Estimating Anesthesia and Surgical Procedure Times from Medicare Anesthesia Claims

2007 ◽  
Vol 106 (2) ◽  
pp. 346-355 ◽  
Author(s):  
Jeffrey H. Silber ◽  
Paul R. Rosenbaum ◽  
Xuemei Zhang ◽  
Orit Even-Shoshan
Keyword(s):  
Rank Correlation ◽  
Absolute Error ◽  
Anesthesia Service ◽  
Orthopedic Surgical Procedures ◽  
Medicare Part B ◽  
Median Absolute Error ◽  
The Individual ◽  
Larger Sample ◽  
Procedure Type ◽  
Individual Hospital

Background Procedure times are important variables that often are included in studies of quality and efficiency. However, due to the need for costly chart review, most studies are limited to single-institution analyses. In this article, the authors describe how well the anesthesia claim from Medicare can estimate chart times. Methods The authors abstracted information on time of induction and entrance to the recovery room ("anesthesia chart time") from the charts of 1,931 patients who underwent general and orthopedic surgical procedures in Pennsylvania. The authors then merged the associated bills from claims data supplied from Medicare (Part B data) that included a variable denoting the time in minutes for the anesthesia service. The authors also investigated the time from incision to closure ("surgical chart time") on a subset of 1,888 patients. Results Anesthesia claim time from Medicare was highly predictive of anesthesia chart time (Kendall's rank correlation tau = 0.85, P < 0.0001, median absolute error = 5.1 min) but somewhat less predictive of surgical chart time (Kendall's tau = 0.73, P < 0.0001, median absolute error = 13.8 min). When predicting chart time from Medicare bills, variables reflecting procedure type, comorbidities, and hospital type did not significantly improve the prediction, suggesting that errors in predicting the chart time from the anesthesia bill time are not related to these factors; however, the individual hospital did have some influence on these estimates. Conclusions Anesthesia chart time can be well estimated using Medicare claims, thereby facilitating studies with vastly larger sample sizes and much lower costs of data collection.

Multi-Method Vs Single Method Appraisal of Clinical Quality Indicators for the Emergency Medical Services

2020 ◽  
Author(s):  
Ian Howard ◽  
Peter Cameron ◽  
Maaret Castrén ◽  
Lee Wallis ◽  
Veronica Lindström
Keyword(s):  
Group Discussion ◽  
Rank Correlation ◽  
Healthcare Setting ◽  
Prehospital Emergency Care ◽  
Spearman’S Rank Correlation ◽  
Prehospital Emergency ◽  
Single Method ◽  
Multi Method Approach ◽  
The Individual ◽  
Method Approach

ABSTRACT Background Quality Indicator (QI) appraisal protocols are a novel methodology that combines multiple appraisal methods to comprehensively assess the "appropriateness" of QIs for a particular healthcare setting. However, they remain inadequately explored compared to the single appraisal method approach. This paper aimed to describe and test a QI appraisal protocol versus the single method approach, against a series of QIs potentially relevant to the South African Prehospital Emergency Care setting. Methods An appraisal protocol was developed consisting of two categorical-based appraisal methods, combined with the qualitative analysis of the discussion generated during the consensus application of each method. The output of the protocol was assessed and compared with the application and output of each method. Inter-rater reliability of each particular method was evaluated prior to group consensus rating. Variation in the number of non-valid QIs and the proportion of non-valid QIs identified between each method and the protocol were compared and assessed. Results There was mixed IRR of the individual methods. There was similarly low to moderate correlation of the results obtained between the particular methods (Spearman’s rank correlation=0.42,p<0.001). From a series of 104 QIs, 11 non-valid QIs were identified that were shared between the individual methods. A further 19 non-valid QIs were identified and not shared by each method, highlighting the benefits of a multi-method approach. The outcomes were additionally evident in the group discussion analysis, which in and of itself added further input that would not have otherwise been captured by the individual methods alone. Conclusion The utilization of a multi-method appraisal protocol offers multiple benefits, when compared to the single appraisal approach, and can provide the confidence that the outcomes of the appraisal will ensure a strong foundation on which the QI framework can be successfully implemented.

scholarly journals Seeking Consensus: A New Approach

2010 ◽  
Vol 138 (12) ◽  
pp. 4402-4415 ◽  
Author(s):  
Paul J. Roebber
Keyword(s):  
Minimum Temperature ◽  
Forecast Accuracy ◽  
Cost Savings ◽  
Absolute Error ◽  
Electricity Production ◽  
Forecast Errors ◽  
Consensus Forecasts ◽  
Temperature Forecast ◽  
Model Output Statistics ◽  
The Individual

Abstract Simulated evolution is used to generate consensus forecasts of next-day minimum temperature for a site in Ohio. The evolved forecast algorithm logic is interpretable in terms of physics that might be accounted for by experienced forecasters, but the logic of the individual algorithms that form the consensus is unique. As a result, evolved program consensus forecasts produce substantial increases in forecast accuracy relative to forecast benchmarks such as model output statistics (MOS) and those from the National Weather Service (NWS). The best consensus produces a mean absolute error (MAE) of 2.98°F on an independent test dataset, representing a 27% improvement relative to MOS. These results translate to potential annual cost savings for electricity production in the state of Ohio of the order of $2 million relative to the NWS forecasts. Perfect forecasts provide nearly $6 million in additional annual electricity production cost savings relative to the evolved program consensus. The frequency of outlier events (forecast busts) falls from 24% using NWS to 16% using the evolved program consensus. Information on when busts are most likely can be provided through a logistic regression equation with two variables: forecast wind speed and the deviation of the NWS minimum temperature forecast from persistence. A forecast of a bust is 4 times more likely to be correct than wrong, suggesting some utility in anticipating the most egregious forecast errors. Discussion concerning the probabilistic applications of evolved programs, the application of this technique to other forecast problems, and the relevance of these findings to the future role of human forecasting is provided.

scholarly journals When Resources Are Scarce - Feasibility of Emergency Ventilation of Two Patients With One Ventilator

2020 ◽  
Author(s):  
Peter C. Reinacher ◽  
Thomas E. Schlaepfer ◽  
Martin A. Schick ◽  
Jürgen Beck ◽  
Hartmut Bürkle ◽  
...  
Keyword(s):  
Tidal Volume ◽  
Respiratory System ◽  
Breathing Circuit ◽  
Absolute Error ◽  
Physical Models ◽  
Respiratory System Mechanics ◽  
Emergency Ventilation ◽  
Artificial Lungs ◽  
Circuit Components ◽  
The Individual

AbstractA potential shortage of intensive care ventilators has led to the idea to ventilate more than one patient with a single ventilator. Besides other problems, this is associated with the lack of knowledge concerning distribution of tidal volume and the patients’ individual respiratory system mechanics.In this study we used two simple hand-manufactured adaptors to connect physical models of two adult respiratory systems to one ventilator. The artificial lungs were ventilated in the pressure-controlled mode and we investigated if disconnecting one lung from the ventilation circuit for several breaths would allow to determine reliably the other lung’s tidal volume and compliance.Compliances and volumes were measured both with the ventilator and external sensors corresponded well. However, tidal volumes measured via the ventilator were smaller compared to the tidal volumes measured via the external sensors with an absolute error of 5.3 ± 2.5%. The tidal volumes of the individual artificial lungs were distributed in proportion to the compliances and did not differ relevantly when both artificial lungs were connected to when one was disconnected.We conclude that in case of emergency, ventilation of two patients with one ventilator requires two simple hand-crafted tubes as adaptors and available standard breathing circuit components. In such a setting, respiratory system mechanics and tidal volume of each individual patient can be reliably measured during short term clamping of the tracheal tube of the respective other patient.

scholarly journals Health Care Professionalism Without Doctors

2018 ◽  
Vol 5 (2) ◽  
pp. 72-94 ◽  
Author(s):  
Marie Østergaard Møller
Keyword(s):  
Health Professionals ◽  
Qualitative Data ◽  
Nationwide Survey ◽  
Relational Theory ◽  
Local Health ◽  
Medical Field ◽  
Data Set ◽  
The Individual ◽  
The Relationship ◽  
Larger Sample

The article uses the organization of health houses in Denmark as a case to study the relationship between spatial surroundings and professionalization. The question is whether these new local health houses comprise an alternative to the medical view on health or ––even in the absence of the hospital–– script the professionals to identify themselves as agents from the medical field? In this article, macro-structural theory is combined with micro-relational theory in order to identify how macro structures such as professionalization nest the way social interaction takes place in concrete spatial situations and surroundings. The argument put forward is that we need to identity this process at the level of the individual in order to qualify and anchor our understanding of professionalization as a macro phenomenon. The empirical basis is two dissimilar locations (health houses), selected from a larger qualitative data set of interviews with health professionals and citizens and observations of health houses, originally selected from a nationwide survey. The presented analysis zooms in on selected places and situations and relates analyses to the overall picture of differences and similarities identified in the larger sample. The analysis shows how entrances, receptions, information screens and coffee tables not only design houses, but also script styles of interaction between health professionals and citizens as well as they work as signs creating expectations about professional roles and how to reflect and act as a professional in a given physical and social setting. The main finding is that spatial surroundings facilitate processes of identification and counter-identification crucial to a new kind of health professionals such as the ones under study here.

scholarly journals Semi-Siamese U-Net for separation of lung and heart bioimpedance images: A simulation study of thorax EIT

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246071
Author(s):  
Yen-Fen Ko ◽  
Kuo-Sheng Cheng
Keyword(s):  
Mean Absolute Error ◽  
Lung Ventilation ◽  
Semantic Segmentation ◽  
Absolute Error ◽  
Similarity Coefficient ◽  
Dice Similarity Coefficient ◽  
Linear Transformations ◽  
Impedance Tomography ◽  
Performance Improvements ◽  
The Individual

Electrical impedance tomography (EIT) is widely used for bedside monitoring of lung ventilation status. Its goal is to reflect the internal conductivity changes and estimate the electrical properties of the tissues in the thorax. However, poor spatial resolution affects EIT image reconstruction to the extent that the heart and lung-related impedance images are barely distinguishable. Several studies have attempted to tackle this problem, and approaches based on decomposition of EIT images using linear transformations have been developed, and recently, U-Net has become a prominent architecture for semantic segmentation. In this paper, we propose a novel semi-Siamese U-Net specifically tailored for EIT application. It is based on the state-of-the-art U-Net, whose structure is modified and extended, forming shared encoder with parallel decoders and has multi-task weighted losses added to adapt to the individual separation tasks. The trained semi-Siamese U-Net model was evaluated with a test dataset, and the results were compared with those of the classical U-Net in terms of Dice similarity coefficient and mean absolute error. Results showed that compared with the classical U-Net, semi-Siamese U-Net exhibited performance improvements of 11.37% and 3.2% in Dice similarity coefficient, and 3.16% and 5.54% in mean absolute error, in terms of heart and lung-impedance image separation, respectively.

scholarly journals Individual Pension Products Offered by Banks in Poland - a Multidimensional Comparative Analysis

2021 ◽  
Vol 17 (4) ◽  
pp. 91-104
Author(s):  
Peterson K. Joanna Rutecka-Góra
Keyword(s):  
Comparative Analysis ◽  
Old Age ◽  
Pension System ◽  
Rank Correlation ◽  
Economic Traits ◽  
Spearman’S Rank Correlation ◽  
Retirement Security ◽  
Spearman’S Rank Correlation Coefficient ◽  
The Interest Rate ◽  
The Individual

Abstract The supplementary old-age pension system in Poland consists of group and individual plans. This research covers the latter, namely the individual retirement accounts and individual retirement security accounts that were introduced in 2004 and 2012 respectively. The main aim of the paper is to conduct a multidimensional comparative analysis of bank retirement products including the linguistic complexity of documents creating the retirement contracts offered to individuals by banks, and the costliness and profitability of such products in the period 2012-2019. Moreover, it identifies the dependencies between the linguistic and economic traits of retirement contracts offered by banks. The correlation analysis conducted using the Spearman’s rank correlation coefficient showed that the more readable a document of a bank contract is, the higher the interest rate is and the higher the cancellation fees. The results of the study are relevant for both financial institutions and public bodies as they show the key characteristics that may influence the demand for individual retirement products in Poland and may serve as either a stimulator or a barrier in the development of supplementary old-age pension provision.

Comparison of a perfusion simulator to a clinical operating room: evaluation of eye tracking data and subjective perception. A pilot study

Perfusion ◽  
2020 ◽  
pp. 026765912097461
Author(s):  
Cynthia Pawelke ◽  
Frank Merkle ◽  
Dino Kurtovic ◽  
Sina Gierig ◽  
Gisela Müller-Plath
Keyword(s):  
Eye Tracking ◽  
Rating Scales ◽  
Objective Measure ◽  
Subjective Perception ◽  
Tracking Data ◽  
Third Phase ◽  
Heart Lung Machine ◽  
Heart Center ◽  
The Individual ◽  
Larger Sample

Background: With the aim of evaluating the perfusion simulator at the German Heart Center Berlin, similarity between simulation and clinical operation room (OR) was investigated regarding subjective perception and eye movement. Methods: Eight perfusionists performed an operation on the heart-lung machine (HLM) wearing eye tracking glasses, each in real OR and simulator. The three most important phases for perfusionists (going on bypass, cardioplegia administration and coming off bypass) were considered. Additional to eye tracking data as objective measure, questionnaires were completed, and interviews conducted afterwards. Results: The structure of simulator and real OR is perceived as basically the same. Yet there are differences in the HLM-models used and the temporal sequence. Different perception of both situations is reported in interviews and reflected in significant differences in the rating scales (NASA-TLX) on three of six subscales. In eye tracking data, certain AOIs could be identified for the individual phases, both in OR and simulator—an indication of fundamental similarity. However, differences regarding the proportions of the individual AOIs, especially in the first and third phase, are leading to the assumption that the simulator, and especially the simulation process, is only valid to a limited extent regarding subjective perception and eye tracking data. Conclusion: The use of the simulator for (advanced) training is accepted and explicitly requested by perfusionists. Yet further research is needed to identify the decisive factors (like simulation duration or additional tasks) for a valid execution in the simulator. Furthermore, a larger sample size should be regarded to allow statistical analysis.

Accuracy of common IOL power formulas in 611 eyes based on axial length and corneal power ranges

2020 ◽  
pp. bjophthalmol-2020-315882
Author(s):  
Veronika Röggla ◽  
Achim Langenbucher ◽  
Christina Leydolt ◽  
Daniel Schartmüller ◽  
Luca Schwarzenbacher ◽  
...  
Keyword(s):  
Axial Length ◽  
Prediction Error ◽  
Absolute Error ◽  
Power Calculation ◽  
Corneal Power ◽  
Biometric Parameters ◽  
Iol Power Calculation ◽  
Iol Power ◽  
Median Absolute Error ◽  
Axial Eye Length

AimsTo provide clinical guidance on the use of intraocular lens (IOL) power calculation formulas according to the biometric parameters.Methods611 eyes that underwent cataract surgery were retrospectively analysed in subgroups according to the axial length (AL) and corneal power (K). The predicted residual refractive error was calculated and compared to evaluate the accuracy of the following formulas: Haigis, Hoffer Q, Holladay 1 and SRK/T. Furthermore, the percentages of eyes with ≤±0.25, ≤±0.5 and 1 dioptres (D) of the prediction error were recorded.ResultsThe Haigis formula showed the highest percentage of cases with ≤0.5 D in eyes with a short AL and steep K (90%), average AL and steep cornea (73.2%) but also in long eyes with a flat and average K (65% and 72.7%, respectively). The Hoffer Q formula delivered the lowest median absolute error (MedAE) in short eyes with an average K (0.30 D) and Holladay 1 in short eyes with a steep K (Holladay 1 0.24 D). SRK/T presented the highest percentage of cases with ≤0.5 D in average long eyes with a flat and average K (80.5% and 68.1%, respectively) and the lowest MedAE in long eyes with an average K (0.29 D).ConclusionOverall, the Haigis formula shows accurate results in most subgroups. However, attention must be paid to the axial eye length as well as the corneal power when choosing the appropriate formula to calculate an IOL power, especially in eyes with an unusual biometry.

Reviewing initial choice of antimicrobial therapy—problems for the individual hospital

1979 ◽  
Vol 36 (3) ◽  
pp. 376-378
Author(s):  
John E. McGowan ◽  
Martha L. Cross ◽  
H. Kenneth Walker ◽  
Jonas A. Shulman
Keyword(s):  
Antimicrobial Therapy ◽  
The Individual ◽  
Initial Choice ◽  
Individual Hospital
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