scholarly journals Rural and Urban Difference in Longitudinal Trends in Prevalence of Dementia in Medicare Claims and Survey Data

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 18-18
Author(s):  
Nasim B Ferdows
Keyword(s):  
Survey Data ◽  
Rural Areas ◽  
Urban Areas ◽  
Claims Data ◽  
Cognitive Test ◽  
Medical Assessment ◽  
Dementia Prevalence ◽  
Medicare Claims ◽  
Diagnosis Codes ◽  
Shortage Of Physicians

Abstract Shortage of physicians in rural areas can lead to lower diagnosis and underestimation of dementia prevalence in these communities. We used data from the nationally representative Health and Retirement Study and a 20-percent sample of Medicare claims to study rural-urban differences in dementia prevalence. The survey dementia diagnosis is free from medical assessment while the claims diagnosis needs a physician diagnosis. We estimated the trends in dementia prevalence from (2002-2016) based on cognitive tests (using survey data) and diagnosis codes (using claims data) utilizing ordinary least squares regression. Dementia prevalence based on diagnosis codes declined in both urban and rural areas over the course of the study, with a sharper decline in urban areas. Dementia prevalence using diagnosis codes showed significantly higher rates in urban areas during all years (0.024 vs 0.018 in 2002 and 0.017 vs 0.013 in 2014 in rural vs urban areas, respectively). Dementia in the cognitive test sample was higher in rural areas (0.11 vs 0.08 in 2000 and 0.08 vs 0.7 in 2014 in rural vs urban areas), a difference that was significant only in 2004. Our results indicate lower dementia prevalence rates in rural areas in claims based sample compared to survey sample which its dementia prevalence is free medical assessment. Claims data are valuable sources for tracking dementia in the US population, however they are based on medical diagnosis.In rural areas, where there is shortage of physicians and a lack of access to health care services, claims based studies may underestimate dementia rates.

scholarly journals Sex, Race, and Age Differences in Prevalence of Dementia in Medicare Claims and Survey Data

2020 ◽  
Author(s):  
Yingying Zhu ◽  
Yi Chen ◽  
Eileen M Crimmins ◽  
Julie M Zissimopoulos
Keyword(s):  
Neuropsychological Assessment ◽  
Age Groups ◽  
Cognitive Test ◽  
Cognitive Tests ◽  
Dementia Prevalence ◽  
Medicare Claims ◽  
Diagnosis Codes ◽  
Nationally Representative ◽  
The Difference ◽  
Over Time

Abstract Objectives This study provides the first comparison of trends in dementia prevalence in the U.S. population using 3 different dementia ascertainments/data sources: neuropsychological assessment, cognitive tests, and diagnosis codes from Medicare claims. Methods We used data from the nationally representative Health and Retirement Study and Aging, Demographics, and Memory Study, and a 20% random sample of Medicare beneficiaries. We compared dementia prevalence across the 3 sources by race, gender, and age. We estimated trends in dementia prevalence from 2006 to 2013 based on cognitive tests and diagnosis codes utilizing logistic regression. Results Dementia prevalence among older adults aged 70 and older in 2004 was 16.6% (neuropsychological assessment), 15.8% (cognitive tests), and 12.2% (diagnosis codes). The difference between dementia prevalence based on cognitive tests and diagnosis codes diminished in 2012 (12.4% and 12.9%, respectively), driven by decreasing rates of cognitive test-based and increasing diagnosis codes-based dementia prevalence. This difference in dementia prevalence between the 2 sources by sex and for age groups 75–79 and 90 and older vanished over time. However, there remained substantial differences across measures in dementia prevalence among blacks and Hispanics (10.9 and 9.8 percentage points, respectively) in 2012. Discussion Our results imply that ascertainment of dementia through diagnosis may be improving over time, but gaps across measures among racial/ethnic minorities highlight the need for improved measurement of dementia prevalence in these populations.

Civic Participation and Social Embeddedness: Differences Between Urban and Rural Communities

2021 ◽  
Vol 3 (1) ◽  
pp. 45-67
Author(s):  
Tuuli-Marja Kleiner
Keyword(s):  
Social Network ◽  
Rural Communities ◽  
Survey Data ◽  
Rural Areas ◽  
Urban Areas ◽  
Civic Participation ◽  
Regional Level ◽  
Social Embeddedness ◽  
The Social ◽  
Multi Level

Does civic participation lead to a large social network? This study claims that high levels of civic participation may obstruct individual social embeddedness. Using survey data from the German Survey on Volunteering (Deutscher Freiwilligensurvey; 1999–2009), this study conducts macro- as well as multi-level regressions to examine the link between civic participation and social embeddedness. Findings reveal that civic participation on the sub-national regional level is not generally associated with social embeddedness, but it affects the participants’ and non-participants’ possibilities for friendships differently. This holds especially true in urban areas, but the effect cannot be found in rural areas. The analysis has implications for further research to enhance the social embeddedness of the excluded.

Linking Provider Specialty and Outpatient Diagnoses in Medicare Claims Data: Data Quality Implications

2021 ◽  
Vol 12 (04) ◽  
pp. 729-736
Author(s):  
Vojtech Huser ◽  
Nick D. Williams ◽  
Craig S. Mayer
Keyword(s):  
Data Quality ◽  
Claims Data ◽  
Medical Toxicology ◽  
Health Care Research ◽  
Real World Data ◽  
Full Spectrum ◽  
Data Completeness ◽  
Medicare Claims ◽  
Diagnosis Codes ◽  
Medicare Claims Data

Abstract Background With increasing use of real world data in observational health care research, data quality assessment of these data is equally gaining in importance. Electronic health record (EHR) or claims datasets can differ significantly in the spectrum of care covered by the data. Objective In our study, we link provider specialty with diagnoses (encoded in International Classification of Diseases) with a motivation to characterize data completeness. Methods We develop a set of measures that determine diagnostic span of a specialty (how many distinct diagnosis codes are generated by a specialty) and specialty span of a diagnosis (how many specialties diagnose a given condition). We also analyze ranked lists for both measures. As use case, we apply these measures to outpatient Medicare claims data from 2016 (3.5 billion diagnosis–specialty pairs). We analyze 82 distinct specialties present in Medicare claims (using Medicare list of specialties derived from level III Healthcare Provider Taxonomy Codes). Results A typical specialty diagnoses on average 4,046 distinct diagnosis codes. It can range from 33 codes for medical toxicology to 25,475 codes for internal medicine. Specialties with large visit volume tend to have large diagnostic span. Median specialty span of a diagnosis code is 8 specialties with a range from 1 to 82 specialties. In total, 13.5% of all observed diagnoses are generated exclusively by a single specialty. Quantitative cumulative rankings reveal that some diagnosis codes can be dominated by few specialties. Using such diagnoses in cohort or outcome definitions may thus be vulnerable to incomplete specialty coverage of a given dataset. Conclusion We propose specialty fingerprinting as a method to assess data completeness component of data quality. Datasets covering a full spectrum of care can be used to generate reference benchmark data that can quantify relative importance of a specialty in constructing diagnostic history elements of computable phenotype definitions.

Abstract 15791: Evaluation of Medicare Claims for Heart Failure Diagnostic Development: A Multisense-linkage Feasibility Analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ramesh Wariar ◽  
Gezheng Wen ◽  
Caroline Jacobsen ◽  
Stephen B Ruble ◽  
John Boehmer
Keyword(s):  
Heart Failure ◽  
Disease Burden ◽  
Diagnostic Performance ◽  
Claims Data ◽  
False Positive Rate ◽  
Fee For Service ◽  
Medicare Claims ◽  
Diagnosis Codes ◽  
Positive Rate ◽  
Contrast Matching

Introduction: The validity of utilizing claims data for the development of worsening heart failure (HF) diagnostics has not been previously reported. Therefore, we linked data from the MultiSENSE study, in which the HeartLogic diagnostic was first reported, with claims data in order to validate claims HF events and compare diagnostic performance. Methods: Identifiers from 791 United States study patients were directly linked with Medicare claims to produce 320 patients with continuous Medicare Part A/B fee-for-service (FFS) coverage during study participation. Claims HF events were defined using primary HF diagnosis codes (DRG and ICD-9-CM) and included inpatient events as well as outpatient events with intravenous decongestive therapy. We matched events by patient and date, calculated agreement between events (Cohen’s kappa coefficient κ), and evaluated HeartLogic diagnostic performance using sensitivity and false positive rate (FPR). Results: The linked cohort was older than the remaining patients and had greater disease burden. Study deaths (N=14) matched exactly with claims. In contrast, matching of 207 study hospitalizations with 197 acute inpatient events resulted in a total of 239 events of which 193 matched with claims (81%), 32 (13%) were claims-unique, and 14 (6%) were study-unique. Claims HF events had substantial agreement with study adjudicated hospitalizations (observed = 93.3%, κ = 0.823). The HeartLogic algorithm detected claims-derived events with a sensitivity of 75.6% and an FPR of 1.539 alerts/pt-year, which was not different from performance derived using study events (sensitivity = 77.6% and FPR = 1.528, P = 0.82 and 0.92). HeartLogic detected events contributed to 91% of HF event costs used for performance evaluation ($605,000 out of $663,000). Conclusions: The agreement between claims and study events, and equivalence of HeartLogic diagnostic performance suggest that claims data may have utility for future diagnostic development/enhancement. Additional data are needed to demonstrate safety, efficacy, and cost-effectiveness of HeartLogic-directed interventions.

An Epidemiological, Diagnostic and Therapeutic Study of Giardia lamblia in Anbar Province – Iraq

2019 ◽  
Vol 9 (01) ◽  
pp. 39-45
Author(s):  
Suad Shallal Shahatha
Keyword(s):  
Teaching Hospital ◽  
Rural Areas ◽  
Giardia Lamblia ◽  
Urban Areas ◽  
Culture Media ◽  
Age Groups ◽  
Stool Samples ◽  
Women And Children ◽  
Teucrium Polium L ◽  
Therapeutic Study

This study was carried out to investigate the epidemiology of Giardia lamblia parasites in patients who visited some of the hospitals in Anbar province, which included (Fallujah Teaching Hospital, Ramadi Teaching Hospital, Ramadi Teaching Hospital for Women and Children and Hit Hospital) during by examining 864 stool samples in a direct examination method, The results revealed the infection rate was 41.7 % and the percentage of infection among males 47.8% is higher than that of females 35.4% with significant differences (p≤0.05). The age groups (1-9) years recorded the highest rates 55.4% and the lowest rate 13.6% in the age group (40-49) years. The highest rate of infection was 62.5% during the month of June, while the month of October was the lowest rate 5% and significant differences. The incidence rate in rural areas was 50.6% higher than in the urban areas 32.5%. The study also included the effect of Teucrium polium L. on the parasite in the culture media HSP-1, the concentrations of 0.5-3 mg / mL significantly affected Giardia, it was noted whenever the greater the concentration, the greater the effect during different treatment periods (1-4) days, as the highest concentration 3 mg/ml killed all Giardia parasites on the fourth day of treatment.

A Study Of Expansion Of The Fmcg Market Across Rural Areas

2019 ◽  
Vol 118 (8) ◽  
pp. 142-151
Author(s):  
Dr. Udayagiri Raghunath ◽  
Dr. V.Venkateswara Rao
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Customer Choice ◽  
Income Levels ◽  
Rural Markets ◽  
Urban Markets ◽  
Tv Media ◽  
Rural Clients ◽  
Tv Watching

The corporate companies dealing with FMCG products have started focusing on rural markets as the urban markets have become saturated and highly competitive. Capturing the rural markets brings forth a whole new set of challenges as it is laborious to break in. This market presents the companies with gamut challenges on a new dimension which demand entirely different strategies as compared to the ones used in urban areas. Studying the rural markets for rural markets has become crucial more than ever. It is an objective learning, psychiatry of dispersion, impact of the FMCG in rural areas. This research uses diverse utensils, procedure toward analyze composed records. Several of the features used in analyzing the data are the consumer characteristics like educational qualifications, professions they are in, and the income levels. The role of TV media advertising is also analyzed. Many deals and promotions advertised on TV are investigated. The scope of authority wield by publicity happening customer choice production has looked into. The different levels of media exposure and preferable TV watching times and their favorite programs considered while analyzing the data. The spending prototype of rural clients on FMCG is examined and further categorized based on their income levels, educational qualifications, and legal awareness of consumer act. All the analyzed data, results, and suggestions presented in the visual formats.

TURNING FARMERS INTO SOCIAL FARMER ENTREPRENEURS FOR DISADVANTAGED PEOPLE

2020 ◽  
Author(s):  
Remus Runcan
Keyword(s):  
Rural Communities ◽  
Low Income ◽  
Rural Areas ◽  
Urban Areas ◽  
Health And Safety ◽  
Physical Work ◽  
Healthy Environment ◽  
Rural And Urban Areas ◽  
Rural Development Programme ◽  
Rural And Urban

According to Romania’s National Rural Development Programme, the socio-economic situation of the rural environment has a large number of weaknesses – among which low access to financial resources for small entrepreneurs and new business initiatives in rural areas and poorly developed entrepreneurial culture, characterized by a lack of basic managerial knowledge – but also a large number of opportunities – among which access of the rural population to lifelong learning and entrepreneurial skills development programmes and entrepreneurs’ access to financial instruments. The population in rural areas depends mainly on agricultural activities which give them subsistence living conditions. The gap between rural and urban areas is due to low income levels and employment rates, hence the need to obtain additional income for the population employed in subsistence and semi-subsistence farming, especially in the context of the depopulation trend. At the same time, the need to stimulate entrepreneurship in rural areas is high and is at a resonance with the need to increase the potential of rural communities from the perspective of landscape, culture, traditional activities and local resources. A solution could be to turn vegetal and / or animal farms into social farms – farms on which people with disabilities (but also adolescents and young people with anxiety, depression, self-harm, suicide, and alexithymia issues) might find a “foster” family, bed and meals in a natural, healthy environment, and share the farm’s activities with the farmer and the farmer’s family: “committing to a regular day / days and times for a mutually agreed period involves complying with any required health and safety practices (including use of protective clothing and equipment), engaging socially with the farm family members and other people working on and around the farm, and taking on tasks which would include working on the land, taking care of animals, or helping out with maintenance and other physical work”

Digital Entrepreneurship for Rural Youth: Entrepreneurial Process

2020 ◽  
Vol 11 (1) ◽  
pp. 76-76
Author(s):  
Wawan Dhewanto ◽  
Salma Azzahra ◽  
Vania NR Rhommadhonni ◽  
Fera Yunita
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Industrial Revolution ◽  
Social Inequalities ◽  
Rural Youth ◽  
Young Generation ◽  
Entrepreneurial Process ◽  
Depth Study ◽  
United Nation ◽  
Digital Entrepreneurship

The young generation has a very important role as the nation's next generation, so it needs special attention to make them strong and independent figures. The young age phase is also a determining gate for the future after completing education (United Nation, 2013). Unfortunately, in Indonesia the number of young unemployed reaches 22.48% (Central Bureau of Statistics, 2018). Under these conditions, one of the efforts that can be done to reduce the unemployment rate is through an entrepreneurial program (Fatoki, 2014). This is a challenge for all parties because Rahmatiah et al (2019) states that currently the young generation of Indonesia is still difficult to become entrepreneurs. Moreover, competition in the 4.0 industrial revolution era is getting tougher. For entrepreneurs in rural areas, the challenges faced are greater than those who live in urban areas (Azzahra & Dhewanto, 2017), however by utilizing digital technology and becoming digital entrepreneurs, rural residents are able to compete, minimize social inequalities and accelerate economic growth (Ratten, 2018 ). Only a few young people have the talent and interest to run a business (Ceptureanu & Ceptueanu, 2015). Therefore an in-depth study of the interests and entrepreneurial processes for rural youth to become a digital entrepreneur is needed. This research was conducted in order to have young digital entrepreneurs who came from rural areas to be able to compete in this 4.0 industry era. Thus, the research questions in this study are: (1). Why does rural youth want to be a digital entrepreneur? How is the entrepreneurial process of rural youth to become digital entrepreneurs? Keywords: Digital Entrepreneurship, Entrepreneurial Process, Rural Youth

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