Samara Rosenfeld

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On this week's episode of Data Book, Chief Healthcare Executive spoke with Steve Wigginton, CEO of Icario, platform that promotes health action to connect everyone to better health. We discussed how value-based care and artificial intelligence are helping health systems and health plans to provide more personalized care and to address social determinants of health.

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Steve Wigginton, CEO of Icario, discussed how value-based care and artificial intelligence are helping health systems and health plans to provide more personalized care and to address social determinants of health.

Podcast: Joining Technology and Value-Based Care to Provide More Personal Care

Opportunities exist to improve the selection of transfer destinations for patients with emergency general surgery conditions.

The findings of the recent study suggested optimizing transfer destination in the interhospital transfer network may improve such outcomes.

Cindy Y. Teng, M.D., and a team of Pittsburgh-based investigators examined whether patients with emergency surgery conditions were consistently directed to hospitals with more resources and better outcomes. The team analyzed interhospital transfers among adults with emergency general surgery conditions from January 1 to December 31, 2016. They used all-payer claims data from the 2016 Healthcare Cost and Utilization Project state inpatient and emergency department databases in eight states.

More than 700 hospitals were included in the study. Eligible participants were at least 18 years old and had an acute care hospital encounter with a diagnosis of an emergency general surgery condition.

The primary outcome was hospital-level centrality ratio — the normalized number of incoming transfers divided by the number of outgoing transfers. If the ratio was higher, it meant there were more incoming transfers per outgoing transfer. The team hypothesized higher hospitality centrality ratio was associated with more resources, higher volume, and better outcomes.

There were more than 80,000 patients analyzed, of whom, the median age was 63 years old, 52.1% were male, and 78.8% were White. The median number of outgoing transfers per hospital was 106, while incoming transfers was 36.

As the investigators hypothesized, a higher log-transformed centrality was associated with more resources like higher ICU capacity and higher emergency general surgery volume. But such a ratio was not linked with better outcomes, such as lower in-hospital mortality and lower failure to rescue — the occurrence of a complication followed by in-hospital death for emergency general surgery episodes that involved an operation or procedure.

Hospitals with a higher ICU capacity, higher volume, and higher-quality trauma care were associated with better emergency general surgery outcomes.

The findings emphasized the need for further research into the appropriate selection of transfer destinations as a strategy to improve emergency general surgery outcomes.

“Our results raise questions about whether [emergency general surgery] transfers are consistently directed to appropriate hospitals for further care and new concerns regarding how we determine appropriate hospitals in the absence of standardized guidelines,” Teng and the team wrote.

Assessment of Hospital Characteristics and Interhospital Transfer Patterns of Adults With Emergency General Surgery Conditions

Articles

Larger hospitals are associated with more resources for emergency general surgery patients.

Improvements Needed for Selection of Transfer Destinations for Emergency General Surgery

Hispanic and low-income communities have the largest percentage increase in telehealth use in response to the COVID-19 pandemic.

Findings of the study suggested virtual care can potentially mitigate the impact of the pandemic on healthcare use in vulnerable populations.

Due to the COVID-19 pandemic, there were dramatic decreases in outpatient healthcare visits and increases in telehealth visits. Still, healthcare workers and investigators were unsure of whether the changes in healthcare access were different based on patient demographics and socioeconomic status.

Lei Qian, Ph.D., and a team of investigators from Kaiser Permanente Southern California assessed the impact of the pandemic on in-person outpatient and telehealth visits by demographic characteristics and household income in a diverse population. The study cohort comprised patients of all ages who were members from January 5, 2020, to October 31, 2020 and the same period in 2019.

The investigators identified outpatient and telehealth visits using the electronic health record (EHR) data and claims data. Outpatient visits included all in-person outpatient visits and telehealth visits included telephone appointment visits and video visits conducted synchronously using real-time telephone or live video-audio interactions.

Of the more than 4.5 million members enrolled in January 2020, 15% were at least 65 years old, 51.5% were female, 39.4% were Hispanic, and 7.7% lived in census tract areas with a median household income less than $40,000.

After the start of the pandemic, outpatient visit rates had a steep drop-off across all sub-groups. Lowest levels of outpatient visits were in early April 2020, then gradually increased but still remained lower than before the pandemic. Patients at least 65 years old had the smallest decrease in outpatient visits with 6.25 visits per person-year during the later pandemic period versus 8.92 visits per person-year during the pre-pandemic period in 2020. Those aged 6-17 years old had the largest decrease, with 1.92 visits per person-year during the later pre-pandemic period versus 3.86 visits per person-year during the pre-pandemic period in 2020. Outpatient visit decreases did not differ statistically by sex, race/ethnicity, and household income groups.

In all sub-groups except patients aged 6-17 years old, telehealth visits increased after the start of the COVID-19 pandemic and then slowly decreased. For those aged 6-17 years old, telehealth visit rates remained stable after initial increase during the pandemic.

Telehealth visits increased the most for children aged 0-5 years old (475.5%; 95% CI, 446.2-506.4) and the least among adults at least 65 years old (236.6%; 95% CI, 228.8-244.5). Such visits increased significantly more among males (293.9%; 95% CI, 283.4-304.7) than females (260%; 95% CI, 252.6-267.6). What’s more, Hispanic patients had the largest increase in telehealth visits (295.5%; 95% CI, 275.5-316.5), and visits for patients in the low-income group increased the most (313.5%; 95% CI, 294.8-333.1).

The use of telehealth and virtual care among these sub-groups reduced exposure to COVID-19, reinforced social distancing, increased the number of patients who could be treated, and may have mitigated the impact of COVID-19 in vulnerable populations.

“Furthermore, the use of virtual care might be a promising way to reduce healthcare disparities even after the COVID-19 pandemic ends,” Qian and the team concluded.

Disparities in Outpatient and Telehealth Visits During the COVID-19 Pandemic in a Large Integrated Health Care Organization: Retrospective Cohort Study

Virtual care can reduce healthcare disparities even after the pandemic ends.

Telehealth Increased Healthcare Access for Hispanic, Low-Income Populations During COVID-19

Exposure to COVID-19-positive household members is a risk factor associated with infection among vaccinated healthcare workers.

The findings of the recent study suggested reconsideration of quarantining vaccinated people who have had significant exposure to household members who tested positive for the virus.

While mass vaccination of Israeli adults who received the BNT162b2 vaccine (Pfizer-BioNTech) is associated with a significantly lower rate of SARS-CoV-2, there are still cases of infection among fully vaccinated adults. And after the vaccination rollout, the CDC eliminated the need for quarantine after exposure.

Yonatan Oster, M.D., and a team of Israel-based investigators studied the association between exposure characteristics and infection risk among vaccinated and non-vaccinated healthcare workers in Israel. To do this, they conducted a case-control study between January and March 2021 at the Hadassah-Hebrew University Medical Center. Hospital executives executed the vaccination program and within two months, it achieved almost complete vaccination coverage and a significant decrease in the number of infected healthcare workers.

The investigators compared all vaccinated healthcare workers who tested positive at least two weeks after getting the second dose. Workers were placed into two control groups — all non-vaccinated workers who had positive test results during the same period and a sample of vaccinated workers who were tested but had negative results. The team collected data including demographic characteristics, symptoms, characteristics of exposure, and disease course.

There were 5,312 vaccinated healthcare workers and 690 non-vaccinated healthcare workers at the end of the study period. Of those vaccinated, .5% had positive test results for COVID-19 and 10% of non-vaccinated healthcare workers had positive test results for the virus.

Among the positive groups, symptoms were the common cause for testing (62% in the non-vaccinated-positive group and 63% in the vaccinate-positive group), but not in the vaccinated-negative group (22%).

Being exposed to a positive household member was significantly more common for healthcare workers in the vaccinated-positive group (56%) compared to the non-vaccinated-positive group (38%) and the vaccinated-negative group (9%). When it came to the odds ratio of exposure to positive household members, vaccinated-positive healthcare workers had an OR of 2.03 compared to non-vaccinated-positive healthcare workers and an OR of 12.5 compared with vaccinated-negative healthcare workers.

Association Between Exposure Characteristics and the Risk for COVID-19 Infection Among Health Care Workers With and Without BN-T162b2 Vaccination

Vaccinated people should quarantine if they are exposed to household members who tested positive for COVID-19.

Samara Rosenfeld

Articles

Podcast: Joining Technology and Value-Based Care to Provide More Personal Care

Improvements Needed for Selection of Transfer Destinations for Emergency General Surgery

Telehealth Increased Healthcare Access for Hispanic, Low-Income Populations During COVID-19

Exposure to COVID-Positive Household Members a Big Risk Factor for Vaccinated Healthcare Workers