Health care resource utilization in adults with congenital heart disease
Female; Humans; Male; Adult; Aged; Middle Aged; Length of Stay; Outcome Assessment (Health Care); Severity of Illness Index; Emergency Service; adolescent; Hospital/utilization; Adolescent Transitions; Patient Acceptance of Health Care/statistics & numerical data; Hospitalization/statistics & numerical data; Heart Defects; Age Distribution; Databases; Factual; Ambulatory Care/utilization; Congenital/epidemiology/etiology/pathology/therapy; Health Resources/utilization; Quebec/epidemiology
The number of adults with congenital heart disease (CHD) is increasing. However, rates of health care resource utilization in this population are unknown. The objectives of this study were to describe the use of general health care resources in adults with CHD and to examine the impact of CHD severity on resource utilization. The study consisted of adults alive in 1996 who had > or = 1 diagnosis of a CHD lesion conforming to the International Classification of Disease, Ninth Revision, in the physician's claims database of the province of Quebec from 1983 to 2000. From 1996 to 2000, rates of health care utilization were measured. The impact of the severity of CHD on the use of health care resources was determined using multivariate models to adjust for age, gender, Charlson co-morbidity score, and duration of follow-up. The study population consisted of 22,096 adults with CHD (42% men). From 1996 to 2000, 87% received outpatient care from specialists, 68% visited emergency rooms, 51% were hospitalized, and 16% were admitted to critical care units. Patients with severe CHD had higher adjusted rates of outpatient cardiologist care (rate ratio [RR] 2.24, 95% confidence interval [CI] 2.06 to 2.45), emergency department utilization (RR 1.09, 95% CI 1.03 to 1.17), hospitalization (RR 1.30, 95% CI 1.19 to 1.43), and days in critical care (RR 2.12, 95% CI 1.80 to 2.50) than patients with other congenital cardiac lesions. Hospitalization rates were higher than in the general Quebec adult population (RR 2.08, 95% CI 2.00 to 2.17). In conclusion, adults with CHD have high rates of health care resource utilization, particularly those with severe lesions. Appropriate resource allocation is required to serve this growing population.
2007
Mackie AS; Pilote L; Ionescu-Ittu R; Rahme E; Marelli AJ
The American Journal Of Cardiology
2007
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Journal Article
<a href="http://doi.org/10.1016/j.amjcard.2006.10.054" target="_blank" rel="noreferrer">10.1016/j.amjcard.2006.10.054</a>
Resource utilization and outcome in gravely ill intensive care unit patients with predicted in-hospital mortality rates of 95% or higher by APACHE III scores: the relationship with physician and family expectations
Female; Humans; Male; Cohort Studies; Adult; Hospital Mortality; Aged; Middle Aged; Professional-Family Relations; Minnesota; Outcome Assessment (Health Care); Intensive Care; Medical Records; adolescent; 80 and over; Family/psychology; APACHE; Physicians/psychology; Health Resources/utilization; Critical Illness/mortality/therapy
OBJECTIVE: To assess resource utilization and outcome in gravely ill patients admitted to an intensive care unit (ICU) and the potential association with health care workers' and family members' expectations. PATIENTS AND METHODS: We retrospectively evaluated ICU patients with a predicted in-hospital mortality rate of 95% or higher (PM95) using the Acute Physiology and Chronic Health Evaluation III (APACHE III) on 2 consecutive days. All patients were admitted to a single institution between September 30, 1994, and August 9, 2001. RESULTS: The APACHE III database contained data from 38,165 ICU patients during the study interval. Of these, 248 (0.65% of ICU admissions) achieved PM95 status and were included in the study. Between PM95 and hospital discharge, resource utilization (eg, blood transfusion, hemodialysis, surgery, and computed tomography or magnetic resonance imaging) was extensive. A total of 23% of patients survived to hospital discharge, yet all but 1 were moderately or severely disabled. One year after achieving PM95, 10% (95% confidence interval, 7%-15%) of patients were alive. For 229 patients, the medical records contained physician documentation that indicated a likely fatal outcome. Thirty-six of these medical records documented unrealistic family expectations of a good outcome. The latter finding correlated with increased resource utilization without significant improvement in 1-year survival. In contrast, absence of physician documentation of a likely fatal outcome In 19 patients correlated with an improved likelihood of hospital (74%) and 1-year (47%) survival. CONCLUSION: Despite better-than-predicted survival outcomes, patient functionality and 1-year survival were poor. Unrealistic family expectations were associated with increased resource utilization without significant survival benefit, whereas absence of physician documentation of likely impending death (which correlated with improved survival) may denote the prognostication skills of experienced clinicians.
2005
Berge KH; Maiers DR; Schreiner DP; Jewell SM; Bechtle PS; Schroeder DR; Stevens SR; Lanier WL
Mayo Clinic Proceedings
2005
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.4065/80.2.166" target="_blank" rel="noreferrer">10.4065/80.2.166</a>
Continuity of care: influence of general practitioners' knowledge about their patients on use of resources in consultations.
Child; Cross-Sectional Studies; Female; Humans; Male; Adult; Aged; Middle Aged; Physicians; Time Factors; adolescent; Preschool; infant; referral and consultation; Norway; Continuity of Patient Care; Drug Prescriptions; Family/psychology; Health Resources/utilization; Physician-Patient Relations
OBJECTIVE--To examine the relation between general practitioners' knowledge about their patients and the use of resources in consultations. DESIGN--A cross sectional evaluation of consultations. SETTING AND SUBJECTS--A representative sample of 133 Norwegian general practitioners were each asked to record 30 consecutive consultations. 131 did so, and of 3990 possible registrations, 3918 (98%) were evaluated. MAIN OUTCOME MEASURES--The influence, as assessed by the doctor, of accumulated knowledge on the use of laboratory tests, expectant management, prescriptions, sickness certification, referrals, and time spent in the consultation. RESULTS--Accumulated knowledge was a substantial factor in saving time, especially in consultations with children, the elderly, patients with psychosocial problems, and those with chronic diseases. It also influenced the overall use of laboratory tests, expectant management, sickness certification, and referrals, and to a lesser degree the use of medication. CONCLUSION--The findings imply strong but complex associations between accumulated knowledge and the use of resources in the consultation.
1991
Hjortdahl P; Borchgrevink CF
British Medical Journal
1991
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1136/bmj.303.6811.1181" target="_blank" rel="noreferrer">10.1136/bmj.303.6811.1181</a>