Php95 Expected Changes in Health Care Utilization Due to Patient Protection and Affordable Care Act

Abstract

and 2005-06 National Ambulatory Medical Care Survey and the outpatient department component of the National Hospital Ambulatory Medical Care Survey was conducted to examine maternal characteristics and physician characteristics associated with Category D and X prescriptions. Descriptive statistics and logistic regression analysis were performed to determine the time trend and predictors associated with prescribing category D and X drugs. RESULTS: Approximately 35 million visits were made by pregnant women annually during these years. Of these visits, 1.4% (95%Confidence Interval (CI):1.13-1.77%) of the visits involved prescription of Category D drugs and 1.1% (CI:0.6-1.4%) of the visits involved prescription of Category X drugs. A significant positive time trend was observed in prescribing of category D and X drugs in 2005-06 (OR-2.14, 95%CI:1.23-3.73) compared to 1997-98. Pregnant women above the age of 30 had greater odds (OR-1.62, 95%CI:1.08-2.44) of receiving these drugs than pregnant women below the age of 30. Pregnant women who received Ն2 medications had greater odds (OR-15.31,95%CI:9.02-26.01) of receiving these drugs than who received Յ1 medication. Significant differences across physician specialty and race were also observed. CONCLUSIONS: Both maternal and physician characteristics play a role in prescribing of Category D and X drugs. With increase in use of category D and X drugs, more research is needed to evaluate the clinical consequences of these prescribing practices. OBJECTIVES:To determine the association between quality of hospital care, using selected Assessing Care of Vulnerable Elders (ACOVE) quality indicators, and short term outcomes for very old patients admitted for acute illnesses in a tertiary hospital. METHODS: This is a retrospective review of medical records of a random sample of all patients aged 80 years and above admitted to the Department of General Medicine and Department of Geriatric Medicine from 2005 to 2008, with an equal number of cases (750) selected for each year. The quality indicators selected were cognitive and functional assessment, discharge planning, delirium evaluation and treatment, mobilization, and aspiration precautions. If patients met the inclusion criteria for each specific quality indicator, they were assessed to determine if the process-of-care was carried out and documented. The outcomes of interest were inhospital mortality, 30-day mortality and hospital readmission within 15 days of discharge. RESULTS: From the review of 2,923 cases, the adherence for the quality indicators ranged from 33.8% for cognitive and functional assessment to 88.1% for discharge planning. In univariate analyses, adherence to delirium evaluation and treatment was associated with a reduction in inhospital (17.5% vs 26.1%, pϭ0.004) and 30-day mortality rates (22.6% vs 32.5%, pϭ0.002). Documentation of cognitive and functional assessment was associated with a reduction in inhospital (6.2% vs 16.2%, pϽ0.005) and 30-day mortality rates (10.3% vs 22.3%, pϽ0.005). The association betw...