Publications by authors named "Nick D Williams"

2 Publications

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The changing patterns of comorbidities associated with human immunodeficiency virus infection, a longitudinal retrospective cohort study of Medicare patients.

Medicine (Baltimore) 2021 Apr;100(16):e25428

The Lister Hill National Center for Biomedical Communications at the National Library of Medicine, National Institutes of Health in the United States, Bethesda, Maryland.

Abstract: The objective of this paper is to determine the temporal trend of the association of 66 comorbidities with human immunodeficiency virus (HIV) infection status among Medicare beneficiaries from 2000 through 2016.We harvested patient level encounter claims from a 17-year long 100% sample of Medicare records. We used the chronic conditions warehouse comorbidity flags to determine HIV infection status and presence of comorbidities. We prepared 1 data set per year for analysis. Our 17 study data sets are retrospective annualized patient level case histories where the comorbidity status reflects if the patient has ever met the comorbidity case definition from the start of the study to the analysis year.We implemented one logistic binary regression model per study year to discover the maximum likelihood estimate (MLE) of a comorbidity belonging to our binary classes of HIV+ or HIV- study populations. We report MLE and odds ratios by comorbidity and year.Of the 66 assessed comorbidities, 35 remained associated with HIV- across all model years, 19 remained associated with HIV+ across all model years. Three comorbidities changed association from HIV+ to HIV- and 9 comorbidities changed association from HIV- to HIV+.The prevalence of comorbidities associated with HIV infection changed over time due to clinical, social, and epidemiological reasons. Comorbidity surveillance can provide important insights into the understanding and management of HIV infection and its consequences.
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April 2021

Reasons for emergency department use: do frequent users differ?

Am J Manag Care 2014 Nov 1;20(11):e506-14. Epub 2014 Nov 1.

Department of Emergency Medicine, Bellevue Hospital Center Room A-345, First Ave and 27th St, New York, NY 10016. E-mail:

Objectives: To examine patients' reasons for using the emergency department (ED) for low-acuity health complaints, and determine whether reasons differed for frequent ED users versus nonfrequent ED users.

Study Design: Prospective cross-sectional survey.

Methods: Patients presenting to an urban public hospital for low-acuity health complaints were surveyed about their reasons for visiting the ED rather than a private doctor's office or clinic. Patients with 3 or more visits to the study hospital ED over the past year were classified as frequent ED users. Multivariable logistic regression was used to determine if frequent ED users gave different reasons for ED use than nonfrequent ED users, while controlling for differences in other baseline patient characteristics.

Results: 940 patients, including 163 frequent ED users, completed the study questionnaire. Commonly cited reasons for using the ED were that coming to the ED was easier than making a clinic appointment (82.3% agreed); the problem could not wait (78.8%); they didn't know how to make a clinic appointment (66.7%); they felt the ED provided better care (56.7%); and they believed the clinic would cost more (54.8%). After controlling for other patient characteristics, there were no significant differences found in reasons for ED use given by frequent versus nonfrequent ED users.

Conclusions: Frequent ED users gave similar reasons for using the ED for low-acuity health complaints compared with nonfrequent ED users. Access, convenience, cost, and quality concerns, as well as feeling that ED care was needed, were all commonly cited as reasons for using the ED.
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November 2014