults with dementia in Ontario, Canada. We included community‐dwelling adults 66 years and older who visited the ED between April 1, 2010, and March 31, 2019 and were discharged home. We recorded all ED visits within one year after the baseline visit. We used recurrent event Cox regression to examine associations between repeat ED visits and individual clinical, demographic, and health service use characteristics. We fit conditional inference trees to identify the most important factors and define subgroups of varying risk. Results: Our cohort included 175,863 older adults with dementia. ED use in the year prior to baseline had the strongest association with recurrent visits (3+ vs.0 adjusted hazard ratio (aHR): 1.92 (1.89, 1.94), 2vs.0 aHR: 1.45 (1.43, 1.47), 1vs.0 aHR: 1.23 (1.21, 1.24)). The conditional inference tree utilized history of ED visits and comorbidity count to define 12 subgroups with ED revisit rates ranging from 0.79 to 7.27 per year. Older adults in higher risk groups were more likely to live in rural and low‐income areas and had higher use of anticonvulsants, antipsychotics, and benzodiazepines. Conclusions: History of ED visits may be a useful measure to identify older adults with dementia who would benefit from additional interventions and supports. A substantial proportion of older adults with dementia have a pattern of recurrent visits and may benefit from dementia‐friendly and geriatric‐focused EDs. Collaborative medication review in the ED and closer follow‐up and engagement with community supports could improve patient care and experience. See related editorial by Shah and Hwang in this issue. [ABSTRACT FROM AUTHOR]

Abstract Background Injury is a leading cause of preventable morbidity and mortality in the USA. Ongoing surveillance is needed to understand changing injury patterns to effectively target prevention efforts. Launched jointly in 2000 by the Consumer Product Safety Commission (CPSC) and the Centers for Disease Control and Prevention (CDC), the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) provides national-level estimates of US emergency department visits for nonfatal injuries. A scoping review of peer-reviewed articles was conducted to characterize how NEISS-AIP data have been used for injury surveillance in the USA. Main Body This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three bibliographic databases (PubMed, Scopus, and Google Scholar) were systematically searched for English language peer-reviewed articles that used NEISS-AIP data as the primary data source during 2001–2021. Key article characteristics from included articles were abstracted to generate descriptive summary statistics to understand the use and limitations of NEISS-AIP for injury surveillance. Database queries returned 6944 citations; 594 citations were manually reviewed, and 167 non-duplicate journal articles were identified. An average of 8.0 articles (range: 1–14) were published annually during 2001–2021. Articles appeared in 72 different journals representing a diverse audience with the majority of articles written by CDC authors. Starting in 2013, a higher proportion of articles were published by non-CDC authors. The largest number of articles examined injury among all age groups (n = 71); however, the pediatric population was the specific age group of greatest interest (n = 48), followed by older adults (n = 23). Falls (n = 20) and motor-vehicle-related injuries (n = 10) were the most studied injury mechanisms. The most commonly identified limitation identified by authors of reviewed articles was that NEISS-AIP only produces national estimates and therefore, cannot be used for state- or county-level injury surveillance (n = 38). Conclusions NEISS-AIP has contributed to nonfatal injury surveillance in the USA. CDC and CPSC continue to work together to expand and enhance NEISS-AIP data collection. Researchers are encouraged to continue using this publicly available dataset for injury surveillance.

Abstract Background Frequent emergency department (FED) visits by cancer patients represent a significant burden to the health system. This study identified determinants of FED in recently hospitalized cancer patients, with a particular focus on opioid use. Methods A prospective cohort discharged from surgical/medical units of the McGill University Health Centre was assembled. The outcome was FED use (≥ 4 ED visits) within one year of discharge. Data retrieved from the universal health insurance system was analyzed using Cox Proportional Hazards (PH) model, adopting the Lunn-McNeil approach for competing risk of death. Results Of 1253 patients, 14.5% became FED users. FED use was associated with chemotherapy one-year pre-admission (adjusted hazard ratio (aHR) 2.60, 95% CI: 1.80–3.70), ≥1 ED visit in the previous year (aHR: 1.80, 95% CI 1.20–2.80), ≥15 pre-admission ambulatory visits (aHR 1.54, 95% CI 1.06–2.34), previous opioid and benzodiazepine use (aHR: 1.40, 95% CI: 1.10–1.90 and aHR: 1.70, 95% CI: 1.10–2.40), Charlson Comorbidity Index ≥ 3 (aHR: 2.0, 95% CI: 1.2–3.4), diabetes (aHR: 1.60, 95% CI: 1.10–2.20), heart disease (aHR: 1.50, 95% CI: 1.10–2.20) and lung cancer (aHR: 1.70, 95% CI: 1.10–2.40). Surgery (cardiac (aHR: 0.33, 95% CI: 0.16–0.66), gastrointestinal (aHR: 0.34, 95% CI: 0.14–0.82) and thoracic (aHR: 0.45, 95% CI: 0.30–0.67) led to a decreased risk of FED use. Conclusions Cancer patients with higher co-morbidity, frequent use of the healthcare system, and opioid use were at increased risk of FED use. High-risk patients should be flagged for preventive intervention.

Abstract Background It is estimated that approximately 300,000 people are experiencing homelessness in England. The aim of this study was to evaluate key causes and long-term trends of emergency departments (EDs) and in hospital inpatient admissions of persons experiencing homelessness in England. Methods ED and hospital inpatient admissions data were obtained from Hospital Episode Statistics (HES) covering all National Health Service (NHS) England hospitals. Anyone identified or declared to be experiencing homelessness during the service usage are recorded in HES datasets. Data were extracted for the 10-year study period and compared to the general population, which includes all patients attending the ED or admitted to inpatient care in England. Results Drug- and alcohol-related causes contribute to the most frequent reasons for attendance and admissions of persons experiencing homelessness in the ED and inpatient respectively. A total of 30,406 ED attendances were recorded for persons experiencing homelessness in the year 2018/2019 (+ 44.9% rise vs 2009/10) of which injuries and poisoning respectively represented 21.8% and 17.9% of all persons experiencing homelessness presentations to the ED. Poisoning (including drug overdose) represented only 1.9% of all attendances by the general population during the same study year (rate ratio vs general populations 9.2 95% CI 9.0–9.4). High mortality rates were observed in relation to presentations attributed to drug- and alcohol-related causes. A total of 14,858 persons experiencing homelessness inpatient admissions were recorded in 2018/2019 (+ 68.6% vs 2009/2010). Psychoactive substance use constituted 12.7% of all admissions in 2018/2019 compared to 0.4% of in the general populations (rate ratio: 33.3, 95% CI: 31.9–34.7). There was a 44.3% rise in the number of admissions related to poisoning in the study period amongst persons experiencing homelessness in England (vs 14.2% in general population). Conclusion Marked disparities around primary causes of ED and inpatient admissions were identified between persons experiencing homelessness and the general population. There is a continued need for prevention measures to reduce the prevalence of drug and alcohol, injury and poisoning-related admissions to the ED, enhanced service provision at the community level, and multisector collaborations. These initiatives should maximise opportunities for early interventions and improve outcomes for persons experiencing homelessness, including increased accessibility of healthcare and mental health services, particularly in areas that demonstrate increasing ED and inpatient attendance rates over time.

Abstract Background and rationale As general health care is publicly funded in Canada and oral health care is not, many people seek care from hospitals for their dental problems. This study assessed if the unprecedented times of Coronavirus disease (COVID-19) affected the hospital visits for dental emergencies, making disadvantaged populations further vulnerable for attendance of their dental problems. Methods Data from IntelliHealth Ontario for emergency department (ED) visits, day surgery visits, and hospitalizations associated with non-traumatic dental conditions (NTDCs) were retrieved for years 2016 to 2020 to assess trends before COVID-19 and changes, if any, for the year 2020. Trends by month, for the years 2019 and 2020, to make straight comparisons and understand the effects of lockdown in Ontario, was also analyzed. Results In the year 2020, there was a reduction of 40% in day surgeries, 21% in ED visits and 8% in hospitalizations compared to 2019. Stratified by month, largest reductions were observed in April 2020: 96% in day surgeries; 50% in ED visits; and 38% reductions in hospitalizations when compared to the same month of 2019. In May 2020, day surgeries and ED visits though remained reduced, hospitalization rates increased by 31%. Conclusion Hospital EDs are inefficient avenues for handling dental emergencies. Nevertheless, they do remain a care setting that is sought by many for dental problems, and if the need for hospitalization and day surgery is there, this care setting is an important avenue for dentally related medical care. Perhaps unsurprisingly, COVID-19 has lessened the opportunity and capacity for such care. Practical implications Administrators and policy makers can utilize this information to strategize on augmenting community infrastructure for building more effective, and cost-efficient avenues of care for timely management of dental problems.

Abstract Background Opioid-related emergency department (ED) visits in Canada increased during the COVID-19 pandemic, but how trends in volume and case severity changed from pre-pandemic times through the pandemic is not known. Trends in ED visits related to specific types of opioids also remain unclear. Our objective was to describe pre-pandemic trends and how they changed with the onset of COVID-19 and thereafter. Methods Based on data from the Canadian Hospitals Injury Reporting and Prevention Program, we identified opioid-related ED visits and constructed a time series from March 12, 2018 through March 7, 2021—two pre-COVID periods and one COVID period. We used an interrupted time series (ITS) analysis to examine trends in volume and case severity. We compared medians and means of monthly counts and percentages of severe cases between the periods, by sex, age, and opioid type. Results Before the pandemic, there was an increasing trend in fentanyl-related visits for males, females and 25- to 64-year-olds, and a decreasing trend in heroin-related visits for males and 18- to 64-year-olds. Fentanyl-related visits for 18- to 24-year-olds showed an immediate increase at the start of the pandemic and a decreasing trend during the pandemic. Heroin-related visits for 12- to 17-year-olds had an immediate increase at the start of the pandemic; for 18- to 24-year-olds and 45- to 64-year-olds, the prior decreasing pre-pandemic trend ceased. For pooled opioid-related visits, no significant trend in the percentage of severe cases was observed throughout the entire study period. Conclusion This study shows that an ITS approach in trend analysis is a valuable supplement to comparisons of before and after measures (with or without controlling seasonal effects). The findings provide evidence on how ED presentations for opioid use evolved in Canada from 2018 to 2021. The results can inform policies designed to reduce opioid-related harm in the context of a public health emergency.

The urgent cancer care (UCC) clinic at CancerCare Manitoba (CCMB) opened in 2013 to provide care to individuals diagnosed with cancer and serious blood disorders experiencing complications from the underlying disorder or its treatment. This study examined the impact of the UCC clinic on other health care utilization in Winnipeg, Manitoba, Canada. An interrupted time series study design was used to compare the rates of emergency department (ED) visits, primary care clinician (PCC) visits, and hospitalizations from 1 January 2010 to 31 December 2015. Rates of ED visits were also stratified by ED location, severity, and cancer type. We found a 6% (95% CI 1.00–1.13, p-value = 0.0389) increase in PCC visits, a 7% (95% CI 0.99–1.15, p-value = 0.0737) increase in hospitalizations, a 4% (95% CI 0.86–1.08, p-value = 0.5053) decrease in the rate of ED visits, and a 3% (95% CI 0.92–1.17, p-value = 0.5778) increase in the rate of ED visits during the UCC clinic hours after the UCC clinic opened. The implementation of the UCC clinic had minimal impact on health care utilization. Future work should examine the impact of the UCC clinic on other aspects of healthcare utilization (e.g., number of tests ordered and time spent waiting in CCMB’s main clinics) and patient quality of life and patient and health care provider experience.

Background Meteorological factors play an important role in human health. Clarifying the occurrence of dog and cat bites (DCBs) under different meteorological conditions can provide key insights into the prevention of DCBs. Therefore, the objective of the study was to explore the relationship between meteorological factors and DCBs and to provide caution to avoid the incidents that may occur by DCBs. Methods In this study, data on meteorological factors and cases of DCBs were retrospectively collected at the Shanghai Climate Center and Jinshan Hospital of Fudan University, respectively, in 2016–2020. The distributed lag non-linear and time series model (DLNM) were used to examine the effect of meteorological elements on daily hospital visits due to DCBs. Results A total of 26,857 DCBs were collected ranging from 1 to 39 cases per day. The relationship between ambient temperature and DCBs was J-shaped. DCBs were positively correlated with daily mean temperature (rs = 0.588, P

Background: This retrospective cohort study aims to investigate emergency department (ED) visits and readmission after bariatric surgery among patients with a history of anxiety and/or depression. We predict that patients with a reported history of anxiety and/or depression will have more ED visits in the year following surgery than patients without a history of mental illness. Methods: Data were collected from the charts of all consecutive patients who underwent sleeve gastrectomy or gastric bypass surgery between March 2012 and December 2019. Data on baseline body mass index, mental health diagnosis and treatment and emergency department visits and hospital readmissions were retrospectively reviewed over the first year following surgery. Results: One thousand two hundred ninety-seven patients were originally included in this study and 1113 patients were included in the final analysis. Patients with a history of depression (OR 1.23; 95% CI 0.87–1.73), anxiety (OR 1.14; 95% CI 0.81–1.60), or both (OR 1.17; 95% CI 0.83–1.65) did not have a statistically significant increase in ED visits compared to patients without these disorders. Patients with a history of depression (OR 1.49; 95% CI 0.86–2.61), anxiety (OR 1.45; 95% CI 0.80–2.65) or both (OR 1.47; 95% CI 0.94–2.29) did not have a statistically significant increase in hospital readmissions in the first year after surgery compared to patients without these disorders. Patients treated with a sleeve gastrectomy were readmitted due to postoperative complications less frequently than those treated with other surgeries (OR 0.20; 95% CI 0.05–0.83). Conclusion: Patients with a history of anxiety, depression or both did not have an increased rate of emergency department visits and hospital readmissions within the first year following bariatric surgery. This contradicts current literature and may be due to the multidisciplinary program patients undergo at this study's home institution. [ABSTRACT FROM AUTHOR]

Objective: To systematically synthesize evidence from a broad range of studies on the association between air pollution and migraine. Background: Air pollution is a ubiquitous exposure that may trigger migraine attacks. There has been no systematic review of this possible association. Methods: We searched for empirical studies assessing outdoor air pollution and any quantified migraine outcomes. We included short‐ and long‐term studies with quantified air pollution exposures. We excluded studies of indoor air pollution, perfume, or tobacco smoke. We assessed the risk of bias with the World Health Organization's bias assessment instrument for air quality guidelines. Results: The final review included 12 studies with over 4,000,000 participants. Designs included case‐crossover, case–control, time series, and non‐randomized pre–post intervention. Outcomes included migraine‐related diagnoses, diary records, medical visits, and prescriptions. Rather than pooling the wide variety of exposures and outcomes into a meta‐analysis, we tabulated the results. Point estimates above 1.00 reflected associations of increased risk. In single‐pollutant models, the percent of point estimates above 1.00 were carbon monoxide 5/5 (100%), nitrogen dioxide 10/13 (78%), ozone 7/8 (88%), PM2.5 13/15 (87%), PM10 2/2 (100%), black carbon 0/1 (0%), methane 4/6 (75%), sulfur dioxide 3/5 (60%), industrial toxic waste 1/1 (100%), and proximity to oil and gas wells 6/13 (46%). In two‐pollutant models, 16/17 (94%) of associations with nitrogen dioxide were above 1.00; however, more than 75% of the confidence intervals included the null value. Most studies had low to moderate risks of bias. Where differences were observed, stronger quality articles generally reported weaker associations. Conclusions: Balancing the generally strong methodologies with the small number of studies, point estimates were mainly above 1.00 for associations of carbon monoxide, nitrogen dioxide, ozone, and particulate matter with migraine. These results were most consistent for nitrogen dioxide. [ABSTRACT FROM AUTHOR]

Objectives: This study investigated the effects of short-term exposure to ambient fine particulate matter (PM2.5) on the worsening of dementia and Parkinson’s disease (PD). Methods: Data regarding emergency department visits (EDVs) for dementia and PD and air pollutant levels in Chiayi City from 2015 to 2019 were obtained from the Chang Gung Research Database and Taiwan’s Environmental Protection Administration, respectively. A time-stratified case–crossover design was adopted to estimate the risks of EDVs for dementia and PD patients associated with short-term exposure to PM2.5. Results: Increased exposure to PM2.5 was associated with a 39% increase in EDVs for PD patients following a 10 mg/m3 increase at Lag 0. Moreover, cumulative effects were observed, with odds ratios (ORs) of 1.29, 1.31, and 1.36 for Lag 0–1 to Lag 0–3, respectively. Among women, PD-related EDVs increased by 53% at Lag 0, and delayed and cumulative effects were evident, with ORs of 1.31, 1.45, 1.51, 1.61, 1.58, and 1.60 for Lag 1, Lag 0–1 to Lag 0–5, respectively. In specific towns (aged, agricultural, and rural), a 46% increase in EDVs was noted for PD at Lag 0. In general towns, PM2.5 exhibited delayed and cumulative effects, with ORs of 1.49, 1.63, and 1.90 for Lag 2, Lag 0–2 to Lag 0–3, respectively. Among individuals aged ≥75 years, PM2.5 had cumulative effects, with ORs of 2.13, 2.28, and 2.40 for Lag 0–3 to Lag 0–5, respectively. However, no significant association was observed between PM2.5 exposure and an increase in EDVs for dementia patients. Conclusions: Short-term PM2.5 exposure increased the risk of PD exacerbation and demonstrated delayed effects. [ABSTRACT FROM AUTHOR]

Background: Injury is a leading cause of preventable morbidity and mortality in the USA. Ongoing surveillance is needed to understand changing injury patterns to effectively target prevention efforts. Launched jointly in 2000 by the Consumer Product Safety Commission (CPSC) and the Centers for Disease Control and Prevention (CDC), the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) provides national-level estimates of US emergency department visits for nonfatal injuries. A scoping review of peer-reviewed articles was conducted to characterize how NEISS-AIP data have been used for injury surveillance in the USA. Main Body: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three bibliographic databases (PubMed, Scopus, and Google Scholar) were systematically searched for English language peer-reviewed articles that used NEISS-AIP data as the primary data source during 2001–2021. Key article characteristics from included articles were abstracted to generate descriptive summary statistics to understand the use and limitations of NEISS-AIP for injury surveillance. Database queries returned 6944 citations; 594 citations were manually reviewed, and 167 non-duplicate journal articles were identified. An average of 8.0 articles (range: 1–14) were published annually during 2001–2021. Articles appeared in 72 different journals representing a diverse audience with the majority of articles written by CDC authors. Starting in 2013, a higher proportion of articles were published by non-CDC authors. The largest number of articles examined injury among all age groups (n = 71); however, the pediatric population was the specific age group of greatest interest (n = 48), followed by older adults (n = 23). Falls (n = 20) and motor-vehicle-related injuries (n = 10) were the most studied injury mechanisms. The most commonly identified limitation identified by authors of reviewed articles was that NEISS-AIP only produces national estimates and therefore, cannot be used for state- or county-level injury surveillance (n = 38). Conclusions: NEISS-AIP has contributed to nonfatal injury surveillance in the USA. CDC and CPSC continue to work together to expand and enhance NEISS-AIP data collection. Researchers are encouraged to continue using this publicly available dataset for injury surveillance. [ABSTRACT FROM AUTHOR]

Objectives Patients with complex medical needs and high inpatient utilization frequently use opioids for non-malignant chronic pain. We examine the association between chronic opioid therapy and healthcare utilization among high-need, high-cost patients insured by Medicare. Methods This study is a retrospective cohort study of Medicare beneficiaries in a medically underserved metropolitan area. Patients were included in the study if they had ≥2 hospitalizations or ≥1 hospitalization and ≥2 emergency department (ED) visits in a 6-month-period preceding an index hospitalization between July 2011 and June 2014. Exclusion criteria included substance abuse, psychosis and malignancy. Multivariable negative binomial regression models assessed associations between baseline opioid medication use and subsequent ED and hospital visits for the study population and two subgroups: (1) those with chronic pain and (2) those with both chronic pain and a primary care provider. Key findings The majority of high-need, high-cost patients filled opioid prescriptions of ≥7-day supply (51%). Yet only 2.7% of patients with chronic pain received an opioid prescription of ≥7-day supply from an ED provider in the baseline period. Overall (n = 677), receipt of a ≥7-day opioid supply was positively associated with subsequent ED utilization but not subsequent hospitalization. Among those with chronic pain and ≥1 primary care practice visit (N = 481), opioid use was associated with inpatient utilization but not ED utilization. Receipt of adjuvant pain prescriptions was not protective of hospitalizations or ED visits. Conclusions Chronic pain and opioid therapy are common among high-need, high-cost patients and they are independently associated with higher ED and hospital utilization. Novel patient-centred outpatient pain management strategies have potential to reduce inpatient care in this population. [ABSTRACT FROM AUTHOR]

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The Earth's precipitation patterns are changing, and regional precipitation is expected to continue to increase in New York State (NYS). Heavy precipitation may negatively affect asthma prevalence through its effect on seasonally varying allergens. We employed a threshold analysis using a time‐stratified semi‐symmetric bi‐directional case‐crossover study design to assess the effect of increase in precipitation on asthma (ICD‐9 code 493.xx, N = 970,903) emergency department (ED) visits between 2005 and 2014 during non‐winter months in NYS. Spatially contiguous gridded meteorological data from North American Land Data Assimilation System (NLDAS) were utilized. We used conditional logistic regression models and stratified the analyses by seasons. During non‐winter months, we found a small, statistically significant risk of asthma ED visits for precipitation levels above 50 mm, with differences by season. These results suggest that heavy precipitation may be related to an increased risk of asthma ED visits. Gridded meteorological estimates provide a means of addressing the gaps in exposure classification, and these findings provide opportunities for further research on interactions with aeroallergens and meteorological conditions in the context of climate and health. Plain Language Summary: Heavy precipitation such as rainfall may be associated with increased risk of asthma through its effect on seasonally varying allergens. Using a case‐crossover study design, we assessed the effect of precipitation on asthma emergency department (ED) visits between 2005 and 2014 during non‐winter months in New York State. A small, statistically significant increased risk of asthma ED visits was observed during non‐winter months for precipitation levels above 50 mm, with differences by seasons. The use of gridded meteorological estimates provides a means of addressing gaps in exposure classification. Further research is needed to explore the interactions with allergens and meteorological conditions in the context of climate and health. Key Points: Heavy precipitation events may be related to increased risk of asthma emergency department (ED) visitsPrecipitation thresholds at which excess risk of asthma ED visits occur differ by seasonSatellite data provides a mean of addressing gaps in exposure classification [ABSTRACT FROM AUTHOR]

Abstract Background Telehealth rapidly expanded since the outbreak of the COVID-19 pandemic. This study aims to understand how telehealth can substitute in-person services by 1) estimating the changes in non-COVID emergency department (ED) visits, hospitalizations, and care costs among US Medicare beneficiaries by visit modality (telehealth vs. in-person) during the COVID-19 pandemic relative to the previous year; 2) comparing the follow-up time and patterns between telehealth and in-person care. Methods A retrospective and longitudinal study design using US Medicare patients 65 years or older from an Accountable Care Organization (ACO). The study period was April-December 2020, and the baseline period was March 2019 – February 2020. The sample included 16,222 patients, 338,872 patient-month records and 134,375 outpatient encounters. Patients were categorized as non-users, telehealth only, in-person care only and users of both types. Outcomes included the number of unplanned events and costs per month at the patient level; number of days until the next visit and whether the next visit happened within 3-, 7-, 14- and 30-days at the encounter level. All analyses were adjusted for patient characteristics and seasonal trends. Results Beneficiaries who used only telehealth or in-person care had comparable baseline health conditions but were healthier than those who used both types of services. During the study period, the telehealth only group had significantly fewer ED visits/hospitalizations and lower Medicare payments than the baseline (ED 13.2, 95% CI [11.6, 14.7] vs. 24.6 per 1,000 patients per month and hospitalization 8.1 [6.7, 9.4] vs. 12.7); the in-person only group had significantly fewer ED visits (21.9 [20.3, 23.5] vs. 26.1) and lower Medicare payments, but not hospitalizations; the both-types group had significantly more hospitalizations (23.0 [21.4, 24.6] vs. 17.8). Telehealth was not significantly different from in-person encounters in number of days until the next visit (33.4 vs. 31.2 days) or the probabilities of 3- and 7-day follow-up visits (9.2 vs. 9.3% and 21.8 vs.23.5%). Conclusions Patients and providers treated telehealth and in-person visits as substitutes and used either depending on medical needs and availability. Telehealth did not lead to sooner or more follow-up visits than in-person services.

Abstract The Earth's precipitation patterns are changing, and regional precipitation is expected to continue to increase in New York State (NYS). Heavy precipitation may negatively affect asthma prevalence through its effect on seasonally varying allergens. We employed a threshold analysis using a time‐stratified semi‐symmetric bi‐directional case‐crossover study design to assess the effect of increase in precipitation on asthma (ICD‐9 code 493.xx, N = 970,903) emergency department (ED) visits between 2005 and 2014 during non‐winter months in NYS. Spatially contiguous gridded meteorological data from North American Land Data Assimilation System (NLDAS) were utilized. We used conditional logistic regression models and stratified the analyses by seasons. During non‐winter months, we found a small, statistically significant risk of asthma ED visits for precipitation levels above 50 mm, with differences by season. These results suggest that heavy precipitation may be related to an increased risk of asthma ED visits. Gridded meteorological estimates provide a means of addressing the gaps in exposure classification, and these findings provide opportunities for further research on interactions with aeroallergens and meteorological conditions in the context of climate and health.

ObjectiveIt is known that the inhalation of air pollutants adversely affects human health. These air pollutants originated from natural sources such as desert storms or human activities including traffic, power generating, domestic heating, etc. This study aimed to investigate the impacts of desert dust storms, particulate matter ≤10 μm (PM10) and daily maximum temperature (MT) on mortality and emergency department (ED) visits due to stroke in the city of Gaziantep, Southeast Turkey.MethodThe data on mortality and ED visits due to stroke were retrospectively recruited from January 1, 2009, to March 31, 2014, in Gaziantep City Centre.ResultsPM10 levels did not affect ED visits or mortality due to stroke; however, MT increased both ED visits [adjusted odds ratio (OR) = 1.002, 95% confidence interval (CI) = 1.001–1.003] and mortality (OR = 1.006, 95% CI = 0.997–1.014) due to stroke in women. The presence of desert storms increased ED visits due to stroke in the total population (OR = 1.219, 95% CI = 1.199–1.240), and all subgroups. It was observed that desert dust storms did not have an increasing effect on mortality.ConclusionOur findings suggest that MT and desert dust storms can induce morbidity and mortality due to stroke.

Background: Frequent emergency department (FED) visits by cancer patients represent a significant burden to the health system. This study identified determinants of FED in recently hospitalized cancer patients, with a particular focus on opioid use. Methods: A prospective cohort discharged from surgical/medical units of the McGill University Health Centre was assembled. The outcome was FED use (≥ 4 ED visits) within one year of discharge. Data retrieved from the universal health insurance system was analyzed using Cox Proportional Hazards (PH) model, adopting the Lunn-McNeil approach for competing risk of death. Results: Of 1253 patients, 14.5% became FED users. FED use was associated with chemotherapy one-year pre-admission (adjusted hazard ratio (aHR) 2.60, 95% CI: 1.80–3.70), ≥1 ED visit in the previous year (aHR: 1.80, 95% CI 1.20–2.80), ≥15 pre-admission ambulatory visits (aHR 1.54, 95% CI 1.06–2.34), previous opioid and benzodiazepine use (aHR: 1.40, 95% CI: 1.10–1.90 and aHR: 1.70, 95% CI: 1.10–2.40), Charlson Comorbidity Index ≥ 3 (aHR: 2.0, 95% CI: 1.2–3.4), diabetes (aHR: 1.60, 95% CI: 1.10–2.20), heart disease (aHR: 1.50, 95% CI: 1.10–2.20) and lung cancer (aHR: 1.70, 95% CI: 1.10–2.40). Surgery (cardiac (aHR: 0.33, 95% CI: 0.16–0.66), gastrointestinal (aHR: 0.34, 95% CI: 0.14–0.82) and thoracic (aHR: 0.45, 95% CI: 0.30–0.67) led to a decreased risk of FED use. Conclusions: Cancer patients with higher co-morbidity, frequent use of the healthcare system, and opioid use were at increased risk of FED use. High-risk patients should be flagged for preventive intervention. [ABSTRACT FROM AUTHOR]

Background: It is estimated that approximately 300,000 people are experiencing homelessness in England. The aim of this study was to evaluate key causes and long-term trends of emergency departments (EDs) and in hospital inpatient admissions of persons experiencing homelessness in England. Methods: ED and hospital inpatient admissions data were obtained from Hospital Episode Statistics (HES) covering all National Health Service (NHS) England hospitals. Anyone identified or declared to be experiencing homelessness during the service usage are recorded in HES datasets. Data were extracted for the 10-year study period and compared to the general population, which includes all patients attending the ED or admitted to inpatient care in England. Results: Drug- and alcohol-related causes contribute to the most frequent reasons for attendance and admissions of persons experiencing homelessness in the ED and inpatient respectively. A total of 30,406 ED attendances were recorded for persons experiencing homelessness in the year 2018/2019 (+ 44.9% rise vs 2009/10) of which injuries and poisoning respectively represented 21.8% and 17.9% of all persons experiencing homelessness presentations to the ED. Poisoning (including drug overdose) represented only 1.9% of all attendances by the general population during the same study year (rate ratio vs general populations 9.2 95% CI 9.0–9.4). High mortality rates were observed in relation to presentations attributed to drug- and alcohol-related causes. A total of 14,858 persons experiencing homelessness inpatient admissions were recorded in 2018/2019 (+ 68.6% vs 2009/2010). Psychoactive substance use constituted 12.7% of all admissions in 2018/2019 compared to 0.4% of in the general populations (rate ratio: 33.3, 95% CI: 31.9–34.7). There was a 44.3% rise in the number of admissions related to poisoning in the study period amongst persons experiencing homelessness in England (vs 14.2% in general population). Conclusion: Marked disparities around primary causes of ED and inpatient admissions were identified between persons experiencing homelessness and the general population. There is a continued need for prevention measures to reduce the prevalence of drug and alcohol, injury and poisoning-related admissions to the ED, enhanced service provision at the community level, and multisector collaborations. These initiatives should maximise opportunities for early interventions and improve outcomes for persons experiencing homelessness, including increased accessibility of healthcare and mental health services, particularly in areas that demonstrate increasing ED and inpatient attendance rates over time. [ABSTRACT FROM AUTHOR]

Background and rationale: As general health care is publicly funded in Canada and oral health care is not, many people seek care from hospitals for their dental problems. This study assessed if the unprecedented times of Coronavirus disease (COVID-19) affected the hospital visits for dental emergencies, making disadvantaged populations further vulnerable for attendance of their dental problems. Methods: Data from IntelliHealth Ontario for emergency department (ED) visits, day surgery visits, and hospitalizations associated with non-traumatic dental conditions (NTDCs) were retrieved for years 2016 to 2020 to assess trends before COVID-19 and changes, if any, for the year 2020. Trends by month, for the years 2019 and 2020, to make straight comparisons and understand the effects of lockdown in Ontario, was also analyzed. Results: In the year 2020, there was a reduction of 40% in day surgeries, 21% in ED visits and 8% in hospitalizations compared to 2019. Stratified by month, largest reductions were observed in April 2020: 96% in day surgeries; 50% in ED visits; and 38% reductions in hospitalizations when compared to the same month of 2019. In May 2020, day surgeries and ED visits though remained reduced, hospitalization rates increased by 31%. Conclusion: Hospital EDs are inefficient avenues for handling dental emergencies. Nevertheless, they do remain a care setting that is sought by many for dental problems, and if the need for hospitalization and day surgery is there, this care setting is an important avenue for dentally related medical care. Perhaps unsurprisingly, COVID-19 has lessened the opportunity and capacity for such care. Practical implications: Administrators and policy makers can utilize this information to strategize on augmenting community infrastructure for building more effective, and cost-efficient avenues of care for timely management of dental problems. [ABSTRACT FROM AUTHOR]

Background: Opioid-related emergency department (ED) visits in Canada increased during the COVID-19 pandemic, but how trends in volume and case severity changed from pre-pandemic times through the pandemic is not known. Trends in ED visits related to specific types of opioids also remain unclear. Our objective was to describe pre-pandemic trends and how they changed with the onset of COVID-19 and thereafter. Methods: Based on data from the Canadian Hospitals Injury Reporting and Prevention Program, we identified opioid-related ED visits and constructed a time series from March 12, 2018 through March 7, 2021—two pre-COVID periods and one COVID period. We used an interrupted time series (ITS) analysis to examine trends in volume and case severity. We compared medians and means of monthly counts and percentages of severe cases between the periods, by sex, age, and opioid type. Results: Before the pandemic, there was an increasing trend in fentanyl-related visits for males, females and 25- to 64-year-olds, and a decreasing trend in heroin-related visits for males and 18- to 64-year-olds. Fentanyl-related visits for 18- to 24-year-olds showed an immediate increase at the start of the pandemic and a decreasing trend during the pandemic. Heroin-related visits for 12- to 17-year-olds had an immediate increase at the start of the pandemic; for 18- to 24-year-olds and 45- to 64-year-olds, the prior decreasing pre-pandemic trend ceased. For pooled opioid-related visits, no significant trend in the percentage of severe cases was observed throughout the entire study period. Conclusion: This study shows that an ITS approach in trend analysis is a valuable supplement to comparisons of before and after measures (with or without controlling seasonal effects). The findings provide evidence on how ED presentations for opioid use evolved in Canada from 2018 to 2021. The results can inform policies designed to reduce opioid-related harm in the context of a public health emergency. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: This study aimed to better understand why people older than 65 years of age visit the ED in Amsterdam and capture the interactions of contributing factors in a causal loop diagram (CLD) through group model building (GMB). Findings: Central contributing factors included, 'acute event', 'frailty', 'functioning of the healthcare professional' and 'availability of alternatives for the ED'. These factors, as well as many underlying factors, showed extensive interaction, thereby contributing directly and via each other to older persons' ED visits. Message: This study helps to better understand the etiology of older persons' ED visits and elucidates the role interactions of contributing factors can play. Purpose: Understanding the etiology of older persons' emergency department (ED) visits is highly needed. Many contributing factors have been identified, however, the role their interactions play remains unclear. Causal loop diagrams (CLDs), as conceptual models, can visualize these interactions and therefore may elucidate their role. This study aimed to better understand why people older than 65 years of age visit the ED in Amsterdam by capturing the interactions of contributing factors as perceived by an expert group in a CLD through group model building (GMB). Methods: Six qualitative online focus group like sessions, known as GMB, were conducted with a purposefully recruited interdisciplinary expert group of nine that resulted in a CLD that depicted their shared view. Results: The CLD included four direct contributing factors, 29 underlying factors, 66 relations between factors and 18 feedback loops. The direct factors included, 'acute event', 'frailty', 'functioning of the healthcare professional' and 'availability of alternatives for the ED'. All direct factors showed direct as well as indirect contribution to older persons' ED visits in the CLD through interaction. Conclusion: Functioning of the healthcare professional and availability of alternatives for the ED were considered pivotal factors, together with frailty and acute event. These factors, as well as many underlying factors, showed extensive interaction in the CLD, thereby contributing directly and indirectly to older persons' ED visits. This study helps to better understand the etiology of older persons' ED visits and in specific the way contributing factors interact. Furthermore, its CLD can help to find solutions for the increasing numbers of older adults in the ED. [ABSTRACT FROM AUTHOR]

The urgent cancer care (UCC) clinic at CancerCare Manitoba (CCMB) opened in 2013 to provide care to individuals diagnosed with cancer and serious blood disorders experiencing complications from the underlying disorder or its treatment. This study examined the impact of the UCC clinic on other health care utilization in Winnipeg, Manitoba, Canada. An interrupted time series study design was used to compare the rates of emergency department (ED) visits, primary care clinician (PCC) visits, and hospitalizations from 1 January 2010 to 31 December 2015. Rates of ED visits were also stratified by ED location, severity, and cancer type. We found a 6% (95% CI 1.00–1.13, p-value = 0.0389) increase in PCC visits, a 7% (95% CI 0.99–1.15, p-value = 0.0737) increase in hospitalizations, a 4% (95% CI 0.86–1.08, p-value = 0.5053) decrease in the rate of ED visits, and a 3% (95% CI 0.92–1.17, p-value = 0.5778) increase in the rate of ED visits during the UCC clinic hours after the UCC clinic opened. The implementation of the UCC clinic had minimal impact on health care utilization. Future work should examine the impact of the UCC clinic on other aspects of healthcare utilization (e.g., number of tests ordered and time spent waiting in CCMB's main clinics) and patient quality of life and patient and health care provider experience. [ABSTRACT FROM AUTHOR]