Geospatial and Explanatory Models for Heart Failure Admissions, 2016 through 2018

Background. About 5.7 million individuals in the United States have heart failure, and the disease was estimated to cost about $42.9 billion in 2020. This research provides geographical incidence models of this disease in the U.S. and explanatory models to account for hospitals’ number of heart failure DRGs using technical, workload, financial, geographical, and time-related variables. The research also provides updated financial and demand estimates based on inflationary pressures and disease rate increases. Understanding patterns is important to both policymakers and health administrators for cost control and planning. Methods. Maps of heart failure diagnosis-related groups (DRGs) from 2016 through 2018 depicted areas of high incidence as well as changes. Spatial regression identified no significant spatial correlations. Simple expenditure forecasts were calculated for 2016 through 2018. Linear, lasso, ridge, and Elastic Net models as well as ensembled tree regressors including were built on an 80% training set and evaluated on a 20% test set. Results: The incidence of heart failure has increased over time with highest intensities in the East and center of the country; however, several Northern states (e.g., Minnesota) have seen large increases in rates from 2016. The best traditional regression model explained 75% of the variability in the number of DRGs experienced by hospital using a small subset of variables including discharges, DRG type, percent Medicare reimbursement, hospital type, and medical school affiliation. The best ensembled tree models achieved R2 over .97 on the blinded test set and identified discharges, percent Medicare reimbursement, hospital acute days, affiliated physicians, staffed beds, employees, hospital type, emergency room visits, medical school affiliation, geographical location, and the number of surgeries as highly important predictors. Conclusions. Overall, the total cost of the three DRGs in the study has increased approximately $61 billion from 2016 through 2018 (average of two estimates). The increase in the more expensive DRG (DRG 291) has outpaced others with an associated increase of $92 billion in expenditures. With the increase in demand (linked to obesity and other factors) as well as the relatively steady-state supply of cardiologists over time, the costs are likely to balloon over the next decade.

Geospatial-Temporal, Explanatory, Demand, and Financial Models for Heart Failure

Background About 5.7 million individuals in the United States have heart failure, and the disease was estimated to cost about $42.9 billion in 2020. This research provides geospatial-temporal incidence models of this disease in the U.S. and explanatory models to account for hospitals’ number of heart failure DRGs using technical, workload, financial, and geospatial-temporal variables. The research also provides updated financial and demand estimates based on inflationary pressures and disease rate increases. Understanding patterns is important to both policymakers and health administrators alike for cost control and planning. Methods Geographical Information Systems maps of heart failure diagnosis-related groups (DRGs) from 2016 through 2018 depicted areas of high incidence as well as changes. Simple expenditure forecasts were calculated for 2016 through 2018. Linear, lasso, ridge, and Elastic Net models as well as ensembled tree regressors including were built on an 80% training set and evaluated on a 20% test set. Results The incidence of heart failure has increased over time with highest intensities in the East and center of the country; however, several Northern states (e.g., Minnesota) have seen large increases in rates from 2016. The best traditional regression model explained 75% of the variability in the number of DRGs experienced by hospital using a small subset of variables including discharges, DRG type, percent Medicare reimbursement, hospital type, and medical school affiliation. The best ensembled tree models achieved R2 over .97 on the blinded test set and identified discharges, percent Medicare reimbursement, hospital acute days, affiliated physicians, staffed beds, employees, hospital type, emergency room visits, medical school affiliation, geographical location, and the number of surgeries as highly important predictors. Conclusions Overall, the total cost of the three DRGs in the study has increased approximately $61 billion from 2016 through 2018 (average of two estimates). The increase in the more expensive DRG (DRG 291) has outpaced others with an associated increase of $92 billion in expenditures. With the increase in demand (linked to obesity and other factors) as well as the relatively steady-state supply of cardiologists over time, the costs are likely to balloon over the next decade.

Indonesian Adolescents' Online Opportunities and Risks

This research aims to 1) explore the benefits of online (benefits obtained when on the internet) and online risks (risks experienced when on the internet) in adolescents in Jakarta; 2) Test differences in online benefits and online risk based on differences in gender, education level, and school affiliation. This study used a survey method with a multilevel random sampling technique performed on adolescents living in Jakarta aged 12-18 (N = 756). The data analysis technique for this study is descriptive analysis and T-test analysis. The results of the research show that teenagers in Jakarta regularly use the internet every day with relatively high duration. More than 60% of teens benefit online in the medium to the high category, with six types of benefits online: learning, creative participation, social participation, social relations, entertainment, commercial benefits, and personal benefits. Most teens experience online risk in the low category, with three types of risks: content risk, contact risk, and behavioral risk. Other findings, namely: (1) there are significant differences in online risk-based on sex and adolescent education level; (2) significant differences in online benefits are based solely on adolescent education levels. There are no significant differences in online and online risk benefits based on school affiliation (non-religious schools and religion-based schools). This research contributes to the importance of distinguishing online benefits and online risks from adolescent education levels.

Social class differences in youths’ participation in organized sports: What are the mechanisms?

Despite several decades of Sport for All policies, social class differences in organized sports participation of youth persist. However, few population-based studies have examined how social class may influence adolescent participation. We use survey data from upper secondary school students (aged 16–19) from the Norwegian capital of Oslo ( N = 10,531) and investigate the factors through which social class operates. To measure parental social class, we use the well-established Erikson, Goldthorpe and Portocarero class scheme, supplemented by indicators of economic and cultural resources. We also include data on immigrant status, neighbourhood and school affiliation. There were large differences in organized sport participation between youth from the higher and lower social classes. Indicators of parental economic resources mediated many of these differences and had an additional independent statistical effect. Indicators of cultural resources, immigrant status, and neighbourhood and school affiliation only had modest effects. We conclude that social class plays a major role in organized sport participation, and economic resources are particularly important. Methodologically, we suggest that well-established social class schemes should be used in such research, supplemented with more detailed indicators of economic resources.

Samarbejde i sig selv løser intet!

Artiklen belyser, hvordan elever med svag skoletilknytning oplever deres skoledeltagelse, og hvordan eleverne forstår de tiltag, der organiseres for at fremme deres skoledeltagelse. Artiklen viser, at de professionelles samarbejde ikke formår at skabe en ny professionel praksis til glæde for de unge. Imidlertid viser det sig, at selvom forskellige professionelle mødes omkring en gruppe af unges udfordringer, har de svært ved bruge deres professionelle forskellighed konstruktivt. Det vises endvidere, at indsatsen ofte gennemføres uden en reel inddragelse af de unge. Det betyder bl.a., at de unge udvikler en indifferent attitude til tiltagene.The article describes how students with weak school affiliation experience their school life, and how they conceive the specially organized efforts made by the professionals to support their school participation. The article shows that teachers and other professionals in special functions not always can develop new practices from which the students can benefit. Yet, it also turns out that the professional groups face some difficulties in using their professional differences in a constructive way. Furthermore, it is shown how the specially organized efforts, of which the students are a part, often are carried through without involving the students themselves. This lead to the students distancing themselves to a certain extent of these efforts.

Abstract 188: Hospital and Regional Variation in Use of High-intensity Statins Following Myocardial Infarction Among Medicare Beneficiaries

Background: American College of Cardiology/American Heart Association guidelines published in 2013 recommend high-intensity statins (atorvastatin 40 or 80 mg or rosuvastatin 20 or 40 mg) for most adults ≤75 years of age with atherosclerotic cardiovascular disease (ASCVD). For adults >75 years of age with ASCVD, the guidelines recommend continuation of tolerated statins or initiation of moderate intensity statins for most patients. Objective: To examine whether guideline concordant use of high-intensity statins following myocardial infarction (MI) among Medicare beneficiaries differed by hospital size, medical school affiliation, and region of the US in 2014 (after publication of the guidelines). Methods: We identified 28,086 Medicare beneficiaries with fee-for-service and pharmacy coverage who filled a statin within 30 days following hospital discharge for MI in 2014. The analyses were restricted to 731 hospitals with at least 20 beneficiaries discharged for MI in 2014. Hospital size and medical school affiliation were determined from the American Hospital Association survey. In subgroups ≤75 and >75 years of age, we calculated the proportion of beneficiaries whose first statin fill after MI was a high-intensity statin by hospital, hospital size, medical school affiliation, and region. Results: Among statin users ≤75 years of age, 10,696 (55%) beneficiaries filled a prescription for a high-intensity statin following MI. The percentage filling high-intensity statins range from 0-100% (25 th percentile 39%, 75 th percentile 69%) across hospitals. High-intensity statin use was more common following hospitalization at larger hospitals, hospitals with medical school affiliations, and those in New England ( Figure ). A lower percentage of Medicare beneficiaries >75 years of age filled high-intensity statins (n = 8,441, 44%), but patterns were similar across hospital characteristics and region. Conclusions: Similar patterns of high-intensity statin use were present among individuals ≤75 years of age, in whom high-intensity statin use is guideline concordant, and individuals >75 years of age, in whom high-intensity statin use is not necessarily guideline concordant, suggesting that variation in high-intensity statin prescriptions may not be directly related to close adherence to guidelines.