Objective To examine the disability, health care resource utilization, and direct annual costs among patients with migraine, categorized according to the number of headache days experienced in the past month. Background Migraine exists on a continuum of different attack frequencies and associated levels of disability. People with migraine have increased health care utilization and incur substantially more direct costs than those without the disease. While the broad implications of migraine are evident, there is a need to comprehensively describe the impact of headache frequency on the burden of illness. Design/Methods Data from a cross‐sectional, self‐administered, Internet‐based survey of respondents recruited from the US National Health and Wellness Survey panel were assessed. Adults who had self‐reported migraine diagnosis or migraine symptoms in the past 3 months were grouped by their frequency of headache days in the past month: low‐frequency episodic migraine (LFEM, <4 days), moderate‐frequency episodic migraine (MFEM, 4–9 days), high‐frequency episodic migraine (HFEM, 10–14 days), and chronic migraine (CM, ≥15 days). Headache‐related disability was determined from the Headache Impact Test (HIT‐6) scores, and health care resource utilization was assessed by the number of ER visits, hospitalizations, and visits to health care practitioners (HCPs) in the past 12 months. The estimated annual direct costs were calculated from the number of each type of visit and all‐cause cost data from the 2014 Medical Expenditure Panel Survey. Results A total of 1347 patients (LFEM, n = 813; MFEM, n = 301; HFEM, n = 105; CM, n = 128) were included. Patient groups differed significantly by comorbidity index, education and income level, alcohol consumption, and insurance type. Overall, patients with LFEM had the least disability and lowest health care utilization and direct costs. Patients with CM scored 3.7 points (adjusted mean score [95% confidence interval, CI] 68.2 [67.3, 69.0] points) higher on HIT‐6 compared with those in the LFEM group (64.5 points [64.1, 64.8]), while those with HFEM and MFEM scored 2.4 (66.8 points [65.9, 67.8]) and 2.3 (66.7 points [66.2, 67.3]) points higher, respectively (all, P < .001). The CM and MFEM groups reported significantly more HCP visits ([mean ± standard error] CM: 7.03 ± 0.83; MFEM: 5.34 ± 0.42; vs LFEM: 3.48 ± 0.18; both, P < .001) and migraine‐related hospitalizations (CM: 0.06 ± 0.03; MFEM: 0.05 ± 0.02; vs LFEM: 0.02 ± 0.01; both, P < .05) than the LFEM group. There were significant differences in the total direct costs between the CM and MFEM groups compared with the LFEM group (CM: $3155 ± $609; MFEM: $2721 ± $342; vs LFEM: $1560 ± $118; both, P < .001), with differences largely driven by costs of HCP visits. Conclusions In patients with migraine, as the number of headache days increased, so did the burden of disease (disability, health care utilization, and direct costs). Elucidating the burden associated with EM and CM has implications for guiding treatment decisions and managem...

The perceptions and practices of junior healthcare managers suggest that there is a culture of acceptance and expectation of work stress, combined with a lack of awareness to effectively and proactively manage it.

BACKGROUND: Migraine is a chronic disease that reduces health-related quality of life. Little is known about the burden of migraine in individuals who are potential candidates for preventive treatment with ≥ 4 monthly headache days currently using migraine medications. OBJECTIVE: To characterize the burden of migraine among patients reporting ≥ 4 monthly headache days while taking acute and/or preventive migraine medications.

BACKGROUND: The functional impairment associated with migraine can cause physical, emotional, and economic ramifications that can affect occupational, academic, social, and family life. Understanding the relationship between headache-free days (HFDs) and the disease burden of migraine may help with decisions regarding treatment and management of migraine. OBJECTIVE: To determine the relationship between burden of disease measures and HFDs among individuals with migraine experiencing ≥ 4 headache days in the previous 30 days. METHODS:The 2016 U.S. National Health and Wellness Survey (N = 97,503) was self-administered to a nationally representative sample of adults. Respondents with a migraine diagnosis who reported ≥ 4 headache days a month were included in the analysis. The primary independent variable was the number of HFDs assessed as both a continuous (HFDs in the previous 30 days) and categorical (0-10, 11-20, and 21-26 HFDs) measure. HFDs were used to predict outcomes using separate generalized linear models. Outcomes included effect on functional status and well-being, measured by the 6-item Headache Impact Test (HIT-6) score; number of days of work and/or household activities missed due to migraine; annualized indirect costs due to work productivity loss (assessed via the Work Productivity and Activity Impairment questionnaire); and annualized direct costs due to health care resource use (health care provider visits, emergency room visits, and hospitalizations). RESULTS:The survey included 372 respondents with diagnosed migraine and ≥ 4 headache days per month. Using HFDs as a continuous variable, each additional HFD was associated with a 0.15-point reduction in HIT-6 scores, a 5% reduction in both number of work days and household activities missed, and a 4% reduction in indirect costs; thus, a 5-day increase in HFDs would lead to a 0.75-point reduction in HIT-6 scores, 25% reduction in days of work or household activities missed, and 20% reduction in indirect costs. Analyzing HFDs as a categorical variable, respondents experiencing 21-26 HFDs had lower HIT-6 total scores than those with 0-10 HFDs (adjusted means: 66.59 vs. 63.91;

Among hospitalized patients, malnutrition is prevalent yet often overlooked and undertreated. We implemented a quality improvement program that positioned early nutritional care into the nursing workflow. Nurses screened for malnutrition risk at patient admission and then immediately ordered oral nutritional supplements for those at risk. Supplements were given as regular medications, guided and monitored by medication administration records. Post-quality improvement program, pressure ulcer incidence, length of stay, 30-day readmissions, and costs of care were reduced.