What Is the Impact of Prior Authorization on the Incidence of Pediatric Tonsillectomy?

2020 ◽  
pp. 019459982096963
Author(s):  
Vanessa F. Torrecillas ◽  
Kaden Neuberger ◽  
Alexander Ramirez ◽  
Paul Krakovitz ◽  
Jeremy D. Meier
Keyword(s):  
Elective Surgery ◽  
Lag Time ◽  
Cross Sectional Study ◽  
Health Claims ◽  
Third Party ◽  
Prior Authorization ◽  
Cross Sectional ◽  
Before And After ◽  
The Mean ◽  
The Impact

Objective Third-party payers advocate for prior authorization (PA) to reduce overutilization of health care resources. The impact of PA in elective surgery is understudied, especially in cases where evidence-based clinical practice guidelines define operative candidacy. The objective of this study is to investigate the impact of PA on the incidence of pediatric tonsillectomy. Study Design Cross-sectional study. Setting Health claims database from a third-party payer. Methods Any pediatric patient who had evaluation for tonsillectomy from 2016 to 2019 was eligible for inclusion. A time series analysis was used to evaluate the change in incidence of tonsillectomy before and after PA. Lag time from consultation to surgery before and after PA was compared with segmented regression. Results A total of 10,047 tonsillectomy claims met inclusion and exclusion criteria. Female patients made up 51% of claims, and the mean age was 7.9 years. Just 1.5% of claims were denied after PA implementation. There was no change in the incidence of tonsillectomy for all plan types ( P = .1). Increased lag time from consultation to surgery was noted immediately after PA implementation by 2.38 days (95% CI, 0.23-4.54; P = .030); otherwise, there was no significant change over time ( P = .98). Conclusion A modest number of tonsillectomy claims were denied approval after implementation of PA. The value of PA for pediatric tonsillectomy is questionable, as it did not result in decreased incidence of tonsillectomy in this cohort.

Deductible Status in the Pediatric Population: A Barrier to Appropriate Care?

2021 ◽  
pp. 019459982110069
Author(s):  
Vanessa F. Torrecillas ◽  
Kaden Neuberger ◽  
Alexander Ramirez ◽  
Andrew Knighton ◽  
Paul Krakovitz ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Pediatric Population ◽  
Fold Increase ◽  
Cross Sectional Study ◽  
Fracture Repair ◽  
Health Claims ◽  
Third Party ◽  
Cross Sectional ◽  
Inappropriate Care ◽  
The Impact

Objective The objective of this study is to evaluate the impact of high-deductible health plans on elective surgery (tonsillectomy) in the pediatric population. Study Design Cross-sectional study. Setting Health claims database from a third-party payer. Methods Data were reviewed for children up to 18 years of age who underwent tonsillectomy or arm fracture repair (nonelective control) from 2016 to 2019. Incidence of surgery by health plan deductible (high, low, or government insured) and met or unmet status of deductibles were compared. Results A total of 10,047 tonsillectomy claims and 9903 arm fracture repair claims met inclusion and exclusion criteria. The incidence of tonsillectomy was significantly different across deductible plan types. Patients with met deductibles were more likely to undergo tonsillectomy. In patients with deductibles ≥$4000, a 1.75-fold increase in tonsillectomy was observed in those who had met their deductible as compared with those who had not. These findings were not observed in controls (nonelective arm fracture). For those with met deductibles, those with high deductibles were much more likely to undergo tonsillectomy than those with low, moderate, and government deductibles. Unmet high deductibles were least likely to undergo tonsillectomy. Conclusions Health insurance plan type influences the incidence of pediatric elective surgery such as tonsillectomy but not procedures such as nonelective repair of arm fracture. High deductibles may discourage elective surgery for those deductibles that are unmet, risking inappropriate care of vulnerable pediatric patients. However, meeting the deductible may increase incidence, raising the question of overutilization.

scholarly journals Resilience and vulnerability of maternity services in Zimbabwe: a comparative analysis of the effect of Covid-19 and lockdown control measures on maternal and perinatal outcomes, a single-centre cross-sectional study at Mpilo Central Hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Clare Shakespeare ◽  
Handsome Dube ◽  
Sikhangezile Moyo ◽  
Solwayo Ngwenya
Keyword(s):  
Perinatal Outcomes ◽  
Control Measures ◽  
Central Hospital ◽  
Cross Sectional ◽  
Maternity Services ◽  
Before And After ◽  
The Mean ◽  
Significant Change ◽  
The Impact ◽  
Mpilo Central Hospital

Abstract Background On the 27th of March 2020 the Zimbabwean government declared the Covid-19 pandemic a ‘national disaster’. Travel restrictions and emergency regulations have had significant impacts on maternity services, including resource stock-outs, and closure of antenatal clinics during the lockdown period. Estimates of the indirect impact of Covid-19 on maternal and perinatal mortality was expected it to be considerable, but little data was yet available. This study aimed to examine the impact of Covid-19 and lockdown control measures on non-Covid outcomes in a government tertiary level maternity unit in Bulawayo, Zimbabwe, by comparing maternal and perinatal morbidity and mortality before, and after the lockdown was implemented. Methods This was a retrospective, observational study, using a cross-sectional design to compare routine monthly maternal and perinatal statistics three months before and after Covid-19 emergency measures were implemented at Mpilo Central Hospital. Results Between January-March and April-June 2020, the mean monthly deliveries reduced from 747.3 (SD ± 61.3) in the first quarter of 2020 to 681.0 (SD ± 17.6) during lockdown, but this was not statistically significant, p = 0.20. The Caesarean section rates fell from a mean of 29.8% (SD ± 1.7) versus 28.0% (SD ± 1.7), which was also not statistically significant, p = 0.18. During lockdown, the percentage of women delivering at Mpilo Central Hospital who were booked at the hospital fell from a mean of 41.6% (SD ± 1.1) to 35.8% (SD ± 4.3) which was statistically significant, p = 0.03. There was no significant change, however, in maternal mortality or severe maternal morbidity (such as post-partum haemorrhage (PPH), uterine rupture, and severe preeclampsia/eclampsia), stillbirth rate or special care baby unit admission. There was an increase in the mean total number of early neonatal deaths (ENND) (mean 18.7 (SD ± 2.9) versus 24.0 (SD ± 4.6), but this was not statistically significant, p = 0.32. Conclusions Overall, maternity services at Mpilo showed resilience during the lockdown period, with no significant change in maternal and perinatal adverse outcomes, with the same number of man-hours worked before and during the lockdown Maternal and perinatal outcomes should continue to be monitored to assess the impact of Covid-19 and the lockdown measures as the pandemic in Zimbabwe unfolds. Further studies would be beneficial to explore women’s experiences and understand how bookings and deliveries at local clinics changed during this time.

scholarly journals The Impact of Bariatric Surgery on Menstrual Abnormalities—a Cross-Sectional Study

2020 ◽  
Vol 30 (11) ◽  
pp. 4505-4509
Author(s):  
Anna Różańska-Walędziak ◽  
Paweł Bartnik ◽  
Joanna Kacperczyk-Bartnik ◽  
Krzysztof Czajkowski ◽  
Maciej Walędziak
Keyword(s):  
Bariatric Surgery ◽  
Menstrual Cycle ◽  
Cross Sectional Study ◽  
Reproductive Age ◽  
Obese Women ◽  
Sectional Study ◽  
Cross Sectional ◽  
Contraception Use ◽  
Before And After ◽  
The Impact

Abstract Introduction Obesity is associated with hyperestrogenism along with other hormonal abnormalities affecting the menstrual cycle. The most effective and decisive method of obesity treatment is bariatric surgery. The aim of this study was to analyze the impact of bariatric surgery on menstrual cycle, the incidence of menstrual abnormalities, hyperandrogenism manifestation, and contraception use. Materials and Methods It was a cross-sectional study of 515 pre-menopausal women who had undergone bariatric surgery between 1999 and 2017 in a bariatric center. Data was collected via anonymous questionnaire, and the questions covered a 1-year period before the surgery and the last year before questionnaire completion. Results Before the surgery, 38.6% of the patients reported irregular menstruations in comparison with 25.0% after bariatric surgery (RR = 0.65; 95%CI 0.53–0.79). The mean number of menstruations per year did not differ before and after surgery (10.2 ± 3.9 vs 10.4 ± 3.3; p < .45). There were no statistically significant differences in terms of prolonged menstruations, acne, and hirsutism prevalence. A total of 14.4% of patients before surgery reported estrogen-based contraception use in comparison with 15.0% after the surgery (p < .95). There were no significant differences in the frequency of OC use (11.0% before surgery vs 13.6% 12 months after the surgery vs 11.5% at the moment of survey administration; p < 0.46). Conclusion Bariatric surgery improves the regularity of the menstrual cycle in obese women in reproductive age. The lack of any changes in the combined hormonal contraception (CHC) use, especially OC, before and after bariatric surgery may be a result of a possibly low level of contraception counseling.

The Social and Psychological Impact of Superficial Dermatophytic Infection using Dlqi and Ghq-12: A Cross-Sectional Study in 174 Patients at a Tertiary Care Centre in Southern-East Rajasthan

2021 ◽  
pp. 1-6
Author(s):  
Shivani Saini ◽  
◽  
Agarwal Shail ◽  
Jain Manish ◽  
Yadav Devendra ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Psychological Impact ◽  
Cross Sectional Study ◽  
World Population ◽  
Sectional Study ◽  
Cross Sectional ◽  
Number Of Patients ◽  
The Mean ◽  
The Impact

Background: Dermatophytosis is a common fungal infection affecting 20-25% of the world population. Aims: Our study was aimed to assess its impact on health-related quality of life(QoL), mental health, and various variables. Materials and Methods: A cross-sectional study was done from April 2019 to September 2019 on 174 patients of dermatophytosis of aged more than 16 years with their informed consent. The impact of infection on the quality of life was assessed by using the Dermatology life quality index questionnaire and General health questionnaire-12 was used to assess psychological impact. A visual analogue scale was used to assess the severity of pruritus. Appropriate statistical tests were applied. Results: Males to females ratio was 1.4:1. The age group of 21-30 was having the highest number of patients with the mean age of 27.8±9.97. Most patients had BSA under 10%. The mean value of DLQI and GHQ-12 were found 15.989±7.407 and 2.8563±2.8964, respectively. We found that dermatophytosis had a very large effect on the quality of life as the maximum number of patients(39%) were within this category. The “work and school” part in the questionnaire gained maximum importance(52.8%). The mean VAS score was 6±2.733 with most patients(32.7%) had moderate itching. We found a positive correlation between VAS and DLQI, VAS and GHQ-12, DLQI, and GHQ-12 with the statistical significance. Conclusion: In our study dermatophytosis affected the quality of life as well as the psychological health of patients. Therefore proper treatment of superficial dermatophtytosis is essential to prevent it from further complications

scholarly journals Family size and marital age

2019 ◽  
Vol 25 (5-6) ◽  
pp. 107-11
Author(s):  
Helena Siregar ◽  
Azwin Lubis ◽  
M. Arif Nasution ◽  
Indra Kesuma Nasution ◽  
Thamrin Tanjung
Keyword(s):  
Family Planning ◽  
Family Size ◽  
Occupational Status ◽  
Married Couples ◽  
Simple Random Sampling ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
The Mean ◽  
Age Of Marriage ◽  
The Impact

A cross sectional study about the relationships between family size and marital age and the impact of educatimt, occupation and family planning programme was conducted in the region of South Tapanuli North Sumatera. The study was performed on 246 married couples by simple random sampling of households in the villages Pakantea, Tamiang, Muarasoro and Sumuran, during the period of September 25 up to October 3, 1982. The eariiest age of marriage for women was 14 years, ancl the latest 20 years. Most of the women (68%) married at 15-20 year. The main education of responders were primary school (67%). The occupational status was mostly (90%) farmer. The mean family size under 20 years old was 6.3 and over 20 years, 5.3. Fertility rate under 20 years was still high. Family Planning was not yet widely accepted in this area.

Impact of bladder cancer (BC) on health-related quality of life (HRQL) in 1,476 older Americans.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9549-9549
Author(s):  
Chunkit Fung ◽  
Chintan Pandya ◽  
Katia Noyes ◽  
Emelian Scosyrev ◽  
Deepak M. Sahasrabudhe ◽  
...  
Keyword(s):  
Smoking Status ◽  
Cross Sectional Study ◽  
Older Age ◽  
Future Research ◽  
Cross Sectional ◽  
Older Americans ◽  
Comorbidity Score ◽  
Before And After ◽  
Related Quality ◽  
The Impact

9549 Background: The impact of BC on HRQL is poorly understood. To our knowledge, this is the first and largest cross-sectional study that compares HRQL of patients before and after BC diagnosis (DX). Methods: Our sample included 1,476 BC patients (≥ age 65) within the SEER-Medicare Health Outcomes Survey linkage database (1998-2007). We assessed differences in HRQL as measured by SF-36 physical (PCS) and mental (MCS) summary scores in patients who had a survey >1 yr before BC DX (n=620) and those who had a survey after BC DX (n=856). We compared groups by year from BC DX using regression analyses and results were adjusted for cancer stage, race, gender, age at BC DX, marital status, education, income, smoking status, activity of daily living (ADLs), and non-cancer comorbidities. Results: Patients who had a survey after BC DX were diagnosed with BC at an older age than those with a survey before BC DX (55.9% at age ≥75 yr vs. 36.8%; P<0.01). Other baseline demographic and socioeconomic characteristics were similar. Baseline HRQL were poor in patients before DX (PCS mean=40.1; MCS mean=51.1) with 50.6% and 31.9% of them having comorbidity score ≥2 and impairment of ≥1 ADLs, respectively. After BC DX, significant decreases in PCS (-2.7; 95% CI -3.8,-1.7) and MCS (-1.4; 95% CI -2.6, -0.3) were observed, with HRQL being lowest in those who had BC DX within 1 yr (PCS mean= 36.6; MCS mean=49.7). Declines in PCS during the <1, 1-3, 3-5, 5-10, and 10+ yr periods after BC DX compared to before BC DX were -3.8 (P<0.01), -2.5 (P<0.01), -2.2 (P=0.01), -1.1 (P=0.19) and -0.8 (P=0.57) whereas decreases in MCS were -2.0 (P=0.01), -2.2 (P<0.01), -1.2 (P=0.21), -0.1 (P=0.92), -0.8 (P=0.62) respectively. More advanced BC, lower educational level, higher comorbidity score, and impaired ADLs were significantly associated with both worse PCS and MCS after BC DX (P<0.05). Lower income and older age at BC DX showed significant association with low PCS (P<0.05). Conclusions: Older BC patients are a vulnerable population with poor baseline HRQL. HRQL of patients after BC DX is significantly worse than HRQL of patients before DX, possibly due to therapy and/or disease progression. Future research that evaluates interventions to improve HRQL in older patients with BC is critical.

scholarly journals The effect of coffee consumption on serum total cholesterol in the Sami and Norwegian populations

2010 ◽  
Vol 13 (11) ◽  
pp. 1818-1825 ◽  
Author(s):  
Tove Nystad ◽  
Marita Melhus ◽  
Magritt Brustad ◽  
Eiliv Lund
Keyword(s):  
Total Cholesterol ◽  
Serum Cholesterol ◽  
Coffee Consumption ◽  
Cross Sectional Study ◽  
Total Serum ◽  
Total Serum Cholesterol ◽  
Cross Sectional ◽  
Cholesterol Levels ◽  
The Mean ◽  
The Impact

AbstractObjectiveTo assess coffee consumption in the Sami and Norwegian populations and to investigate the impact of unfiltered boiled coffee consumption on serum cholesterol concentrations.DesignA cross-sectional study. Information was collected by self-administrated questionnaires and total serum cholesterol was analysed. Participants were divided into three ethnic groups: Sami I (Sami used as home language in the last three generations), Sami II (at least one Sami identity marker) and Norwegian.SettingIn an area with Sami, Kven/Finnish and Norwegian populations, the SAMINOR study, 2003–2004.SubjectsA total of 5647 men and 6347 women aged 36–79 years.ResultsMore than 90 % of the study populations were coffee drinkers. Only 22 % were unfiltered coffee consumers. Sami I had the highest proportion of participants who consumed nine or more cups of unfiltered coffee per day, although the number of participants was limited. Total coffee consumption was associated with increased total cholesterol for men (P < 0·01) and women (P < 0·0001). For those who drank only unfiltered coffee, a significant association was found only in Norwegian men, adjusted for physical activity in leisure time, BMI and smoking habits (P < 0·001). From the lowest (less than five cups) to the highest (nine or more cups) unfiltered coffee consumption category, the mean total cholesterol levels increased by 0·29 mmol/l in Norwegian men.ConclusionsUnfiltered coffee consumption was lower in the present study compared to previous reports. In general, total coffee consumption was positively associated with total cholesterol levels. However, for unfiltered coffee consumption, an association was found only in Norwegian men.

scholarly journals Evaluation of the Results of Arthroscopic Release in Limits of Movement in Knees

2020 ◽  
Author(s):  
Mohammad Reza Sobhan ◽  
Seyed Hossein Saeed Banadaky ◽  
Mohammad Shafiee ◽  
Mohammad Gheisari
Keyword(s):  
Statistical Tests ◽  
Cross Sectional Study ◽  
Knee Score ◽  
Cross Sectional ◽  
Mean Values ◽  
Arthroscopic Release ◽  
Lysholm Knee Score ◽  
Significant Difference ◽  
Before And After ◽  
The Mean

Introduction: Limits of movement in knees is one of the most common complications following trauma and surgery. With early diagnosis and appropriate treatment choices, knee replacement and performance improvement are expected in many patients. However, limits of movement in knees is unpleasant and should be corrected as soon as possible. In this study, we decided to evaluate the results of arthroscopic release in motion limits of knees. Methods: This was a descriptive cross-sectional study.14 patients who referred to the Shahid Sadoughi Hospital of Yazd from 2014 to 2016 and diagnosed with knee limitation (flexion or extension restriction of more than 10 degrees) were selected. Patients were undergone arthroscopic release and followed-up for 6 months. Lysholm knee score, degrees of flexion and extension, and patient satisfaction were evaluated. The results were analyzed by SPSS-18 and statistical tests Paired T-test as well as Spearman correlation. Results: The mean age of the patients was 28.92±10.99 years. The most common type of trauma in the patients was femoral distal fracture (46.7%). The frequency of the patients' satisfaction with arthroscopy was as followed: 50% (7 patients), had moderate satisfaction, 28.6% (4 ones), high satisfaction, and 21.4% (3 ones) had low satisfaction.The mean difference in Lysholm Knee Score, improvement in degree of extension, improvement in degree of flexion and pain score before and after arthroscopy were 26.21±14.11,64.78±26.13,3.57±2.92 and 4.13±1.65,respectively.There was a significant difference between the mean values of these factors before and after arthroscopy. Conclusion: According to the results obtained, we can conclude that arthroscopic release is an effective and low-complication method in motion limits of knees.

scholarly journals Awareness of Diagnosis and Decision-Making Preferences of Greek Cancer Patients

2020 ◽  
pp. 5-12
Author(s):  
Despoina G Alamanou ◽  
Konstantinos Giakoumidakis ◽  
Dimosthenis G Theodosiadis ◽  
Nikolaos V Fotos ◽  
Elissavet Patiraki ◽  
...  
Keyword(s):  
Decision Making ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Active Role ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Medical Encounter ◽  
The Mean ◽  
The Impact ◽  
The City

Objective: In Greece, the old phenomenon of hiding cancer diagnosis and depriving cancer patients of their right to participate in decisionmaking remains a reality. The aim of this study was to assess the decision-making preferences of Greek cancer patients and their awareness of diagnosis. Methods: It was a cross-sectional study. The sample consisted of 229 adult Greek patients diagnosed with cancer, attending the oncology outpatient department (outpatients) or being hospitalized (inpatients), in one general hospital in Athens. Patients who were aware of cancer diagnosis (n=209) were administered at the Control Preference Scale (CPS), a tool, designed to elicit decision-making preferences. The IBM SPSS program, version 21.0 was used for statistical analysis. Results: One hundred and one patients (52.8%) were males. The mean [±standard deviation (SD)] age was 64.8 (±11.2) years. The vast majority of patients knew they suffered from cancer (n=209, 91.3%). Older patients (p=0.003), those who lived in suburbs of the city (p=0.01), those who had lower educational level (p=0.001), those with lower personal income (p=0.001) and shorter disease duration (p=0.001) stated that were unaware of cancer diagnosis. Seventy five (36.2%) patients chose the shared-decision role in decision-making procedures. Lower age (OR 1.04, 95%, CI: 1.00-1.08, p= 0.05) and higher education level (OR 2, 63, 95%, CI: 1.11-6.29, p=0.03) were significantly associated with the preference of patients to actively participate in decision-making regarding treatment. Conclusions: Although Greek cancer patients are aware of cancer diagnosis and treatment, nowadays, they still seem to hesitate in playing a more active role in the decision-making procedures, which portrays the impact of the dominating paternalistic model of doctor-patient relationship in the Greek medical encounter

scholarly journals Gender Differences in Attitude Towards Pornography Among Youth in Kelantan

2021 ◽  
Vol 6 (1) ◽  
pp. 268-278
Author(s):  
Norazlifah Muhamad ◽  
Azrianii Ab Rahman ◽  
Mohd Ismail Ibrahim ◽  
Razlina Abdul Rahman ◽  
Wan Nor Arifin Wan Mansor ◽  
...  
Keyword(s):  
College Students ◽  
Gender Differences ◽  
Private Colleges ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
The Mean ◽  
The Impact ◽  
Self Administered Questionnaire

Although the number of pornography exposure is increasing, our understandings on the issues are still lacking. This study aimed to compare gender differences in the attitudes towards pornography among youth in Kelantan. A cross sectional study was conducted using a validated self-administered questionnaire (PORQUE) on 930 college students in both government and private colleges in Kelantan. The mean scores were significantly higher among females for majority of the items assessing non-permissive feelings toward pornography materials (p<0.001), perception on impact of pornography (p<0.05) and perception on factors contributed to pornography (p<0.05). The mean score for majority of the items assessing permissive and perceptions toward pornography materials were significantly higher among males(p<0.001). Females were more non-permissive towards pornography, better perceived the impact of pornography and factors contributed to pornography compared to males. These findings are important as it serve as a guide for the stakeholders to implement pornography intervention for youth in Malaysia.

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