scholarly journals An algorithm to identify medication nonpersistence using electronic pharmacy databases

2015 ◽  
Vol 22 (5) ◽  
pp. 957-961 ◽  
Author(s):  
Melissa M Parker ◽  
Howard H Moffet ◽  
Alyce Adams ◽  
Andrew J Karter
Keyword(s):  
Healthcare Systems ◽  
Healthcare Operations ◽  
Timely Manner ◽  
Pharmacy Records ◽  
Grace Period ◽  
Adult Diabetes ◽  
Primary Nonadherence ◽  
Medication Taking Behavior ◽  
Novel Algorithm

Abstract Objective Identifying patients who are medication nonpersistent (fail to refill in a timely manner) is important for healthcare operations and research. However, consistent methods to detect nonpersistence using electronic pharmacy records are presently lacking. We developed and validated a nonpersistence algorithm for chronically used medications. Materials and Methods Refill patterns of adult diabetes patients (n = 14,349) prescribed cardiometabolic therapies were studied. We evaluated various grace periods (30-300 days) to identify medication nonpersistence, which is defined as a gap between refills that exceeds a threshold equal to the last days’ supply dispensed plus a grace period plus days of stockpiled medication. Since data on medication stockpiles are typically unavailable for ongoing users, we compared nonpersistence to rates calculated using algorithms that ignored stockpiles. Results When using grace periods equal to or greater than the number of days’ supply dispensed (i.e., at least 100 days), this novel algorithm for medication nonpersistence gave consistent results whether or not it accounted for days of stockpiled medication. The agreement (Kappa coefficients) between nonpersistence rates using algorithms with versus without stockpiling improved with longer grace periods and ranged from 0.63 (for 30 days) to 0.98 (for a 300-day grace period). Conclusions Our method has utility for health care operations and research in prevalent (ongoing) and new user cohorts. The algorithm detects a subset of patients with inadequate medication-taking behavior not identified as primary nonadherent or secondary nonadherent. Healthcare systems can most comprehensively identify patients with short- or long-term medication underutilization by identifying primary nonadherence, secondary nonadherence, and nonpersistence.

scholarly journals Clustering electricity market participants via FRM models

2020 ◽  
pp. 1-12
Author(s):  
Ayla Gülcü ◽  
Sedrettin Çalişkan
Keyword(s):  
Electricity Market ◽  
Distance Metrics ◽  
Agglomerative Clustering ◽  
Timely Manner ◽  
Short Term ◽  
Clustering Techniques ◽  
Market Participants ◽  
Cosine Distance ◽  
Collateral Mechanism

Collateral mechanism in the Electricity Market ensures the payments are executed on a timely manner; thus maintains the continuous cash flow. In order to value collaterals, Takasbank, the authorized central settlement bank, creates segments of the market participants by considering their short-term and long-term debt/credit information arising from all market activities. In this study, the data regarding participants’ daily and monthly debt payment and penalty behaviors is analyzed with the aim of discovering high-risk participants that fail to clear their debts on-time frequently. Different clustering techniques along with different distance metrics are considered to obtain the best clustering. Moreover, data preprocessing techniques along with Recency, Frequency, Monetary Value (RFM) scoring have been used to determine the best representation of the data. The results show that Agglomerative Clustering with cosine distance achieves the best separated clustering when the non-normalized dataset is used; this is also acknowledged by a domain expert.

Forty years of rural reform in China: retrospect and future prospects

2019 ◽  
Vol 11 (3) ◽  
pp. 460-470 ◽  
Author(s):  
Xiwen Chen
Keyword(s):  
Rural Areas ◽  
Agricultural Policies ◽  
Timely Manner ◽  
Content Type ◽  
Rural Reform ◽  
Fields Of Study ◽  
The Future ◽  
The Government

Purpose Bottlenecked by rural underdevelopment, China’s overall development is bound to be inadequate and unbalanced. Through a brief retrospect of the reform directed against the “equalitarianism (egalitarianism)” in China’s rural areas, as well as the Chinese Government’s conceptual transformation and systemic construction and improvement thereof, the purpose of this paper is to clarify the panoramic significance of rural reform; the necessity, priority, and long-term nature of the current rural development; and the important role of public policy in doing so. It also looks ahead to consider the prospects for future rural reform. Design/methodology/approach This paper first reviews the rural reforms that were carried out in 1978. Second, it introduces the government’s conceptual change regarding rural reform and the establishment and improvement of the system that underlies it. Finally, the future of rural reform is envisaged. Findings The initial rural reforms brought extensive and profound changes to China’s rural areas. The experience of rural reform has been referred to and escalated by other fields of study. Hence, rural reforms have become something of global significance. Moreover, since the government can undertake reforms well beyond the reach of farmers, its views must be modified in a timely manner, and only then may it reasonably construct and improve the system pertaining to the “three rural issues (agriculture, rural areas, and farmers).” Originality/value This paper reviews the rural reforms carried out in 1978. It introduces the government’s change of concept with respect to rural reforms and the establishment and improvement of the system based on the “three rural issues,” thus looking forward to the future of rural reforms. The findings of this paper are of significance to the formulation of future agricultural policies.

The process of transition from pediatric to adult diabetes care: recommendations for US healthcare systems

2015 ◽  
Vol 5 (5) ◽  
pp. 379-391 ◽  
Author(s):  
David V Wagner ◽  
Jenae Ulrich ◽  
Ines Guttmann-Bauman ◽  
Danny C Duke
Keyword(s):  
Diabetes Care ◽  
Healthcare Systems ◽  
Adult Diabetes

Hip screening in newborns in the UK: what are the latest guidelines?

2021 ◽  
pp. 1-7
Author(s):  
Ayla C Newton ◽  
Marion Bohatschek ◽  
Andreas Rehm ◽  
Elizabeth Ashby
Keyword(s):  
Physical Examination ◽  
Congenital Abnormalities ◽  
Screening Programme ◽  
Developmental Dysplasia ◽  
Special Focus ◽  
Timely Manner ◽  
Appropriate Treatment ◽  
The Uk

The Newborn and Infant Physical Examination screening is a national screening programme which aims to identify infants with congenital abnormalities to minimise the risk of long-term complications. It involves a top to toe examination with special focus on the heart, eyes, testes and hips. The hip component of the Newborn and Infant Physical Examination screen aims to pick up infants with developmental dysplasia of the hips and refer them for appropriate treatment in a timely manner. Guidelines for the hip section of have recently changed. This article reviews these changes, the timings of the follow up and investigations, and the diagnosis and management of developmental dysplasia of the hips.

Key Considerations for the Adoption and Implementation of Knowledge Management in Healthcare Operations

2010 ◽  
pp. 125-142 ◽  
Author(s):  
Nilmini Wickramasinghe ◽  
Elie Geisler
Keyword(s):  
Knowledge Management ◽  
Healthcare System ◽  
Healthcare Costs ◽  
Cost Effective ◽  
Healthcare Setting ◽  
Healthcare Systems ◽  
Healthcare Operations ◽  
Healthcare Settings ◽  
Adoption And Implementation ◽  
The U.S

The importance of knowledge management (KM) to organizations in today’s competitive environment is being recognized as paramount and significant. This is particularly evident for healthcare both globally and in the U.S. The U.S. healthcare system is facing numerous challenges in trying to deliver cost effective, high quality treatments and is turning to KM techniques and technologies for solutions in an attempt to achieve this goal. While the challenges facing the U.S. healthcare are not dissimilar to those facing healthcare systems in other nations, the U.S. healthcare system leads the field with healthcare costs more than 15% of GDP and rising exponentially. What is becoming of particular interest when trying to find a solution is the adoption and implementation of KM and associated KM technologies in the healthcare setting, an arena that has to date been notoriously slow to adopt technologies and new approaches for the practice management side of healthcare. We examine this issue by studying the barriers encountered in the adoption and implementation of specific KM technologies in healthcare settings. We then develop a model based on empirical data and using this model draw some conclusions and implications for orthopaedics.

Algorithmic vulnerabilities and the datalogical: Early motherhood and tracking-as-care regimes

2019 ◽  
Vol 25 (2) ◽  
pp. 171-185 ◽  
Author(s):  
Helen Thornham
Keyword(s):  
Healthcare Systems ◽  
Sociotechnical Systems ◽  
Young Mothers ◽  
Maternal Subjectivity ◽  
Early Motherhood ◽  
Female Embodiment ◽  
Care Regimes

This article draws on work from a 6-month project with 12 young mothers in which we mapped and tracked ourselves and our infants. The project employed a range of methods including digital ethnographies, walk-along methods, hacking and playful experimentations. We explored, broke and tested a range of wearables and phone-based tracking apps, meeting regularly to discuss and compare our experiences and interrogate the sociotechnical systems of postnatal healthcare alongside the particular politics of certain apps and their connective affordances. In this article, I use the project as a springboard to explore what I call algorithmic vulnerabilities: the ways that the contemporary datalogical anthropocene is exposing and positioning subjects in ways that not only rarely match their own lived senses of identity but are also increasingly difficult to interrupt or disrupt. While this is not necessarily a new phenomenon (see Clough et al., 2015; Hayles, 2017), I argue that the particular algorithmic vulnerabilities within this context, which are forged in part through the ideological enmeshing of the long-running atomization of maternal and infant bodies within the healthcare systems (Crowe, 1987; Shaw, 2012; Wajcman, 1991) and the new and emergent tracking apps (Greenfield, 2016; Lupton, 2016; O’Riordan, 2017) create momentary stabilizations of sociotechnical systems in which maternal subjectivity and female embodiment become algorithmically vulnerable in affective and profound ways. These stabilizations become increasingly and problematically normative, partly because they feed and perpetuate a wider ‘taken-for granted’ sensibility of gendered neoliberalism (Gill, 2017: 609) which, as I argue, is coming to encapsulate the contemporary datalogical anthropocene. Secondly, the sociotechnical politics of the apps and the healthcare systems are revealed as co-dependent, raising a number of questions about long-term algorithmic vulnerabilities and normativities which predate the contemporary datalogical ‘turn’ and impact both practices and methods.

scholarly journals Sharing hospital-based health technology assessments internationally

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Marchetti ◽  
S Daugbjerg
Keyword(s):  
New Technologies ◽  
Health Technology ◽  
Healthcare Systems ◽  
Decision Makers ◽  
Fiscal Sustainability ◽  
Specific Information ◽  
Long Term Effects ◽  
Short And Long Term ◽  
Sustainability Challenges

Abstract Issue/problem National healthcare systems worldwide are at a critical point due to the fiscal sustainability challenges faced. At the same time, healthcare systems are under pressure to meet the global demand for adaptation of medical innovations arriving into the market persistently. Description of the problem Hospitals often serve as the entry point for new technologies to the healthcare system. It is therefore extremely important that Health Technology Assessments (HTA) are available in timely order to accurately inform decision-makers on both short- and long-term effects of a health technology to avoid inappropriate investments. Hospital based HTA (HB-HTA) was developed to accommodate the need for evidence-based hospital-specific information in a timely manner. A substantial increase in the use of HB-HTA has been observed in the last years. However, only few reports are being published. A database for the structured collection of HB-HTA reports could help the dissemination and collaboration between hospitals. Effects/changes A survey answered by an international group of experts knowledgeable in HB-HTA from eighteen different countries has showed that there is an interest to realize the collection and dissemination of HB-HTA reports on an international scale. However, confidentiality and resources for a database are barriers for the dissemination of HB-HTA reports. The challenge will therefore be to overcome these barriers and design a database containing high quality, comparable and complete HB-HTA reports with proper data security, regular maintenance and user support. Lessons International collaboration in HB-HTA is the key to timely inform decision-makers without compromising the quality of the data or the methodology.

Evaluation of Glipizide and Glyburide in a Health Maintenance Organization

1992 ◽  
Vol 26 (10) ◽  
pp. 1215-1220 ◽  
Author(s):  
Margaret A. Noyes ◽  
Barry L. Carter ◽  
Dennis K. Helling ◽  
William C. McCormick ◽  
Ramie Ramirez
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Statistical Difference ◽  
Fasting Blood Glucose ◽  
Health Maintenance Organization ◽  
Percentage Increase ◽  
Pharmacy Records ◽  
Health Maintenance ◽  
Daily Dose

OBJECTIVE: To determine if there was a difference in the long-term glycemic control, average daily dose, and cost of therapy in patients with noninsulin-dependent diabetes mellitus (NIDDM) treated with glyburide and glipizide in a health maintenance organization (HMO). DESIGN: Retrospective evaluation of medical and pharmacy records. SETTING: Multispecialty group practice HMO. PATIENTS: 140 NIDDM patients being treated with either glyburide (n=70) or glipizide (n=70) were randomly selected from the populations of patients receiving either drug using computerized pharmacy records. MAIN OUTCOME MEASURE: Mean daily doses and blood glucose measurements (fasting blood glucose, random blood glucose, hemoglobin A1C) were stratified in 3-month periods from the time the drug therapy was started or the patient first presented to the clinic for a total of 18 months. Long-term glycemic control was defined as fasting blood glucose <8.33 mmol/L (150 mg/dL). RESULTS: The groups were comparable with regard to age (53.4 y glyburide, 56.7 y glipizide), gender (43 M:27 F glyburide, 47 M:23 F glipizide), race (38 W/16 B/16 H glyburide, 45 W/16 B/9 H glipizide), concurrent medical conditions, adverse effects, and compliance. Long-term glycemic control was similar in both groups. Although the number of subjects who were controlled (by definition) tended to be greater in the glyburide group, no clinical or statistical difference was found. There was no statistical difference in mean daily dose between the ethnic groups, but the small numbers preclude further analysis. The glipizide group had a larger percentage increase in dose within the first year than did the glyburide group; however, the percentage increase from the 3-month dose was similar after 18 months (22.7 percent glyburide, 27.5 percent glipizide.) Average daily cost of therapy, based on mean daily dose, was slightly lower for glyburide-treated patients. CONCLUSIONS: If glycemic control is similar with glyburide and glipizide, as seen in this study, economic considerations regarding choice of therapy and formulary inclusion may be appropriate.

scholarly journals A Multivariate Forecasting Model for the COVID-19 Hospital Census Based on Local Infection Incidence

2021 ◽  
Author(s):  
Hieu M. Nguyen ◽  
Philip Turk ◽  
Andrew McWilliams
Keyword(s):  
Time Series ◽  
Multivariate Time Series ◽  
Healthcare Systems ◽  
Leading Indicators ◽  
Short Term ◽  
Correction Model ◽  
Vector Error Correction ◽  
Infection Incidence ◽  
Vector Error

AbstractCOVID-19 has been one of the most serious global health crises in world history. During the pandemic, healthcare systems require accurate forecasts for key resources to guide preparation for patient surges. Fore-casting the COVID-19 hospital census is among the most important planning decisions to ensure adequate staffing, number of beds, intensive care units, and vital equipment. In the literature, only a few papers have approached this problem from a multivariate time-series approach incorporating leading indicators for the hospital census. In this paper, we propose to use a leading indicator, the local COVID-19 infection incidence, together with the COVID-19 hospital census in a multivariate framework using a Vector Error Correction model (VECM) and aim to forecast the COVID-19 hospital census for the next 7 days. The model is also applied to produce scenario-based 60-day forecasts based on different trajectories of the pandemic. With several hypothesis tests and model diagnostics, we confirm that the two time-series have a cointegration relationship, which serves as an important predictor. Other diagnostics demonstrate the goodness-of-fit of the model. Using time-series cross-validation, we can estimate the out-of-sample Mean Absolute Percentage Error (MAPE). The model has a median MAPE of 5.9%, which is lower than the 6.6% median MAPE from a univariate Autoregressive Integrated Moving Average model. In the application of scenario-based long-term forecasting, future census exhibits concave trajectories with peaks lagging 2-3 weeks later than the peak infection incidence. Our findings show that the local COVID-19 infection incidence can be successfully in-corporated into a VECM with the COVID-19 hospital census to improve upon existing forecast models, and to deliver accurate short-term forecasts and realistic scenario-based long-term trajectories to help healthcare systems leaders in their decision making.Author summaryDuring the COVID-19 pandemic, healthcare systems need to have adequate resources to accommodate demand from COVID-19 cases. One of the most important metrics for planning is the COVID-19 hospital census. Only a few papers make use of leading indicators within multivariate time-series models for this problem. We incorporated a leading indicator, the local COVID-19 infection incidence, together with the COVID-19 hospital census in a multivariate framework called the Vector Error Correction model to make 7-day-ahead forecasts. This model is also applied to produce 60-day scenario forecasts based on different trajectories of the pandemic. We find that the two time-series have a stable long-run relationship. The model has a good fit to the data and good forecast performance in comparison with a more traditional model using the census data alone. When applied to different 60-day scenarios of the pandemic, the census forecasts show concave trajectories that peak 2-3 weeks later than the infection incidence. Our paper presents this new model for accurate short-term forecasts and realistic scenario-based long-term forecasts of the COVID-19 hospital census to help healthcare systems in their decision making. Our findings suggest using the local COVID-19 infection incidence data can improve and extend more traditional forecasting models.

scholarly journals Healthcare Network Centric Operations

2007 ◽  
pp. 127-147 ◽  
Author(s):  
Dag von Lubitz ◽  
Nilmini Wickramasinghe
Keyword(s):  
Communication Technologies ◽  
Healthcare Operations ◽  
Policy Makers ◽  
Healthcare Network ◽  
Essential Components ◽  
Integral Role ◽  
Network Centric Operations ◽  
Constituent Elements ◽  
The Military

Healthcare has yet to realize the true potential afforded by e-health. To date, technology-based healthcare operations are conducted chaotically, at a wide variety of non-integrated fronts, with little or no long-term strategy, and at a tremendous and ever increasing cost. This chapter proposes that in order for healthcare to ever reap the full benefits from e-health it is imperative for the development of a doctrine of healthcare network centric operations. Otherwise, millions if not billions of dollars will be spent on a futile chase of the definitions of how and when will the computer, healthcare provider, and healthcare administrator interact most efficiently and at the least expense. The concept of a doctrine - “conceptual platform” that outlines the consequent, goal-oriented way forward, and integrates all constituent elements into a smoothly operating whole, is utilized to great effect in the military. Drawing upon the strategies and techniques employed by the military to develop a network centric doctrine, the chapter outlines the essential components necessary for the establishment of the doctrine for healthcare network centric operations (HNCO), and in so doing not only highlights the integral role played by information computer and communication technologies (IC2T) but also the pivotal role of policy makers and governments. In fact, HNCO underscores the important yet rarely acknowledged confluence of e-health and e-government

Sign in / Sign up

Export Citation Format

Share Document