Health Service Utilization Patterns Among Adults With Congenital Heart Disease: A Population‐Based Study
Background Several studies have examined hospitalizations among patients with adult congenital heart disease (ACHD). Few investigated other services or utilization patterns. Our aim was to study service utilization patterns and predictors among patients with ACHD. Methods and Results We identified 1...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-01-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.018037 |
| _version_ | 1819179065742983168 |
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| author | Michal Benderly Jonathan Buber Ofra Kalter‐Leibovici Leonard Blieden Alexander Dadashev Avraham Lorber Amiram Nir Sergei Yalonetsky Gabriel Chodick Dahlia Weitzman Ran Balicer Efrat Mazor Dray Havi Murad Yaron Razon Rafael Hirsch |
| author_facet | Michal Benderly Jonathan Buber Ofra Kalter‐Leibovici Leonard Blieden Alexander Dadashev Avraham Lorber Amiram Nir Sergei Yalonetsky Gabriel Chodick Dahlia Weitzman Ran Balicer Efrat Mazor Dray Havi Murad Yaron Razon Rafael Hirsch |
| author_sort | Michal Benderly |
| collection | DOAJ |
| description | Background Several studies have examined hospitalizations among patients with adult congenital heart disease (ACHD). Few investigated other services or utilization patterns. Our aim was to study service utilization patterns and predictors among patients with ACHD. Methods and Results We identified 11 653 patients with ACHD aged ≥18 years (median, 47 years), through electronic records of 2 large Israeli healthcare providers (2007–2011). The association between patient, disease, and sociogeographic characteristics and healthcare resource utilization were modeled as recurrent events accounting for the competing death risk. Patients with ACHD had high healthcare utilization rates compared with the general population. The highest standardized service utilization ratios (SSRs) were found among patients with complex congenital heart disease including primary care visits (SSR, 1.53; 95% CI, 1.47–1.58), cardiology outpatient visits (SSR, 5.17; 95% CI, 4.69–5.64), hospitalizations (SSR, 6.68; 95% CI, 5.82–7.54), and days in hospital (SSR, 15.37; 95% CI, 14.61–16.12). Adjusted resource utilization hazard increased with increasing lesion complexity. Hazard ratios (HRs) for complex versus simple disease were: primary care (HR, 1.14; 95% CI, 1.06–1.23); cardiology outpatient visits (HR, 1.40; 95% CI, 1.24–1.59); emergency department visits (HR, 1.19; 95% CI, 1.02–1.39); and hospitalizations (HR, 1.75; 95% CI, 1.49–2.05). Effects attenuated with age for cardiology outpatient visits and hospitalizations and increased for emergency department visits. Female sex, geographic periphery, and ethnic minority were associated with more primary care visits, and female sex (HR versus men, 0.89 [95% CI, 0.84–0.94]) and periphery (HR, 0.72 [95% CI, 0.58–0.90] for very peripheral versus very central) were associated with fewer cardiology visits. Arab minority patients also had high hospitalization rates compared with the majority group of Jewish or other patients. Conclusions Healthcare utilization rates were high among patients with ACHD. Female sex, geographic periphery, and ethnicity were associated with less optimal service utilization patterns. Further research should examine strategies to optimize service utilization in these groups. |
| first_indexed | 2024-12-22T21:52:31Z |
| format | Article |
| id | doaj.art-b2ec3166e065495fb93880fd80b9ad1c |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T21:52:31Z |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-b2ec3166e065495fb93880fd80b9ad1c2022-12-21T18:11:20ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-01-0110210.1161/JAHA.120.018037Health Service Utilization Patterns Among Adults With Congenital Heart Disease: A Population‐Based StudyMichal Benderly0Jonathan Buber1Ofra Kalter‐Leibovici2Leonard Blieden3Alexander Dadashev4Avraham Lorber5Amiram Nir6Sergei Yalonetsky7Gabriel Chodick8Dahlia Weitzman9Ran Balicer10Efrat Mazor Dray11Havi Murad12Yaron Razon13Rafael Hirsch14Cardiovascular Epidemiology Unit Gertner Institute for Epidemiology and Health Policy Research Sheba Medical Center Ramat‐Gan IsraelSackler Faculty of Medicine Tel Aviv University Tel Aviv IsraelCardiovascular Epidemiology Unit Gertner Institute for Epidemiology and Health Policy Research Sheba Medical Center Ramat‐Gan IsraelSackler Faculty of Medicine Tel Aviv University Tel Aviv IsraelSackler Faculty of Medicine Tel Aviv University Tel Aviv IsraelPediatric Cardiology and GUCH Unit Rambam Health Care CampusTechnion Faculty of Medicine Haifa IsraelPediatric Cardiology and Adult Congenital Heart Disease Unit Shaare Zedek Medical Center Jerusalem IsraelPediatric Cardiology and GUCH Unit Rambam Health Care CampusTechnion Faculty of Medicine Haifa IsraelSackler Faculty of Medicine Tel Aviv University Tel Aviv IsraelSackler Faculty of Medicine Tel Aviv University Tel Aviv IsraelClalit Research Institute Clalit Health Services Tel Aviv IsraelFaculty of Health Sciences Ben‐Gurion University of the Negev Negev IsraelBiostatistics Unit Gertner Institute for Epidemiology and Health Policy Research Sheba Medical Center Ramat‐Gan IsraelFaculty of Health Sciences Ben‐Gurion University of the Negev Negev IsraelSackler Faculty of Medicine Tel Aviv University Tel Aviv IsraelBackground Several studies have examined hospitalizations among patients with adult congenital heart disease (ACHD). Few investigated other services or utilization patterns. Our aim was to study service utilization patterns and predictors among patients with ACHD. Methods and Results We identified 11 653 patients with ACHD aged ≥18 years (median, 47 years), through electronic records of 2 large Israeli healthcare providers (2007–2011). The association between patient, disease, and sociogeographic characteristics and healthcare resource utilization were modeled as recurrent events accounting for the competing death risk. Patients with ACHD had high healthcare utilization rates compared with the general population. The highest standardized service utilization ratios (SSRs) were found among patients with complex congenital heart disease including primary care visits (SSR, 1.53; 95% CI, 1.47–1.58), cardiology outpatient visits (SSR, 5.17; 95% CI, 4.69–5.64), hospitalizations (SSR, 6.68; 95% CI, 5.82–7.54), and days in hospital (SSR, 15.37; 95% CI, 14.61–16.12). Adjusted resource utilization hazard increased with increasing lesion complexity. Hazard ratios (HRs) for complex versus simple disease were: primary care (HR, 1.14; 95% CI, 1.06–1.23); cardiology outpatient visits (HR, 1.40; 95% CI, 1.24–1.59); emergency department visits (HR, 1.19; 95% CI, 1.02–1.39); and hospitalizations (HR, 1.75; 95% CI, 1.49–2.05). Effects attenuated with age for cardiology outpatient visits and hospitalizations and increased for emergency department visits. Female sex, geographic periphery, and ethnic minority were associated with more primary care visits, and female sex (HR versus men, 0.89 [95% CI, 0.84–0.94]) and periphery (HR, 0.72 [95% CI, 0.58–0.90] for very peripheral versus very central) were associated with fewer cardiology visits. Arab minority patients also had high hospitalization rates compared with the majority group of Jewish or other patients. Conclusions Healthcare utilization rates were high among patients with ACHD. Female sex, geographic periphery, and ethnicity were associated with less optimal service utilization patterns. Further research should examine strategies to optimize service utilization in these groups.https://www.ahajournals.org/doi/10.1161/JAHA.120.018037adult congenital heart diseasehealthcare service utilizationmortalitypopulation‐based study |
| spellingShingle | Michal Benderly Jonathan Buber Ofra Kalter‐Leibovici Leonard Blieden Alexander Dadashev Avraham Lorber Amiram Nir Sergei Yalonetsky Gabriel Chodick Dahlia Weitzman Ran Balicer Efrat Mazor Dray Havi Murad Yaron Razon Rafael Hirsch Health Service Utilization Patterns Among Adults With Congenital Heart Disease: A Population‐Based Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease adult congenital heart disease healthcare service utilization mortality population‐based study |
| title | Health Service Utilization Patterns Among Adults With Congenital Heart Disease: A Population‐Based Study |
| title_full | Health Service Utilization Patterns Among Adults With Congenital Heart Disease: A Population‐Based Study |
| title_fullStr | Health Service Utilization Patterns Among Adults With Congenital Heart Disease: A Population‐Based Study |
| title_full_unstemmed | Health Service Utilization Patterns Among Adults With Congenital Heart Disease: A Population‐Based Study |
| title_short | Health Service Utilization Patterns Among Adults With Congenital Heart Disease: A Population‐Based Study |
| title_sort | health service utilization patterns among adults with congenital heart disease a population based study |
| topic | adult congenital heart disease healthcare service utilization mortality population‐based study |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.018037 |
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