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BackgroundIntegration of health-related social needs (HRSNs) data into clinical care is recognized as a driver for improving healthcare. However, few published studies on HRSNs and their impact are available. CMS sought to fill this gap through the Accountable Health Communities (AHC) Model, a national RCT of HRSN screening, referral, and navigation. Data from the AHC Model could significantly advance the field of HRSN screening and intervention in the USA.ObjectiveTo present data from the Greater Houston AHC (GH-AHC) Model site on HRSN frequency and the association between HRSNs, sociodemographic factors, and self-reported ED utilization using a cross-sectional design. Analyses included descriptive statistics and multinomial logistic regression.Participants (or Patients or Subjects)All community-dwelling Medicare, Medicaid, or dually covered beneficiaries at participating GH-AHC clinical delivery sites were eligible.Main MeasuresSelf-reported ED utilization in the previous 12 months served as the outcome; demographic characteristics including race, ethnicity, age, sex, income, education level, number of people living in the household, and insurance type were treated as covariates. HRSNs included food insecurity, housing instability, transportation, difficulty paying utility bills, and interpersonal safety. Clinical delivery site type was used as the clustering variable.Key ResultsFood insecurity was the most common HRSN identified (38.7%) followed by housing instability (29.0%), transportation (28.0%), and difficulty paying utility bills (26.7%). Interpersonal safety was excluded due to low prevalence. More than half of the beneficiaries (56.9%) reported at least one of the four HRSNs. After controlling for covariates, having multiple co-occurring HRSNs was strongly associated with increased risk of two or more ED visits (OR 1.8–9.47 for two to four needs, respectively; p < 0.001). Beneficiaries with four needs were at almost 10 times higher risk of frequent ED utilization (p < 0.001).ConclusionsTo our knowledge, this is only the second published study to report screening data from the AHC Model. Future research focused on the impact of multiple co-occurring needs on health outcomes is warranted.

Background Patients diagnosed with cancer are frequent users of the emergency department (ED). While many visits are unavoidable, a significant portion may be potentially preventable ED visits (PPEDs). Cancer treatments have greatly advanced, whereby patients may present with unique toxicities from targeted therapies and are often living longer with advanced disease. Prior work focused on patients undergoing cytotoxic chemotherapy, and often excluded those on supportive care alone. Other contributors to ED visits in oncology, such as patient-level variables, are less well-established. Finally, prior studies focused on ED diagnoses to describe trends and did not evaluate PPEDs. An updated systematic review was completed to focus on PPEDs, novel cancer therapies, and patient-level variables, including those on supportive care alone. Methods Three online databases were used. Included publications were in English, from 2012-2022, with sample sizes of ≥50, and reported predictors of ED presentation or ED diagnoses in oncology. Results 45 studies were included. Six studies highlighted PPEDs with variable definitions. Common reasons for ED visits included pain (66%) or chemotherapy toxicities (69.1%). PPEDs were most frequent amongst breast cancer patients (13.4%) or patients receiving cytotoxic chemotherapy (20%). Three manuscripts included immunotherapy agents, and only one focused on end-of-life patients. Conclusion This updated systematic review highlights variability in oncology ED visits during the last decade. There is limited work on the concept of PPEDs, patient-level variables and patients on supportive care alone. Overall, pain and chemotherapy toxicities remain key drivers of ED visits in cancer patients. Further work is needed in this realm. Patients diagnosed with cancer are frequent users of the emergency department. This review focuses on potentially preventable emergency department visits, novel cancer therapies, and patient-level variables, such as supportive care.

Background The COVID-19 pandemic impacted nearly every aspect of modern society. The medical industry was underprepared for the pandemic-related shifts in emergency department (ED) utilization, which significantly altered healthcare access for millions of Americans, particularly those within socially vulnerable groups. Objective To provide understanding of how the pandemic caused shifts in ED visit severity through the lens of the social determinants of health is critical for better informing healthcare policy decisions when we’re facing the next pandemic or disease-related disaster. Methods A retrospective, observational cohort study spanning 2 years before and after the first COVID-19 case was declared in Tennessee on March 8, 2020. Data from the University of Tennessee Health Science Center’s Research Enterprise Data Warehouse (rEDW) was collected for over 1 million ED visits, each of which was assigned a visit reason by the NYU-EDA. Independent variables included age, race, gender, Charlson Comorbidity Index (CCI), healthcare system, and both community- and individual-level social vulnerability indicators. Patients were considered vulnerable by either a documented Z-code or a CDC Social Vulnerability Index (SVI) below the 10th percentile. Results Our final analysis included 654,232 patients and 1,432,571 ED visits across the pre- and post- periods; 70,698 (11%) were considered socially vulnerable individuals. The average number of visits was 1.95 over two years, compared to 1.64 average visits for individuals in the two years following this date (95% CI = [0.29983, 0.32417]). The steepest decline occurred near the beginning of the pandemic. The difference in means was 0.32 (95% CI: [0.300, 0.324]). The mean ED visit per socially vulnerable patient saw a statistically significant decline after COVID-19 began, where the average visits decreased from 6.84 pre-COVID to 4.96 post-COVID (95% CI = [0.120, 0.180], [1.245, 2.515]). However, vulnerable populations had the highest average visits both before and after the pandemic’s onset. Conclusions By quantifying ED utilization during the 2-year period before and after the pandemic, we revealed significant shifts in visit frequency and severity across different demographics and social vulnerability groups.

Introduction Prolonged Length of Stay (LOS) in ED (Emergency Department) has been associated with poor clinical outcomes. Prediction of ED LOS may help optimize resource utilization, clinical management, and benchmarking. This study aims to systematically review models for predicting ED LOS and to assess the reporting and methodological quality about these models. Methods The online database PubMed, Scopus, and Web of Science (10 Sep 2023) was searched for English language articles that reported prediction models of LOS in ED. Identified titles and abstracts were independently screened by two reviewers. All original papers describing either development (with or without internal validation) or external validation of a prediction model for LOS in ED were included. Results Of 12,193 uniquely identified articles, 34 studies were included (29 describe the development of new models and five describe the validation of existing models). Different statistical and machine learning methods were applied to the papers. On the 39-point reporting score and 11-point methodological quality score, the highest reporting scores for development and validation studies were 39 and 8, respectively. Conclusion Various studies on prediction models for ED LOS were published but they are fairly heterogeneous and suffer from methodological and reporting issues. Model development studies were associated with a poor to a fair level of methodological quality in terms of the predictor selection approach, the sample size, reproducibility of the results, missing imputation technique, and avoiding dichotomizing continuous variables. Moreover, it is recommended that future investigators use the confirmed checklist to improve the quality of reporting.

BackgroundShopping for health insurance is encouraged as a way to find the most affordable coverage that best meets an enrollee’s needs. However, the extent to which individuals switch insurance and subsequent changes in health care utilization that might arise, particularly new physician visits, are not well understood.ObjectiveTo examine the relationship between insurance switching and new physician and emergency department visits around the time of a switch.DesignObservational study using a difference-in-differences design to compare those switching insurance carriers with propensity score-matched controls who did not switch, stratified based on whether individuals initially had private or Medicaid insurance coverage. All analyses adjusted for individual and insurance characteristics.ParticipantsContinuously insured, non-elderly individuals with private or Medicaid insurance coverage in Massachusetts from 2010 to 2013.Main MeasuresRates of new primary care and specialist physician visits, as well as rates of emergency department visits.Key ResultsBefore matching, among 1,628,057 continuously insured individuals, 418,231 (26%) switched insurance carriers during a 2-year period. Characteristics of switchers and non-switchers were similar after matching (n = 316,343 in each group). After matching, switching plans was associated with a 203% and 47.5% increase in the rate of new primary care physician visits following switching for those initially with Medicaid or private coverage, respectively (both p < 0.001), with a large short-term increase, diminishing over time. Among those with Medicaid coverage, switching was associated with a 14.9% higher rate of ED visits during the month of switching (p < 0.001), but otherwise decreased modestly after switching.ConclusionsInsurance switching is common, and is associated with increased new physician visits and temporarily increased ED use among the publicly insured. As insurance markets become more volatile in the current policy environment, understanding changes in utilization after insurance switching may become increasingly important.

Background Patients with persistently high emergency department (ED) utilization (10 + visits in two consecutive years) represent a unique and complex population. We sought to understand drivers of persistently high ED use among individuals with substance use disorders (SUD) to optimize care delivery and improve health for this population. Methods This mixed-methods study examines healthcare utilization and decision-making among patients in an opioid treatment program with a co-located primary care clinic within one mile of the ED in a Mid-Atlantic urban academic health system. Quantitative data were extracted from health records to assess utilization, comorbidities, and health-related social needs. Semi-structured interviews were conducted with a subset of 12 patients and thematic analyses explored motivations for ED use. Results Among 454 identified patients, 19 met criteria for persistently high ED use with a mean of 23 ED visits and average $35,677 ED charges per patient. Cohort patients had multiple chronic conditions and unmet social needs: 63% had cardiovascular disease; 74% had hepatitis C; 84% had non-psychotic mental illness, and > 50% experienced financial and housing insecurity or social isolation. Qualitative analysis identified key factors influencing ED use, including perceived illness severity, convenience, interpersonal interactions with healthcare providers, the impact of SUD, and unmet social needs. Most patients preferred outpatient care for routine health management, yet described barriers to this care, including limited access and unfamiliarity with available services. Patients experienced stigma in hospital settings, yet they viewed the ED as the most logical option for their care needs. Conclusion Patients with SUD and persistently high ED utilization often seek emergency care due to a perceived need for immediate access to complex interventions, reflecting similar motivations to those of the broader ED patient population. Despite primary care engagement, patients face intersecting medical, behavioral, mental health, and social challenges that interfere with managing complex chronic conditions and influence healthcare-seeking behaviors. Our findings can inform quality improvement efforts to strengthen care for similar populations, such as removing barriers to outpatient services and addressing SUD stigma. Policy and system-level interventions targeting structural determinants—such as healthcare models, payment structures, social isolation, and poverty—are needed to better support this population.

Background Telemedicine has expanded healthcare accessibility, particularly during the COVID-19 pandemic. However, evidence regarding its economic efficiency and clinical quality remains inconclusive, with some studies suggesting increased costs, service utilization, and inappropriate antibiotic prescribing compared to traditional care modalities. Objective This study evaluated pediatric telemedicine services across three dimensions: clinical outcomes (antibiotic prescribing patterns), resource utilization implications (healthcare utilization and emergency department visits), and equity considerations (sociodemographic distribution of services). Methods We conducted a retrospective cohort study analysis of 1,500 children under 19 years within Israel’s Clalit Health Services (Shron-Shomron District) from January 2021 to January 2022. Participants were randomly sampled from three groups based on their telemedicine utilization patterns: in-person primary care physician (PCP) visits only ( n  = 500); PCP plus phone/video telemedicine ( n  = 500); and PCP plus phone/video plus Tyto device telemedicine ( n  = 500). These children were classified as discrete groups, not only as solitary visits. We assessed emergency department (ED) admission rates, antibiotic prescription frequencies for common pediatric conditions, and sociodemographic characteristics across the groups. Results Analysis of 21,968 visits revealed striking socioeconomic disparities in telemedicine utilization. While 58.1% of all participants had high socioeconomic status (SES), this increased to 68.6% among Tyto device users. Conversely, low-SES patients comprised 26.4% of in-person-only visits but only 3% of Tyto users. ED admission rates for all groups combined were 4.0%, 1.6% for the “PCP only” group, 5.4% for the “PCP + phone/video” group (12% after phone/video visits), and 3.6% for the “PCP + phone/video + Tyto” group (4.1% after Tyto only). Antibiotic prescribing rates were similarly divergent: mean rates of antibiotic prescriptions after PCP visits were 10.3%, after telephone/video visits were 16.8%, and after Tyto visits were 21.4% ( p  < 0.001). Multivariable analysis confirmed those findings and demonstrated higher ED utilization and antibiotic prescribing among low-SES patients and those in remote locations, independent of visit type. Conclusions Our findings challenge prevailing assumptions about telemedicine benefits, revealing unexpected associations between telemedicine services and higher ED utilization and antibiotic prescribing compared to traditional care, particularly among vulnerable populations. These associations may reflect complex interactions between patient characteristics, provider behavior, and care modalities that warrant further investigation. Healthcare systems should reconsider the implementation of telemedicine services to ensure they deliver on promises of expanded access while maintaining quality, appropriate resource utilization, and equitable distribution of benefits across socioeconomic groups. Clinical trial number Not applicable.

Background Emergency Departments (EDs) worldwide are increasingly utilized for potentially non-urgent cases, imposing substantial clinical and economic burdens. In Israel, there is limited nationwide data evaluating the scope and predictors of potentially non-urgent ED utilization. This study aimed to evaluate the extent and associated determinants of potentially non-urgent ED visits in Israel. Methods This nationwide, retrospective multi-center study analyzed 2,843,190 ED visits recorded between January 2018 and April 2022, from all general hospitals operated by Clalit Health Services and one additional public hospital (Assuta Ashdod Public Hospital), which together serve patients insured by all four Health Maintenance Organizations (HMOs) in Israel, and included only treat-and-release ED visits that did not result in inpatient admission or in-ED death. Visits were classified as urgent or potentially non-urgent using a validated multi-parameter classification algorithm. Multivariable logistic regression and Generalized Estimating Equation (GEE) models were applied to identify factors associated with potentially non-urgent visits and to account for repeated visits by the same patients. Results Among treat-and-release ED visits (discharged without inpatient admission or in-ED death), 49.4% were classified as potentially non-urgent. Younger age, female gender, self-referral, shorter visit duration, non-specific presenting complaints, and diagnoses in categories such as musculoskeletal disorders, dermatologic conditions were significantly associated with potentially non-urgent visits. The model showed good discriminatory ability (AUC = 0.79), and GEE analysis confirmed these associations remained robust across repeated visits. Conclusions Nearly half of treat-and-release ED visits (discharged without inpatient admission or in-ED death) in our sample were classified as potentially non-urgent and might be managed in community or other more cost-effective care settings. A multifaceted approach is required, including strengthening primary care services, improving triage processes, enhancing public education, and using classification and predictive models mainly for planning and evaluation to optimize ED utilization and resource allocation.

This study aimed to investigate the patterns of pediatric patients visiting emergency departments (EDs) before and after the COVID-19 pandemic and evaluate the interactive effect between the COVID-19 outbreak and age groups. We performed a cross-sectional study using the nationwide emergency patient database in Korea from January 2019 to December 2020. Pediatric patients (≤18 years) who visited all 402 nationwide EDs were included. The age- and sex-standardized incidence rates of pediatric ED visits per 1,000,000 person-days were calculated, and the incidence rate ratio (IRR) was calculated. The adjusted odds ratio (aOR) and 95% confidence interval (CI) of in-hospital mortality were calculated by a multivariable logistic regression. Among 2,808,756 patients, 1,835,045 (65.3%) patients visited before COVID-19, and 973,711 (34.7%) patients visited after the COVID-19 period. The standardized incidence rates of ED visits per 1,000,000 person-days were 589.3 in the before COVID-19 group and 326.9 in the after COVID-19 group (IRR (95% CI): 0.55 (0.53–0.58)). By diagnosis, the IRRs (95% CI) of mental health disorders (0.84 (0.42–1.65)) and self-harm or suicidal attempts (0.99 (0.38–2.59) were not significant, while the incidence rate of infectious disease was significantly decreased (0.48 (0.42–0.54)). The aOR (95% CI) of in-hospital mortality after COVID-19 was 1.58 (1.44–1.73) compared to that before COVID-19. During the COVID-19 pandemic, the incidence of pediatric ED visits decreased, and these effects differed by age group. Age-specific policies are needed to ensure that children receive the care they need at the right time. •During the COVID-19 outbreak, the incidence rates of pediatric patients who visited EDs decreased.•The proportions of ED visits for mental health diseases and self-harm or suicide attempts in the 13–18-year-old group increased.•The number of ED visits for violence or assault among infants also increased.

Background The use of patient-reported outcomes (PROs) for routine cancer distress screening is endorsed globally as a quality-care standard. However, there is little research on the integration of PROs in “real-world” oncology practices using implementation science methods. The Improving Patient Experience and Health Outcome Collaborative (iPEHOC) intervention was established at multisite disease clinics to facilitate the use of PRO data by clinicians for precision symptom care. The aim of this study was to examine if patients exposed to the intervention differed in their healthcare utilization compared with contemporaneous controls in the same time frame. Methods We used a PRE- and DURING-intervention population cohort comparison study design to estimate the effects of the iPEHOC intervention on the difference in difference (DID) for relative rates (RR) for emergency department (ED) visits, hospitalizations, psychosocial oncology (PSO), palliative care visits, and prescription rates for opioids and antidepressants compared with controls. Results A small significantly lower Difference in Difference (DID) (− 0.223) in the RR for ED visits was noted for the intervention compared with controls over time (0.947, CI 0.900–0.996); and a DID (− 0.0329) for patients meeting ESAS symptom thresholds (0.927, CI 0.869–0.990). A lower DID in palliative care visits (− 0.0097), psychosocial oncology visits (− 0.0248), antidepressant prescriptions (− 0.0260) and an increase in opioid prescriptions (0.0456) in the exposed population compared with controls was also noted. A similar pattern was shown for ESAS as a secondary exposure variable. Conclusion Facilitating uptake of PROs data may impact healthcare utilization but requires examination in larger scale “real-world” trials.