32 research outputs found
Comparative Effectiveness and Safety of AntiâTumor Necrosis Factor Agents in Biologic-Naive Patients With Crohnâs Disease
Inhibitors of tumor necrosis factor (anti-TNF agents) are the most effective therapy for Crohnâs disease (CD). We evaluated the real-world comparative effectiveness and safety of different anti-TNF agents (infliximab, adalimumab, and certolizumab pegol) in biologic-naĂŻve patients with CD in a retrospective, propensity-matched cohort study using a national administrative claims database (Optum Labs Data Warehouse)
Predictors of Return Visits Among Insured Emergency Department Mental Health and Substance Abuse Patients, 2005-2013
Introduction: Our goal was to describe the pattern and identify risk factors of early-return ED visits or inpatient admissions following an index mental health and substance abuse (MHSA)-related ED visit in the United States. Methods: We performed a retrospective cohort study using Optum Labs Data Warehouse, a nationally representative database containing administrative claims data on privately insured and Medicare Advantage enrollees. Authors identified patients presenting to an ED with a primary diagnosis of MHSA between 2005 and 2013 who were discharged home. Study inclusion required continuous insurance enrollment for the 12 months preceding and the 31 days following the index ED visit. During the study period we included only the first ED visit for each patient. Results: A total of 49,672 (14.2%) had a return visit to the ED or had a hospitalization within 30 days following discharge. Mean time to the next ED visit or inpatient admission was 11.7 days. An increased age (age 65+ vs. age <18 years; OR 1.65, 95% CI [1.57 to 1.74]), chronic medical comorbidities (Hwang comorbidity 5+ vs 0; OR 1.31, 95% CI [1.27 to 1.35]), prior ED and inpatient utilization (4+ visits vs 0 visits; OR 5.59, 95% CI [5.41 to 5.78]) were associated with return visits within 30 days following discharge. Conclusion: In an analysis of nearly 350,000 ED visits for MHSA, 14.2 % of patients returned to the ED or hospital within 30 days. This study identified a number of factors associated with return visits for acute care
Predictors of Return Visits Among Insured Emergency Department Mental Health and Substance Abuse Patients, 2005â2013
Introduction: Our goal was to describe the pattern and identify risk factors of early-return ED visits or inpatient admissions following an index mental health and substance abuse (MHSA)-related ED visit in the United States. Methods: We performed a retrospective cohort study using Optum Labs Data Warehouse, a nationally representative database containing administrative claims data on privately insured and Medicare Advantage enrollees. Authors identified patients presenting to an ED with a primary diagnosis of MHSA between 2005 and 2013 who were discharged home. Study inclusion required continuous insurance enrollment for the 12 months preceding and the 31 days following the index ED visit. During the study period we included only the first ED visit for each patient. Results: A total of 49,672 (14.2%) had a return visit to the ED or had a hospitalization within 30 days following discharge. Mean time to the next ED visit or inpatient admission was 11.7 days. An increased age (age 65+ vs. age <18 years; OR 1.65, 95% CI [1.57 to 1.74]), chronic medical comorbidities (Hwang comorbidity 5+ vs 0; OR 1.31, 95% CI [1.27 to 1.35]), prior ED and inpatient utilization (4+ visits vs 0 visits; OR 5.59, 95% CI [5.41 to 5.78]) were associated with return visits within 30 days following discharge. Conclusion: In an analysis of nearly 350,000 ED visits for MHSA, 14.2 % of patients returned to the ED or hospital within 30 days. This study identified a number of factors associated with return visits for acute care
Utilization of imaging during staging and surveillance of localized colon cancer in a large insured population.
922 Comparative Effectiveness and Safety of Anti-TNF Agents for Crohn's Disease in Biologic-NaĂŻve Patients
923 Comparative Effectiveness and Safety of Infliximab and Adalimumab for Ulcerative Colitis in Biologic-NaĂŻve Patients
Epidemiology of cardiogenic shock and cardiac arrest complicating nonâSTâsegment elevation myocardial infarction: 18âyear US study
Abstract Aims This study aims to evaluate the impact of the combination of cardiogenic shock (CS) and cardiac arrest (CA) complicating nonâSTâsegment elevation myocardial infarction (NSTEMI). Methods and results Adult (>18Â years) NSTEMI admissions using the National Inpatient Sample database (2000 to 2017) were stratified by the presence of CA and/or CS. Outcomes of interest included inâhospital mortality, early coronary angiography, hospitalization costs, and length of stay. Of the 7Â 302Â 447 hospitalizations due to NSTEMI, 147Â 795 (2.0%) had CS only, 155Â 522 (2.1%) had CA only, and 41Â 360 (0.6%) had both CS and CA. Compared with 2000, the adjusted odds ratios (ORs) and 95% confidence interval (CIs) for CS, CA, and both CS and CA in 2017 were 3.75 (3.58â3.92), 1.46 (1.42â1.50), and 4.52 (4.16â4.87), respectively (all PÂ <Â 0.001). The CSÂ +Â CA (61.2%) cohort had higher multiorgan failure than CS (42.3%) and CA only (32.0%) cohorts, PÂ <Â 0.001. The CA only cohort had lower rates of overall (52% vs. 59â60%) and early (17% vs. 18â27%) angiography compared with the other groups (all PÂ <Â 0.001). CSÂ +Â CA admissions had higher inâhospital mortality compared with those with CS alone (aOR 4.12 [95% CI 4.00â4.24]), CA alone (aOR 1.69 [95% CI 1.65â1.74]), or without CS/CA (aOR 22.66 [95% CI 22.06â23.27]). The presence of CS, either alone or with CA, was associated with higher hospitalization costs and longer hospital length of stay. Conclusions The combination of CS and CA is associated with higher rates of acute nonâcardiac organ failure and inâhospital mortality in NSTEMI admissions as compared with those with either CS or CA alone