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Background: Whether health inequalities of disease burden and medical utilization exist by ethnicity in Asian breast cancer (BC) patients remains unclear. The authors aim to measure ethnic disparities in disease burden and utilization among Mongolian and Han female BC patients in China. Materials and methods: Based on data extracted from Inner Mongolia Regional Health Information Platform, a retrospective cohort study was established during 2012-2021. Disease burden including incidence, 5-year prevalence, mortality, survival rate, and medical cost were analyzed and compared between Han and Mongolian patients. Results: A total of 34 878 female patients [mean (SD) age, 52.34 (10.93) years] were included among 18.19 million Chinese, and 4315 (12.03%) participants were Mongolian. Age-standardized rates of incidence are 32.68 (95% CI: 20.39-44.98) per 100 000. Higher age-specific incidence and 5-year prevalence were observed in Mongolian than in Han. The cost of BC annually per capita was significantly lower for Mongolian than Han [$1948.43 (590.11-4 776.42) vs. $2227.35 (686.65-5929.59), P<0.001]. Mongolian females showed higher all-cause mortality [30.92 (95% CI: 28.15-33.89) vs. 27.78 (95% CI: 26.77-28.83) per 1000, P= 0.036] and BC-specific mortality [18.78 (95% CI: 16.64-21.13) vs. 15.22 (95% CI: 14.47-16.00) per 1000, P =0.002] than Han females. After adjusting covariates, Mongolian were associated with increased all-cause mortality [HR, 1.21, (95% CI: 1.09-1.34); P<0.001] and BC-specific mortality [HR, 1.31, (95% CI: 1.14-1.49); P <0.001]. Conclusion: The findings of this cohort study highlight a higher level of disease burden with unmet medical demand in Mongolian patients, suggesting that more practical efforts should be made for the minority. Further research is needed to explore the concrete mechanisms of the disparities as well as eliminate health disproportion. [ABSTRACT FROM AUTHOR]

Yen-Hsun Huang,1 Hsien-Chih Chiou,1 Chun-Hung Pan,1,2 I-Shuan Wang,1 Ya-Tang Liao,3 Sheng-Siang Su,1 Chiao-Chicy Chen,4– 6 Chian-Jue Kuo1,4,5 1Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; 2Department of Psychology, National Chengchi University, Taipei, Taiwan; 3Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; 4Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; 5Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; 6Department of Psychiatry, Mackay Memorial Hospital, Taipei, TaiwanCorrespondence: Chian-Jue Kuo, Department of General Psychiatry, Taipei City Psychiatric Center, 309 Sung-Te Road, Taipei, 110, Taiwan, Email tcpckuo@seed.net.twBackground: Patients with asthma experience more physical, psychological, and financial burdens; a link between asthma and suicidality has been reported in research.Purpose: This study analyzed the medical utilization and comorbidity before their self-injurious behavior in patients with asthma.Methods: We enrolled 186,862 patients newly diagnosed with asthma between 1999 and 2013 from the National Health Insurance Research Database in Taiwan. A total of 500 case subjects had ever conducted self-injurious behaviors during the study period. Based on a nested case-control study, each case was matched with 10 controls derived from the asthma cohort to analyze differences between them and their medical use models.Results: The results indicated that, compared to the control group, the cases presented higher frequencies of outpatient visits and hospitalizations. Regarding comorbidity, the cases had more cardiovascular diseases (adjusted odds ratio [aOR]=1.58; p< 0.001), bipolar disorder (aOR=2.97; p< 0.001), depression (aOR=4.44; p< 0.001), and sleep disorder (aOR=1.83; p< 0.001) than the controls.Conclusion: The evidence-based information serves as a reference for medical staff to reduce the occurrence of self-injurious behavior in patients with asthma.Keywords: self-injurious behavior, asthma, medical utilization, psychiatric comorbidity, physical comorbidity

Introduction: Unexplained physical signs and symptoms represent a significant portion of patient presentations in acute care settings. Even in cases where a patient presents with a known medical condition, functional or somatic symptoms may complicate the diagnostic and treatment processes and prognostic outcome. One umbrella category for neurologically related somatic symptoms, functional neurological disorder (FND), presents as involuntary neurological symptoms incompatible with another medical condition. Symptoms may include weakness and/or paralysis, movement disorders, non-epileptic seizures, speech or visual impairment, swallowing difficulty, sensory disturbances, or cognitive symptoms (1). While FND presents as neuropsychiatric, providers commonly report feeling hesitant to diagnose these disorders. Inexperience or lack of appropriate education on relevant research regarding evidence-based practices or standard of practice (SOP) may result in over- or underperforming diagnostic workups and consultations, utilizing inappropriate medications, and failing to offer evidence-based psychological interventions. Being mindful of these challenges when treating patients presenting with functional symptoms in acute care settings can help to support and protect the patients and care team and appropriately control healthcare costs. Methods: The University of Alabama at Birmingham Medical Center identified cases representing categories of quality and safety problems that arise in treating FND in acute care settings. Patients signed a consent form to participate in the case report. The case information for each was presented without identifying information. Discussion: The cases highlight potential challenges when caring for patients presenting with FND in acute care settings. The challenges covered include over- or underutilization of diagnostic workups and consultation, over- or underutilization of psychopharmacological medications, and over- or undertreating a medical condition when a functional symptom is present. In each case, these lapses and errors caused the patient distress, additional treatments, care delays, and delayed symptom remission. Additionally, these challenges have direct and indirect fiscal costs, which can be mitigated with the appropriate education and training, resources, and protocols. Hospitals can benefit from system-wide SOP to improve the identification and management of FND to prevent harm to patients. An SOP commonly presents to specific specialties and ensures the appropriate diagnostic workup, consultations, and timely evidence-based interventions. [ABSTRACT FROM AUTHOR]

Case management (CM)-based community therapy for patients with schizophrenia had little effect on reducing suicide mortality. We investigate the long-term suicide mortality outcome and associated risk factors in patients with schizophrenia receiving homecare (CM) in Taiwan. We enrolled a nationwide cohort of patients with schizophrenia who newly received homecare CM intervention (n = 13 317) between January 1, 2001, and December 31, 2015; their data were derived from Taiwan's National Health Insurance Research Database. We calculated the incidence rate of suicide methods. We examined the demographic and medical utilization profile for suicide and then performed a nested case–control study and multivariate regression to identify independent risk factors for suicide mortality. Among the 13 317 patients who received homecare CM intervention, 1766 died during the study period, of whom 213 died by suicide, which is the leading cause of unnatural death. Jumping from a high place, self-poisoning, and hanging were the top 3 suicide methods. Increased medical utilization was noted for both psychiatric and non-psychiatric services within 3 months of suicide mortality. Comorbidities of depressive disorder, nonspecific heart diseases, pneumonia, and gastrointestinal ulcers were identified as independent risk factors for suicide mortality. Suicide was the leading cause of unnatural mortality in patients with schizophrenia receiving homecare CM intervention in Taiwan. We noted the preferred suicide methods, high medical utilization, and comorbidities before suicide. Thus, we suggest that the CM team should assess lethal methods for suicide and ensure that patients adhere to psychiatry treatment for improving the current care model for this specified population. [ABSTRACT FROM AUTHOR]

IntroductionUnexplained physical signs and symptoms represent a significant portion of patient presentations in acute care settings. Even in cases where a patient presents with a known medical condition, functional or somatic symptoms may complicate the diagnostic and treatment processes and prognostic outcome. One umbrella category for neurologically related somatic symptoms, functional neurological disorder (FND), presents as involuntary neurological symptoms incompatible with another medical condition. Symptoms may include weakness and/or paralysis, movement disorders, non-epileptic seizures, speech or visual impairment, swallowing difficulty, sensory disturbances, or cognitive symptoms (1). While FND presents as neuropsychiatric, providers commonly report feeling hesitant to diagnose these disorders. Inexperience or lack of appropriate education on relevant research regarding evidence-based practices or standard of practice (SOP) may result in over- or underperforming diagnostic workups and consultations, utilizing inappropriate medications, and failing to offer evidence-based psychological interventions. Being mindful of these challenges when treating patients presenting with functional symptoms in acute care settings can help to support and protect the patients and care team and appropriately control healthcare costs.MethodsThe University of Alabama at Birmingham Medical Center identified cases representing categories of quality and safety problems that arise in treating FND in acute care settings. Patients signed a consent form to participate in the case report. The case information for each was presented without identifying information.DiscussionThe cases highlight potential challenges when caring for patients presenting with FND in acute care settings. The challenges covered include over- or underutilization of diagnostic workups and consultation, over- or underutilization of psychopharmacological medications, and over- or undertreating a medical condition when a functional symptom is present. In each case, these lapses and errors caused the patient distress, additional treatments, care delays, and delayed symptom remission. Additionally, these challenges have direct and indirect fiscal costs, which can be mitigated with the appropriate education and training, resources, and protocols. Hospitals can benefit from system-wide SOP to improve the identification and management of FND to prevent harm to patients. An SOP commonly presents to specific specialties and ensures the appropriate diagnostic workup, consultations, and timely evidence-based interventions.

Background: From 2020 to 2022, South Korea has experienced significant direct and indirect damage because of the coronavirus pandemic. Preventive measures aimed at controlling the spread of the virus have inadvertently limited healthcare accessibility for patients without COVID-19, leading to detrimental consequences, particularly for patients with chronic diseases. Hence, there is a growing need to comprehensively examine the changes in healthcare utilization among patients with chronic diseases owing to the COVID-19 pandemic, along with the associated factors and health outcomes. Methods: To examine changes in healthcare utilization among patients with chronic diseases and their impact on health outcomes, we used the NHIS database. Logistic regression analysis was used to investigate changes in healthcare utilization, and a two-part model was applied to explore the effects of reduced healthcare utilization on hospitalization status and length of hospital stay. Results: Since the onset of the pandemic, the likelihood of hospitalization has been 1.10 times higher than that during pre-pandemic times in the population groups with a 20 % decrease in outpatient healthcare utilization. Notably, individuals belonging to the low-income group exhibited a 1.77-fold higher likelihood of hospitalization than those in the high-income group. Furthermore, in cases where hospitalization could have been avoided, low-income individuals had an extended hospital stay of 16.7 days compared with high-income individuals. Conclusion: There is a need for a more proactive approach for classifying patients with chronic diseases based on various vulnerability factors to effectively respond to future novel infectious diseases and reduce the long-term burden on the nation.

Abstract Background Adults with back pain commonly consult chiropractors, but the impact of chiropractic use on medical utilization and costs within the Canadian health system is unclear. We assessed the association between chiropractic utilization and subsequent medical healthcare utilization and costs in a population-based cohort of Ontario adults with back pain. Methods We conducted a population-based cohort study that included Ontario adult respondents of the Canadian Community Health Survey (CCHS) with back pain from 2003 to 2010 (n = 29,475), followed up to 2018. The CCHS data were individually-linked to individual-level health administrative data up to 2018. Chiropractic utilization was self-reported consultation with a chiropractor in the past 12 months. We propensity score-matched adults with and without chiropractic utilization, accounting for confounders. We evaluated back pain-specific and all-cause medical utilization and costs at 1- and 5-year follow-up using negative binomial and linear (log-transformed) regression, respectively. We assessed whether sex and prior specialist consultation in the past 12 months were effect modifiers of the association. Results There were 6972 matched pairs of CCHS respondents with and without chiropractic utilization. Women with chiropractic utilization had 0.8 times lower rate of cause-specific medical visits at follow-up than those without chiropractic utilization (RR5years = 0.82, 95% CI 0.68-1.00); this association was not found in men (RR5years = 0.96, 95% CI 0.73–1.24). There were no associations between chiropractic utilization and all-cause physician visits, all-cause emergency department visits, all-cause hospitalizations, or costs. Effect modification of the association between chiropractic utilization and cause-specific utilization by prior specialist consultation was found at 1-year but not 5-year follow-up; cause-specific utilization at 1 year was lower in adults without prior specialist consultation only (RR1year = 0.74, 95% CI 0.57–0.97). Conclusions Among adults with back pain, chiropractic use is associated with lower rates of back pain-specific utilization in women but not men over a 5-year follow-up period. Findings have implications for guiding allied healthcare delivery in the Ontario health system.

Objective: This study sought to investigate mental disorder and mortality risks and medical utilization among various long-term care (LTC) services and examine the associated factors. Methods: This retrospective cohort study used data from the National Health Insurance Research Database of the entire population of Taiwan recorded between 2006 and 2017. A total of 41,407 patients using LTC (study group) were identified and propensity score–matched with 41,407 LTC nonusers (control group) at a ratio of 1:1 according to sex, age, salary-based premium, comorbidity index score, and urbanization level. Patients were divided into four groups according to LTC service type. The age distribution was as follows: 50–60  years (10.47%), 61–70  years (14.48%), 71–80  years (35.59%), and 81  years and older (39.45%). The mean age was 70.18  years and 53.57% of female participants were included. The major statistical methods were the Cox proportional hazards model and the general linear model (GLM). Results: Users of both institutional and inhome LTC services had the highest risk of mental disorder [adjusted hazard ratio (aHR)  =  3.2]. The mean mortality rate in LTC nonusers was 46.2%, whereas that in LTC users was 90.4%, with the highest found among the users of both institutional and inhome LTC (90.6%). The institutional LTC users had the shortest survival time (4.1  years). According to the adjusted Cox model analysis, the odds of mortality was significantly higher among institutional LTC users than among inhome LTC users (aHR  =  1.02). After the adjustment of covariates, adjusted GLM model results revealed that the annual medical expenditure per capita of LTC nonusers was NT$46,551, which was 1.6 times higher that of LTC users. Conclusion: Users of both institutional and inhome LTC services have higher risk of mental disorder, shorter survival time, and lower medical utilization. [ABSTRACT FROM AUTHOR]

Background: Adults with back pain commonly consult chiropractors, but the impact of chiropractic use on medical utilization and costs within the Canadian health system is unclear. We assessed the association between chiropractic utilization and subsequent medical healthcare utilization and costs in a population-based cohort of Ontario adults with back pain. Methods: We conducted a population-based cohort study that included Ontario adult respondents of the Canadian Community Health Survey (CCHS) with back pain from 2003 to 2010 (n = 29,475), followed up to 2018. The CCHS data were individually-linked to individual-level health administrative data up to 2018. Chiropractic utilization was self-reported consultation with a chiropractor in the past 12 months. We propensity score-matched adults with and without chiropractic utilization, accounting for confounders. We evaluated back pain-specific and all-cause medical utilization and costs at 1- and 5-year follow-up using negative binomial and linear (log-transformed) regression, respectively. We assessed whether sex and prior specialist consultation in the past 12 months were effect modifiers of the association. Results: There were 6972 matched pairs of CCHS respondents with and without chiropractic utilization. Women with chiropractic utilization had 0.8 times lower rate of cause-specific medical visits at follow-up than those without chiropractic utilization (RR5years = 0.82, 95% CI 0.68-1.00); this association was not found in men (RR5years = 0.96, 95% CI 0.73–1.24). There were no associations between chiropractic utilization and all-cause physician visits, all-cause emergency department visits, all-cause hospitalizations, or costs. Effect modification of the association between chiropractic utilization and cause-specific utilization by prior specialist consultation was found at 1-year but not 5-year follow-up; cause-specific utilization at 1 year was lower in adults without prior specialist consultation only (RR1year = 0.74, 95% CI 0.57–0.97). Conclusions: Among adults with back pain, chiropractic use is associated with lower rates of back pain-specific utilization in women but not men over a 5-year follow-up period. Findings have implications for guiding allied healthcare delivery in the Ontario health system. [ABSTRACT FROM AUTHOR]

Home health care (HHC) and nursing home care (NHC) are mainstays of long-term service in the aged population. Therefore, we aimed to investigate the factors associated with 1-year medical utilization and mortality in HHC and NHC recipients in Northern Taiwan. This study employed a prospective cohort design. We enrolled 815 HHC and NHC participants who started receiving medical care services from the National Taiwan University Hospital, Beihu Branch between January 2015 and December 2017. Multivariate Poisson regression modeling was used to quantify the relationship between care model (HHC vs NHC) and medical utilization. Cox proportional-hazards modeling was used to estimate hazard ratios and factors associated with mortality. Compared with NHC recipients, HHC recipients had higher 1-year utilization of emergency department services [incidence rate ratio (IRR) 2.04, 95% CI 1.16-3.59] and hospital admissions (IRR 1.49, 95% CI 1.14-1.93), as well as longer total hospital length of stay (LOS) (IRR 1.61, 95% CI 1.52-1.71) and LOS per hospital admission (IRR 1.31, 95% CI 1.22-1.41). Living at home or in a nursing home did not affect the 1-year mortality. Compared with NHC recipients, HHC recipients had a higher number of emergency department services and hospital admissions, as well as longer hospital LOS. Policies should be developed to reduce emergency department and hospitalization utilization in HHC recipients. [ABSTRACT FROM AUTHOR]

Background: This study examined the pattern of medical utilization and the distribution of comorbidities shortly before death among adolescents who died from suicide and compared these data with those of living controls. Methods: From Taiwan's National Health Insurance Research Database, this study identified adolescents aged 10–19 years who died from suicide (n = 935) between 1 January 2000, and 31 December 2016, by linking each patient with the national mortality database. The researchers conducted a nested case–control study through risk set sampling, and for each case, 20 age- and sex-matched controls (n = 18 700) were selected from the general population. The researchers applied conditional logistic regression to investigate differences in medical utilization and physical and psychiatric comorbidities between cases and controls. Results: Cases had a higher proportion of contact with the psychiatric department but a similar proportion of contact with any non-psychiatric medical department within 1 year before suicide compared with controls. There were 18.6% of adolescent suicide victims who only had contacted with a psychiatric department 3 months before suicide. Moreover, cases had a higher proportion of contact with non-psychiatric services within 3 months before suicide, particularly with emergency, surgery, and internal medicine departments. Cases had higher risks of several psychiatric disorders and physical illnesses, including heart diseases, pneumonia, and ulcer disease, than did controls. Conclusions: The findings of increased medical utilization and higher risks of physical and psychiatric comorbidities in adolescent suicide victims are crucial for developing specific interventions to prevent suicide in this population. [ABSTRACT FROM AUTHOR]

Abstract Background The public health care system in South Korea is a two-tiered system. The lowest-income population is covered by the Medical Aid program, and the remaining population is covered by the National Health Insurance. The near poor, a relatively low-income population which is excluded from South Korea’s Medical Aid program due to exceeding the income threshold, experiences insufficient use of medical services and incurs high out-of-pocket expenses due to a lack of coverage under the country’s National Health Insurance (NHI) program. This study aims to examine medical utilization, out-of-pocket spending, and the occurrence of catastrophic health expenditures among the near-poor group compared to both Medical Aid beneficiaries and other (higher income) NHI members. Methods A cross-sectional study was conducted drawing upon a nationally representative dataset derived from the 2018 Korea Welfare Panel Study. The study classified people into three groups: Medical Aid beneficiaries; the near-poor population below 50 % of the median income threshold but still not qualifying for Medical Aid and thus enrolled in NHI; and NHI members above the threshold of 50 % of the median income. Using a generalized boosted model to estimate the propensity score weights between study groups, this study examined medical utilization, out-of-pocket spending, and the occurrence of catastrophic health expenditure among the study groups. Results The findings suggest that the utilization of medical services was not significantly different among the study groups. However, out-of-pocket spending and the occurrence of catastrophic health expenditure were significantly higher in the near-poor group compared to the other two groups. Conclusions The study found that the near-poor group was the most vulnerable among the Korean population because of their higher chance of incurring greater out-of-pocket spending and catastrophic health expenditures than is the case among the Medical Aid beneficiary and above-poverty line groups. Health policy needs to take the vulnerability of this near-poor population into account.

Objective: There are few nationwide studies regarding the long-term analysis of cervical cancer patients in Taiwan. Thus, this study aimed to evaluate medical service utilization, and survival among cervical cancer patients initially diagnosed with or without anxiety and/or depressive disorders. Materials and methods: This was a retrospective longitudinal study using data from the National Health Insurance Research Database from 1996 to 2010. The study subjects were cervical cancer patients identified by ICD-9-CM codes 180.X, while subjects with anxiety and/or depressive disorders were identified using the following codes: 300.0X–300.9X (minus 300.4X) for anxiety disorder, and 296.2X, 296.3X, 300.4, and 311.X for depressive disorder. The cervical patients with anxiety or/and depression disorder were classified as anxiety/depression (AD) group or the non-disorder (ND) group. Propensity score matching (PSM) was used to adjust for differences between the AD and ND groups. T-tests were used to evaluate differences in medical utilization and the Kaplan–Meier method was used to evaluate survival conditions between the two groups. Statistical analyses were performed using SPSS Statistics 20.0. Results: A total of 3664 patients were identified, with 862 (23.5%) having anxiety, 149 (4.1%) with depression, and 349 (9.5%) having both anxiety and depression. In total, 1360 cervical cancer patients had anxiety/depression disorders. After PSM, the AD group had significantly more outpatient department (OPD) visits than the ND group (p

Background: Evidence of patterns of medical utilization and distribution of comorbidities among individuals using methamphetamine remains limited Objective: This study aims to investigate changes in medical utilization and comorbidities before and after a diagnosis of methamphetamine use disorder. Methods: A total of 3321 cases (79% were male) of methamphetamine use disorder between January 1, 1996, and December 31, 2012, were identified from Psychiatric Inpatient Medical Claims database in Taiwan. Information was collected on demographics, diagnoses, and medical utilizations. The date of newly diagnosed with methamphetamine use disorder was defined as the baseline. Mirror-image study design was used to compare changes in medical utilization and comorbidities between the pre-baseline period (within 1 year before diagnosis) and the post-baseline period (within 1 year after diagnosis). Conditional logistic regression was used to estimate changes in medical utilization and comorbidities. Results: Most cases (77%) were first identified in a psychiatric department. There is a significant increase (P <.001) in psychiatric admission (odds ratio[OR] = 2.19), psychiatric emergency visits (OR = 1.31), and psychiatric outpatient visits (OR = 1.15) after diagnosis. Multivariable analysis revealed significantly increased risks (P <.001) of non-methamphetamine drug induced mental disorders (adjusted OR[aOR] = 29.47), schizophrenia (aOR = 2.62), bipolar disorder (aOR = 2.14), organic mental disorder (aOR = 1.82), and upper respiratory tract infection (aOR = 2.03) after diagnosis. Conclusions: We found significant increases of medical utilization and psychiatric comorbidities after diagnosed with methamphetamine use disorder. These findings may reflect the problem of delayed diagnosis and treatment. Enhancement of early identification of methamphetamine use disorder in general practice is required for early intervention and decreased subsequent morbidities. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to understand the frequency of patients receiving rehabilitation services at various periods after stroke and the possible medical barriers to receiving rehabilitation. Design : A retrospective cohort study was conducted using a nationally representative sample in Taiwan. A total of 14,600 stroke patients between 2005 and 2011 were included. Utilization of physical therapy or occupational therapy at different periods after stroke onset was the outcome variable. Individual and geographic characteristics were investigated to determine their effect on patients' probability of receiving rehabilitation. Results : More severe stroke or more comorbid diseases increased the odds of receiving physical therapy and occupational therapy; older age was associated with decreased odds. Notably, sex and stroke type influenced the odds of rehabilitation only in the early period. Copayment exemption lowered the odds of rehabilitation in the first 6 mos but increased the odds in later periods. Rural and suburban patients had significantly lower odds of receiving physical therapy and occupational therapy, as did patients living in areas with fewer rehabilitation therapists. Conclusions: Besides personal factors, geographic factors such as urban-rural gaps and number of therapists were significantly associated with the utilization of post-stroke rehabilitation care. Furthermore, the influence of certain factors, such as sex, stroke type, and copayment exemption type, changed over time. [ABSTRACT FROM AUTHOR]

Abstract Background The decreased life expectancy and care costs of mental disorders could be enormous. However, research that compares mortality and utilization concurrently across the major category of mental disorders is absent. This study investigated all-cause mortality and medical utilization among patients with and without mental disorders, with an emphasis on identifying the psychiatric category of high mortality and low medical utilization. Methods A total of 570,250 individuals identified from the 2002–2013 Taiwan National Health Insurance Reearch Database consistuted 285,125 psychiatric patients and 285,125 non-psychiatric peers through 1:1 dual propensity score matching (PSM). The expenditure survival ratio (ESR) was proposed to indicate potential utilization shortage. The category of mental disorders and 13 covariates were analyzed using the Cox proportional hazard model and general linear model (GLM) through SAS 9.4. Results PSM analyses indicated that mortality and total medical expenditures per capita were both significantly higher in psychiatric patients than those in non-psychiatric patients (all P

Aims: Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are effective in reducing cardiovascular events, but their impact on all-cause mortality and medical utilization compared to statins is unclear. This study investigated PCSK9 inhibitor use and its impact on mortality and medical utilization vs. statins, using TriNetX database data with up to 9 years of follow-up., Methods and Results: This retrospective cohort study analysed TriNetX data spanning 1 July 2015, to 31 December 2023, including 79 194 PCSK9 inhibitor users (alirocumab, evolocumab, inclisiran) and 5 437 513 statin users with hyperlipidaemia. The primary outcomes were all-cause mortality and medical utilization, including hospital inpatient services, emergency department visits, critical care, and mechanical ventilation. Propensity score matching showed that PCSK9 inhibitor use was associated with a 28.3% lower risk of all-cause mortality [adjusted hazard ratio (aHR) 0.717, 95% confidence interval (CI): 0.673-0.763] and significant reductions in medical utilization (hospital inpatient services usage: aHR 0.692, 95% CI: 0.664-0.721; emergency department services: aHR 0.756, 95% CI: 0.726-0.788; critical care services: aHR 0.619, 95% CI: 0.578-0.664; and mechanical ventilation: aHR 0.537, 95% CI: 0.484-0.596) compared to statins. These findings were consistent across various demographics and clinical subgroups. The sensitivity analyses supported the robustness of the findings., Conclusion: PCSK9 inhibitors significantly reduced all-cause mortality and medical utilization compared to statins, suggesting their important role in dyslipidaemia management, particularly for statin-naïve or intolerant patients. Further research, including randomized controlled trials, is needed to confirm these findings and explore the underlying mechanisms., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Our goal was to identify discrete clinical characteristics associated with safe discharge from an emergency department/urgent care for patients with a history of cancer and concurrent COVID-19 infection during the SARS-CoV-2 pandemic and prior to widespread vaccination. We retrospectively analyzed 255 adult patients with a history of cancer who presented to Memorial Sloan Kettering Cancer Center (MSKCC) urgent care center (UCC) from March 1, 2020 to May 31, 2020 with concurrent COVID-19 infection. We evaluated associations between patient characteristics and 30-day mortality from initial emergency department (ED) or urgent care center (UCC) visit and the absence of a severe event within 30 days. External validation was performed on a retrospective data from 29 patients followed at Fred Hutchinson Cancer Research Center that presented to the local emergency department. A late cohort of 108 additional patients at MSKCC from June 1, 2020 to January 31, 2021 was utilized for further validation. In the MSKCC cohort, 30-day mortality and severe event rate was 15% and 32% respectively. Using stepwise regression analysis, elevated BUN and glucose, anemia, and tachypnea were selected as the main predictors of 30-day mortality. Conversely, normal albumin, BUN, calcium, and glucose, neutrophil–lymphocyte ratio <3, lack of (severe) hypoxia, lack of bradycardia or tachypnea, and negative imaging were selected as the main predictors of an uneventful course as defined as a Lack Of a Severe Event within Thirty Days (LOSETD). Utilizing this information, we devised a tool to predict 30-day mortality and LOSETD which achieved an area under the operating curve (AUC) of 79% and 74% respectively. Similar estimates of AUC were obtained in an external validation cohort. A late cohort at MSKCC was consistent with the prior, albeit with a lower AUC We identified easily obtainable variables that predict 30-day mortality and the absence of a severe event for patients with a history of cancer and concurrent COVID-19. This has been translated into a bedside tool that the clinician may utilize to assist disposition of this group of patients from the emergency department or urgent care setting. [ABSTRACT FROM AUTHOR]

Background: The public health care system in South Korea is a two-tiered system. The lowest-income population is covered by the Medical Aid program, and the remaining population is covered by the National Health Insurance. The near poor, a relatively low-income population which is excluded from South Korea's Medical Aid program due to exceeding the income threshold, experiences insufficient use of medical services and incurs high out-of-pocket expenses due to a lack of coverage under the country's National Health Insurance (NHI) program. This study aims to examine medical utilization, out-of-pocket spending, and the occurrence of catastrophic health expenditures among the near-poor group compared to both Medical Aid beneficiaries and other (higher income) NHI members.Methods: A cross-sectional study was conducted drawing upon a nationally representative dataset derived from the 2018 Korea Welfare Panel Study. The study classified people into three groups: Medical Aid beneficiaries; the near-poor population below 50 % of the median income threshold but still not qualifying for Medical Aid and thus enrolled in NHI; and NHI members above the threshold of 50 % of the median income. Using a generalized boosted model to estimate the propensity score weights between study groups, this study examined medical utilization, out-of-pocket spending, and the occurrence of catastrophic health expenditure among the study groups.Results: The findings suggest that the utilization of medical services was not significantly different among the study groups. However, out-of-pocket spending and the occurrence of catastrophic health expenditure were significantly higher in the near-poor group compared to the other two groups.Conclusions: The study found that the near-poor group was the most vulnerable among the Korean population because of their higher chance of incurring greater out-of-pocket spending and catastrophic health expenditures than is the case among the Medical Aid beneficiary and above-poverty line groups. Health policy needs to take the vulnerability of this near-poor population into account. [ABSTRACT FROM AUTHOR]

Abstract Background Regional variation in medical care costs can indicate heterogeneity in clinical practice, inequities in access, or inefficiencies in service delivery. We aimed to estimate regional variation in medical costs for people living with HIV (PLHIV), adjusting for demographics and case-mix. Methods We conducted a retrospective cohort study using linked health administrative databases of PLHIV, from 2010 to 2014, in British Columbia (BC), Canada. Quarterly health care costs (2018 CAD) were derived from inpatient, outpatient, prescription drugs, antiretroviral therapy (ART), and HIV diagnostics. We used a two-part model with a logit link for the probability of incurring costs, and a log link and gamma distribution for observations with positive costs. We also estimated quarterly utilization rates for hospitalization-, physician billing- and prescription drug-days. Primary variables were indicators of individuals’ Health Service Delivery Area (HSDA). We adjusted cost and utilization estimates for demographic characteristics, HIV-disease progression, and comorbidities. Results Our cohort included 9577 PLHIV (median age 45.5 years, 80% male). Adjusted total quarterly costs for all 16 HSDAs were within 20% of the provincial mean, 8/16 for hospitalization costs, 16/16 for physician billing costs and 10/16 for prescription drug costs. Northern Interior and Northeast HSDAs had 38 and 44% lower quarterly non-ART prescription drug costs, and 2 and 5% higher quarterly inpatient costs, respectively. Conclusions We observed limited variation in medical care costs and utilization among PLHIV in BC. However, lower levels of outpatient care and higher levels of inpatient care indicate possible barriers to accessing care among PLHIV in the most rural regions of the province.

Objectives: To compare healthcare utilization and medical costs between patients with seronegative (SN) and seropositive (SP) rheumatoid arthritis (RA). Methods: We conducted a nationwide population study using the Korean health insurance claims database in 2016. We divided patients with RA into SN and SP groups and compared healthcare utilization including medications, medical utilization, and direct medical costs for 1 year between the groups in a cross-sectional analysis. Differences in costs between patients with SPRA and SNRA were assessed using the quantile regression model. We performed longitudinal analysis using data from 2012 and 2016 to examine changes over time. Results: A total of 103,815 SPRA and 75,809 SNRA patients were included in the analyses. The SPRA group used significantly more methotrexate (73.2% versus 30.3%) and biologic agents (7.9% versus 2.9%) than the SNRA group. The number of RA-related outpatient visits [6.0 ± 3.7 versus 4.4 ± 4.0 times/year, standardized difference (SD) = 0.41] and annual medical costs per patient ($1027 versus $450/year, SD = 0.25) were higher in the SPRA group than the SNRA group. Quantile regression results indicated that the incremental cost of seropositivity on total medical costs of RA patients gradually increased as medical costs approached the upper quantile. The annual direct medical costs for each patient between 2012 and 2016 increased in both groups: by 25.1% in the SPRA group and 37.6% in the SNRA group. Conclusion: Annual RA-related direct medical costs and RA-related healthcare utilization per patient are higher in patients with SPRA than those with SNRA. [ABSTRACT FROM AUTHOR]

Pin-Kuei Fu,1–4 Yu-Chi Tung,1 Chen-Yu Wang,2 Sheau-Feng Hwang,5,6 Shin-Pin Lin,7 Chiann-Yi Hsu,8 Duan-Rung Chen9 1Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan; 2Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; 3Department of Biotechnology, Hungkuang University, Taichung, Taiwan; 4School of Chinese Medicine, China Medical University, Taichung, Taiwan; 5Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan; 6Palliative Care Unit, Taichung Veterans General Hospital, Taichung, Taiwan; 7Computer and Communications Center, Taichung Veterans General Hospital, Taichung, Taiwan; 8Biostatistics Task Force, Taichung Veterans General Hospital, Taichung, Taiwan; 9Institute of Health Behaviors and Community Sciences, National Taiwan University, Taipei, Taiwan Purpose: The unpredictable trajectory of COPD can present challenges for patients when faced with a decision regarding a do-not-resuscitate (DNR) directive. The current retrospective analysis was conducted to investigate factors associated with an early DNR decision (prior to last hospital admission) and differences in care patterns between patients who made DNR directives early vs late. Patients and methods: Electronic health records (EHR) were reviewed from 271 patients with terminal COPD who died in a teaching hospital in Taiwan. Clinical parameters, patterns of DNR decisions, and medical utilization were obtained. Those patients who had a DNR directive earlier than their last (terminal) admission were defined as “Early DNR” (EDNR). Results: A total of 234 (86.3%) patients died with a DNR directive, however only 30% were EDNR. EDNR was associated with increased age (OR=1.07; 95% CI: 1.02–1.12), increased ER visits (OR=1.22; 95% CI: 1.10–1.37), rapid decline in lung function (OR=3.42; 95% CI: 1.12–10.48), resting heart rate ≥100 (OR=3.02; 95% CI: 1.07–8.51), and right-sided heart failure (OR=2.38; 95% CI: 1.10–5.19). The median time period from a DNR directive to death was 68.5 days in EDNR patients and 5 days in “Late DNR” (LDNR) patients, respectively (P

Objectives: The demand for hospice care is increasing because of the rapidly aging population in Taiwan. Since 2009, health insurance payments have been expanded to cover eight categories of noncancer terminal diseases, thus making hospice care accessible to more people. Previous discussions on hospice care have focused only on patients with end-of-life cancer, to the neglect of other patients. This study fi lls this gap by exploring the effect of hospice care expenses and utilization on patients with cancer and patients with noncancer terminal diseases. Methods: Data were obtained from the Million People File - a study of 5,062 adult patients with either cancer or diseases in one of the eight categories of noncancer terminal diseases who died in 2012. Multivariate logistic regression and linear regression were used to verify the use of hospice care for end-of-life aggressive care utilization and overall medical expenses. Results: End-of-life patients receiving hospice care used fewer aggressive treatments 30 days prior to death, including use of intensive care units, intubations, mechanical ventilation, and cardiopulmonary resuscitation, and were less likely to die in a hospital. The use of hospice care reduced the total cost of medical care in the fi nal months before death. Conclusions: In general, for end-of-life patients receiving hospice care, the use of aggressive care before death has been declining. End-of-life patients treated with hospice care had better care quality and less medical utilization. The total medical expenses for hospice care decreased during the fi nal month prior to death. [ABSTRACT FROM AUTHOR]

This study explored the characteristics of medical care utilization in patients encountering traffic accidents according to injury severity. Retrospective cohort study. Population-based study. Patients claiming automobile insurance due to a traffic accident between 2014 and 2019 were included in the study (n=11,476,597). Patients without medical institution information after a traffic accident were excluded (n=5). This was an observational study. The main outcome of this study was the severity of injury caused by traffic accidents. We reviewed automobile insurance data from the Health Insurance Review & Assessment Service between 2014 and 2019. Patients with traumatic injuries were identified using the International Classification of Diseases, 10th revision (S or T codes). Injury severity was defined using an Excess Mortality Ratio-adjusted Injury Severity Score (EMR-ISS). Injury severity was classified as mild (EMR-ISS ≤ 8), moderate (9 ≤ EMR-ISS ≤ 24), or severe (EMR-ISS ≤ 24). Between 2014 and 2019, the proportion of mild injuries was the highest, followed by moderate and severe injuries. The age- and sex-adjusted incidence of traffic accidents increased significantly (34.4 per 1,000 cases in 2014; 42.0 per 1,000 cases in 2019). After stratification according to severity, only the incidence of mild injuries were found to increase significantly. The use of Korean medicine hospitals by all patients encountering traffic accidents increased significantly from 3.5% in 2014 to 14.2% in 2019; particularly, the use of Korean medicine hospitals increased most rapidly in patients with mild injuries. From 2014 to 2019, although the proportion of inpatient care for patients encountering traffic accidents gradually decreased, the median total medical costs increased, while the median length of stay remained constant. Patients encountering traffic accidents presented different characteristics of medical utilization according to the severity of injury. Our findings can contribute to the development of strategies for providing medical services tailored to the severity of patients encountering traffic accidents. This study was supported by a grant from the Ministry of Land, Infrastructure and Transport (MOLIT) Research Fund (NTRH RF-2023001). [ABSTRACT FROM AUTHOR]

Jeong Uk Lim,1 Kyungjoo Kim,2 Sang Hyun Kim,3 Myung Goo Lee,4 Sang Yeub Lee,5 Kwang Ha Yoo,6 Sang Haak Lee,1 Ki-Suck Jung,7 Chin Kook Rhee,2 Yong Il Hwang7 1Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, St Paul’s Hospital, 2Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, 3Big Data Division, Health Insurance Review and Assessment Service, Wonju, 4Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, 5Department of Internal Medicine, Korea University, Anam Hospital, 6Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, 7Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Republic of Korea Introduction: Patients with mild to moderate chronic obstructive pulmonary disease (COPD) are underdiagnosed and undertreated due to the asymptomatic nature of the disease. Previous studies on patients with mild COPD have focused on symptomatic patients. Therefore, in this study, we evaluated the treatment status of patients with early COPD in Korea.Materials and methods: We compared hospital visits, medical costs per person, and COPD medication use by patients with COPD screened from the general population and COPD cohort patients. Patients with COPD aged ≥40 years with the value of forced expiratory volume in 1 s (FEV1) ≥60% were selected from the 2007 to 2012 Korea National Health and Nutrition Examination Survey (KNHANES) data. Data including the number of outpatient clinic visits, admission to hospitals, COPD-related medications, and medical costs were obtained from the Health Insurance Review and Assessment Service and were compared with the data of patients with COPD with FEV1 ≥60% from the Korean COPD Subtype Study (KOCOSS) cohort.Results: Based on EuroQol 5-dimension questionnaire index scores of 0.9±0.14, we found that patients with COPD from the KNHANES group showed few symptoms compared to those from the KOCOSS cohort. In 2007, among the patients with COPD with an FEV1 value of ≥60%, only 3.6% from the KNHANES group and 30% from the KOCOSS cohort visited medical facilities. Total medical cost per person per year increased from 264.37±663.41 US Dollars (USD) in 2007 to 797.00±2,724.21 USD in 2012 for the KNHANES group. In 2012, only 20.7% of the patients from KNHANES database received long-acting muscarinic agonists (LAMA), whereas 78.7% of the patients from KOCOSS database received LAMA.Conclusion: Medical resource utilization and medical costs per person for patients with early COPD in Korea increased. However, asymptomatic patients with COPD represented by the KNHANES group do not receive adequate long-term treatment compared to relatively symptomatic patients, and require more clinical attention from physicians. Keywords: early COPD, medical cost, medical utilization

Extant research provides equivocal conclusions if the combined presentation of health anxiety with severe somatic symptoms confers risk for greater future primary care usage. The present study further examined the combination of health anxiety and somatic symptoms as a predictor of healthcare usage in primary care. Using a prospective longitudinal design, a large sample (N = 530) of patients presenting for treatment at a community health center completed self-report measures assessing health anxiety and somatic symptom severity. A medical record review at the time of questionnaire administration and 1 year following that administration was completed to assess the frequency of medical visits during the preceding and subsequent year. As expected, the interactive effect between health anxiety and somatic symptom severity predicted greater subsequent year medical visits. Covariates included preceding year medical visits, sociodemographic variables, body mass index, smoking status, and depressive symptom severity. Simple effects indicated that health anxiety predicted greater subsequent year medical visits when coupled with relatively severe, but not mild, somatic symptoms. Assessing health anxiety and somatic symptom severity in primary care settings could be important for identifying individuals at risk for future frequent healthcare visits and who may benefit from intervention. [ABSTRACT FROM AUTHOR]

Objective: The impact of natural disasters on medical utilization is largely unknown and often overlooked how it affects bereaving and non-bereaving survivors. The aim of this study is to determine the medical utilization between both survivor groups and long-term effects.Study Design: A 10-year 1999-2009 population-based retrospective study by using the National Health Insurance claim database and the Household Registration database from the Department of Health, Executive Yuan, Taiwan.Settings: Taiwan 1999 Chi-Chi earthquake-affected areas.Participants: A total of 49 834 individuals which included 1183 bereaving survivors and 48 651 non-bereaving earthquake survivors.Intervention(s): None.Main Outcome Measures: Medical utilization of bereaving and non-bereaving survivors.Results: The results showed that bereaving survivors had significantly more outpatient visits before the earthquake, within 3-month period and 1 year after earthquake (odds ratio (OR) = 1.11, 1.16 and 1.08). However, after 1 year after earthquake their outpatient visits were not significantly different from non-bereaving, and even significantly less in some years. Inpatient visits of bereaving survivors had similar trend to outpatient visits, i.e. visits were more both before earthquake and within 3-month period after earthquake (OR = 1.59 and 1.89), however, they were not significantly higher than non-bereaving survivors for the following years of the study.Conclusion: Our study reveals that compared to non-bereaving survivors, bereaving survivors slightly had higher medical utilization in the beginning stage of earthquake, i.e. for the first 3-month period or 1 year after earthquake. However, there were no differences between these two groups in medical utilization including outpatient and inpatient visits in long run. [ABSTRACT FROM AUTHOR]

Jongmin Lee,1 Jae Ha Lee,1 Jee-Ae Kim,2 Chin Kook Rhee1 1Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, 2Pharmaceutical Policy Evaluation Research Team, Research Institution, Health Insurance Review and Assessment Service, Wonju-si, Republic of Korea Background: There are only a few longitudinal studies regarding medical utilization and costs for patients with COPD. The purpose of this study was to analyze the trend of medical utilization and costs on a long-term basis. Methods: Using the Korean Health Insurance Review and Assessment Service (HIRA) data from 2008 to 2013, COPD patients were identified. The trend of medical utilization and costs was also analyzed. Results: The number of COPD patients increased by 13.9% from 2008 to 2013. During the same period, the cost of COPD medication increased by 78.2%. Methylxanthine and systemic beta agonists were most widely prescribed between 2008 and 2013. However, inhaled medications such as long-acting beta-2 agonist (LABA), long-acting muscarinic agonist, and inhaled corticosteroid plus LABA were dispensed to a relatively low proportion of patients with COPD. The number of patients who were prescribed inhaled medications increased gradually from 2008 to 2013, while the number of patients prescribed systemic beta agonist and methylxanthine has decreased since 2010. Conclusion: This study shows that there is a large gap between the COPD guidelines and clinical practice in Korea. Training programs for primary care physicians on diagnosis and guideline-based treatment are needed to improve the management of COPD. Keywords: pulmonary disease, chronic obstructive, drug prescriptions, medical utilization, medical cost

Taiwan has one of the fastest growing aging populations in the world, which makes the effective allocation of scarce medical resources a key issue. This paper investigates patterns in the use of outpatient services by elderly individuals in Taiwan under the National Health Insurance (NHI) program. Methods: We assembled a random sample from the NHI Research Database in Taiwan, comprising 50% of all claims made for elderly people (65 years old) in 2010 (n 1,239,836 beneficiaries) including 14 variables. Results: In 2010, individuals aged 65 years or older comprised 10.74% of the population of Taiwan, and accounted for 11.39% of all physician and outpatient visits. The rate of medical care visits was 28.54 ± 21.23 (Standard deviation) times per person per annum, with a higher rate for women, those in the 80–84 age group, low-income beneficiaries, and the inhabitants of offshore islands. The three most frequent diagnoses for elderly patients were hypertension, diabetes, and acute upper respiratory infections. The mean insured medical costs per person per annum were US Dollars 1,132, with higher expenses for men, those in the 80–84 age group, and those inhabiting urban areas. Conclusion: This study employed nationally representative data in the detection of patterns in outpatient care utilization by elderly individuals in Taiwan. Medical care providers and policymakers should be fully aware of the complex patterns unique to older patients. The results of this study could be used as a benchmark with which to assess the impact of future medical care policy on elderly people.

Aim: To examine whether long‐term care insurance (LTCI) reduces medical utilization and the burden of medical costs of beneficiaries. Methods: The elderly cohort database of the National Health Insurance Service during 2005–2013 was used. The participants were 3029 beneficiaries who received consecutive LTCI services. We carried out a 1:3 case–control match on the propensity score to select a comparison group, and the final participants were 12 116 people, including 9087 who formed the control group. The dependent variables were semi‐annually measured medical utilizations (inpatient, outpatient and drug prescription) and the burden of medical costs at the individual level. This study applied the method of generalized estimating equations to the data. Results: The present study showed that the number of hospitalizations of beneficiaries significantly decreased compared with non‐beneficiaries (ratio 0.95, 95% CI 0.95–0.96). Similarly, the length of stay of beneficiaries also showed a significant reduction compared with non‐beneficiaries (ratio 0.76, 95% CI 0.73–0.79). The number of outpatient visits and receipt of drug prescriptions of beneficiaries and non‐beneficiaries increased marginally. The burden of medical costs of beneficiaries reduced considerably compared with non‐beneficiaries (ratio 0.80, 95% CI 0.77–0.83). Conclusions: The study results show that the burden of medical costs for LTCI beneficiaries were significantly reduced compared with non‐beneficiaries, despite the rise in medical costs among older adults. The positive effect of LTCI supports continuous implementation and expansion of the LTCI service for non‐beneficiaries who require care assistance. Geriatr Gerontol Int 2018; 18: 1641–1646. [ABSTRACT FROM AUTHOR]

Wellness programs constitute central components of disease prevention efforts under the Affordable Care Act and are likely to remain a component of employer provided health insurance. This paper evaluates the impact of such programs on medical utilization 4 to 7 years after enrollment in the plan. Using a unique suited data provided by a large private employer, I analyze medical expenditure and utilization for individuals enrolled in a wellness plan. The analysis compares expenditures and visits between wellness members and nonmembers who are matched through propensity score methods. The results show that although the wellness program increases utilization of preventive and outpatient care, by as much as 1.57 visits per year, there is no comparable decline in emergency or inpatient care, resulting in an overall increase in medical expenditure of around $507 per person per year. The increase in medical expenditure persists even 6 to 7 years of continued enrollment in wellness. I find some evidence of improved health, as diagnoses of diabetes decline 0.8 percentage points among wellness members. The results suggest that employer savings stemming from improved health and more judicious use of medical services are not likely to materialize in this wellness program. [ABSTRACT FROM AUTHOR]

Background: Patients with alcohol dependence (AD) often seek help from medical professionals due to alcohol-related diseases, but the overall distribution of medical specialties identifying new AD cases is unclear. We investigated how such cases were identified and how medical resources were utilized before the identification of AD in a nationwide cohort.Methods: We enrolled a population-based cohort (N = 1,000,000) using the National Health Insurance Research Database of Taiwan; 8181 cases with incident AD were retrieved between January 1, 2000, and December 31, 2010. For this nested case-control study, four controls were matched for age and sex with each case based on risk-set sampling. We measured various dimensions of medical utilization before AD was diagnosed, including department visited, physical comorbidity, and medication used. Conditional logistic regression was used for estimating the variables associated with AD.Results: Patients living in less urbanized areas who were unemployed were more likely to develop AD. The highest proportions (34.2%) of AD cases were identified in the internal medicine department, followed by the emergency (22.3%) and psychiatry (18.7%) departments. AD patients had a higher risk of comorbid chronic hepatic disease (adjusted RR = 2.72, p < 0.001) before identification of AD than controls. AD patients also had greater numbers of hospital admissions than controls, including non-psychiatric and psychiatric hospitalizations. Outpatient visit numbers were similar for AD patients and controls.Conclusions: The findings indicate that clinicians providing care in diverse medical settings should be prepared to screen for unhealthy alcohol use and to mitigate its detrimental effects. [ABSTRACT FROM AUTHOR]

Background: It is not clear whether the benefits of tracheostomy remain the same in the population. This study aimed to better examine the effect of tracheostomy on clinical outcome among prolonged ventilator patients. Methods: Data were from the medical claims data in Taiwan. A total of 3880 patients with ventilator use for more than 14 days between 2005 and 2009 were identified. Among them, 645 patients with tracheostomy conducted within 30 days of ventilator use were compared to 2715 patients without tracheostomy on death during hospitalization and study period, and successful weaning and medical utilization during hospitalization. Cox proportional hazards and linear regression models were used to examine the associations between tracheostomy and the main outcomes. Results: The tracheostomy rate was 30%, and 55% of tracheostomies were performed within 30 days of mechanical ventilation. After adjustments, patients with tracheostomy were at a lower risk of death during hospitalization (hazard ratio [HR] =0.51; 95% confidence interval [CI] =0.43–0.61) and 5-year observation (HR = 0.73; 95% CI = 0.66–0.81), and a lower probability of successful weaning (HR = 0.88; 95% CI = 0.79–0.99). Higher medical use was also observed in patients with tracheostomy. Conclusions: The beneficial effect for tracheostomy observed in our data was the reduction of death. However, patients with tracheostomy were less likely to wean and more likely to consume medical resources.

Objective: The aim of this paper was to analyze medical utilization patterns of female patients with anorexia nervosa before their first inpatient care visit for anorexia nervosa using the National Health Insurance Research Database (NHIRD) of Taiwan.Method: We selected female anorexia nervosa patients (n=239) and control participants hospitalized for peptic ulcers (n=478) or appendectomy (n=478) who were matched by age and incident year from two subsets of the NHIRD. The number of visits, specialists, diagnosis distribution, and selected procedures used in ambulatory services during the 2-year period before the index admission were identified and compared. Healthcare service expenditures were also analyzed.Results: Compared to the control groups, the female anorexia nervosa patients used more outpatient services (anorexia nervosa, 58.6±45.0 visits; peptic ulcers, 45.3±37.3 visits; appendectomy, 32.5±26.0 visits), mainly due to psychiatric visits. Anorexia nervosa patients were more likely to have received a diagnosis of digestive, endocrine/metabolic, and mental disorders than patients in the control groups. Although nearly equal percentages of patients in the three groups had obtained a diagnosis of a digestive disease, anorexia nervosa patients received digestive disease diagnoses with greater frequency.Conclusions: We posit that the various physical symptoms of anorexia nervosa patients and physicians' low level of suspicion of anorexia nervosa led to delayed diagnoses and greater medical utilization than that of the controls groups. Education to raise awareness of anorexia nervosa and other eating disorders among physicians is warranted. [ABSTRACT FROM AUTHOR]

Health anxiety is commonly seen in medical clinics and is related to the overutilization of primary care services, but existing studies have not yet considered the possible moderating effect of age. We examined if age moderated the association between health anxiety and medical utilization. A secondary aim was to examine potential racial/ethnic differences in health anxiety. An ethnoracially diverse group of patients ( N = 533) seeking treatment from a primary care clinic completed a self-report measure of health anxiety. Three indices of medical utilization were assessed using medical records, including the number of: (a) clinic visits over the past two years, (b) current medications, and (c) lab tests over the past two years. Age moderated the effect of health anxiety on multiple indices of medical utilization. Supplemental analyses found that the moderating effect of age was specific to a somatic/body preoccupation, rather than health worry, dimension of health anxiety. Mean-level differences in health anxiety were either not supported (health anxiety composite, somatic/body preoccupation) or were small in magnitude (health worry) among self-identifying Black, Latino, and White participants. Results indicate that assessing for health anxiety could be particularly important for older adult patients who frequently seek out medical services. [ABSTRACT FROM AUTHOR]

Objectives: A clinical manifestation of rheumatic disease is chronic inflammation that may increase the risk of cancer. The purpose of this study was to explore the risk of cancer and the precancerous medical utilization by children with rheumatism in Taiwan. Methods: This was a retrospective study with secondary data analysis. The data were drawn from the National Health Insurance Research Database from 2000 to 2012. Patients under the age of 18 with a diagnosis of pediatric rheumatic disease, including systemic lupus erythematosus, juvenile idiopathic arthritis, Sjögren’s syndrome, scleroderma, polymyositis, dermatomyositis, vasculitis and Behçet’s disease. A total of 1,741 cases were identified. The Cox proportional hazards model was used to analyze the risk of cancer, and the Mann-Whitney U Test was used to assess whether the patient’s medical use was different from that in the year prior to the diagnosis of cancer. Results: The overall risk for children with rheumatism compared with non-rheumatic patients was 3.71 times the risk for cancer; for systemic lupus erythematosus, juvenile idiopathic arthritis and Sjögren’s syndrome, the cancer risk was 3.94 times, 5.93 times and 5.29 times, respectively. The risk for cancer was increased by 5.65 times in those who had used immunoregulatory drugs, and this was 26.01 times more than that of those who had used biological agents. For children with rheumatism, in the year before the diagnosis of cancer and in terms of overall medical use before cancer, the number of outpatient visits and expenses increased, but the number of hospitalizations, hospital days, and cost reduction were not significantly different. Conclusions: Based on the results of this study, we suggest that the health authorities pay more attention to the medical care of children with rheumatism in order to avoid future social costs. [ABSTRACT FROM AUTHOR]

Background: Age-related loss of skeletal muscle mass (SMM) and function (sarcopenia) are associated with poor health outcomes and an economic burden on health care services. An appropriate diet and physical activity have been proposed for prevention and treatment of sarcopenia. Nevertheless, the effects on medical service utilization and costs remain unclear. This study determined the effects of SMM in conjunction with diet quality and physical activity on medical service utilization and expenditure in community-dwelling older Taiwanese. Methods: In total, 1337 participants from the Elderly Nutrition and Health Survey in Taiwan (1999-2000) were enrolled. An SMM index [SMMI, calculated by dividing SMM (kg) by height (m²)] was used as the marker of sarcopenia. Participants with the lowest SMMI quartiles (<11.4 kg/m² for men and 8.50 kg/m² for women) comprised the high-risk group, and the remainder comprised the low-risk group. Dietary information (dietary diversity: low and high) and physical activity (low and moderate) were obtained at baseline. Annual medical service utilization and expenditure were calculated from National Health Insurance claims until December 31, 2006. Generalized linear models were used to determine the association between the SMMI and annual medical service utilization and costs in conjunction with dietary diversity or physical activity. Results: After 8 follow-up years, regardless of gender, participants in the high-risk group reported significantly more hospitalization (days and expenditure) and total medical expenditure. Participants in the high-risk group who had low dietary diversity made fewer annual outpatient (14%), preventive care (19%), and dental (40%) visits, but exhibited longer hospitalization (102%) than did those who had a low SMMI and high dietary diversity. Similar patterns were observed in the corresponding medical expenditures. The findings were similar when considering physical activity. Being in the low-risk group in conjunction with having high dietary diversity or more physical activity was associated with the lowest annual adjusted mean hospitalization days with expenditure, and also total expenditure. Conclusions: A lower SMMI was associated with more hospitalization days and costs. However, high dietary diversity and more physical activity can attenuate the effects of lower SMMI on medical service utilization and expenditure. [ABSTRACT FROM AUTHOR]

The intercategory relationship of various medical services is of importance to both health care management and policy-making. The purpose of this study was to explore the intercategory relationship of emergency medical services and other medical services and to examine the medical utilization patterns of emergency department (ED) users. Methods: The sample was selected from the National Health Insurance Research Database in Taiwan for the year 2004. A total of 6775 patients who visited the ED were included. Multiple logistic regression analyses were performed to determine relationships between emergency medical services and other medical services, and cluster analysis characterized different medical utilization patterns of ED users. Results: Frequent ED users (≥ 4 ED visits during the year) were more likely to use other health care services: their odds ratios (ORs) were 10.30 (95% confidence interval [CI], 7.53-14.10) for 11 or more visits to hospital outpatient departments, 1.51 (95% CI, 1.14-1.99) for 13 or more visits to primary care physicians, and 4.90 (95% CI, 3.74-6.43) for in-hospital care. Moreover, ED users fell into four medical utilization patterns: low health care users (61.91%), hospital fans (11.93%), primary care favorers (21.21%) and high health care users (4.95%). Conclusion: Frequent ED users also heavily used other health care services. ED users have different utilization patterns, which is a reflection of the unique needs for various health care services. Such knowledge is critically important for both health care providers and policymakers who must meet the needs of different patient groups.

Background/Introduction Urolithiasis is a common disease with high prevalence and recurrence rates in Taiwan. A national survey in Taiwan determined that 9.6% of the population suffered stones throughout their lifetime. Purpose/Aim This study analyzed the epidemiological characteristics and patterns of inpatient treatment for urolithiasis and thus provides a reference for the implementation of future health strategies. Methods A cross-sectional study was conducted using data collected from the Inpatient Expenditures by Admissions and Registry for Contracted Medical Facilities files of the National Health Insurance Research Database. A total of 40,027 patients were included in the final data analysis. SPSS 22.0 statistical software was used to analyze the epidemiological characteristics and corresponding treatments for each patient group. Results The average age of the inpatients with urolithiasis was 52 ± 14 years, with a male-to-female sex ratio of 2.4:1. The highest admission rate occurred between July and August (10.4–10.6%). Ureteral stones were the most common (76.4%), followed by kidney stones (15.8%), bladder stones (7.5%), and urethral stones (0.4%). Moreover, 57.4% of the patients were treated at regional hospitals and 27.5% were treated at medical centers. Of the 4531 urolithiasis examinations conducted, 63.6% involved intravenous urography, 21.8% abdominal sonography, and 5.9% retrograde pyelography. In total, 13,610 treatments were performed in the 40,027 inpatients with urolithiasis, with a surgical treatment rate of 34%. Extracorporeal shock wave lithotripsy (ESWL) is the most commonly used treatment for patients with renal or ureteral stones with an annual medical expenditure of nearly NT $3 billion. Regional hospitals conducted the highest number of ESWL treatment for inpatients with stones, whereas medical centers conducted more percutaneous nephrostomy lithotripsy than did regional hospitals. Conclusion This study reveals patterns in the epidemiology and utilization of medical resources for inpatients with urolithiasis and provides a basis for the implementation of stone treatment guidelines in Taiwan. [ABSTRACT FROM AUTHOR]

Background/purpose: Taiwan has one of the fastest growing aging populations in the world, which makes the effective allocation of scarce medical resources a key issue. This paper investigates patterns in the use of outpatient services by elderly individuals in Taiwan under the National Health Insurance (NHI) program.Methods: We assembled a random sample from the NHI Research Database in Taiwan, comprising 50% of all claims made for elderly people (65 years old) in 2010 (n 1,239,836 beneficiaries) including 14 variables.Results: In 2010, individuals aged 65 years or older comprised 10.74% of the population of Taiwan, and accounted for 11.39% of all physician and outpatient visits. The rate of medical care visits was 28.54 ± 21.23 (Standard deviation) times per person per annum, with a higher rate for women, those in the 80-84 age group, low-income beneficiaries, and the inhabitants of offshore islands. The three most frequent diagnoses for elderly patients were hypertension, diabetes, and acute upper respiratory infections. The mean insured medical costs per person per annum were US Dollars 1,132, with higher expenses for men, those in the 80-84 age group, and those inhabiting urban areas.Conclusion: This study employed nationally representative data in the detection of patterns in outpatient care utilization by elderly individuals in Taiwan. Medical care providers and policymakers should be fully aware of the complex patterns unique to older patients. The results of this study could be used as a benchmark with which to assess the impact of future medical care policy on elderly people. [ABSTRACT FROM AUTHOR]

Objectives: This study determined the effects of a “pay-for-performance program for schizophrenia” on patient utilization of the outpatient department, emergency services, and hospitalization. Methods: This study analyzed 2236 patients from a psychiatric hospital in northern Taiwan who joined the “pay-for-performance program for schizophrenia.” Two datasets were analyzed, including the 2009-2013 Hospital Information System and the Schizophrenia Case Management System. The Generalized Estimating Equation (GEE) method was used to determine the effects of the program on patient utilization measures. Results: The “pay-for-performance program for schizophrenia” significantly decreased the yearly incidence of compulsory hospitalization, days of acute psychiatric hospitalization, and annual emergency department visits. In addition, the number of psychiatric outpatient visits decreased significantly, but persisted at > 12 times per year. The number of 6-month readmissions to the acute psychiatric ward did not change significantly after implementing the program. Conclusions: Implementing the “pay-for-performance program for schizophrenia” enhanced self-management of schizophrenic patients, improved medical care outcomes, and prevented worsening of diseases. [ABSTRACT FROM AUTHOR]

In patients with Parkinson's disease (PD), long-term care insurance (LTCI), which can provide physical activity, might affect medical costs and utilization. We investigated the impact of LTCI on medical costs and utilization among patients with PD aged ≥60 years. Data were derived from the 12-year Korean National Health Insurance Service‒Senior cohort. Among patients with newly developed PD, the intervention group receiving LTCI was matched with the control group using propensity score risk-set matching. As medical costs and utilization may increase markedly immediately before LTCI allocation, the baseline period was set from 5 years to 1 year prior to receiving LTCI. Medical costs and utilization were recorded in six 1-year intervals thereafter. We compared medical costs and utilization between groups using a comparative interrupted time-series analysis. 5011 LTCI beneficiaries and 5011 propensity score- and risk-set-matched controls were included. The overall mean (standard deviation) age was 77.73 (5.7) years, and 66.2% were women, in both groups. LTCI benefit was associated with reduced overall direct medical costs for 5 years (post-intervention year 5: -270$, p = 0.033) , and overall hospital length-of-stay (LOS) for 2 years post-LTCI (post-intervention year 2: -2.43 days, p = 0.002), although medical costs and LOS increased immediately pre-LTCI implementation. The long-term care hospital LOS of LTCI beneficiaries increased relatively by 3-years post-LTCI implementation, particularly in those with a high Charlson Comorbidity Index score (post-intervention year 3: +2.65 days, p = 0.04). LTCI benefit stably decreased medical costs for patients with PD for 5 years, despite the steep increase immediately pre-LTCI benefit, but was limited in reducing medical utilization, particularly as reflected by LOS in long-term care hospitals and patients with comorbidities. LTCI could be a useful health policy to reduce PD disease burden. However, further development is required to provide services that can reduce LOS to PD patients with comorbidities. • In PD patients, just before receiving LTCI, medical costs rose sharply. • Receiving LTCI stably decreased medical costs for patients with PD for 5 years. • In PD patients with comorbidities, LTCI did not effectively lower utilization. • This phenomenon was particularly evident in long-term care hospitals. [ABSTRACT FROM AUTHOR]