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Kereri, Dovison. "Relationship between Affordable Care Act and Emergency Department Visits." Diss., NSUWorks, 2018. https://nsuworks.nova.edu/hpd_hs_stuetd/11.
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Affordable Care Act (ACA) was passed and implemented to expand insurance coverage, reduce health care cost, and improve the quality of care. The purpose of this dissertation study was to investigate whether the ACA insurance expansion correlates with the number of visits made to emergency departments (EDs). The quasi-experimental design interrupted time series was utilized in the analysis. The ED visits were compared using MANOVA to determine the relationship between ED visits and ACA and canonical correlation analysis to assess the strength of the relationship and the extent to which independent variables could predict the dependent variable. The hypothesis was that the ACA will reduce the uninsured, increase the insured, and reduce the ED visits. The relationship between number of ED visits and the ACA will present whether the uninsured patients contributed significantly to the ED overcrowding. Analysis of secondary data from four EDs (H1, H2, H3, and H4) in the Chicago area showed that 484,742 visits were made, and 2,801 were excluded due to unknown payer type. Medicaid patients recorded the largest number of visits (181,226) while the uninsured patients recorded the least number of visits (56,572). The ED visits decreased by 6% from 2012 to 2013 (pre-ACA) and increased by 4% from 2013 to 2105 (post-ACA). The ACA implementation increased the people with insurance who visited the EDs by 11%. The results demonstrated a strong relationship between ACA and ED visits. The correlation of the variables (hospital and year) and ED visits demonstrated that the hospital could explain 97% of the Medicaid visits and 87% of uninsured while the year could predict 82.6% of the uninsured visits and 52.5% of Medicaid visits.
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Knight, Elizabeth Pickering. "Symptom Trajectories After Emergency Department Visits for Potential Acute Coronary Syndrome." Diss., The University of Arizona, 2015. http://hdl.handle.net/10150/594909.
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Background: Many patients evaluated for acute coronary syndrome (ACS) in emergency departments (EDs) experience ongoing or recurrent symptoms after discharge, regardless of their ultimate medical diagnosis. A comprehensive understanding of post-ED symptom trajectories is lacking. Aims: Aim 1 was to determine trajectories of severity of common symptoms (chest pressure, chest discomfort, unusual fatigue, chest pain, shortness of breath, lightheadedness, upper back pain and shoulder pain) in the six months following an ED visit for potential ACS. Aim 2 was to identify relationships between symptom trajectories and baseline physiologic factors (age, gender, diabetes status, diagnosis, comorbidities, functional status) and situational factors (marital status, insurance status, education level). Aim 3 was to identify relationships between symptom trajectories and health service use (outpatient visits and calls, ED visits, 911 calls, hospitalization) in the six months after the ED visit. Methods: This was a secondary data analysis from a study conducted in five U.S. EDs. Patients (n=1002) who had abnormal electrocardiogram or biomarker testing and were identified by the triage nurse as potentially having ACS were enrolled. Symptom severity was assessed in the hospital and 30 days and six months post-discharge using the 13-item ACS Symptom Checklist. Symptom severity was modeled across the three study time points using growth mixture modeling. Model selection was based on interpretability, theoretical justification, and statistical fit indices. Patient characteristics were used to predict trajectories using logistic regression and differences in health service use were tested using chi-square analysis. Results: Between two and four distinct trajectory classes were identified for each symptom. Identified trajectories were labeled "tapering off," "mild/persistent," "moderate/persistent," "moderate/worsening," "moderate/improving," "late onset," and "severe/improving." Age, sex, diabetes, BMI, functional status, insurance status, and diagnosis significantly predicted symptom trajectories. Clinic visits and phone calls, 911 calls, ED visits, and probability of hospitalization varied significantly among trajectories. Conclusions: Research on the individual nature of symptom trajectories can support patient-centered care. Patients at risk for ongoing symptoms and increased health service use can be targeted for education and follow-up based on clinically observable characteristics. Further research is needed to verify the existence of multiple symptoms trajectories in diverse populations.
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Cyr, Julia Anne, and Julia Anne Cyr. "Evaluation of a Nurse Practitioner Led Program on Decreasing Emergency Room Visits." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/626651.
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Background: The overuse of the emergency department (ED) for non- critical patients has been associated with overcrowding and a rise in healthcare cost. Green Valley Fire Department (GVFD) has created a program, Fire-Based Urgent Medicals Service (FBUMS) with a nurse practitioner (NP). Patients can call 9-1-1 or the ""NP hotline"" and request to be seen by the NP instead of being immediately transported to the hospital via ambulance.
Purpose: The purpose of this project is to evaluate the impact of the nurse practitioner led FBUMS, on ED visits and ambulance transports.
Methods: A survey was mailed to all persons, age 18 and older, who were seen by the NP with FBUMS between February 2017 and March 2017. The survey asked about the reasons for contacting GVFD, the type of treatment received, and whether they went to ED after treatment.
Data analysis: Descriptive statistics including frequencies, percentages, means and standard deviations were used to analyze each of the answered survey questions in Microsoft Excel©.
Results: Surveys completed (n=42). The majority, 39 (92.9%) stated they did not receive care at the ED within 72 hours following their appointment with the NP, three (7.1%) stated they did. By dramatically decreasing transport to the hospital and associated ED treatment, it is estimated to have saved approximately $53,425 in ambulance costs and $54,210 in ED treatment for a total savings of $99,632.52.
Conclusion: A Fire-Based Urgent Medical Service led by a nurse practitioner decreased emergency room visits and ambulance transports.
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Shaffer, Claire. "EMERGENCY DEPARTMENT CROWDING: EXPLORING BIAS AND BARRIERS TO EQUITABLE ACCESS OF EMERGENCY CARE." Master's thesis, Temple University Libraries, 2018. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/487771.
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Urban BioethicsM.A.
The emergency department (ED) has often been considered the safety net of the American healthcare system. It earned this distinction because every person in the United States has access to a medical screening exam and stabilization at an ED regardless of their ability to pay. Unfortunately, over the past several decades, decreasing numbers of EDs and inpatient beds, coupled with increasing rates of ED usage, has led to crowding of EDs across the country. Crowding leads to unsafe conditions that may increase morbidity and mortality for patients, or cause patients to leave the ED without being evaluated by a physician. Essentially, crowding causes a barrier for patients to access their right to emergency evaluation. The problem of crowding is most pronounced in large urban communities, and these already frequently underserved patients suffer the most from the crowding burden. The main cause of crowding seems to be the boarding of admitted patients in the ED, however many often cite high rates of non-urgent patients presenting to the ED as a cause of crowding. Some have even suggested diverting non-urgent patients to help solve the problem of crowding. I became interested in this topic due to crowding concerns and initiatives to decrease the number of patients who left without being seen at my own institution. As I reviewed relevant research, I became aware of my own misconceptions and noted a trend of literature suggesting non-urgent patients are not the cause of crowding. Drawing on research from many different sources, paired with evaluation based on principles in bioethics, I have come to several conclusions. I believe the systematic diversion of non-urgent patients is unsafe, and that the unequal burden of ED crowding on urban communities represents an unjust barrier in access to care. We must continue to carefully research the demographics of patients frequently presenting to EDs to avoid perpetuating stereotypes about which types of patients are responsible for crowding. We should also look for ways to ease the crowding burden in urban communities. Additionally, we should take a qualitative assessment of our individual communities to determine if there are any particular reasons in our community that people choose to use the ED rather than other healthcare options. I believe these suggestions can be an important addition to the efforts already in motion to help reduce ED crowding and provide equitable access to emergency medical evaluation.
Temple University--Theses
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Barrows, Erik A. "An investigation of inhaled corticosteroid adherence and lifetime emergency department visits for asthma /." View abstract, 1999. http://library.ctstateu.edu/ccsu%5Ftheses/1517.html.
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Thesis (M.S.)--Central Connecticut State University, 1999.Thesis advisor: Dr. Cheryl Watson. " ... in partial fulfillment of the requirements for the degree of Master of Science." Includes bibliographical references (leaves 38-41).
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Marsella, Sarah A. "Emergency department visits for mental health: an examination of wait times to see a provider." Thesis, Boston University, 2014. https://hdl.handle.net/2144/21212.
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Thesis (M.S.H.P.)BACKGROUND: Emergency department (ED) visits for psychiatric issues have grown at a disproportionately higher rate than other visits. This has been attributed to factors including severe cuts in mental health (MH) services and identified as a culprit in ED overcrowding. Little is known, however, about how mental health reason-for-visit (MHRFV) interacts with patient and hospital characteristics to affect wait times to see an ED provider. OBJECTIVE: To determine if wait time (WT) to see a provider at the ED differs for those presenting with MHRFV and how various patient and hospital-level characteristics interact to affect it. METHODS: Data were obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for visits to EDs throughout the United States. We examined data for patients ≥ 18 years of age who visited an ED in years 2009 and 2010. Patient weights were used to generate national estimates. Patients’ primary reasons-for-visit were used to identify the MH group for analysis and comparison to all other RFVs. Predictors of WT were chosen based on the Andersen Behavioral and ED overcrowding models. WTs were log-transformed for initial bivariate and final multivariate regression models to assure a more normal distribution. RESULTS: Mean WT was 56.5 and 55.8 minutes for MHRFV and all others respectively with a shared median of 31 minutes. As expected with our large sample (n = 47,831), all variables of interest were significantly associated with WT. Adjusting for patient and hospital level characteristics, a multivariate regression revealed that MHRFV prolonged WT by about 50%. After adjustment for independent variables, interactions with MHRFV were tested as the main outcomes of interest. Blacks with MHRFV had WTs 62% longer, patients age 41-64 31% longer, payer status of Medicare/Medicaid or no coverage had WTs about 24% and 14% longer than private insurance. Conversely, patients at government owned hospitals had WTs 145%, and non-profits 42%, lower than private hospitals. CONCLUSIONS: This is the first time that ED WT has been examined in this depth with a sample of patients presenting with MH issues. The results indicate that disparities are more pronounced in this subgroup of ED patients.
2031-01-01
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Dominguez, Jr Arthur. "Decreasing Primary-Care-Related Emergency Department Visits in the Hispanic Population Using Patient Navigators." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4616.
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Primary-care-related emergency department (PCR-ED) visits by Hispanic patients enrolled in a not-for-profit Medi-Cal and Medicare health plan resulted in longer wait times in the emergency department (ED) at a regional medical center in Southern California. This congestion decreased access for those with true emergencies, created capacity issues, increased ED length of stay, and resulted in potential safety risks. This project focused on decreasing PCR-ED visits in the Hispanic population using patient navigators in Southern California. Applying the health belief model and Lippitt's theory of change, this doctoral project involved the creation and implementation of a culturally appropriate, population-specific patient navigator model for the Hispanic population. Evaluation of outcomes was accomplished using electronic health record (EHR) results, which demonstrated a reduction of PCR-ED visits and revisits. The project exceeded the goal of 10% reduction in PCR-ED visits and revisits in the target population and resulted in a 14.31% reduction of PCR-ED visits and revisits within 1 month of implementation. Emergency Severity Index levels, wait time associated with each Emergency Severity Index level, and visits of the targeted Hispanic population enrolled in the health plan were analyzed to evaluate the success of the program. This project may lead to improvements in nursing practice and positive social change by supporting population health management and continuum of care to a primary care physician through safe and efficient patient navigation to treatment and care.
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Murtagh, Kurowski Eileen M. D. "Evaluation of Differences Between Pediatric and General Emergency Departments in Rate of Admission and Resource Utilization for Visits by Children and Young Adults with Complex Chronic Conditions." University of Cincinnati / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1353950161.
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Ionescu-Ittu, Raluca. "Continuity of primary care and return visits to the emergency department for seniors in Quebec." Thesis, McGill University, 2004. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=82255.
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Background. Continuity of care as a principle of health care planning is losing ground in favor of new principles such as accessibility and plurality of provision, but the long-term effects of these changes on the utilization of expensive health services such as hospitalizations and emergency department utilization are still unknown.Objective. To investigate among individuals aged 66 years or older who have had an index visit to an emergency department (ED) whether there is an association between the continuity with a primary care provider and the likelihood of having an ED return visit 14 days after the index ED visit.
Conclusions. Among Quebec seniors, relational continuity of care measured by UPC may not be an important protective factor against returning to the ED after an index visit. The main study limitations to be considered in the interpretation of these results relate to the use of administrative data, and include potential misclassification of ED visits and return visits, inability to distinguish planned from unplanned return visits, and residual confounding due to covariates that were either not measured or measured at the ecological level (e.g., socioeconomic status).
Research and policy implications. Further research, using different data sources and measures, is needed to investigate the association between continuity of care and ED utilization among seniors in Quebec. (Abstract shortened by UMI.)
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Leon, Stephanie L. "Pediatric Mental Illness in the Emergency Department: Understanding the Individual, Family and Systemic Factors in Return Visits." Thesis, Université d'Ottawa / University of Ottawa, 2018. http://hdl.handle.net/10393/37246.
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This dissertation addresses some of the gaps in the research on pediatric mental health (MH) repeat visits to the emergency department (ED). The primary objectives of this thesis are to systematically review the existing literature on youth MH return visits to the ED and to determine the incremental contribution of family factors in predicting these repeat ED visits.
The first study systematically reviewed and qualitatively summarized the available literature to better understand predictor of repeat visits. A search was performed using the following databases: PsycINFO, PubMed, and CINAHL. Reporting followed the PRISMA statement checklist and methodological quality was assessed using the following eight criteria: design, generalizability, breadth of predictors, reporting of effect sizes, additional outcomes, interaction terms, confounding variables, and clear definition of outcome. A total of 178 articles were retrieved; 11 articles met inclusion criteria. Findings revealed that repeat visits to the ED for MH concerns is a complex phenomenon that can be attributed to various demographic, clinical, and MH care access and utilization factors. Common predictors associated with repeat ED MH visits included socioeconomic status, involvement with child protective services, as well as previous and current MH service use. For studies using a six-month repeat window, the most common factors were previous psychiatric hospitalization and currently receiving MH services. This systematic review concluded that in order to further elucidate which variables are most significantly associated with repeat ED visits; future research should consider the use of prospective designs and the inclusion of family factors. Investigating recency and frequency outcomes may also be of importance. The second study aimed to determine if family characteristics are significantly associated with repeat ED visits over and above the contribution of demographic, clinical or service utilization factors. A retrospective cohort study of youth aged six to18 years treated at a tertiary pediatric ED for a discharge diagnosis related to MH was conducted. Data were gathered from medical records, telephone interviews, and questionnaires. Of 266 participants, 70 (26%) had a repeat visit. Receiving MH services within six-months of the index visit, having a parent with a history of treatment for MH concerns, higher severity of symptoms and living closer to the hospital were significantly associated with repeat visits as well as earlier and more frequent repeat visits. Prior psychiatric hospitalization was associated with repeat visits and more frequent repeat visits, while presenting with suicidality was associated with more frequent repeat visits. Family functioning and perceived family burden were not associated with repeat ED visits.
This thesis contributes to the growing literature on ED use in pediatric patients with mental illnesses and may be clinically useful to professionals working with repeat visitors. The identification of key factors could provide essential information to ED decision-makers and lead to the development of best practices with this population.
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Zielinski, Nicholas C., and Grant Skrepek. "Mortality and Cost Outcomes of Emergency Department Visits Associated with Primary or Disseminated Liver Cancer in the United States; 2009." The University of Arizona, 2012. http://hdl.handle.net/10150/614537.
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Class of 2012 AbstractSpecific Aims: To evaluate associations between hospital and patient characteristics and mortality and economic outcomes. Included records were of adult patients age 18 years or older with a diagnosis of primary or disseminated liver cancer. Methods: This study was a retrospective cohort design that utilized emergency department discharge records from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) National Emergency Department Sample (NEDS). Generalized linear models were used for analyses to assess outcomes of mortality and total charges. Logistic regression was utilized for mortality; gamma regression with log-link was utilized for charges. Main Results: Overall, 239,895 adult records were included in the study with diagnoses of ICD-9 155.x or 197.7. Total charges for all records were over $8.23 billion in 2009. The average age of the case was 65.07 (±13.8) years with 48.7% being female. Mortality (either in the ED or hospital) was 11.1% (n=26,701). The mean length of stay was 6.47 (±6.05) days. Charges for each record were $42,874.50 (±53,956.34). Increased mortality was associated the most with hospital teaching status and primary payer. Increased charges were associated with hospitals located in the Western region. Conclusions: The differences in clinical outcomes were primarily from different payers and economical outcomes differed greatly by the Western region hospital location. Data taken from the nationally-representative investigation reveals that primary and disseminated liver cancer still remains a clinical high burden-of-illness with an 11.1% mortality rate and total charges approaching $10.3 billion dollars.
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Almanie, Sarah. "Prescription Drug Monitoring Programs and Opioid Poisoning: Evaluating the Impact of Prescriber Use Mandates on Prescription Opioid Poisoning Emergency Department Visits." VCU Scholars Compass, 2018. https://scholarscompass.vcu.edu/etd/5545.
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Introduction: Prescription drug monitoring programs (PDMPs) are one strategy established to curb the prescription opioid abuse epidemic. Prescriber use mandates has emerged as a promising practice to increase PDMPs impact on prescription opioid abuse; however, evidence of its effectiveness has not yet been established. Kentucky was the first state to implement comprehensive prescriber use mandates in July 2012.
Objective: To assess the relationship between prescriber use mandates policy and emergency department (ED) visits related to prescription opioid poisoning among adults in Kentucky and
North Carolina. Secondary aim: to evaluate the economic impact of prescriber use mandates in Kentucky.
Methods: A controlled, pre-post study design. Data from the State Emergency Department Databases (SEDD) and the State Inpatient databases (SID) were used to identify prescription opioid poisoning ED visits among those ≥ 12 years old. Prevalence rate were estimated. Prescription opioid poisoning ED visits were characterized based on sociodemographic and clinical characteristics. Logistic regression was applied to compare occurrences of prescription opioid poisoning ED visits pre and post prescriber use mandates in Kentucky, and between Kentucky and North Carolina for the period 2011 to 2014. A cost of illness framework was applied to estimate direct medical costs associated with prescription opioid poisoning ED visits. The economic impact of prescriber use mandates was quantified based on logistic regression coefficient for the interaction term (state*time to implementation).
Results: There were 7,419 and 12,598 prescription opioid poisoning -related ED visits in Kentucky and North Carolina, respectively. Young and Middle age, male gender, white, having one or more chronic conditions, and psychiatric conditions (such as depression and drug abuse) were significantly associated with prescription opioid poisoning ED visits (p-value<0.05). The odds of having a prescription opioid poisoning ED visit in Kentucky were significantly lower compared to North Carolina in 2012, 2013, and 2014 compared to 2011 (OR = 0.9, 0.7, and 0.7 respectively). The total estimated direct medical costs were $13.77 and $24.37 million in Kentucky and North Carolina, respectively. In Kentucky, the economic impact of prescriber use mandates was estimated at - $2.3 million.
Conclusion: Prescriber use mandates is effective in reducing prescription opioid poisoning ED visits, and its economic impact is considerable.
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Boonyapuk, Pimrat. "The Impact of Population Characteristics and Health Behaviors on Missing School Days and Emergency Department Visits Among Children and Youth Diagnosed With ADHD in the United States." Case Western Reserve University School of Graduate Studies / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=case1435791815.
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Johnson, Lula Juanita. "The effects of home based primary care with chronically ill older adults on visits to the emergency department, hospitalization, and bed days of care." free to MU campus, to others for purchase, 2004. http://wwwlib.umi.com/cr/mo/fullcit?p1422981.
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Boothe, Vickie L. "Effects of Estimated Exposure to Cumulative Traffic-Related Pollutants on Asthma, Cardiovascular, and Stroke Outcomes in an Urban Area." Digital Archive @ GSU, 2008. http://digitalarchive.gsu.edu/iph_theses/47.
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BACKGROUND: A growing body of research has suggested that exposure to traffic-related emissions is associated with numerous adverse health effects including prevalence and severity of symptoms of asthma, hospitalizations for acute myocardial infarctions, and cardiovascular-related mortality. No previous studies have assessed the association between proximity to traffic and respiratory and cardiovascular outcomes across all age groups. OBJECTIVE: The purpose of this study was to assess the association between proximity to traffic emissions within the City of Atlanta and respiratory and cardiovascular 911 Emergency Management Service (EMS) calls and subsequent emergency department (ED) visits. METHODS: Case and control diagnostic groups were established for 5,450 EMS calls received between 2004 and 2008 from residents of the City of Atlanta based on ICD-9 codes assigned within the ED. Case diagnostic groups included asthma, cardiovascular outcomes, and stroke. Gastrointestinal diagnostic groups were selected as controls. Cumulative traffic within a 100 m buffer of the call origination location was used as an indicator of exposure to traffic emissions. Using a case-control study design, the associations between exposure to traffic emissions and the case diagnostic groups were evaluated using logistic regression, controlling for potential confounding factors including age, gender, ethnicity, and socio-economic status (SES). Subgroup analyses were performed to evaluate differences by select age categories, gender, and SES. P-values of <0.05 and 95% confidence intervals (CI) were used to determine statistical significance. RESULTS: Increased cumulative traffic near the call location was associated with an increase in the odds of an EMS call and ED visit for cardiovascular outcomes compared to the control diagnostic group even after adjustment for confounding factors (OR = 1.07; 95% CI ,1.01-1.12). The strongest effects were among men and individuals aged 40-75 years. Increased cumulative traffic was also associated with an increased odds of an EMS call and ED visit for stroke among individuals aged 18-39 years after adjusting for confounding (OR = 1.16; 95% CI, 1.01-1.34). No statistically significant associations were found between increased cumulative traffic and the odds of an EMS call and ED visit for asthma. CONCLUSION: These results provide additional evidence that proximity to traffic is associated with adverse cardiovascular outcomes and stroke in certain age groups.
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Fraguada, Destiney. "The Association Between Behavior Disorders and Return Visit to the Emergency Department." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7645.
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Presently, extensive research supporting the overcrowding of emergency departments (EDs) and behavior disorder patients presenting to EDs are prevalent. There exists a knowledge gap between specific behavior disorders diagnoses associated to repeated visits to the ED. The purpose of this quantitative study was to address whether a relationship exists between patients with psychotic and/or substance abuse disorders and the repeated ED visits within 72 hours. The Andersen Behavioral framework model and the secondary data were used in the study. The cross-sectional archival data from the 2016 National Ambulatory Medical Care Survey was analyzed by using cross-tabulation with the 2 test followed by multiple logistic regression analysis. The author found that the primary independent variables were not significant in (un)weighted multivariate results. However, the primary independent variables were statistically significant in the unweighted cross tabulation analyses, along with the covariates of homelessness, geographical region, and gender. The findings also showed a strong likelihood of return to the ED for the primary independent variables and covariates. The implications of this study with regard to social change and health care practices are providing proper outpatient resources through behavior disorder urgent care facilities, behavior disorder travel clinics, follow-up communications directly to the patients’ care managers, and creating a treatment team, which will decrease future financial effects on the healthcare system.
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Sharan, Viktor. "Hospital Admission and Emergency Department Visit After Bariatric Surgery, a 2- Year Follow Up." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-86761.
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Introduction Previous study investigating Emergency Department (ED) visits rate and admission rates in bariatric patients’ post-surgery shows a 2-year admission rate of 26%. Aim The primary aim of this study was to assess the number of ED visits and admissions as well as examine if there is a correlation with comorbidities, education level, quality of life, and image method used. The secondary aim was to compare the ED and admission rate between the cohort and the general population. Methods This retrospective study included a total of 190 patients. They were followed for 2 years. All the patients were operated on during 2017 in Region Örebro. The cohort and data were obtained from the Scandinavian Obesity Surgery Registry and data concerning ED visit and admittance rate was collected by reviewing medical records. Results The ED visit rate was 116 (61%) and the admittance rate was 76 (40%). Poor mental health, low education level and smoking were correlated to a higher degree of admittance and ED visit rate. There were more imagining used in the group that visited the ED or got admitted. The most common diagnoses were symptoms related to the digestive system and abdomen. The study population had a higher degree of admittance and ED visit rate than the general population. Conclusions Rate of admittance seem to be correlated to factors related to socioeconomic status. More research is needed to investigate what intervention would help this subgroup most, so they don’t have to seek medical care to the same degree.
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Hsu, Hua-Kuei, and 許華桂. "Analysis of Emergency Department Visits among Hemodialysis Patietnts." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/djpy63.
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碩士國立臺北護理健康大學
健康事業管理研究所
105
Abstract Graduate school: graduate institute of health care management Thesis title: Analysis of Emergency Department Visits among Hemodialysis Patietnts. Adviser: Chen, Chu-Chieh PH.D Graduate student: Hsu, Hua-Kuei Background: The emergency room used to receive all patients of a variety of diseases, and taking into consideration time and confusion of choosing which medical department most people regard the emergency room as a top priority of gaining fast medical care. The incidence rate of the end-stage renal disease of Taiwanese people is still ranked first across the globe, much higher than that of Europe, America, and Japan. Also, the prevailing rate is also in the first place in the world. And the number of hemodialysis patients and people seeking emergency medical care has been increasing year by year. Objectives: First, this study researches how the objects of the study use the emergency medical treatment. Second, this study researches the related factors regarding the degree of seriousness of the emergency inspection and classification of the objects of the study. Methods: This study employs the sampling files of one million people of the research database of national health insurance issued by National Institute of Health using SAS9.4 statistical package software to conduct data analysis and statistical analysis to find 2,889 hemodialysis patients（the medical records group）. In addition, using the 1:1 matching condition in terms of gender, age, and CCI score, we choose 2,889 non-hemodialysis patients（the contrast group）. Totally, the objects of the study are 5,778 persons. First, we use descriptive statistics and the T test、Chi square homogeneity test and Fisher's exact test to research how the objects use the emergency medical treatment. Second, General Estimating Equations are used to research the related factors regarding the degree of seriousness of inspection and classification of the objects of the study. Results: 1,747 persons（60.47%）of the medical records group（2,889 hemodialysis patients）have ever used the emergency medical treatment 5,147 times. The average time of each person is 1.78 times. For those who have used emergency medical treatment, the average time of each person using emergency medical treatment is 2.95 times. On a yearly basis, 443 persons （15.34%）used emergency medical treatment over four times. 882 persons（30.53%）in the contrast group（2,889 non-hemodialysis patients） have used emergency medical treatment totally 1,953 times. The average time of each person using emergency medical treatment is 0.68 times. For those who used emergency medical treatment, the average time of each person using emergency medical treatment is 2.21 times. And on a yearly basis, 130 persons（4.50%）used emergency medical treatment more than four times (four times included). And in terms of the levels of hospitals, the area hospitals are more. The rate of the patients of the medical records group seeking medical help in the medical center is apparently higher than that of the contrast group. In terms of the types of medical diagnosis, other rates of the medical records group are remarkably higher than that of the contrast group. In terms of the rate of symptoms, the rate of the contrast group is significantly higher than that of the medical records group. In terms of the degree of inspection and classification, the third degree is more, and the first and second degree of the medical records group is remarkably higher than that of the contrast group. In terms of death, the rates of death of the two groups are not high; however, the rate of death of the medical records group is remarkably higher than that of the contrast group. In terms of first aid, the rates of first aid of the two groups are not high, and there are no remarkable differences. After controlling other factors, the independent factors of influencing the degree of seriousness of emergency inspection and classification are whether they are hemodialysis patients, age, the frequency of outpatient service in the previous year, the level of hospitals and the types of disease diagnosis. Results: The yearly emergency medical treatment usage rate, the yearly average time of an individual, the rate over four times of yearly medical treatment usage, and the degree of seriousness of inspection and classification of the hemodialysis patients are higher than that of the non hemodialysis patients. It is suggested that clinical medical professionals should offer continuous treatment and health care to hemodialysis patients to reduce the usage rate of emergency medical treatment and the degree of seriousness of diseases. Keywords: Hemodialysis; the usage of emergency medical treatment; inspection and classification
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Shuler, Garyn Fredrick. "Opioid-related emergency department visits in the Texas Medicaid population." 2013. http://hdl.handle.net/2152/21963.
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Prescription drug abuse, in particular prescription opioid abuse is a public health concern. One measurement of the effects of prescription opioids is the number of patients visiting the emergency departments (ED) with opioid-related problems. Knowing more about the patients who visit the ED with opioid-related problems may assist in addressing this problem.
This study examined hospital and prescription claims of Texas Medicaid enrollees from 2008 to 2011 to determine whether demographic factors could help predict the opioid prescription history of the ED patients. Age, sex and race/ethnicity were used as demographic predictors. A patient’s prescriptive history was categorized as a non-prescribed user, a short-term user, or a long-term user based on Texas Medicaid prescription claims. Of the 1001 Texas Medicaid enrollees in our dataset who had a claim for an opioid-related ED visit, 622 were classified as non-prescribed users, 65 were short-term users, and 314 were long-term users. Our ordinal logistic regression model was a poor model for predicting prescriptive history. This study does suggest that the number of opioid-related ED visits in the Texas Medicaid population is increasing. The majority of Texas Medicaid enrollees in our study were classified as non-prescribed users. Focused efforts to address the growing problem of opioid-related ED visits cannot be limited to the patients being with claims for opioid prescriptions.text
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Huang, Yu-Hui, and 黃焴慧. "To use HFMEA elevate the safety of emergency department visits program." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/73642045501191915612.
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碩士義守大學
管理碩博士班
102
There were numbers of preventable medical errors happened in Taiwan. It’s important to prevent the medical errors with the effective quality management tools for improving the quality of healthcare. This aims of the study were to check the medical treatment procedure failure modes in emergency room (ER), and to evaluate the effects by applying these recommendations. We used “Healthcare Failure Mode and Effects Analysis (HFMEA)” to check these medical treatment procedures, graphically describing the process, and conducting a hazard analysis (determining the severity and probability of the potential failure modes, checking the hazard score matrix, and following the decision tree). The results showed that it was a high risk healthcare environment in ER. 9 possible risks were identified. Several strategies were determined for prevent the potential medical errors during the patients stayed in ER, such as patient identified bar code system and electronic medical record system et al. We effectively reduced the hazard scores by implementing these strategies. It could improve the severity and probability of the potential failure modes, enhance the effectiveness of healthcare quality management strategies, and facilitate the process control with HFMEA. We recommend to check all health care procedures with HFMEA in the hospital. The results could be the reference to improve the patient safety events in emergency department.
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Huang, Zong-Xian, and 黃宗賢. "The Factors Associated with Unplanned Re-visits among Patients in Emergency Department." Thesis, 2006. http://ndltd.ncl.edu.tw/handle/09959909753899684579.
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碩士長庚大學
醫務管理學研究所
94
The management of emergency room has become an important issue in a medical setting under global budget payment system. Both issues in medical cost containment and quality control are not dilemma for hospital administrators to any further extent because of the policy requirements. Therefore, the unplanned revisit following an emergency visiting is selected as a succinct indicator for medical quality of emergency room patients. This research has adopted the model of health service quality reported by Donabedian to evaluate the quality of emergency service. A total of 140,393 visits in the year of 2005 extracted from database of emergency room were used to further analyze. The objectives of this study are two folds. Firstly, the difference of total medical consumptions between patients of non-revisiting and unplanned revisiting in emergency room was investigated. Secondly, the associated factors of unplanned revisits were studied from the aspects of quality dimensions such as structure, process, and outcome. The major findings of this analysis are summarized as follows. 1.The medical consumption of unplanned revisit was 7,444 NT dollars per visit higher than 3,214 of non-revisiting patients. The hiking of medical consumption was in part attributable to inefficiency of management in emergency room. 2.Further examination of cases unplanned revisit, the study has demonstrated that factors such as sex, age, arriving time, causes of disease, numbers of treatment, and length of stay were significantly associated. 3.Patients diagnosed with manifestation of psychological disorders and cancers are likely to revisit again. Those who were inadequately treated are tended to come back with the same reason. A U-shape relationship was observed in the variable of age while examining the factors associating with unplanned revisit of emergency room. The study has further elaborated that unplanned revisiting can be avoided in some extents hence reducing the medical consumption. Strategies were derived to enhance efficiency of management. Professional training, information platform, and process improvement were advised as key plans for the goal to be met.
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AlSagob, Eman I. "Non-traumatic dental visits to hospital-based emergency departments Rhode Island." Thesis, 2017. https://hdl.handle.net/2144/26203.
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OBJECTIVES: (1) to investigate trends in non-traumatic dental visits (NTDV) to hospital-based emergency departments (ED) in Rhode Island (RI) and to compare them with those for other ambulatory sensitive care conditions (ACSC); (2) to examine the effect of expansion of Medicaid coverage on the rate NTDV to ED; (3) and to examine community-level factors associated with NTDVs.
METHODS: Data for ED visits in 2005–2014 were obtained from RI hospital discharge data and annual population estimates from the U.S.Census Bureau, and were used to calculate annual visit rates. Medicaid enrollment report for the calendar years 2013 and 2014 were used to calculate monthly enrollment and an interrupted time series analysis was used to examine the effect of expansion of Medicaid coverage on visit rates. Zip code was used as a unit of analysis for community-level factor analysis, 2010 data. A negative binomial regression model with log link was performed.
RESULTS: From January 2005 to December 2014, the annual average number of ED NTDV was 7440, accounting for 1.4–2.1% of all ED visits each year, there was a slight but not statistically significant decrease in the NTDV rate between 2005 and 2014. Visits for asthma also declined slightly, but the decrease was statistically significant. There were statistically significant increases in ED visit rates for diabetes and back pain. The NTDV rate increased by 34.8/100,000 enrollees per month immediately and significantly after expansion, amounting to more than 1000 additional ED visits. ED visits for asthma and back pain declined immediately after the expansion of coverage, but not significantly so. Community-level factors associated with NTDVs were higher level of poverty and communities with younger population (more individuals aged 20–34 years) which had significantly higher ED NTDV rates.
CONCLUSION: RI NTDVs slightly declined, but still accounts for around 1.6% of ED visits. Medicaid expansion under the ACA, caused an immediate increase in NTDVs to ED, that might be attributed to the increased number of Medicaid enrollees, with no change in the workforce. Among community-level factors, high poverty level and high percent of young population had the highest impact on visit rates.2019-09-26T00:00:00Z
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Ko, Ming-Chung, and 柯明中. "Proportions of and predictors for frequent utilization of emergency department and early return visits to the emergency department: A population-based study." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/4gq6m4.
Full textAbstract:
博士國立陽明大學
公共衛生研究所
104
Objectives: Frequent emergency department (ED) users contribute to a disproportionate number of ED visits that consume a substantial amount of medical resources. When patients return to the ED shortly after a previous visit, it is generally assumed that their initial evaluation or treatment was inadequate. We conducted, based on a nationally representative sample, a population-based study to estimate the proportions of frequent ED users and early return visits (ERVs) to the ED among all ED users, and to explore factors associated with frequent ED visits and early return visits to the ED. Methods: This is a population-based cross-sectional study. Data of one million people randomly selected from all beneficiaries of Taiwan’s National Health Insurance claim database in 2010 were analyzed to estimate the distribution of ED visit among ED users. Multivariate logistic regression was employed to calculate the independent associations of factors with prevalence of frequent (4-12 ED visits per year) and highly frequent (>12 ED visits per year) ED visits. For ERVs to the ED, all ED visits in 2012 were analyzed. The ERVs to the ED were defined as those ED re-visits within 3 days after the initial ED visit. We employed a generalized estimation equation model to investigate the independent effects of various characteristics associated with the initial ED visit on ERVs. Results: Of the one million beneficiaries 170,475 subjects used ED service in 2010 and 103,111 (60.5%), 37,964 (22.3%), 14,881 (8.7%), 14,041 (8.2%), and 460 (0.3%) subjects had 1, 2, 3, 4-12, and more than 12 ED visits, respectively. ED users with 4-12 visits and those with > 12 visits disproportionally accounted for 24.1% and 3.0%, respectively, of all ED visits in 2010. We noted significant associations of frequent ED visit with a number of factors including socio-demographics, health care utilization, and co-morbidity. Among them, the most increased adjusted odds ratio (AOR) was noted for hospitalization during the past year (AOR=1.85) and younger ages (1-6 years) (AOR=1.84). On the other hand, the significant predictors for highly frequent ED visit with greater AOR included hospitalization during the past year (AOR=3.95), >12 outpatient visits during the past year (AOR=2.66), and a history of congestive heart failure (AOR=2.64) and psychiatric disorders (AOR=2.35). The overall proportion of ERVs within 3 days with a same dichotomous diagnostic category according to injury or non-injury was 4.3% (6,740/158,132) and the overall proportion of hospitalizations after ERVs was 24.1% (1,627/6,740). Male subjects were more likely to have ERVs with an AOR of 1.10 (95% confidence interval (CI): 1.04-1.16). Compared with patients aged 18-64 years, those aged >64 years had a significantly increased risk of ERVs (AOR: 1.49, 95% CI: 1.39-1.59). Compared with patients initially treated at medical centers, those initially treated at regional (AOR: 1.28, 95% CI: 1.20-1.37) or district hospitals (AOR: 1.38, 95% CI: 1.27-1.49) had significantly higher risks of ERVs. Among the 6,740 patients with ERVs, 2,622 (38.9%) returned to a different hospital, and these patients tended to be those aged 18-64 years and initially treated at district hospitals. Conclusion: People admitted and with frequent outpatients were at greater risk of frequent ED visit. Because people with a history of various co-morbidity were also vulnerable to become frequent ED users, careful management of those co-morbidities by clinicians may help further reduce the likelihood of frequent ED visit. Risk of ERVs was associated with demographic characteristics, diagnosis at initial ED visit, and accreditation level of hospital. We noted a large proportion of patients with ERVs to a different hospital. The reason underlying this phenomenon warrants further investigations.
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Ying-FangHsia and 夏瑩芳. "Cumulative effect of indoor temperature on cardiovascular and respiratory diseases emergency department visits." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/khwean.
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Liao, Tsai-Yu, and 廖彩鈺. "Reasons and Dispositions of Emergency Department Visits by Long-Term Care Residents : A Survey in a Medical Center Emergency Department of Central Taiwan." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/8z8b29.
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Chiang, Yi-Bei, and 江怡蓓. "A study of patients’ returning visits to emergency department within three days after hospitalization." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/27792074398206880275.
Full textAbstract:
碩士中國醫藥大學
醫務管理學系碩士班
100
Background and Objective Unplanned returning visits to emergency department after hospitalization may not only increase the consumption of emergency resources and health care costs, but also exist potential medical negligence or event legal issues if patients do not choose the original hospitals. In this study, we wish to understand the related factors which may related to patients’ returning visits to emergency department within three days after hospitalization and the difference between patients’ retuning to the original and the different hospitals. Method Dataset from the National Health Insurance Research Database was retrieved. All patients, from January 1 to December 28, 2008. discharged from all hospitals and returned visits to emergency department after hospitalization are included in this study. The excluding criteria are transfers, death, and automatically discharged from hospital in critical condition. Result In 2008, there were 2,565 patients returned visit to emergency department after hospitalization. In which, 1,322 (51.54%) patients visited the emergency in original hospitals and 1,243 (48.46%) patients visited emergency department in different hospitals. Patients’ age, disease status with seriously ill, patients’ insured areas, discharged hospital level, specialties of hospitalization, and the interval between discharge and returning visit to emergency department, are significantly related to visit the original or different hospitals’ emergency departments within three days after hospitalizatio. Conclusion Patients with "elder age", "seriously ill", discharged from specialties of "Pediatrics" and "Obstetrics and Gynecology" are tend to have returning visits to the original hospitals’ emergency departments within three days after hospitalization; Patients insured area in the Kaohsiung and Pingtung areas, discharged from lower hospital levels, or with shorter interval between discharge and returning visit to emergency department, are tend to have returning visits to different hospitals’ emergency departments within three days after hospitalization.
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CHEN, SHIH-JU, and 程詩茹. "Factors predicting early return visits with an adverse outcome after emergency department discharge of elderly population." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/3jajk9.
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碩士國立臺北護理健康大學
健康事業管理研究所
106
Background ：Early return visit to the emergency department (ED) is a known quality care indicator. Early return visit with hospitalization raises the concern about poor quality of initial emergency care. However, only a few population-based studies reported on early return visits with hospitalization of elderly population Methods：The claim data of one million subjects randomly selected from all beneficiaries of National Health Insurance Data (NHID) in year 2010 were analyzed in this study. All ED visits in year 2012 were analyzed for return visits to ED. First, we will demonstrate rates of and factors associated with return visits with hospitalization, hospitalization to intensive care units and hospitalization with in-hospital mortality of elderly population. Secondly, we will evaluate rates of and factors associated with return visits to another ED with hospitalization, hospitalization to intensive care units and hospitalization with in-hospital mortality of elderly population. Third, we will demonstrate rates of and factors associated with return visits with hospitalization, hospitalization to intensive care units and hospitalization with in-hospital mortality among those with a triage three score at first ED visit of elderly population. Fourth, we will evaluate rates of and factors associated with return visits to another ED with hospitalization, hospitalization to intensive care units and hospitalization with in-hospital mortality among those with a triage three score at first ED visit of elderly population. All statistic analysis was done with statistic software SAS. A P value <0.05 was considered statistically significant. Results：In 2012, the number of patients over the age of 65 who made emergency return visits within 3 days was 17,015, with 496 (2.91%) being hospitalized after their emergency return visits, 93 (0.54%) being hospitalized in the ICU and 9 (0.05%) dying after being hospitalized. The factors affecting elderly patients making emergency return visits within 3 days and being hospitalized as a result are: the gender of the patient and disease correlation factors (AOR=1.203), the age range the patient 75-84 (AOR=1.387), the type of diagnosis and its signs and symptoms (AOR=0.521), other (AOR=0.534), ESI level 4 (AOR=0.550), CCI scores <3 (AOR=1.300), and the level of institutionalization of regional hospitals (AOR=1.364). Factors influencing elderly patients making return visits within 3 days and consequently being hospitalized in the ICU: patients and the correlation factor of their disease with ESI levels 1 and 2 (AOR=3.507), (AOR=2.493), whether the patient is a frequent ER user ≥4 (AOR=1.941) and the level of institutionalization of regional hospitals (AOR=1.735). Conclusion：Results from this study can supplement the gap of knowledge on the epidemiology of unscheduled return visits of elderly population and to remind the public sector to pay more attention on this important issue. Information form this study may prove useful as a reference for conducting a health policy to reduce unscheduled return visits of elderly population and to promote emergency quality care.
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HO, YU-PING, and 何宇屏. "Investigating the Characteristics of Low Urgent Visits in the Emergency Department by a Decision Tree Method." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/96746620680118143256.
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碩士輔仁大學
資訊管理學系碩士班
105
Societies increasingly depend on emergency medical services as a rapid means to access medical resources. According to Taiwan’s Ministry of Health and Welfare, from 2000 to 2014 the number of emergency cases rose from 4,961,941 to 6,498,546 in Taiwan alone. Consequently, the amounts of hospital emergency services and medical expenses have also risen; during the same period, the cost of emergency care in Taiwan’s medical system increased from NTD 8,266,880 to NTD 19,643,544, or by 237%. As a result, overcrowding in emergency departments (ED) has become a critical problem for the Ministry of Health and Welfare as well as hospitals in Taiwan. In response, we adopted a decision tree induction method that considers the perspectives of medical diagnosis and individual information in order to analyze characteristics of ED visits with various lengths of stay (LOS), especially brief ones. We also analyzed the relationship between characteristics of low-urgency visits in EDs and ED overcrowding. Our decision tree method involved using the C4.5 algorithm (i.e., J48, provided by the Weka data-mining tool) to analyze characteristics of ED visits with various LOSs. We interpreted results based on the consistency and communicability of the tree and ultimately scored the tree according to clinical values and clinical correctness after consulting the attending physician in the ED. The preliminary major findings of our research as follows are several. First, adjusting the value scale of the input attribute (i.e., number of lab technicians engaged and age) can increase the explanatory capability and accuracy of the decision tree. Second, low-urgency visits involving brief LOSs in the ED represent the majority of visits that cause ED overcrowding, and numerous personal attributes of patients in the decision tree emerged based on the analysis of DTIM. Third and lastly, ICD-9-CM codes for patient age, number of laboratories, and patient arrival times are important attributes for analyzing the behaviors of patients that cause ED overcrowding. Consequently, our results can serve as a reference for ED personnel to alleviate overcrowding problems in efforts to provide higher-quality care.
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Salam, Lialoma. "Predictors of Emergency Room Visits or Acute Hospital Admissions Prior to Death among Hospice Palliative Care Clients in the Community." Thesis, 2012. http://hdl.handle.net/10012/6914.
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Background: The demand for hospice palliative care (HPC) services is expected to grow due to the increasing number of seniors living into advanced old age, the changing nature of death, and the changing family structure. HPC is a philosophy of care that aims to relieve suffering and improve the quality of life for clients with life-threatening illnesses or end of life issues. The goals of HPC are not only to ameliorate clients’ symptoms but also to reduce unneeded or unwanted medical interventions such as emergency room visits or hospitalizations (ERVH). Hospitals are considered a setting ill-prepared for end of life issues. Therefore, use of such acute care services has to be considered an indicator of poor quality end of life care. It is important to understand the factors that contribute to ERVH in order to determine how to minimize the number of avoidable hospital visits.
Objectives: The objectives of this study were to report the proportion of palliative home care clients with ERVH, describe the characteristics of clients with ERVH, and identify the predisposing, enabling, and need-for-care variables associated with ERVH.
Methods: Analysis of secondary data was performed on a palliative home care dataset from the Hamilton Community Care Access Centre (CCAC). All palliative home care clients receiving services from the Hamilton branch were assessed using the interRAI Palliative Care (interRAI PC), which is a comprehensive, standardized instrument. One assessment for each client assessed between April 2008 and July 2010 was used, for a final sample size of 764.
Results: Half of the palliative home care clients had one or more ERVH. Visits to the emergency department by time of the day and day of the week were relatively stable. Logistic regression and Cox regression analyses showed that wish to die at home and advance care directives are protective against ERVH. Unstable health, identified by a Changes in Health End stage disease and Signs and Symptoms scale (CHESS) score of 3 or higher, was associated with reduced odds of ERVH, while infections such as prior pneumonia and prior urinary tract infections increased odds of ERVH.
Conclusions: Predisposing characteristics (i.e., wish to die at home and advance care directives) are nearly as important as need variables (i.e., CHESS and prior urinary tract infection) in determining ERVH among palliative home care clients, which challenges the assumption that need variables are the most important determinants of ERVH. There was a lack of significant association between many assessed needs and ERVH, perhaps due to the fluctuating health status among such clients and the stability of measurements. Ongoing assessment of palliative home care clients is essential in reducing ERVH, as reassessments at specified intervals will allow care and service plans to be adjusted with clients’ changing health needs and end of life preferences.
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CHEN, LI-AN, and 陳立安. "A Deep Neural Network Based Non-linear Ensemble Framework for Time Series Forecasting of Emergency Department Patients Visits." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/6cbgrb.
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碩士輔仁大學
資訊管理學系碩士班
107
Due to the convenience of medical treatment and the provision of National Health Insurance in Taiwan, there are often problems in which emergency department are often and emergency overcrowding occurs. This research will use the historical emergency visits data to predict the daily patient visits through a time series model for doctors and nurses to make the most appropriate head count arrangement. From the above motivations, this study will develop three research purposes. 1. Use a time series data to make predictions and evaluate the effectiveness of each prediction model. 2. Use a heuristic algorithm in the model to see if it will effectively improve the model. 3. Use the combined forecasting method to confirm whether the prediction accuracy of the model can be improved. This research will combine the linear and nonlinear combination prediction methods with the following five models. Autoregressive Integrated Moving Average model(ARIMA), Gray Prediction, Recurrent Neural Networks(RNN), Long Short-Term Memory(LSTM), Gated Recurrent Unit(GRU). In addition to combine five models to predict the numbers of emergency patients, the research will also be adjusted in each model by using Differential Evolution(DE). Using Mean Square Error(MSE), Mean Absolute Percentage Error(MAPE) evaluation indicators to judge the quality of the results. It can be known from the experimental results that in the single model, the traditional time series model has a poorer prediction effect than the cyclic neural network model. The addition of heuristic algorithm and combined prediction method can improve the prediction accuracy, and the result is better than the single model.
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Li, Hai-Wei, and 李海微. "Constructing the Prediction Model of Pediatric Patients Return Visits to the Emergency Department using the National Health Insurance Database." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/bjnwkg.
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碩士國立中正大學
醫療資訊管理研究所
104
Objectives: Patients return visit to the emergency department is the most common situation in the emergency department (ED). Pediatric patients are high-risk medical group among all the patients. Thus, this study aims to figure out the factors which influence pediatric patients return visits to the ED within 72 hours using the data of children’s first visit record of the ED. Methods: We analyzed the Longitudinal Health Insurance Database data in 2005 derived from the National Health Insurance Research Database (NHIRD). Multivariable logistic regression analysis were performed to determine factors associated with return visits and a classification and regression tree (CART) technique to identify high-risk groups. Results: Of 323,960 eligible pediatric patients, 19,929 (6.15%) returned within 72 hours. Factors associated with return visits included Age, Allergic disease, Triage, Diagnostic Category, Intravenous infusion, Laboratory Examination, Specialist license, Hospital Level, Day of the week, Season, Whether the patient had been discharged from the hospital within the last 7 days, Number of ED visits in the previous year. Children younger than 2 years who visited on Saturday, diagnoses not belonging to the diseases of the sense organs, complications of pregnancy, childbirth, and the puerperium, diseases of the skin and subcutaneous tissue, diseases of the musculoskeletal system and connective tissue, injury and poisoning, external causes of injury, and used the ED for 1 time in the previous year had the highest probability of returning to the ED within 72 hours.
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Liu, Sung-Wei, and 劉松維. "The study of adult patients with return visits to the emergency department within 72 hours resulting in an inpatient admission." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/11592988843427579118.
Full textAbstract:
碩士慈濟大學
公共衛生學系碩士班
103
Background：Return visits to emergency department (ED) are not uncommon among hospital of different levels. This phenomenon has been a clinical indicator of quality of care in ED for decades, and also as a topic of numerous journal articles in the literature. However, most of these articles focused on the characteristics of the patients returning within 72 hours after ED discharge, and articles focusing on those with subsequent admission are numbered. Objective：This study’s purpose is to identify risk factors for admission among 72-hour return visit in ED adult population. Hypothesis：Demographic and clinical characteristics will influence the risk for admission among ED 72-hour return visits. Method：This case-control study was conducted in a medical center in Eastern Taiwan by retrospectively reviewing medical records of patients returning within 72 hours after discharged from emergency department. The study period was from Jan 1, 2013 to Dec 31, 2013. The eligible cases were identified after fully reviewing their data, including demographic and clinical characteristics. We excluded patients who left against medical advice or without being seen, who was admitted or transferred at the index ED visit, whose medical records were incomplete, whose cause of revisit were unrelated to the index ED visit, and whose age was below 18 years old. Patients with 72-hour return visit and admission were defined as the case group; patients with 72-hour return visit and no admission were defined as the control group. Significant variables were selected based on univariate analysis and later entered into multivariate logistic regression analysis to identify risk factors for 72-hour return admission. Result：There were 1,575 eligible visits during study period. After excluding those meeting the exclusion criteria, there were 1,119 visits entering into the final analysis. Male gender (OR=1.44), ambulance-transport at return visit (OR=3.68), senior staff (OR=1.52), work-up at index visit (OR=3.03), and longer length of stay at index visit were associated with higher risks of admission among ED 72-h return visits. Age, comorbidity, mode of transport at index visit, consultation, triage, trauma/non-trauma, outpatient department visit between ED visits, and interval between index and return visits were not significantly associated with return admission. Conclusion：Gender, mode of transportation, staff experience, check-up, and length of stay are associated with ED return admission.
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Wu, Pin-Chieh, and 吳品潔. "A Study of Patients’ Returning Visits to Emergency Department within Three Days after Hospitalization- a Regional Hospital in Eastern Taiwan." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/65751255363717164403.
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碩士元培醫事科技大學
醫務管理系碩士班
105
Objective:The patient is hospitalized for a stable or rehabilitative condition. The medical care team and the attending physician may be discharged or referred to other institutions for convalescence. However, some of the patients are returned to the medical institution for treatment in a short period of time. If the condition is unstable in the discharge, it is likely to occur non-planned return to emergency or re-hospitalization. Not only will increase the cost of emergency medical resources, medical costs, and the emergence of medical disputes and possible derivative legal issues. The study found that a regional hospital in the eastern region of 2012 to 2014, "three days after discharge, re-emergency rate" indicators higher than the national average and peer values. In view of this, the study obtained the medical data file for the hospital, for the "three days after discharge of the re-emergency" phenomenon, in-depth analysis and discussion of the relevant abnormalities, to provide institutions to improve care and processes the quality of hospital care. Methods: In this study, an exclude the discharge of subjects for the psychiatric, nursing home, the selected three days after discharge of emergency patients a total of 3,375 objects in 2010 to 2015. Statistical analysis and inferential statistics were performed with SPSS 22.0 statistical software: statistical analysis of independent samples t test, chi-square, ANOVA and logistic regression. Results and conclusion：Of the 3,375 patients in the three days after the discharge of the study, 83.6% of them were diagnosed with emergency, and the male was the most than female. Over 65 years of age and the maximum number of days of hospitalization is also the highest in discharged from the Department of thoracic medicine and surgery The same diagnostic category was "malignant tumor" within three days after discharge. The number of emergency injuries is at the third triage level (emergency). The results of this study inference: male, with a Catastrophic illness, the higher of the age, the three days after discharge more easy to induce the same diagnosis category of re-emergency.
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Liao, Yun-Chan, and 廖芸禪. "Associations between patient characteristics and the return visits to the emergency department within 72 hours in a regional teaching hospital." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/20886463634723347453.
Full textAbstract:
碩士國立臺灣大學
公共衛生碩士學位學程
102
Recently, the number of patients visiting the emergency department is increasing. Some of these patients returned shortly after receiving medical attention. This scenario increases medical expenditure and indicates poor medical services, which negatively affect the hospital. A patients’ return to the hospital within 72 h after treatment is one of the emergency department’s quality indicators that should be improved. We aimed to determine the cause of unscheduled return visits to the emergency department through the patient’s perspective. Research was conducted in a regional teaching hospital in New Taipei City from 5 July to 30 September 2013. A total of 204 patients were included in the study. These patients included those who returned to the hospital within 72 h after receiving medical treatment and several randomly selected patients who visited the emergency department during the same period (control group). The patient’s area of residence (P = 0.005) and substance abuse behavior (P = 0.004) were correlated with unscheduled return visits. Based on the results of the research, the following data were obtained. (1) Patients with substance abuse behavior often exhibit poor mental health and lack social support, thereby limiting the improvement in their physical health. Thus, emergency medical treatment should properly address the needs of such patients and offer appropriate services. The hospital may also transfer the patient to professional counseling. Emergency room doctors must provide care and restrain the behavior of such patients. (2) The emergency department’s management should properly handle the patients’ medical demands, including the provision of suitable counseling transfer, case tracing, and referring the patients to doctors that can provide appropriate care. Moreover, restraining the behavior of these patients should be done when such patients demand to see a doctor without following the proper schedule. (3) The region of residence of these patients affects the rate of return visit, thereby suggesting that the patients visit the emergency room under the non-compact, active counseling referral hospital outpatient follow-up treatment. Appropriate health education and information about their disease must be provided to patients during the initial appointment in the hospital outpatient services. Such a decision may strengthen the communication between the patients and the hospital outpatient medical services.
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Carlisle, Corine Elizabeth. "Continuity of Care, Emergency Department Visits and Readmission in Adolescents with Psychiatric Disorders: A Retrospective Cohort Study using Propensity Score Matching." Thesis, 2010. http://hdl.handle.net/1807/25443.
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Objective: To determine whether continuity of care (COC) reduces emergency department (ED) visits and/or readmission in adolescents with psychiatric disorders. Methods: A retrospective cohort of adolescents discharged with psychiatric disorder between April 1, 2002 and March 1, 2004 was identified using hospital administrative databases. Good COC was defined as at least one aftercare contact in 30 days. Confounding by patient characteristics was adjusted for by propensity-score-matching of good and poor COC adolescents. Cox PH was used to analyze time to outcome. Results: 48.77% of adolescents had good COC. 38.39% of adolescents had ED visit or readmission in the year post-discharge. Good COC increased risk of readmission (HR = 1.38 (1.14 – 1.66)), but not of ED visits (HR = 1.14 (0.95 – 1.37)). Conclusions: COC increased risk of readmission by 38% but did not increase risk of ED visits. These findings are contextualized. Implications to adolescent mental health service delivery are discussed.
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Hsieh, Chia-Ying, and 謝佳穎. "Patient Characteristics, Outcome and the Significance of Toxicologic Screening among Drug Abuse-Related Emergency Department Visits in a Medical Center in Taiwan." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/10664240958277184753.
Full textAbstract:
碩士國立陽明大學
環境與職業衛生研究所
103
Introduction: Drug abuse is a public health and medical problem worldwide. With the rapid growth of internet trafficking and easy availability of new recreational drugs, drug abuse related problems are likely to become more severe and complicated and may lead to more emergency department (ED) visits. Nevertheless, the lack of toxicologic screening facility in many EDs probably hinders the accurate and timely evaluation of the role of abused drugs, particularly novel psychoactive substances, in drug abuse related poisonings. Therefore, the aims of this study are to explore the association between drug abuse-related ED patients’ baseline demographic, clinical characteristics and clinical outcome, and to investigate the significance of toxicologic screening in clinical practice. Methods: We conducted a retrospective study in a medical center from 2009 to 2013 in Taiwan. All patients who visited the ED of Taipei Veterans General Hospital and tested positive for any abused drugs were included in this study. Data on patients’ baseline demographic, clinical characteristics and clinical outcome were collected and tabulated. We further examined the association between patients’ baseline characteristics and their outcome (severe vs. non-severe)/ consistency of diagnosis (consistent vs inconsistent). Severe outcome was defined if the patient required endotracheal intubation or intensive care, or was dead during the hospitalization. Consistent diagnosis was defined if the primary clinical diagnosis was consistent with the result of toxicologic screening. All statistical analyses were performed using the SAS 9.4. The significance was set at P< 0.05. Results: During the study period, 623 patients were identified and eligible for final analysis. Most patients were females (64.0%) and aged 20-49 years (67.1%). The majority of patients were classified as triage category 2 (50.1%). Benzodiazepines (n= 469) were the most frequent culprit of drug-abuse related ED visits, followed by “Z” drugs (e.g. zopiclone, zaleplon and zolpidem; n= 173), central nervous system (CNS) depressants (e.g. ketamine, barbiturates and heroin; n= 93), CNS stimulants (e.g. methamphetamine, ecstasy and mephedrone; n= 66) and CNS hallucinogens (e.g. phencyclidine and cannabinoids; n= 4). One hundred and sixty-three patients abused ≧2 drugs. Among the 623 patients, 121 patients, including 11 fatalities, had a severe outcome. In multiple logistic regression analysis adjusted for variables that were significant in bivariate analysis, ED triage, smoking, aspiration pneumonia, leukocytosis, hypernatremia, increased creatinine, elevated ALT, and hypocalcemia were associated with the risk of severe outcome. Besides, the primary clinical diagnosis was less likely to be consistent with the result of toxicologic screening among patients who developed severe outcome (OR= 0.589, 95% CI 0.358-0.969) and/or aspiration pneumonia (OR= 0.550, 95% CI 0.313-0.967). Conclusion: Drug abuse-related ED visits were not uncommon and primarily involved younger patients and patients receiving psychotropic medications. Most patients were classified as ED triage 1 or 2 and 21.7% of them developed severe outcome, indicating the probable need of more medical resources in managing these patients. Toxicologic screening is also important in confirming the diagnosis and can provide important information to ED physicians in better managing patients with drug abuse related poisonings.
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Oblath, Rachel. "Utilization of mental health services among urban youth with emotional and behavioral disorders: racial/ethnic differences in emergency department and outpatient visits." Thesis, 2020. https://hdl.handle.net/2144/40941.
Full textAbstract:
Rising rates of pediatric emergency department (ED) visits for psychiatric reasons pose a significant burden for healthcare systems in the United States. Utilization of outpatient mental health treatment by youth and their families may prevent some behavioral health crises requiring emergency services, as well as non-urgent ED visits where emergency care is not necessary. This study utilized de-identified electronic health records to examine seasonal and secular patterns in both psychiatric ED presentation and outpatient mental health care utilization among youth, as well as the association of outpatient mental health care with psychiatric ED visits. Racial/ethnic differences in service utilization were also examined. The study sample consisted of 25,545 school-aged youth who were diagnosed with an emotional or behavioral disorder and received services at Boston Medical Center (BMC) between 2009 and 2018. Results indicate significant seasonal patterns in both psychiatric ED visits and outpatient mental healthcare that parallel the school calendar, with more youth receiving services during the school year than in the summer. Mental healthcare among youth of color was more closely aligned with the school calendar than among White youth, suggesting that schools may be more instrumental for the referral of youth of color into mental healthcare than for White youth. In addition, youth who accessed outpatient care were at decreased risk for psychiatric ED presentation as compared to youth who had not accessed outpatient services. Longer duration of outpatient treatment and a greater number of visits were associated with increased risk for ED presentation, whereas greater frequency of visits was associated with decreased risk for ED presentation. Findings suggest that preventive outreach for youth and families may be particularly helpful in late summer and early winter, prior to significant increases in both psychiatric ED visits and outpatient service use.
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Enad, Racquel. "Emergency department utilization among adult patients diagnosed with chronic pain and depression from an urban safety-net patient population." Thesis, 2016. https://hdl.handle.net/2144/19185.
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BACKGROUND: Patients visit the emergency department (ED) for life-threatening conditions, such as broken bones or chest pain, and non-life threatening conditions such as medication refills and pain management. Patients may make ED visits for non-life threatening conditions because they lack access to primary care. Research has shown that patients who are low-income, have chronic conditions, such as pain, and have depression are among those most likely to use the ED at a high rate. One of the most common reasons for visiting the ED is for pain relief, and therefore an intervention on patient self-management might prevent ED visits.
The Program for Integrative Medicine and Health Care Disparities at Boston Medical Center (BMC) developed the Integrative Medicine Group Visit (IMGV) model to address chronic pain and depression among low-income patients, with the goal to improve patient’s adherence to self-management of pain and depression. The IMGV model consists of three non-pharmacologic components: evidence-based complementary medicine, mindfulness-based stress reduction, and group medical visits – all of which have been used to manage pain and depression. In a pre-post study of IMGV conducted in 2014, IMGV was associated with a significant decrease in ED utilization. Currently, the Program is conducting a randomized clinical trial (RCT) to compare a number of outcomes between the IMGV model and standard of care. The aim of this study was to determine if IMGV affects ED utilization in adult patients diagnosed with chronic pain and depression from an urban safety-net hospital population.
METHODS: We conducted a secondary database analysis of participants enrolled in the IMGV RCT. The RCT is a two-armed study, and the medical chart review is part of the RCT. The study had patients who sought primary care at BMC and two affiliated outpatient urban community clinics. Only emergency visits made at BMC’s Emergency Department were included in our analysis. The inclusion criteria included reporting a pain level score > 4 on a 0-10 scale and having a score > 5 on the Patient Health Questionnaire-9. The intervention consisted of 10 IMGV sessions over 21 weeks. The control was standard treatment of care.
Data extraction was completed in two ways: (1) the BMC Clinical Data Warehouse was extracted from Epic and (2) hand review took place by research assistant. The primary outcomes included ED encounters at two different time points: (1) 90 days before Session 1 and (2) Session 1 to Session 9. The extracted information also included information about patients’ chief complaints and discharge diagnoses. A visit was categorized as being a preventable emergency visit (PEV) or a non-preventable emergency visit (NEPV). Descriptive statistics and two-sample T-tests were used to analyze outcomes.
RESULTS: At baseline, 22 of the 31 participants made at least one ED visit in the 90 days before Session 1. At 9-weeks, 14 of the 26 participants made at least ED visit. From baseline to 9-weeks, the number of participants who had at least one ED visit decreased for the intervention group (13 to 4), but increased for the control group (9 to 10). From baseline to 9-weeks, the number of visits decreased among intervention participants (16 to 5) but increased among control participants (11 to 12). The two-sample T-test, which compared the ED utilization among the intervention and control, resulted in the mean values of -0.7333 and 0.0625, respectively. This result indicated that intervention participants had overall lower ED visit use from baseline to 9-weeks.
Emergency visits were also analyzed by whether they were PEV or NPEV. Of the 27 ED visits at baseline, 21 were classified as being a PEV, and 6 were classified as being a NPEV. Of the 17 ED visits at 9-weeks, the number of visits decreased for both PEVs (21 to 13) and NPEV (6 to 4).
CONCLUSION: We wanted to determine if the IMGV reduces ED utilization in patients with chronic pain and depression. Our results suggest that the IMGV model may be associated with reduced overall ED utilization and reduced preventable ED visits. However, one limitation is that we have a very small sample size. This finding needs to be produced in an adequately powered clinical trial. Further research might explore the mechanisms for how the IMGV model can lead to lower ED utilization among patients with chronic pain and depression.
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PERRY, ALEXANDER. "Forecasting Hospital Emergency Department Visits for Respiratory Illness Using Ontario's Telehealth System: An Application of Real-Time Syndromic Surveillance to Forecasting Health Services Demand." Thesis, 2009. http://hdl.handle.net/1974/2585.
Full textAbstract:
Background: Respiratory illnesses can have a substantial impact on population health and burden hospitals in terms of patient load. Advance warnings of the spread of such illness could inform public health interventions and help hospitals manage patient services. Previous research showed that calls for respiratory complaints to Telehealth Ontario are correlated up to two weeks in advance with emergency department visits for respiratory illness at the provincial level.
Objectives: This thesis examined whether Telehealth Ontario calls for respiratory complaints could be used to accurately forecast the daily and weekly number of emergency department visits for respiratory illness at the health unit level for each of the 36 health units in Ontario up to 14 days in advance in the context of a real-time syndromic surveillance system. The forecasting abilities of three different time series modeling techniques were compared.
Methods: The thesis used hospital emergency department visit data from the National Ambulatory Care Reporting System database and Telehealth Ontario call data and from June 1, 2004 to March 31, 2006. Parallel Cascade Identification (PCI), Fast Orthogonal Search (FOS), and Numerical Methods for Subspace State Space System Identification (N4SID) algorithms were used to create prediction models for the daily number of emergency department visits using Telehealth call counts and holiday/weekends as predictors. Prediction models were constructed using the first year of the study data and their accuracy was measured over the second year of data. Factors associated with prediction accuracy were examined.
Results: Forecast error varied widely across health units. Prediction error increased with lead time and lower call-to-visits ratio. Compared with N4SID, PCI and FOS had significantly lower forecast error. Forecasts of the weekly aggregate number of visits showed little evidence of ability to accurately flag corresponding actual increases. However, when visits were aggregated over a four day period, increases could be flagged more accurately than chance in six of the 36 health units accounting for approximately half of the Ontario population.
Conclusions: This thesis suggests that Telehealth Ontario data collected by a real-time syndromic surveillance system could play a role in forecasting health services demand for respiratory illness.Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2009-08-11 16:20:44.553
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Lin, Chien-Hao, and 林鍵皓. "The health impact of the typhoon (tropical cyclone) on emergency department visits and disease patterns-A study in eastern Taiwan (Ilan, Hualian, and Taitung)-." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/68138104206512553585.
Full textAbstract:
碩士國立臺灣大學
健康政策與管理研究所
99
Background and objectives A tropical cyclone (typhoon) is a storm system characterized by a large low-pressure center, which could produce strong winds, and heavy rain. Previous studies in the United States have shown that tropical cyclones would increase the healthcare demand, shown by the increase of the emergency department(ED) visits after the landfall day. People would possibly get injured more easily during the impact, and also the recovery period. It was suggested that more manpower should be prepared in the EDs to meet the healthcare needs. Taiwan, located at the west Pacific Ocean, is one of the areas frequently impacted by tropical cyclones with an average of 3 to 4 tropical cyclones per year. From this study, we’d like to know the healthcare impact of tropical cyclones and prepare for the possible increased needs in the EDs of Taiwan. By using the different characteristics of each tropical cyclone, we’d also like to show which the strong predictors of ED visits were and the major diseases presented. Methods This was a retrospective observational study performed in three counties in east Taiwan, Ilan, Hualiang, and Taitung. After excluding those EDs with yearly average daily ED visits less than 10, total twenty hospitals (1 medical center, 7 regional hospitals, and others were area hospitals) were included. We used the National Health Insurance Research Database (NHIRD) provided by National Health Research Institutes. The claimed data, including sex, birthday, visiting date, three codes of “The International Classification of Diseases, 9th Revision, Clinical Modification" (ICD-9 codes) and treatment codes, of all the patients applied for emergency services in the three counties from June to November from 2000 A.D. to 2008 A.D. were collected. ICD-9 codes were further used for identifying trauma and non-trauma patients and different types of trauma. Hospital profiles, including location, contract types (medical center, regional hospital or area hospital) were retrieved from NHIRD, too. All tropical cyclones’ profiles were subtracted from the Tropical Cyclones Database provided by Central Weather Bureau (CWB) of the Republic of China. Total twenty-two tropical cyclones which came from the eastern of Taiwan and had covered any of the three counties were included in the study. The characteristics of those tropical cyclones were retrieved, including the radius, the minimum pressure recorded, maximum windspeed, grade, landing area and total alarm days. The daily rainfall amounts were also retrieved from CWB. The primary outcome was the daily ED visits of each hospital. Different types of diseases, age group, triage level, sex group were the secondary outcomes. Linear regression was used to evaluate the univariate or multivariate associations between the characteristics of tropical cyclones and all primary and secondary outcomes. The regression models were further adjusted by yearly ED visits, holidays. The stepwise variable selection procedure (with iterations between the forward and backward steps) was applied to obtain the candidate final regression model. A two-tailed p-value, 0.05, was considered significant. Results In the areas the severe typhoon landed directly, the ED visits would increase for two days since the landfall day. For a hospital with a yearly average ED visit of 100 per day, there would be 18.1 visits more than the non-typhoon day (not affected by typhoon and the daily rain amount <50 mm) (p<0.001) on the day of landfall and 24.9 visits more (p<0.001) on the next day after landfall day. In the areas, where the severe typhoon didn’t land directly but brought heavy rain (daily rain amount >50 mm), the ED visits would increase by 6.3 on the day of landfall (p<0.001). The percentage of trauma ED visits would increase in the area landed by severe typhoon on the landfall day. For a hospital with a yearly average ED visit of 100 per day, the trauma ED visits increased 4.5% compared with the non-typhoon day (p<0.001). Among the traumatic ED visits, patients visited ER for skin laceration increased 4.1% (p<0.001). There were no significant differences of trauma ED visits on the other days after landfall day. However, patients with skin laceration still increased 6.9% (p=0.02) in the areas where the severe typhoon brought heavy rain without direct landing. In the areas where tropical storm passed, the ED visits were not significantly different on the day of landfall, but decreased on the next day of landfall day. In the areas where moderate typhoons passed, the ED visits decreased on the day before landfall day, but there were 7.2 more visits per day in the direct landing area on the landfall day, for a hospital with a yearly average ED visit of 100 per day (p=0.002). Discussion The emergency department managers and health authorities should consider preparing more manpower to meet the increased ED visits, for two days in the severe typhoon landfall area since the landfall day of and for one day in the non-landfall area with heavy rain. Doctors and nursing staffs that specialized in trauma care, especially wound management were needed preferentially. Future emergency response planning and prepare of both hospitals and health authorities for tropical cyclones could based on the current findings, in order to meet the health care need.
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Chang, Ting, and 張婷. "The Association of Quality of Primary Care and the Potentially Avoidable Emergency Department (ED) Visit." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/f8e28b.
Full textAbstract:
碩士國立臺灣大學
健康政策與管理研究所
105
Background: Overcrowding in emergency departments (EDs) decreases the quality of care and increases hospital costs. This is currently a matter of concern in Taiwan''s health care system. Avoidable emergency department visits often indicate that the quality of primary care is subpar. Improving the quality and availability of primary care should reduce avoidable ED visits, thereby improving the quality of care and reducing costs. Objective: This research aims to explore the relationship between avoidable ED visits and the quality of primary care in Taiwan through the analysis of secondary data. A better understanding of this relationship could help inform strategies that seek to alleviate overcrowding in emergency departments. Methods: This study analyzed secondary claims data from the National Health Research Institutes for the period covering 2010 to 2013 using a case-control matching design. In so doing, we focused on ED visits for ambulatory care sensitive conditions (ACSC). The study group comprised patients that had been admitted to the ED for ACSC, and the control group comprised outpatients who had not been admitted to the ED for ACSC during the same year. The continuity of care index (COCI) was used as an indicator to measure the quality of primary care. Specifically, we were interested in how avoidable ED visits are impacted by patient characteristics, the continuity of care, and the level of the outpatient medical institution. Data pertaining to avoidable ED visits for ACSC were obtained from the CMS published in 2015. Results: Between 2010 and 2013, the rate of ED visits for ACSC was lower for patients who were insured at a level higher than NT$22800 (OR = 0.635 ~ 0.763). Multivariate analysis further revealed that the rate of ED visits for ACSC was higher for patients with lower continuity of care (OR = 1.925 to 3.225) and for regional hospitals (OR = 3.544) and medical centers (OR = 2.924). Conclusions: Higher continuity of care was found to significantly lower the risk of avoidable ED visits. Health policy stakeholders are therefore encouraged to improve continuity of care, especially as it pertains to clinics. Avoidable ED visits may also be useful monitoring indicators for the quality of primary care.
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Yu, Hung-Cheng, and 余鴻彰. "The Impact of Pay-For-Performance (P4P) Program on Emergent Department Visits for Diabetic Hypoglycemia." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/66321567187193966044.
Full textAbstract:
碩士亞洲大學
健康管理研究所
99
Background & objectives：In disease management of diabetes, intensive glycemic control aims to prevent or delay the diabetic complications. But the threat of diabetic hypoglycemia often increases with the intensive glycemic control, it becomes a barrier of glycemic control and management. The severe episodes may require the emergency care visits. Since 2001, Taiwan has begun the implementation of Diabetes Mellitus Pay-for-performance (P4P) program that rewarded providers based on outcome-based performance to achieve the total quality care of patients with diabetes. Prevention and education of hypoglycemia is one of key elements of the program. We explore the impact of pay-for-performance programs on diabetic hypoglycemia in this study. Methods：The retrospective longitudinal study utilizes data from Taiwan National Health Insurance Research database focusing on diabetes mellitus collected during 1998-2009. If the subjects in database meet the criteria of at least one hospital admission with a diagnostic ICD-9-CM code of diabetes or three or more outpatient visits with a diabetes diagnostic ICD-9-CM code within 365 days, we included them as the study sample in the analysis. Using propensity score for 1:1 matching, we selected the P4P and non- P4P patients by matching their characteristics and covariates related to the probability of their participation in the program. Subsequently, we use Cox proportional hazard model to analyze the different risk of diabetic hypoglycemia with emergency department visit between the P4P and non- P4P patients. Results：From the matched group included the P4P and non-P4P patients, we screened a total of 6,433 diabetic patients with severe hypoglycemia and ED visit. Of those, 4,198 (1.47%) were P4P patients and 2,235 (0.78%) were non-P4P patients. The results showed the hazard ratio of P4P patients was 1.7 (95% CI: 1.63-1.80), and after adjusted for other covariates, the hazard ratio was 1.5 (95% CI: 1.41-1.59). The risk of severe hypoglycemia with ED visits was higher in the P4P patients. Other variables such as patient characteristics including female, younger than 25 years old or more than 64 years old, lower premium-based salary, lower urbanization, and Type 1 diabetes have a significant hazard ratio for higher risk of severe hypoglycemia with ED visits. Besides, the Charlson comorbidity index could predict the risk of severe hypoglycemia. As the CCI > 5, the adjusted HR was 2.11 (95% CI: 1.92-2.33); the diabetes severity complication index also could predict the risk. As the DSCI>3, the adjusted HR was 2.09 (95% CI: 1.92-2.28); If the subjects were treated mostly in tertiary hospitals or non-public hospitals, the risk was significantly higher than clinics or public hospitals. Besides, if the subjects were treated mostly in the medical institution or physician with large of diabetes service volume, the risk was also higher than those in lower service volume. Conclusions：We should encourage the non-P4P diabetic patient to participation in the program. After participation, the risk of severe hypoglycemia should be notified and avoided.
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Chen, Mengyan. "The Impact of Social Services on the Utilization of Health Care Services." Thesis, 2018. http://hdl.handle.net/1805/18515.
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Indiana University-Purdue University Indianapolis (IUPUI)The unnecessary medical care causes a heavy financial burden for the patients themselves and the society, and they also negatively impact the quality of medical care. An estimated 13% to 27% of ED visits in the United States could be managed in physician offices, clinics, and urgent care centers, saving $4.4 billion annually, and 26 percent of hospitalizations were potentially avoidable at a cost of $5.6 billion in 2005. If we can help people become more aware of health care services, it could be a potentially effective way to reduce emergency service overuse. we focused on mental health service and social work service as intervention variable, preventable ED visit, preventable ED visit due to mental health problem and hospitalization due to mental health problem as outcomes to determine the impact of specific social service on utilization of specific health care service adjusting for other characteristics of patients (demographic and utilization history information). The data which involved 24074 patients was provided from and managed by the Regenstrief Institute. The date of having the specific service and the frequency of using the specific health care service per year from 2011 to 2014 for each patient was recorded as well as the baseline information including gender, age, race, primary care visit per year before 2011, ACG risk score at 2011, ED visit per year before 2011. For each of preventable ED visit, preventable ED visit due to mental health problem and hospitalization due to mental health problem, we fitted a multiple linear regression model to ascertain the effects of mental health service and social work service adjusted for the baseline information. There was a significant relationship between preventable ED visit & mental health service, hospitalization due to mental health problems & mental health service, as well as hospitalization due to mental health problems & social work service. We found that in most situation, social services were positively associated with health care service. But in the second model which described the impact of mental health service on utilization of hospitalization due to mental health problem, receiving one mental health service can reduce the utilization of hospitalization due to mental health problem, which is as our expectation. According to our study, appropriate amount of services appears helpful on reducing the overuse of ED and hospitalization due to mental health problem. However, people who overused ED or hospitalization in the past were also more likely to be frequent service users, and they tended to continue overuse ED or Incur more hospitalization. There is a group of people who overuse ED or hospitalization without having any service. ED or hospitalization may be their first choice because of their financial condition or other factors, which makes them have no interest to take services.
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Wu, Chia-Hsin, and 吳佳欣. "Characteristics of Patients Who Visited the Emergency Department of a Medical Center due to Drug Abuse Related Illnesses." Thesis, 2009. http://ndltd.ncl.edu.tw/handle/63db7m.
Full textAbstract:
碩士國立陽明大學
環境與職業衛生研究所
97
Abstract Objectives: The prevalence of drug abuse in Taiwan has been increasing in recent years. The number of drug abuse related illnesses and poisonings is also increasing; however little is known about the magnitude of such hazards. The aim of this study was to understand the characteristics of patients who visited the emergency department (ED) of a medical center due to drug abuse related illnesses. Materials and Methods: We collected and analyzed the data of patients who visited the ED of Taipei Veterans General Hospital because of drug abuse related illnesses and who were tested positive for abused drugs by the clinical toxicology laboratory between January 2007 and December 2008. We also conducted a 1:1 case-control study to explore the differences in baseline characteristics, clinical data, utilization of medical care, and outcomes between patients with and patients without drug abuse. Results: During the study period, a total of 294 patients who had drug abuse related illnesses and were tested positive for abused drugs were identified. Most of the patients (81.0%) abused benzodiazepines or other sedative-hypnotics. The main reason of ED visit was attempted suicide (82.3%); more than 60% of the patients required hospitalization. The case fatality rate was 1%. In multiple logistic regression analysis, case patients (drug abusers) were more likely to be females, senior high school graduates, smokers and ethanol drinkers; visited ED by ambulance more frequently; had fewer comorbidities (Charlson Comorbidity Index < 3); and had better prognosis after appropriate treatment, as compared to the control patients (non-abusers). Conclusions: As compared to non-drug abusers, we found that drug abusers were more likely to be classified as triage level one and visited ED by ambulance more frequently, which indicated the higher severity of drug abuse related illnesses and their need of prompt therapy and more utilization of medical resources. To prevent drug abuse related hazards, a better policy to control drug abuse in Taiwan is warranted; the diagnosis and treatment of drug abuse related illnesses also need improvement. Key words: acute poisoning, case-control study, drug abuse, emergency department
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Chang, Tzu-Yu, and 張紫渝. "A Study of the Characteristics of Patients Who Visited the Emergency Department of a Medical Center due to Substance Abuse Related Accidents." Thesis, 2010. http://ndltd.ncl.edu.tw/handle/94167013124929621847.
Full textAbstract:
碩士國立陽明大學
環境與職業衛生研究所
98
Objectives: The prevalence of drug abuse in Taiwan was rapidly increasing in recent years. Alcohol and drug abuse related accidents are also increasing, however relevant studies are still lacking in Taiwan. To better understand the relation between substance abuse and accidents, to assess the risk of saccidents related to specific substance, and to help the government improve the policy on substance control and the quality of managing patients with substance abuse, this study specifically evaluated the characteristics of patients who visited the emergency department (ED) of a medical center due to alcohol or drug abuse related accidents. Materials and Methods: This study collected the information of patients who visited the ED of the Taipei Veterans General Hospital (TVGH) due to drug abuse (confirmed by medical history and/or by toxicology laboratory analysis) or alcohol abuse (diagnosed by medical history and serum alcohol level≧ 50mg/dL) related accidents from 2007 through 2009 to assess the prevalence, pattern of healthcare utilization, and clinical outcome of substance abuse related accidents in the ED. We also analyzed the differences in baseline characteristics, clinical toxicity, utilization of healthcare service and clinical outcome between drug abusers and alcoholics and between patients with different injury severity.We further compared the baseline characteristics between current drug abusers and prior drug abusers who visited the ED due to accidents. Result: During the study period, a total of 441 patients with alcohol abuse and 97 patients with drug abuse (including 58 patients who were tested positive for abused drugs) were identified. Most of the drug abusers used sedative-hypnotic agents (68.0%); aged between 31 and 40 years old (34％); and were males (59.8％) and single, senior high school graduates, and jobless. Most common accidents were cutting injury, burn injury and hanging (29.9%). 27.9％ of patients had concomitant use of alcohol and other poisons; more than half of the patients (56.7%) required hospitalization, and 6 of them died (6.2%). As compared to alcohol abusers, drug abusers were likely to be younger (61.8％ were less than 40 years old), had more psychiatric comorbidities (OR= 3.9), visited the ED more frequently due to either suicide attempt or deliberate self-harm (OR= 4.2), and were more likely to be hospitalized (OR= 3.4). Moreover, patients who aged between 51 and 60 years old, lived outside Taipei City, visited ED by ambulance or referral from other hospitals, and used central nervous system depressants or mixed drugs were more likely to have severe trauma or death (defined by Injury Severity Score≧16, p<0.05). Conclusion: We found that as compared to alcohol abusers, drug abusers were younger, had more suicidal attempts, and were more likely to require hospitalization, which indicated the severity of drug abuse related hazards. In addition, patients who used mixed drugs were more likely to suffer severe illnesses and death. The results are likely to be helpful in enforcing the policy control of substance abuse and in improving the medical management of substance abuse related illnesses in Taiwan.
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Lan, Kai-Ping, and 藍凱平. "The Analysis of Poisoning Severity Score and Their Associated Factors in Poisoned Patients Visited Emergency Department – A Study of One Medical Center in Northern Taiwan." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/8a9k6j.
Full textAbstract:
碩士國立臺灣大學
公共衛生碩士學位學程
107
Purpose: In Taiwan, the incidence of poisoned are 0.16-0.22 per 1000 people, and that usually caused emergency department visited and even hospitalization or death. Thus, the aim of this study was to explore the factors that affected the poisoning severity score(PSS) in poisoned people who visited emergency department by scientific research method, in order to help clinical employee developing their care strategy, and to help public health authorities making the policies for poisoning prevention. Methods: This is a prospective observational study, by using the medical chart review, and enrolled the poisoned people who visited the northern medical center in 1 January, 2015 to 31 December, 2016, total 1136 cases. And divided this 1136 cases into two groups (mild or severe) by poisoning severity score, then using the Logistic regression model to analyze and calculate odds ratios, finally, to determine the factors that affecting the severity of poisoning. Results: In the aspect of where patient came from, compared to the patients who came to emergency department directly, the patients who transferred from other hospital had 2.33 times chance to be the severe group (95% C.I.:1.338-3.813); In the reason of poisoning, compared to unintentional group, the intentional group had 2.9 times chance to be the severe group (95% C.I.:1.844-6.320); In the substances of poisoning, compared to medical medications group, the pesticide group had 2.09 times chance to be the severe group (95% C.I.:1.419-4.135), and the biotoxin group had 0.12 times chance to be the severe group (95% C.I.:-0.935-0.392). Conclusion: The patient who visited emergent department via other hospital referral, intentional poisoned, or pesticide intoxication had more chance to be the poisoned severe group, clinical care staffs should pay more attentions to those groups, they might need hospital admission or even intensive care unit for further care and management. In the aspect of public health, pesticide intoxication patients had more chance to be the severe group and almost all the reasons of intentional poisoned were suicide or self-harmed behaviors, thus, restricting the assess and availability of pesticide and early prevention strategies to high risk groups of self-harmed or suicide by policies making could improve people’s health and reduce the expenditure of medical care system.