scholarly journals Leveraging Existing Data from CMS-Linked Cohort Studies for the Advancement and Translation of Frailty Research

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 777-777
Author(s):  
Qian-Li Xue ◽  
Kristine Ensrud ◽  
Shari Lin
Keyword(s):  
Cohort Studies ◽  
Healthcare Utilization ◽  
Risk Adjustment ◽  
Healthcare Services ◽  
Self Report ◽  
Added Value ◽  
Care Organization ◽  
Frailty Phenotype ◽  
Frailty Assessment ◽  
The Impact

Abstract As population aging is accelerating rapidly, there is growing concern on how to best provide patient-centered care for the most vulnerable. Establishing a predictable and affordable cost structure for healthcare services is key to improving quality, accessibility, and affordability. One such effort is the “frailty” adjustment model implemented by the Centers for Medicare & Medicaid Services (CMS) that adjusts payments to a Medicare managed care organization based on functional impairment of its beneficiaries. Earlier studies demonstrated added value of this frailty adjuster for prediction of Medicare expenditures independent of the diagnosis-based risk adjustment. However, we hypothesize that further improvement is possible by implementing more rigorous frailty assessment rather than relying on self-report of ADL difficulties as used for the frailty adjuster. This is supported by the consensus and clinical observations that neither multimorbidity nor disability alone is sufficient for frailty identification. This symposium consists of four talks that leverage data from three CMS-linked cohort studies to investigate the utility of assessment of the frailty phenotype for predicting healthcare utilization and costs. Talk 1 and 2 use data from the NHATS cohort to assess healthcare utilization by frailty status in the general population and the homebound subset. Talk 3 and 4 use data from the MrOS study and the SOF study to investigate the impact of frailty phenotype on healthcare costs. Taken together, their findings highlight the potential of incorporating phenotypic frailty assessment into CMS risk adjustment to improve the planning and management of care for frail older adults.

scholarly journals Adjusting Client-Level Risks Impacts on Home Care Organization Ranking

2021 ◽  
Vol 18 (11) ◽  
pp. 5502
Author(s):  
Aylin Wagner ◽  
René Schaffert ◽  
Julia Dratva
Keyword(s):  
Risk Factors ◽  
Home Care ◽  
Risk Adjustment ◽  
Care Quality ◽  
Assessment Instrument ◽  
Care Organization ◽  
Discrimination Power ◽  
Adjustment Model ◽  
Risk Adjustment Model ◽  
The Impact

Quality indicators (QIs) based on the Resident Assessment Instrument-Home Care (RAI-HC) offer the opportunity to assess home care quality and compare home care organizations’ (HCOs) performance. For fair comparisons, providers’ QI rates must be risk-adjusted to control for different case-mix. The study’s objectives were to develop a risk adjustment model for worsening or onset of urinary incontinence (UI), measured with the RAI-HC QI bladder incontinence, using the database HomeCareData and to assess the impact of risk adjustment on quality rankings of HCOs. Risk factors of UI were identified in the scientific literature, and multivariable logistic regression was used to develop the risk adjustment model. The observed and risk-adjusted QI rates were calculated on organization level, uncertainty addressed by nonparametric bootstrapping. The differences between observed and risk-adjusted QI rates were graphically assessed with a Bland-Altman plot and the impact of risk adjustment examined by HCOs tertile ranking changes. 12,652 clients from 76 Swiss HCOs aged 18 years and older receiving home care between 1 January 2017, and 31 December 2018, were included. Eight risk factors were significantly associated with worsening or onset of UI: older age, female sex, obesity, impairment in cognition, impairment in hygiene, impairment in bathing, unsteady gait, and hospitalization. The adjustment model showed fair discrimination power and had a considerable effect on tertile ranking: 14 (20%) of 70 HCOs shifted to another tertile after risk adjustment. The study showed the importance of risk adjustment for fair comparisons of the quality of UI care between HCOs in Switzerland.

scholarly journals How the COVID-19 pandemic can distort risk adjustment of health plan payment

2021 ◽  
Author(s):  
Richard C. van Kleef ◽  
Mieke Reuser
Keyword(s):  
Conceptual Framework ◽  
Healthcare Utilization ◽  
Health Plan ◽  
Surgical Procedures ◽  
Risk Adjustment ◽  
Adjustment System ◽  
The Impact

AbstractThe COVID-19 pandemic has led to disruptions in healthcare utilization and spending. While some changes might persist (e.g. substitution of specialist visits by online consultations), others will be transitory (e.g. fewer surgical procedures due to cancellation of treatments). This paper discusses the implications of transitory changes in healthcare utilization and spending for risk adjustment of health plan payment. In practice, risk adjustment methodologies typically consist of two steps: (1) calibration of payment weights for a given set of risk adjusters and (2) calculation of payments to insurers by combining the calibrated weights with enrollee characteristics. In this paper, we first introduce a simple conceptual framework for analyzing the (potential) distortions from the pandemic for both steps and then provide a hypothetical illustration of how these distortions can lead to under- or overpayment of insurers. The size of these under-/overpayments depends on (1) the impact of the pandemic on patterns in utilization and spending, (2) the distribution of risk types across insurers, (3) the extent to which insurers are disproportionately affected by the pandemic, and (4) features of the risk adjustment system.

scholarly journals Multimorbidity and healthcare utilization: A register-based study in Denmark

2019 ◽  
Author(s):  
Anne Frølich ◽  
Nermin Ghith ◽  
Michaela Schiøtz ◽  
Ramune Jacobsen ◽  
Anders Stockmarr
Keyword(s):  
Educational Attainment ◽  
Healthcare Utilization ◽  
Chronic Conditions ◽  
Healthcare Services ◽  
Socioeconomic Gradient ◽  
Hospitalization Rates ◽  
Study Population ◽  
Bed Days ◽  
The Impact

AbstractBackgroundPeople with multimorbidity have reduced functional capacity, lower quality of life, and higher mortality rates and use healthcare resources more intensively than healthy people or those with a single chronic condition. The aim of this study was to explore associations between multimorbidity and use of healthcare services and the impact of socioeconomic status on utilization of hospitalizations and bed days.MethodsThe study population included all individuals aged 16 years and older who lived in the Capital Region of Denmark on January 1st, 2012. Data on chronic conditions, use of healthcare services and demographics were obtained from Danish national administrative and health registries. Zero-inflated models were used to calculate anticipated annual use of hospitalizations and bed days.FindingsThe study population comprised 1,397,173 individuals; the prevalence of multimorbidity was 22%. Prevalence was inversely related to educational attainment. For people with multimorbidity, utilization of hospitalizations and bed days increased approximately linearly with the number of chronic conditions. However, a steep increase in utilization of bed days was observed between five and six or more chronic conditions. An educational gradient in hospitalization rates and use of bed days was observed regardless of the number of chronic conditions. Educational attainment was strongly associated with healthcare utilization.ConclusionMultimorbidity was associated with a significant increase in utilization of all healthcare services in Denmark. In addition, a socioeconomic gradient was observed in utilization of hospitalizations and bed days.

The Stereotype Threat Effect

2018 ◽  
Vol 29 (4) ◽  
pp. 249-258 ◽  
Author(s):  
Steffen Moritz ◽  
Insa Happach ◽  
Karla Spirandelli ◽  
Tania M. Lincoln ◽  
Fabrice Berna
Keyword(s):  
Stereotype Threat ◽  
Self Report ◽  
Neuropsychological Performance ◽  
Neurocognitive Deficits ◽  
Online Study ◽  
Memory And Attention ◽  
Threat Effect ◽  
Efficacy Expectations ◽  
Study Participants ◽  
The Impact

Abstract. Neurocognitive deficits in patients with mental disorders are partially due to secondary influences. “Stereotype threat” denotes the phenomenon that performance is compromised when a participant is confronted with a devaluing stereotype. The present study examined the impact of stereotype threat on neuropsychological performance in schizophrenia. Seventy-seven participants with a self-reported diagnosis of schizophrenia were randomly assigned to either an experimental condition involving stereotype threat activation or a control condition in an online study. Participants completed memory and attention tests as well as questionnaires on motivation, self-efficacy expectations, cognitive complaints, and self-stigmatization. Contrary to our prediction, the two groups showed no significant differences regarding neuropsychological performance and self-report measures. Limitations, such as a possibly too weak threat cue, are discussed and recommendations for future studies are outlined.

Research Participation Experiences of Informants of Suicide and Control Cases

Crisis ◽  
2010 ◽  
Vol 31 (5) ◽  
pp. 238-246 ◽  
Author(s):  
Paul W. C. Wong ◽  
Wincy S. C. Chan ◽  
Philip S. L. Beh ◽  
Fiona W. S. Yau ◽  
Paul S. F. Yip ◽  
...  
Keyword(s):  
Ethical Issues ◽  
Research Participation ◽  
Self Report ◽  
Initial Contact ◽  
Psychological Autopsy ◽  
Autopsy Study ◽  
The People ◽  
And Control ◽  
The Impact

Background: Ethical issues have been raised about using the psychological autopsy approach in the study of suicide. The impact on informants of control cases who participated in case-control psychological autopsy studies has not been investigated. Aims: (1) To investigate whether informants of suicide cases recruited by two approaches (coroners’ court and public mortuaries) respond differently to the initial contact by the research team. (2) To explore the reactions, reasons for participation, and comments of both the informants of suicide and control cases to psychological autopsy interviews. (3) To investigate the impact of the interviews on informants of suicide cases about a month after the interviews. Methods: A self-report questionnaire was used for the informants of both suicide and control cases. Telephone follow-up interviews were conducted with the informants of suicide cases. Results: The majority of the informants of suicide cases, regardless of the initial route of contact, as well as the control cases were positive about being approached to take part in the study. A minority of informants of suicide and control cases found the experience of talking about their family member to be more upsetting than expected. The telephone follow-up interviews showed that none of the informants of suicide cases reported being distressed by the psychological autopsy interviews. Limitations: The acceptance rate for our original psychological autopsy study was modest. Conclusions: The findings of this study are useful for future participants and researchers in measuring the potential benefits and risks of participating in similar sensitive research. Psychological autopsy interviews may be utilized as an active engagement approach to reach out to the people bereaved by suicide, especially in places where the postvention work is underdeveloped.

International Remittances and Private Healthcare in Kerala, India

2020 ◽  
Vol 17 (3) ◽  
pp. 445-460
Author(s):  
Mohd Imran Khan ◽  
Valatheeswaran C.
Keyword(s):  
Instrumental Variable ◽  
Capital Investment ◽  
Healthcare Expenditure ◽  
Healthcare Services ◽  
Private Healthcare ◽  
International Remittances ◽  
Variable Approach ◽  
Using Data ◽  
The Impact ◽  
Instrumental Variable Approach

The inflow of international remittances to Kerala has been increasing over the last three decades. It has increased the income of recipient households and enabled them to spend more on human capital investment. Using data from the Kerala Migration Survey-2010, this study analyses the impact of remittance receipts on the households’ healthcare expenditure and access to private healthcare in Kerala. This study employs an instrumental variable approach to account for the endogeneity of remittances receipts. The empirical results show that remittance income has a positive and significant impact on households’ healthcare expenditure and access to private healthcare services. After disaggregating the sample into different heterogeneous groups, this study found that remittances have a greater effect on lower-income households and Other Backward Class (OBC) households but not Scheduled Caste (SC) and Scheduled Tribe (ST) households, which remain excluded from reaping the benefit of international migration and remittances.

The Impact of Mobile Gadget in EFL Learning: Perceptions of EFL Undergraduates

2018 ◽  
Vol 7 (1) ◽  
Author(s):  
Imam - Fauzi
Keyword(s):  
Self Report ◽  
Fourth Generation ◽  
Learning Activity ◽  
Advanced Country ◽  
Innovative Methods ◽  
Phone Calls ◽  
Teachers And Students ◽  
Efl Students ◽  
The Impact ◽  
Efl Learning

AbstractMost of young people are enthusiasticin having the most recent mobile gadgets just to boast among their peers. They likely utilize them to make phone calls, take pictures, listen to songs, watch videos, or surf the internet access for learning or just entertainment. In a technologically advanced country like Indonesia, the third and fourth generation (3G, 4G) mobile devices are available at affordable prices, and people of all streams find it necessary to own a mobile gadget for connecting and communicating.  Moreover, it has become a common trend among undergraduates to carry a mobile gadget to the classroom as well.In this paper, the researcher emphasize the potential of mobile gadgets as a learning tool for students and have incorporated them into the learning environment.The present study examines the application of mobile gadgetin EFL learning and investigates the perceptions of EFL students about mobile gadget in learning activity.  A field study was conducted on thirty undergraduatestudents majoring in accounting study Serang Raya University.  The methodology of data collection included a self-report for students and teachers’ and students’ questionnaire. Findings of the research are significant for EFL teachers and researchers for introducing innovative methods and helpful materials for the English classroom.Keywords: Mobile gadget, students’ perception, teachers’ perception..

Healthcare System in the Arctic Zone of Russia. Known and Emerging Issues and Solutions to Them

2019 ◽  
pp. 3-20
Author(s):  
V.N. Leksin
Keyword(s):  
Metallurgical Industry ◽  
Healthcare Services ◽  
The Arctic ◽  
Russian Arctic ◽  
Arctic Zone ◽  
Shift Workers ◽  
The North ◽  
Medical Institutions ◽  
Emerging Issues ◽  
The Impact

The impact on healthcare organization on the territory of Russian Arctic of unique natural and climatic, demographic, ethnic, settlement and professional factors of influencing the health of population, constantly or temporarily living on this territory is studied. The necessity is substantiated of various forms and resource provision with healthcare services such real and potential patients of Arctic medical institutions, as representatives of indigenous small peoples of the North, workers of mining and metallurgical industry, military personnel, sailors and shift workers. In this connection a correction of a number of All-Russian normative acts is proposed.

The Impact of Mobile Phone Technology in Bridging the Gaps in The Health Care Service Delivery in Kenya: A Case of Nairobi County. (Preprint)

2019 ◽  
Author(s):  
Alice Ndwiga
Keyword(s):  
Service Delivery ◽  
Mobile Phone ◽  
Care Service ◽  
Health Care Service ◽  
Informal Settlements ◽  
Healthcare Services ◽  
P Value ◽  
Delivery Of Healthcare ◽  
Mobile Phone Technology ◽  
The Impact

BACKGROUND INTRODUCTION: The Kenyan constitution seeks to guarantee every citizen the right to quality healthcare services. Quite often this delivery is hampered by geographical location, socio-economic statuses among other factors. The country has a high mobile phone penetration rate. Digitalization of the healthcare sector is a vital aspect that contributes to effective delivery of care services. This study set out to assess the impact of mobile technology in closing the gaps within the health care service delivery. The objective of the study was to investigate the impact of mobile phone technology in bridging the gap in healthcare service delivery in Kenya with a focus on Nairobi, Kibera informal settlements. Hypothesis testing using P-value of 0.05 also showed that use of mobile phone technology positively impacted the delivery of healthcare services. OBJECTIVE The objective of the study was to investigate the impact of mobile phone technology in bridging the gap in healthcare service delivery in Kenya with a focus on Nairobi, Kibera informal settlements. Hypothesis testing using P-value of 0.05 also showed that use of mobile phone technology positively impacted the delivery of healthcare services. METHODS The target population were patients visiting Médecins Sans Frontières (MSF) clinic in Kibera informal settlements. A cross-sectional study design was employed. Purposive and simple random sampling method was used to select the study sample of 210 participants and 3 healthcare providers. Data were collected using survey questionnaire that was provider-administered and Data were analyzed using SPSS version. RESULTS The characteristics of the respondents were general (mean age, education level, social economic status) to only patients who visited the clinics for HIV tests and other related services such as going for ARVs. The main findings showed that 66.12% of the respondents (14.29% strongly agreed + 55.24% agreed) that the use of mobile phone technology improved their access to healthcare services. Using chi square, there was a statistical difference due to the positive impact of mobile technology on healthcare delivery (p=0.05). CONCLUSIONS The study findings showed that 66.12% of the respondents agreed that the use of mobile phone technology and SMS improved their access to healthcare services. The results hypothesis also proved that use of mobile phone technology positively impacts the delivery of healthcare services.

Why Ecological Momentary Assessment Surveys Go Incomplete?: When It Happens and How It Impacts Data

2020 ◽  
Author(s):  
Yu-Hsiang Wu ◽  
Jingjing Xu ◽  
Elizabeth Stangl ◽  
Shareka Pentony ◽  
Dhruv Vyas ◽  
...  
Keyword(s):  
Real Time ◽  
Self Report ◽  
Data Logging ◽  
Time Data ◽  
Real Time Data ◽  
Report Data ◽  
Self Report Data ◽  
Ecological Momentary ◽  
The Impact ◽  
Momentary Assessment

Abstract Background Ecological momentary assessment (EMA) often requires respondents to complete surveys in the moment to report real-time experiences. Because EMA may seem disruptive or intrusive, respondents may not complete surveys as directed in certain circumstances. Purpose This article aims to determine the effect of environmental characteristics on the likelihood of instances where respondents do not complete EMA surveys (referred to as survey incompletion), and to estimate the impact of survey incompletion on EMA self-report data. Research Design An observational study. Study Sample Ten adults hearing aid (HA) users. Data Collection and Analysis Experienced, bilateral HA users were recruited and fit with study HAs. The study HAs were equipped with real-time data loggers, an algorithm that logged the data generated by HAs (e.g., overall sound level, environment classification, and feature status including microphone mode and amount of gain reduction). The study HAs were also connected via Bluetooth to a smartphone app, which collected the real-time data logging data as well as presented the participants with EMA surveys about their listening environments and experiences. The participants were sent out to wear the HAs and complete surveys for 1 week. Real-time data logging was triggered when participants completed surveys and when participants ignored or snoozed surveys. Data logging data were used to estimate the effect of environmental characteristics on the likelihood of survey incompletion, and to predict participants' responses to survey questions in the instances of survey incompletion. Results Across the 10 participants, 715 surveys were completed and survey incompletion occurred 228 times. Mixed effects logistic regression models indicated that survey incompletion was more likely to happen in the environments that were less quiet and contained more speech, noise, and machine sounds, and in the environments wherein directional microphones and noise reduction algorithms were enabled. The results of survey response prediction further indicated that the participants could have reported more challenging environments and more listening difficulty in the instances of survey incompletion. However, the difference in the distribution of survey responses between the observed responses and the combined observed and predicted responses was small. Conclusion The present study indicates that EMA survey incompletion occurs systematically. Although survey incompletion could bias EMA self-report data, the impact is likely to be small.

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