scholarly journals Is X-ray Exposure Related to Dentist Remuneration?

2021 ◽  
Author(s):  
Olivier Kalmus ◽  
Martin Chalkley ◽  
Stefan Listl
Keyword(s):  
Health Care Providers ◽  
Fixed Effects ◽  
Adult Population ◽  
Common Source ◽  
Fee For Service ◽  
X Rays ◽  
Care Providers ◽  
X Ray ◽  
Fixed Effects Panel Regression ◽  
Provider Payment

Abstract Background: In many market settings individuals are encouraged to switch health care providers as a means of ensuring more competition. Switching may have a potentially undesirable side effect of increasing unnecessary treatment. Focusing on the most common source of medical radiation (dental X-rays), the purpose of this study was to assess whether, upon switching dentist, X-ray exposure increases depending on the type of provider payment. Methods: The analysis used longitudinal data from 2005 to 2016 covering a 5% random sample of the Scottish adult population covered by the National Health Service (NHS). Multiple fixed-effects panel regression analyses were employed to determine the correlation of provider remuneration with patients' likelihood of receiving an X-ray upon switching to a new dentist other things equal. A broad set of covariates including a patient’s copayment status was controlled for. Results: Upon switching to a dentist who was paid fee-for-service, patients had a by 9.6 %-points (95% CI: 7.4%-11.8%) higher probability of receiving an X-ray, compared to switching to a salaried dentist. Results were robust when accounting for patient exemption status, as well as unobserved patient and dentist characteristics. Conclusions: In comparison to staying with the same dentist, patients may be exposed to substantially more X-rays upon switching to a dentist who is paid fee-for-service. There may need to be better guidance and regulation to protect the health of those who have to switch provider due to moving and greater caution in advocating voluntary switching.

scholarly journals Effects of provider incentives on dental X-raying in NHS Scotland: what happens if patients switch providers?

2021 ◽  
Author(s):  
Olivier Kalmus ◽  
Martin Chalkley ◽  
Stefan Listl
Keyword(s):  
Health Care Providers ◽  
Fixed Effects ◽  
Adult Population ◽  
Common Source ◽  
Fee For Service ◽  
X Rays ◽  
Care Providers ◽  
X Ray ◽  
Fixed Effects Panel Regression ◽  
Provider Payment

Abstract Background In many market settings individuals are encouraged to switch health care providers as a means of ensuring more competition. Switching may have a potentially undesirable side effect of increasing unnecessary treatment. Focusing on the most common source of medical radiation (dental X-rays), the purpose of this study was to assess whether, upon switching dentist, X-ray exposure increases depending on the type of provider payment. Methods The analysis used longitudinal data from 2005 to 2016 covering a 5% random sample of the Scottish adult population covered by the National Health Service (NHS). Multiple fixed-effects panel regression analyses were employed to determine the correlation of provider remuneration with patients’ likelihood of receiving an X-ray upon switching to a new dentist other things equal. A broad set of covariates including a patient’s copayment status was controlled for. Results Upon switching to a dentist who was paid fee-for-service, patients had a by 9.6%-points (95% CI 7.4–11.8%) higher probability of receiving an X-ray, compared to switching to a salaried dentist. Results were robust when accounting for patient exemption status, as well as unobserved patient and dentist characteristics. Conclusions In comparison to staying with the same dentist, patients may be exposed to substantially more X-rays upon switching to a dentist who is paid fee-for-service. There may need to be better guidance and regulation to protect the health of those who have to switch provider due to moving and greater caution in advocating voluntary switching.

scholarly journals Depression and Suicidality in Gay Men: Implications for Health Care Providers

2017 ◽  
Vol 11 (4) ◽  
pp. 910-919 ◽  
Author(s):  
Carrie Lee ◽  
John L. Oliffe ◽  
Mary T. Kelly ◽  
Olivier Ferlatte
Keyword(s):  
Health Care ◽  
Gay Men ◽  
Health Care Providers ◽  
Help Seeking ◽  
Adult Population ◽  
Well Being ◽  
Sexual Practices ◽  
Care Providers ◽  
Physical And Mental Health ◽  
Prevalence Of Depression

Gay men are a subgroup vulnerable to depression and suicidality. The prevalence of depression among gay men is three times higher than the general adult population. Because depression is a known risk factor for suicide, gay men are also at high risk for suicidality. Despite the high prevalence of depression and suicidality, health researchers and health care providers have tended to focus on sexual health issues, most often human immunodeficiency virus in gay men. Related to this, gay men’s health has often been defined by sexual practices, and poorly understood are the intersections of gay men’s physical and mental health with social determinants of health including ethnicity, locale, education level, and socioeconomic status. In the current article summated is literature addressing risk factors for depression and suicidality among gay men including family acceptance of their sexual identities, social cohesion and belonging, internalized stigma, and victimization. Barriers to gay men’s help seeking are also discussed in detailing how health care providers might advance the well-being of this underserved subgroup by effectively addressing depression and suicidality.

Bedrails and Falls in Nursing Homes: A Systematic Review

2020 ◽  
pp. 105477382090780
Author(s):  
David Huynh ◽  
Olivia N. Lee ◽  
Phuong M. An ◽  
Twyla A. Ens ◽  
Cynthia A. Mannion
Keyword(s):  
Systematic Review ◽  
Nursing Homes ◽  
Health Care Providers ◽  
Assisted Living ◽  
Fall Prevention ◽  
Adult Population ◽  
Healthcare Providers ◽  
Primary Data ◽  
Care Providers ◽  
Prevention Measures

Bedrail use for fall prevention in elderly clients (>65 years) is controversial. Some healthcare providers believe bedrails prevent falls, while others think they are ineffective and dangerous. A systematic review was conducted to address: “For older adults living in nursing homes, does more or less bedrail use reduce the incidence of falls?” We searched HealthStar, MEDLINE, CINAHL, Academic Search complete ProQuest and Canadian Health Research Collection using “elder*,” “bedrail*,” “fall*,” and “assisted-living*.” After filtering for primary data, English records, older adult population, relationship between bedrails and falls, fourteen studies remained. Results suggest using alternative fall prevention measures, and bedrails are either beneficial, harmful, or do not influence falls. Bedrail reduction with fall prevention interventions led to no changes in fall frequency. Ambiguity persists regarding fall frequencies and bedrail use without using other fall prevention strategies. Educating health care providers on fall prevention is key to patient safety.

scholarly journals Clinical Diabetes Centers of Excellence: A Model for Future Adult Diabetes Care

2018 ◽  
Vol 103 (3) ◽  
pp. 809-812 ◽  
Author(s):  
Boris Draznin ◽  
Peter A Kahn ◽  
Nicole Wagner ◽  
Irl B Hirsch ◽  
Mary Korytkowski ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Diabetes Care ◽  
The United States ◽  
Clinical Diabetes ◽  
Diabetes Research ◽  
Fee For Service ◽  
Care Providers ◽  
Centers Of Excellence ◽  
Care Experience

Abstract Although diabetes research centers are well defined by National Institutes of Health, there is no clear definition for clinical Diabetes Centers of Excellence (DCOEs). There are multiple clinical diabetes centers across the United States, some established with philanthropic funding; however, it is not clear what defines a DCOE from a clinical perspective and what the future will be for these centers. In this Perspective we propose a framework to guide advancement for DCOEs. With the shift toward value-based purchasing and reimbursement and away from fee for service, defining the procedures for broader implementation of DCOEs as a way to improve population health and patient care experience (including quality and satisfaction) and reduce health care costs becomes critically important. It is prudent to implement new financial systems for compensating diabetes care that may not be provided by fiscally constrained private and academic medical centers. We envision that future clinical DCOEs would be composed of a well-defined infrastructure and six domains or pillars serving as the general guiding principles for developing expertise in diabetes care that can be readily demonstrated to stakeholders, including health care providers, patients, payers, and government agencies.

scholarly journals Alternative payment approaches for advancing comprehensive medication management in primary care

2020 ◽  
Vol 18 (4) ◽  
pp. 2238
Author(s):  
Katherine Pham
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Care Delivery ◽  
Medication Management ◽  
Fee For Service ◽  
Care Providers ◽  
Care Community ◽  
Improved Outcomes ◽  
And Performance ◽  
Value Based Care

The increasing prevalence of complex, chronic conditions has profound implications on the growing demand and cost of health care. The Center for Medicare and Medicaid Innovation is testing data-driven approaches to care delivery and payment that are drawn from innovative practices of health care providers and other partners in the health care community. The shift from fee-for-service to value-based care and performance-based payment places increased priority on improved outcomes at lower costs. To advance comprehensive medication management, pharmacists need to understand the opportunities in the evolving value-based payment models and align medication optimization with the specific goals and incentives of these models.

scholarly journals “Making Sense of a Disease That Makes No Sense”: Understanding Alzheimer’s Disease and Related Disorders Among Caregivers and Providers Within Alaska Native Communities

2020 ◽  
Author(s):  
Jordan P Lewis ◽  
Spero M Manson ◽  
Valarie B Jernigan ◽  
Carolyn Noonan
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Health Care ◽  
Support Groups ◽  
Health Care Providers ◽  
Alaska Native ◽  
Adult Population ◽  
Memory Loss ◽  
Cost Of Care ◽  
Care Providers

Abstract Background and Objectives With the rate of Alzheimer’s disease and related dementias (ADRD) increasing among Alaska Indian/Alaska Native (AI/AN) people, the Alaska Native Health system is ill-prepared to meet the challenges associated with the growing population at risk of ADRD. The high cost of care, inadequate training of health care providers, and lack of supportive services for caregivers are especially concerning. Research Design and Methods Interviews were conducted with 22 AN caregivers for ANs with ADRD and 12 ANs and non-Native health care providers in communities across Alaska. Interviews lasted approximately 60 min and were transcribed verbatim. We employed directed content analysis to examine the major agreements and disagreements between the participants’ understandings of ADRD in each of the domains of Kleinman’s Explanatory Model of Illness. Results Caregivers and health care providers expressed concerns about the lack of understanding, resources, and awareness of ADRD among ANs in rural and urban communities. Both caregivers and providers recognized the need to obtain an early diagnosis, blend Western and traditional medicines, promote lifestyle and dietary changes, and foster training for caregivers. Health care providers acknowledged their limited exposure to AN understanding of ADRD and wish to receive culturally relevant training to better serve AN. Discussion and Implications As the older AN adult population grows, the need for culturally responsive training and support services will continue to increase. We recommend establishing rural outreach and support groups for caregivers, developing an understanding of how ANs view ADRD to train and educate health care providers, and implement screening early for memory loss during routine medical examinations.

Psychiatry and the Need for Mental Health Care in Australia: Findings from the National Survey of Mental Health and Wellbeing

2002 ◽  
Vol 36 (2) ◽  
pp. 210-216 ◽  
Author(s):  
Graham Meadows ◽  
Bruce Singh ◽  
Philip Burgess ◽  
Irene Bobevski
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Health Care Providers ◽  
National Survey ◽  
Adult Population ◽  
Psychiatric Services ◽  
Care Providers ◽  
Perceived Needs ◽  
Health And Wellbeing

Objective: This paper describes the pattern of consultations reported with psychiatrists and primary mental health care providers in the Australian adult population. It explores whether inequalities found in utilization of psychiatric services according to area are different in degree from inequalities in utilization of medical and surgical specialists, and describes the meeting of perceived needs for mental health care within those seen by psychiatrists. Method: The National Survey of Mental Health and Wellbeing (NSMHW) was a community survey employing clustered probability sampling, with a computerized field questionnaire which included sections of the composite international diagnostic interview (CIDI), as well as self-reported service utilization and perceived needs for care. Results: By survey estimates, 1.8% of the Australian population consulted a psychiatrist in the last year. Among people with an ICD 10-diagnosed mental disorder, 7.3% consulted a psychiatrist. Only about one in five people seen by a psychiatrist report the psychiatrist as the only mental health care provider. Disadvantaged areas of the cities and remote areas, when compared with the least deprived areas of the cities, showed lower rates of utilization. This effect is stronger in psychiatry than in other specialities. Patients seeing psychiatrists seem to be a more satisfied group than those seeing only other providers; nonetheless, some needs are not well met, and the role of the psychiatrist cannot be isolated as the cause of this satisfaction. Conclusions: Most care delivered by psychiatrists is de facto shared care. Psychiatrists as clinical professionals need to be continually mindful of the need to communicate with others providing care. Psychiatric services in Australia are not delivered in an equitable manner, and the inequalities are greater for psychiatric services than for other medical specialities.

scholarly journals Longitudinal Changes in the Genital Hiatus Preceding the Development of Pelvic Organ Prolapse

2019 ◽  
Vol 188 (12) ◽  
pp. 2196-2201 ◽  
Author(s):  
Victoria L Handa ◽  
Joan L Blomquist ◽  
Megan Carroll ◽  
Jennifer Roem ◽  
Alvaro Muñoz
Keyword(s):  
Pelvic Organ Prolapse ◽  
Health Care Providers ◽  
Fixed Effects ◽  
Mixed Model ◽  
Pelvic Organ ◽  
Care Providers ◽  
Genital Hiatus ◽  
Rate Of Increase ◽  
The Mean ◽  
Using Data

Abstract We aimed to explore relationships between changes in genital hiatus (GH) and development of pelvic organ prolapse using data from the Mothers’ Outcomes After Delivery (MOAD) Study, a Baltimore, Maryland, cohort study of parous women who underwent annual assessments during 2008–2018. Prolapse was defined as any vaginal segment protrusion beyond the hymen or reported prolapse surgery. For each case, 5 controls (matched on birth type and interval from first delivery to study enrollment) were selected using incidence sampling methods. We used a mixed model whose fixed effects described the initial size and slope of the GH as a function of prolapse status (case vs. control) and with nested (women within matched sets) random effects. Among 1,198 women followed for 1.0–7.3 years, 153 (13%) developed prolapse; 754 controls were matched to those women, yielding 3,664 visits for analysis. GH was 20% larger among the cases at enrollment (3.16 cm in cases vs. 2.62 cm in controls; P < 0.001), and the mean rate of increase in the size of the GH was more than 3 times greater (0.56 cm per 5-year period vs. 0.15 cm per 5-year period in controls; P < 0.001). Thus, to identify women at highest risk for developing prolapse, health-care providers could evaluate not simply the size of the GH but also changes in the GH over time.

scholarly journals Automated Classification of Radiographic Positioning of Hand X-Rays Using a Deep Neural Network

2021 ◽  
pp. 229255032199701
Author(s):  
Tomas J. Saun
Keyword(s):  
Neural Network ◽  
Health Care Providers ◽  
Deep Neural Network ◽  
Confusion Matrix ◽  
Training Data ◽  
X Rays ◽  
Automated Classification ◽  
Care Providers ◽  
Image Brightness ◽  
Data Set

Background: Hand X-rays are ordered in outpatient, inpatient, and emergency settings, the results of which are often initially interpreted by non-radiology trained health care providers. There may be utility in automating upper extremity X-ray analysis to aid with rapid initial analysis. Deep neural networks have been effective in several medical imaging analysis applications. The purpose of this work was to apply a deep learning framework to automatically classify the radiographic positioning of hand X-rays. Methods: A 152-layer deep neural network was trained using the musculoskeletal radiographs data set. This data set contains 6003 hand X-rays. The data set was filtered to remove pediatric X-rays and atypical views. The X-rays were all labeled as either posteroanterior (PA), lateral, or oblique views. A subset of images was set aside for model validation and testing. Data set augmentation was performed, including horizontal and vertical flips, rotations, as well as modifications in image brightness and contrast. The model was evaluated, and performance was reported as a confusion matrix from which accuracy, precision, sensitivity, and specificity were calculated. Results: The augmented training data set consisted of 80 672 images. Their distribution was 38% PA, 35% lateral, and 27% oblique projections. When evaluated on the test data set, the model performed with overall 96.0% accuracy, 93.6% precision, 93.6% sensitivity, and 97.1% specificity. Conclusions: Radiographic positioning of hand X-rays can be effectively classified by a deep neural network. Further work will be performed on localization of abnormalities, automated assessment of standard radiographic measures and eventually on computer-aided diagnosis and management guidance of skeletal pathology.

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