A prospective evaluation of the effect of managed care on medical care utilization among severely disabled independently living adults

We conducted an 18-month longitudinal evaluation of a model-managed medical care program for severely disabled, independently living adults. Regression analyses using an additive model (no interaction effects) suggest that persons in the study group did not have statistically significantly different utilization experiences than members of the comparison group. Regression analyses that include interaction effects suggest that, for certain segments of the cohort, the study group's utilization experience was significantly lower than that of members of the comparison group. Persons in the study group with higher baseline emergency room (ER) utilization had significantly fewer hospital admissions (P = 0.0055). The participants with better self-assessments of health experienced significantly fewer hospital days per person (P = 0.0075) and days per person hospitalized (P = 0.0056), and persons with organizational affiliations reported significantly fewer ER visits (P = 0.0264).     

The self-reported functional measure: Predictive validity for health care utilization in multiple sclerosis and spinal cord injury

OBJECTIVE: To examine the predictive validity of the Self-Reported Functional Measure (SRFM), a new measure derived from the FIMtrade mark instrument, for health care utilization in multiple sclerosis (MS) and spinal cord injury (SCI). DESIGN: Prospective cohort study using a mailed survey in 1995 and administrative records from 1996 and 1997. SETTING: Veterans Health Administration hospitals and outpatient clinics. PATIENTS: A total of 6361 veterans with SCI and 1789 veterans with MS. MAIN OUTCOME MEASURES: SRFM score was compared with subsequent outpatient visits, hospitalizations, hospital lengths of stay (LOSs), and residence peri-hospitalization. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for these variables. RESULTS: A total of 3836 subjects (47.6%) were hospitalized during 1996-1997, and all but 874 (10.7%) had 1 or more outpatient visits. SRFM score predicted inpatient, but not outpatient health care utilization. Persons in the lowest SRFM quartile were over 90% (OR = 1.91, 95% CI = 1.71-2.13) more likely to be hospitalized compared with those in the highest SRFM quartile; also, they were over 2 times (OR = 2.18, 95% CI = 1.85-2.57) more likely to have a LOS greater than 7 days, were over 2 times (OR = 2.41, 95% CI = 1.62-3.58) more likely to die in hospital, and were nearly 3 times (OR = 2.86, 95% CI = 2.00-4.08) more likely to be discharged to an institution. CONCLUSIONS: SRFM had excellent predictive validity for hospitalization, LOS, and discharge destination among patients with MS or SCI.     

A staged management diabetes foot program versus standard care: a 1-year cost and utilization comparison in a state public hospital system

OBJECTIVE: To determine whether staged management of foot ulcers reduces health care costs and utilization. DESIGN: Nonrandomized retrospective study using data from 1998-1999 in the Louisiana public hospital system. SETTING: Louisiana public hospital system. PARTICIPANTS: Forty-five patients with diabetes foot ulcer who received staged management foot care and 169 patients with diabetes foot ulcer who received standard foot care. INTERVENTIONS: Staged management of foot ulcers consisting of devices to offload pressure; self-care education; and, after healing, custom-fabricated orthoses and footwear, and monitored progressive ambulation. MAIN OUTCOME MEASURES: One-year levels of the number of foot-related inpatient hospitalizations, number of amputation-related hospitalizations, total number of foot-related inpatient days, total charges for foot-related inpatient hospitalizations, all-cause outpatient visits, total charges for all-cause outpatient visits, and combined outpatient and foot-related inpatient charges. RESULTS: Over the 12-month study period, the staged management group had a lower foot-related hospitalization rate than did the comparison group (.09 admissions per person vs.50 admissions per person, P=.0002); lower foot-related inpatient days (.91d per person vs 3.97d per person, P=.0289); lower foot-related inpatient charges ($1321 per person vs $5411 per person, P=.0151); fewer amputation-related hospitalizations (.04 per person vs.19 per person, P=.0351); fewer emergency department visits (.60 visits per person vs 1.22 visits per person, P=.0043); lower emergency department charges ($104 per person vs $208 per person, P=.0057); and lower total charges ($4776 per person vs $9402 per person, P=.0141). The staged management group had a higher number of outpatient visits (24.91 per person vs 8.04 per person, P<.0001) and higher outpatient charges ($2169 per person vs $1471 per person, P<.0001). CONCLUSIONS: A staged management diabetes foot program significantly reduced emergency department and hospital utilization and charges in a statewide public hospital system.     

Rehospitalization and spinal cord injury: cross-sectional survey of adults living independently

A cross-sectional survey of 96 people living independently with spinal cord injuries (SCI) in Eastern Massachusetts shows that 57% had been hospitalized at least once in the year before the survey. Sample means were 1.0 admissions and 16.0 days/person/year. Eight percent of the sample (eight persons) accounted for 22% of admissions and 59% of total hospital days. For those hospitalized, the mean was 1.7 admissions and 45.1 days/person/year. Mean length-of-stay was 34.7 days/admission. Multiple regression analysis shows that three variables appear to be independently related to increased numbers of admissions: self-assessment of health; place of residence; and age (younger respondents at higher risk). One variable is independently associated with total days of hospitalization: leaving home at least once daily (as opposed to less frequently) is associated with lower risk. There were no statistically significant relationships between either numbers of hospitalizations or total days hospitalized and ADL or IADL status, education, employment, medical insurance, household composition, gender, age at onset of disability, time since onset of disability, substance use (alcohol, cannabis, or tobacco), level of SCI lesion, or social supports.     

Health care service utilization among the elderly: findings from the Study to Understand the Chronic Condition Experience of the Elderly and the Disabled (SUCCEED project)

Rationale and objectives Age‐related effects on health service utilization are not well understood. Most previous studies have examined only a single specific health care service or disease condition or have focused exclusively on economic variables. We aim to measure age‐related change in health care utilization among the elderly. Methods A population‐based retrospective cohort study was conducted using linked data from four administrative databases (OHIP, ODB, CIHI and RPDB). All Ontario residents over the age of 65 years and eligible for public health coverage were included in the analysis (approximately 1.6 million residents). Main outcome measures include utilization indicators for family physician visits, specialist physician visits, Emergency Department visits, drugs, lab claims, X‐rays, inpatient admissions, CT scans and MRI scans. Results The mean number of utilization events for Ontarians aged 65+ years for the 1‐year study period was 70 events (women = 76, men = 63). The overall absolute difference between the 65–69 age group and the 85+ age group was 155% (women = 162%, men = 130%), or 76 more events per person in the older group (women = 82, men = 61). Women averaged more events per person than men, as well as greater percentage differences by age. Drugs and diagnostics account for the majority of events. Only MRI and specialist visits were not higher among the older age groups. Conclusions At the population level, overall health care utilization would appear to increase significantly with age. It is unclear whether increasing health care utilization prevents morbidity, decreases mortality, or improves quality of life.     

Chronic disease self-management program: 2-year health status and health care utilization outcomes

OBJECTIVES: To assess the 1- and 2-year health status, health care utilization and self-efficacy outcomes for the Chronic Disease Self-Management Program (CDSMP). The major hypothesis is that during the 2-year period CDSMP participants will experience improvements or less deterioration than expected in health status and reductions in health care utilization. DESIGN: Longitudinal design as follow-up to a randomized trial. SETTING: Community. PARTICIPANTS: Eight hundred thirty-one participants 40 years and older with heart disease, lung disease, stroke, or arthritis participated in the CDSMP. At 1- and 2-year intervals respectively 82% and 76% of eligible participants completed data. MAIN OUTCOME MEASURES: Health status (self-rated health, disability, social/role activities limitations, energy/fatigue, and health distress), health care utilization (ER/outpatient visits, times hospitalized, and days in hospital), and perceived self-efficacy were measured. MAIN RESULTS: Compared with baseline for each of the 2 years, ER/outpatient visits and health distress were reduced (P <0.05). Self-efficacy improved (P <0.05). The rate of increase is that which is expected in 1 year. There were no other significant changes. CONCLUSIONS: A low-cost program for promoting health self-management can improve elements of health status while reducing health care costs in populations with diverse chronic diseases.     

Impact of an emergency department pain management protocol on the pattern of visits by patients with sickle cell disease

This study explores how implementation of pain management guidelines in concert with clinic case management affected emergency department (ED) utilization, clinic visits, and hospital admissions for patients with sickle cell disease. A pain management guideline that eliminated meperidine and encouraged timely use of morphine or hydromorphone for pain control in sickle cell crisis was introduced as a quality improvement project. This study is a retrospective review of ED visits, clinic visits, and admissions from 1 year before and 3 years after the guideline implementation. Working with the ED, the Hematology Clinic began to proactively seek the return of their patients for clinic follow-up. A formal case management program for sickle cell patients was initiated in June 2003. A total of 1584 visits by 223 patients were collected, 1097 to the ED and 487 to the Hematology Clinic. Total hospital visits did not change significantly in any of the 4 years, p > 0.10 for each comparison. Total ED visits decreased significantly over the 4-year study period (p < 0.001), whereas clinic visits steadily increased (p < 0.001). Return visits to the ED within 30 days also declined significantly, p < 0.001. Both the absolute number of admissions per year and the total admissions per hospital visit per year declined significantly over the study period, p = 0.001. Although total admissions per hospital visit did not change, the proportion of ED visits that resulted in admission in year 1 (29%) was significantly lower than the proportion admitted in year 2 (43%), p = 0.04. A pain protocol using morphine or hydromorphone coupled with increased access to outpatient clinics decreased ED visits, hospitalizations, and increased utilization of a more stable primary care clinic setting by patients with sickle cell disease.     

Pressure ulcers in veterans with spinal cord injury: a retrospective study

Pressure ulcers are a major complication of spinal cord injury (SCI) and have a significant effect on general health and quality of life. The objectives of this retrospective chart review were to determine prevalence, duration, and severity of pressure ulcers in veterans with SCI and to identify predictors of (1) outcome in terms of healing without surgery, not healing, or referral for surgery; (2) number of visits veterans made to the SCI outpatient clinic or received from home care services for pressure ulcer treatment; and (3) number of hospital admissions and days hospitalized for pressure ulcer treatment. From a sampling frame of 553 veterans on the Houston Veterans Affairs Medical Center SCI roster, 215 (39%) were reported to have visited the clinic or received home care for pressure ulcers (ICD-9 code 707.0 = decubitus, any site) during the 3 years studied (1997, 1998, and 1999). From this sample, 102 veterans met the inclusion criteria for further analyses, 56% of whom had paraplegia. The duration of ulcers varied greatly from 1 week to the entire 3-year time-frame. Overall, Stage IV pressure ulcers were the most prevalent as the worst ulcer documented. Number and severity of ulcers predicted outcome and healthcare utilization. This study illustrates the magnitude of the pressure ulcer problem among veterans with SCI living in the community. Reducing the prevalence of pressure ulcers among veterans with SCI will have a significant impact on the Department of Veterans Affairs' financial and social resources. Innovative approaches are needed to reduce pressure ulcer risk in veterans with SCI.     

Health service consumption and parent reported episodes of illness in children 0–3 years

Objective - To describe health service consumption and to find out whether a series of possible explanatory variables can help us to predict the number of contacts among children.

Design - A prospective study following a cohort of children during the first four years of life.

Setting - A municipality in southern Norway.

Participants - 183 children born in the community from October 1979 to and including December 1980.

Main outcome measure - Direct and indirect encounters with general practitioners (GPs) from the bills to the national insurance office, outpatient encounters and hospital admissions from the hospital files, and episodes of illness as reported in postal questionnaires to the parents. Results - Each child had on average 10.6 GP contacts (2.6 per year), and the frequency of contacts decreased as they grew. Telephone contacts were almost as frequent as consultations at the doctor's surgery, and the doctors made more home visits to the youngest children. Of the contacts, 4/5 took place in the day tune, but most of the home visits took place during the evening/night/weekend. Each child had 1.9 hospital contacts in 4 years, i.e. 0.3 admissions and 1.6 outpatient department contacts.

The parents reported an average of 11.5 episodes of illness during the period, more than twice as many in the first year as in the last year. Information about sex, duration of breast feeding, smoking in the family, family history of allergy, parents' education, whether in kindergarten, and presence of psychosocial problems cannot help in predicting health care consumption. Conclusion - The low number of contacts with GPs can partly be explained by the fact that the children also have contact with a well-baby clinic. In our study, a series of possible explanatory factors did not help us to predict the amount of health care consumption during the first four years of life.     

Ambulatory care sensitive hospitalizations and emergency visits: experiences of Medicaid patients using federally qualified health centers

BACKGROUND: Federally Qualified Health Centers (FQHCs) serve as regular sources of preventive and primary care for low-income families within their communities and are key parts of the health care safety net. OBJECTIVES: Compare admissions and emergency room visits for ambulatory care sensitive conditions (ACSCs) among Medicaid beneficiaries relying on FQHCs to other Medicaid beneficiaries. RESEARCH DESIGN: Retrospective analysis of 1992 Medicaid claims data for 48,738 Medicaid beneficiaries in 24 service areas across five states. SUBJECTS: Medicaid beneficiaries receiving more than 50% of their preventive and primary care services from FQHCs are compared with Medicaid beneficiaries receiving outpatient care from other providers in the same areas. Exclusions-managed care enrollees, beneficiaries more than age 65, dual eligibles (Medicaid and Medicare), and institutionalized populations. MEASURES: Admissions and emergency room (ER) visits for a set of chronic and acute conditions, known in the literature as ambulatory care sensitive conditions (ACSCs). RESULTS: Medicaid beneficiaries receiving outpatient care from FQHCs were less likely to be hospitalized (1.5% vs. 1.9%, P < 0.007) or seek ER care (14.9% vs. 15.7%, P < 0.02) for ACSCs than the comparison group. Controlling for case mix and other demographic variables, the odds ratios were, for hospitalizations, OR, 0.80; 95% CI, 0.67 to 0.95; P < 0.01, and for ER visits, OR, 0.87; 95% CI, 0.82 to 0.92; P < 0.001. CONCLUSIONS: Having a regular source of care such as FQHCs can significantly reduce the likelihood of hospitalizations and ER visits for ACSCs. If the reported differentials in ACSC admissions and ER visits were consistently achieved for all Medicaid beneficiaries, substantial savings might be realized.     

The use of a county hospital emergency room by diabetic patients

The use of a county hospital emergency room (ER) by diabetic patients was investigated by comparing ER visits for diabetes to a sample to total ER visits over a period of 1 yr. The major problems of ER use by diabetic patients were an excessive number of visits for diabetes complications, a high rate of hospital admissions from the ER, and the high cost of ER use. Approximately 20% of visits for diabetic patients were attributed to preventable complications of diabetes. The rate of hospital admissions from the ER was over four times greater for the diabetic patients than for the random sample. The median cost of an ER visit was nearly three times higher for diabetic patients than for the random sample. These problems may be best resolved through improved access to primary care and educational services that can assist the person with diabetes in self-management and prevention of the acute complications of the disease.     

The impact of trauma exposure and post-traumatic stress disorder on healthcare utilization among primary care patients

BACKGROUND: Trauma exposure and post-traumatic stress disorder (PTSD) increase healthcare utilization in veterans, but their impact on utilization in other populations is uncertain. OBJECTIVES: To examine the association of trauma exposure and PTSD with healthcare utilization, in civilian primary care patients. RESEARCH DESIGN: Cross-sectional study. SUBJECTS: English speaking patients at an academic, urban primary care clinic. MEASURES: Trauma exposure and current PTSD diagnoses were obtained from the Composite International Diagnostic Interview. Outcomes were nonmental health outpatient and emergency department visits, hospitalizations, and mental health outpatient visits in the prior year from an electronic medical record. Analyses included bivariate unadjusted and multivariable Poisson regressions adjusted for age, gender, income, substance dependence, depression, and comorbidities. RESULTS: Among 592 subjects, 80% had > or =1 trauma exposure and 22% had current PTSD. In adjusted regressions, subjects with trauma exposure had more mental health visits [incidence rate ratio (IRR), 3.9; 95% confidence interval (CI), 1.1-14.1] but no other increased utilization. After adjusting for PTSD, this effect of trauma exposure was attenuated (IRR, 3.2; 95% CI, 0.9-11.7). Subjects with PTSD had more hospitalizations (IRR, 2.2; 95% CI, 1.4-3.7), more hospital nights (IRR, 2.6; 95% CI, 1.4-5.0), and more mental health visits (IRR, 2.2; 95% CI, 1.1-4.1) but no increase in outpatient and emergency department visits. CONCLUSIONS: PTSD is associated with more hospitalizations, longer hospitalizations, and greater mental healthcare utilization in urban primary care patients. Although trauma exposure is independently associated with greater mental healthcare utilization, PTSD mediates a portion of this association.     

Youth and young adults with cerebral palsy: their use of physician and hospital services

OBJECTIVES: To examine patterns of health care utilization among youth and young adults who have cerebral palsy (CP) and to provide information to guide the development of health services for adults who have CP. DESIGN: This study analyzed health insurance data for outpatient physician visits and hospital admissions for a 4-year period. SETTING: Six children's treatment centers in Ontario, Canada. PARTICIPANTS: The sample included 587 youth and 477 adults with CP identified from health records. Youths were 13 to 17 years of age, and adults were 23 to 32 years of age at the end of the data range. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We computed the annual rates of outpatient physician visits and hospitalizations per 1000 persons and compared these with rates for the general population. RESULTS: Annual rates of outpatient physician visits were 6052 for youth and 6404 for adults with CP, 2.2 times and 1.9 times higher, respectively, than rates for age-matched peers (P<.01). Specialists provided 28.4% of youth visits but only 18.8% of adult visits. Annual hospital admission rates were 180 for youth and 98 for adults with CP, 4.3 times and 10.6 times higher, respectively, than rates for age-matched peers (P<.01). CONCLUSIONS: It appears that youth and adults with CP continue to have complex care needs and rely heavily on the health care system. Comprehensive services are essential to support their health as they move into youth and adulthood. However, there appear to be gaps in the adult health care system, such as limited access to specialist physicians.     

Utilization of medical healthcare among people receiving long‐term care at home or in special accommodation

Scand J Caring Sci; 2010; 24; 404–413
Utilization of medical healthcare among people receiving long‐term care at home or in special accommodation Aim: To investigate the utilization of medical healthcare, hospital care and outpatient care, during a 1‐year period in relation to informal care, multimorbidity, functional status and health complaints and to long‐term care at home or in special accommodation among people aged 65+, with one or more hospital admissions and receiving long‐term care. Method: A total of 694 people receiving long‐term care during the year 2001 were studied. Data were collected by means of the administrative registers Patient Administrative Support in Skåne and PrivaStat and through the study Good Ageing in Skåne. Those at home and those in special accommodation were compared regarding utilization of medical healthcare, informal care, multimorbidity, functional status and health complaints. Multiple logistic regression analysis was performed using at home vs. in special accommodation as the dependent variable and also two multiple linear regression analyses using the number of hospital stays and the number of contacts with the physician in outpatient care separately as dependent variables. Findings: Those at home were significantly younger (mean age: 81 vs. 84 years) and less dependent in personal and instrumental activities of daily living (PADL/IADL) than those in special accommodation. A larger proportion of those at home was admitted to hospital three times or more (21 vs. 14%) and they had significantly more contacts with physicians in outpatient care (md: 10 vs. md: 7). Informal care was associated with care at home (OR = 0.074) and with utilization of outpatient care (B = 2.045). Dependency in PADL was associated with care in special accommodation (OR = 1.375) and with utilization of hospital care (B = ?0.060) and outpatient care (B = ?0.581). Conclusion: Medical healthcare seems more accessible to those who live at home are younger, less dependent and who have access to informal caregivers.     

Resource utilization of patients with hypochondriacal health anxiety and somatization.

OBJECTIVES: To examine the resource utilization of patients with high levels of somatization and health-related anxiety. DESIGN: Consecutive patients on randomly chosen days completed a self-report questionnaire assessing somatization and health-related, hypochondriacal anxiety. Their medical care utilization in the year preceding and following completion of the questionnaire was obtained from an automated patient record. The utilization of patients above and below a predetermined threshold on the questionnaire was then compared. PATIENTS AND SETTING: Eight hundred seventy-six patients attending a primary care clinic in a large, urban, teaching hospital. OUTCOME MEASURES: Number of ambulatory physician visits (primary care and specialist), outpatient costs (total, physician services, and laboratory procedures), proportion of patients hospitalized, and proportion of patients receiving emergency care. RESULTS: Patients in the uppermost 14% of the clinic population on somatization and hypochondriacal health anxiety had appreciably and significantly higher utilization in the year preceding and the year following completion of the somatization questionnaire than did the rest of the patients in the clinic. After adjusting for group differences in sociodemographic characteristics and medical comorbidity, significant differences in utilization remained. In the year preceding the assessment of somatization, their adjusted total outpatient costs were $1,312 (95% CI $1154, $1481) versus $954 (95% CI $868, $1057) for the remainder of the patients and the total number of physician visits was 9.21 (95% CI 7.94, 10.40) versus 6.33 (95% CI 5.87, 6.90). In the year following the assessment of somatization, those above the threshold had adjusted total outpatient costs of $1,395 (95% CI $1243, $1586) versus $1,145 (95% CI $1038, $1282), 9.8 total physician visits (95% CI 8.66, 11.07) versus 7.2 (95% CI 6.62, 7.77), and had a 24% (95% CI 19%, 30%) versus 17% (95% CI 14%, 20%) chance of being hospitalized. CONCLUSIONS: Primary care patients who somatize and have high levels of health-related anxiety have considerably higher medical care utilization than nonsomatizers in the year before and after being assessed. This differential persists after adjusting for differences in sociodemographic characteristics and medical morbidity.     

Economics of trauma in a small academic medical center

The recent changes in the mechanisms of health care funding have complicated trauma care and trauma center development. Hard data are needed on the current financial position of trauma care to plan for the future. To reduce the cost of trauma care without sacrificing the quality, we must know how the trauma dollar is spent. We reviewed the records of 100 random admissions to the trauma service of our institution in 1985. The records were examined for length of stay (LOS), intensive care unit length of stay (ICU-LOS), total hospital bill, types of third-party coverage, and overall collection rate. The hospital bill was broken down to identify the origins of trauma costs. To provide a control group, 100 patients admitted to the general surgical service and 100 other admissions were also analyzed. Trauma patients had greater LOS, ICU-LOS, total bills, and costs per day. Blunt trauma resulted in a greater LOS than penetrating trauma, but similar total bills. The collection rate from the blunt trauma patients was significantly greater. The greatest differences between trauma patients and others in resource utilization are the result of longer ICU-LOS and greater use of blood products. We did not identify any sites of potentially significant cost cutting that would not compromise patient care.     

Factors predicting perceived improved health after emergency room visits

Aim. This study examines the key factors contributing to perceived improved health after emergency room (ER) visits. Background. Perceived health is a subjective measure of health status. It is an important and useful concept in nursing and assessment of health services because it reflects the clients’ own assessment of his/her health, which may have led to their subsequent health‐seeking behaviour. Methods. Secondary analysis of a main study which aimed at examining the effects of nurse follow‐up on ER revisits using randomized‐controlled trial. In this study, binary logistic regressions were conducted to identify factors associated with the dependent variable, perceived improved health 30 days after the index ER visit. Data were collected from 795 subjects and the sources of data were from medical records and telephone interviews. Results. Gender, income, usual practice in managing minor illness, what to do other than attending the ER, nurse follow‐up, general self‐rated health, triage, considered other doctors on the day of index ER visit, times of attending general outpatient clinic and times of attending general practitioner were found to be significantly associated with perceived improved health 30 days after the index ER visit. Conclusion. Many of the variables identified in this study that predicted perceived improved health concurred with previous findings. What is of interest is that nurse follow‐up but not multiple medical consultations helped enhance perceived improved health. We speculate that there was no continuity of care in the multiple medical consultations. Where as in the nurse follow‐up, the nurse was able to follow through the care of individuals, monitor their progress and make appropriate referrals. This study shows that the nurse is an appropriate person to mediate the health needs of individuals and the healthcare system and to enhance health maintenance for individuals in the community without excessively using medical services. Relevance to clinical practice. The nurses providing care during the transitional phase should not only include the traditional clinical or hospital system variables, but should also take into account the general health perception of patients, because these are the predictors of health services utilization and morbidity.     

Youth and Young Adults With Spina Bifida: Their Utilization of Physician and Hospital Services

Objective

To describe current patterns of health care utilization of youth and young adults who have spina bifida (SB) and provide evidence to guide the development of health care for this growing population.

Design

We conducted a secondary analysis of health services utilization data from the Canadian Institute for Health Information to determine the rates and patterns of health care utilization, because comprehensive health care has been recognized as critical to positive health outcomes.

Setting

Participants were identified from 6 publicly funded children's treatment centers.

Participants

Health records from youth (n=164; age range, 13.0–17.9y) and adults (n=120; age range, 23.0–32.9y) with SB contributed to this study.

Interventions

Not applicable.

Main Outcome Measures

The rates of outpatient physician visits and hospital admissions for the youth and adult groups were calculated. The proportion with a “medical home” was also calculated.

Results

The annual rates of outpatient physician visits per 1000 persons were 8031 for youth and 8524 for adults with SB. These rates were approximately 2.9 and 2.2 times higher, repectively, than for their age-matched peers. On average, 12% of youth and 24% of adults with SB had a medical home. The annual rates of hospital admissions per 1000 persons were 329 for youth and 285 for adults with SB. Rates of admissions were 19.4 and 12.4 times higher, respectively, for these groups than for the general population.

Conclusions

It appears that persons with SB are accessing health services more often than their age-matched peers, and few have a medical home. We recommend that seamless medical care be provided to all adults with SB, coordinated by a primary care provider, to facilitate comprehensive care.     

Alcohol treatment outcomes following discharge from a partial hospital program

Background: Thousands of individuals in the United States seek alcohol treatment each year, typically in outpatient settings. Partial hospital programs provide a high level of structured, individualized outpatient care for individuals who are in treatment for alcohol use disorder. Previous research in other outpatient and inpatient settings has found that psychological distress, pain, and aftercare utilization are associated with treatment outcomes. Objectives: The current study evaluates baseline characteristics and aftercare utilization predictors of alcohol use outcomes of individuals in a week-long partial hospital program. Methods: The 113 participants (59.3% male) were interviewed during their time in the program and then were reassessed one month post-discharge. Results: Results indicated that a greater number of mental health provider visits and 12-step attendance were associated with abstinence at follow-up such, while baseline characteristics did not consistently predict outcomes. Conclusions: Findings highlight the importance of aftercare planning, particularly in our more severe, clinical sample.     

Rehospitalization after initial rehabilitation for acute spinal cord injury: incidence and risk factors

Many acute spinal cord injury (SCI) patients require rehospitalization after discharge from initial rehabilitation. Previous studies of rehospitalization for these patients have been cross-sectional with respect to time since injury (in years), and have not allowed for comparison of patients with equal exposure to the risk of medical complications once they have reentered the community. To examine the incidence, cause, and monetary cost of rehospitalizations during the first year after discharge from initial rehabilitative care (day 365), the medical records of 88 consecutive, acute SCI patients who completed initial rehabilitation at a regional model SCI care system were reviewed. Cases were excluded from the study if the patient was lost to follow-up before day 365. All readmissions to the regional SCI care system during the follow-up period were reviewed for primary diagnosis, length of stay (LOS), and hospital charges incurred. Thirty-four patients (39%) were readmitted at least once by day 365. There was a total of 47 readmissions; mean LOS was 11.9 +/- 2.1 days per admission (+/- 1SE), and mean hospital charge per admission was $9,683. Univariate comparisons between the characteristics of patients who were readmitted vs those who were not indicated that the readmitted group was less educated (11.8 +/- 2.1 years vs 12.9 +/- 0.3 years, p less than 0.05) and had a substantially longer initial rehabilitation LOS (88.9 +/- 6.6 days vs 72.9 +/- 5.1 days, p less than 0.05). Readmissions were less common among patients who were discharged at Frankel class C or D (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)