Search Results (64)

Background: Opioid Use Disorder (OUD) has claimed the lives of many Americans, with rates of overdose steadily rising over the past decade. Despite having highly effective medications to treat this condition, many providers still hesitate to prescribe them. Psychiatric inpatient facilities have a unique opportunity to engage patients with co-occurring disorders in the treatment of OUD; however, significant barriers exist. This study describes a novel OUD–buprenorphine (BUP) consultation service that provides such care to hospitalized psychiatric patients. Methods: This IRB-approved retrospective study reviewed the medical records of 123 hospitalized psychiatric patients who received consultations from the BUP consultation service. Descriptive and comparative statistics were performed. Results: The sample was predominantly male, with significant unemployment and housing instability. Patients were hospitalized for depressive, bipolar, and schizophrenia spectrum disorders. Over 90% of patients were discharged on buprenorphine, with over 50% being connected to specialized substance use services. No increase in the length of stay was found, and no difference in outcomes was observed based on diagnosis or BUP discharge status. Discussion/Conclusions: This novel service was effective in providing OUD treatment to patients with complex co-occurring psychiatric disorders without significantly increasing their length of stay. Despite acute exacerbations in psychiatric illness, patients were able to engage in discussions regarding BUP. While the study was limited in scope, it underscores the feasibility of integrating OUD treatment in the acute psychiatric inpatient setting. Full article

On 24 February 2024, Italian physicians, dentists and oral care specialists, students, nurses, psychologists, dental hygienists, and other professionals met (live or online) to discuss controversial issues about medication-related osteonecrosis of the jaw (MRONJ). One section hosted international experts who gave lectures about MRONJ experiences in North America, Europe, and Italy. A second section summarized the principal points of an Italian MRONJ position paper published in February 2024 by experts from the Italian Societies of Oral Pathology and Medicine (SIPMO) and Maxillofacial Surgery (SICMF). The following section collates expert opinions about open issues and required fields of research: different definitions of MRONJ and impact on staging; the assessment of individual MRONJ risk before the start of antiresorptive therapy; surgery and implantology in patients at risk for MRONJ; cancer patients without metastases and prevention of cancer-treatment-induced bone Loss (CTIBL); the role of dental hygiene professionals; combined (medical and surgical) and surgical therapy for MRONJ in-patients and out-patients; and legal aspects and claims related to MRONJ diagnosis and treatment. Scientific contributions from hospitals and universities all over Italy were presented in specific sessions (epidemiology; case series; special case reports; prevention experiences; MRONJ treatment). Conclusions: the conference confirmed the importance of the adequate imaging study of bone in the diagnosis and staging of MRONJ cases, the role of surgery in MRONJ treatment, and the value of oral hygiene in the MRONJ prevention. Full article

Background/Objectives: Vaginitis is a common infection among women of reproductive age. Although various diagnostic methodologies exist, diagnosis without the utilization of available diagnostic tests remains prevalent. This study aimed to assess downstream healthcare utilization and the cost of patients with and without diagnostic testing. Methods: This retrospective, observational study utilized the IQVIA PharMetrics^® Plus database from July 2020 to October 2023. Patients with an index claim (ICD-10 code indicating vaginitis) were categorized into two cohorts: those who received a syndromic polymerase chain reaction (PCR) test and those who had no documented test on the index date or within two days. Total and service-specific healthcare resource utilization and costs were assessed for 6 months following the index event. This study was designed to inform how Syndromic Vaginitis PCR testing is used to make treatment decisions and to track outpatient and inpatient healthcare utilization for 6 months post index date represented by cost. Results: Patients who received a Syndromic Vaginitis PCR test had significantly fewer outpatient medical services in the 6 months following initial diagnosis compared to those who received no diagnostic test. This was largely attributed to a substantial decrease in other medical service visits, resulting in mean cost savings of USD 2067 (Syndromic PCR = USD 6675, SD = USD 17,187; No Test = USD 8742, SD = USD 29,894) (p-value 0.0009). Conclusions: Many vaginitis patients do not receive testing, but Syndromic Vaginitis PCR testing may be an effective diagnostic tool for reducing costs associated with vaginitis infections. Full article

Background: Oral anticoagulants (OACs), such as apixaban and warfarin, are indicated for reducing the risk of recurrent venous thromboembolism (VTE) and are often initiated in the hospital. The aim of this study was to evaluate OAC continuity from inpatient to outpatient settings and the risk of recurrent VTE among patients with an initial event. Methods: This retrospective cohort study utilized hospital charge data and medical and prescription claims from 1 July 2016 to 31 December 2022 to identify adults treated with apixaban or warfarin while hospitalized for VTE. Patients were followed to assess switching or discontinuation post-discharge and the risk of recurrent VTE. The index date was the date of the first apixaban or warfarin claim within 30 days post-discharge. Results: Of the 19,303 eligible patients hospitalized with VTE, 85% (n = 16,401) were treated with apixaban and 15% (n = 2902) received warfarin. After discharge, approximately 70% had ≥1 fill for their respective apixaban or warfarin therapy. The cumulative incidence of discontinuation over the 6 months following index was 50.5% and 52.2% for the apixaban and warfarin cohorts, respectively; the cumulative incidence of switching was 6.0% and 20.9%, respectively. The incidence rates of recurrent VTE were 1.2 and 2.5 per 100 person-years for the apixaban and warfarin cohorts, respectively. Conclusions: The majority of patients continued their apixaban or warfarin therapy following hospital discharge; however, a considerable proportion either switched or discontinued OAC upon transitioning from inpatient care. Among those who continued therapy, discontinuation, switch, and recurrent VTE occurred less often with apixaban vs. warfarin. Full article

Background: The COVID-19 pandemic affected the utilization of healthcare services in many parts of the world. The response to the healthcare burden imposed by the COVID-19 pandemic was associated with ensuring the provision of optimum healthcare services. This study aimed to estimate the effect of the COVID-19 pandemic on health services utilization and spending patterns in Dubai, the UAE. Methods: This cross-sectional study used secondary data on healthcare utilization and spending to compare between 2019 and 2020. The data was extracted from the health insurance claims on the eClaimLink platform. Descriptive and inferential statistics were used to calculate the percent change of service utilization and spending and percentages of total claims by each encounter type across major diagnostic categories (MDCs). Results: In 2020, there was an overall reduction in outpatient visits and inpatient admissions of 27% and 21%, respectively, compared to 2019. Outpatient visits and prescriptions decreased across all the MDCs except mental and behavioral disorders, which showed an increase of 8% in outpatient visits and 29% in prescriptions. The admissions to the healthcare facilities were also reduced significantly across various MDCs, ranging from 10% to 44%. Similarly, a downward trend was seen in diagnostics for different MDCs. An increase in expenditure on diagnostics and drugs for neoplasm was reported, despite a corresponding decrease in outpatient and inpatient admissions for the same. Conclusion: A significant decrease in overall healthcare utilization and corresponding healthcare spending, resulting from a decline in outpatient and inpatient volume in healthcare facilities at all the levels (hospitals, clinics, speciality centres), was reported during the pandemic. The impact of the pandemic on mental health was reported by this study, as it showed an upward trend in utilization and spending. For the neoplasms, although the utilization declined, the expenditure on diagnostics and drugs during each encounter increased significantly. Full article

Background and Objectives: This retrospective, cross-sectional, and descriptive study used claims data from the Korean Health Insurance Review and Assessment Service (HIRA) between 2010 and 2019 to analyze the trend of surgical service utilization in patients with lumbar spinal stenosis (LSS). Materials and Methods: The national patient sample data provided by the HIRA, which consisted of a 2% sample of the entire Korean population, was used to assess all patients who underwent decompression or fusion surgery at least once in Korea, with LSS as the main diagnosis from January 2010 to December 2019. An in-depth analysis was conducted to examine the utilization of surgical services, taking into account various demographic characteristics of patients, the frequency of claims for different types of surgeries, reoperation rates, the specific types of inpatient care associated with each surgery type, prescribed medications, and the overall expense of healthcare services. Results: A total of 6194 claims and 6074 patients were analyzed. The number of HIRA claims for patients increased from 393 (2010) to 417 (2019) for decompression, and from 230 (2010) to 244 (2019) for fusion. As for the medical expenses of surgery, there was an increase from United States dollar (USD) 867,549.31 (2010) to USD 1,153,078.94 (2019) for decompression and from USD 1,330,440.37 (2010) to USD 1,780,026.48 (2019) for fusion. Decompression accounted for the highest proportion (65.8%) of the first surgeries, but more patients underwent fusion (50.6%) than decompression (49.4%) in the second surgery. Across all sex and age groups, patients who underwent fusion procedures experienced longer hospital stays and incurred higher medical expenses for their inpatient care. Conclusion: The surgical service utilization of patients with LSS and the prescribing rate of opioids and non-opioid analgesics for surgical patients increased in 2019 compared to 2010. From mid-2010 onward, claims for fusion showed a gradual decrease, whereas those for decompression showed a continuously increasing trend. The findings of this study are expected to provide basic research data for clinicians, researchers, and policymakers. Full article

Adverse outcomes after childhood cancer have been assessed in a range of settings, but most existing studies are historical and ascertain outcomes only after 5-year survival. Here, we describe the Alberta Childhood Cancer Survivorship Research Program and its foundational retrospective, population-based cohort of Albertan residents diagnosed with a first primary neoplasm between the ages of 0 and 17 years from 1 January 2001 to 31 December 2018. The cohort was established in collaboration with the Alberta Cancer Registry and Cancer in Young People in Canada program and has been linked to existing administrative health databases and patient-reported outcome questionnaires. The cohort comprised 2581 survivors of childhood cancer, 1385 (53.7%) of whom were 5-year survivors. Approximately 48% of the cohort was female, 46% of the cohort was diagnosed between 0 and 4 years of age, and the most frequent diagnoses were leukemias (25.3%), central nervous system tumors (24.2%), and lymphomas (14.9%). Detailed treatment information was available for 1745 survivors (67.6%), with manual abstraction ongoing for those with missing data. By the study exit date, the median time since diagnosis was 5.6 years overall and 10.3 years for 5-year survivors. During the follow-up time, 94 subsequent primary cancers were diagnosed, 16,669 inpatient and 445,150 ambulatory/outpatient events occurred, 396,074 claims were reported, and 408 survivors died. The results from this research program seek to inform and improve clinical care and reduce cancer-related sequelae via tertiary prevention strategies. Full article

Persistent inflammation, immunosuppression, and catabolism syndrome (PICS) is a serious condition after critical care. We examined the efficacy of antithrombin, which may attenuate coagulopathy with the control of inflammation, for PICS among patients with sepsis-induced disseminated intravascular coagulation (DIC). The present study used the inpatient claims database with laboratory findings to identify patients admitted to intensive care units and diagnosed with sepsis and DIC. A composite of the incidence of PICS on day 14 or 14-day mortality as the primary outcome was compared between the antithrombin and control groups using a propensity-score-matched analysis. Secondary outcomes were the incidence of PICS on day 28, 28-day mortality, and in-hospital mortality. A total of 324 well-balanced matched pairs were generated from 1622 patients. The primary outcome did not differ between the antithrombin and control groups (63.9% vs. 68.2%, respectively, p = 0.245). However, the incidences of 28-day and in-hospital mortality were significantly lower in the antithrombin group (16.0% vs. 23.5% and 24.4% vs. 35.8%, respectively). Similar results were obtained in a sensitivity analysis using overlap weighting. Antithrombin did not reduce the occurrence of PICS on day 14 in patients with sepsis-induced DIC; however, it was associated with a better mid-term (day 28) prognosis. Full article

Objective: To report age- and population-adjusted trends in the prevalence of inpatient vaginal prolapse (VP), rectal prolapse (RP), and concurrent VP/RP surgical procedures in women in Washington State over a 12-year period. Methods: The Comprehensive Hospital Abstract Reporting System, an inpatient claims database, was queried for female patients aged 20 years or older with a diagnosis of VP and/or RP and associated surgical procedures from 2008 to 2019. Rates for female patients were adjusted by age and population based on census results. Results: Between 2008 and 2019, inpatient admissions for concurrent VP/RP surgery remained stable, with adjusted rates ranging from 1.42 to 3.38 per 100 000, with a majority performed in patients < 80 years old. The population-adjusted rate of inpatient RP repairs remained stable at 3.12 to 5.14 per 100 000. The population-adjusted rate of inpatient VP repairs decreased dramatically, from 81.79 to 6.96 per 100 000. Conclusions: The rate of inpatient RP and combined RP/VP surgical procedures was low and remained stable, while inpatient VP surgical repairs decreased substantially. Since the dataset is limited to inpatient surgery, this trend may reflect a shift to outpatient settings for VP surgeries. Nationally in the United States, there has been a trend toward multidisciplinary surgical management of concurrent VP/RP. However, this same trend does not appear to be reflected in Washington State, suggesting that nationwide trends may not be reflective of trends within each state. Further study is needed to understand how and why local trends in the management concurrent VP/RP may differ from national trends, and potentially improve concurrent VP/RP management using multidisciplinary approaches. Full article

Endometriosis is a disease that is often diagnosed late and that may lead to significant reduction in quality of life and serious complications (e.g., infertility). We aimed to assess the prevalence and the annual, nationwide health insurance treatment cost of endometriosis in Hungary using a quantitative, descriptive, cross-sectional method, focusing on the year 2019. We used claims data obtained from the Hungarian National Health Insurance Fund Administration (NHIFA). Patient numbers, total and age-specific prevalence, annual health insurance expenditure, and the distribution of costs across age groups were determined. The NHIFA spent a total of HUF 619.95 million (EUR 1.91 million) on endometriosis treatment. The highest number of patients and prevalence (10,058 women, 197.3 per 100,000) were found in outpatient care. In acute inpatient care, prevalence was substantially lower (23.5 per 100,000). Endometriosis, regardless of its type, affects 30–39-year-olds in the highest number: 4397 women (694.96 per 100,000) in this age group were affected in 2019. The average annual health insurance expenditure per capita was EUR 189.45. In addition to early detection and diagnosis of endometriosis, it is of pivotal importance to provide adequate therapy to reduce costs and reduce the burden on the care system. Full article

The impact of the 2019 coronavirus disease (COVID-19) pandemic is still being revealed, and little is known about the effect of COVID-19-induced outpatient and inpatient losses on hospital operations in many counties. Hence, we aimed to explore whether hospitals adopted profit compensation activities after the 2020 first-wave outbreak of COVID-19 in China. A total of 2,616,589 hospitalization records from 2018, 2019, and 2020 were extracted from 36 tertiary hospitals in a western province in China; we applied a difference-in-differences event study design to estimate the dynamic effect of COVID-19 on hospitalized patients’ total expenses before and after the last confirmed case. We found that average total expenses for each patient increased by 8.7% to 16.7% in the first 25 weeks after the city reopened and hospital admissions returned to normal. Our findings emphasize that the increase in total inpatient expenses was mainly covered by claiming expenses from health insurance and was largely driven by an increase in the expenses for laboratory tests and medical consumables. Our study documents that there were profit compensation activities in hospitals after the 2020 first-wave outbreak of COVID-19 in China, which was driven by the loss of hospitalization admissions during this wave outbreak. Full article

Adverse events and medical harm comprise major health concerns for people all over the world, including Thailand. The prevalence and burden of medical harm must always be monitored, and a voluntary database should not be used to represent national value. The purpose of this study is to estimate the national prevalence and economic impact of medical harm in Thailand using routine administrative data from the inpatient department electronic claim database under the Universal Coverage scheme from 2016 to 2020. Our findings show that there are approximately 400,000 visits with potentially unsafe medical care per year (or 7% of all inpatient visits under the Universal Coverage scheme). The annual cost of medical harm is estimated to be approximately USD 278 million (approximately THB 9.6 billion), with an average of 3.5 million bed-days per year. This evidence can be used to raise safety awareness and support medical harm prevention policies. Future work should focus on improving medical harm surveillance using better data quality and more comprehensive data on medical harm. Full article

Patient data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) are used to assess the effect of biguanide administration on rates of lactic acidosis (LA) in hospitalized diabetes mellitus (DM) patients. In this retrospective cohort study (from April 2013 to March 2016), we compare DM inpatients prescribed biguanides to DM inpatients who were not prescribed biguanides to quantify the association between biguanides and incidence of LA. In total, 8,111,848 DM patient records are retrieved from the NDB. Of the 528,768 inpatients prescribed biguanides, 782 develop LA. Of the 1,967,982 inpatients not prescribed biguanides, 1310 develop LA. The rate ratio of inpatients who develop LA and are administered biguanides to those who developed LA without receiving biguanides is 1.44 (95% CI, 1.32–1.58). Incidence rates and rate ratios for both sexes are elevated in the group prescribed biguanides for patients aged 70 years and older, markedly in those 80 years and older: 40.12 and 6.31 (95% CI, 4.75–8.39), respectively, for men and 34.96 and 5.40 (95% CI, 3.91–7.46), respectively, for women. Biguanides should be used conservatively in patients older than 70 years, particularly for those with comorbidities, and with caution in patients 80 years and older. Full article

We identified inconsistency in fracture definitions in a prior review of studies that utilized claims data. Here, we aimed to compare fracture rates estimated using thirteen hip and seven radius/ulna fracture definitions. Our primary analysis compared results in a cohort of 120,363 older adults treated with oral bisphosphonates for ≥3 years. The most inclusive definition (hip: inpatient or emergency diagnosis; radius/ulna: inpatient, emergency, or outpatient diagnosis) served as a referent to compare the number and proportion of fractures captured. In sensitivity analyses, we considered a 180-day washout, excluded fractures associated with trauma; and hip only, excluded: (1) subtrochanteric fractures, and (2) hip replacement procedures. Hip fractures varied by definition in number (52–8058) and incidence (0.7–111.8/10,000 person-years). The second most inclusive definition required one inpatient diagnosis and identified 8% fewer hip fractures than the referent. Excluding hip replacements missed 33% of hip fractures relative to the primary analysis. Radius/ulna fractures also ranged in number (1589–6797) and incidence (22.0–94.3/10,000 person-years). Outpatient data were important, when restricted to inpatient or emergency data, only 78% of radius/ulna fractures were identified. Other than hip replacement procedures, sensitivity analyses had minimal impact on fracture identification. Analyses were replicated in a cohort of patients treated with long-term glucocorticoids. This study highlights the importance and impact of coding decisions on fracture outcome definitions. Further research is warranted to inform best practice in fracture outcome identification. Full article

Due to the growing aging population and the increased number of long-term patients staying in nursing facilities, the prevalence of scabies has recently been increasing, even in developed countries. This study aimed to identify the actual status of hospitalized patients with scabies in South Korea using the national health insurance claims data. From 2010 to 2019, 2586 patients were hospitalized with scabies (B86) as the primary diagnosis. There were more females than males (χ² = 31.960, p < 0.001) and patients aged 80 years or older in long-term care hospitals (χ² = 431.410, p < 0.001). Scabies patients were mainly hospitalized in internal medicine, family medicine, and dermatology for all provider types (χ² = 170.033, p < 0.001). In long-term care hospitals, the rate of accompanying dementia was 31.9% (χ² = 193.418, p < 0.001), cerebral infarction was 10.4% (χ² = 106.271, p < 0.001), and cancer was 2.1% (χ² = 17.963, p < 0.001), which was higher than other provider types. Additionally, 20.6% in general hospitals (χ² = 198.952, p < 0.001) had an indwelling catheter, while 49.1% in hospitals and 41.1% in general hospitals were administered steroids (χ² = 214.440, p < 0.001). The KOH smear test was performed in 11.3% of all inpatients with scabies. We suggest recognizing these characteristics of scabies patients and thoroughly checking the skin lesions during physical examination for early diagnosis and prevention of scabies infection. Full article