SPOTLIGHT – June, 2019
Continuity of Outpatient Care and Avoidable Hospitalization: a Systematic Review

Yu-Hsiang Kao, Wei-Ting Lin, Wan-Hsuan Jenny Chen, Shiao-Chi Wu, and Tung-Sung Tseng.

Continuity of care (COC) is a core element of primary care, which has been associated with improved health outcomes. Hospitalizations for ambulatory care–sensitive conditions (ACSCs) are potentially preventable if these conditions are managed well in the primary care setting. This team of researchers, including Dr. Kao and Dr. Tung-Sung Tseng’s aim, was to conduct a systematic review of literature on the association between COC and hospitalizations for ACSCs. They used the Systematic literature review, a method which all published literature was searched for in PubMed and MEDLINE using PRISMA guidelines for collecting empirical studies. Studies published in English between 2008 and 2017 that measured the association between COC and at least one measure of ACSC hospitalizations were included in this review.

Their results, a total of 15 studies met the inclusion criteria and applied claims data to examine the association between COC and ACSC hospitalizations. Most studies (93.3%) demonstrated a statistically significant association of higher COC in the outpatient setting with reduced likelihood of hospitalization for either all ACSCs or a specific ACSC. A strong association was observed among studies focusing on patients with a specific ACSC. Additionally, most studies used the Bice-Boxerman COC index to measure COC and measured COC before a period of measuring ACSC hospitalizations. The team concluded that this systematic review identified an increased COC in outpatient care is associated with fewer hospitalizations for ACSCs. Increasing COC is favorable for patients who are managing a specific ACSC.

READ FULL ARTICLE HERE or go to https://www.ajmc.com/journals/issue/2019/2019-vol25-n4/continuity-of-outpatient-care-and-avoidable-hospitalization-a-systematic-review


Using the emergency department to investigate smoking in young adults

Faculty and researchers at the LSU School of Medicine (Stephen Kantrow and Sarah Jolley), LSU School of Public Health (Xinnan Wang, Tung-Sung Tseng, Dodie Arnold, Claudia Leonardi, Richard Scribner, Edward Trapido, Hui-Yi Lin), Ochsner Health System (Eboni Price Haywood) and the Louisiana Public Health Institute (Lisanne Brown) used emergency department (ED) data to estimate the prevalence of smoking in young adults. Most state or national surveys of smoking are limited in size- especially when looking at county level data, and phone based surveys have had decreasing responses. School based surveys are helpful, but limited by age. The researchers used data from EHRs for five EDs within U.S. Census-defined metropolitan New Orleans (New Orleans–Metairie, LA) for persons 18-24 years old. (15% of young adults are reported to have used EDs in the past year). Smoking status was available for 55,777 persons (91% of the total Emergency Departments); 61% were women, 55% were black, 35% were white, and 8% were Hispanic. One third of patients were uninsured. Most smokers used cigarettes (95%). Prevalence of current smoking was 21.7% for women and 42.5% for men. Smoking prevalence was highest for substance use disorder (58%), psychiatric illness (41%) and alcohol use (39%), and lowest for pregnancy (13.5%). In multivariable analyses, male gender, white race, lack of health insurance, alcohol use, and illicit drug use were independently associated with smoking. Smoking risk among alcohol and drug users varied by gender, race, and/or age.

The BRFSS estimated 29% prevalence during the same time, and had data on 597 subjects aged 18–30 years. Although ED data are likely to overestimate tobacco use, the large sample size is useful- especially for stratum-specific estimates- particularly in a demographically diverse population. Dr. Stephen Kantrow, the lead investigator, stated ”this approach provides smoking data for a large sample of young adults in one metropolitan area, and may support longitudinal studies of smoking in high and low risk populations.

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Descriptive Study of 30-day Hospital Readmissions for Person 65 and Older in Louisiana 2011-2014

Since 2012 greater scrutiny is being given to factors associated with patients readmitted to a hospital within 30 days of a discharge from the same hospital. Interest in these readmissions is driven by higher health costs as well as healthcare outcomes. Utlizing patient admission records from the Lousiana Hospital Inpatient Discharge Database (LAHIDD) for fiscal years 2011 to 2014, an interdisciplinary team at LSU Health Sciences Center in New Orleans investigated the relationships between patient race, gender, discharge status and comorbidities and 30-day readmissions among Louisianans 65 years and older.

The research team, School of Public Health associate professor Susanne Straif-Bourgeois, assistant professor Elizabeth Levitzky and MPH student Asha Buehler and Center for Interprofessional Education and Collaborative Practice director Tina Gunaldo, analyzed over 300,000 patient admissions during the 4-year period. The team evaluated the total number of admissions as well as the number of 30-days readmissions for each patient, focusing on five diagnosis categories – circulatory, digestive, infectious, respiratory diseases and unintentional injuries.

The researchers found differences in readmission rates among patients 65 years and older grouped by race, gender, and discharge location prior to readmission. Within these older patients, the rate of readmission varied by diagnosis code category with circulatory diseases having the highest rate among the five diagnosis categories of interest. White males showed the highest rates in each category. The discharge location prior to the 30-day readmission also differed among the race and gender groups.  Full article here


Supporting health system transformation through an interprofessional education experience focused on population health

Kari F. Brisolara, Sonia Gasparini, Alison H. Davis, Shane Sanne, Sandra Carlin Andrieu, Jerald James, Donald E. Mercante, Raquel Baroni De Carvalho & Tina Patel Gunaldo

The purpose of this study according to Dr. Kari Brisolara, of the LSUHSC School of Public Health, was to determine the impact of an interprofessional education (IPE) experience on first year students across all schools of a health sciences center on the topic of pediatric immunizations. The research team conducted a pre-/post-test at Louisiana State University Health Sciences Center-New Orleans with 731 first year students from 25 academic programs encompassing all six schools (Allied Health, Dentistry, Graduate Studies, Medicine, Nursing and Public Health). In the four questions related to the Interprofessional Education Collaborative (IPEC) sub-competencies and the three questions related to professional role regarding immunizations, there was a statistically significant difference in the pre-/post-test survey results (< 0.0001). Student learning related to the collaboration needed to make a larger impact on patient outcomes was demonstrated through assessment of an open-ended question. IPE experiences can improve first-year students’ perceptions of IPEC sub-competencies regarding the importance of population health and teamwork. By utilizing a population health focus with IPE activities, novice learners are equipped to learn and apply collaborative practice skills along with recognizing the importance of promoting overall health and well-being instead of just health care.

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A Partnership in Health-Related Social Media for Young Breast Cancer Survivors

Donna L. Williams, DrPH, Timiya S. Nolan, PhD, Yu-wen Chiu, DrPH, MPH, Laura Ricks, MPH, Silvia Gisiger Camata,MPH, Barbara Craft, MD, Karen Meneses, PhD

In the United States, about 11% (26,393) of those diagnosed with breast cancer in 2016 will be young or less than 45 years old. Young breast cancer survivors, compared to older cancer survivors, are a disparate group that experience higher incidence of advanced disease, greater mortality, and poorer quality of life, and are often faced with difficulty locating support that meets the unique needs of young women. The Gulf States Young Breast Cancer Survivor Network, composed of three sister networks, formed a partnership aimed at harnessing the power of social media to reach and impact the lives of young women with breast cancer. The collaborative partnership framework and the power of synergy are shown in merging two existing programs and incorporating a third new program.

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A Platform for Monitoring Fiscal Health and Sustainability of the Public Health System

According to a new study titled, “The Public Health Uniform National Data System (PHUND$): A Platform for Monitoring Fiscal Health and Sustainability of the Public Health System,” published in the Journal of Public Health Management and Practice on August 13, 2018, it states, “Leaders of government agencies are responsible for stewardship over taxpayer investments. Stewardship […]

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Subgroup-specific dose finding in phase I clinical trials based on time to toxicity allowing adaptive subgroup combination ~ Andrew G. Chapple and Peter F. Thall

A Bayesian design is presented that does precision dose finding based on time to toxicity in a phase I clinical trial with two or more patient subgroups. The design, called Sub-TITE, makes sequentially adaptive subgroup-specific decisions while possibly combining subgroups that have similar estimated dose-toxicity curves. Decisions are based […]

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Analyzing over diagnosis risk in cancer screening: A case of screening mammography for breast cancer ~ Mahboubeh Madadi, Mohammadhossein Heydari, Shengfan Zhang, Edward Pohl, Chase Rainwater & Donna L. Williams

Overdiagnosis is defined as the diagnosis of an asymptotic cancer that would not have presented clinically in a patient’s lifetime in the absence of screening. Quantifying overdiagnosis is difficult, since it is impossible to distinguish between a cancer that would cause symptoms in the patient lifetime and the ones that would not. In this study, a mathematical framework is developed to estimate the lifetime overdiagnosis and cancer mortality risks associated with cancer screening policies […]

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 LATEST RESEARCH NEWS – Fall 2018