scholarly journals A publicly available score for evaluating hospital financial standing

2020 ◽  
Author(s):  
Radoslav Zinoviev ◽  
Harlan Krumholz ◽  
Richard A. Ciccarone ◽  
Rick Antle ◽  
Howard Forman
Keyword(s):  
Gold Standard ◽  
Financial Stability ◽  
Credit Rating ◽  
Financial Data ◽  
Composite Score ◽  
List Type ◽  
Financial Outcomes ◽  
Hospital Operations ◽  
Financial Metrics ◽  
Initial Dataset

A.AbstractObjectivesTo create a straightforward scoring procedure based on widely available, inexpensive financial data that provides an assessment of the financial health of a hospital.DesignMethodological study.SettingMulticenter study.ParticipantsAll hospitals and health systems reporting the required financial metrics in 2017 were included for a total of 1,075 participants.InterventionsWe examined a list of 232 hospital financial indicators and used existing models and financial literature to select 30 metrics that sufficiently describe hospital operations. In a set of hospital financial data from 2017, we used Principal Coordinate Analysis to assess collinearity among variables and eliminated redundant variables. We isolated 10 unique variables, each assigned a weight equal to the share of its coefficient in a regression onto Moody’s Credit Rating, our predefined gold standard. The sum of weighted variables is a single composite score named the Yale Hospital Financial Score (YHFS).Primary Outcome MeasuresAbility to reproduce both financial trends from a “gold standard” metric and known associations with non-fiscal data.ResultsThe validity of the YHFS was evaluated by: (1) assessing its reproducibility with previously excluded data; (2) comparing it to existing models; and, (3) replicating known associations with non-fiscal data. Ten percent of the initial dataset had been reserved for validation and was not used in creating the model; the YHFS predicts 96.7% of the variation in this reserved sample, demonstrating reproducibility. The YHFS predicts 90.5% and 88.8% of the variation in Moody’s and Standard and Poor’s bond ratings, respectively, supporting its validity. As expected, larger hospitals had higher YHFS scores whereas a greater share of Medicare discharges correlated with lower YHFS scores.ConclusionsWe created a reliable and publicly available composite score of hospital financial stability.B.Article SummaryStrengths and Limitations of This StudyThere is a lack of models for assessing the financial state of hospitals in a robust and systematic way using publicly available data.We created the Yale Hospital Financial Score, a compound financial ranking of hospitals using a diverse collection of hospital financial metrics.The score ranks hospitals from 0 to 100 and was validated by showing reproducibility on a pre-excluded sample and strong correlation with “gold standard” metricsThis score has been developed to aid health policy researchers and has not yet been validated in studies of longitudinal financial outcomes

scholarly journals Multicentre methodological study to create a publicly available score of hospital financial standing in the USA

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e046500
Author(s):  
Radoslav Zinoviev ◽  
Harlan M Krumholz ◽  
Richard Ciccarone ◽  
Rick Antle ◽  
Howard P Forman
Keyword(s):  
Gold Standard ◽  
Financial Stability ◽  
Credit Rating ◽  
Financial Data ◽  
Composite Score ◽  
Methodological Study ◽  
Bond Ratings ◽  
Hospital Operations ◽  
Initial Dataset ◽  
The Usa

ObjectivesTo create a straightforward scoring procedure based on widely available, inexpensive financial data that provides an assessment of the financial health of a hospital.DesignMethodological study.SettingMulticentre study.ParticipantsAll hospitals and health systems reporting the required financial metrics in the USA in 2017 were included for a total of 1075 participants.InterventionsWe examined a list of 232 hospital financial indicators and used existing models and financial literature to select 30 metrics that sufficiently describe hospital operations. In a set of hospital financial data from 2017, we used principal coordinate analysis to assess collinearity among variables and eliminated redundant variables. We isolated 10 unique variables, each assigned a weight equal to the share of its coefficient in a regression onto Moody’s Credit Rating, our predefined gold standard. The sum of weighted variables is a single composite score named the Yale Hospital Financial Score (YHFS).Primary outcome measuresAbility to reproduce both financial trends from a ‘gold-standard’ metric and known associations with non-fiscal data.ResultsThe validity of the YHFS was evaluated by: (1) cross-validating it with previously excluded data; (2) comparing it to existing models and (3) replicating known associations with non-fiscal data. Ten per cent of the initial dataset had been reserved for validation and was not used in creating the model; the YHFS predicts 96.7% of the variation in this reserved sample, demonstrating reproducibility. The YHFS predicts 90.5% and 88.8% of the variation in Moody’s and Standard and Poor’s bond ratings, respectively, supporting its validity. As expected, larger hospitals had higher YHFS scores whereas a greater share of Medicare discharges correlated with lower YHFS scores.ConclusionsWe created a reliable and publicly available composite score of hospital financial stability.

scholarly journals Agricultural Insurance with State Support in Russia in the Conditions of Uncertainty and Risk

2018 ◽  
Vol 7 (3.14) ◽  
pp. 431
Author(s):  
Lubov Konstantinovna Ulibina ◽  
Olga Alekseevna Okorokova ◽  
Yuri Borisovich Turaev ◽  
Elvira Antsasovna Rusetskaya ◽  
Tatiana Vladimirovna Il'ina
Keyword(s):  
Financial Stability ◽  
Agricultural Products ◽  
State Support ◽  
Agricultural Insurance ◽  
Agricultural Producers ◽  
Financial Outcomes ◽  
Sectoral Analysis ◽  
Factors Influencing ◽  
Federal Districts ◽  
High Uncertainty

The relevance of the topic of the research is determined by the necessity to implement insurance as a method to control agricultural risks in order to increase the financial stability of agricultural producers in the conditions of high uncertainty of natural and climatic conditions.Insurance as a means to stabilising risks in the agrarian sphere enables not only to compensate for the losses connected with the loss of agricultural products but also to protect the producers from possible bankruptcy, to enhance the predictability of financial outcomes of activities. The authors put the greater emphasis on the underlying factors influencing the formation and dynamics of crucial indicators of agricultural insurance with state support compared to Russian and foreign experience. The sectoral analysis of was carried out, the peculiarities of implementing instruments of agricultural insurance in terms of federal districts and insurance institutions were revealed, provisions on innovative programmes were developed in order to improve agreements between actors for strengthening agricultural producers’ activities.  

Financial Risk and Financial Imbalances

2020 ◽  
pp. 1-31
Author(s):  
Carlos Piñeiro Sanchez ◽  
Pablo de Llano-Monelos
Keyword(s):  
Random Sample ◽  
Financial Stability ◽  
Financial Risk ◽  
Financial Data ◽  
Financial Ratios ◽  
Diagnostic Tools ◽  
Z Score ◽  
Resource Based View ◽  
It Resources ◽  
The 1960S

The study of the financial imbalances of companies is a common topic for academics and practitioners because bankruptcy affects financial stability and modifies the investors' behavior. Since the 1960s, financial ratios have been used as diagnostic tools and also as independent variables within models aimed at quantifying firms' financial risk (e.g., Altman's Z-Score). In parallel, the strategic theory has developed theoretical constructs to explain why competitiveness is empirically heterogeneous. The resource-based view argues that companies can outperform rivals if they manage scarce, expensive, and hard-to-imitate resources. Ultimately, outperformers should be able to avoid (or overcome) financial imbalances. This chapter intends to analyze whether IT resources modify firm performance and financial risk. To do that, the authors collected data from a random sample of Galician SMEs, combining questionnaires, focused interviews, and public financial data. Hypotheses are explored by applying parametric statistical methods.

THUR 071 Towards an integrated tool for pnes assessment

2018 ◽  
Vol 89 (10) ◽  
pp. A8.2-A8
Author(s):  
d’Ersu Eleanor ◽  
Al-Mayhani Talal ◽  
Sidhu Meneka
Keyword(s):  
Clinical Practice ◽  
Conversation Analysis ◽  
Gold Standard ◽  
Reliability And Validity ◽  
Epileptic Seizures ◽  
List Type ◽  
Clinical Tool ◽  
Medical Assessment ◽  
Diagnostic Challenge ◽  
Autonomic Activation

IntroductionPsychogenic non-epileptic seizures (PNES) can present a real diagnostic challenge, with subsequent impact on the course of the disorder and its management. A number of studies have looked into predictive factors for PNES. However, no guidance is available for applying the findings of these studies in clinical practice.AimThe aim is to combine the most recognised discriminative features into an integrated clinical tool, ultimately, to improve the predictive value of the medical assessment of patients with possible PNES in a clinic setting. This can be invaluable in centres with limited access to video telemetry (VT).MethodsThe following criteria were employed and compared with the results of VT as gold standard:Patient comorbiditiesConversation analysisReview of system questionnaireIctal semiology and autonomic activationPostictal prolactin and lactateResults and conclusionThis QIP will assess the reliability and validity of various criteria in recognising PNES clinically. Based on our findings, an integrated tool will then be designed as an adjunct to the standard medical assessment in settings where VT is not readily available.

Central Banks

2018 ◽  
Author(s):  
Alex Cukierman
Keyword(s):  
Interest Rate ◽  
Exchange Rates ◽  
Gold Standard ◽  
Financial Stability ◽  
Global Financial Crisis ◽  
Developing Economies ◽  
Financial System ◽  
Price Stability ◽  
Bretton Woods ◽  
Developed Economies

The first CBs were private institutions that were given a monopoly over the issuance of currency by government in return for help in financing the budget and adherence to the rules of the gold standard. Under this standard the price of gold in terms of currency was fixed and the CB could issue or retire domestic currency only in line with gold inflows or outflows. Due to the scarcity of gold this system assured price stability as long as it functioned. Wars and depressions led to the replacement of the gold standard by the more flexible gold exchange standard. Along with restrictions on international capital flows this standard became a major pillar of the post–WWII Bretton Woods system. Under this system the U.S. dollar (USD) was pegged to gold, and other countries’ exchange rates were pegged to the USD. In many developing economies CBs functioned as governmental development banks.Following the world inflation of the 1970s and the collapse of the Bretton Woods system in 1971, eradication of inflation gradually became the explicit number one priority of CBs. The hyperinflationary experiences of the first half of the 20th century, which were mainly caused by over-utilization of the printing press to finance budgetary expenditures, convinced policymakers in developed economies, following Germany’s lead, that the conduct of monetary policy should be delegated to instrument independent CBs, that governments should be prohibited from borrowing from them, and that the main goal of the CB should be price stability. During the late 1980s and the 1990s numerous CBs obtained instrument independence and started to operate on inflation targeting systems. Under this system the CB is expected to use interest rate policy to deliver a low inflation rate in the long run and to stabilize fluctuations in economic activity in the short and medium terms. In parallel the fixed exchange rates of the Bretton Woods system were replaced by flexible rates or dirty floats. The conjunction of more flexible rates and IT effectively moved the control over exchange rates from governments to CBs.The global financial crisis reminded policymakers that, of all public institutions, the CB has a comparative advantage in swiftly preventing the crisis from becoming a generalized panic that would seriously cripple the financial system. The crisis precipitated the financial stability motive into the forefront of CBs’ policy concerns and revived the explicit recognition of the lender of last resort function of the CB in the face of shocks to the financial system. Although the financial stability objective appeared in CBs’ charters, along with the price stability objective, also prior to the crisis, the crisis highlighted the critical importance of the supervisory and regulatory functions of CBs and other regulators. An important lesson from the crisis was that micro-prudential supervision and regulation should be supplemented with macro-prudential regulation and that the CB is the choice institution to perform this function. The crisis led CBs of major developed economies to reduce their policy rates to zero (and even to negative values in some cases) and to engage in large-scale asset purchases that bloat their balance sheets to this day. It also induced CBs of small open economies to supplement their interest rate policies with occasional foreign exchange interventions.

scholarly journals Computed tomography scan can be misleading in the lateralisation of aldosterone excess

2019 ◽  
Vol 2019 ◽  
Author(s):  
G Leksic ◽  
A M Alduk ◽  
V Molnar ◽  
A Haxhiu ◽  
A Haxhiu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Gold Standard ◽  
Secondary Hypertension ◽  
Standard Test ◽  
List Type ◽  
Gold Standard Test ◽  
Unilateral Disease ◽  
Bilateral Adrenal Hyperplasia ◽  
Aldosterone Producing Adenoma ◽  
Unreliable Method

Summary Primary aldosteronism (PA) is characterised by aldosterone hypersecretion and represents a common cause of secondary hypertension. During diagnostic evaluation, it is essential to determine the aetiology of PA since the treatment of unilateral and bilateral disease differs significantly. Adrenal vein sampling (AVS) has been implemented as a gold standard test for the diagnosis of PA subtype. However, due to the AVS complexity, costs and limited availability, many patients with PA are being treated based on the computed tomography (CT) findings. In this article, we present two patients with discrepant CT and AVS results, demonstrating that AVS is the only reliable method for localising the source of aldosterone excess. Learning points: CT is an unreliable method for distinguishing aldosterone-producing adenoma (APA) from bilateral adrenal hyperplasia (BAH). CT can be misleading in defining lateralisation of the aldosterone excess in case of unilateral disease (APA). AVS is the gold standard test for defining the PA subtype.

scholarly journals A Mobile App to Screen for Neurocognitive Impairment: Preliminary Validation of NeuroScreen Among HIV-Infected South African Adults (Preprint)

2017 ◽  
Author(s):  
Reuben N Robbins ◽  
Hetta Gouse ◽  
Henry G Brown ◽  
Andries Ehlers ◽  
Travis M Scott ◽  
...  
Keyword(s):  
South African ◽  
Sensitivity And Specificity ◽  
Gold Standard ◽  
Health Workers ◽  
Neuropsychological Test ◽  
Test Battery ◽  
Clinical Staff ◽  
Composite Score ◽  
Lay Health Workers ◽  
Standard Neuropsychological Test

BACKGROUND Neurocognitive impairment (NCI) is one of the most common complications of HIV infection, and has serious medical and functional consequences. South Africa has 7 million people living with HIV (PLHIV) with up to three-quarters of antiretroviral therapy (ART)-naïve individuals having NCI. South Africa’s health system struggles to meet the care needs of its millions of PLHIV; screening for NCI is typically neglected due to limited clinical staff trained to administer, score, and interpret neuropsychological tests, as well as long test batteries and limited screening tools for South African populations. Without accurate, clinically useful, and relatively brief NCI screening tests that can be administered by all levels of clinical staff, critical opportunities to provide psychoeducation, behavioral planning, additional ART adherence support, and adjuvant therapies for NCI (when they become available) are missed. To address these challenges and gap in care, we developed an mHealth app screening tool, NeuroScreen, to detect NCI that can be administered by all levels of clinical staff, including lay health workers. OBJECTIVE The purpose of this study was to examine sensitivity and specificity of an adapted version of NeuroScreen to detect NCI (as determined by a gold standard neuropsychological test battery administered by a trained research psychometrist) among HIV-infected South Africans when administered by a lay health worker. METHODS A total of 102 HIV-infected black South African adults who had initiated ART at least 12 months prior were administered NeuroScreen and a gold standard neuropsychological test battery in the participants’ choice of language (ie, English or isiXhosa). Three composite z scores were calculated for NeuroScreen: (1) sum of all individual test scores, (2) sum of all individual test scores and error scores from four tests, and (3) sum of four tests (abbreviated version). Global deficit scores were calculated for the gold standard battery where a score of 0.5 or greater indicated the presence of NCI. RESULTS The mean age of participants was 33.31 (SD 7.46) years, most (59.8%, 61/102) had at least 12 years of education, and 81.4% (83/102) of the sample was female. Gold standard test battery results indicated that 26.5% (27/102) of the sample had NCI. Sensitivity and specificity of age-, education-, and sex-adjusted NeuroScreen scores were 81.48% and 74.67% for composite score 1, 81.48% and 81.33% for composite score 2, and 92.59% and 70.67% for composite score 3, respectively. CONCLUSIONS NeuroScreen, a highly automated, easy-to-use, tablet-based screening test to detect NCI among English- and isiXhosa-speaking South African HIV patients demonstrated robust sensitivity and specificity to detect NCI when administered by lay health workers. NeuroScreen could help make screening for NCI more feasible. However, additional research is needed with larger samples and normative test performance data are needed.

Government Policy of Financial Stability

2008 ◽  
pp. 51-61
Author(s):  
S. Moiseev
Keyword(s):  
Government Policy ◽  
Financial Stability ◽  
Deposit Insurance ◽  
Credit Rating ◽  
Information Policy ◽  
The State ◽  
Fine Tuning ◽  
Russian Government ◽  
State Budget ◽  
Official Information

Russian government has prepared the package of measures to help the country’s financial system maintain financial stability. The paper discusses the state measures and formulates the propositions of Russian Union of Industrialists and Entrepreneurs (RSPP). The most important ones include coordination of regulators, unsecured refinancing and refinancing of external debts, guarantees of interbank loans, budget deposits in banks. The author analyzes subordinated loans for Russian banks from the state budget, nationalization of several banks and the future of government intervention in the stock market. Special attention is paid to the Deposit Insurance, the development of national credit rating system and the official information policy. The author believes that state measures need the following fine-tuning.

scholarly journals Inattention tests for delirium

2017 ◽  
Vol 29 (9) ◽  
pp. 1579-1580
Author(s):  
Paul Regal
Keyword(s):  
Cognitive Impairment ◽  
Gold Standard ◽  
Psychological Symptoms ◽  
Digit Span ◽  
Semantic Knowledge ◽  
List Type ◽  
Term Care ◽  
Dsm 5 ◽  
Diagnosis Of Dementia ◽  
High Level

Voyer and colleagues (2016) report an interesting and important comparison of ten attention/concentration tests for DSM-5 delirium. I have a number of questions and comments as follows: (1)What training did the research assistants have? DSM-5 diagnosis is generally regarded as a decision by medical specialists. When the person has prior dementia, identifying delirium is a high-level medical skill. Behavioral and psychological symptoms of dementia can closely mimic delirium unless the examiner focuses on behavioral triggers and the speed of cognitive decline.(2)The requirement of taking medications twice a day may have eliminated some delirium patients with impaired swallowing or refusal to take medications.(3)Lumping dementia, confusion, and disorientation into one label “cognitive impairment” is problematic and reduces the usefulness of Table 3.(4)The authors used prior diagnosis of dementia as a gold standard when in fact many people with that label have mild cognitive impairment.(5)The ten “concentration” subtests in the Hierarchic Dementia Scale (HDS) (Cole and Dastoor, 1987) are not purely indices of concentration. Serial seven subtraction is impaired in low education with normal concentration. Months of the year backwards is often ranked as both an attention and executive function test and it requires semantic knowledge. Digit span forward is a rapid attention test missing from the HDS which has been of great value in my delirium research.(6)As expected DSM-5 delirium was more common among medical inpatients than long-term care residents (14.9% vs. 4.0%, Table 1).(7)The Central Coast Australia Delirium Intervention Study (Regal, 2015) supported the gold standard to prove delirium was the speed and amplitude of both onset and recovery. In CADIS, the mean recovery of five-digit span forward was two days, six-DSF 5.6 days and Delirium Index 8.0 days.

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