Telehealth Expansion and Medicare Beneficiaries’ Care Quality and Access

JAMA Network Open, Journal Year: 2024, Volume and Issue: 7(5), P. e2411006 - e2411006

Published: May 13, 2024

Importance Understanding the association of telehealth use with health care outcomes is fundamental to determining whether waivers implemented during COVID-19 public emergency should be made permanent. The current literature has yielded inconclusive findings owing its focus on select states, practices, or systems. Objective To estimate for all Medicare fee-for-service (FFS) beneficiaries by comparing hospital service areas (HSAs) different levels use. Design, Setting, and Participants This US population-based, retrospective cohort study was conducted from July 2022 April 2023. included claims attributed HSAs FFS enrollment in Parts A B. Exposures Low, medium, high tercile created ranking according number visits per 1000 beneficiaries. Main Outcomes Measures primary were quality (ambulatory care–sensitive [ACS] hospitalizations department [ED] beneficiaries), access (clinician encounters beneficiary), cost (total Part and/or B services beneficiary) determined a difference-in-difference analysis. Results In this approximately 30 million (mean [SD] age 2019, 71.04 [1.67] years; mean percentage female 53.83% [2.14%]) within 3436 HSAs, between second half 2019 2021, ACS ED declined sharply, clinician beneficiary slightly, total semester increased slightly. Compared low group, group had more (1.63 additional beneficiaries; 95% CI, 1.03-2.22 hospitalizations), (0.30 semester; 0.23-0.38 encounters), higher ($164.99 $101.03-$228.96). There no statistically significant difference groups. Conclusions Relevance across associated encounters, hospitalizations, costs. cases still period study, which suggests that these partially reflect capacity providing intensity than other HSAs.

Language: Английский

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Frequency and Type of Outpatient Visits for Patients With Cardiovascular Ambulatory‐Care Sensitive Conditions During the COVID‐19 Pandemic and Subsequent Outcomes: A Retrospective Cohort Study

Journal of the American Heart Association, Journal Year: 2023, Volume and Issue: 12(3)

Published: Feb. 3, 2023

Background Because the impact of changes in how outpatient care was delivered during COVID‐19 pandemic is uncertain, we designed this study to examine frequency and type visits between March 1, 2019 February 29, 2020 (prepandemic) from 28, 2021 (pandemic) specifically compared outcomes after virtual versus in‐person pandemic. Methods Results Population‐based retrospective cohort all 3.8 million adults Alberta, Canada. We examined physician 30‐ 90‐day outcomes, with a focus on those cardiovascular ambulatory‐care sensitive conditions heart failure, hypertension, diabetes. Our primary outcome emergency department visit or hospitalization, evaluated using survival analysis accounting for competing risk death. Although decreased by 38.9% year (10 142 184 16 592 599 prior year), introduction (7 152 147; 41.4% total) meant that total increased 4.1% first Albertan adults. Outpatient (albeit virtual, 58.6% in‐person) prescribing patterns were stable onset patients examined, but laboratory test declined 20% (serum creatinine) 47% (glycosylated hemoglobin). In pandemic, associated fewer subsequent hospitalizations (compared visits) failure (adjusted hazard ratio [aHR], 0.90 [95% CI, 0.85–0.96] at 30 days 0.96 0.92–1.00] 90 days), hypertension (aHR, 0.88 0.85–0.91] 0.93 0.91–0.95] diabetes 0.87–0.93] days). Conclusions The adoption rapid uptake did not negatively follow‐up, prescribing, short‐term could have potentially positively impacted some these diabetes, setting where there an active reimbursement policy visits. Given declines monitoring screening activities, further research needed evaluate whether long‐term will differ.

Language: Английский

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Socioeconomically Disadvantaged Groups May Have Underused The Emergency Department For Nonavoidable Visits, 2018–22

Health Affairs, Journal Year: 2025, Volume and Issue: 44(3), P. 322 - 332

Published: March 1, 2025

In the decades preceding COVID-19 pandemic, emergency department (ED) use increased more rapidly for socioeconomically disadvantaged patients than advantaged patients, often because of barriers to accessing office-based care. However, it remains unknown whether pandemic has had durable effects on socioeconomic disparities in ED use. We conducted a retrospective cohort study visits US, using multipayer claims data. used difference-in-differences approach compare visit rates between March 2020 and August 2022 with from same months 2018-19. Among 15.6 million visits, potentially avoidable persistently declined all insured populations during period. Potentially nonavoidable also early but rebounded 95 percent expected rates. stratifying by insurance revealed that this rebound occurred among commercially Medicare fee-for-service patients; only returned about 75 Medicaid dual-eligible patients. Although suggests beneficial reduction use, indicates simultaneous emergence disparity wherein groups may be underusing higher-acuity illness.

Language: Английский

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Healthcare utilization trends in adults with asthma or COPD during the first year of COVID-19 pandemic in comparison to pre-pandemic: A population-based study

PLoS ONE, Journal Year: 2025, Volume and Issue: 20(3), P. e0316553 - e0316553

Published: March 6, 2025

To assess how changes in outpatient services during the first year of COVID-19 pandemic were related to acute healthcare use (emergency department or hospitalizations) for individuals with asthma chronic obstructive pulmonary disease (COPD). We conducted an observational study using health administrative data Ontario (Canada) from January 2016 March 2021 on all adults diagnosed COPD. used monthly time series auto-regressive integrated moving-average (ARIMA) and pre-pandemic rates (January February 2020) calculate projected (i.e., a had not occurred) (March 2020 2021), Quasi-Poisson models two-way interaction estimate crude adjusted rate ratios. In year, COPD, visit started lower than (Mar-May 2020), returned middle (Jun-Aug then rose higher between Sep Mar 2021: observed 80,293 per 100,000 persons vs. 74,192 (95% CI: 68,926-79,868) asthma, 92,651 85,871 79,975-92,207) Acute care remained below year. While function test (PFT) both populations, decrease visits pandemic, compared pre-pandemic, was noted months highest PFT (interaction p-values < 0.0001). Despite COPD being ambulatory-care sensitive conditions, beginning associated increased use. Lower rates, suggesting that access is likely important

Language: Английский

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Preparedness for care transitions to home and acute care use of skilled nursing facility patients

BMC Geriatrics, Journal Year: 2025, Volume and Issue: 25(1)

Published: March 11, 2025

The purpose of this study was two-fold: (1) describe the relationship between patient or caregiver reported preparedness for care transitions, and acute use in 30 days after discharge from a skilled nursing facility (SNF); (2) explore how is influenced by patient, Charlson index, race social determinants. design secondary analysis data collected as part cluster randomized trial Connect-Home transitional intervention. setting 6 facilities located US state North Carolina. sample 249 dyads with (i.e., emergency department hospital readmission) transfers SNFs to home. Preparedness transitions measured Care Transitions Measure-15 (CTM-15), 15 item Likert scaled measure scores potentially ranging 0 100, higher indicating better preparedness. association use, overall within subgroups defined five selected dyad background characteristics, quantified an incident rate ratio corresponding multiplicative change mean number 10 unit increase CTM-15 score, using marginalized zero-inflated negative binomial regression. Patients had age 76.4 years, 63.8% were female, 73.6% White. Caregivers female (73.6%) adult children (42.3%). score 72.9 SNF 0.62. For among male patients decreased 33% (IRR = 0.67; 95%CI: 0.44, 0.99); White 25% reduction 0.75; 0.55, 1.02), low area deprivation (lower quartile, ADI 54) 31% 0.69; 0.47, 1.01), high total (upper quartile 9) have 22% 0.78; 0.61, 1.02). important outcome high-quality associated reduced further care. More research necessary evaluate sociodemographic subgroups.

Language: Английский

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Effects of a Standardized Community Health Worker Intervention on Health Care Utilization Within an Integrated Delivery System

Journal of General Internal Medicine, Journal Year: 2025, Volume and Issue: unknown

Published: April 11, 2025

Language: Английский

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Outcomes Among Patients Hospitalized With Non–COVID-19 Conditions Before and During the COVID-19 Pandemic in Alberta and Ontario, Canada

JAMA Network Open, Journal Year: 2023, Volume and Issue: 6(7), P. e2323035 - e2323035

Published: July 12, 2023

The association of inpatient COVID-19 caseloads with outcomes in patients hospitalized non-COVID-19 conditions is unclear.To determine whether 30-day mortality and length stay (LOS) for medical differed (1) before during the pandemic (2) across caseloads.This retrospective cohort study compared patient hospitalizations between April 1, 2018, September 30, 2019 (prepandemic), vs 2020, 2021 (during pandemic), 235 acute care hospitals Alberta Ontario, Canada. All adults heart failure (HF), chronic obstructive pulmonary disease (COPD) or asthma, urinary tract infection urosepsis, coronary syndrome, stroke were included.The monthly surge index each hospital from 2020 through was used as a measure caseload relative to baseline bed capacity.The primary outcome all-cause after admission 5 selected measured by hierarchical multivariable regression models. Length secondary outcome.Between 2018 2019, 132 240 (mean [SD] age, 71.8 [14.8] years; 61 493 female [46.5%] 70 747 male [53.5%]) their most responsible diagnosis 115 225 71.9 [14.7] years, 52 058 [45.2%] 63 167 [54.8%]) (114 414 [99.3%] whom had negative SARS-CoV-2 test results). Patients admitted any concomitant exhibited much longer LOS [SD], 8.6 [7.1] days median 6 [range, 1-22 days]) greater (varying diagnoses, but mean absolute increase at 30 4.7% [3.1%]) than those without coinfection. similar LOSs pandemic, only HF (adjusted odds ratio [AOR], 1.16; 95% CI, 1.09-1.24) COPD asthma (AOR, 1.41; 1.30-1.53) higher risk-adjusted pandemic. As experienced surges, remained stable COVID-19. Once capacity reached above 99th percentile, patients' AOR 1.80 (95% 1.24-2.61) when below 75th percentile.This found that surges caseloads, rates significantly However, results (except asthma) even suggesting resiliency event regional hospital-specific occupancy strains.

Language: Английский

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Missing Care: the Initial Impact of the COVID-19 Pandemic on CKD Care Delivery

Journal of General Internal Medicine, Journal Year: 2022, Volume and Issue: 37(16), P. 4241 - 4247

Published: Sept. 26, 2022

Chronic kidney disease (CKD) is a common condition with adverse health outcomes addressable by early management. The impact of the COVID-19 pandemic on care utilization for CKD population unknown.

Language: Английский

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Trends in inequalities in avoidable hospitalisations across the COVID-19 pandemic: a cohort study of 23.5 million people in England

BMJ Open, Journal Year: 2024, Volume and Issue: 14(1), P. e077948 - e077948

Published: Jan. 1, 2024

To determine whether periods of disruption were associated with increased 'avoidable' hospital admissions and wider social inequalities in England.

Language: Английский

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Respiratory pathogen and clinical features of hospitalized patients in acute exacerbation of chronic obstructive pulmonary disease after COVID 19 pandemic

Scientific Reports, Journal Year: 2024, Volume and Issue: 14(1)

Published: May 7, 2024

Respiratory infections are common causes of acute exacerbation chronic obstructive lung disease (AECOPD). We explored whether the pathogens causing AECOPD and clinical features changed from before to after coronavirus 2019 (COVID-19) outbreak. reviewed medical records patients hospitalized with at four university hospitals between January 2017 December 2018 2021 December. evaluated 1180 for whom medication histories were available. After outbreak, number was almost 44% lower compared Patients outbreak younger (75 vs. 77 years, p = 0.003) more often stayed home (96.6% 88.6%, < 0.001) than Hospital stay longer (10 8 days. 0.001). COVID-19 identification rates S. pneumoniae (15.3 6.2%, Hemophilus influenzae (6.4 2.4%, 0.002) decreased, whereas P. aeruginosa (9.4 13.7%, 0.023), Klebsiella (5.3 9.8%, 0.004), methicillin-resistant Staphylococcus aureus (1.0 2.8%, 0.023) increased. rate influenza A decreased (10.4 1.0%, 0.023). community-transmitted tended decrease, capable colonization increase. During period large-scale viral outbreaks that require quarantine, might be given consideration treatment against strains can colonize respiratory rather community acquired pathogens.

Language: Английский

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