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Anxiety disorders (ADs) are associated with increased healthcare use (HCU), and individuals may seek healthcare through various pathways according to clinical and individual characteristics. This study aimed to characterize care trajectories (CTs) of individuals with ADs. This is a retrospective cohort study using the Care Trajectories - Enriched Data cohort, a linkage between the Canadian Community Health Surveys (CCHS), and health administrative data from Quebec. The cohort included 5143 respondents reporting ADs to the CCHS between 2009 and 2016. We measured CTs over 5 years before CCHS using a state sequence analysis. The cohort was categorized into five types of CTs. Type 1 (52.7 %) was the lowest care-seeking group, with fewer comorbidities. Type 2 (24.0 %) had higher levels of physical and mental health comorbidities and moderate HCU, mainly ambulatory visits to general practitioners. Type 3 (13.1 %) represented older patients with the highest level of physical illnesses and high HCU, predominantly ambulatory consultation of specialists other than psychiatrists. Types 4 and 5 combined young and middle-aged patients suffering from severe psychological distress. HCU of type 4 (6.7 %) was high, mainly consultations of ambulatory psychiatrists, and HCU of type 5 (3.5 %), was the highest and mostly in acute care. Administrative and survey data may have coding errors, missing data and self-report biases. Five types of CTs showed distinct patterns of HCU often modulated by physical and mental health comorbidities, which emphasizes the importance of considering ADs when individuals seek care for other mental health conditions or physical illness. • This cohort study identified five types of care trajectories of individuals reporting ADs over a period of five years. • Results provided a comprehensive sight of medical care providers and settings utilization that may influence healthcare-seeking. • Each type of care trajectories emphasizes the importance of detection, diagnosis, and treatment of ADs. [ABSTRACT FROM AUTHOR]

• Patients with TMO can experience moderate to severe pain, disability, disturbed emotional well-being, limited quality of life, and reduced work productivity. • Pain frequency and magnitude of disability accounted for 59.0% of the variance in TMO pain intensity while sex, pain intensity, depression, and education explained 60.1% of the variance in magnitude of disability. • The greater the intensity of the pain and the magnitude of the disability, the more the hand therapist should be attentive to depressive symptoms (eg, feelings of worry or despair). • Education in ergonomic principles and assistive devices are provided to only a small proportion of the participants (20%); since the efficacy of these interventions has been soundly demonstrated, they should be more broadly offered. • Since pain experience is unique to each individual, patients with TMO should benefit from interventions most suited to their specific needs from a biopsychosocial perspective. Trapeziometacarpal osteoarthritis (TMO) is one of the most prevalent and painful forms of hand osteoarthritis. This study aimed at (1) describing the TMO pain experience, (2) identifying biopsychosocial factors associated with pain intensity and disability, and 3) documenting the use of non-surgical management modalities. Cross-sectional. Participants who presented for care for TMO were recruited from 15 healthcare institutions. They completed a questionnaire addressing sociodemographic, pain, disability, psychological well-being, quality of life (QoL), productivity, and treatment modalities employed. Multivariable regression analyses identified biopsychosocial factors associated with pain intensity and magnitude of disability. Among our 228 participants aged 62.6 years, 78.1% were women. More than 80% of the participants reported average pain of moderate to severe intensity in the last 7 days. Nearly 30 % of them scored clinically significant levels of anxiodepressive symptoms. The participants' norm-based physical QoL score on the SF-12v2 was 41/100. Among the 79 employed respondents, 13 reported having missed complete or part of workdays in the previous month and 18 reported being at risk of losing their job due to TMO. Factors independently associated with more intense pain included higher pain frequency and greater disability, accounting for 59.0% of the variance. The mean DASH score was 46.1 of 100, and the factors associated with greater magnitude of disability were higher pain intensity, greater levels of depression, female sex, and lower level of education, explaining 60.1% of the variance. Acetaminophen, oral non-steroid anti-inflammatory drugs, cortisone injections, orthoses, hand massage/exercises, and heat/cold application were the most frequently employed modalities. Most participants never used assistive devices, ergonomic techniques, and psychosocial services. Patients with TMO can experience severe pain, disability, disturbed emotional well-being, limited QoL and reduced productivity. As disability is associated with TMO pain, and depressive symptoms with disability, reducing such modifiable factors should be one of the clinicians' priorities. [ABSTRACT FROM AUTHOR]

Balancing the economic costs related to mental illness is a pressing matter globally. Scarce monetary and staff resources impose an ongoing challenge. Therapeutic leaves (TL) are an established clinical tool in psychiatry possibly improving therapy outcome and potentially lowering direct mental healthcare costs in the long term. We thus examined the association between TL and direct inpatient healthcare costs. We analyzed the association between the number of TL and direct inpatient healthcare costs in a sample of 3151 inpatients, using a tweedie multiple regression model, including eleven confounders. Using multiple linear (bootstrap) and logistic regression models we assessed the robustness of our results. The tweedie model showed that the number of TL was associated with lower costs following the initial inpatient stay (B = –.141, CI 95% = [–0.225, –.057], p < 0.001). Results of the multiple linear and the logistic regression models matched those of the tweedie model. Our findings suggest a link between TL and direct inpatient healthcare costs. TL might lower direct inpatient healthcare costs. In the future RCTs might examine whether an increased utilization of TL leads to a reduction of outpatient treatment costs and evaluate the association of TL with outpatient treatment costs and indirect costs. The systematic use of TL during inpatient treatment could reduce healthcare costs following the initial inpatient stay which is highly relevant due to global rise of mental illness and the associated financial pressure on healthcare systems. [ABSTRACT FROM AUTHOR]

Among children younger than 18 years, the prevalence of long-term chronic diseases (LTDs) is not well known in France, nor the frequency of the use of healthcare services. This nationwide observational study focused on both topics over a 1-year period following the birth or birthday of French children in 2018 and compared the LTD status and use of healthcare. We selected children living in mainland France from the national health data system (SNDS). It includes data concerning the LTD status, which guarantees 100% reimbursement for related healthcare expenditures. We calculated the median and interquartile range (IQR) for the prevalence of LTDs and the rate of children using healthcare services at least once during the year. We included 13.211 million children (51.2% boys), of whom 4% had at least one LTD (boys: 4.6%, girls: 3.3%). Mental and behavioral disorders were the most frequent cause (1.6%). At least one visit to a general practitioner (GP) or pediatrician was found for 88% of children (median: 3, IQR: 2–6): 98% for children under 1 year of age and 81% for children aged 14–17 years. A pediatrician was visited by 17% of children, another specialist by 39%, a dentist by 37%, with peaks of about 60% at the ages of 6, 9, and 12 years; 8% visited a nurse and 7% visited a physiotherapist. At least one emergency department visit was recorded for 24% of children (42% <1 year) and one short-stay hospitalization (SSH) for 9%. Regional variations were observed. Children with LTDs more frequently used all services, such as specialist visits (50% vs. 40%), ED visits (32% vs. 23%), SSHs (26% vs. 8% and 15% vs. 4.0% for one night or more), and psychiatric hospital admissions (5% vs. 0.1%). Most children saw a GP or pediatrician during the year and children with an LTD showed more frequent use. Nevertheless, outpatient visits appeared to be underutilized with respect to recommendations or free-of-charge prevention visits, such as for dentists. More detailed studies are required to identify factors associated with the use of healthcare services in France, for example, studies including the deprivation index and regional variations. [ABSTRACT FROM AUTHOR]

Promoting equity in healthcare use requires to respect both principles of horizontal equity, that guarantees everyone the same use of healthcare for a given level of need, and vertical equity, that requires the sickest to receive more care than others, in a proportion deemed appropriate. This study explores the extent to which horizontal and vertical equity in healthcare use among individuals aged 50+ in Europe has been restructured during the COVID-19 pandemic. Using the variance as an inequality measure, we assess horizontal equity in healthcare use based on the fairness gap approach and propose two new measures of vertical equity. The sample includes 24,965 respondents of the SHARE survey from 18 European countries, who participated in wave 8 just before the pandemic and the second SHARE Corona survey in 2021. These data provide information on use of physician and hospital care over the year for each period, as well as on a wide range of health and socio-economic variables. Although pro-rich inequities in healthcare use were observed in some countries before the outbreak, our results do not reveal any significant evolution in horizontal equity during the pandemic. Conversely, vertical equity in healthcare use would have significantly declined in most countries, especially in Central or Eastern Europe. Telemedicine appears to have played a protective role against this decline in vertical equity in countries where it was heavily used during the pandemic. Our results support the case for public policies aimed at restoring access to care for individuals with the highest needs. • "Pro-rich" horizontal inequity in healthcare use before Covid-19 in Europe. • No significant change in horizontal equity in healthcare use with the pandemic. • The normative issue of vertical equity is addressed with simple empirical measures. • Vertical equity in healthcare use has declined with the pandemic in Europe. • Telemedicine has played a protective role against the decline in vertical equity. [ABSTRACT FROM AUTHOR]

Functional somatic symptoms (FSS) accumulate within families. Exposure to family patterns of high healthcare use may induce maladaptive symptom coping and thereby potentially contribute to the transgenerational transmission of FSS. This study aimed to uncover associations between parental and child healthcare use during the child's first years of life (age 0–4) and childhood FSS at age 5–7. We utilized data from the Copenhagen Child Cohort (CCC2000), a population-based birth cohort. Parent-reported FSS of their 5–7-year-old children were linked to Danish national registry data on parental and child healthcare use (including general practitioner [GP] consultations and hospital contacts) during child age 0–4 years. Logistic regression analyses were performed to investigate longitudinal associations between family healthcare use and child FSS. We found an association between prior parental healthcare use and child FSS at age 5–7 (OR = 1.02, 95% CI [1.01–1.04]). Key sensitivity analyses specifically focusing on GP consultations, revealed modest but statistically significant associations between parental (OR = 1.03, 95% CI [1.02–1.05]) and child (OR = 1.18, 95% CI [1.04–1.34]) GP consultations and impairing FSS at age 5–7. Family healthcare use, especially within the general practice, may play a role in the transgenerational transmission of FSS. Early-stage FSS identification and care might be improved through training aimed at GPs. Future research may identify vulnerable families at whom parent-focused interventions for symptom-coping could be targeted. This could potentially contribute to the prevention of transgenerational transmission of FSS. [ABSTRACT FROM AUTHOR]

This study estimates and decomposes components of different measures of inequality in health and healthcare use among millennial adolescents, a sizeable cohort of individuals at a critical stage of life. Administrative data from the UK Hospital Episode Statistics are linked to Next Steps, a survey collecting information about millennials born between 1989 and 1990, providing a uniquely comprehensive source of health and socioeconomic variables. Socioeconomic inequalities in psychological distress, long-term illness and the use of emergency and outpatient hospital care are measured using a corrected concentration index. Shapley-Shorrocks decomposition techniques are employed to measure the relative contributions of childhood socioeconomic circumstances to adolescents' health and healthcare inequality of opportunity. Results show that income-related deprivation contributes to significant inequalities in mental and physical health among adolescents aged between 15 and 17 years old. There are also pro-rich inequalities in the use of specific outpatient hospital services (e.g., orthodontic and mental healthcare), while pro-poor disparities are found in the use of emergency care services. Regional and parental circumstances are leading factors in influencing inequality of opportunity in the use of hospital care among adolescents. These findings shed light on the main drivers of health inequalities during an important stage of human development and have potentially important implications on human capital formation across the life-cycle. • Socioeconomic deprivation contributes to significant health inequalities for millennial adolescents. • There are pro-rich inequalities in the use of mental health and orthodontic outpatient hospital services. • Pro-poor disparities are found in the use of, and waiting times for, emergency hospital services. • Findings have important implications on human capital formation across life-cycles. [ABSTRACT FROM AUTHOR]

This study aimed to explore the association of visual, hearing, or dual sensory impairment with healthcare use and costs. This is a cohort study. These research data were from the China Health and Retirement Longitudinal Study spanning 2011–2018 and included 8982 community-dwelling middle-aged and older adults (aged ≥45 years at baseline). Sensory impairment was measured according to self-reported assessment of visual and hearing functions, and healthcare use and costs were ascertained via self-report. The associations of sensory impairment with healthcare use and costs were estimated using the mixed-effects regression models. Of the 8982 respondents, 4346 (48.39%) were females and their mean (standard deviation) age at baseline was 57.03 (8.26) years. Individuals with hearing impairment (HI) only, visual impairment (VI) only, and dual sensory impairment (DSI) were all at significantly higher risks of healthcare use and catastrophic health expenditure than those without sensory impairment (all P < 0.05), except that VI only non-significantly prolonged inpatient days. Compared with no impairment, DSI was associated with increases in outpatient (β = 50.67, 95% confidence interval [CI] = 17.47–83.86) and inpatient out-of-pocket costs (β = 40.35, 95% CI = 5.94–74.76), while VI only or HI only did not show significant effects. Further stratification analyses indicated that the associations between sensory impairment and outpatient use were more pronounced among males than among females but that age group did not moderate the associations with any healthcare outcomes. HI and VI were independently and together associated with higher risks of healthcare use and catastrophic health expenditure. Dual sensory impairment was the only category consistently associated with increased outpatient and inpatient costs. [ABSTRACT FROM AUTHOR]

Objectives: The Affordable Care Act's Medicaid Expansion Program influences healthcare use by increasing insurance coverage. Of particular interest is how this will affect inefficient and expensive emergency department (ED) visits. We estimated the impact of the Medicaid expansion on ED use by states and payer (Medicaid, private insurance, and uninsured) 5 years after the implementation of the Medicaid expansion and illustrated the use of the generalized synthetic control method.Methods: In this quasi-experiment study, we implemented the generalized synthetic control method to compare states with Medicaid expansion and states without Medicaid expansion. Data were from the Healthcare Cost Utilization Project Fast Stats, which cover >95% of all ED visits. We included states with complete data from 2010 to 2018.Results: Overall, the Medicaid expansion increased Medicaid share of ED visits (average treatment effect on the treated [ATT] 11.39%; 95% confidence interval [CI] 8.76-14.02) and decreased private share of ED visits (ATT -5.80%; 95% CI -7.40 to -4.12) and uninsured share of ED visits (ATT -6.66%; 95% CI -9.78 to -3.55).Conclusions: Medicaid Expansion Program shifted ED payer mix to Medicaid ED visits from private insurance and uninsured ED visits for adults at age of 19 to 64 years, whereas its effect on total ED volume is mixed among states. States that experienced the largest increase in Medicaid enrollment seem to experience an increase in ED visits although such results did not reach statistical significance. [ABSTRACT FROM AUTHOR]

Background: Mismatch between need and mental healthcare (MHC) use (under-and overuse) has mainly been studied with cross-sectional designs, not accurately capturing patterns of persistence or change in clinical burden and MHC-use among persons with depressive and/or anxiety disorders.Aims: Determining and describing [mis]match of longitudinal trajectories of clinical burden and MHC-use.Methods: Six-year longitudinal burden and MHC-use data came from the Netherlands Study of Depression and Anxiety (n=2981). The sample was split into four subgroups: I) no clinical burden but constant MHC use, II) constant clinical burden but no MHC-use, III) changing clinical burden and MHC-use, and IV) healthy non-users. Within subgroups I)-III), specific clinical burden and MHC trajectories were identified (growth mixture modeling). The resulting classes' associations with predisposing, enabling, and need factors were investigated (regression analysis).Results: Subgroups I-III revealed different trajectories. I) increasing MHC without burden (4.1%). II) slightly increasing (1.9%), strongly increasing (2.4%), and decreasing (9.5%) burden without MHC. III) increasing (41.4%) or decreasing (19.4%) burden and concurrently increasing MHC use (first underuse, then matched care), thus revealing delayed MHC-use. Only having suicidal ideation (p<.001, Cohen's d= .6-1.5) was a significant determinant of being in latter classes compared to underusers (strongly increasing burden without MHC-use).Limitations: More explanatory factors are needed to explain [mis]match.Conclusion: Mismatch occurred as constant underuse or as delayed MHC-use in a high-income country (Netherlands). Additionally, no meaningful class revealed constantly matched care on average. Presence of suicidal ideation could influence the probability of symptomatic individuals receiving matched MHC or not. [ABSTRACT FROM AUTHOR]

Objective: To examine the associations between post-traumatic stress of parents of infants with complex congenital heart defects and their healthcare use for their infants during the early months of life.Study Design: The current study is a secondary data analysis from a randomized controlled trial in which 216 parent-infant dyads were recruited from 3 cardiac intensive care units of large pediatric centers in Northeastern America. The current sample included 153 dyads with post-traumatic stress data at hospital discharge and at 4-months' follow-up. Poisson regressions were used to estimate the effect of post-traumatic stress change scores on number of emergency department (ED) visits, unscheduled cardiologist visits, and unscheduled pediatrician visits outcomes.Results: Infants whose parents gained post-traumatic stress disorder over the study period were at increased risk for ED visits and unscheduled cardiologist visits. Increased symptom severity predicted more unscheduled cardiologist visits and more unscheduled pediatrician visits. Increased symptom clusters (avoidance, arousal, re-experiencing) predicted more ED visits, more unscheduled cardiologist visits, and more unscheduled pediatrician visits.Conclusions: Parents of infants with cardiac conditions may experience post-traumatic stress following cardiac surgery, which can be linked to greater healthcare use. Findings highlight the importance of screening and treating post-traumatic stress to preserve parental mental health and prevent adverse outcomes. [ABSTRACT FROM AUTHOR]

Study Objective: To determine the impact of surgical wait time on healthcare use and surgical outcomes for patients undergoing hysterectomy for benign gynecologic indications.Design: Retrospective cohort study.Setting: Urban, academic tertiary care center.Patients: Patients who underwent hysterectomy for benign disease between 2012 and 2018.Interventions: None.Measurements and Main Results: Patients were categorized into 2 groups, dichotomized by surgical wait times >30 days or ≤30 days. Healthcare use was measured by the number of discrete patient interactions with the healthcare system through phone calls, secure electronic messaging, and office and emergency room visits. Univariate and multivariable logistic regression models were performed to assess the association between surgical wait time and healthcare use and perioperative outcomes while controlling for confounders. A total of 277 patients were included in our analysis: 106 (38.3%) had surgical wait times >30 days (median 47 days, range 24-68 days), and 171 (67.1%) had surgical wait times ≤30 days (median 19 days; range 12-26 days). The groups did not differ by age, insurance status, substance use, or comorbid conditions. Patients in the group with surgical wait times >30 days were more likely to have increased healthcare use (69 of 106, 65% vs 43 of 171, 25%; odds ratio 5.55; 95% confidence interval, 3.27-9.41). There were no differences in intraoperative complications (9 of 106, 8% vs 19 of 171, 11%; p = .482) or postoperative complications (28 of 106, 26% vs 32 of 171, 19%; p = .13) between the groups; however, after controlling for potential confounders, patients with surgical wait times >30 days were 3.22 times more likely to be readmitted than patients with surgical wait times ≤30 days (95% confidence interval, 1.27-8.19).Conclusion: A surgical wait time >30 days in patients undergoing a hysterectomy for benign disease is associated with increased healthcare use in the interim. Although patients who experience longer surgical wait times do not experience worse surgical outcomes, they may be at higher risk for readmission after surgery. Targeted interventions to optimize perioperative coordination of care for patients undergoing a hysterectomy for benign disease, especially those within vulnerable populations, are needed to improve quality of care, decrease any redundant or inefficient healthcare use, and reduce any unnecessary delays. [ABSTRACT FROM AUTHOR]

Objective: To examine the possible association between diaper need, difficulty affording an adequate amount of diapers, and pediatric care visits for urinary tract infections and diaper dermatitis.Study Design: This cross-sectional analysis using nationally representative survey data collected July-August 2017 using a web-based panel examined 981 parents of children between 0 and 3 years of age in the US (response rate, 94%). Survey weighting for differential probabilities of selection and nonresponse was used to estimate the prevalence of diaper need and to perform multivariable logistic regression of the association between parent reported diaper need and visits to the pediatrician for diaper rash or urinary tract infections within the past 12 months.Results: An estimated 36% of parents endorsed diaper need. Both diaper need (aOR 2.37; 95% CI 1.69-3.31) and visiting organizations to receive diapers (aOR 2.14; 95% CI 1.43-3.21) were associated with diaper dermatitis visits. Similar associations were found for diaper need (aOR 2.63; 95% CI 1.54-4.49) and visiting organizations to receive diapers (aOR 4.50; 95% CI 2.63-7.70) for urinary tract infection visits.Conclusions: Diaper need is common and associated with increased pediatric care visits. These findings suggest pediatric provider and policy interventions decreasing diaper need could improve child health and reduce associated healthcare use. [ABSTRACT FROM AUTHOR]

Respiratory tract infections (RTIs) are important health problems with high incidence and consequent economic costs. The study aimed to analyze trajectories of experienced RTI symptoms and use of healthcare and antibiotics. The study adopted a cross-sectional design and face-face interview using a structured questionnaire. The questionnaire comprised: a) social demographics; b) last episode of symptomatic RTIs; c) responses to the RTIs; d) antibiotics obtained from clinics and medicine shops for the RTIs. The study subjects were residents in randomly selected villages in Anhui, China. The study settings were the residents households. Descriptive analyses were conducted to draw symptoms trajectory and identify relationship between healthcare seeking and symptoms and common sociodemographic variables. A total 91.1% (1968) of 2160 eligible residents completed the interview who reported 1.83 episodes of RTIs in the pass year on average. Over half (54.8%) of these RTI episodes had led to visit to clinics for professional care and 51.9%, to use of antibiotics. The trajectories of common RTI symptoms featured a sharp increase and peak followed by a long tail along the days after onset of the infection. Over 60.5% of healthcare-seeking happened between two days before and one day after the symptoms peak. The study also revealed interesting pattern in the timing of different type of treatment following, e.g., taking leftover medicine and antibiotics happened the earliest and seeking professional help and getting antibiotics from clinics, the latest. RTIs incur a large volume of healthcare-seeking and antibiotics use and there is an urgent need for effective education measures on proper service especially antibiotics use. Patients' reported RTI symptoms manifest peculiar trajectories and their retrospective recall of the course of prior RTI episodes and associated actions may guide their future responses to similar infections. Knowledge of these may help inform doctors about patient expectations, enabling them better manage shared decision- making around antibiotic treatment. [ABSTRACT FROM AUTHOR]

Idiopathic pulmonary fibrosis (IPF) is a severe progressive disease with poor prognosis. Patients show an increased healthcare utilization pattern consisting of regular physician consultations and monitoring tests. The aim of the present study was to estimate healthcare resource utilization and out-of-pocket expenditures for IPF patients in Greece. An IPF-specific questionnaire was constructed, which focused on retrospective healthcare resource utilization and out-of-pocket expenditures within a 6-month period. Upon informed consent, the questionnaires were completed anonymously. The study sample included 123 IPF patients. Within a 6-month period, 85.4% of the patients visited their treating physician (mean, 2.35; standard deviation [SD], 1.400), 29.4% visited other physicians for IPF-related reasons (mean, 1.90; SD, 1.595), 42.9% visited a healthcare setting, and 10.6% required hospitalization (mean duration, 2.86 days; SD, 3.338). Spirometry (98.1%) and blood tests (88.5%) were the most common tests for IPF monitoring. Almost half of the respondents (48.6%) stated they had private expenditures for IPF medication, physician visits, hospital services, medical tests, or other IPF-related reasons. IPF management requires regular contact with healthcare services and uptake of specific medical tests. Considering the high proportion of patients bearing out-of-pocket costs, along with the decline of incomes in Greece, improvement of the disease management is important, and action should be taken to lower the financial burden imposed on patients. • Idiopathic pulmonary fibrosis (IPF) imposes a high economic burden on both patients and healthcare systems. Although the overall cost and healthcare utilization of IPF has been identified as quite high for health systems worldwide, the cost that the disease imposes on individual patients has not been investigated. • The participation of almost half of the IPF patients in this study to their health expenditure is alarming in light of the high cost that the disease incurs. Considering the decreased income and constantly decreasing pensions in Greece, a reasonable question arises as for how long IPF patients, along with other chronic patients, will be able to bear the economic burden imposed by the disease and the inadequate support of the state. [ABSTRACT FROM AUTHOR]

Objectives: The Elderly Risk Assessment (ERA) score is a validated index for primary care patients that predict hospitalizations, mortality, and Emergency Department (ED) visits. The score incorporates age, prior hospital days, marital status, and comorbidities. Our aim was to validate the ERA score in ED patients.Methods: Observational cohort study of patients age ≥ 60 presenting to an academic ED over a 1-year period. Regression analyses were performed for associations with outcomes (hospitalization, return visits and death). Medians, interquartile range (IQR), odds ratios (OR) and 95% confidence intervals (CI) were calculated.Results: The cohort included 27,397 visits among 18,607 patients. Median age 74 years (66-82), 48% were female and 59% were married. Patients from 54% of visits were admitted to the hospital, 16% returned to the ED within 30 days, and 18% died within one year. Higher ERA scores were associated with: hospital admission (score 10 [4-16] vs 5 [1-11], p < 0.0001), return visits (11 [5-17] vs 7 [2-13], p < 0.0001); and death within one year (14 [7-20] vs 6 [2-13], p < 0.0001). Patients with ERA score ≥ 16 were more likely to be admitted to the hospital, OR 2.14 (2.02-2.28, p < 0.0001), return within 30 days OR 1.99 (1.85-2.14), and to die within a year, OR 2.69 (2.54-2.85).Conclusion: The ERA score can be automatically calculated within the electronic health record and helps identify patients at increased risk of death, hospitalization and return ED visits. The ERA score can be applied to ED patients, and may help prognosticate the need for advanced care planning. [ABSTRACT FROM AUTHOR]

Depressive symptoms and physical comorbidity are common health problems in older adults and are both posing increasingly considerable challenges to global healthcare systems. This study investigated the relationships of depressive symptoms, alone or together with physical comorbidity, with healthcare utilization and spending among older adults, as well as examined sex differences. We used data of the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018 and enrolled 6519 participants. Depressive symptoms was operationalized following the Center for Epidemiological Studies Depression Scale and physical comorbidity was assessed according to the presence of 11 physical non-communicable diseases. The relationships of depressive symptoms and comorbidity with healthcare outcomes were examined using mixed-effects regression models. Compared with the neither depressive symptoms nor physical comorbidity category, older adults classified as depressive symptoms-only, physical comorbidity-only or both conditions were all associated with elevated risks for healthcare use and spending (all OR/IRR > 1; all p < 0.001). Depressive symptoms and physical comorbidity in combination consistently led to higher risks for studied endpoints than either condition alone (outpatient visit: OR = 3.50, outpatient visit number: IRR = 3.39, inpatient visit: OR = 3.35, hospitalization days: IRR = 2.82, catastrophic health expenditure: OR = 1.70; all p-trend < 0.001). Stratification analyses revealed similar relationships irrespective of sex. Depressive symptoms and physical comorbidity are separately and jointly associated with increased healthcare utilization and spending among Chinese older adults. These two conditions in combination lead to highest risks than either condition alone. Early screen for depressive symptoms, alone or together with physical comorbidity, may offer implications for appropriate policy interventions. • Depressive symptoms alone could result in increased healthcare use and spending. • Physical comorbidity was also individually associated with increased healthcare. • Two conditions in combination led to highest risk of healthcare use and spending. • Concerted efforts are needed toward early intervention and holistic care. [ABSTRACT FROM AUTHOR]

Using healthcare, whether for routine preventative examinations, chronic condition management, or emergent conditions, is an essential element of achieving and maintaining health. Over 44 million migrants live in the US today and nearly half (44.6 %) are Latino. To the extent that immigration law-related concerns deter US Latino migrants from using healthcare, they jeopardize the health of a substantial though marginalized US subpopulation. A multistate sample (N = 1750) of noncitizen adult, Spanish speaking Latino migrants (both undocumented and documented) living in the US completed a cross-sectional survey comprising a scale assessing perceptions of immigration laws and consequences related to healthcare use and whether they had received and/or needed but did not receive healthcare in the previous 12-months. Participants were recruited in community settings and by word-of-mouth. Univariate analyses examined associations among study outcomes and common predictors of healthcare use. Multivariable analyses examined the relative contribution of perceived immigration laws and consequences on healthcare use and unmet need. Perceptions of immigration laws and immigration consequences were a significant predictor of not having received healthcare in the previous 12-months and having needed and not received healthcare in the same period, even when considered relative to common predictors of healthcare use. Immigration documentation status and preferred language predicted healthcare use in univariate analyses but not in the multivariable model. Perceived immigration laws and consequences related to healthcare use may influence migrants' healthcare use. Effective interventions should be developed to address immigration-related concerns. [ABSTRACT FROM AUTHOR]

Objective: To assess whether children and youth with concussion receive follow-up visits in accordance with the recommended guidelines.Study Design: We conducted a retrospective, population-based study using linked health administrative data from all concussion-related visits to emergency department and physician offices by children aged 5 through 18 years (range, 5.00-18.99) in Ontario between 2003 and 2013. We analyzed the percentage of children and youth seen for follow-up. The Mann-Kendall test for trends was used to assess a monotonic increasing trend over time in concussion follow-up visits.Results: A total of 126 654 children and youth were evaluated for an index concussion visit. The number of children and youth assessed for concussion follow-up (N = 45 155) has increased significantly over time (P < .001). In 2003, 781 of 7126 patients (11.0%; 95% CI, 10.3-11.7) with an index visit for concussion had a follow-up assessment. By 2013, 6526 of 21 681 (30.1%; 95% CI, 29.5-30.7) patients received follow-up care.Conclusions: The proportion of children and youth receiving follow-up after an acute concussion has significantly increased between 2003 and 2013. Nevertheless, more than two-thirds of all patients do not seek medical follow-up or clearance as recommended by current concussion guidelines, suggesting that ongoing efforts to improve and monitor compliance with recommended guidelines by patients and physicians are important. [ABSTRACT FROM AUTHOR]

Purpose: To conduct a systematic review regarding psychosocial barriers to healthcare use in individuals with diabetes mellitus, using a well-established model of health-service use as a theoretical framework.Methods: We used database-specific controlled vocabularies and additional free text terms, and conducted searches via MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, OVID Journals. Included studies were rated according to the UK National Institute for Health and Care Excellence (NICE) criteria. A narrative data synthesis was conducted, using the Andersen model and developing categories from the included studies.Principal Results: In total, 2923 studies were identified, and 15 finally included. We identified barriers according to the main categories "population characteristics", "norms and values", and "healthcare services" on a contextual and individual level, as well as "health status". Frequently reported barriers were "socioeconomic status", and "physician characteristics". Ethnic minorities were frequently analysed and may have specific barriers, e.g. "cultural beliefs" and "language".Major Conclusions: We identified a broad range of barriers to healthcare use in individuals with diabetes mellitus. However, the number of studies is low. Further research is needed to analyse barriers in more detail considering special subgroups. [ABSTRACT FROM AUTHOR]

• Five multimorbidity clusters were identified among middle-aged and older adults in China: minimal disease, arthritis, cardiovascular disease, lung/asthma, and multisystem morbidity. • The multisystem morbidity group had the highest use in outpatient, inpatient and self-treament healthcare, and the highest cost in self-treatment. • The five groups did not show significant differences in outpatient costs. While the lung/asthma and arthritis groups reported lower inpatient costs than other groups. This study investigated multimorbidity patterns among middle-aged and older Chinese people and whether healthcare costs varied among different multimorbidity patterns. Data were from the 2011–2018 waves of the China Health and Retirement Longitudinal Study (CHARLS). We included 20,855 unique observations with information coming from their last wave of interviews and aged at least 45 years or older. Latent class analysis (LCA) was performed to classify individuals with common multimorbidity clusters based on 14 self-reported chronic diseases. Healthcare costs were from participants' self-reports and categorized into outpatient, inpatient, and self-treatment. Two-part regression was performed to analyze the association of multimorbidity patterns with healthcare costs. Five multimorbidity clusters were identified: minimal disease, arthritis, cardiovascular disease (CVD), lung/asthma, and multisystem morbidity. The multisystem morbidity group had the highest use in all three types of healthcare and the highest self-treatment cost. Compared with the minimal disease group, the other four groups did not show significant differences in outpatient costs. Relative to the minimal disease group, the lung/asthma group reported lower inpatient costs. Healthcare use and costs varied across multimorbidity patterns among middle-aged and older Chinese people. Implementing an integrated care plan for multimorbidity is suggested to improve the cost-effectiveness of healthcare provision and reduce the financial burden of the healthcare system. Reimbursement policy design should also take multimorbidity patterns into account. [ABSTRACT FROM AUTHOR]

Summary Background Malnutrition is common in patients with chronic obstructive pulmonary disease (COPD). This study aimed to explore its association with all-cause mortality, emergency hospitalisation and subsequently healthcare costs. Methods A prospective cohort observational pilot study was carried out in outpatients with COPD that attended routine respiratory clinics at a large tertiary Australian hospital during 2011. Electronic hospital records and hospital coding was used to determine nutritional status and whether a patient was coded as nourished or malnourished and information on healthcare use and 1-year mortality was recorded. Results Eight hundred and thirty four patients with COPD attended clinics during 2011, of those 286 went on to be hospitalised during the 12 month follow-up period. Malnourished patients had a significantly higher 1-year mortality (27.7% vs. 12.1%; p = 0.001) and were hospitalised more frequently (1.11 SD 1.24 vs. 1.51 SD 1.43; p = 0.051). Only malnutrition (OR 0.36 95% CI 0.14–0.91; p = 0.032) and emergency hospitalisation rate (OR 1.58 95% CI 1.2–2.1; p = 0.001) were independently associated with 1-year mortality. Length of hospital stay was almost twice the duration in those coded for malnutrition (11.57 SD 10.93 days vs. 6.67 SD 10.2 days; p = 0.003) and at almost double the cost (AUD $23,652 SD $26,472 vs. $12,362 SD $21,865; p = 0.002) than those who were well-nourished. Conclusion Malnutrition is an independent predictor of 1-year mortality and healthcare use in patients with COPD. Malnourished patients with COPD present both an economic and operational burden. [ABSTRACT FROM AUTHOR]

• COVID-19 pandemic critically affected healthcare use across age-specific population groups and across different locations of healthcare institutions. • The greatest healthcare claim reduction was for patients aged under 20, followed by the 20–39 group and the 40–59 group after outbreak of the COVID-19 pandemic. • The number of claims significantly decreased in both urban and rural areas. However, the magnitude of this decrease was greater in urban areas than in rural areas. The COVID-19 pandemic affected healthcare use globally. However, there have been few studies examining how it affected age-specific healthcare use by patients as related to the locations of healthcare institutions. We explore changes in healthcare use while focusing on age-specific patient groups and facility locations after the COVID-19 pandemic. We compared two databases of cross-sectional outpatient health-insurance claims that have equivalent time points yearly and quarterly both before and after the COVID-19 pandemic. We categorized patients of healthcare institutions into five age groups and two facility locations. The number of claims in 2020 significantly decreased by about 15% compared to 2019. The greatest reduction was for patients aged under 20 (-43.7%), followed by the 20–39 group (-15.0%) and the 40–59 group (-11.9%). Moreover, the number of claims significantly decreased in both urban and rural areas (p < 0.001); however, the magnitude of this decrease was greater in urban areas (-15.2%) than in rural areas (-10.8%). The annual decrease in healthcare use by age groups and location of facility was still supported even after controlling for institutional covariates, except for the patient group aged 80 or over in rural areas. We found that the COVID-19 pandemic critically affected healthcare use across age-specific population groups and different locations of healthcare institutions. It suggests there is a need for further research and policy implications as to whether the declining healthcare use among those age groups is in core health care, and as to whether there are any unmet healthcare needs. [ABSTRACT FROM AUTHOR]

Objective The aim of this study is to examine the extent to which functional, interactive and critical health literacy are associated with patients’ perceived control over care and frequency of GP visits. Methods Data from the Dutch ‘National Panel of People with Chronic Illness or Disability’ was used ( N = 2508). Health literacy was assessed by the Functional, Communicative and Critical Health Literacy measure. Perceived control over care was indicated by perceived ability to organize care, interact with providers and to perform self-care. By multivariate linear and logistic regression analyses, associations between health literacy and perceived control over care and subsequently frequency of GP visits were studied. Results Mainly interactive health literacy was associated with patients’ perceived ability to organize care, interact with healthcare providers and perform self-care, whereas only functional health literacy was associated with number of GP visits. Conclusion The results imply that some patients’ may be less able to exert control over their care because of lower health literacy. Functional, interactive and critical health literacy vary in their relevance for patients’ ability to exert control. Practice implications Initiatives for strengthening patients’ role in healthcare may be improved by paying attention to patients’ health literacy, specifically functional and interactive health literacy. [ABSTRACT FROM AUTHOR]

This paper estimates effects of long-term care (LTC) benefits on utilization of primary and secondary healthcare in Catalonia (Spain). Identification comes from plausibly exogenous variation in the leniency of LTC needs assessment. We estimate that receiving LTC benefits worth 365 euros per month, on average, reduces the probability of avoidable hospital admissions by 66%, and has no significant effect on planned hospitalisations nor on hospitalisation for any reason. Receiving LTC benefits is estimated to reduce unscheduled primary care visits by 44% and has no significant effect on scheduled visits. These findings have important policy implications suggesting that allocating resources to LTC may not only increase the welfare of LTC beneficiaries but also reduce avoidable and unscheduled utilisation of healthcare. [ABSTRACT FROM AUTHOR]

Objective: To determine associations between adverse childhood experiences (ACEs) at age 5 years and healthcare utilization patterns at age 9 years.Study Design: We conducted a secondary analysis using longitudinal data from the Fragile Families and Child Wellbeing Study. Caregivers (n = 2521) provided data on their child's ACEs at age 5 years and on 4 types of healthcare utilization at age 9 years: past-year well visits, dental visits, primary care sick visits for injury or illness, and emergency room (ER) visits. Logistic regression analysis was used to examine the association between ACEs at age 5 and each type of healthcare utilization, adjusting for relevant sociodemographic covariates.Results: Among the 2521 children (51% male, 48% Non-Hispanic Black), 77% had ≥1 ACE at age 5. Children with ≥4 ACEs had lower odds of a dental visit (aOR, 0.51; 95% CI, 0.29-0.91) and higher odds of a primary care sick visit (aOR, 1.77; 95% CI, 1.20-2.64) and an ER visit (aOR, 1.70; 95% CI, 1.11-2.59) compared with children with no reported ACEs.Conclusion: Our findings demonstrate suboptimal healthcare utilization patterns among families with ACEs and indicate a need for targeted interventions that support appropriate healthcare utilization for children who endure adversity. [ABSTRACT FROM AUTHOR]

Objective: Healthcare use is elevated among individuals with eating disorders (EDs); however, most people with EDs do not receive ED-specific care, likely due to factors such as the cost and availability of treatment as well as stigma. U.S. military veterans historically have been understudied in ED research. We investigated healthcare use and barriers to care among recently separated veteran men and women.Method: In this cross-sectional study, 1494 participants completed an online or paper survey assessing ED symptoms, healthcare use, and logistical and attitudinal barriers to care. We estimated logistic regression models to investigate the association of ED status with healthcare use variables and examined gender similarities and differences in barriers to care.Results: Men and women with probable EDs reported low rates of ED treatment but greater healthcare use, during military service and since separating from service, compared to veterans without probable EDs (odds ratios = 1.57-7.05). Large proportions of participants reported that they did not know where to get help for EDs and that treatment is too costly. There were few gender differences in barriers to care (Cramer's V = 0.02-0.32).Conclusion: Veterans reported high healthcare use but low rates of ED treatment. Findings underscore the need to increase the reach and accessibility of ED treatment in potentially vulnerable groups. [ABSTRACT FROM AUTHOR]

This study investigated the effect of spatial accessibility to healthcare services (HS) in residential and workplace neighbourhoods on the use of HS. Questionnaire data from the RECORD Study (2007–2008) were merged with administrative healthcare and geographic data. A novel method was developed to assess clustering of visits to HS around the residence/workplace. We found clustered use of HS around the workplace for few participants (11%). Commuting from suburbs to Paris and commuting distance were associated with a higher use of HS around the workplace. No associations were found between the spatial accessibility to and the use of HS. [ABSTRACT FROM AUTHOR]

Abstract: Background: Falls are a common mechanism of injury in the older population, putting an increasing demand on scarce healthcare resources. The objective of this study was to determine healthcare costs due to falls in the older population. Methods: An incidence-based cost model was used to estimate the annual healthcare costs and costs per case spent on fall-related injuries in patients ≥65 years, The Netherlands (2007–2009). Costs were subdivided by age, gender, nature of injury, and type of resource use. Results: In the period 2007–2009, each year 3% of all persons aged ≥65 years visited the Emergency Department due to a fall incident. Related medical costs were estimated at €675.4 million annually. Fractures led to 80% (€540 million) of the fall-related healthcare costs. The mean costs per fall were €9370, and were higher for women (€9990) than men (€7510) and increased with age (from €3900 at ages 65–69 years to €14,600 at ages ≥85 year). Persons ≥80 years accounted for 47% of all fall-related Emergency Department visits, and 66% of total costs. The costs of long-term care at home and in nursing homes showed the largest age-related increases and accounted together for 54% of the fall-related costs in older people. Discussion: Fall-related injuries are leading to a high healthcare consumption and related healthcare costs, which increases with age. Programmes to prevent falls and fractures should be further implemented in order to reduce costs due to falls in the older population and to avoid that healthcare systems become overburdened. [Copyright &y& Elsevier]

Abstract: The health of migrants in the UK and their access to healthcare is of considerable policy interest. There is evidence of ethnic inequalities in health and access to and use of healthcare but insufficient consideration of the importance of birth abroad and length of residence in the UK. This study examines indicators of health status, behaviour and healthcare use among mothers of infants in the Millennium Cohort Study, according to whether born in the UK or abroad, individual ethnic grouping, and length of residence. Our findings show there are both positive and negative health indicators associated with ethnicity, birth abroad, and length of residence and presenting results on a single factor in isolation could lead to a misinterpretation of associations. For mothers ethnicity has an important relationship with most health indicators independent of country of birth, length of residence and socio-demographic circumstances. Once adjusted for ethnicity and socio-demographic variables, association with birth abroad disappears for most health outcomes suggesting that there may not be an independent migrant penalty in health. There is a linear trend in decreasing health status with increasing length of residence but no independent association between length of residence and healthcare use. This suggests that while there are continuing barriers to good health for migrants in the receiving society as shown in other studies, factors important for one health outcome may not apply to another. Our findings challenge linear acculturation models for migrants’ health in showing that a linear trend in improving socio-economic circumstances for mothers in some ethnic groups is not always associated with better health outcomes or changes in health behaviour. Our results point to a need for a comprehensive collection of information and analysis for all categories of migrants for understanding patterns of and factors underlying health and use of healthcare. [Copyright &y& Elsevier]

Abstract: Influenza vaccines are universally funded in Ontario, Canada. Some public health units (PHUs) vaccinate children in schools. We examined the impact of school-based delivery on vaccination rates and healthcare use of the entire population over seven influenza seasons (2000–2007) using population-based survey and health administrative data. School-based vaccination was associated with higher vaccination rates in school-age children only. Doctors’ office visits were lower for PHUs with school-based vaccination for children aged 12–19 but not for other age groups. Emergency department use and hospitalizations were similar between the two groups. In the context of universal influenza vaccination, school-based delivery is associated with higher vaccination rates and modest reductions in healthcare use in school-age children. [Copyright &y& Elsevier]

Purpose: The aim of this study was to examine the effectiveness of a telemedicine program in improving timeliness of and access to healthcare services in adolescent correctional facilities. Method: This study is a pre/post quasi-experimental design comparing time to treatment and healthcare use in the year preceding and the 2 years after the implementation of a telemedicine program in four facilities housing adolescents from 12 to19. Timeliness of care is measured by time from referral to date of service (for behavioral healthcare only). Access to care is measured by use of outpatient care, emergency department (ED) visits, and inpatient visits. Results: Two of the four state correctional facilities had a significant decrease (24%) in time from referral to treatment after the implementation of the telemedicine intervention. The facilities not showing significant improvements in timeliness experienced difficulty implementing the telemedicine program. The telemedicine program was also associated with significant improvements in access to care. Outpatient visits increased by 40% in the 2 years after implementation of telemedicine. For each 1% increase in telemedicine usage, outpatient visits increased by 1%, whereas emergency room visits decreased by 7%. Conclusions: Telemedicine can have a positive impact on timeliness of and access to care for youth in correctional facilities. [Copyright &y& Elsevier]

Summary: Objective: The objective of this analysis was to investigate whether patients with severe or difficult-to-treat asthma who experienced recent severe asthma exacerbations are at increased risk of future asthma exacerbations. Methods: We conducted a 1.5-year prospective analysis of 2780 patients ⩾12 years of age from The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens study. Severe exacerbations were defined as either an asthma-related emergency department visit or night of hospitalization in the 3 months prior to study visit; a secondary analysis assessed prior steroid bursts as an independent predictor and outcome. Potential confounding was assessed by statistical adjustment for demographic and clinical factors, as well as asthma severity and asthma control. Results: Compared with patients without a recent severe exacerbation, patients with a recent exacerbation were at increased risk of future exacerbation (odds ratio=6.33; 95% CI 4.57, 8.76), even after adjustment for demographics and clinical factors (odds ratio=3.77; 95% CI 2.62, 5.43), asthma severity (physician-assessed: odds ratio=5.62; 95% CI 4.03, 7.83), National Asthma Education and Prevention Program (odds ratio=5.07; 95% CI 3.62, 7.11), Global Initiative for Asthma (odds ratio=5.32; 95% CI 3.80, 7.47), and asthma control (odds ratio=3.90; 95% CI 2.77, 5.50). Conclusion: This analysis suggests that recent severe asthma exacerbations are a strong independent factor predicting future exacerbations and, as such, should be considered as part of the clinical assessment of patients with severe or difficult-to-treat asthma. [Copyright &y& Elsevier]

• A prodromal phase in Multiple Sclerosis is being consistently recognised. • This phase usually precedes diagnosis by 5-10 years. • Prodromal phase is associated with a high frequency of healthcare use. • Prodromal symptoms are nonspecific, including musculoskeletal and gastrointestinal. • This phase has a high request rate of complementary exams requests. Multiple sclerosis (MS) is a chronic immune-mediated disease of the central nervous system. Prodromal symptoms and higher healthcare use have been suggested in patients who later develop MS. Assess the healthcare utilization pattern of relapsing-remitting MS (RRMS) patients in the five years prior to MS diagnosis. Retrospective, multicentric study. Demographic and clinical data, drug prescriptions and diagnostic tests were collected from electronic health records five-years previous to MS diagnosis and compared with national data. Included 168 patients, 112 (66.7%) female, median age 34±11 years. The mean number of healthcare use per patient per year was 3.14±2,69, most of them in primary healthcare (47%). Most frequent symptoms were musculoskeletal (22%), gastrointestinal (17%), sensitive (14%) and sensory organs (14%). Median number of diagnostic tests per patient was 6 (IQR 7), and drug prescriptions per patient was 6 (IQR 9). Most frequently prescribed drugs were analgesic/anti-inflammatories, antibiotics and anxiolytics and there was a high request rate of MRIs. RRMS patients had a high frequency of healthcare utilization when compared to national data. This supports the current evidence showing a prodromal phase in MS. [ABSTRACT FROM AUTHOR]

Schizophrenia Spectrum Disorder (SSD) is characterized by its chronic, episodic nature. The clear definition of such episodes is essential for various clinical and research purposes. Most current definitions of episodes in SSD are based on either hospitalizations or on symptom scales. Both have drawbacks; symptom scales are measured infrequently, while hospitalization rates are often affected by policy. This study presents an approach for defining episodes in healthcare data that does not suffer such drawbacks. Healthcare use of 13,155 SSD patients in the Northern Netherlands with up to 12 years of follow-up was available. Patient-level structural changes in the trend of healthcare use costs were determined using Exponentially Weighted Moving Average (EWMA) control charts. Control charts restart with updated parameters after a detected structural change. Episodes were defined using these structural changes. The resulting episodes were validated by investigating their association with the Global Assessment of Functioning (GAF) scale. The mean number of episodes was 0.61 (sd: 0.60) per patient per year. For the sub-group without hospitalizations this was 0.51 (sd: 0.71). Average episode duration of the sub-group (147 days, sd: 309.4) was similar to that of the full sample (150 days, sd: 305.5). A significant inverse association was identified between GAF scores and the episode-state indicator. The repeated application of EWMA control charts based on healthcare-intensity is a feasible and promising tool for quantifying patient-level healthcare episodes. The validation using GAF scores indicates that our episode indicator is associated with lower levels of global functioning. Results for individuals without hospitalizations indicate that the method is robust with regard to changes in healthcare policy. • We present a method for defining episodes in time series data of chronic diseases. • It applies to various observed outcomes, e.g. symptoms, resource use, or lab tests. • The method supports disease modeling, clinical evaluation, and health care policy. • A case study of schizophrenia results in 0.61 episodes per patient per year. • The healthcare use episodes were associated with lower levels of functioning. [ABSTRACT FROM AUTHOR]

Objective: To determine whether clinical and patient-reported outcomes differ in children receiving blenderized diets compared with conventional formula.Study Design: We conducted a prospective cohort study of 70 children aged 1-18 years receiving blenderized diets vs conventional formula via feeding tube. We assessed rates of hospitalization and visits to the emergency department (ED) at Boston Children's Hospital in 2017 and Likert scale addressing satisfaction with feeding regimen; Pediatric Gastroesophageal Reflux Disease Symptom and Quality of Life Questionnaire; Pediatric Quality of Life Inventory; and Pediatric Quality of Life Inventory Gastrointestinal Symptoms Scale.Results: Participants receiving blenderized diets (n = 42, 60%) did not differ in demographics or comorbid diagnoses from those receiving conventional formula (n = 28, 40%). Rates of total visits to the ED (0.8 ± 1.5 vs 1.4 ± 2.7, P = .05), total admissions (0.8 ± 1.2 vs 1.7 ± 2.3, P = .01), and respiratory-related admissions (0.2 ± 0.5 vs 0.6 ± 0.8, P = .04) per year were significantly lower in participants receiving blenderized diets, and respiratory-related visits to the ED trended toward significance (0.1 ± 0.4 vs 0.4 ± 0.8, P = .08). Compared with those receiving conventional formula, participants on blenderized diets reported greater satisfaction ratings (Likert scale 4.3 ± 1.0 vs 3.3 ± 1.2, P = .001), lower symptom (0.7 ± 0.8 vs 1.2 ± 1.1, P = .03), and total (0.8 ± 0.8 vs 1.2 ± 1.0, P = .02) scores on Pediatric Gastroesophageal Reflux Disease Symptom and Quality of Life Questionnaire and greater scores on the Pediatric Quality of Life Inventory Gastrointestinal Symptoms Scale, indicating less nausea and vomiting (64.0 ± 22.6 vs 49.0 ± 37.9, P = .02), abdominal pain (65.0 ± 26.8 vs 56.4 ± 33.9, P = .04), diarrhea (87.9 ± 15.5 vs 73.6 ± 26.3, P = .004), and fewer total symptoms (70.2 ± 16.3 vs 62.3 ± 19.6, P = .03).Conclusions: Blenderized diets are associated with decreased healthcare use, improved symptom scores, and increased patient satisfaction compared with conventional formulas. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between cesarean delivery and healthcare utilization and costs in offspring from birth until age 7 years.Study Design: A retrospective cohort study of singleton term births in the Canadian province of Nova Scotia between 2003 and 2007 followed until age 7 years was conducted using data from the Nova Scotia Atlee Perinatal Database and administrative health data. The main exposure was mode of delivery (cesarean delivery vs vaginal birth); the outcome was healthcare utilization and costs during the first 7 years of life. Associations were modeled using multiple regression adjusting for maternal prepregnancy weight and sociodemographic factors.Results: In total, 32 464 births were included in the analysis. Compared with children born by vaginal birth, children born by cesarean delivery had more physician visits (incidence rate ratio 1.06, 95% CI 1.05-1.08) and longer hospital stays (incidence rate ratio 1.12, 95% CI 1.03-1.21) and were more likely to be high utilizers of physician visits (OR 1.23, 95% CI 1.10-1.37). Physician and hospital costs were $775 higher for children born by cesarean delivery compared with vaginal birth.Conclusions: Cesarean delivery compared with vaginal birth is associated with small but statistically significant increases in healthcare utilization and costs during the first 7 years of life. [ABSTRACT FROM AUTHOR]