Adherence to Antiseizure vs Other Medications Among US Medicare Beneficiaries With and Without Epilepsy

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000013119
Author(s):  
Samuel Waller Terman ◽  
Wesley T Kerr ◽  
Carole E Aubert ◽  
Chloe E Hill ◽  
Zachary A Marcum ◽  
...  
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Correlation Coefficients ◽  
International Classification Of Diseases ◽  
Kappa Statistics ◽  
Spearman Correlation ◽  
Medicare Beneficiaries ◽  
Cohen’S Kappa ◽  
Diagnostic Codes ◽  
Cohen's Kappa ◽  
Classification Of Diseases

Objective:To 1) compare adherence to antiseizure medications (ASMs) versus non-ASMs among individuals with epilepsy, 2) assess the degree to which variation in adherence is due to differences between individuals versus between medication classes among individuals with epilepsy, and 3) compare adherence in individuals with versus without epilepsy.Methods:This was a retrospective cohort study using Medicare. We included beneficiaries with epilepsy (≥1 ASM, plus International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes), and a 20% random sample without epilepsy. Adherence for each medication class was measured by the proportion of days covered (PDC) in 2013-2015. We used Spearman correlation coefficients, Cohen’s kappa statistics, and multilevel logistic regressions.Results:There were 83,819 beneficiaries with epilepsy. Spearman correlation coefficients between ASM PDCs and each of the 5 non-ASM PDCs ranged 0.44-0.50, Cohen’s kappa ranged 0.33-0.38, and within-person differences between each ASM’s PDC minus each non-ASM’s PDC were all statistically significant (p<0.01) though median differences were all very close to 0. Fifty-four percent of variation in adherence across medications was due to differences between individuals. Adjusted predicted probabilities of adherence were: ASMs 74% (95% confidence interval [CI] 73%-74%), proton pump inhibitors 74% (95% CI 74%-74%), antihypertensives 77% (95% CI 77%-78%), selective serotonin reuptake inhibitors 77% (95% CI 77%-78%), statins 78% (95% CI 78%-79%), and levothyroxine 82% (95% CI 81%-82%). Adjusted predicted probabilities of adherence to non-ASMs were 80% (95% CI 80%-81%) for beneficiaries with epilepsy versus 77% (77%-77%) for beneficiaries without epilepsy.Conclusion:Among individuals with epilepsy, ASM and non-ASM adherence were moderately correlated, half of variation in adherence was due to between-person rather than between-medication differences, adjusted adherence was slightly lower for ASMs than several non-ASMs, and epilepsy was associated with a quite small increase in adherence to non-ASMs. Nonadherence to ASMs may provide an important cue to the clinician to inquire about adherence to other potentially life-prolonging medications as well. Although efforts should focus on improving ASM adherence, patient-level rather than purely medication-specific behaviors are also critical to consider when developing interventions to optimize adherence.

scholarly journals RELIABILITY OF ANTHROPOMETRIC MEASUREMENTS CONDUCTED IN NATIONAL PHYSICAL FITNESS STANDARD (SEGAK) ASSESSMENTS AMONG SCHOOL-AGED ADOLESCENTS IN TERENGGANU, MALAYSIA

2019 ◽  
Vol 19 (2) ◽  
pp. 141-148
Author(s):  
Nurzaime Zulaily ◽  
Aryati Ahmad ◽  
Mohd Razif Shahril ◽  
Fadzli Syed Abdullah ◽  
Amran Ahmed
Keyword(s):  
Physical Fitness ◽  
Weight Status ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Anthropometric Measurements ◽  
Kappa Statistics ◽  
Altman Plot ◽  
Cohen’S Kappa ◽  
Bland Altman Plot ◽  
Cohen's Kappa

School-based health programs implemented by the Malaysian Ministry of Education (MOE) through the National Physical Fitness Standard (SEGAK) assessments provided an important platform in health status monitoring among schoolchildren. However, to date, there is still no reliability study conducted on this method. Therefore, this study aimed to determine the reliability of the anthropometric data collected by physical education (PE) teachers in the SEGAK assessments. Anthropometry measurements of standard six school adolescents involved in the Health of Adolescents in Terengganu study were taken by trained researchers using a standardised protocol. The anthropometrics data were then compared with PE teachers’ measurements from the SEGAK assessments obtained from the specifically developed Health Monitoring System database. Reliability of the anthropometric measurements were analysed using Pearson’s correlation test, Intraclass Correlation Coefficients (ICC), Bland-Altman plot and Cohen’s Kappa statistics. Intraclass correlation coefficient between teacher-measured and researcher-measured values shows good correlation in weight (ICC = 0.93), height (ICC = 0.98) and BMI (ICC = 0.91). The Bland-Altman plot showed a relatively small difference in mean of weight, height, and BMI between teacher-measured and researcher-measured value. The mean difference between teacher-measured and researcher-measured value of weight, height, and BMI were 1.8kg, 0.1cm, and 0.8kg/m2 respectively. Overall, Cohen’s Kappa statistics showed substantial agreement (κ = 0.642) in BMI categorisation between the two measurements. Findings from reliability analysis conducted affirmed that anthropometrics assessments conducted by PE teachers in SEGAK assessments are reliable to be used for identification of body weight status among school children and adolescents particularly in Terengganu, Malaysia.

Abstract 167: Correlation of 30-day Hospital Readmission Rates by Payer and Penalty Status

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Neel M Butala ◽  
Daniel B Kramer ◽  
Jordan B Strom ◽  
Kevin F Kennedy ◽  
Robert W Yeh
Keyword(s):  
Correlation Coefficients ◽  
Weighted Kappa ◽  
Hospital Performance ◽  
Teaching Hospitals ◽  
Kappa Statistics ◽  
Medicare Beneficiaries ◽  
Readmission Rates ◽  
Hospital Readmission Rates ◽  
Medicare Patients ◽  
Group B

Background: Readmission rates for heart failure (HF), acute myocardial infarction (MI), and pneumonia (PNA) hospitalizations among Medicare beneficiaries are used to assess hospital quality and determine global reimbursement. However, whether these measures reflect readmission rates for other conditions or insurance groups is unknown. Methods: All hospitals with >30 index admissions for HF, MI or pneumonia in 2013 in the all-payer Nationwide Readmissions Database (NRD) were included. For each hospital, we estimated 30-day all-cause risk-standardized readmission rates (RSRRs) for 3 groups: (A) Medicare beneficiaries admitted with HF/MI/PNA, (B) Medicare beneficiaries admitted for other conditions, and (C) non-Medicare beneficiaries admitted for HF/MI/PNA. Pair-wise correlations of these measures were assessed using Spearman correlation coefficients. Hospitals were divided into quartiles based on their calculated RSRR for each group, and inter-rater agreement between groups was assessed using weighted kappa statistics. We then examined pair-wise Spearman correlations among subgroups based on hospital characteristics (size, ownership status, and teaching status). Results: Among 1,228 hospitals, wide variation in RSRRs was seen across conditions and insurance type. Groups A vs. B had moderate correlation and agreement (Spearman 0.631, quartile weighted kappa 0.440). However, A vs. C had only modest correlation and fair agreement (Spearman 0.399, quartile weighted kappa 0.243). Compared with their quartile rank for the publicly reported group A, 46% of hospitals were ranked in the same quartile for group B and 35% for group C (Figure). Correlations between groups A vs. B and A vs. C were strongest among metro teaching hospitals (Spearman 0.674 and 0.507, respectively). Conclusions: Risk-standardized readmission rates for HF/MI/PNA are generalizable measures of a hospital’s readmission rate for other conditions among Medicare-insured patients. However, publicly reported RSRRs for HF/MI/PNA among Medicare patients are less suitable measures of hospital performance for non-Medicare patients admitted for these conditions.

Development of the Korean Global Physical Activity Questionnaire: reliability and validity study

2019 ◽  
Vol 27 (3) ◽  
pp. 44-55 ◽  
Author(s):  
Junga Lee ◽  
Choae Lee ◽  
Jihee Min ◽  
Dong-Woo Kang ◽  
Ji-Young Kim ◽  
...  
Keyword(s):  
Physical Activity ◽  
Reliability And Validity ◽  
Correlation Coefficients ◽  
Cohen’S Kappa ◽  
Physical Activity Questionnaire ◽  
Work Related ◽  
Cohen's Kappa ◽  
Global Physical Activity Questionnaire ◽  
Test Retest Reliability ◽  
Activity Questionnaire

The goal of this study was to develop a Korean version of the Global Physical Activity Questionnaire (K-GPAQ) and to examine its reliability and validity. The English version of the GPAQ was translated to the Korean language (K-GPAQ) via forward–backward translation. Reliability of the K-GPAQ was evaluated using a one-week interval test–retest method with 115 individuals. Criterion-related validity of the K-GPAQ was examined with 199 participants using accelerometers. Cohen’s kappa and Spearman’s correlation coefficients were used to measure test–retest reliability and validity, respectively. A Bland–Altman analysis was used to assess agreement between physical activity (PA) levels measured via K-GPAQ and the accelerometer. Coefficients for the reliability of the K-GPAQ showed moderate agreement for recreational PA and slight agreement for work-related PA (Cohen’s kappa: 0.60–0.67 for recreational PA and 0.30–0.38 for work-related PA and Spearman’s rho: 0.27–0.47 for work-related PA and 0.53–0.70 for recreational PA). Criterion validity of the total amount of PA, as measured by the K-GPAQ and the accelerometer, showed a weak but significant correlation ( r = 0.34, p < 0.01). The K-GPAQ is a reliable and valid questionnaire to measure PA although K-GPAQ overestimated PA levels.

scholarly journals Comparative analysis of imaging and novel markerless approach for measurement of postural parameters in dental seating tasks

2020 ◽  
Vol 53 (7-8) ◽  
pp. 1059-1069
Author(s):  
Vibha Bhatia ◽  
Jagjit Singh Randhawa ◽  
Ashish Jain ◽  
Vishakha Grover
Keyword(s):  
Real Time ◽  
Musculoskeletal Disorders ◽  
Wearable Sensors ◽  
Correlation Coefficients ◽  
Slow Motion ◽  
Feedback System ◽  
Percentage Error ◽  
Cohen’S Kappa ◽  
Kinect V2 ◽  
Cohen's Kappa

Postural inaccuracies in persistent dental tasks indicated an upsurge in the prevalence of musculoskeletal disorders in dentists. This makes it imperative to restrain awkward postural movements while working. Biased results in self-reporting surveys; discomfort, expense, and time consumption involved in using wearable sensors; and expert’s opinion are required in observational methods. Hence, it is important to use significantly reliable, cheap technology as a substitute to overcome the shortcomings of the mentioned techniques. In this study, the markerless Kinect V2–based system was developed and compared with the conventional imaging technique for real-time postural assessment of dental seating tasks. The study assessed the angle parameters related to the dentist’s bodily movement of upper arm, lower arm, wrist, neck, and trunk. Ten dentists from the local dental institution volunteered for the study. Dentists were monitored with both techniques while performing real-time dental procedures. The agreement between the techniques was assessed using Bland–Altman plot at 95% bias, Pearson’s (r1) and concordance (r2) correlation coefficients, mean difference, and percentage error. For conclusive agreement analysis, contingency coefficient, proportion agreement index, Cohen’s kappa, and Mann–Whitney U at 95% confidence interval (CI) were evaluated. Data acquired from both techniques possessed strong correlations (r1 and r2 >0.90). Good agreement in Rapid Upper Limb Assessment data using Cohen’s kappa (0.67) at standard Landis and Koch’s scale was also observed. Postural analysis of slow-motion tasks like dentistry using the Kinect V2 system proved to be unobtrusive and efficient. This may be used by dentists to have periodic postural check. In future, Kinect V2–based feedback system may be used to develop an assistive technology using predictive algorithms, which may help in reducing the probability of occurrence of work-related musculoskeletal disorders in dentists.

scholarly journals Rural–urban differences in suicide attempts and mortality among young people in northern Sweden, 1998–2017: A register-based study

2020 ◽  
Vol 48 (8) ◽  
pp. 794-800
Author(s):  
Miguel San Sebastián ◽  
Anette Edin-Liljegren ◽  
Frida Jonsson
Keyword(s):  
Suicide Attempts ◽  
International Classification Of Diseases ◽  
Northern Region ◽  
Northern Sweden ◽  
Men And Women ◽  
Diagnostic Codes ◽  
Classification Of Diseases ◽  
Rural Municipalities ◽  
And Gender ◽  
Suicide Prevention Programs

Aim: The aim of this study was to assess trends in suicide attempts and mortality between 1998 and 2017 by residential area and gender among northern Swedish youths. Methods: Events of suicide attempts and deaths for each municipality in the four counties of the northern Swedish region, stratified by gender, were retrieved for each year from 1998 to 2017. All cases identified within the registers with the diagnostic codes X60–X84 or Y10–Y34 (International Classification of Diseases, 10th revision) for individuals aged 15–24 years were included. Place of residence at municipal level was categorized into three groups: rural – municipalities with a population of <10,000 inhabitants; semi-rural – those between 10,000 and 50,000; and urban – those with >50,000 inhabitants. Results: The rates of attempted suicides in the northern region were higher in both men and women than in Sweden, while the rates of suicide deaths were slightly higher in young men but similar in young women compared to the national averages. Overall, the risk of suicide attempts was higher in semi-rural municipalities compared to urban ones, particularly among women. A significantly higher risk of mortality was also observed for men and women in semi-rural municipalities, but only in the period 2010–2013. Conclusions: The high rates of attempted and completed suicides among youth in northern Sweden and the higher risks in rural and semi-rural municipalities need close attention. The implementation of suicide prevention programs, especially in rural and semi-rural municipalities, should be intensified.

Correlations Between Physician and Hospital Stroke Thrombectomy Volumes and Outcomes: A Nationwide Analysis

Stroke ◽  
2021 ◽  
Author(s):  
Laura K. Stein ◽  
J Mocco ◽  
Johanna Fifi ◽  
Nathalie Jette ◽  
Stanley Tuhrim ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Inpatient Rehabilitation ◽  
International Classification Of Diseases ◽  
Data Sets ◽  
Medicare Beneficiaries ◽  
Inpatient Mortality ◽  
Discharge Disposition ◽  
Good Outcome ◽  
Classification Of Diseases

Background and Purpose: Despite the Joint Commission’s certification requirement of ≥15 stroke thrombectomy (ST) cases per center and proceduralist annually, the relationship between ST case volumes and outcomes is uncertain. We sought to determine whether a proceduralist or hospital volume threshold exists that is associated with better outcomes among Medicare beneficiaries. Methods: Retrospective cohort study using validated International Classification of Diseases, Tenth Revision , Clinical Modification codes to identify admissions with acute ischemic stroke and treatment with ST. We used de-identified, national 100% inpatient Medicare data sets from January 1, 2016, to December 31, 2017 for US individuals aged ≥65 years. We calculated total procedures by proceduralist and hospital. We performed adjusted logistic regression of total cases as a predictor of inpatient mortality, good outcome (defined by dichotomized discharge disposition of inpatient rehabilitation or better), and 30-day readmission. We adjusted for sex, age, Charlson Comorbidity Index, availability of neurocritical care, teaching hospital status, socioeconomic status, 2-year stroke volume, and urban versus rural hospital location. We dichotomized case numbers incrementally to determine a volume threshold for better outcomes. Results: Thirteen thousand three hundred thirty-five patients were treated with ST by 2754 proceduralists at 641 hospitals. For every 10 more proceduralist cases, patients had 4% lower adjusted odds of inpatient mortality (adjusted odds ratio, 0.96 [95% CI, 0.95–0.98], P <0.0001) and 3% greater adjusted odds of good outcome (adjusted odds ratio, 1.03 [95% CI, 1.02–1.04], P <0.0001). For every 10 more hospital cases, patients had 2% lower odds of inpatient mortality (adjusted odds ratio, 0.98 [95% CI, 0.98–0.99], P =0.0003) and 2% greater odds of good outcome (adjusted odds ratio, 1.02 [95% CI, 1.01–1.02], P <0.0001). With increasing volumes, there were higher odds of better outcomes. Conclusions: Nationally, higher proceduralist and hospital ST case volumes were associated with reduced inpatient mortality and better outcome. These data support volume requirements in guidelines for ST training and certification.

scholarly journals Nationwide Analysis of Endovascular Thrombectomy Provider Specialization for Acute Stroke

Stroke ◽  
2020 ◽  
Vol 51 (12) ◽  
pp. 3651-3657 ◽  
Author(s):  
Laura K. Stein ◽  
Stanley Tuhrim ◽  
Nathalie Jette ◽  
Johanna Fifi ◽  
J Mocco ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Urban Areas ◽  
International Classification Of Diseases ◽  
Medicare Beneficiaries ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Classification Of Diseases ◽  
The Impact ◽  
Modern Era

Background and Purpose: Determine the extent of cerebrovascular expertise among the specialties of proceduralists providing endovascular thrombectomy (ET) for emergent large vessel occlusion stroke in the modern era of acute stroke among Medicare beneficiaries Methods: Retrospective cohort study using validated International Classification of Diseases, Tenth Revision , Clinical Modification codes to identify admissions with acute ischemic stroke and treatment with ET. We identified proceduralist specialty by linking the National Provider Identifier provided by Medicare to the specialty listed in the National Provider Identifier database, grouping into radiology, neurology, neurosurgery, other surgical, and internal medicine. We calculated the number of proceduralists and hospitals who performed ET, ET team specialty composition by hospital, and number of proceduralists who performed ET at multiple hospitals. Results: Forty-two percent (n=5612) of ET were performed by radiology-background proceduralists, with unclear knowledge of how many were cerebrovascular specialists. Neurosurgery- and neurology-background interventionalists performed fewer but substantial numbers of cases, accounting for 24% (n=3217) and 23% (n=3124) of total cases, respectively. ET teams included a neurology- or neurosurgery-background proceduralist at 65% (n=407) of hospitals that performed ET and included both in 26% (n=160) of teams. Conclusions: Almost two-thirds of ET teams nationwide include a neurology- or neurosurgery-background proceduralist and higher volume centers in urban areas were more likely to have neurology- or neurosurgery-background proceduralists with cerebrovascular expertise on their team. It is unclear how many radiology-background interventionalists are cerebrovascular specialists versus generalists. Significant work remains to be done to understand the impact of proceduralist specialty, training, and cerebrovascular expertise on ET outcomes.

Identifying Obstructive Sleep Apnea in Administrative Data

2015 ◽  
Vol 123 (2) ◽  
pp. 253-263 ◽  
Author(s):  
Daniel I. McIsaac ◽  
Andrea Gershon ◽  
Duminda Wijeysundera ◽  
Gregory L. Bryson ◽  
Neal Badner ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
International Classification Of Diseases ◽  
International Classification ◽  
Diagnostic Codes ◽  
Obstructive Sleep ◽  
Classification Of Diseases

Abstract Background: Health administrative (HA) databases are increasingly used to identify surgical patients with obstructive sleep apnea (OSA) for research purposes, primarily using diagnostic codes. Such means to identify patients with OSA are not validated. The authors determined the accuracy of case-ascertainment algorithms for identifying patients with OSA with the use of HA data. Methods: Clinical data derived from an academic health sciences network within a universal health insurance plan were used as the reference standard. The authors linked patients to HA data and retrieved all claims in the 2 yr before surgery to determine the presence of any diagnostic codes, diagnostic procedures, or therapeutic interventions consistent with OSA. Results: The authors identified 4,965 patients (2003 to 2012) who underwent preoperative polysomnogram. Of these, 4,353 patients were linked to HA data; 2,427 of these (56%) had OSA based on diagnosis by a sleep physician or the apnea hypopnea index. A claim for a polysomnogram and receipt of a positive airway pressure device had a sensitivity, specificity, and positive likelihood ratio (+LR) for OSA of 19, 98, and 10.9%, respectively. An International Classification of Diseases, Tenth Revision, code for sleep apnea in hospitalization abstracts was 9% sensitive and 98% specific (+LR, 4.5). A physician billing claim for OSA (International Classification of Diseases, Ninth Revision, 780.5) was 58% sensitive and 38% specific (+LR, 0.9). A polysomnogram and a positive airway pressure device or any code for OSA was 70% sensitive and 36% specific (+LR, 1.1). Conclusions: No code or combination of codes provided a +LR high enough to adequately identify patients with OSA. Existing studies using administrative codes to identify OSA should be interpreted with caution.

scholarly journals Integration of the ICD-11 and DSM-5 Dimensional Systems for Personality Disorders Into a Unified Taxonomy With Non-overlapping Traits

2021 ◽  
Vol 12 ◽  
Author(s):  
Fernando Gutiérrez ◽  
Josep M. Peri ◽  
Miguel Gárriz ◽  
Gemma Vall ◽  
Estela Arqué ◽  
...  
Keyword(s):  
Personality Disorder ◽  
Discriminant Validity ◽  
Correlation Coefficients ◽  
International Classification Of Diseases ◽  
Personality Inventory ◽  
Diagnostic Categories ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Classification Of Diseases

The promise of replacing the diagnostic categories of personality disorder with a better-grounded system has been only partially met. We still need to understand whether our main dimensional taxonomies, those of the International Classification of Diseases, 11th Revision (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), are the same or different, and elucidate whether a unified structure is possible. We also need truly independent pathological domains, as they have shown unacceptable overlap so far. To inquire into these points, the Personality Inventory for DSM-5 (PID-5) and the Personality Inventory for ICD-11 (PiCD) were administered to 677 outpatients. Disattenuated correlation coefficients between 0.84 and 0.93 revealed that both systems share four analogous traits: negative affectivity, detachment, dissociality/antagonism, and disinhibition. These traits proved scalar equivalence too, such that scores in the two questionnaires are roughly interchangeable. These four domains plus psychoticism formed a theoretically consistent and well-fitted five-factor structure, but they overlapped considerably, thereby reducing discriminant validity. Only after the extraction of a general personality disorder factor (g-PD) through bifactor analysis, we could attain a comprehensive model bearing mutually independent traits.

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