Explore the vast range of titles available.

The influenza pandemic caused by the 2009 H1N1 virus underscores the immediate and critical need to prepare for a public health emergency in which thousands, tens of thousands, or even hundreds of thousands of people suddenly seek and require medical care in communities across the United States.

Background and Purpose: Among patients with acute stroke symptoms, delay in hospital admission is the main obstacle for the use of thrombolytic therapy and other interventions associated with decreased mortality and disability. The primary aim of this study was to assess whether an elderly clinical population correctly endorsed the response to call for emergency services when presented with signs and symptoms of stroke using a standardized questionnaire. Methods: We performed a cross-sectional study among elderly out-patients (≥60 years) in Buenos Aires, Argentina randomly recruited from a government funded health clinic. The correct endorsement of intention to call 911 was assessed with the Stroke Action Test and the cut-off point was set at ≥75%. Knowledge of stroke and clinical and socio-demographic indicators were also collected and evaluated as predictors of correct endorsement using logistic regression. Results: Among 367 elderly adults, 14% correctly endorsed intention to call 911. Presented with the most typical signs and symptoms, only 65% reported that they would call an ambulance. Amaurosis Fugax was the symptom for which was called the least (15%). On average, the correct response was chosen only 37% of the time. Compared to lower levels of education, higher levels were associated to correctly endorsed intention to call 911 (secondary School adjusted OR 3.53, 95% CI 1.59-7.86 and Tertiary/University adjusted OR 3.04, 95% CI 1.12-8.21). Conclusions: These results suggest the need to provide interventions that are specifically designed to increase awareness of potential stroke signs and symptoms and appropriate subsequent clinical actions.

Using data from multiple health systems (2009–2010) and the largest sample to date, this study compares health services use among youth with and without an autism spectrum disorder (ASD)—including preventive services not previously studied. To examine these differences, we estimated logistic and count data models, controlling for demographic characteristics, comorbid physical health, and mental health conditions. Results indicated that youth with an ASD had greater health care use in many categories, but were less likely to receive important preventive services including flu shots and other vaccinations. An improved understanding of the overall patterns of health care use among this population could enable health systems to facilitate the receipt of appropriate and effective health care.

Objectives. We evaluated whether a brief, universal, postnatal nurse home-visiting intervention can be implemented with high penetration and fidelity, prevent emergency health care services, and promote positive parenting by infant age 6 months. Methods. Durham Connects is a manualized 4- to 7-session program to assess family needs and connect parents with community resources to improve infant health and well-being. All 4777 resident births in Durham, North Carolina, between July 1, 2009, and December 31, 2010, were randomly assigned to intervention and control conditions. A random, representative subset of 549 families received blinded interviews for impact evaluation. Results. Of all families, 80% initiated participation; adherence was 84%. Hospital records indicated that Durham Connects infants had 59% fewer infant emergency medical care episodes than did control infants. Durham Connects mothers reported fewer infant emergency care episodes and more community connections, more positive parenting behaviors, participation in higher quality out-of-home child care, and lower rates of anxiety than control mothers. Blinded observers reported higher quality home environments for Durham Connects than for control families. Conclusions. A brief universal home-visiting program implemented with high penetration and fidelity can lower costly emergency medical care and improve family outcomes.

Objectives: I determined incremental increases in health care expenditures and utilization associated with chronic rhinosinusitis (CRS). Methods: Patients with a reported diagnosis of CRS were extracted from the 2007 Medical Expenditure Panel Survey medical conditions file and linked to the consolidated expenditures file. The patients with CRS were then compared to patients without CRS to determine differences in health care utilization (office visits, emergency facility visits, and prescriptions filled), as well as differences in health care expenditures (total health care costs, office visit costs, prescription medication costs, and self-expenditures) by use of demographically adjusted and comorbidity-adjusted multivariate models. Results: An estimated 11.1 ± 0.48 million adult patients reported having CRS in 2007 (4.9% ± 0.2% of the US population). The additional incremental health care utilizations associated with CRS relative to patients without CRS for office visits, emergency facility visits, and number of prescriptions filled were 3.45 ± 0.42, 0.09 ± 0.03, and 5.5 ± 0.8, respectively (all p ≥ 0.001). Similarly, additional health care expenditures associated with CRS for total health care expenses, office-based expenditures, prescription expenditures, and self-expenditures were $772 ± $300, $346 ± $130, $397 ± $88, and $90 ± $24, respectively (all p ≥ 0.01). Conclusions: Chronic rhinosinusitis is associated with a substantial incremental increase in health care utilization and expenditures due to increases in office-based and prescription expenditures. The national health care costs of CRS remain very high, at an estimated $8.6 billion per year.

To examine whether or not a mobile integrated health (MIH) program may improve health-related quality of life while reducing emergency department (ED) transports, ED admissions, and inpatient hospital admissions in frequent utilizers of ED services. A small retrospective evaluation assessing pre- and post-program quality of life, ED transports, ED admissions, and inpatient hospital admissions was conducted in patients who frequently used the ED for non-emergent or emergent/primary care treatable conditions. Pre- and post-program data available on 64 program completers are reported. Of those with mobility problems (n=42), 38% improved; those with problems performing usual activities (N=45), 58% reported improvement; and of those experiencing moderate to extreme pain or discomfort (N=48), 42% reported no pain or discomfort after program completion. Frequency of ED transports decreased (5.34±6.0 vs. 2.08±3.3; p <0.000), as did ED admissions (9.66±10.2 vs. 3.30±4.6; p<0.000), and inpatient hospital admissions (3.11±5.5 vs. 1.38±2.5; p=0.003). Results suggest that MIH participation is associated with improved quality of life, reduced ED transports, ED admissions, and inpatient hospital admissions. The MIH program may have potential to improve health outcomes in patients who are frequent ED users for non-emergent or emergent/primary care treatable conditions by teaching them how to proactively manage their health and adhere to therapeutic regimens. Programmatic reasons for these improvements may include psychosocial bonding with participants who received in-home care, health coaching, and the MIH team's 24/7 availability that provided immediate healthcare access.

ABSTRACT BACKGROUND The rates of emergency department (ED) utilization vary substantially by type of health insurance, but the association between health insurance type and patient-reported reasons for seeking ED care is unknown. OBJECTIVE We evaluated the association between health insurance type and self-perceived acuity or access issues among individuals discharged from the ED. DESIGN, PATIENTS This was a cross-sectional analysis of the 2011 National Health Interview Survey. Adults whose last ED visit did not result in hospitalization ( n  = 4,606) were asked structured questions about reasons for seeking ED care. We classified responses as 1) perceived need for immediate evaluation (acuity issues), or 2) barriers to accessing outpatient services (access issues). MAIN MEASURES We analyzed survey-weighted data using multivariable logistic regression models to test the association between health insurance type and reasons for ED visits, while adjusting for sociodemographic characteristics. KEY RESULTS Overall, 65.0 % (95 % CI 63.0–66.9) of adults reported ≥ 1 acuity issue and 78.9 % (95 % CI 77.3–80.5) reported ≥ 1 access issue. Among those who reported no acuity issue leading to the most recent ED visit, 84.2 % reported ≥ 1 access issue. Relative to those with private insurance, adults with Medicaid (OR 1.05; 95 % CI 0.79–1.40) and those with Medicare (OR 0.98; 95 % CI 0.66–1.47) were similarly likely to seek ED care due to an acuity issue. Adults with Medicaid (OR 1.50; 95 % CI 1.06–2.13) and Medicaid + Medicare (dual eligible) (OR 1.94; 95 % CI 1.18–3.19) were more likely than those with private insurance to seek ED care for access issues. CONCLUSION Variability in reasons for seeking ED care among discharged patients by health insurance type may be driven more by lack of access to alternate care, rather than by differences in patient-perceived acuity. Policymakers should focus on increasing access to alternate sites of care, particularly for Medicaid beneficiaries, as well as strategies to increase care coordination that involve ED patients and providers.

IntroductionThe use of emergency services among adolescents and adults with autism spectrum disorder (ASD) transitioning into adult health services has not been well described.ObjectivesTo describe emergency service use including emergency departments (EDs), paramedics, and police involvement among adolescents and adults with ASD and to examine predictors of using emergency services.MethodsCaregivers of 396 adolescents and adults with ASD were recruited through autism advocacy agencies and support programmes in Ontario to complete a survey about their child's health service use. Surveys were completed online, by mail and over the phone between December 2010 and October 2012. Parents were asked to describe their child's emergency service use and provide information about potential predictive factors including predisposing, enabling and clinical need variables.ResultsAccording to parents, 13% of their children with ASD used at least one emergency service in a 2-month period. Sedation or restraints were used 23% of the time. A combination of need and enabling variables predicted emergency service use with previous ED use in the last year (OR 3.4, 95% CI 1.7 to 6.8), a history of hurting others (OR 2.3, 95% 1.2 CI to 4.7) and having no structured daytime activities (OR 3.2, 95% CI 1.4 to 7.0) being the strongest multivariate predictors in the model.ConclusionsPatients with ASD and their families are likely to engage with paramedics or police or visit the ED. Further education and support to families and emergency clinicians are needed to improve and, when possible, prevent such occurrences.

Study design: Cross-sectional survey. Objectives: To investigate annual rates and geographic variation of health care utilization in persons with spinal cord injury (SCI), and to identify factors associated with health care utilization. Setting: Community setting, entire country of Switzerland. Methods: Annual rates of planned and emergency visits to the general practitioner (GP), planned and emergency outpatient clinic visits and in-patient hospitalizations were compared between individuals with chronic SCI, over 16 years of age residing in Switzerland between late 2011 and early 2013 and a population sample (2012) of the Swiss general population. Risk factors for increased health service utilization were identified by means of regression models adjusted for spatial variation. Results: Of 492 participants (86.2% response rate), 94.1% visited a health care provider in the preceding year, with most persons visiting GPs (88.4%) followed by outpatient clinics (53.1%) and in-patient hospitals (35.9%). The increase in utilization as compared with the general population was 1.3-, 4.0- and 2.9-fold for GP, outpatient clinic and in-patient hospital visit, respectively. GP utilization was highest in persons with low income (incidence rate ratio (IRR) 1.85) and old age (IRR 2.62). In the first 2 years post injury, health service visits were 1.7 (GP visits) to 5.8 times (emergency outpatient clinic visits) more likely compared with those later post injury. Conclusions: People with SCI more frequently use health services as compared with the general population, across all types of medical service institutions. GP services were used most often in areas where availability of specialized outpatient clinic services was low.

In this report, investigators from the New Vaccine Surveillance Network, sponsored by the Centers for Disease Control and Prevention, prospectively assessed the pediatric burden of undiagnosed influenza infection in inpatient and outpatient settings. In children presenting with fever or an acute respiratory tract infection, influenza was clinically diagnosed only 28 percent of the time in the inpatient setting and 13 percent of the time in the outpatient setting. In children presenting with fever or an acute respiratory tract infection, influenza was clinically diagnosed only 28 percent of the time in the inpatient setting and 13 percent of the time in the outpatient setting. Influenza virus is an important cause of respiratory illness among children. Modeling studies suggest that children younger than two years of age have high rates of hospitalization attributable to influenza; these rates are similar to rates of hospitalization attributable to influenza among older adults. 1 , 2 However, rates of hospitalization and outpatient visits attributable to laboratory-confirmed influenza infections are not well described. In 1999, the New Vaccine Surveillance Network (NVSN), sponsored by the Centers for Disease Control and Prevention (CDC), began prospective surveillance to determine population-based rates of laboratory-confirmed influenza and to assess the effects of recommendations regarding vaccination. 3 Before 2002, . . .