Frequent Utilization of the Emergency Department for Acute Heart Failure Syndrome

Hasegawa, Kohei; Tsugawa, Yusuke; Camargo, Carlos A.; Brown, David F.M.

doi:10.1161/circoutcomes.114.000949

Cited by 33 publications

(31 citation statements)

References 30 publications

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“…Moreover, the HCUP data are considered accurate and widely used to estimate diagnoses and hospitalization frequency. 7, 10, 36 Second, we identified ID hospitalizations with an ID listed as the primary diagnosis to limit potential misclassification, while this would also have led to an underestimation of ID hospitalizations. Third, the KID contains discharge-level records and not patient-level records.…”

Section: Discussionmentioning

confidence: 99%

Trends in Infectious Disease Hospitalizations in US Children, 2000 to 2012

Goto

Tsugawa

Mansbach

et al. 2016

The Pediatric Infectious Disease Journal

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Background Although infectious diseases (IDs) remain a major public health problem in U.S. children, there have been no recent efforts to examine comprehensively the change in epidemiology of ID hospitalizations. Methods A serial cross-sectional analysis using the Kids’ Inpatient Database 2000, 2003, 2006, 2009, and 2012. We identified children ≤19 years of age with a primary diagnosis of IDs. Outcomes were national rate of ID hospitalizations, in-hospital mortality, length-of-stay and hospitalization-related direct costs. Negative binomial and multivariable logistic models were constructed to test the change in hospitalization rate and in-hospital mortality, respectively. Results We identified 3,691,672 weighted hospitalizations for IDs, accounting for 24.5% of all pediatric hospitalizations. From 2000 to 2012, the rate of overall ID hospitalizations decreased from 91.0 to 75.8 per 10,000 U.S. children (P<0.001). The most frequently listed ID subgroup was lower respiratory infections (42.8% of all ID hospitalizations in 2012). Although the hospitalization rate for most ID subgroups decreased, the hospitalization rate for skin infections significantly increased (67.6% increase; P<0.001). The multivariable model demonstrated a significant decline in in-hospital mortality (OR for comparison of 2012 with 2000, 0.63; 95%CI, 0.51–0.79). From 2000 to 2012, there was no significant change in the median length-of-stay (2 days in 2000 to 2 days in 2012; Ptrend=0.33). The median direct cost for ID hospitalization increased from $3,452 in 2003 to $3,784 in 2012 (P=0.007), with the nationwide direct cost of $4.4 billion in 2012. Conclusions We found a statistically significant decline in overall ID hospitalization rate among U.S. children from 2000 to 2012, whereas skin infections statistically significantly increased. Additionally, the median direct cost per ID hospitalization increased by 10% during the study period.

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Section: Discussionmentioning

confidence: 99%

Trends in Infectious Disease Hospitalizations in US Children, 2000 to 2012

Goto

Tsugawa

Mansbach

et al. 2016

The Pediatric Infectious Disease Journal

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“…In an analysis of ED and inpatient data available through the Healthcare Cost and Utilization Project, investigators found that among 113,033 unique patients presenting to the ED for acute HF in Florida and California, 34,793 (31%) had O2 visits for acute HF during a 1-year period. 24 In those 2 states, patients with O2 visits accounted for 55% of all ED visits for acute HF during the same 1-year period. These data underscore the central role of the ED in acute HF care and suggest that programs designed to optimize care for these patients in the ED could reduce rehospitalizations.…”

Section: Post-discharge Emergency Department Carementioning

confidence: 99%

Thinking Outside the Box: Treating Acute Heart Failure Outside the Hospital to Improve Care and Reduce Admissions

DeVore

Allen

Eapen

2015

Journal of Cardiac Failure

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The management of acute heart failure is shifting toward treatment approaches outside of a traditional hospital setting. Many heart failure providers are now treating patients in less familiar health care settings, such as acute care clinics, emergency departments, and skilled nursing facilities. In this review we describe the current pressures driving change in the delivery of acute heart failure and summarize the evidence regarding treatments for acute heart failure outside of the inpatient setting. We also provide considerations for the design of future treatment strategies to be implemented in alternative care settings. (J Cardiac Fail 2015;21:667e673)

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“…Repeated utilization of a healthcare service by a small group of patients is costly 1,2 and also suggests that the medical care those patients are receiving is not adequately addressing their needs. 3,4 Frequent utilization of emergency department (ED) services have been extensively studied, 5–13 in part because ED care is more expensive than primary care and these two types of care may be substitutes for one another in some cases.…”

Section: Introductionmentioning

confidence: 99%

Repeated Emergency Medical Services Use by Older Adults: Analysis of a Comprehensive Statewide Database

Evans

Platts‐Mills

Fernández

et al. 2017

Annals of Emergency Medicine

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OBJECTIVE The objective of this study was to characterize repeat Emergency Medical Services (EMS) transports among older adults across a large and socioeconomically diverse region. METHODS Using the North Carolina Prehospital Medical Information System (PreMIS), we analyzed the frequency of repeat EMS transports within 30 days of an index EMS transport among adults aged 65 years and older from 2010–2015. We used multivariable logistic regressions to determine characteristics associated with repeat EMS transport. RESULTS Over the 6-year period, EMS performed 1,711,669 transports for 689,664 unique older adults in North Carolina. Of these, 303,099 (17.7%) transports were followed by another transport of the same patient within 30 days. The key characteristics associated with an increased adjusted odds ratio of repeat transport within 30 days include: transport from an institutionalized setting (OR 1.42, 95% Confidence Interval (CI) 1.38–1.47), Blacks compared to Whites (OR 1.29, 95% CI 1.24–1.33), a dispatch complaint of psychiatric problems (OR 1.38, 95% CI 1.25–1.52), back pain (OR 1.35, 95% CI 1.26–1.45), breathing problems (OR 1.21, 95% CI 1.15–1.30), and diabetic problems (OR 1.14, 95% CI 1.06–1.22). Falls accounted for 15.6% of all transports and had a modest association with repeat transports (OR 1.07, 95% CI 1.00–1.14). CONCLUSIONS More than 1 in 6 EMS transports of older adults in North Carolina are followed by a repeat transport of the same patient within 30 days. Patient characteristics and chief complaints may identify increased risk for repeat transport and suggest the potential for targeted interventions to improve outcomes and manage EMS utilization.

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Frequent Utilization of the Emergency Department for Acute Heart Failure Syndrome

Cited by 33 publications

References 30 publications

Trends in Infectious Disease Hospitalizations in US Children, 2000 to 2012

Trends in Infectious Disease Hospitalizations in US Children, 2000 to 2012

Thinking Outside the Box: Treating Acute Heart Failure Outside the Hospital to Improve Care and Reduce Admissions

Repeated Emergency Medical Services Use by Older Adults: Analysis of a Comprehensive Statewide Database

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