There are few high-quality studies of the costs of Clostridium difficile infection (CDI), and the majority of studies focus on the costs of CDI in acute-care facilities. Analysis of the best available data, from 2008, indicates that CDI may have resulted in $4.8 billion in excess costs in US acute-care facilities. Other areas of CDI-attributable excess costs that need to be investigated are costs of increased discharges to long-term care facilities, of CDI with onset in long-term care facilities, of recurrent CDI, and of additional adverse events caused by CDI.

Burden of Clostridium difficile on the healthcare system.

Carpal tunnel syndrome is the most common peripheral nerve entrapment syndrome worldwide. The clinical symptoms and physical examination findings in patients with this syndrome are recognised widely and various treatments exist, including non-surgical and surgical options. Despite these advantages, there is a paucity of evidence about the best approaches for assessment of carpal tunnel syndrome and to guide treatment decisions. More objective methods for assessment, including electrodiagnostic testing and nerve imaging, provide additional information about the extent of axonal involvement and structural change, but their exact benefit to patients is unknown. Although the best means of integrating clinical, functional, and anatomical information for selecting treatment choices has not yet been identified, patients can be diagnosed quickly and respond well to treatment. The high prevalence of carpal tunnel syndrome, its effects on quality of life, and the cost that disease burden generates to health systems make it important to identify the research priorities that will be resolved in clinical trials.

Carpal tunnel syndrome: clinical features, diagnosis, and management

https://www.umassmed.edu/contentassets/15113f8a672840fca8b783ca95a800af/investing-in-the-health-wellbeing-of-young-adults.pdf

Investing in the Health and Well-Being of Young Adults

https://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1101&context=medfp

Sickle cell pain: a critical reappraisal

Objectives.Improvements in survival for children with sickle cell disease (SCD) during the last 30 years have been well established. Whether similar improvements for adults with the disease have oc...

Mortality rates and age at death from sickle cell disease: U.S., 1979-2005.

Context Published rates of health care utilization and rehospitalization by people with sickle cell disease have had limited generalizability and are not population based. Objective To provide benchmark data for rates of acute care utilization and rehospitalizations for patients with sickle cell disease. Design Retrospective cohort of sickle cell disease–related emergency department (ED) visits and hospitalizations from select states in the 2005 and 2006 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases and State Emergency Department Databases. Setting Eight geographically dispersed states (Arizona, California, Florida, Massachusetts, Missouri, New York, South Carolina, and Tennessee) that provide encrypted identifiers and have sufficient numbers of patients with sickle cell disease; together these states have 33% of the US population with sickle cell disease. Patients A total of 21 112 patients with sickle cell–related treat-and-release ED visits or inpatient hospitalizations. Main Outcome Measures Rates of acute care utilization and rehospitalizations. Population-based utilization rates were also calculated. Results The 21 112 people with sickle cell disease had 109 344 encounters, a mean of 2.59 (95% confidence interval [CI], 2.53-2.65) encounters per patient per year, 1.52 (95% CI, 1.48-1.55) encounters for hospitalizations and 1.08 (95% CI, 1.04-1.11) for treat-and-release ED visits. Utilization was highest for 18- to 30-year-olds, 3.61 (95% CI, 3.47-3.75) encounters per patient per year, and those with public insurance, 3.22 (95% CI, 3.13-3.31) encounters per patient per year. Publicly insured 18- to 30-year-olds had 4.80 (95% CI, 4.58-5.02) encounters per patient per year. Approximately 29% of the population had no encounters while 16.9% had 3 or more encounters per year. The 30-day and 14-day rehospitalization rates were 33.4% (95% CI, 33.0%-33.8%) and 22.1% (95% CI, 21.8%-22.4%), respectively. The rehospitalization rate was highest for 18- to 30-year-olds, with 41.1% (95% CI, 40.5%-41.7%) rehospitalized within 30 days and 28.4% (95% CI, 27.8%-29.0%) within 14 days. Rehospitalizations were also highest for publicly insured patients. Conclusion Among patients with sickle cell disease, acute care encounters and rehospitalizations were frequent, particularly for 18- to 30-year-olds.

https://jamanetwork.com/journals/jama/articlepdf/185633/joc05031_1288_1294.pdf

Acute Care Utilization and Rehospitalizations for Sickle Cell Disease

Importance Surgical site infections can result in substantial morbidity following inpatient surgery. Little is known about serious infections following ambulatory surgery. Objective To determine the incidence of clinically significant surgical site infections (CS-SSIs) following low- to moderate-risk ambulatory surgery in patients with low risk for surgical complications. Design, Setting, and Participants Retrospective analysis of ambulatory surgical procedures complicated by CS-SSIs that require a postsurgical acute care visit (defined as subsequent hospitalization or ambulatory surgical visit for infection) using the 2010 Healthcare Cost and Utilization Project State Ambulatory Surgery and State Inpatient Databases for 8 geographically dispersed states (California, Florida, Georgia, Hawaii, Missouri, Nebraska, New York, and Tennessee) representing one-third of the US population. Index cases included 284 098 ambulatory surgical procedures (general surgery, orthopedic, neurosurgical, gynecologic, and urologic) in adult patients with low surgical risk (defined as not seen in past 30 days in acute care, length of stay less than 2 days, no other surgery on the same day, and discharged home and no infection coded on the same day). Main Outcomes and Measures Rates of 14- and 30-day postsurgical acute care visits for CS-SSIs following ambulatory surgery. Results Postsurgical acute care visits for CS-SSIs occurred in 3.09 (95% CI, 2.89-3.30) per 1000 ambulatory surgical procedures at 14 days and 4.84 (95% CI, 4.59-5.10) per 1000 at 30 days. Two-thirds (63.7%) of all visits for CS-SSI occurred within 14 days of the surgery; of those visits, 93.2% (95% CI, 91.3%-94.7%) involved treatment in the inpatient setting. All-cause inpatient or outpatient postsurgical visits, including those for CS-SSIs, following ambulatory surgery occurred in 19.99 (95% CI, 19.48-20.51) per 1000 ambulatory surgical procedures at 14 days and 33.62 (95% CI, 32.96-34.29) per 1000 at 30 days. Conclusions and Relevance Among patients in 8 states undergoing ambulatory surgery, rates of postsurgical visits for CS-SSIs were low relative to all causes; however, they may represent a substantial number of adverse outcomes in aggregate. Thus, these serious infections merit quality improvement efforts to minimize their occurrence.

https://jamanetwork.com/journals/jama/articlepdf/1829988/joi140003.pdf

Surgical Site Infections Following Ambulatory Surgery Procedures

Annual report on health care for children and youth in the United States: focus on trends in hospital use and quality

https://www.jvascsurg.org/article/S0741-5214(11)02740-6/pdf

Pamela L Owens

Papers

Acute Care Utilization and Rehospitalizations for Sickle Cell Disease

Surgical Site Infections Following Ambulatory Surgery Procedures

Annual report on health care for children and youth in the United States: focus on trends in hospital use and quality

Population-based analysis of inpatient vascular procedures and predicting future workload and implications for training

Emergency Department Visits for Injurious Falls among the Elderly, 2006