Trends in lung cancer diagnosis and care among visible minorities and non-visible minorities in Canada.

BACKGROUND: Identifying factors that influence the diagnosis and treatment of lung cancer is an important public health initiative. Various sociodemographic factors, including race and ethnicity, may influence an individual's risk of developing lung cancer, as well as access to relevant diagnostic and therapeutic procedures. METHODS: Data from the 2006 Canadian long-form census were cross-linked with the Canadian Cancer Registry and hospital data to determine rates of lung cancer diagnosis among visible minorities and non-visible minorities in Canada, and to assess for differences in rates of hospital-based procedures pertaining to a lung cancer diagnosis based on visible-minority status. Individuals were allocated into six visible-minority categories, and separate results were generated nationally and across seven regions. Multivariate logistic regression controlled for relevant confounders. RESULTS: Rates of lung cancer were significantly lower among visible minorities versus non-visible minorities (329 versus 1108 cases per 100 000). This result is consistent across all visible-minority subgroups. Among those with a diagnosis of lung cancer, procedure rates were higher for all visible minorities nationally (53.4% [95% CI 53.2-53.6]). Multivariable analysis demonstrated higher procedure rates in general for visible minorities with a lung cancer diagnosis compared to non-visible minorities (OR 1.158 95% CI 1.053-1.273). INTERPRETATION: In Canada, visible minorities experience lower rates of lung cancer diagnosis than non-visible minorities. Among those with a lung cancer diagnosis, we did not identify any negative disparities in rates of relevant diagnostic or therapeutic procedures, based on visible-minority status.

Association of Caregiving Receipt With Mental Health Utilization in a National Cohort of Older Adults.

OBJECTIVE: There exist significant age disparities in mental health (MH) utilization, such that older adults, including older veterans, are much less likely to use MH services. In-home caregivers represent a novel, yet understudied, pathway to increase appropriate utilization. We sought to examine the association between receiving caregiving assistance and MH utilization and test moderation effects of cognitive status and depression severity in a sample of older veterans. METHODS: Cross-sectional, mixed effects logistic regression with moderation analyses was used with a unique data resource combining survey data from the 2000-2012 U.S. Health and Retirement Study with Veterans Affairs (VA) healthcare administrative records. The analytic sample included N=1,957 Community-dwelling veterans (mean age 68.2 [9.7]), primarily male (96.5%) and non-Hispanic white (77.0%). Measures included MH utilization extracted from VA records or self-report; CESD-8 for depressive symptoms; and the Langa-Weir cognitive status classification using the modified TICS. RESULTS: After accounting for demographics, spousal caregiver availability, health factors, and socioeconomic status, caregiving receipt was associated with two-fold odds of MH utilization, compared to receiving no assistance (8,839 person-year observations; OR = 2.02; 95% CI 1.54-2.65) and remained similar following VA policy changes to enhance MH access. Exploratory analyses revealed that categories of cognition and depressive symptoms may moderate the association. CONCLUSION: Receipt of any in-home caregiving is associated with increased likelihood of MH use by older adults. Caregivers may represent an underutilized resource to reduce age-related mental health access disparities.

Identifying potential cases of eating disorders in an acute medical hospital.

OBJECTIVE: To identify patients presenting to an acute medical hospital with common signs and symptoms that occur in people with eating disorders (EDs), and determine by retrospective file audit if these are diagnosed cases of an ED. METHOD: The investigators screened electronic medical records of people 16 years and older for common signs and symptoms of an ED such as hypokalemia, in patients presenting to an acute hospital in Sydney, Australia from 2018 to 2020. Cases where the clinical finding was unexplained had their file audited. Cases with a known ED diagnosis or coded with an ED were also retrieved to audit. RESULTS: Investigators identified 192 definite ED cases with a total of 598 episodes of care from 2018 to 2020 presenting to the hospital. Eighty-three cases were identified as possible EDs due to unexplained clinical signs consistent with an ED, but were not confirmed cases due to lack of clinical history in the file. Only 19.1% of presentations were diagnostically coded with an ED in the electronic medical record. DISCUSSION: Our study revealed a large number of definite ED cases presenting to an acute medical hospital via the emergency department, who were not recognized as having an ED. Greater awareness of clinical signs and symptoms of an ED, such as unexplained low body mass index and hypokalemia, is necessary among acute care clinicians. Correctly identifying EDs in those seeking somatic care should be a public health priority, to facilitate timely and equitable access to diagnostic assessment and evidence based treatment. PUBLIC SIGNIFICANCE: People with eating disorders (EDs) present to acute care settings and have a relatively high utilization of generalist health services with nonspecific problems such as abdominal pain. An enhanced understanding of healthcare utilization by people with EDs, who may not disclose their symptoms, is crucial for improving access to treatment.

A spatial feature analysis of primary health care utilization in a large city in China and its implications for family doctor contract service policy.

BACKGROUND: Family doctor contract policy is now run by the State Council as an important move to promote the hierarchical medical system. Whether the family doctor contract policy achieves the initial government's goal should be measured further from the perspective of patient visits between hospitals and community health centers, which are regarded as grass medical agencies. METHODS: The spatial feature measurement method is applied with ArcGIS 10.2 software to analyze the spatial aggregation effect of patient visits to hospitals or community health centers among 20 districts of one large city in China and analyze the family doctor contract policy published in those areas to compare the influence of visit tendencies. RESULTS: From year 2016-2020, visits to hospitals were in the high-high cluster, and the density was spatially overflow, while there was no such tendency in visits to community health centers. The analysis of different family doctor contract policy implementation times in 20 districts reflects that the family doctor contract policy has a very limited effect on the promotion of the hierarchical medical system, and the innovation of the family doctor contract policy needs to be considered. CONCLUSIONS: A brief summary and potential implications. A multi-integrated medical system along with family doctor contract policy needs to be established, especially integrated in leadership and governance, financing, workforce, and service delivery between hospitals and community health centers, to promote the hierarchical medical system.

Dental service utilization and the COVID-19 pandemic, a micro-data analysis.

BACKGROUND: Global crises and disease pandemics, such as COVID-19, negatively affect dental care utilization by several factors, such as infection anxiety, disrupted supply chains, economic contraction, and household income reduction. Exploring the pattern of this effect can help policy makers to be prepared for future crises. The present study aimed to investigate the financial impact of COVID-19 disruptions on dental service utilization. METHODS: Data on the number of dental services offered in Dental School Clinics of Tehran University of Medical Sciences was collected over a period of two years, before and after the initial COVID-19 outbreak in Iran. School of Dentistry operates two clinics; one with competitive service fees and one with subsidies. Regression analyses were performed to determine the effect of the pandemic on the number of dental services divided by dental treatment groups and these clinics. The analyses were adjusted for seasonal patterns and the capacity of the clinics. RESULTS: There was a significant drop in dental services offered in both clinics across all dental groups in the post-COVID period (on average, 77 (39.44%) fewer services per day). The majority of the procedure loss happened in the Private clinic. Adjusting for seasonal patterns and the service capacity, regression results documented 54% and 12% service loss in Private and Subsidized clinics following the pandemic, respectively. Difference-in-difference analysis documented that the Subsidized clinic performed 40% more treatments than the Private clinic in the post-COVID period. CONCLUSIONS: Pandemic -reduction in dental care utilization could have long-term ramifications for the oral health of the population, and policymakers need to provide supportive packages to the affected segments of the economy to reverse this trend.

Utilization of adolescent health services during the COVID-19 pandemic: evidence on impact and adaptations from a rapid assessment survey in the Philippines.

BACKGROUND: Due to the COVID-19 pandemic, many challenges in adolescent health have been exacerbated including increased cases of early marriages, domestic violence, higher rates of anxiety and depression, and reduced access to sexual and reproductive health services for adolescents. This study examines the impacts of the pandemic on adolescent health services utilization and potential adaptations in the Philippines. METHODS: The data used in this study was from a rapid telephone assessment survey of 148 adolescent-friendly health facilities (rural health units) in the Philippines. We employed a mixed-methods research approach comprising both quantitative and qualitative analyses in three phases. First, we conducted a descriptive analysis of the status of adolescent healthcare access and utilization during COVID-19. Next, we examined using multivariate ordered logistic regressions how staff availability and adolescent health (AH) service provision modalities influenced AH service utilization in terms of the average number of adolescents served per week during compared to before the pandemic. We also conducted a complementing qualitative analysis of the challenges and corresponding adaptive solutions to ensuring continuity of AH services in facilities. RESULTS: We find that two months into the pandemic, 79% of adolescent-friendly trained staff were reporting for duty and 64% of facilities reported no staff disruptions. However, only 13% of facilities were serving the same number of adolescents or greater than before COVID-19. The use of more modalities for AH service provision (including telehealth) by facilities was significantly associated with increased likelihood to report serving the same number of adolescent or greater than before COVID-19 compared to those who used only one modality. CONCLUSION: Investments in multiple modalities of care provision, such as telehealth could improve AH services utilization and help sustain connection with adolescents during shocks, including future outbreaks or other stressors that limit physical access to health facilities.

Effects of life-sustaining treatment plans on healthcare expenditure and healthcare utilization.

PURPOSE: To develop an ethical and cultural infrastructure for Life-Sustaining Treatment (LST) plan, it is crucial to carefully analyze its impact and ensure that healthcare utilization is maintained at an appropriate level, avoiding excessive medical interventions. This study aims to investigate the effects of LST decisions on both healthcare expenditure and utilization. METHODS: This cohort study utilized claims data from the National Health Insurance Service, encompassing all medical claims in South Korea. We included individuals who had planned to withdraw or withhold their LST between January and December 2018, identified by claim code IA71, IA72, IA73. We followed a total of 28,295 participants with documented LST plan who were deceased by June 2020. Participants were categorized into LST withdrawal / withholding and LST continuation groups. The dependent variables were healthcare expenditure and utilization. We construct a generalized linear model to analyze the association between these variables. RESULTS: Out of the 28,295 participants, 24,436 (86.4%) chose to withdraw or withhold LST, while the rest opted for its continuation. Compared to the LST continuation group, those who chose to withdraw or withhold LST had 0.91 times lower odds for total cost. Additionally, they experienced 0.91 times fewer hospitalization days and 0.92 times fewer outpatient visits than those in the LST continuation group. CONCLUSION: Healthcare expenditure and utilization deceased among those choosing to withdraw or withhold LST compared to those continuing it. These findings underscore the significance of patients actively participating in decision regarding their treatment to ensure appropriate levels of medical intervention for LST. Furthermore, they emphasize the critical role of proper education and the establishment of a cultural framework for LST plans.

Maternal Health Experiences and Health Care Utilization of African Immigrant Women: A Review of The Literature.

INTRODUCTION: This systematic review summarizes the maternal health experiences and healthcare utilization of African immigrant women who have immigrated to the United States using an adapted version of the healthcare utilization model. METHODS: Published journal articles from the year 2000 to 2022 were identified from seven large databases; 13 studies satisfied the inclusion criteria. RESULTS: The results of the study are reported according to the individual and contextual factors for healthcare utilization for African immigrant women in the United States. Individual factors that facilitated the use of maternal healthcare were having transportation, higher health literacy levels, insurance, and family support. Contextual factors that facilitated maternal health utilization included access to interpreters and female doctors. DISCUSSION: Facilitators and barriers to maternal health utilization were impacted by cultural and environmental factors. First, African immigrant women included in the studies, believe pregnancy and childbirth are safe and normal, therefore prenatal care is unnecessary. Second, the fear of obstetrical interventions, especially from women who have had female genital mutilation. Third, the misconceptions regarding pain medications and the roles of hospital staff. Further research is necessary for addressing the facilitators and barriers to healthcare utilization in African immigrant women.

Migration is an important social determinant of health that can greatly affect health outcomes. Despite the advances in maternal and child health in the United States, women who migrate from Africa to the United States from low or middle-income countries often face maternal healthcare challenges. The maternal healthcare utilization of African immigrant women is important as pregnancy often constitutes a period of increased vulnerability for adverse health outcomes. African immigrant women experience adverse maternal health outcomes following their migration which is not explained by maternal risk factors alone. Therefore, there is a critical need to understand the maternal health experiences and healthcare utilization for African immigrant women. This systematic review summarized research on the maternal health experiences of African immigrant women and how these experiences facilitate or hinder the use of maternal health services.

Health and economic implications of the ongoing coronavirus disease (COVID-19) pandemic on women and children in Africa.

The coronavirus disease (COVID-19) pandemic continues to pose major health and economic challenges for many countries worldwide. Particularly for countries in the African region, the existing precarious health status resulting from weak health systems have made the impact of the pandemic direr. Although the number of the COVID-19 infections in Africa cannot be compared to that of Europe and other parts of the world, the economic and health ramifications cannot be overstated. Significant impacts of the lockdowns during the onset of the pandemic caused disruptions in the food supply chain, and significant declines in income which decreased the affordability and consumption of healthy diets among the poor and most vulnerable. Access and utilization of essential healthcare services by women and children were also limited because of diversion of resources at the onset of the pandemic, limited healthcare capacity, fear of infection and financial constraint. The rate of domestic violence against children and women also increased, which further deepened the inequalities among these groups. While all African countries are out of lockdown, the pandemic and its consequent impacts on the health and socio-economic well-being of women and children persist. This commentary discusses the health and economic impact of the ongoing pandemic on women and children in Africa, to understand the intersectional gendered implications within socio-economic and health systems and to highlight the need for a more gender-based approach in response to the consequences of the pandemic in the Africa region.

Use of medical services in Chile: How sensitive are the results to different econometric models?

BACKGROUND: We compared different econometric specifications to model the use of medical services in Chile, focussing on visits to general practitioners and specialist physicians. METHODS: The evaluated models are the Poisson, Negative Binomial, Zero Inflated Poisson and Negative Binomial, two-step Hurdle model, sample-selection Poisson, and Latent Class model. These models were estimated using Chilean data for the years 2009 and 2015, separated by gender. RESULTS: Unlike previous literature that supported the use of the latent class model, our results show that the latent class model is not always the model with the best goodness of fit. Furthermore, the model with the best fit is not necessarily the model with the best predictive power. For instance, depending on the year and medical services, either the latent class model or the sample-selection Poisson model performs better than the other models. The results also show that the selection of the econometric model may have implications for the estimated influence that variables such as age, income, or affiliation to the public versus private sector have on the use of medical services. CONCLUSION: Using Chilean data, we have tested that the selection of an econometric method to model the use of medical services is not a problem with a unique answer. We recommend performing a sensitivity analysis of goodness of fit and predictive power between gender, healthcare services, or different years of datasets in future applications to be sure about the best model specification in each context.

Perceptions of mental health and utilization of mental health services among new immigrants in Canada: A qualitative study.

The impact of immigration on individuals' overall health, including mental health, is complex. New immigrants' concepts of mental health, mental healthcare utilization, and their knowledge of existing services in Regina, Canada were explored using a hermeneutic phenomenological approach. Three focus groups were conducted with 37 participants recruited from English language classes provided by a non-governmental organization in the city. Irrespective of country of origin, participants recognized the impact of mental health on general wellbeing. Access to existing mental healthcare was hindered by language barriers, inadequate information about existing healthcare services, and individuals' perceptions about what and when services should be accessed. Despite challenges, participants viewed relocation positively and exhibited resilience when dealing with daily stress. Participants had knowledge gaps surrounding the role of family physicians in managing mental health conditions. Information on ways to access existing healthcare services should be delivered in collaboration with community organizations serving new immigrants.

National Estimates of Workplace Telehealth Use Among Emergency Nurses and All Registered Nurses in the United States.

INTRODUCTION: The goal of this research was to quantify the baseline status of prepandemic workplace emergency nursing telehealth as a key consideration for ongoing telehealth growth and sustainable emergency nursing care model planning. The purpose of this research was to: (1) generate national estimates of prepandemic workplace telehealth use among emergency and other inpatient hospital nurses and (2) map the geographic distribution of prepandemic workplace emergency nurse telehealth use by state of nurse residence. METHODS: We generated national estimates using data from the 2018 National Sample Survey of Registered Nurses. Data were analyzed using jack-knife estimation procedures coherent with the complex sampling design selected as representative of the population and requiring analysis with survey weights. RESULTS: Weighted estimates of the 161 865 emergency nurses, compared with 1 191 287 other inpatient nurses revealed more reported telehealth in the workplace setting (49% vs 34%) and individual clinical practice telehealth use (36% vs 15%) among emergency nurses. The geographic distribution of individual clinical practice emergency nurse telehealth use indicates greatest adoption per 10 000 state residents in Maine, Alaska, and Missouri with more states in the Midwest demonstrating emergency nurse adoption of telehealth into clinical practice per population than other regions in the United States. DISCUSSION: By quantifying prepandemic national telehealth use, the results provide corroborating evidence to the potential long-term adoptability and sustainability of telenursing in the emergency nursing specialty. The results also implicate the need to proactively define emergency nursing telehealth care model standards of practice, nurse competencies, and reimbursement.

Maternal education level and maternal healthcare utilization in the Democratic Republic of the Congo: an analysis of the multiple indicator cluster survey 2017/18.

BACKGROUND: Understanding how socioeconomic factors influence maternal health services utilization is crucial to reducing preventable maternal deaths in the DRC. Maternal education is considered an important associate of maternal health service utilization. This study aims to investigate the association between maternal education and the utilization of maternal health services, as well as present geographical and socio-economic disparities in the utilization. METHODS: The MICS survey was employed as the data source, which is a nationally representative survey conducted from 2017 to 2018 in the DRC. The exposure for this study was the maternal education level, which was categorized into three groups: (1) below primary and none, (2) primary and (3) secondary and above. Prenatal care indicators included: if the mother ever received prenatal care, if the mother had antenatal checks no less than four times, and if a skilled attendant was present at birth. Postnatal care indicators included: if the mother received postnatal care and if the baby was checked after birth. Emergency obstetric interventions were indicted by cesarean sections. Descriptive analyses and logistic regressions were used as analytical methods. RESULTS: Of all 8,560 participants included, 21.88 % had below primary school or no education, 39.81 % had primary school education, and 38.31 % had secondary education or above. The majority of participants were from rural areas, except for Kinshasa. Overall, a better education was associated with higher utilization of antenatal care. A dose-response effect was also observed. Compared to women with below primary or no education, women with secondary and above education were more likely to receive cesarean sections. Wealth status, as well as rural and urban division, modified the associations. CONCLUSIONS: Mothers' education level is an important associate for utilizing appropriate maternal healthcare, with wealth and region as modifying factors. Educational levels should be considered when designing public health interventions and women's empowerment programs in the DRC. For example, relevant programs need to stratify the interventions according to educational attainment.

Association of self-reported hearing loss severity and healthcare utilization outcomes among Medicare beneficiaries.

PURPOSE: Understanding health utilization trends in the elderly population is pivotal for Medicare and policymakers. This study evaluates the association between hearing status and health utilization outcomes in a representative sample of elderly Medicare beneficiaries. MATERIALS AND METHODS: We employed the 2017 Medicare Current Beneficiary Survey (MCBS), which includes self-reported hearing loss data and weighted health utilization information. Analyses were limited to Medicare beneficiaries aged 65 and older without hearing aids. Multivariable logistic regression was performed to assess association between self-reported hearing loss and health utilization outcomes. RESULTS: Of 7160 respondents, 55.1%, 39.9% and 4.9% reported no trouble hearing, little trouble hearing, and a lot of trouble hearing, respectively. On multivariable logistic regression, both a little and a lot of trouble hearing were associated with trouble accessing care (little trouble hearing: odds ratio [OR] = 1.79, 95% confidence interval [CI]: 1.33-2.40, p < 0.001; lot of trouble hearing: OR = 2.89, 95% CI: 1.81-4.60, p < 0.001) and emergency room (ER) visits (little trouble hearing: OR = 1.24, 95% CI: 1.08-1.42, p = 0.002; lot of trouble hearing: OR = 1.44, 95% CI: 1.10-1.89, p = 0.01). A lot of trouble hearing was associated with avoiding doctor visits (OR = 1.63 95% CI: 1.21-2.21, p = 0.002). Self-reported hearing status was not associated with inpatient or skilled nursing facility (SNF) admission on adjusted analyses. CONCLUSIONS: Increasing reported hearing loss severity is associated with decreased access to and avoidance of routine medical visits, and increased utilization of ER visits. These findings have important implications for Medicare, clinicians and policymakers. Further studies should evaluate if hearing aids can mitigate these outcomes.

Correlates of antenatal care usage among adolescent mothers in Nigeria: a pooled data analysis.

This study examined selected correlates of timing and frequency of antenatal care visits among adolescent mothers aged 15-19 in Nigeria. Data from the women's recode dataset of the Nigeria Demographic and Health Surveys between 2003 and 2018 were pooled, with a sample size of 4,775. Multivariate data analysis was carried out using binary logistic regression. It was found that being educated (aOR = 1.54; CI = 1.14-2.08; aOR = 1.64; CI = 1.11-2.42); higher wealth status (aOR = 1.88; CI = 1.45-2.43; aOR = 1.92; CI = 1.33-2.76); contributing to health decision-making (aOR = 1.44, CI = 1.15-1.81); having an educated partner (aOR = 1.73; CI = 1.31-2.30; aOR = 2.44; CI = 1.84-3.25); and living in the South West region (aOR = 3.68; CI = 1.72-7.87) were associated with higher complete antenatal care utilization. Having difficulty getting permission to go to the health facility (aOR = 0.75, CI = 0.57-0.99) and with the distance to the health facility (aOR = 0.61, CI = 0.49-0.75) were associated with lower likelihood of ANCU. Respondents with secondary and higher education were more likely to start ANC early (aOR = 1.57, CI = 1.05-2.34), but Muslim mothers (aOR = 0.61, CI = 0.40-0.32) and those living in the North West (aOR = 0.43, CI = 0.26-0.71), South-South (aOR = 0.30, CI = 0.17-0.53) and South West (aOR = 0.29, CI = 0.12-0.69) were less likely to begin ANC early. Therefore, interventions to increase antenatal care must be region-specific, and focus attention on lower status adolescent mothers with less autonomy.

Health benefits of social insurance.

This paper studies the potential positive externality of unemployment insurance (UI) on infant birth outcomes. Taking advantage of variations of UI benefits across states and over time, we find that UI improves birth outcomes, including mean birth weight, full-term birth weight, low birth weight, fetal growth, and preterm birth. If all states apply the UI schedule of the most generous state (Massachusetts), the average birth weight increases by roughly 19 g.

Andersen's model on determining the factors associated with antenatal care services in Nepal: an evidence-based analysis of Nepal demographic and health survey 2016.

BACKGROUND: With the formulation of the National Safe Motherhood Policy in 1998, safe motherhood has forever been a priority program in Nepal. Under the safe motherhood program, every woman is provided with essential maternal health care services until now through the four-tire district health care system. There is a considerable increase in the utilization of antenatal care (ANC) by a skilled health provider from 2011 to 2016, 58 to 84%, respectively. However, inequality, exclusion, and under-utilization in health care services continue in many regions of Nepal. The present study aimed to explore the different types of socio-demographic factors associated with current ANC service utilization in Nepal. METHODS: A cross-sectional study was conducted using the Nepal Demographic and Health Surveys data (DHS-7, 2016-2017). We estimated the latest pregnancy and live births in recent 5 years with the utilization of ANC services, and socio-economic differentials in these indicators under the framework of the Andersen behavioral model. RESULTS: Two in three (69.8%) with last birth accessed at least four ANC visits. The rate of live birth was about 98.6% in the ANC4+ group, higher than that of 96.8% in the ANC4- group (χ2: 14.742, P <  0.001). In the multilevel logistic regression analysis, we found that women from province 2 (OR: 0.48; 95%CI: 0.32-0.74) and province 6 (OR: 0.46; 95%CI: 0.30-0.71) were significantly less likely to visit ANC 4 or more times. Age (OR: 0.95; 95%CI: 0.93-0.96) was also significantly associated with the frequency of ANC visits. Level of Women's education and education of her partner were both significantly associated with the ANC visits: women (OR: 4.64; 95%CI: 3.05-7.05) and her partner (OR: 1.45; 95%CI: 1.01-2.06) having higher education were most likely to go for the recommended number of ANC visits. Moreover, women having exposure to multimedia were more likely to go for four or more ANC check-ups. CONCLUSIONS: The results highlight the need for governments and health care providers to develop special health promotion program with a focus on the vulnerable and disadvantaged and to use multi-media for maternal health literacy improvement flexibly, and maternal health system strengthening.

Community-based outreach associated with increased health utilization among Navajo individuals living with diabetes: a matched cohort study.

BACKGROUND: Navajo community members face high rates of diabetes mellitus and other chronic diseases. The Navajo Community Health Representative Outreach Program collaborated with healthcare providers and academic partners to implement structured and coordinated outreach to patients living with diabetes. The intervention, called Community Outreach and Patient Empowerment or COPE, provides home-based health coaching and community-clinic linkages to promote self-management and engagement in healthcare services among patients living with diabetes. The purpose of this study was to evaluate how outreach by Navajo Community Health Representatives ("COPE Program") affected utilization of health care services among patients living with diabetes. METHODS: De-identified data from 2010 to 2014 were abstracted from electronic health records at participating health facilities. In this observational cohort study, 173 cases were matched to 2880 controls. Healthcare utilization was measured as the number of times per quarter services were accessed by the patient. Changes in utilization over 4 years were modeled using a difference-in-differences approach, comparing the trajectory of COPE patients' utilization before versus after enrollment with that of the control group. The model was estimated using generalized linear mixed models for count outcomes, controlling for clustering at the patient level and the service unit level. RESULTS: COPE enrollees showed a 2.5% per patient per quarter (pppq) greater increase in total utilization (p = 0.001) of healthcare services than non-COPE enrollees; a 3.2% greater increase in primary care visits (p = 0.024); a 6.3% greater increase in utilization of counseling and behavioral health services (p = 0.013); and a 9.0% greater increase in pharmacy visits (p <  0.001). We found no statistically significant differences in utilization trends of inpatient, emergency room, specialty outpatient, dental, laboratory, radiology, or community encounter services among COPE participants versus control. CONCLUSIONS: A structured intervention consisting of Community Health Representative outreach and coordination with clinic-based providers was associated with a modest increase in health care utilization, including primary care and counseling services, among Navajo patients living with diabetes. Community health workers may provide an important linkage to enable patients to access and engage in clinic-based health care. TRIAL REGISTRATION: NCT03326206, registered 10/31/2017, retrospectively registered.

Health care utilization in geriatric patients admitted with alcohol withdrawal from 2005 to 2014.

BACKGROUND: Alcohol-related and alcohol withdrawal (AW) hospitalizations are routinely underestimated in the geriatric population and can have a significant impact on healthcare resource utilization. OBJECTIVES: To examine various patient-characteristics, hospitalization-outcomes, and prevalence of AW related-hospitalizations. METHODS: In this retrospective study, we examined the objectives mentioned above over a 10-year period (2005 to 2014) using the Nationwide Inpatient Sample (NIS) in adults aged 65 years or older. National estimates of trends for AW prevalence and matched-regression analyses were conducted. RESULTS: Increased prevalence of hospitalizations for AW was observed (148-cases-per-100,000-discharges in 2005 to 283-cases-per-100,000-discharges in 2014). Of the overall nationwide hospital admissions in patients aged 65 and older (128,111,787), 0.21% (264,786) with documented AW were identified. Of these, those of age 65-74 years accounted for 72.7% of admissions with the highest prevalence amongst males (males accounted for 74%, women 26%) and individuals of Caucasian ethnicity (79.9%).On comparing AW to Non-AW related-hospitalizations, patients admitted with AW had a higher median length of stay (five vs. four days), more significant functional decline with only 44.2% discharges being discharged home (vs. 47.2%) and 34.4% AW related discharges requiring discharge to skilled nursing facilities (vs. 28.5%). Higher hospitalization costs totaling $4,000 more on bivariate analysis were observed for the AW group. CONCLUSIONS: The prevalence of admissions with AW has increased in the inpatient geriatric population, contributing to increased length of stay, higher hospitalization costs, and greater functional decline. Recognition of these findings and the development of programs supporting older adults with alcohol use disorder may improve patient outcomes.

Health-care use and cost for multimorbid persons with dementia in the National Health and Aging Trends Study.

BACKGROUND: Most persons with dementia have multiple chronic conditions; however, it is unclear whether co-existing chronic conditions contribute to health-care use and cost. METHODS: Persons with dementia and ≥2 chronic conditions using the National Health and Aging Trends Study and Medicare claims data, 2011 to 2014. RESULTS: Chronic kidney disease and ischemic heart disease were significantly associated with increased adjusted risk ratios of annual hospitalizations, hospitalization costs, and direct medical costs. Depression, hypertension, and stroke or transient ischemic attack were associated with direct medical and societal costs, while atrial fibrillation was associated with increased hospital and direct medical costs. No chronic condition was associated with informal care costs. CONCLUSIONS: Among older adults with dementia, proactive and ambulatory care that includes informal caregivers along with primary and specialty providers, may offer promise to decrease use and costs for chronic kidney disease, ischemic heart disease, atrial fibrillation, depression, and hypertension.