CMS ESRD quality incentive program has not improved patient dialysis vascular access

2021 ◽  
pp. 112972982110270
Author(s):  
Sapan Shah ◽  
Paul J Feustel ◽  
Christina E Manning ◽  
Loay Salman
Keyword(s):  
United States ◽  
The United States ◽  
Geographic Region ◽  
Dialysis Access ◽  
Median Income ◽  
Hemodialysis Catheter ◽  
Incentive Program ◽  
Significant Difference ◽  
Quality Incentive

Purpose: Over 468,000 patients in the United States use hemodialysis to manage End Stage Renal Disease (ESRD). The purpose of this study was to determine whether the dialysis access Clinical Performance Measures (CPMs) of Centers for Medicare & Medicaid Services (CMS) ESRD Quality Incentive Program (QIP) have increased arteriovenous fistula (AVF) rates and decreased long-term tunneled hemodialysis catheter (TDC) rates among hemodialysis patients in United States. Methods: Retrospective observational study: evaluated reported AVF and long-term TDC rates of 4804 dialysis facilities which reported dialysis access data as part of the ESRD QIP from Payment Year (PY) 2014–2020. Facilities were also sorted by specific additional criteria to examine disparities in dialysis access. Results: Mean AVF rates of included facilities increased from 63.7% in PY 2014 to 67.2% in PY 2016 ( p < 0.05), did not change in PY 2017 ( p > 0.05), and declined significantly in PY 2018–2020 to 64.1% in PY 2020, near AVF rates at the inception of program. Long-term TDC rates decreased from 10.4% in PY 2014 to 9.88% in PY 2015 ( p < 0.05), then increased in PY 2015–PY 2020 to rates higher than at the inception of program, at 11.8% in PY 2020 ( p < 0.05). Facilities serving majority Black ZIP Code Tabulation Areas (ZCTAs) or ZCTAs with median income <$45,000 achieved significantly lower AVF rates ( p < 0.05) with no significant difference in long-term TDC rates ( p > 0.05). AVF rates correlated positively and long-term TDC rates correlated negatively with star rating of facilities ( p < 0.05). Conclusion: As one of the first financial QIPs in healthcare, the ESRD QIP has not achieved the stated goals of the CMS to increase AVF access rates above 68% and reduce long-term TDC clinical rates below 10%. Systemic disparities in race, geographic region, economic status, healthcare access, and education of providers and patients prevent successful attainment of goal metrics.

scholarly journals Prevalence of advanced directives in the geriatric population with in long-term care facilities in the United States

2021 ◽  
Vol 12 (2) ◽  
pp. 173-178
Author(s):  
Ateequr Rahman ◽  
Druti Shukla ◽  
Lejla Cukovic ◽  
Kirstin Krzyzewski ◽  
Noopur Walia ◽  
...  
Keyword(s):  
United States ◽  
Long Term Care ◽  
The United States ◽  
Living Wills ◽  
Term Care ◽  
Advanced Directive ◽  
Advanced Directives ◽  
Significant Difference ◽  
Care Facilities

Advanced directives, such as Living Wills and Do Not Resuscitate (DNR) orders, provide the ability to identify, respect, and implement an individual's wishes for medical care during serious illness or end-of-life care. The aim of this study was to evaluate the prevalence of advanced directives amongst the residents of long-term care facilities in the United States. A total of 527 cases were extracted from 2018 National Study of Long-Term Care Providers, which was collected by the National Center for Health Statistics through the surveys of residential care communities and adult day services centers. Advanced directive rates were higher in patients 90 years of age and above as compared to other age groups. Nursing home residents were more likely to have advanced directives than other long term care facilities. There was no significant difference among males and females in the rate of advanced directives. Nursing home and Hospice residents had more advanced directives compared to other facilities. The Black population had the highest rate of advanced directive preparedness. Overall, the finding of this study revealed that there was a significant difference in the preparedness of DNR orders and Living Wills by patient demographics and the type of long-term care facility. Offering advanced directive services at public health/social services facilities can enhance the rate of advanced directive preparedness. Advanced directives ease the stress and anxiety of patients, family, and friends during difficult times.

Assessing the Correlation of Culture With Business Ethics of Company Managers in the United States and Mexico

2018 ◽  
pp. 73-99
Author(s):  
Mark A. Anderson
Keyword(s):  
United States ◽  
National Culture ◽  
The United States ◽  
Business Managers ◽  
Ethical Attitudes ◽  
Cultural Elements ◽  
Management Scholar ◽  
Significant Difference

Observable harm has been inflicted upon business by unethical decisions and misconduct. Much of this phenomenon can be traced to impoverished ethical attitudes. Among the various reasons for this problem is that of a manager's culture, which has a distinct influence on attitudes and behaviors. The purpose of this chapter was to determine, through empirical data, whether differences rooted in culture significantly contribute to differences in ethical attitudes. Management scholar Geert Hofstede's classification of cultural elements for understanding and explaining aspects of national culture was correlated with the ethical attitudes of business managers in the two national cultures of the United States and Mexico. Results indicated a significant positive relationship between national culture and ethical attitudes and the dultural dimensions of uncertainty avoidance, masculinity, and long-term orientation. A significant difference in ethical attitudes between managers from the United States and Mexico was also found.

Ankyloglossia: Update on Trends in Diagnosis and Management in the United States, 2012-2016

2020 ◽  
Vol 163 (5) ◽  
pp. 1029-1031
Author(s):  
Eric X. Wei ◽  
David Tunkel ◽  
Emily Boss ◽  
Jonathan Walsh
Keyword(s):  
United States ◽  
Hospital Setting ◽  
The United States ◽  
Geographic Region ◽  
Healthcare Research ◽  
Inpatient Setting ◽  
Median Income ◽  
Sex Type ◽  
Tongue Mobility ◽  
Zip Code

Ankyloglossia, or “tongue-tie,” refers to limited tongue mobility caused by a restrictive lingual frenulum. Previous studies have demonstrated rapid increases in diagnosis and treatment of ankyloglossia in the United States up to 2012. We performed an updated retrospective review of data from the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality (AHRQ) to evaluate trends in diagnosis of ankyloglossia and use of lingual frenotomy in the hospital setting. From 2012 to 2016, there was an 110.4% increase in reported diagnosis of ankyloglossia in the inpatient setting with similar increases in lingual frenotomy procedures. As seen previously, sex, type of insurance, median income ZIP code, and geographic region were associated with diagnosis of ankyloglossia. The observed trends from prior to 2012 have continued to increase, while unanswered questions about diagnostic criteria and about which infants should undergo frenotomy remain.

Managerial Ethics and the Function of Culture in Mexico and the United States

2020 ◽  
pp. 53-82
Author(s):  
F. Sigmund Topor
Keyword(s):  
United States ◽  
Positive Relationship ◽  
The United States ◽  
Cultural Dimensions ◽  
Ethical Attitudes ◽  
Two Cultures ◽  
Significant Positive Relationship ◽  
Attitudes And Behaviors ◽  
Significant Difference

This chapter is a reflection on the ethical distinctions between two cultures that share the same civilization (i.e., Mexico and the United States). Impoverished ethical attitudes have inflicted observable harm upon business by unethical decisions and misconduct. Much of this phenomenon is traceable to distinctive cultural construal of ethics. This phenomenon exemplifies the influence that culture exerts on managers, which has a distinct influence on attitudes and behaviors. This chapter explores, through empirical data, whether differences rooted in culture have any contribution to differences in ethical attitudes. Results indicated a significant positive relationship between national culture and ethical attitudes and the cultural dimensions of uncertainty avoidance, masculinity, and long-term orientation. A significant difference in ethical attitudes between managers from the United States and Mexico was also found.

scholarly journals Freestanding Dialysis Facility Quality Incentive Program Scores and Mortality Among Incident Dialysis Patients in the United States

2020 ◽  
Vol 75 (2) ◽  
pp. 177-186 ◽  
Author(s):  
Fozia Ajmal ◽  
Janice C. Probst ◽  
John M. Brooks ◽  
James W. Hardin ◽  
Zaina Qureshi ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Dialysis Patients ◽  
Incentive Program ◽  
Dialysis Facility ◽  
Quality Incentive

Speech-Language Pathology in the Peace Corps: Necessity and Sustainability

2012 ◽  
Vol 2 (1) ◽  
pp. 11-18
Author(s):  
Melissa A. Pierce
Keyword(s):  
United States ◽  
Special Education ◽  
Peace Corps ◽  
People With Disabilities ◽  
Communication Disorders ◽  
The United States ◽  
Speech Language Pathology ◽  
Speech Language Pathologists ◽  
Language Pathology

In countries other than the United States, the study and practice of speech-language pathology is little known or nonexistent. Recognition of professionals in the field is minimal. Speech-language pathologists in countries where speech-language pathology is a widely recognized and respected profession often seek to share their expertise in places where little support is available for individuals with communication disorders. The Peace Corps offers a unique, long-term volunteer opportunity to people with a variety of backgrounds, including speech-language pathologists. Though Peace Corps programs do not specifically focus on speech-language pathology, many are easily adapted to the profession because they support populations of people with disabilities. This article describes how the needs of local children with communication disorders are readily addressed by a Special Education Peace Corps volunteer.

Mafias on the Move

2011 ◽  
Author(s):  
Federico Varese
Keyword(s):  
United States ◽  
New York ◽  
Organized Crime ◽  
The United States ◽  
The West ◽  
Market Expansion ◽  
The North ◽  
Economic Transformations ◽  
At Will

Organized crime is spreading like a global virus as mobs take advantage of open borders to establish local franchises at will. That at least is the fear, inspired by stories of Russian mobsters in New York, Chinese triads in London, and Italian mafias throughout the West. As this book explains, the truth is more complicated. The author has spent years researching mafia groups in Italy, Russia, the United States, and China, and argues that mafiosi often find themselves abroad against their will, rather than through a strategic plan to colonize new territories. Once there, they do not always succeed in establishing themselves. The book spells out the conditions that lead to their long-term success, namely sudden market expansion that is neither exploited by local rivals nor blocked by authorities. Ultimately the inability of the state to govern economic transformations gives mafias their opportunity. In a series of matched comparisons, the book charts the attempts of the Calabrese 'Ndrangheta to move to the north of Italy, and shows how the Sicilian mafia expanded to early twentieth-century New York, but failed around the same time to find a niche in Argentina. The book explains why the Russian mafia failed to penetrate Rome but succeeded in Hungary. A pioneering chapter on China examines the challenges that triads from Taiwan and Hong Kong find in branching out to the mainland. This book is both a compelling read and a sober assessment of the risks posed by globalization and immigration for the spread of mafias.

Leaded Aviation Fuel May Present Long-Term Effects on Campus Life from the Adjacent Albert Whitted Airport

2020 ◽  
Author(s):  
Joseph Matthews ◽  
Madhu Pandey
Keyword(s):  
United States ◽  
Particulate Matter ◽  
The United States ◽  
Aviation Fuel ◽  
University Campus ◽  
Long Term Effects ◽  
Aviation Gasoline ◽  
Suspended Particulate ◽  
Descent Line

Propeller planes and small engine aircraft around the United States, legally utilize leaded aviation gasoline. The purpose of this experiment was to collect suspended particulate matter from a university campus, directly below an airport’s arriving flight path’s descent line, and to analyze lead content suspended in the air. Two collection sets of three separate samples were collected on six separate days, one set in July of 2018 and the second set in January 2019.

Markets, Technological Change and Economic Growth (The Quaid-i-Azam Lecture)

1994 ◽  
Vol 33 (4I) ◽  
pp. 327-356 ◽  
Author(s):  
Richard G. Lipsey
Keyword(s):  
United States ◽  
Economic Growth ◽  
Developing Countries ◽  
Common Ground ◽  
The United States ◽  
Industrial Countries ◽  
Canadian Institute ◽  
Primary Focus ◽  
Short Time

I am honoured to be invited to give this lecture before so distinguished an audience of development economists. For the last 21/2 years I have been director of a project financed by the Canadian Institute for Advanced Research and composed of a group of scholars from Canada, the United States, and Israel.I Our brief is to study the determinants of long term economic growth. Although our primary focus is on advanced industrial countries such as my own, some of us have come to the conclusion that there is more common ground between developed and developing countries than we might have first thought. I am, however, no expert on development economics so I must let you decide how much of what I say is applicable to economies such as your own. Today, I will discuss some of the grand themes that have arisen in my studies with our group. In the short time available, I can only allude to how these themes are rooted in our more detailed studies. In doing this, I must hasten to add that I speak for myself alone; our group has no corporate view other than the sum of our individual, and very individualistic, views.

The Future of Muslim Education in the United States: An Agenda for Research

2003 ◽  
Vol 20 (3-4) ◽  
pp. 46-82
Author(s):  
Fathi Malkawi
Keyword(s):  
United States ◽  
The United States ◽  
American Education ◽  
Future Trends ◽  
Muslim Community ◽  
Short Term ◽  
The Future ◽  
Muslim Education ◽  
Future Plans

This paper addresses some of the Muslim community’s concerns regarding its children’s education and reflects upon how education has shaped the position of other communities in American history. It argues that the future of Muslim education will be influenced directly by the present realities and future trends within American education in general, and, more importantly, by the well-calculated and informed short-term and long-term decisions and future plans taken by the Muslim community. The paper identifies some areas in which a wellestablished knowledge base is critical to making decisions, and calls for serious research to be undertaken to furnish this base.

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