Analysis of Hospital Readmissions After Prosthetic Urologic Surgery in the United States: Nationally Representative Estimates of Causes, Costs, and Predictive Factors

Abstract Objective Exponential increases in rehabilitation intensity in skilled nursing facilities (SNFs) motivated recent changes in Medicare reimbursement policies, which remove financial incentives for providing more minutes of physical therapy, occupational therapy, and speech therapy. Yet there is concern that SNFs will reduce therapy provision and patients will experience worse outcomes. The purpose of this systematic review was to synthesize current evidence on the relationship between therapy intensity and patient outcomes in SNFs. Methods PubMed, Medline, Scopus, Embase, CINAHL, PEDro, and COCHRANE databases were searched. English-language studies published in the United States between 1998 and February 14, 2020, examining the relationship between therapy intensity and community discharge, hospital readmission, length of stay (LOS), and functional improvement for short-stay SNF patients were considered. Data extraction and risk of bias were performed using the American Academy of Neurology (AAN) Classification of Evidence scale for causation questions. AAN criteria were used to assess confidence in the evidence for each outcome. Results Eight observational studies met inclusion criteria. There was moderate evidence that higher intensity therapy was associated with higher rates of community discharge and shorter LOS. One study provided very low-level evidence of associations between higher intensity therapy and lower hospital readmissions after total hip and knee replacement. There was low-level evidence indicating higher intensity therapy is associated with improvements in function. Conclusions This systematic review concludes, with moderate confidence, that higher intensity therapy in SNFs leads to higher community discharge rates and shorter LOS. Future research should improve quality of evidence on functional improvement and hospital readmissions. Impact This systematic review demonstrates that patients in SNFs may benefit from higher intensity therapy. Because new policies no longer incentivize intensive therapy, patient outcomes should be closely monitored to ensure patients in SNFs receive high-quality care.

Download Full-text

Real-World Utilization of Oral Anticancer Agents Costs in Older Adults with Metastatic Renal Cell Carcinoma in the United States

Kidney Cancer ◽

10.3233/kca-210119 ◽

2021 ◽

pp. 1-13

Author(s):

Lauren E. Wilson ◽

Lisa Spees ◽

Jessica Pritchard ◽

Melissa A. Greiner ◽

Charles D. Scales ◽

...

Keyword(s):

United States ◽

Anticancer Agents ◽

Patient Characteristics ◽

The United States ◽

Socioeconomic Indicators ◽

Economic Implications ◽

Southern Us ◽

Race Ethnicity ◽

Nationally Representative ◽

Oral Anticancer Agents

Background: Substantial racial and socioeconomic disparities in metastatic RCC (mRCC) have persisted following the introduction of targeted oral anticancer agents (OAAs). The relationship between patient characteristics and OAA access and costs that may underlie persistent disparities in mRCC outcomes have not been examined in a nationally representative patient population. Methods: Retrospective SEER-Medicare analysis of patients diagnosed with mRCC between 2007–2015 over age 65 with Medicare part D prescription drug coverage. Associations between patient characteristics, OAA receipt, and associated costs were analyzed in the 12 months following mRCC diagnosis and adjusted to 2015 dollars. Results: 2,792 patients met inclusion criteria, of which 32.4%received an OAA. Most patients received sunitinib (57%) or pazopanib (28%) as their first oral therapy. Receipt of OAA did not differ by race/ethnicity or socioeconomic indicators. Patients of advanced age (> 80 years), unmarried patients, and patients residing in the Southern US were less likely to receive OAAs. The mean inflation-adjusted 30-day cost to Medicare of a patient’s first OAA prescription nearly doubled from $3864 in 2007 to $7482 in 2015, while patient out-of-pocket cost decreased from $2409 to $1477. Conclusion: Race, ethnicity, and socioeconomic status were not associated with decreased OAA receipt in patients with mRCC; however, residing in the Southern United States was, as was marital status. Surprisingly, the cost to Medicare of an initial OAA prescription nearly doubled from 2007 to 2015, while patient out-of-pocket costs decreased substantially. Shifts in OAA costs may have significant economic implications in the era of personalized medicine.

Download Full-text

Gender, Parenting, and The Rise of Remote Work During the Pandemic: Implications for Domestic Inequality in the United States

Gender & Society ◽

10.1177/08912432211001301 ◽

2021 ◽

Vol 35 (2) ◽

pp. 194-205

Author(s):

Allison Dunatchik ◽

Kathleen Gerson ◽

Jennifer Glass ◽

Jerry A. Jacobs ◽

Haley Stritzel

Keyword(s):

United States ◽

Child Care ◽

Division Of Labor ◽

Single Parents ◽

The United States ◽

Child Care Centers ◽

Remote Work ◽

Representative Survey ◽

Working Parents ◽

Nationally Representative

We examine how the shift to remote work altered responsibilities for domestic labor among partnered couples and single parents. The study draws on data from a nationally representative survey of 2,200 US adults, including 478 partnered parents and 151 single parents, in April 2020. The closing of schools and child care centers significantly increased demands on working parents in the United States, and in many circumstances reinforced an unequal domestic division of labor.

Download Full-text

Is Music Teacher Professional Development Becoming More Effective? Evaluating Practice and Policy in the United States, 1993–2012

Journal of Research in Music Education ◽

10.1177/0022429420982525 ◽

2020 ◽

pp. 002242942098252

Author(s):

Justin J. West

Keyword(s):

Professional Development ◽

United States ◽

Social Interaction ◽

Teacher Professional Development ◽

The United States ◽

Music Teacher ◽

Policy Practice ◽

Teacher Professional ◽

Nationally Representative ◽

Using Data

The purpose of this study was to evaluate music teacher professional development (PD) practice and policy in the United States between 1993 and 2012. Using data from the nationally representative Schools and Staffing Survey (SASS) spanning these 20 years, I examined music teacher PD participation by topic, intensity, relevance, and format; music teachers’ top PD priorities; and the reach of certain PD-supportive policies. I assessed these descriptive results against a set of broadly agreed-on criteria for “effective” PD: content specificity, relevance, voluntariness/autonomy, social interaction, and sustained duration. Findings revealed a mixed record. Commendable improvements in content-specific PD access were undercut by deficiencies in social interaction, voluntariness/autonomy, sustained duration, and relevance. School policy, as reported by teachers, was grossly inadequate, with only one of the nine PD-supportive measures appearing on SASS reaching a majority of teachers in any given survey year. Implications for policy, practice, and scholarship are presented.

Download Full-text

The ideological divide in public perceptions of self-driving cars

Public Understanding of Science ◽

10.1177/0963662520917339 ◽

2020 ◽

Vol 29 (4) ◽

pp. 436-451

Author(s):

Yilang Peng

Keyword(s):

Artificial Intelligence ◽

United States ◽

Scientific Literacy ◽

Autonomous Vehicles ◽

The United States ◽

Public Perceptions ◽

New Information ◽

Nationally Representative ◽

Self Driving Cars ◽

Social Conservatism

Applications in artificial intelligence such as self-driving cars may profoundly transform our society, yet emerging technologies are frequently faced with suspicion or even hostility. Meanwhile, public opinions about scientific issues are increasingly polarized along the ideological line. By analyzing a nationally representative panel in the United States, we reveal an emerging ideological divide in public reactions to self-driving cars. Compared with liberals and Democrats, conservatives and Republicans express more concern about autonomous vehicles and more support for restrictively regulating autonomous vehicles. This ideological gap is largely driven by social conservatism. Moreover, both familiarity with driverless vehicles and scientific literacy reduce respondents’ concerns over driverless vehicles and support for regulation policies. Still, the effects of familiarity and scientific literacy are weaker among social conservatives, indicating that people may assimilate new information in a biased manner that promotes their worldviews.

Download Full-text

Neighborhood Contextual Factors, Alcohol Use, and Alcohol Problems in the United States: Evidence From a Nationally Representative Study of Young Adults

Alcoholism Clinical and Experimental Research ◽

10.1111/acer.13033 ◽

2016 ◽

Vol 40 (5) ◽

pp. 1010-1019 ◽

Cited By ~ 12

Author(s):

Wendy S. Slutske ◽

Arielle R. Deutsch ◽

Thomas M. Piasecki

Keyword(s):

United States ◽

Young Adults ◽

Alcohol Use ◽

Contextual Factors ◽

The United States ◽

Alcohol Problems ◽

Representative Study ◽

Nationally Representative

Download Full-text

Are There Racial Disparities in Psychotropic Drug Use and Expenditures in a Nationally Representative Sample of Men in the United States? Evidence From the Medical Expenditure Panel Survey

American Journal of Men s Health ◽

10.1177/1557988313496564 ◽

2013 ◽

Vol 8 (1) ◽

pp. 82-90 ◽

Cited By ~ 6

Author(s):

Geraldine Pierre ◽

Roland J. Thorpe ◽

Gniesha Y. Dinwiddie ◽

Darrell J. Gaskin

Keyword(s):

United States ◽

Drug Use ◽

Racial Disparities ◽

Psychotropic Drug ◽

Medical Expenditure Panel Survey ◽

The United States ◽

Medical Expenditure ◽

Panel Survey ◽

Psychotropic Drug Use ◽

Nationally Representative

This article sought to determine whether racial disparities exist in psychotropic drug use and expenditures in a nationally representative sample of men in the United States. Data were extracted from the 2000-2009 Medical Expenditure Panel Survey, a longitudinal survey that covers the U.S. civilian noninstitutionalized population. Full-Year Consolidated, Medical Conditions, and Prescribed Medicines data files were merged across 10 years of data. The sample of interest was limited to adult males aged 18 to 64 years, who reported their race as White, Black, Hispanic, or Asian. This study employed a pooled cross-sectional design and a two-part probit generalized linear model for analyses. Minority men reported a lower probability of psychotropic drug use (Black = −4.3%, 95% confidence interval [CI] = [−5.5, −3.0]; Hispanic = −3.8%, 95% CI = [−5.1, −2.6]; Asian = −4.5%, 95% CI = [−6.2, −2.7]) compared with White men. After controlling for demographic, socioeconomic, and health status variables, there were no statistically significant race differences in drug expenditures. Consistent with previous literature, racial and ethnic disparities in the use of psychotropic drugs present problems of access to mental health care and services.

Download Full-text

A science confidence gap: Education, trust in scientific methods, and trust in scientific institutions in the United States, 2014

Public Understanding of Science ◽

10.1177/0963662515617367 ◽

2015 ◽

Vol 26 (6) ◽

pp. 704-720 ◽

Cited By ~ 22

Author(s):

Peter Achterberg ◽

Willem de Koster ◽

Jeroen van der Waal

Keyword(s):

United States ◽

The United States ◽

Modernization Theory ◽

Reflexive Modernization ◽

Scientific Methods ◽

Educational Differences ◽

Scientific Institutions ◽

Nationally Representative ◽

Great Trust

Following up on suggestions that attitudes toward science are multi-dimensional, we analyze nationally representative survey data collected in the United States in 2014 ( N = 2006), and demonstrate the existence of a science confidence gap: some people place great trust in scientific methods and principles, but simultaneously distrust scientific institutions. This science confidence gap is strongly associated with level of education: it is larger among the less educated than among the more educated. We investigate explanations for these educational differences. Whereas hypotheses deduced from reflexive-modernization theory do not pass the test, those derived from theorizing on the role of anomie are corroborated. The less educated are more anomic (they have more modernity-induced cultural discontents), which not only underlies their distrust in scientific institutions, but also fuels their trust in scientific methods and principles. This explains why this science confidence gap is most pronounced among the less educated.

Download Full-text

Gender and Marital Satisfaction: Data from the National Survey of Families and Households

Psychological Reports ◽

10.2466/pr0.1998.83.1.319 ◽

1998 ◽

Vol 83 (1) ◽

pp. 319-327 ◽

Cited By ~ 10

Author(s):

Walter R. Schumm ◽

Farrell J. Webb ◽

Stephan R. Bollman

Keyword(s):

United States ◽

Marital Satisfaction ◽

Representative Sample ◽

The United States ◽

Nationally Representative ◽

Relationship Of ◽

The Relationship ◽

Satisfaction Relationship ◽

Representative Samples ◽

Small Support

In 1972, Bernard argued that marriage was good for men and bad for women. Subsequent research noted that wives, on average, reported lower marital satisfaction than husbands. Furthermore, when differences within couples existed on marital satisfaction, the wife was usually the less satisfied spouse; however, most previous studies of the gender/marital satisfaction relationship had not been based on nationally representative samples. A nationally representative sample from the 1988 Survey of Families and Households was used to assess the relationship of gender with marital satisfaction. Within-couple analyses indicated that wives were less satisfied with their marriages than husbands and that, when substantial within-couple differences occurred with respect to marital satisfaction, the wife was usually the less satisfied spouse. Results provide at least small support for feminist assertions about the relatively adverse nature of marriage for women in the United States.

Download Full-text

(A231) Deficiencies in the Preparedness of Emergency Medical Services Providers for Terrorist Incidents Involving Children

Prehospital and Disaster Medicine ◽

10.1017/s1049023x11002172 ◽

2011 ◽

Vol 26 (S1) ◽

pp. s63-s63

Author(s):

M. Reilly

Keyword(s):

Public Health ◽

United States ◽

Emergency Medical Services ◽

A Priori ◽

The United States ◽

Medical Services ◽

Special Populations ◽

Provider Education ◽

Emergency Medical ◽

Nationally Representative

IntroductionRecent studies have discussed major deficiencies in the preparedness of emergency medical services (EMS) providers to effectively respond to disasters, terrorism and other public health emergencies. Lack of funding, lack of national uniformity of systems and oversight, and lack of necessary education and training have all been cited as reasons for the inadequate emergency medical preparedness in the United States.MethodsA nationally representative sample of over 285,000 emergency medical technicians (EMTs) and Paramedics in the United States was surveyed to assess whether they had received training in pediatric considerations for blast and radiological incidents, as part of their initial provider education or in continuing medical education (CME) within the previous 24 months. Providers were also surveyed on their level of comfort in responding to and potentially treating pediatric victims of these events. Independent variables were entered into a multivariate model and those identified as statistically significant predictors of comfort were further analyzed.ResultsVery few variables in our model caused a statistically significant increase in comfort with events involving children in this sample. Pediatric considerations for blast or radiological events represented the lowest levels of comfort in all respondents. Greater than 70% of respondents reported no training as part of their initial provider education in considerations for pediatrics following blast events. Over 80% of respondents reported no training in considerations for pediatrics following events associated with radiation or radioactivity. 88% of respondents stated they were not comfortable with responding to or treating pediatric victims of a radiological incident.ConclusionsOut study validates our a priori hypothesis and several previous studies that suggest deficiencies in preparedness as they relate to special populations - specifically pediatrics. Increased education for EMS providers on the considerations of special populations during disasters and acts of terrorism, especially pediatrics, is essential in order to reduce pediatric-related morbidity and mortality following a disaster, act of terrorism or public health emergency.

Download Full-text