The relationship between utilization of mobile health technology and in-person care
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ABSTRACT:
SUBMITTER: Glass J
PROVIDER: S-EPMC4347459 | biostudies-literature | 2015 Jan
REPOSITORIES: biostudies-literature
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Project description:ObjectiveTo explore the relationship between commercial health care prices and Medicare spending/utilization across U.S. regions.Data sourcesClaims from large employers and Medicare Parts A/B/D over 2007-2009.Study designWe compared prices paid by commercial health plans to Medicare spending and utilization, adjusted for beneficiary health and the cost of care, across 301 hospital referral regions.Principal findingsA 10 percent lower commercial price (around the average level) is associated with 3.0 percent higher Medicare spending per member per year, and 4.3 percent more specialist visits (p < .01).ConclusionsCommercial health care prices are negatively associated with Medicare spending across regions. Providers may respond to low commercial prices by shifting service volume into Medicare. Further investigation is needed to establish causality.
| S-EPMC4450935 | biostudies-literature
Project description:BackgroundCritical care patients with delirium are at an increased risk of functional decline and mortality long term.ObjectiveTo determine the relationship between delirium severity in the intensive care unit and mortality and acute health care utilization within 2 years after hospital discharge.MethodsA secondary data analysis of the Pharmacological Management of Delirium and Deprescribe randomized controlled trials. Patients were assessed twice daily for delirium or coma using the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Delirium severity was measured using the CAM-ICU-7. Mean delirium severity (from time of randomization to discharge) was categorized as rapidly resolving, mild to moderate, or severe. Cox proportional hazards regression was used to model time to death, first emergency department visit, and rehospitalization. Analyses were adjusted for age, sex, race, Charlson Comorbidity Index, Acute Physiology and Chronic Health Evaluation II score, discharge location, diagnosis, and intensive care unit type.ResultsOf 434 patients, those with severe delirium had higher mortality risk than those with rapidly resolving delirium (hazard ratio 2.21; 95% CI, 1.35-3.61). Those with 5 or more days of delirium or coma had higher mortality risk than those with less than 5 days (hazard ratio 1.52; 95% CI, 1.07-2.17). Delirium severity and number of days of delirium or coma were not associated with time to emergency department visits and rehospitalizations.ConclusionIncreased delirium severity and days of delirium or coma are associated with higher mortality risk 2 years after discharge.
| S-EPMC7891863 | biostudies-literature
Project description:ImportanceTelemedicine is an increasingly used yet understudied vehicle to deliver pediatric primary care. Evidence detailing downstream health care utilization after telemedicine visits is needed.ObjectiveTo compare pediatric primary care conducted via telemedicine (video or telephone) with in-person office visits with regard to physician medication prescribing and imaging and laboratory ordering and downstream follow-up office visits, emergency department (ED) visits, and hospitalizations.Design, setting, and participantsThis cohort study included all patients younger than 18 years who had scheduled primary care appointments with a pediatrician from January 1 to December 31, 2022, in the Kaiser Permanente Northern California health system, a large integrated health care delivery system offering in-person office visits, video visits, or telephone visits for pediatric primary care.ExposurePediatric primary care in-person visit, telephone visit, or video visit.Main outcome and measuresRates of physician medication prescribing and imaging and laboratory ordering during an index telemedicine or office visit and rates of in-person office visits, ED visits, and hospitalizations within 7 days after the visit, adjusted for patient and clinical characteristics.ResultsOf 782 596 total appointments (51.1% male) among 438 638 patients, telemedicine was used for 332 153 visits (42.4%). After adjustment, there was more medication prescribing for in-person visits (39.8%) compared with video visits (29.5%; adjusted difference, -10.3%; 95% CI, -10.6% to -10.0%) or telephone visits (27.3%; adjusted difference, -12.5%; 95% CI, -12.5% to -12.7%). There was also more laboratory ordering for in-person visits (24.6%) compared with video visits (7.8%; adjusted difference, -16.8%; 95% CI, -17.0% to -16.6%) or telephone visits (8.5%; adjusted difference, -16.2%; 95% CI, -16.3% to -16.0%). There was more imaging ordering for in-person visits (8.5%) compared with video visits (4.0%; adjusted difference, -4.5%; 95% CI, -4.6% to -4.4%) and telephone visits (3.5%; adjusted difference, -5.0%; 95% CI, -5.1% to -4.9%). After adjustment, fewer in-person follow up visits occurred for index visits that were in-person (4.3%) compared with video (14.4%; adjusted difference, 10.1%; 95% CI, 9.9%-10.3%) or telephone (15.1%; adjusted difference, 10.8%; 95% CI, 10.7%-11.0%) visits. The rate of ED visits following an in-person visit was slightly lower (1.75%) compared with after video visits (2.04%; adjusted difference, 0.29%; 95% CI, 0.21%-0.38%) or telephone visits (2.00%; adjusted difference, 0.25%; 95% CI, 0.18%-0.33%). There was no statistically significant difference in the 7-day rate of hospitalizations.Conclusions and relevanceIn this cohort study, telephone and video visits for pediatric primary care were associated with less prescribing and ordering than in-person visits. Telemedicine visits were associated with modestly higher rates of subsequent in-person visits and slightly higher rates of ED visits, and there was no difference in hospitalizations. Telemedicine appears to be a useful vehicle for health care delivery in the pediatric population, although it is not a universal substitute for in-person visits.
| S-EPMC11584922 | biostudies-literature
Project description:BackgroundThe collaborative care model (CoCM) is a well-established system of behavioral health care in primary care settings. There is potential for digital and mobile technology to augment the CoCM to improve access, scalability, efficiency, and clinical outcomes.ObjectiveThis study aims to conduct a scoping review to synthesize the evidence available on digital and mobile health technology in collaborative care settings.MethodsThis review included cohort and experimental studies of digital and mobile technologies used to augment the CoCM. Studies examining primary care without collaborative care were excluded. A literature search was conducted using 4 electronic databases (MEDLINE, Embase, Web of Science, and Google Scholar). The search results were screened in 2 stages (title and abstract screening, followed by full-text review) by 2 reviewers.ResultsA total of 3982 nonduplicate reports were identified, of which 20 (0.5%) were included in the analysis. Most studies used a combination of novel technologies. The range of digital and mobile health technologies used included mobile apps, websites, web-based platforms, telephone-based interactive voice recordings, and mobile sensor data. None of the identified studies used social media or wearable devices. Studies that measured patient and provider satisfaction reported positive results, although some types of interventions increased provider workload, and engagement was variable. In studies where clinical outcomes were measured (7/20, 35%), there were no differences between groups, or the differences were modest.ConclusionsThe use of digital and mobile health technologies in CoCM is still limited. This study found that technology was most successful when it was integrated into the existing workflow without relying on patient or provider initiative. However, the effect of digital and mobile health on clinical outcomes in CoCM remains unclear and requires additional clinical trials.
| S-EPMC8892315 | biostudies-literature
Project description:Personality traits and physical health both change over the life span. Theoretical models and empirical evidence suggest that these changes are related. The current study investigated the dynamic relations between personality traits and physical health at both the between-person and the within-person levels. Data were drawn from three longitudinal studies: the Veterans Affairs Normative Aging Study (NAS; N = 1,734), the Longitudinal Internet Studies for the Social Sciences (LISS; N = 13,559), and the Swedish Adoption/Twin Study of Aging (SATSA, N = 2,209). Using random intercept cross-lagged panel models (RI-CLPMs) and the continuous time (CT) models, after controlling the between-person variance, generally, evidence was found for bidirectional associations between changes in neuroticism and extraversion and changes in self-rated health and general disease level. Bidirectional associations between changes in neuroticism and change in cardiovascular diseases and central nervous system diseases were observed only when time was modeled as continuous. We also found within-person associations between changes in neuroticism and extraversion and changes in performance-based ratings of motor functioning impairment. According to the current findings, the dynamic within-person relations between personality traits and health outcomes were largely in the direction consistent with their between-person connections, although the within-person relationships were substantially smaller in strength when compared their between-person counterparts. Findings from the current study highlight the importance of distinguishing between-person and within-person effects when examining the longitudinal relationship between personality traits and health. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
| S-EPMC8867777 | biostudies-literature
Project description:BackgroundAbortion and its complications have always been associated with challenges such as the lack of awareness, high cost of receiving in-person services, lack of access to the skilled healthcare workers, distance from healthcare centers in remote areas, and cultural sensitivities. Therefore, the use of mobile health technology in post-abortion care has been suggested. This study aimed to investigate factors influencing the acceptance and use of mhealth technology in post-abortion care.MethodA mixed-methods study was completed in 2023. Initially, a literature review was conducted. Then, a five-point Likert-scale questionnaire was designed based on the results of the literature review. The research participants were gynecologists (n = 24), midwives (n = 38), and women who had experience of abortion (n = 183). Data were analyzed using descriptive and inferential statistics.ResultsThe findings revealed that the participants had different opinions about the importance of motivating and inhibiting factors which included individual, technical, economic, organizational, and ethico-legal aspects. It seems that the individual, organizational, economic, and ethico-legal motivating factors as well as the ethico-legal inhibiting factors were more important than other factors and had higher mean values. In addition, there was a statistically significant difference between the mean values of gynecologists and patients regarding the individual motivating (P = 0.014) and technical inhibiting factors (P = 0.016). The gynecologists' opinions regarding the technical motivating factors were also significantly different from midwives (P = 0.044) and patients (P = 0.010).ConclusionMultiple factors may influence the acceptance and use of mhealth technology in post-abortion care. Therefore, mhealth service developers must consider these factors to improve the quality of services and increase technology adoption. This will lead to saving costs, improving health, reducing abortion complications, and ultimately improving quality of life for women. However, further research in patient engagement and health interventions tailored to diverse cultural contexts are recommended.
| S-EPMC11428438 | biostudies-literature
Project description:BackgroundVirtual urgent care (VUC) is intended to support diversion of patients with low-acuity complaints and reduce the need for in-person emergency department visits. We aimed to describe subsequent health care utilization and outcomes of patients who used VUC compared with similar patients who had an in-person emergency department visit.MethodsWe used patient-level encounter data that were prospectively collected for patients using VUC services provided by 14 pilot programs in Ontario, Canada. We linked the data to provincial administrative databases to identify subsequent 30-day health care utilization and outcomes. We defined 2 subgroups of VUC users; those with a documented prompt referral to an emergency department by a VUC provider, and those without. We matched patients in each cohort to an equal number of patients presenting to an emergency department in person, based on encounter date, medical concern and the logit of a propensity score. For the subgroup of patients not promptly referred to an emergency department, we matched patients to those who were seen in an emergency department and then discharged home.ResultsOf the 19 595 patient VUC visits linked to administrative data, we matched 2129 patients promptly referred to the emergency department by a VUC provider to patients presenting to the emergency department in person. Index visit hospital admissions (9.4% v. 8.7%), 30-day emergency department visits (17.0% v. 17.5%), and hospital admissions (12.9% v. 11.0%) were similar between the groups. We matched 14 179 patients who were seen by a VUC provider with no documented referral to the emergency department. Patients seen by VUC were more likely to have a subsequent in-person emergency department visit within 72 hours (13.7% v. 7.0%), 7 days (16.5% v. 10.3%) and 30 days (21.9% v. 17.9%), but hospital admissions were similar within 72 hours (1.1% v. 1.3%), and higher within 30 days for patients who were discharged home from the emergency department (2.6% v. 3.4%).InterpretationThe impact of the provincial VUC pilot program on subsequent health care utilization was limited. There is a need to better understand the inherent limitations of virtual care and ensure future virtual providers have timely access to in-person outpatient resources, to prevent subsequent emergency department visits.
| S-EPMC10627570 | biostudies-literature
Project description:ObjectiveTo measure the effect of a mobile integrated health community paramedicine (MIH-CP) transitional care program on hospital utilization, emergency department visits, and charges.Data sourcesRetrospective secondary data from the electronic health record and regional health information exchange were used to analyze patients discharged from a large academic medical center and an affiliated community hospital in Baltimore, Maryland, May 2018-October 2019.Study designWe performed an observational study comparing patients enrolled in an MIH-CP program to propensity-matched controls. Propensity scores were calculated using measures of demographics, clinical characteristics, social determinants of health, and prior health care utilization. The primary outcome is inpatient readmission within 30 days of discharge. Secondary outcomes include excess days in acute care 30 days after discharge and emergency department visits, observation hospitalizations, and total health care charges within 30 and 60 days of discharge.Data collectionIncluded patients were over 18 years old, discharged to home from internal/family medicine services, and live in eligible ZIP codes. The intervention group was enrolled in the MIH-CP program; controls met inclusion criteria but were not enrolled during the study period.Principal findingsThe adjusted model showed no difference in 30-day inpatient readmission between 464 enrolled patients and propensity-matched controls (adjusted incidence rate ratio = 1.19, 95% confidence interval [CI] [0.89, 1.60]). There was a higher rate of observation hospitalizations within 30 days of index discharge for MIH-CP patients (adjusted incidence rate ratio = 1.78, 95% CI = [1.01, 3.14]). This difference did not persist at 60 days, and there were no differences in other secondary outcomes.ConclusionsWe found no significant difference in short-term health care utilization or charges between patients enrolled in an MIH-CP transitional care program and propensity-matched controls. This highlights the importance of well-controlled, robust evaluations of effectiveness in novel care-delivery systems.
| S-EPMC8586470 | biostudies-literature
Project description:BackgroundThe federal government is investing approximately $20 billion in electronic health records (EHRs), in part to address escalating health care costs. However, empirical evidence that provider use of EHRs decreases health care costs is limited.ObjectiveTo determine any association between EHRs and health care utilization.MethodsWe conducted a cohort study (2008-2009) in the Hudson Valley, a multi-payer, multiprovider community in New York State. We included 328 primary care physicians in predominantly small practices (median practice size four primary care physicians), who were caring for 223,772 patients. Data from an independent practice association was used to determine adoption of EHRs. Claims data aggregated across five commercial health plans was used to characterize seven types of health care utilization: primary care visits, specialist visits, radiology tests, laboratory tests, emergency department visits, hospital admissions, and readmissions. We used negative binomial regression to determine associations between EHR adoption and each utilization outcome, adjusting for ten physician characteristics.ResultsApproximately half (48%) of the physicians were using paper records and half (52%) were using EHRs. For every 100 patients seen by physicians using EHRs, there were 14 fewer specialist visits (adjusted p < 0.01) and 9 fewer radiology tests (adjusted p = 0.01). There were no significant differences in rates of primary care visits, laboratory tests, emergency department visits, hospitalizations or readmissions.ConclusionsPatients of primary care providers who used EHRs were less likely to have specialist visits and radiology tests than patients of primary care providers who did not use EHRs.
| S-EPMC4377559 | biostudies-literature
Project description:Well-child visits are protective for child health but underutilized in the United States. The Supplemental Nutrition Assistance Program (SNAP), the largest federal food assistance program in the United States, has been shown to reduce food insecurity and may also promote child health by supporting preventative health care utilization. We examined the relationship between SNAP participation and infant well-child visits using state administrative data from Missouri's Department of Social Services for the period January 2006 to July 2014 for more than 50,000 infant-mother dyads. We find that compared to always receiving SNAP, leaving SNAP or receiving SNAP unstably reduces the likelihood that an infant receives all recommended well-child visits in the first year. These patterns are more pronounced for infants living in urban areas, infants with Black or Hispanic mothers, and infants whose mothers are diagnosed with depression. We also find that stable SNAP participation primarily influences vaccination rates through well-child visits, which is when most infants receive their immunizations. Given the increased public health risk of foregone care, these results may inform policy makers as they consider making permanent policy waivers to reduce the administrative burden of the recertification process and increase the stability of SNAP participation.
| S-EPMC8441191 | biostudies-literature