scholarly journals Variability in Hospital Admission Rates for Neonates With Fever in North Carolina

2019 ◽  
Vol 6 ◽  
pp. 2333794X1986544
Author(s):  
Winston Wu ◽  
Katie Harmon ◽  
Anna Estelle Waller ◽  
Courtney Mann
Keyword(s):  
North Carolina ◽  
Significant Variation ◽  
Health Care Disparity ◽  
Admission Rates ◽  
Patient Disposition ◽  
Event Tracking ◽  
Lower Likelihood ◽  
Pediatric Service ◽  
Emergency Room Setting ◽  
Using Data

Background. Despite multiple guidelines recommending admission, there is significant variation among emergency departments (EDs) regarding disposition of neonates presenting with fever. We performed a statewide epidemiologic analysis to identify characteristics that may influence patient disposition in such cases within North Carolina. Methods. This study is a retrospective cohort study of infants 1 to 28 days old with a diagnosis of fever presenting to North Carolina EDs from October 1, 2010, to September 30, 2015, using data from the NC DETECT (North Carolina Disease Event Tracking and Epidemiologic Collection Tool) database. We analyzed various patient epidemiology characteristics and their associations with patients being admitted or discharged from the emergency room setting. Results. Of 2745 unique patient visits for neonatal fever, 1173 (42.7%) were discharged from the ED, while 1572 (57.3%) were either admitted or transferred for presumed admission. Age, sex, region within North Carolina, and the presence of a pediatric service did not significantly influence disposition. An abnormal documented ED temperature was associated with higher likelihood of admission ( P < .01). The size of the hospital was also found to be significant when comparing large with small hospitals ( P < .01). Government-funded insurance was associated with lower likelihood of admission ( P < .01). Conclusions. A high number of neonates diagnosed with fever were discharged home, inconsistent with current recommendations. An association with a government-funded insurance represents a possible health care disparity. Further studies are warranted to further understand these variations in practice.

scholarly journals A Structural Approach to Estimating Rate of Return Expectations of Farmers

1993 ◽  
Vol 25 (2) ◽  
pp. 56-68 ◽  
Author(s):  
Bruce L. Ahrendsen
Keyword(s):  
Time Series ◽  
North Carolina ◽  
Cost Function ◽  
Structural Approach ◽  
Rate Of Return ◽  
Dairy Farmers ◽  
Return On Assets ◽  
Rates Of Return ◽  
Sample Mean ◽  
Using Data

AbstractA dual cost function approach is developed as an alternative to time series and simplistic approaches for estimating farmers' expected operating rates of return on assets. A translog restricted cost function is estimated using data provided by 152 North Carolina dairy farmers over the period 1976 through 1986. The predicted costs from the fitted restricted cost function are used to construct estimates of farmers' expected operating rates of return on assets. The estimates from this structural approach explain more of the variation in observed rates than do time series estimates or sample mean observed rates.

Association between Performance in a Maintenance of Certification Program and Disciplinary Actions against the Medical Licenses of Anesthesiologists

2018 ◽  
Vol 129 (4) ◽  
pp. 812-820 ◽  
Author(s):  
Yan Zhou ◽  
Huaping Sun ◽  
Alex Macario ◽  
Mark T. Keegan ◽  
Andrew J. Patterson ◽  
...  
Keyword(s):  
North Carolina ◽  
Lower Incidence ◽  
Cumulative Incidence ◽  
Hazard Ratio ◽  
Certification Program ◽  
Disciplinary Actions ◽  
Maintenance Of Certification ◽  
Lower Likelihood ◽  
Significant Change ◽  
Certification Requirements

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background In 2000, the American Board of Anesthesiology (Raleigh, North Carolina) began issuing time-limited certificates requiring renewal every 10 yr through a maintenance of certification program. This study investigated the association between performance in this program and disciplinary actions against medical licenses. Methods The incidence of postcertification prejudicial license actions was compared (1) between anesthesiologists certified between 1994 and 1999 (non–time-limited certificates not requiring maintenance of certification) and those certified between 2000 and 2005 (time-limited certificates requiring maintenance of certification); (2) within the non–time-limited cohort, between those who did and did not voluntarily participate in maintenance of certification; and (3) within the time-limited cohort, between those who did and did not complete maintenance of certification requirements within 10 yr. Results The cumulative incidence of license actions was 3.8% (587 of 15,486). The incidence did not significantly differ after time-limited certificates were introduced (hazard ratio = 1.15; 95% CI, 0.95 to 1.39; for non–time-limited cohort compared with time-limited cohort). In the non–time-limited cohort, 10% (n = 953) voluntarily participated in maintenance of certification. Maintenance of certification participation was associated with a lower incidence of license actions (hazard ratio = 0.60; 95% CI, 0.38 to 0.94). In the time-limited cohort, 90% (n = 5,329) completed maintenance of certification requirements within 10 yr of certificate issuance. Not completing maintenance of certification requirements (n = 588) was associated with a higher incidence of license actions (hazard ratio = 4.61; 95% CI, 3.27 to 6.51). Conclusions These findings suggest that meeting maintenance of certification requirements is associated with a lower likelihood of being disciplined by a state licensing agency. The introduction of time-limited certificates in 2000 was not associated with a significant change in the rate of license actions.

scholarly journals Modelling out-of-area admissions

2018 ◽  
Vol 213 (4) ◽  
pp. 615-616 ◽  
Author(s):  
Lewis W. Paton ◽  
Paul A. Tiffin
Keyword(s):  
Mental Health ◽  
Community Services ◽  
Referral Rate ◽  
Referral Rates ◽  
Admission Rates ◽  
Department Of Health ◽  
Potential Impact ◽  
Using Data ◽  
Out Of Area ◽  
Health Trust

SummaryOut-of-area (OOA) placements occur when patients cannot be admitted to local facilities, which can be extremely stressful for patients and families. Thus, the Department of Health aims to eliminate the need for OOA admissions. Using data from a UK mental health trust we developed a ‘virtual mental health ward’ to evaluate the potential impact of referral rates and length of stay (LOS) on OOA rates. The results indicated OOA rates were equally sensitive to LOS and referral rate. This suggests that investment in community services that reduce both LOS and referral rates are required to meaningfully reduce OOA admission rates.Declaration of interestP.A.T. holds an honorary consultant contract with the Tees, Esk and Wear Valleys NHS Foundation Trust.

scholarly journals Exploring Costing Methods for Environmental Health Services in North Carolina

2016 ◽  
Vol 132 (1) ◽  
pp. 37-40
Author(s):  
Simone R. Singh ◽  
Nancy L. Winterbauer ◽  
Ashley Tucker ◽  
Lisa Macon Harrison
Keyword(s):  
North Carolina ◽  
Health Services ◽  
Environmental Health ◽  
Economies Of Scale ◽  
Bivariate Analysis ◽  
Local Health ◽  
Health Departments ◽  
Local Health Departments ◽  
Site Water ◽  
Using Data

All local health departments in North Carolina are mandated to provide a defined set of environmental health services, yet few have the tools to understand the costs incurred in delivering these services. The objectives of this study were to (1) derive cost estimates for 2 commonly provided environmental health services—food and lodging inspections and on-site water services—and (2) explore factors that drive variations in costs, focusing on the roles of economies of scale and scope. Using data from 15 local health departments in North Carolina, we found that costs varied substantially. A bivariate analysis found evidence of economies of scale: higher volumes of services were associated with lower costs per service. Providing a greater scope of services, however, was not consistently associated with reduced costs. In-depth cost data provide public health officials with key information when deciding how to best serve their communities.

Use of AFLP Markers to Assess Genetic Diversity in Palmer Amaranth (Amaranthus palmeri) Populations from North Carolina and Georgia

Weed Science ◽  
2013 ◽  
Vol 61 (1) ◽  
pp. 136-145 ◽  
Author(s):  
Aman Chandi ◽  
Susana R. Milla-Lewis ◽  
David L. Jordan ◽  
Alan C. York ◽  
James D. Burton ◽  
...  
Keyword(s):  
Genetic Diversity ◽  
North Carolina ◽  
Total Variation ◽  
Significant Variation ◽  
Cropping Systems ◽  
Geographic Region ◽  
Palmer Amaranth ◽  
Aflp Markers ◽  
Amaranthus Palmeri ◽  
Management Approaches

Glyphosate-resistant Palmer amaranth is a serious problem in southern cropping systems. Much phenotypic variation is observed in Palmer amaranth populations with respect to plant growth and development and susceptibility to herbicides. This may be related to levels of genetic diversity existing in populations. Knowledge of genetic diversity in populations of Palmer amaranth may be useful in understanding distribution and development of herbicide resistance. Research was conducted to assess genetic diversity among and within eight Palmer amaranth populations collected from North Carolina and Georgia using amplified fragment length polymorphism (AFLP) markers. Pair-wise genetic similarity (GS) values were found to be relatively low, averaging 0.34. The highest and the lowest GS between populations were 0.49 and 0.24, respectively, while the highest and the lowest GS within populations were 0.56 and 0.36, respectively. Cluster and principal coordinate (PCO) analyses grouped individuals mostly by population (localized geographic region) irrespective of response to glyphosate or gender of individuals. Analysis of molecular variance (AMOVA) results when populations were nested within states revealed significant variation among and within populations within states while variation among states was not significant. Variation among and within populations within state accounted for 19 and 77% of the total variation, respectively, while variation among states accounted for only 3% of the total variation. The within population contribution towards total variation was always higher than among states and among populations within states irrespective of response to glyphosate or gender of individuals. These results are significant in terms of efficacy of similar management approaches both in terms of chemical and biological control in different areas infested with Palmer amaranth.

When Do We Think About Detection? Structural Opportunity and Taxpaying Behavior

1989 ◽  
Vol 14 (03) ◽  
pp. 481-503 ◽  
Author(s):  
Loretta J. Stalans ◽  
Kent W. Smith ◽  
Karyl A. Kinsey
Keyword(s):  
Explanatory Power ◽  
Social Situation ◽  
Individual Characteristics ◽  
Internal Revenue Service ◽  
Complete Understanding ◽  
Telephone Surveys ◽  
Illegal Behavior ◽  
Lower Likelihood ◽  
Situational Characteristic ◽  
Using Data

Past studies have generally found that perceptions of the likelihood of formal and informal sanctions have lower explanatory power of noncompliance with laws than do internalized norms. Using data from two telephone surveys, we examined a situational characteristic, structural opportunity, that may prod individuals to think about the likelihood of detection from the Internal Revenue Service for underreporting income. Structural opportunity is the degree to which an individual's economic or social situation provides ways to avoid detection. Individuals with high structural opportunity perceived a lower likelihood of IRS detection and indicated that they were less likely to feel guilty if they engaged in tax cheating. Our data also suggested that some individuals with high structural opportunity may be in social networks which condone tax cheating. As expected, structural opportunity provided a condition under which individuals took into consideration the perceived likelihood of formal and informal detection in formulating intentions to engage in tax cheating. Our findings suggest that an examination of the interaction between situational and individual characteristics will provide a more complete understanding of decisions to engage in illegal behavior. Implications for deterrence theory are discussed.

Accuracy of rapid disposition by emergency clinicians

2017 ◽  
Vol 41 (2) ◽  
pp. 133 ◽  
Author(s):  
Andrew Backay ◽  
Adam Bystrzycki ◽  
De Villiers Smit ◽  
Martin Keogh ◽  
Gerard O'Reilly ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Prediction Accuracy ◽  
Model Of Care ◽  
Tertiary Referral Hospital ◽  
Patient Journey ◽  
Admission Rates ◽  
Patient Disposition ◽  
Standard Assessment ◽  
And Performance ◽  
Disposition Model

Objectives Rapid disposition protocols are increasingly being considered for implementation in emergency departments (EDs). Among patients presenting to an adult tertiary referral hospital, this study aimed to compare prediction accuracy of a rapid disposition decision at the conclusion of history and examination, compared with disposition following standard assessment. Methods Prospective observational data were collected for 1 month between October and November 2012. Emergency clinicians (including physicians, registrars, hospital medical officers, interns and nurse practitioners) filled out a questionnaire within 5 min of obtaining a history and clinical examination for eligible patients. Predicted patient disposition (representing ‘rapid disposition’) was compared with final disposition (determined by ‘standard assessment’). Results There were 301 patient episodes included in the study. Predicted disposition was correct in 249 (82.7%, 95% confidence interval (CI) 78.0–86.8) cases. Accuracy of predicting discharge to home appeared highest among emergency physicians at 95.8% (95% CI 78.9–99.9). Overall accuracy at predicting admission was 79.7% (95% CI 67.2–89.0). The remaining 20.3% (95% CI 11.0–32.8) were not admitted following standard assessment. Conclusion Rapid disposition by ED clinicians can predict patient destination accurately but was associated with a potential increase in admission rates. Any model of care using rapid disposition decision making should involve establishment of inpatient systems for further assessment, and a culture of timely inpatient team transfer of patients to the most appropriate treating team for ongoing patient management. What is known about the topic? In response to the National Emergency Access Targets, there has been widespread adoption of rapid-disposition-themed care models across Australia. Although there is emerging data that clinicians can predict disposition accurately, this data is currently limited. What does this paper add? Results of this study support the previously limited evidence that ED practitioners can accurately predict disposition early in the patient journey through ED, and that accuracy is similar across clinician groups. In addition to overall prediction accuracy, admission, discharge and treating team predictions were separately measured. These additional outcomes lend insight into safety and performance aspects relating to a rapid disposition model of care. What are the implications for practitioners? This study offers practical insights that could aid safe and efficient implementation of a rapid disposition model of care.

Comparing Disciplinary Infraction Rates of North Carolina Fair Sentencing and Structured Sentencing Inmates: A Natural Experiment

1999 ◽  
Vol 79 (1) ◽  
pp. 45-71 ◽  
Author(s):  
JOHN M. MEMORY ◽  
GUANG GUO ◽  
KEN PARKER ◽  
TOM SUTTON
Keyword(s):  
North Carolina ◽  
Natural Experiment ◽  
Negative Binomial ◽  
Cox Regression ◽  
Negative Binomial Regression ◽  
Research Literature ◽  
Prison Inmates ◽  
Binomial Regression ◽  
Truth In Sentencing ◽  
Using Data

Using data collected from June 1, 1995, to August 30, 1996, the researchers compared the disciplinary conviction rates of North Carolina prison inmates admitted during the study period before the truth-in-sentencing law and inmates admitted during that period under the truth-in-sentencing law. Based on deterrence theory, the researchers hypothesized that pre-truth-in-sentencing inmates, who could lose time off for good behavior and parole as results of a disciplinary conviction, would have higher disciplinary conviction rates than truth-in-sentencing inmates. Truth-in-sentencing inmates, with shorter sentences, could lose neither time off for good behavior nor parole as a result of disciplinary conviction. Cox regression and negative binomial regression procedures using control variables identified in the research literature generally supported the research hypotheses.

Reputation, Symmetry, and Alliance Design

2012 ◽  
Vol 66 (4) ◽  
pp. 679-707 ◽  
Author(s):  
Michaela Mattes
Keyword(s):  
Bargaining Power ◽  
Significant Variation ◽  
Military Alliances ◽  
Issue Linkage ◽  
Major Powers ◽  
History Of ◽  
Minor Powers ◽  
Using Data

AbstractThere is significant variation in the design of military alliances but scholars currently do not have a good understanding of when members choose one design over another. This article argues that alliance design is motivated, at least in part, by reliability considerations. If concerns about opportunism are high—when prospective members have a history of alliance violation—the signatories should be more willing to implement costly reliability-enhancing provisions such as greater precision in when alliance obligations apply, issue linkage, and increased institutionalization. However, this should be more likely in symmetric alliances where members of similar power levels rely on the support of their partners and thus sensitivity to opportunism is high. In asymmetric alliances, major powers may not find reliability-enhancing provisions necessary and minor powers, who do worry about the reliability of their partners, are unable to force more costly alliance designs given their limited bargaining power. The theoretical expectations are tested using data on bilateral alliances between 1919 and 2001 and the results are generally supportive of the hypotheses.

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