A171 Objectives: To compare the rate of inpatient admissions of pediatric patients with acute asthma that came through the emergency department (ED) visits and mean charges per ED visit between Medicaid patients and privately insured patients. To identify factors associated with hospital admissions through the ED among pediatric patients with asthma. MethOds: A retrospective analysis using 2010-2011 National Emergency Department Sample (NEDS), the largest all-payer hospital based ED database in the United States (US), was conducted. All ED visits with a primary diagnosis of acute asthma for patients aged 2-17 years were identified using ICD-9-CM codes of 493.XX. ED visits with unknown destination were excluded. Multivariable logistic regression and Generalized Linear Mixed Model were used to compare the rate of hospital admissions through the ED and mean ED charges between asthma children with Medicaid vs private insurance. Results: A total of 110,964 pediatric asthma related ED visits from 1,713 US EDs was identified (Medicaid patients: n= 69,410 (63%), mean age= 7yrs, 39.86% female; Private insured patients: n= 41,554 (37%), mean age= 7yrs, 39.79% female). Of these occurrences, 96,307 (87%) were discharged and 14,657 (13%) were admitted to hospital after ED visits. After adjusting for demographic and clinical factors, privately insurance patients were 12% more likely to be admitted to hospital after ED visits compared to Medicaid patients. (Odds ratio= 1.12, [95% confidence interval: 1.13-1.32]). The mean charge per ED visit for Medicaid insured patients was $1,330, compared to $1,380 among private insured patients (p< 0.01). Other factors associated with hospital admissions through ED were younger age, severity, weekday visits, and urban-rural location of patient's residence. cOnclusiOns: Compared to asthma children with Medicaid, privately insured pediatric patients had increased hospital admissions through ED and ED charges. In addition to insurance type, factors relating to severity and hospital characteristics were related to hospital admissions through the ED.
There were no differences within 31 to 365 days after the surgery date and within the 30 days post-discharge. Risk of operative mortality was 19% higher for mechanical valves than for bioprosthetic valves (OR, 1.21; 95% CI, 1.13-1.30; P< 0.0001). The number needed to treat with mechanical valves to observe one additional death on the surgery date was 290. Consistent findings were observed in subgroup analyses of patients who underwent concurrent AVR and Coronary Artery Bypass Graft (CABG), but not in isolated AVR subgroup. ConClusions: In this cohort analysis of Medicare beneficiaries, mechanical aortic valves were associated with a higher risk of death on the surgery date and within the 30 days following surgery when compared with bioprosthetic aortic valves among patients who underwent concurrent AVR and CABG, but not isolated AVR.
Objectives: The Medicare population accounts for majority of chronic obstructive pulmonary disease (COPD) hospitalizations in United States (US). Integrated care models and Hospital Readmissions Reduction Program have raised concerns due to lack of best practices. Monitoring of healthcare utilization prior to a COPD hospitalization may identify potential predictors of admission. The objective was to examine healthcare utilization of COPD Medicare beneficiaries 3 months prior to a COPD hospitalization compared to those without. MethOds: Using Medicare Current Beneficiary Survey data set from 2006-2011, beneficiaries were diagnosed with COPD if they had a COPD hospitalization or COPD claim(s) (ICD-9-CM codes). The cohorts of COPD patients with at least one COPD hospitalization and without were followed 3 months prior to a COPD hospitalization and a randomly assigned date respectively. Cohorts were compared on healthcare utilization (physician visits, inpatient visits, emergency room visits, home health care episodes, skilled nursing facility (SNF) stays, and COPD prescription fills). Covariates assessed were patient characteristics, access to care and socioeconomic factors, comorbidities, COPD severity, and health behaviors. Results: The sample of 236 beneficiaries with COPD hospitalization and 1,546 beneficiaries without had 51.7% and 48.8% male beneficiaries respectively. There was a significant difference (p< 0.001) for those with COPD hospitalization vs. without for median (interquartile range) emergency room visits (1.
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