Predictors of Urgent Cancer Care Clinic and Emergency Department Visits for Individuals Diagnosed with Cancer.
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ABSTRACT:
SUBMITTER: Decker K
PROVIDER: S-EPMC8161790 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Americans seek a large amount of nonemergency care in emergency departments, where they often encounter long waits to be seen. Urgent care centers and retail clinics have emerged as alternatives to the emergency department for nonemergency care. We estimate that 13.7-27.1 percent of all emergency department visits could take place at one of these alternative sites, with a potential cost savings of approximately $4.4 billion annually. The primary conditions that could be treated at these sites include minor acute illnesses, strains, and fractures. There is some evidence that patients can safely direct themselves to these alternative sites. However, more research is needed to ensure that care of equivalent quality is provided at urgent care centers and retail clinics compared to emergency departments.
| S-EPMC3412873 | biostudies-literature
Project description:ObjectiveTo determine associations of incident cancer diagnoses in women with recent emergency department (ED) care.Patients and methodsA retrospective cohort study analyzing biological females aged 18 years and older, who were diagnosed with an incident primary cancer (12 cancer types studied) from January 1, 2015, to December 31, 2021, from electronic health records. The primary outcome was a cancer diagnosis within 6 months of a preceding ED visit. Secondary outcomes included patient factors associated with a preceding ED visit.ResultsOf 25,736 patients (median age of 62 years, range 18-101) diagnosed with an incident primary cancer, 1938 (7.5%) had an ED visit ≤6 months before a diagnosis. The ED-associated cancer cases were highest in lung cancer (n=514, 14.7%) followed by acute lymphoblastic leukemia (n=22, 13.3%). Patient factors increasing the likelihood of ED evaluation before diagnosis included 18-50 years of age (OR=1.32; 95% CI, 1.09-1.61), Elixhauser score (measure of comorbidities) >4 (OR=17.90; 95% CI, 14.21-22.76), use of Medicaid or other government insurance (OR=2.10; 95% CI, 1.63-2.69), residence within the institutional catchment areas (OR=3.18; 95% CI, 2.78-3.66), non-Hispanic Black race/ethnicity (OR=1.41; 95% CI, 1.04-1.88), and established primary care provider at Mayo Clinic (OR=1.45; 95% CI, 1.28-1.65). The ED visits were more likely in those who died within 6 months of diagnosis (n=327, 37.8%) than those who did not die (n=1611, 6.5%).ConclusionPatient characteristics identified in this study offer opportunities to provide cancer risk assessment and health navigation, particularly among individuals with comorbidities and limited health care access.
| S-EPMC11002794 | biostudies-literature
Project description:We sought to understand patient perceptions of the emergency department/urgent care (ED/UC) HIV diagnosis experience as well as factors that may promote or discourage linkage to HIV care. We conducted in-depth interviews with patients (n=24) whose HIV infection was diagnosed in the ED/UC of a public hospital in San Francisco at least six months prior and who linked to HIV care at the hospital HIV clinic. Key diagnosis experience themes included physical discomfort and limited functionality, presence of comorbid diagnoses, a wide spectrum of HIV risk perception, and feelings of isolation and anxiety. Patients diagnosed with HIV in the ED/UC may not have their desired emotional supports with them, either because they are alone or they are with family members or friends to whom they do not want to immediately disclose. Other patients may have no one they can rely on for immediate support. Nearly all participants described compassionate disclosure of test results by ED/UC providers, although several noted logistical issues that complicated the disclosure experience. Key linkage to care themes included the importance of continuity between the testing site and HIV care, hospital admission as an opportunity for support and HIV education, and thoughtful matching by linkage staff to a primary care provider. ED/UC clinicians and testing programs should be sensitive to the unique roles of sickness, risk perception, and isolation in the ED/UC diagnosis experience, as these things may delay acceptance of HIV diagnosis. The disclosure and linkage to care experience is crucial in forming patient attitudes towards HIV and HIV care, thus staff involved in disclosure and linkage activities should be trained to deliver compassionate, informed, and thoughtful care that bridges HIV testing and treatment sites.
| S-EPMC3753265 | biostudies-literature
Project description:PURPOSE:To determine the frequency of emergency department (ED) visits for nonurgent and urgent ocular conditions and risk factors associated with ED use for nonurgent and urgent ocular problems. DESIGN:Retrospective, longitudinal cohort analysis. PARTICIPANTS:All enrollees aged 21 years or older in a United States managed care network during 2001-2014. METHODS:We identified all enrollees visiting an ED for ocular conditions identified by International Classification of Diseases, billing codes. Diagnosis is well-described as urgent, nonurgent, or other. We assessed the frequency of ED visits for urgent and nonurgent ocular conditions and how they changed over time. Next, we performed multivariable Cox regression modeling to determine factors associated with visiting an ED for urgent or nonurgent ocular conditions. MAIN OUTCOME MEASURES:Hazard ratios (HRs) with 95% confidence intervals (CIs) of visiting an ED for urgent or nonurgent ocular conditions. RESULTS:Of the 11?160?833 enrollees eligible for this study, 376 680 (3.4%) had 1 or more ED visit for an eye-related problem over a mean ± standard deviation of 5.4±3.3 years' follow-up. Among these enrolled, 86 473 (23.0%) had 1 or more ED visits with a nonurgent ocular condition and 25 289 (6.7%) had at least 1 ED visit with an urgent ocular condition. Use of the ED for nonurgent ocular problems was associated with younger age (P < 0.0001 for all comparisons), black race or Latino ethnicity (P < 0.0001 for both), male sex (P < 0.0001), lower income (P < 0.0001 for all comparisons), and those who frequently sought treatment at an ED for nonophthalmologic medical problems in a given year (P < 0.0001). Enrollees with established eye care professionals had a 10% reduced hazard of visiting the ED for nonurgent ocular conditions (adjusted HR, 0.90; 95% CI, 0.88-0.92; P < 0.0001). CONCLUSIONS:Nearly one-quarter of enrollees who visited the ED for an ocular problem received a diagnosis of a nonurgent condition. Better educating and incentivizing patients to seek care for nonurgent ocular diseases in an office-based setting could yield considerable cost savings without adversely affecting health outcomes and could allow EDs to better serve patients with more severe conditions.
| S-EPMC5668138 | biostudies-literature
Project description:ObjectivesTo determine the percentage of non-urgent (NU) visits in an Iranian emergency department (ED), to explore why patients with NU conditions refer to EDs and also to assess the association between patients' characteristics and their visits.DesignA cross sectional study based on face to face survey.SettingA territorial, teaching and military hospital in Tehran province, Iran.Participants and data collectionAll patients who visited the ED during the 2-week period were recruited. Data were collected using a validated questionnaire.ResultsOf 1884 patients who visited the ED, 1217 (64.6%) patients were triaged as NU while 667 (35.4%) were urgent and semiurgent visits cases. The most important reasons for NU visits were seeking prompt (36.6%) and less costly care (35.9%). We found that NU visits have increased with younger patients, during weekends and night shifts, and with patients suffering from recurrent symptoms lasting in 1?week or less.ConclusionsEDs are a common source of care for NU problems in Iran. The most invaluable solution is building up special clinics for providing healthcare services to NU patients during the weekends and, in the busy and night shifts. Receiving higher fees from NU patients could also be adopted with caution. Promoting awareness and knowledge of both healthcare providers and patients about the main role of EDs will contribute in improving their performance. As a long-term solution, adopting the family physician programme and ameliorating the referral system are recommended.
| S-EPMC6797411 | biostudies-literature
Project description:OBJECTIVE: To better understand the issue of inappropriate pediatric Emergency Department (ED) visits in Italy, including the impact of the last National Health System reform. STUDY DESIGN: A retrospective cohort study was conducted with five health care providers in the Veneto region (Italy) in a 2-year period (2010-2011). ED visits were considered "inappropriate" by evaluating both nursing triage and resource utilization, as addressed by the Italian Ministry of Health in 2007. Factors associated with inappropriate ED visits were identified. The cost of each visit was calculated. PRINCIPAL FINDINGS: In total, 134,358 ED visits with 455,650 performed procedures were recorded in the 2-year period; of these, 76,680 (57.1 percent) were considered inappropriate ED visits. Patients likely to make inappropriate ED visits were younger, female, visiting the ED during night or holiday, when the primary care provider (PCP) is not available. CONCLUSION: The National Health System reform aims to improve efficiency, effectiveness, and costs by opening PCP offices 24 hours a day and 7 days a week. This study highlights the need for a deep reorganization of the Italian Primary Care System not only providing a larger time availability but also treating the parents' lack of education on children's health.
| S-EPMC4239850 | biostudies-other
Project description:IntroductionNatural disasters are increasingly common and devastating. It is essential to understand children's health needs during disasters as they are a particularly vulnerable population. The objective of this study was to evaluate pediatric disease burden after Hurricane Harvey compared to the preceding month and the same period in the previous year to inform pediatric disaster preparedness.MethodsThis was a retrospective cross-sectional study of patients seen at pediatric emergency departments (ED) and urgent care centers (UCC) 30 days before (late summer) and after (early fall) the hurricane and from the same time period in 2016. We collected demographic information and the first five discharge diagnoses from a network of EDs and UCCs affiliated with a quaternary care children's hospital in Houston, Texas. We calculated the odds of disease outcomes during various timeframes using binary logistic regression modeling.ResultsThere were 20,571 (median age: 3.5 years, 48.1% female) and 18,943 (median age: 3.5 years, 47.3% female) patients in 2016 and 2017, respectively. Inpatient admission rates from the ED a month after Harvey were 20.5%, compared to 25.3% in the same period in 2016 (P<0.001). In both years, asthma and other respiratory illnesses increased from late summer to early fall. After controlling for these seasonal trends, the following diseases were more commonly seen after the hurricane: toxicological emergencies (adjusted odds ratio [aOR]: 2.61, 95% [confidence interval] CI, 1.35-5.05); trauma (aOR: 1.42, 95% CI, 1.32-1.53); and dermatological complaints (aOR: 1.34, 95% CI, 1.23-1.46).ConclusionWe observed increases in rashes, trauma, and toxicological diagnoses in children after a major flood. These findings highlight the need for more medication resources and public health and education measures focused on pediatric disaster preparedness and management.
| S-EPMC8203006 | biostudies-literature
Project description:ObjectiveAdmissions for ambulatory care sensitive conditions (ACSCs) are often used to measure potentially preventable emergency care. Visits to emergency departments with ACSCs may also be preventable care but are excluded from such measures if patients are not admitted. We established the extent and composition of this preventable emergency care.MethodsWe analysed 1,505,979 emergency department visits (5% of the national total) between 1 April 2015 and 31 March 2017 at six hospital Trusts in England, using International Classification of Diseases diagnostic coding. We calculated the number of visits for each ACSC and examined the proportions of these visits that did not result in admission by condition and patient characteristics.Results11.1% of emergency department visits were for ACSCs. 55.0% of these visits did not result in hospital admission. Whilst the majority of ACSC visits were for acute rather than chronic conditions (59.4% versus 38.4%), acute visits were much more likely to conclude without admission (70.3% versus 33.4%). Younger, more deprived and ethnic minority patients were less likely to be admitted when they visited the emergency department with an ACSC.ConclusionsOver half of preventable emergency care is not captured by measures of admissions. The probability of admission at a preventable visit varies substantially between conditions and patient groups. Focussing only on admissions for ACSCs provides an incomplete and skewed picture of the types of conditions and patients receiving preventable care. Measures of preventable emergency care should include visits in addition to admissions.
| S-EPMC9277334 | biostudies-literature
Project description:ObjectivesTo explore magnitude and factors associated with non-urgent visits to the emergency department (ED) in a tertiary care centre, western Saudi Arabia.DesignA cross-sectional study.SettingED of a tertiary care hospital in western Saudi Arabia.Participants400 patients, both men and women.InterventionsAn interview-based questionnaire was administered to a consecutive sample of patients who visited the ED during morning shifts, where primary healthcare centres (PHCs) and outpatient clinics were available.Primary outcome measureED visits classified as non-urgent versus urgent (excluding life-threatening conditions) based on the Canadian Triage and Acuity Scale (CTAS). Levels IV and V were classified as non-urgent.ResultsMajority of the cases were adult (97.3%) and half of them were women (54.8%). Non-urgent visits represented 78.5% among non-life-threatening cases. One-third of the patients (33.8%) had three visits or more to the ED during the past year. Main reasons for visiting the ED were perception that the condition was urgent (42.0%), easy access (25.5%) and limited resources and services at the PHCs (17.8%). Patients 40-50 years old were more likely to have non-urgent visits (OR=3.21, 95% CI 1.15 to 8.98). However, likelihood of non-urgent visits was significantly lower among patients with cancer (OR=0.37, 95% CI 0.19 to 0.72) and cardiovascular disease (OR=0.43, 95% CI 0.23 to 0.83), and those who live near the hospital (OR=0.49, 95% CI 0.28 to 0.88).ConclusionsThe current study reported overuse of the ED. Enhancement of the primary care services, in concordance with community awareness, is an important component to reduce burden due to non-urgent use of the ED.
| S-EPMC7539577 | biostudies-literature
Project description:OBJECTIVE:To examine whether care provided by general practitioners (GPs) to non-urgent patients in the emergency department differs significantly from care provided by usual accident and emergency (A&E) staff in terms of process outcomes and A&E clinical quality indicators. DESIGN:Propensity score matched cohort study. SETTING:GPs in A&E colocated within the University Hospitals Coventry and Warwickshire NHS Trust between May 2015 and March 2016. PARTICIPANTS:Non-urgent attendances visits to the A&E department. MAIN OUTCOMES:Process outcomes (any investigation, any blood investigation, any radiological investigation, any intervention, admission and referrals) and A&E clinical indicators (spent 4?hours plus, left without being seen and 7-day reattendance). RESULTS:A total of 5426 patients seen by GPs in A&E were matched with 10?852 patients seen by emergency physicians (ratio 1:2). Compared with standard care in A&E, GPs in A&E significantly: admitted fewer patients (risk ratio (RR) 0.28, 95% CI 0.25 to 0.31), referred fewer patients to other specialists (RR 0.31, 95%?CI 0.24 to 0.40), ordered fewer radiological investigations (RR 0.38, 95%?CI 0.34 to 0.42), ordered fewer blood tests (0.57, 95%?CI 0.52 to 0.61) and ordered fewer investigations (0.93, 95%?CI 0.90 to 0.96). However, they intervened more, offered more primary care follow-up (RR 1.78, 95%?CI 1.67 to 1.89) and referred more patients to outpatient and other A&E clinics (RR 2.29, 95%?CI 2.10 to 2.49). Patients seen by GPs in A&E were on average less likely to spend 4?hours plus in A&E (RR 0.37, 95%?CI 0.30 to 0.45) compared with standard care in A&E. There was no difference in reattendance after 7?days (RR 0.96, 95%?CI 0.84 to 1.09). CONCLUSION:GPs in A&E tended to manage self-reporting minor cases with fewer resources than standard care in A&E, without increasing reattendance rates.
| S-EPMC5950695 | biostudies-other