The Association of Bedside Nurse Staffing on Patient Outcomes and Throughput in a Pediatric Cardiac Intensive Care Unit

Health care throughput is the progression of patients from admission to discharge, limited by bed occupancy and hospital capacity. This study examines heart center throughput, cascading effects of limited beds, transfer delays, and nursing staffing on outcomes utilizing elective surgery cancellation during the initial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic wave. This study was a retrospective single-center study of staffing, adverse events, and transfers. The study period was January 1, 2018 to December 31, 2020 with the SARS-CoV-2 period March to May 2020. There were 2,589 patients, median age 5 months (6 days-4 years), 1,543 (60%) surgical and 1,046 (40%) medical. Mortality was 3.9% ( n = 101), median stay 5 days (3-11 days), median 1:1 nurse staffing 40% (33-48%), median occupancy 54% (43-65%) for step-down unit, and 81% (74-85%) for cardiac intensive care unit. Every 10% increase in step-down unit occupancy had a 0.5-day increase in cardiac intensive care unit stay ( p = 0.044), 2.1% increase in 2-day readmission ( p = 0.023), and 2.6% mortality increase ( p < 0.001). Every 10% increase in cardiac intensive care unit occupancy had 3.4% increase in surgical delay ( p = 0.016), 6.5% increase in transfer delay ( p = 0.020), and a 15% increase in total reported adverse events ( p < 0.01). Elective surgery cancellation is associated with reduced high occupancy days (23-10%, p < 0.001), increased 1:1 nursing (34-55%, p < 0.001), decreased transfer delays (19-4%, p = 0.008), and decreased mortality (3.7-1.5%, p = 0.044). In conclusion, Elective surgery cancellation was associated with increased 1:1 nursing and decreased mortality. Increased cardiac step-down unit occupancy was associated with longer cardiac intensive care unit stay, increased transfer, and surgical delays.

An infectious disease model considering the impact of imported cases on internal spread of COVID-19

The coronavirus disease 2019(COVID-19) pandemic spreads across borders with the frequent global population movement. To explore the impact of the COVID-19 pandemic on China's domestic epidemic prevention and control, based on the classical infectious disease dynamics model this paper proposes an infectious disease model that considers oversea imported cases. The model can simulate three situations:national pandemic without imported cases, no domestic cases with only imported cases, and domestic cases with international travellers entering simultaneously. By calculating the peak case number and range of infection spread duration in these situations, as well as the amount of medical resources invested, the model has shown the different results of impact of entry type on the domestic pandemic and different pressures on medical resources. Finally, the paper suggests that testing measures should be taken according to the degree of pandemic risk and resource conditions, that strict prevention and control should be applied to the people not entering through customs, and closed-loop management to the people entering through customs, that entry quarantine measures and quarantine periods should be dynamically adjusted and international exchanges should be gradually resumed in the context of ensuring domestic and overseas epidemic prevention and control in advance, and that it is necessary to integrate medical resources, improve allocation efficiency, and relieve the pressure of resource occupation.

The features and prospects of recreational use of thermal mineral springs by resort hotels

The Russian invasion of Ukraine and the COVID-19 pandemic have actualized the need to rethink the recreational use of thermal mineral springs by resort hotels in order to treat the consequences of post-war injuries, psychological rehabilitation and health restoration. Solving these problems requires strengthening the role of recreational enterprises and resort hotels in restoring the health of the population by expanding the directions of their economic activity and forming the investment attractiveness of the national resort and recreational product in world markets. The publication pays special attention to determining the physical and chemical properties of thermal mineral springs, which is an important component in the development of healing methods and the creation of specific health recovery programs. The spatial structure of the distribution of thermal mineral springs by regions of the world is clarified. The main types of establishments with thermal mineral springs, which provide recreational, healing and therapeutic services, are determined. In addition, the amount of financial losses suffered by institutions with thermal mineral springs as a result of the COVID-19 pandemic is determined, as well as the dynamics of volume and forecast of growth of the world market of thermal mineral springs, due to the need to recover health, is identified. According to the results of the study, it is found that thermal mineral springs are a unique natural resource. Their recreational use is the main activity of many resort hotels. As a result of the Russian aggression and the COVID-19 pandemic, there was a shift in emphasis in the functioning of resort hotels from relaxation and rest towards treatment and rehabilitation, which will help restore the demand for resort and recreational services in the post-war period. Thus, the increase in demand for the health-recovering, medical and recreational services will make it possible to expand the recreational use of thermal mineral springs, update the menu of services and become more appealing for attracting investment capital.

History repeats itself: an ethic for two pandemics

The emergence of the human immunodeficiency virus (HIV) in the 1980s brought ethical conflicts that meant a bioethics challenge. Among others, issues of confidentiality, stigmatization, justice, duty of care and investigation arose. Bioethical reflection had been focused on conflicts involving respect for individual autonomy, nevertheless HIV highlighted the needs of the community. Almost four decades later, the COVID-19 pandemic has brought the ethical conflicts typical of public health back to the bioethical scene. Quarantines, various restrictions on mobility, the obligation of masks, poorly protected health care, rationing of scarce resources, rushed research, the vaccines allocation, stigmatization and discrimination, the immune passport, or the moralization of infectious disease have highlighted the need for an ethical framework that helps to reflect and justify public health decisions. In this article we review and analyze the ethical conflicts that arose with HIV and how they have reappeared and been reinterpreted with the COVID-19 pandemic.

Impact of Telehealth and Process Virtualization on Healthcare Utilization

Technological advancements and the COVID-19 pandemic have catapulted process virtualization across many industries, including healthcare, where telehealth has enabled significant digital transformation of care delivery. Although telehealth has been proposed as a potential solution to improve access to care and restrain runaway healthcare costs, it can increase spending if telehealth use leads to new types of resource utilization. Drawing on the lens of process virtualization theory, we study the impact of telehealth on healthcare utilization by examining visit-level patient data of telehealth use in facilitating e-visits with healthcare providers. On average, a telehealth visit reduces the number of future outpatient visits by 13.6% (or 0.15 visits), equal to a reduction of $239 in total cost within 30 days after the visit. Our results suggest that the benefits of telehealth use are observed primarily among diseases with high virtualization potential. Specifically, patients with mental health, skin, metabolic, and musculoskeletal diseases exhibit a significant reduction of 0.21 outpatient visits per quarter (an equivalent cost reduction of $179) when they are treated via telehealth, suggesting a substitution effect with respect to traditional clinic visits. Our research identifies the boundary conditions that determine the nuanced impact of telehealth on care utilization and shows that its effectiveness depends on the process virtualization potential of different diseases. Our findings have several practical and theoretical implications for fostering telehealth use in a value-based healthcare environment, especially for diseases with high virtualization potential where telehealth use should be promoted to bend the cost curve.

COVID-19 Pandemisinin Kanser Erken Teşhis Tarama ve Eğitim Merkezleri Hizmetlerinin Kullanımına Etkisi

Objective: This study was conducted to evaluate the impact of the COVID-19 pandemic on the use of Cancer Early Diagnosis, Screening, and Education Centers (KETEM) services. Materials and Methods: In this study, which was conducted as a descriptive retrospective cohort type, a total of 52.955 patient application records made to KETEM between January 1st and December 31st, 2017-2020 and January 1st-1 October 2021 were examined. The data obtained within the scope of the study were expressed as frequency and percentage. Results: In the study, it was determined that the numbers decreased as compared to previous three years (2017, 2018 and 2019) 70.4%, 59.1%, 68.8% for mammography screenings, 75.8%, 68.8%, 65.8% for HPV-Pap smear scans and 46.1%, 81.9%, and 72.2% for colorectal scans, respectively. Conclusion: It was detected that mammography, HPV-Pap, smear, and colorectal screenings offered within the scope of KETEM services decreased significantly in 2020 and 2021 which includes the pandemic process, compared to the previous years. It is estimated that cancers that cannot be detected in the early period due to the decrease in the number of applications will cause a significant increase in cancer mortality in the following years. Accordingly, it is recommended that the society, especially the individuals in the risk group, not delay their applications to cancer screening services, to take the necessary pandemic measures to inform them about making their applications without delay, and to improve their awareness about this issue. Amaç: Bu çalışma COVID-19 pandemisinin Kanser Erken Teşhis, Tarama ve Eğitim Merkezleri (KETEM) hizmetlerinin kullanımı üzerindeki etkisini değerlendirmek amacıyla yapılmıştır. Gereç ve Yöntem: Retrospektif kohort tipinde betimleyici olarak yürütülen bu araştırmada, 2017-2020 yıllarında 1 Ocak-31 Aralık tarihleri ile 1 Ocak-1 Ekim 2021 tarihleri arasında bir ilin Kanser Erken Teşhis, Tarama ve Eğitim Merkezleri'ne yapılan toplam 52.955 hasta başvuru kaydı incelenmiştir. Çalışma kapsamında elde edilen veriler frekans ve yüzde ile ifade edilmiştir. Bulgular: Çalışmada 2020 yılındaki mamografi tarama sayısının önceki üç yıla kıyasla (2017, 2018, 2019) sırasıyla %70.4, %59.1, %68.8 oranında;HPV-Pap smear tarama sayısının %75.8, %68.8, %65.8 oranında;kolorektal tarama sayısının ise sırasıyla %46.1, %81.9 ve %72.2 oranında düştüğü saptanmıştır. Sonuç: Bu araştırmada KETEM hizmetleri kapsamında sunulan mamografi, HPV-Pap smear ve kolorektal taramalarının pandemi sürecini kapsayan 2020 ve 2021 yıllarında önceki yıllara nazaran önemli düzeylerde azaldığı belirlenmiştir. Başvuru sayısındaki azalmaya bağlı olarak erken dönemde tespit edilemeyen kanserlerin ilerleyen yıllarda kanser mortalitesinde önemli bir artışa neden olacağı ön görülmektedir. Bu doğrultuda özellikle risk grubunda yer alan bireyler başta olmak üzere toplumun kanser tarama hizmetlerine başvurularını ertelememeleri, gerekli pandemi tedbirlerini alarak vakit kaybetmeden başvurularını gerçekleştirmeleri konusunda bilgilendirilmesi ve bu duruma yönelik farkındalıklarının geliştirilmesi önerilmektedir.

The Effect of the COVID-19 Pandemic on Use of Select Child Health Services in Kenyan Hospitals

Introduction. Kenya reported its first case of coronavirus disease (COVID-19) in March 2020. Pandemics may disrupt provision of essential health services. This study sought to find out if the COVID-19 outbreak had any effect on reported paediatric workload in Kenya. Methods. Aggregate workload data for 12 months before COVID-19 outbreak and 12 months of the COVID-19 outbreak were extracted from the Kenya Health Information System and negative binomial regression conducted. Results. A significant decline was observed across all indicators. Paediatric clinics attendance declined by 36%, paediatric admissions by 31.4%, outpatient attendance by 28.7%, and child wellness clinics attendance by 10.3%. In outpatient attendance, the five conditions with the highest attendance reported a decline ranging from 17.3% to 33.8%. Conclusion. COVID-19 partially disrupted essential health services among children in Kenya. Children in need of specialized treatment were more disadvantaged.

Remarks on the use of drones and data in precision agriculture. (L'Accademia per il post Covid-19.)

Precision agriculture is certainly one of the most interesting innovation for the management of agricultural crops. Drones, SAPRs, can be easily used for a targeted distribution of production inputs, such as plant protection products, fertilizers and biological protection, pollution reduction, dispersion and tracking the use of products. The article examines the regulatory aspects that hinder the spread of this practice and the possibility of making full use of the benefits and describes: - the provisions currently in force that prohibit the spraying of plant protection products by air, except for exceptions, with complex and highly limiting procedures (regional and ministry opinion). - the difficulties of monitoring and collecting data that can be used by the individual farmer to make choices within business context, but can also be used by consultants or transferred to platforms and clouds on the web. - aspects related to the protection, exchange and in particular the ownership of non-personal data relating to agricultural activity. The article concludes that, faced to the initiatives aimed at advancing precision agriculture and the digitization of the agricultural sector, it is necessary to address, in the appropriate institutional settings, the regulatory and legal elements that hinder the diffusion of innovations in support sustainable use of resources.

The Use of Interpreters in Health Centers: A Mixed-Methods Analysis

Health centers serve millions of patients with limited English proficiency (LEP) through highly variable language services programs that reflect patient language preferences, the availability of bilingual staff, and very limited sources of third-party funding for interpreters. We conducted a mixed-methods study to understand interpreter services delivery in federally qualified health centers during 2009–2019. Using the Uniform Data System database, we conducted a quantitative analysis to determine characteristics of centers with and without interpreters, defined as staff whose time is devoted to translation and/or interpreter services. We also analyzed Medicaid-relevant policies' association with health centers' interpreter use. The qualitative component used a sample of 28 health centers to identify interpreter services models. We found that the use of interpreters, as measured by the ratio of interpreter full-time equivalents per patients with LEP, decreased between 2009 and 2019. We did not find statistically significant relationships between interpreter staffing and number of patients with LEP served, or in our examination of Medicaid-relevant policies. Our qualitative analysis uncovered homegrown models with varying program characteristics. Key themes included the critical role of bilingual staff, inconsistent interpreter training, and the reasonably smooth transition to virtual interpretation during COVID-19.

Szűrőbuszok statikus pontként való alkalmazása a Covid-19-járvány idején

Purpose: The aim of our study is to present the results of the mobile sampling of the National Public Health Center during the Covid-19 pandemic, the implementation process of the screening buses of the program "We bring the screening tests in place” as static points, as well as the spatial and temporal frequency of use. Methods: Our retrospective analysis was performed in Pest County between 12th of November, 2020 and 18th of April 2022 by evaluating the Covid-19 sampling results from screening buses (N=164,576). Descriptive statistical methods were used to process the data. Results: In most cases, the screening was carried out in the patient's car, which reduced the risk of infection and ensured the safety and smoothness of the work by moving quickly through the screening point. Sampling was performed using AbottTM, Clintest® and VivaDiagTM rapid tests, and in case of a negative result, another nasopharyngeal sampling was performed for RT-PCR. An average of 504 samples were taken per day, of which on average almost 1⁄3(31.41%) were positive. Conclusion: The advantage of the screening buses was the ability to perform a significant number of tests, their mobility, the fact that they can be placed in easily accessible locations and the reduced risk of infection. Mass testing at static points has proven to be an efficient process that can be used in the future if the need arises. Célkitűzés: Tanulmányunk célja a Covid-19-járvány során a Nemzeti Népegészségügyi Központ mobil mintavételezésének, a „Helybe visszük a szűrővizsgálatokat” program szűrőbuszainak statikus pontként történő megvalósítási folyamatának, illetve területi és időbeni igénybevételi gyakoriságának, eredményeinek bemutatása. Vizsgálat módszere: Retrospektív elemzésünk Budapesten és Pest megyében 2020. november 12. és 2022. április 18. között a szűrőbuszokon végzett Covid-19-mintavételi leleteinek értékelésével valósult meg (N=164 576). A kapott adatok feldolgozásához leíró statisztikai módszereket alkalmaztunk. Eredmények: A teszteléseket legtöbb esetben a páciens személygépjárműjében végeztük el, ami csökkentette az infektálódás kockázatát, illetve a szűrőponton való gyors áthaladás szavatolta a munka biztonságát és gördülékenységét is. A mintavételezések során az AbottTM, a Clintest®, valamint a VivaDiagTM rapid tesztjeit használtuk, negatív eredmény esetén újabb nasopharingealis mintavétel történt RT-PCR elvégzése céljából. Naponta átlagosan 504 mintavétel valósult meg, amelynek átlagosan közel egyharmada (31,41%) mutatott pozitivitást. Következtetések: A szűrőbuszok előnye a nagyszámú tesztek elvégzésének lehetőségében, a mozgathatóságban, a mindenki számára könnyen megközelíthető pontokra való kihelyezésben, valamint a fertőződés kockázatának csökkentésében mutatkozott meg. A tömeges tesztelések statikus pontokon való lebonyolítása hatékonynak bizonyult, amely folyamatot a jövőben is alkalmazhatunk, ha arra szükség lesz.

COVID-19-Related Emergency Department Visits Among Undocumented Patients in Los Angeles County

Undocumented immigrants may be vulnerable to poor COVID-19 outcomes, but also may be less likely to seek medical care. To our knowledge, there have not been any investigations of potential COVID-19 disparities by immigration status. We analyzed emergency department (ED) visit data from March 20, 2020 to September 30, 2020 among patients in a safety-net hospital in Los Angeles County (n=30,023). We compared the probability of COVID-19-related ED visits between undocumented immigrants and Medi-Cal patients. We also examined differences in these comparisons over time. Undocumented patients had higher odds of COVID-19-related ED visits than Medi-Cal patients (OR: 1.41, 95% CI: 1.24–1.60) for all months in the study period except September. Even in the earliest days of the pandemic, undocumented patients were more likely than Medi-Cal patients to have a COVID-19-related ED visit. Additional analyses suggest this was likely because of higher COVID-19 exposure rather than differences in ED utilization.

Outcomes, Healthcare Resource Utilization, and Costs of Overall, Community-Acquired, and Hospital-Acquired Acute Kidney Injury in COVID-19 Patients.

Background: In hospitalized patients with COVID-19, acute kidney injury (AKI) is associated with higher mortality, but data are lacking on healthcare resource utilization (HRU) and costs related to AKI, community-acquired AKI (CA-AKI), and hospital-acquired AKI (HA-AKI). Objectives: To quantify the burden of AKI, CA-AKI, and HA-AKI among inpatients with COVID-19. Methods: This retrospective cohort study included inpatients with COVID-19 discharged from US hospitals in the Premier PINC AI™ Healthcare Database April 1-October 31, 2020, categorized as AKI, CA-AKI, HA-AKI, or no AKI by ICD-10-CM diagnosis codes. Outcomes were assessed during index (initial) hospitalization and 30 days postdischarge. Results: Among 208 583 COVID-19 inpatients, 30%, 25%, and 5% had AKI, CA-AKI, and HA-AKI, of whom 10%, 7%, and 23% received dialysis, respectively. Excess mortality, HRU, and costs were greater for HA-AKI than CA-AKI. In adjusted models, for patients with AKI vs no AKI and HA-AKI vs CA-AKI, odds ratios (ORs) (95% CI) were 3.70 (3.61-3.79) and 4.11 (3.92-4.31) for intensive care unit use and 3.52 (3.41-3.63) and 2.64 (2.52-2.78) for in-hospital mortality; mean length of stay (LOS) differences and LOS ratios (95% CI) were 1.8 days and 1.24 (1.23-1.25) and 5.1 days and 1.57 (1.54-1.59); and mean cost differences and cost ratios were $7163 and 1.35 (1.34-1.36) and $19 127 and 1.78 (1.75-1.81) (all P < .001). During the 30 days postdischarge, readmission LOS was ≥6% longer for AKI vs no AKI and HA-AKI vs CA-AKI; outpatient costs were ≥41% higher for HA-AKI vs CA-AKI or no AKI. Only 30-day new dialysis (among patients without index hospitalization dialysis) had similar odds for HA-AKI vs CA-AKI (2.37-2.8 times higher for AKI, HA-AKI, or CA-AKI vs no AKI). Discussion: Among inpatients with COVID-19, HA-AKI had higher excess mortality, HRU, and costs than CA-AKI. Other studies suggest that interventions to prevent HA-AKI could decrease excess morbidity, HRU, and costs among inpatients with COVID-19. Conclusions: In adjusted models among COVID-19 inpatients, AKI, especially HA-AKI, was associated with significantly higher mortality, HRU, and costs during index admission, and higher dialysis and longer readmission LOS during the 30 days postdischarge. These findings support implementation of interventions to prevent HA-AKI in COVID-19 patients.

Design and rationale of FINE-REAL: A prospective study of finerenone in clinical practice.

AIMS: Contemporary patterns of care of patients with chronic kidney disease (CKD) associated with type 2 diabetes (T2D) and the adoption of finerenone are not known. The FINE-REAL study (NCT05348733) is a prospective observational study in patients with CKD and T2D to provide insights into the use of the nonsteroidal mineralocorticoid receptor antagonist (MRA) finerenone in clinical practice. METHODS: FINE-REAL is an international, prospective, multicenter, single-arm study enrolling approximately 5500 adults with CKD and T2D in an estimated 200 sites across 22 countries. The study is anticipated to be ongoing until 2027. RESULTS: The primary objective is to describe treatment patterns in patients with CKD and T2D treated with finerenone in routine clinical practice. Secondary objectives include assessment of safety with finerenone. Other endpoints include characterization of healthcare resource utilization and occurrence of newly diagnosed diabetic retinopathy or its progression from baseline in patients with existing disease. A biobank is being organized for future explorative analyses with inclusion of participants from the United States. CONCLUSIONS: FINE-REAL is the first prospective observational study with a nonsteroidal MRA in a population with CKD and T2D and is expected to provide meaningful insights into the treatment of CKD associated with T2D. FINE-REAL will inform decision-making with respect to initiation of finerenone in patients with CKD and T2D.

Emergency medical admissions and COVID-19: impact on 30-day mortality and hospital length of stay.

BACKGROUND: The COVID-19 pandemic has put considerable strain on healthcare systems. AIM: To investigate the effect of the COVID-19 pandemic on 30-day in-hospital mortality, length of stay (LOS) and resource utilization in acute medical care. METHODS: We compared emergency medical admissions to a single secondary care centre during 2020 to the preceding 18 years (2002-2019). We investigated 30-day in-hospital mortality with a multiple variable logistic regression model. Utilization of procedures/services was related to LOS with zero truncated Poisson regression. RESULTS: There were 132,715 admissions in 67,185 patients over the 19-year study. There was a linear reduction in 30-day in-hospital mortality over time; over the most recent 5 years (2016-2020), there was a relative risk reduction of 36%, from 7.9 to 4.3% with a number needed to treat of 27.7. Emergency medical admissions increased 18.8% to 10,452 in 2020 with COVID-19 admissions representing 3.5%. 18.6% of COVID-19 cases required ICU admission with a median stay of 10.1 days (IQR 3.8, 16.0). COVID-19 was a significant univariate predictor of 30-day in-hospital mortality, 18.5% (95%CI: 13.9, 23.1) vs. 3.0% (95%CI: 2.7, 3.4)-OR 7.3 (95%CI: 5.3, 10.1). ICU admission was the dominant outcome predictor-OR 12.4 (95%CI: 7.7, 20.1). COVID-19 mortality in the last third of 2020 improved-OR 0.64 (95%CI: 0.47, 0.86). Hospital LOS and resource utilization were increased. CONCLUSION: A diagnosis of COVID-19 was associated with significantly increased mortality and LOS but represented only 3.5% of admissions and did not attenuate the established temporal decline in overall in-hospital mortality.

Preliminary evaluation of a multicomponent youth development program for siblings separated by foster care: pandemic related impacts to service delivery and youth well-being

A preliminary evaluation of a multicomponent youth development program for siblings in foster care was conducted prior to and during the COVID-19 pandemic. Pretest posttest measures of youth well-being were collected from sixteen youth, caregivers, and caseworkers over a six-month period. Caregivers reported increased internalizing and externalizing behaviors, sibling relationship difficulties, prosocial behavior, and resilience during the study period. Youth reported reduced school engagement, increased resilience, and prosocial behavior. In-person sibling programming was associated with increased prosocial behavior. Virtual sibling programming was associated with lower hyperactivity, increased prosocial behavior, and increased emotional problems. Implications for research and practice are discussed.

Disposal and resource utilization of waste masks: a review.

Waste masks pose a serious threat to the environment, including marine plastic pollution and soil pollution risks caused by landfills since the outbreak of COVID-19. Currently, numerous effective methods regarding disposal and resource utilization of waste masks have been reported, containing physical, thermochemical, and solvent-based technologies. As for physical technologies, the mechanical properties of the mask-based materials could be enhanced and the conductivity or antibacterial activity was endowed by adding natural fibers or inorganic nanoparticles. Regarding thermochemical technologies, catalytic pyrolysis could yield considerable hydrogen, which is an eco-friendly resource, and would mitigate the energy crisis. Noticeably, the solvent-based technology, as a more convenient and efficient method, was also considered in this paper. In this way, soaking the mask directly in a specific chemical reagent changes the original structure of polypropylene and obtains multi-functional materials. The solvent-based technology is promising in the future with the researches of sustainable and universally applicable reagents. This review could provide guidance for utilizing resources of waste masks and address the issues of plastic pollution.

Dimethyl fumarate is associated with lower rates of infection and lower infection-related healthcare costs when compared with ocrelizumab.

BACKGROUND: Infections in people with multiple sclerosis (PwMS) may have a detrimental effect on disease progression, risk of hospitalization, and healthcare resource utilization (HRU). The infection risk and HRU costs may vary between disease-modifying therapies (DMTs); however, the individual risks and differences associated with DMTs are not well characterized. Some DMTs may increase the risk for infections in PwMS; however, previous studies have reported an intact humoral immune response in dimethyl fumarate (DMF)-treated patients. The objective was to compare infection-related HRU and healthcare costs (HCCs) between PwMS treated with DMF or ocrelizumab (OCR). METHODS: Eligible patients were identified from the Optum US claims database between April 2017 and September 2020 (DMF n = 1429; OCR n = 3170). Patients were followed from index date to first occurrence of: (1) end of study, (2) end of insurance eligibility, (3) discontinuation of index DMT, or (4) switch from index DMT to another DMT. Outcomes were annualized rate of infection encounters (defined as infection encounters [n] during follow-up window / days followed [n] × 365); annualized infection-related HCCs (defined as aggregated costs of infection encounters during follow-up window / days followed [n] × 365); location-specific infections, and overall infection-related events. Propensity score matching (PSM) 1:1 method was used; PS was calculated via logistic regression for probability of DMF treatment conditional on demographics and comorbidities. Mean differences (MD) were reported for infection encounter measures. RESULTS: After PSM, DMF and OCR cohorts (n = 1094 in each cohort) were balanced based on baseline characteristics (standardized MD of adjusted baseline characteristics <0.1). Mean (standard deviation) follow-up was 296 (244) days for DMF patients and 297 (243) for OCR patients. DMF patients experienced lower annualized rates of overall infection encounters vs OCR patients (MD -0.51 [95% confidence interval (CI): -0.92 to -0.11], p = 0.01). When stratified by type of infection encounter, DMF patients experienced significantly lower annualized rates of outpatient (MD [95% CI]: -0.44 [-0.80 to -0.08], p = 0.02) and inpatient/hospitalization infection encounters (-0.08 [-0.14 to -0.02], p<0.01) vs OCR patients. A trend towards a shorter duration of infection-related hospitalization in the DMF vs the OCR group was observed (MD [95% CI]: -2.20 [-4.73 to 0.26] days, p = 0.08). The most common infection types in both DMT groups were urinary tract infections, sepsis, and pneumonia. DMF patients experienced lower annualized infection-related HCCs (MD [95% CI]: -$3642 [-$6380 to -$904], p < 0.01) vs OCR patients, which were driven largely by infection-related hospitalization costs (-$3639 [-$6019 to -$1259], p < 0.01). CONCLUSION: DMF-treated patients PS-matched with OCR patients experienced lower annualized rates of infection encounters and lower infection-related HCCs.

Assessment of Healthcare Resource Utilization by Anticoagulant Heparinoid Dosage Level in Patients Hospitalized with COVID-19.

The aim was to describe inpatients with COVID-19 empirically prescribed heparinoid anticoagulants and compare resource utilization between prophylactic/low-dose and therapeutic/high-dose groups. Methods: This retrospective observational study used real-world data from 880 US hospitals in the PINC AI™ Healthcare Database during 4/1/2020-11/30/2020. Descriptive analysis was used to characterize patients. Multivariable regression was used to evaluate intensive care unit (ICU) admissions, length of stay (LOS), mortality, and costs by anticoagulation dose group, adjusting for cohort characteristics. Among 122,508 inpatients, 29,225 (23.9%) received therapeutic/high-dose, and 93,283 (76.1%) received prophylactic/low-dose anticoagulation. The high-dose group had more comorbidities and worse laboratory values compared with low-dose. Respectively, ICU admission rates were 36.7% and 19.1% and LOS median (Q1, Q3) was 8 (5, 15) and 5 (3, 9) days. In separate adjusted models, high-dose anticoagulation was associated with a 45% increase in odds of ICU admission, 26% increase in odds of in-hospital mortality, 21% longer average LOS, and 28% greater average total cost compared with low-dose (each P < 0.001). Prophylactic/low-dose anticoagulation treatment was associated with decreased healthcare resource utilization (HRU) in hospitalized patients with COVID-19.