Characterizing Medicare Reimbursements and Clinical Activity Among Female Otolaryngologists

2021 ◽  
pp. 000348942110424
Author(s):  
Neelima Panth ◽  
Sina J. Torabi ◽  
David A. Kasle ◽  
Emily L. Savoca ◽  
Cheryl K. Zogg ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Rural Areas ◽  
Temporal Trends ◽  
Clinical Activity ◽  
Fee For Service ◽  
Current Procedural Terminology ◽  
Cross Sectional ◽  
Urban Settings ◽  
Rural Settings

Objective: To evaluate geographic and temporal trends in Medicare fee-for-service (FFS) billing and reimbursements across female otolaryngologists (ORL). Methods: We performed a cross-sectional, retrospective analysis of the 2017 Medicare Physician and Other Suppliers Aggregate File. We analyzed differences in the number of services, patients, reimbursements, unique Current Procedural Terminology (CPT) codes used, and services billed per patient among female ORLs. Results: Female ORLs accounted for 15.2% of the 8453 Medicare-reimbursed ORLs. Female ORLs who graduated between 2000 and 2010 were reimbursed a median of $58 031.9 (IQR: $32 286.5-$91 512.2) and performed a median of 702 (IQR: 359.5-1221.5) services, significantly less than those who graduated between 1990 and 1999 (median: $67 508.9; IQR: 37 018.0-110 471.5; P < .001; median: 1055.5; IQR: 497.3-1944; P < .001). Female ORLs who graduated between 2000 and 2010 saw a median of 232 patients (IQR: 130.5-368), significantly less than those who graduated between 1990 and 1999 (median: 308; IQR: 168.3-496; P < .001) patients, significantly more than those. Female ORLs in urban settings performed a median of 795 (IQR: 364-1494.3) services and billed for a median of 42 (IQR: 28-58) unique codes, significantly fewer than their counterparts in rural settings (median: 1096; IQR: 600-2192.5; P = .002; median: 54; IQR: 31.5-64.5; P = .001). Conclusions: Medicare reimbursements and billing patterns across female ORLs varied by graduation decade and geography. Female ORLs further along in their careers may be reimbursed more with greater clinical volume and productivity. Those practicing in urban settings may have practices with decreased procedural diversity and lower clinical volume compared to their counterparts in rural areas.

scholarly journals Needs and rights awareness of stroke survivors and caregivers in urban and rural China: a cross-sectional, multiple-centre questionnaire survey

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e021820
Author(s):  
Xiaoshuang Xia ◽  
Xiaolin Tian ◽  
Tianli Zhang ◽  
Peilu Wang ◽  
Yanfen Du ◽  
...  
Keyword(s):  
Social Support ◽  
Rural Areas ◽  
Urban Areas ◽  
Rural China ◽  
Potential Effect ◽  
Psychological Support ◽  
Stroke Survivors ◽  
Cross Sectional ◽  
Urban Settings ◽  
Rural And Urban

ObjectivesStroke survivors require assistance and support in their daily lives. This survey aims to investigate the needs and rights awareness in Chinese stroke survivors and caregivers in rural and urban settings.SettingThis survey was adapted from the one created by the World Stroke Organization. The questionnaire included demands for psychological support, treatment and care, social support and information. From January 2015 to January 2016, the survey was pilot tested with urban and rural-dwelling stroke survivors and caregivers from 12 hospitals. Stroke survivors were invited to participate if they were over 18 years old and had experienced a stroke. Exclusion criteria were patients who had disorders of consciousness, significant cognitive impairment, aphasia, communication difficulties or psychiatric disorders. Only caregivers who were family members of the patients were chosen. Paid caregivers were excluded.ParticipantsOne thousand, one hundred and sixty-seven stroke survivors and 1119 caregivers were enrolled.Primary outcome measuresThe needs of stroke survivors and caregivers in rural and urban areas were compared. The correlations between needs of rural and urban stroke survivors and caregivers and potential effect factors were analysed, respectively.ResultsAmong the cohort, 93.5% reported the need for psychological support, 88.6% for treatment and care, 84.8% for information and 62.7% for social support. The total needs and each aspect of needs of stroke survivors in urban settings were greater than of those in rural settings (p<0.01). In rural areas, total needs and each aspect of needs were positively correlated with education level (p<0.01).ConclusionsNeeds and rights awareness of stroke survivors should also be recognised in both urban and rural China. According to the different needs of patients and their caregivers, regional and individualised services were needed by stroke survivors and their caregivers.

scholarly journals The rural–urban gap: differences in injury characteristics

2019 ◽  
Vol 39 (12) ◽  
pp. 317-322
Author(s):  
Felix Bang ◽  
Steven McFaull ◽  
James Cheesman ◽  
Minh T. Do
Keyword(s):  
Rural Areas ◽  
Motor Vehicle ◽  
Soft Tissue Injuries ◽  
Eye Injuries ◽  
Injury Rates ◽  
Urban Settings ◽  
Rural And Urban ◽  
Rural Settings ◽  
Severity Of Injury ◽  
The Difference

Background Injuries are among the top 10 leading causes of death in Canada. However, the types and rates of injuries vary between rural versus urban settings. Injury rates increase with rurality, particularly those related to motor vehicle collisions. Factors such as type of work, hazardous environments and longer driving distances contribute to the difference in rural and urban injury rates. Further examination of injuries comparing rural and urban settings with increased granularity in the nature of injuries and severity is needed. Methods The study population consisted of records from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) from between 2011 and July 2017. Rural and urban status was determined based on postal codes as defined by Canada Post. Proportionate injury ratios (PIRs) were calculated to compare rural and urban injury rates by nature and severity of injury and sex, among other factors. Results Rural injuries were more likely to involve multiple injuries (PIR = 1.66 for 3 injuries) and crush injuries (PIR = 1.72). More modestly elevated PIRs for rural settings were found for animal bites (1.14), burns (1.22), eye injuries (1.32), fractures (1.20) and muscle or soft tissue injuries (1.11). Injuries in rural areas were more severe, with a higher likelihood of cases being admitted to hospital (1.97), and they were more likely to be due to a motor vehicle collision (2.12). Conclusion The nature of injuries in rural settings differ from those in urban settings. This suggests a need to evaluate current injury prevention efforts in rural settings with the aim to close the gap between rural and urban injury rates.

Abstract 12494: The Disparities of Gender-Based Out of Hospital Cardiac Arrest Characteristics and Outcomes: Comparing Rural to Urban Vancouver Island

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Rahaf Al Assil
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Rural Areas ◽  
Survival Rates ◽  
Vancouver Island ◽  
P Value ◽  
Urban Settings ◽  
Rural Settings ◽  
Gender Based ◽  
Hospital Cardiac Arrest

Introduction: The relationship between the “chain of survival” metrics of Out of Hospital Cardiac Arrest (OHCA) and survival rates in rural settings has not been fully examined. In previous studies, low survival rate was attributable to the modifiable prehospital metrics and Return Of Spontaneous Circulation (ROSC). We sought to examine the association of the modifiable and non-modifiable OHCA characteristics and patient outcomes with rural settings. Methods: We did a post-hoc analyses of data from the British Columbia cardiac arrest registry, which enrolled all emergency medical system (EMS)-treated OHCAs. All non-EMS-witnessed OHCAs on Vancouver Island from Jan. 2019 to Oct. 2020 were included. The independent variable of interest was rural versus urban settings. Rural areas were defined as all areas outside the urban clusters (population ≥ 1000 and a population density of ≥ 400/km2). Our outcomes were 1. Post resuscitation ROSC, and 2. Survival to hospital discharge. We reported gender-mediated measures and adjusted odds ratios using logistic regression models. Results: We included 1172 OHCA patients, with 23% in rural settings, 33% Female, 30% had ROSC, and 23% survived to hospital discharge. The median EMS response time, from 911-call to first EMS arrival, was prolonged [10.5 mins (IQR 7.5-15)] in rural settings compared to urban settings [6.5 mins (IQR 5-9)] (p value<.001) . Among females, rural settings were associated with higher odds of bystander CPR compared to males [(OR 1.86; 95% CI 1.04-3.35), (OR 1.42; 95% CI 0.95-2.13)], respectively. After adjusting for all covariates, rural settings were associated with lower odds of ROSC among males compared to females [(OR 0.53; 95% CI 0.31-0.90), (OR 0.70; 95% CI 0.34-1.41)], respectively; however, not associated with survival to hospital discharge. Conclusions: There are significant disparities in the modifiable prehospital OHCA characteristics, and post resuscitation ROSC between rural and urban Vancouver Island. An officially integrated rural CPR community-based program, and innovations focused on gender-based implementation may significantly improve OHCA survival rates and subsequent prognostication.

Patterns of weekday and weekend physical activity in youth in 2 Canadian provinces

2013 ◽  
Vol 38 (2) ◽  
pp. 115-119 ◽  
Author(s):  
Melisa Comte ◽  
Erin Hobin ◽  
Sumit R. Majumdar ◽  
Ronald C. Plotnikoff ◽  
Geoff D.C. Ball ◽  
...  
Keyword(s):  
Physical Activity ◽  
Rural Areas ◽  
Vigorous Physical Activity ◽  
Optimal Growth ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Canadian Youth ◽  
Rural Settings ◽  
Low Levels ◽  
Canadian Provinces

Few Canadian children are meeting physical activity (PA) guidelines for optimal growth and health. There is little information describing the patterns of PA among Canadian youth, so it is difficult to determine where the deficits occur. The purpose of this study was to identify subgroups of youth and windows of time characterized by low PA and high sedentary behaviour. We conducted a cross-sectional study of 626 youth (aged 10–15 years) in 2 Canadian provinces. The primary exposure variables included geographic setting (rural vs. urban), sex, and days of the week (weekend days vs. weekdays). The primary outcome measures were minutes of light PA, moderate to vigorous physical activity (MVPA), and sedentary behavior, assessed with accelerometry. Compared with weekdays, MVPA was ∼30% lower on weekend days (55.8 ± 23.0 min vs. 38.7 ± 26.7 min; p < 0.001), whereas light PA was ∼15% higher. Significantly more youth achieved an average of >60 min of MVPA on weekdays than on weekend days (46% vs. 22%; p < 0.001). Sex-specific differences in MVPA were more pronounced on weekdays than on weekend days (∼13 vs ∼8 min per day; p < 0.01). Youth in rural settings achieved ∼9 fewer minutes of MVPA daily than youth in urban settings (p < 0.001). In youth 10 to 15 years of age, daily MVPA is lower and light PA is higher on weekend days than on weekdays. Girls and students living in rural areas were particularly vulnerable to low levels of MVPA.

scholarly journals Constructing a Measure of Anesthesia Intensity Using Cross-Sectional Claims Data

2019 ◽  
Author(s):  
Emily Gillen ◽  
Nicole M. Coomer ◽  
Christopher Beadles ◽  
Amy Mills
Keyword(s):  
Claims Data ◽  
Intensity Measure ◽  
Cross Sectional ◽  
Urban Settings ◽  
Bundled Payments ◽  
Anesthesia Service ◽  
Time Component ◽  
Rural Settings ◽  
Episodes Of Care ◽  
Base Units

With intensifying emphasis on episodes of care and bundled payments for surgical admissions, anesthesia expenditures are increasingly important in assessing variation in expenditures for surgical episodes. When comparing anesthesia expenditures across surgical settings, adjustment for anesthesia case complexity and duration of anesthesia services, also known as anesthesia service intensity, is desirable. A single anesthesia intensity measure allows researchers to make more direct comparisons between anesthesia outcomes across settings and services. We describe a process for creating a claims-based anesthesia intensity measure using Medicare claims. We create the measure using two fields: base units associated with American Medical Association Current Procedural Terminology codes on the anesthesia claim and time units associated with the service. We rescaled the time component of the anesthesia intensity measure to equally represent base units and time units. For illustration, we applied the measure to Medicare anesthesia expenditures stratified by rural/urban location. We found that adjustments for intensity were greater in urban settings because the level of intensity is greater. Compared with rural settings, unadjusted expenditures in urban settings are roughly 26 percent higher, whereas adjusted expenditures in urban settings are only 20 percent higher. Even absent longitudinal data, researchers can adjust anesthesia outcomes for intensity using our cross-sectional claims-based intensity method.

scholarly journals Assessing Heat-Related Mortality Risks among Rural Populations: A Systematic Review and Meta-Analysis of Epidemiological Evidence

2018 ◽  
Vol 15 (8) ◽  
pp. 1597 ◽  
Author(s):  
Emmanuel Odame ◽  
Ying Li ◽  
Shimin Zheng ◽  
Ambarish Vaidyanathan ◽  
Ken Silver
Keyword(s):  
Rural Communities ◽  
Rural Areas ◽  
Selection Criteria ◽  
Meta Analysis ◽  
Epidemiological Studies ◽  
Included Study ◽  
Rural Populations ◽  
Urban Settings ◽  
Rural Settings ◽  
Related Mortality

Most epidemiological studies of high temperature effects on mortality have focused on urban settings, while heat-related health risks in rural areas remain underexplored. To date there has been no meta-analysis of epidemiologic literature concerning heat-related mortality in rural settings. This study aims to systematically review the current literature for assessing heat-related mortality risk among rural populations. We conducted a comprehensive literature search using PubMed, Web of Science, and Google Scholar to identify articles published up to April 2018. Key selection criteria included study location, health endpoints, and study design. Fourteen studies conducted in rural areas in seven countries on four continents met the selection criteria, and eleven were included in the meta-analysis. Using the random effects model, the pooled estimates of relative risks (RRs) for all-cause and cardiovascular mortality were 1.030 (95% CI: 1.013, 1.048) and 1.111 (95% CI: 1.045, 1.181) per 1 °C increase in daily mean temperature, respectively. We found excess risks in rural settings not to be smaller than risks in urban settings. Our results suggest that rural populations, like urban populations, are also vulnerable to heat-related mortality. Further evaluation of heat-related mortality among rural populations is warranted to develop public health interventions in rural communities.

scholarly journals “When I Retire, I’ll Move Out of the City”: Mental Well-being of the Elderly in Rural vs. Urban Settings

2020 ◽  
Vol 17 (7) ◽  
pp. 2442 ◽  
Author(s):  
Manuela Alcañiz ◽  
Maria-Carme Riera-Prunera ◽  
Aïda Solé-Auró
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Later Life ◽  
Well Being ◽  
The Elderly ◽  
Positive Outcome ◽  
Living Environment ◽  
Cross Sectional ◽  
Urban Settings ◽  
Mental Well Being

This study examines the influence of risk factors on mental well-being at older ages focusing on the level of rurality of the living environment. We used cross-sectional, nationally representative survey data for Catalonia (Spain) from 2015 to 2017 to explain the mental well-being of the population aged 65 years and over. Based on a sample of 2621 individuals, we created a score of current mental well-being using the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS). Using logistic regression and non-parametric tests, we identified the sociodemographic, health and lifestyle variables which, in combination with the features of the rural and urban settings of the living space, were associated with poor SWEMWBS scores. Our results reveal that adequate social support is linked to expectations of good mental well-being in later life. Poor self-perceived health and ageing limitations are associated with less deterioration of the well-being for the elderly living in rural areas, whereas living in urban areas is linked to a higher risk of suffering from emotional distress attributable to economic difficulties or low educational attainment. Incentivizing older people to live in rural environments could result in greater well-being in the last stages of life; appropriate prospective studies are needed to test this positive outcome.

scholarly journals FACTORS AFFECTING WILLINGNESS OF DOCTORS TO WORK IN RURAL AREAS OF PAKISTAN

1970 ◽  
Vol 7 (2) ◽  
pp. 100-104
Author(s):  
Abida Sultana ◽  
Sayema Awais ◽  
Aashi Mughal ◽  
Bushra Anwar
Keyword(s):  
Rural Areas ◽  
Negative Attitude ◽  
Cross Sectional Study ◽  
P Value ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Rural Settings ◽  
The Government ◽  
Practice Methods ◽  
Structured Questionnaire

Background: The objective of this study was to assess the willingness of medical doctors to work in rural areas. The study also aimed to elucidate the factors influencing the decision of doctors to work in rural versus urban location of clinical practice. Methods: It is a cross-sectional study that was conducted from 8th January 2016 to 18th January, 2016 including randomly selected House officers (Hos), Postgraduate Trainees (PGTs) and Medical Officers (MOs) working in various departments of Holy Family Hospital, Rawalpindi using a self-administered semi-structured questionnaire. The questions related to demographic details, future plans and willingness of doctors. Factors facilitating or preventing them from accepting a rural position were also enquired about. Results: Thirty (30%) of the respondents were found willing to work inrural areas while 45% were neutral and 25% had a negative attitude towards practice in rural areas. Factors significantly related to rural choice of practice included rural place of birth (p value=.001), previous experience of having lived in rural settings (p value= .001)payment of fees by parents rather than by family or loans (p value=.001) and with the doctors' expectations of whether they are likely to work in rural/urban/foreign locations (p value=.001). Conclusion: The study shows that most of the doctors who have a rural birthplace/ experience of living are more willing to work in rural areas. Therefore, if the government wants to fill the vacant posts in rural locales, scholarship schemes for students from rural areas should be increased.

Twitter Usage Using Common Reference to Tinnitus

2020 ◽  
Vol 29 (2) ◽  
pp. 206-217
Author(s):  
Jianyuan Ni ◽  
Monica L. Bellon-Harn ◽  
Jiang Zhang ◽  
Yueqing Li ◽  
Vinaya Manchaiah
Keyword(s):  
Nonprofit Organizations ◽  
Temporal Trends ◽  
Temporal Analysis ◽  
Cross Sectional ◽  
For Profit ◽  
Common Reference ◽  
Personal Experiences ◽  
Twitter Users ◽  
Sectional Analysis ◽  
Share Information

Objective The objective of the study was to examine specific patterns of Twitter usage using common reference to tinnitus. Method The study used cross-sectional analysis of data generated from Twitter data. Twitter content, language, reach, users, accounts, temporal trends, and social networks were examined. Results Around 70,000 tweets were identified and analyzed from May to October 2018. Of the 100 most active Twitter accounts, organizations owned 52%, individuals owned 44%, and 4% of the accounts were unknown. Commercial/for-profit and nonprofit organizations were the most common organization account owners (i.e., 26% and 16%, respectively). Seven unique tweets were identified with a reach of over 400 Twitter users. The greatest reach exceeded 2,000 users. Temporal analysis identified retweet outliers (> 200 retweets per hour) that corresponded to a widely publicized event involving the response of a Twitter user to another user's joke. Content analysis indicated that Twitter is a platform that primarily functions to advocate, share personal experiences, or share information about management of tinnitus rather than to provide social support and build relationships. Conclusions Twitter accounts owned by organizations outnumbered individual accounts, and commercial/for-profit user accounts were the most frequently active organization account type. Analyses of social media use can be helpful in discovering issues of interest to the tinnitus community as well as determining which users and organizations are dominating social network conversations.

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