scholarly journals Predictive Modeling of 30-Day Emergency Hospital Transport of German Patients Using a Personal Emergency Response: Retrospective Study and Comparison with the United States

10.2196/25121 ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. e25121
Author(s):  
Jorn op den Buijs ◽  
Marten Pijl ◽  
Andreas Landgraf
Keyword(s):  
United States ◽  
Health Care ◽  
High Risk ◽  
Predictive Model ◽  
The United States ◽  
Data Set ◽  
Targeted Interventions ◽  
Emergency Hospital ◽  
The Us ◽  
Hospital Transport

Background Predictive analytics based on data from remote monitoring of elderly via a personal emergency response system (PERS) in the United States can identify subscribers at high risk for emergency hospital transport. These risk predictions can subsequently be used to proactively target interventions and prevent avoidable, costly health care use. It is, however, unknown if PERS-based risk prediction with targeted interventions could also be applied in the German health care setting. Objective The objectives were to develop and validate a predictive model of 30-day emergency hospital transport based on data from a German PERS provider and compare the model with our previously published predictive model developed on data from a US PERS provider. Methods Retrospective data of 5805 subscribers to a German PERS service were used to develop and validate an extreme gradient boosting predictive model of 30-day hospital transport, including predictors derived from subscriber demographics, self-reported medical conditions, and a 2-year history of case data. Models were trained on 80% (4644/5805) of the data, and performance was evaluated on an independent test set of 20% (1161/5805). Results were compared with our previously published prediction model developed on a data set of PERS users in the United States. Results German PERS subscribers were on average aged 83.6 years, with 64.0% (743/1161) females, with 65.4% (759/1161) reported 3 or more chronic conditions. A total of 1.4% (350/24,847) of subscribers had one or more emergency transports in 30 days in the test set, which was significantly lower compared with the US data set (2455/109,966, 2.2%). Performance of the predictive model of emergency hospital transport, as evaluated by area under the receiver operator characteristic curve (AUC), was 0.749 (95% CI 0.721-0.777), which was similar to the US prediction model (AUC=0.778 [95% CI 0.769-0.788]). The top 1% (12/1161) of predicted high-risk patients were 10.7 times more likely to experience an emergency hospital transport in 30 days than the overall German PERS population. This lift was comparable to a model lift of 11.9 obtained by the US predictive model. Conclusions Despite differences in emergency care use, PERS-based collected subscriber data can be used to predict use outcomes in different international settings. These predictive analytic tools can be used by health care organizations to extend population health management into the home by identifying and delivering timelier targeted interventions to high-risk patients. This could lead to overall improved patient experience, higher quality of care, and more efficient resource use.

scholarly journals Predictive Modeling of 30-Day Emergency Hospital Transport of German Patients Using a Personal Emergency Response: Retrospective Study and Comparison with the United States (Preprint)

2020 ◽  
Author(s):  
Jorn op den Buijs ◽  
Marten Pijl ◽  
Andreas Landgraf
Keyword(s):  
United States ◽  
Health Care ◽  
High Risk ◽  
Predictive Model ◽  
The United States ◽  
Data Set ◽  
Targeted Interventions ◽  
Emergency Hospital ◽  
The Us ◽  
Hospital Transport

BACKGROUND Predictive analytics based on data from remote monitoring of elderly via a personal emergency response system (PERS) in the United States can identify subscribers at high risk for emergency hospital transport. These risk predictions can subsequently be used to proactively target interventions and prevent avoidable, costly health care use. It is, however, unknown if PERS-based risk prediction with targeted interventions could also be applied in the German health care setting. OBJECTIVE The objectives were to develop and validate a predictive model of 30-day emergency hospital transport based on data from a German PERS provider and compare the model with our previously published predictive model developed on data from a US PERS provider. METHODS Retrospective data of 5805 subscribers to a German PERS service were used to develop and validate an extreme gradient boosting predictive model of 30-day hospital transport, including predictors derived from subscriber demographics, self-reported medical conditions, and a 2-year history of case data. Models were trained on 80% (4644/5805) of the data, and performance was evaluated on an independent test set of 20% (1161/5805). Results were compared with our previously published prediction model developed on a data set of PERS users in the United States. RESULTS German PERS subscribers were on average aged 83.6 years, with 64.0% (743/1161) females, with 65.4% (759/1161) reported 3 or more chronic conditions. A total of 1.4% (350/24,847) of subscribers had one or more emergency transports in 30 days in the test set, which was significantly lower compared with the US data set (2455/109,966, 2.2%). Performance of the predictive model of emergency hospital transport, as evaluated by area under the receiver operator characteristic curve (AUC), was 0.749 (95% CI 0.721-0.777), which was similar to the US prediction model (AUC=0.778 [95% CI 0.769-0.788]). The top 1% (12/1161) of predicted high-risk patients were 10.7 times more likely to experience an emergency hospital transport in 30 days than the overall German PERS population. This lift was comparable to a model lift of 11.9 obtained by the US predictive model. CONCLUSIONS Despite differences in emergency care use, PERS-based collected subscriber data can be used to predict use outcomes in different international settings. These predictive analytic tools can be used by health care organizations to extend population health management into the home by identifying and delivering timelier targeted interventions to high-risk patients. This could lead to overall improved patient experience, higher quality of care, and more efficient resource use.

scholarly journals Cost-effectiveness Analysis of Sequential Treatment of Abaloparatide Followed by Alendronate Versus Teriparatide Followed by Alendronate in Postmenopausal Women With Osteoporosis in the United States

2018 ◽  
Vol 53 (2) ◽  
pp. 134-143 ◽  
Author(s):  
Quang A. Le ◽  
Joel W. Hay ◽  
Russell Becker ◽  
Yamei Wang
Keyword(s):  
United States ◽  
Health Care ◽  
Cost Effectiveness ◽  
High Risk ◽  
The United States ◽  
Clinical Event ◽  
Risk Of Fracture ◽  
Life Years ◽  
The Us ◽  
Des Model

Background: The US Food and Drug Administration has recently approved abaloparatide (ABL) for treatment of women with postmenopausal osteoporosis (PMO) at high risk of fracture. With increasing health care spending and drug prices, it is important to quantify the value of newly available treatment options for PMO. Objective: To determine cost-effectiveness of ABL compared with teriparatide (TPTD) for treatment of women with PMO in the United States. Methods: A discrete-event simulation (DES) model was developed to assess cost-effectiveness of ABL from the US health care perspective. The model included three 18-month treatment strategies with either placebo (PBO), TPTD, or ABL, all followed by additional 5-year treatment with alendronate (ALN). High-risk patients were defined as women with PMO ⩾65 years old with a prior vertebral fracture. Baseline clinical event rates, risk reductions, and patient characteristics were based on the Abaloparatide Comparator Trial in Vertebral Endpoints (ACTIVE) trial. Results: Over a 10-year period, the DES model yielded average total discounted per-patient costs of $10 212, $46 783, and $26 837 and quality-adjusted life-years (QALYs) of 6.742, 6.781, and 6.792 for PBO/ALN, TPTD/ALN, and ABL/ALN, respectively. Compared with TPTD/ALN, ABL/ALN accrued higher QALYs at lower cost and produced an incremental cost-effectiveness ratio (ICER) of $333 266/QALY relative to PBO/ALN. In high-risk women, ABL/ALN also had more QALYs and less cost over TPTD/ALN and yielded an ICER of $188 891/QALY relative to PBO/ALN. Conclusion and Relevance: ABL is a dominant treatment strategy over TPTD. In women with PMO at high risk of fracture, ABL is an alternative cost-effective treatment.

Transformation of the US Veterans Health Administration

2006 ◽  
Vol 1 (2) ◽  
pp. 99-105 ◽  
Author(s):  
Jonathan B. Perlin
Keyword(s):  
United States ◽  
Health Care ◽  
Veterans Health Administration ◽  
The United States ◽  
Veterans Affairs ◽  
United States Department ◽  
Veterans Health ◽  
Department Of Veterans Affairs ◽  
Health Administration ◽  
The Us

Ten years ago, it would have been hard to imagine the publication of an issue of a scholarly journal dedicated to applying lessons from the transformation of the United States Department of Veterans Affairs Health System to the renewal of other countries' national health systems. Yet, with the recent publication of a dedicated edition of the Canadian journal Healthcare Papers (2005), this actually happened. Veterans Affairs health care also has been similarly lauded this past year in the lay press, being described as ‘the best care anywhere’ in the Washington Monthly, and described as ‘top-notch healthcare’ in US News and World Report's annual health care issue enumerating the ‘Top 100 Hospitals’ in the United States (Longman, 2005; Gearon, 2005).

Health care quality experiences among cancer survivors in the United States, 2011.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 246-246
Author(s):  
Janice Bell ◽  
Robin L. Whitney ◽  
Sarah Reed ◽  
Andra Davis ◽  
Katherine Kim ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Side Effects ◽  
Cancer Survivors ◽  
Active Treatment ◽  
The United States ◽  
Targeted Interventions ◽  
Health Care Experiences ◽  
Lifestyle Recommendations

246 Background: Recent national reports highlight gaps in the quality of health care received by the growing population of cancer survivors in the United States. A deeper understanding of the health care experiences of cancer survivors and related disparities could inform interventions designed to address these gaps. Methods: Data from the 2011 Medical Expenditures Panel Survey Household Component and Experiences with Cancer Survivorship Supplement (n=1,592) were used to compare health care experiences of survivors those those of individuals in active treatment. Logistic regression models of three outcomes (receipt of necessary care; detailed discussions with providers about late or long-term side effects of cancer treatment; and detailed discussions with providers about lifestyle or health recommendations e.g., diet, exercise, quitting smoking) were controlled for potential confounding variables including age, sex, health insurance status, education, race/ethnicity, and marital status. Survey weights were applied to account for the complex sampling design and estimates are generalizable to the US civilian, non-institutionalized population. Results: Most respondents (96%), whether or not they were in active treatment, reported they had received all medical care, tests, or treatments that they or their providers believed were necessary. Fewer survivors, compared to respondents in active treatment, reported their providers had discussed late or long-term side effects (37% versus 61%; p<0.01) or lifestyle recommendations with them in detail (57% versus 72%). These associations persisted in the multivariable models of side effect discussions (OR=0.38; 95% CI: 0.26, 0.55) and lifestyle recommendations (OR=; 95% CI: 0.35, 0.68) regardless of the length of time since treatment had finished. Subgroups with lower odds of all three outcomes included those with public or no insurance and those with lower levels of education. Conclusions: Care received after treatment for cancer may not fully address the unique needs of cancer survivors and, in particular, those with public or no insurance and with low levels of education regardless of treatment status. Targeted interventions with a focus on these subgroups may be required.

What Is the Affordable Care Act a Case of? Understanding the ACA through the Comparative Method

2020 ◽  
Vol 45 (4) ◽  
pp. 677-691
Author(s):  
Holly Jarman ◽  
Scott L. Greer
Keyword(s):  
United States ◽  
Health Care ◽  
Welfare State ◽  
Affordable Care Act ◽  
Strong Support ◽  
The United States ◽  
The Us ◽  
The Affordable Care Act ◽  
Shed Light ◽  
The Welfare State

Abstract International comparisons of US health care are common but mostly focus on comparing its performance to peers or asking why the United States remains so far from universal coverage. Here the authors ask how other comparative research could shed light on the unusual politics and structure of US health care and how the US experience could bring more to international conversations about health care and the welfare state. After introducing the concept of casing—asking what the Affordable Care Act (ACA) might be a case of—the authors discuss different “casings” of the ACA: complex legislation, path dependency, demos-constraining institutions, deep social cleavages, segmentalism, or the persistence of the welfare state. Each of these pictures of the ACA has strong support in the US-focused literature. Each also cases the ACA as part of a different experience shared with other countries, with different implications for how to analyze it and what we can learn from it. The final section discusses the implications for selecting cases that might shed light on the US experience and that make the United States look less exceptional and more tractable as an object of research.

scholarly journals The Implementation and Evaluation of the United States Affordable Care Act

2019 ◽  
Vol 12 (1) ◽  
pp. 17-38
Author(s):  
David Schultz
Keyword(s):  
United States ◽  
Health Care ◽  
Affordable Care Act ◽  
Access To Health Care ◽  
Care Delivery ◽  
The United States ◽  
Health Care Delivery System ◽  
Health Care Outcomes ◽  
The Us ◽  
American Health Care

In 2010 the United States Congress adopted the Patient Protection and Affordable Care Act (“ACA”), more commonly referred to as Obamacare. The ACA was proposed by President Barack Obama while running for president and it was passed with a near straight party-line vote of Democrats in the US House and Senate in 2010. The ACA was meant to address several problems with the American health care delivery system, including cost, access and outcomes. This article describes the major features of the ACA including the context of the US health care system, evaluates the ACA’s implementation history and assesses its fate and future reforms throughout the presidency of Donald Trump. The overall conclusion based on its implementation is that while the ACA made significant reforms in terms of access to health care, it is not clear that it addressed affordability or began to improve health care outcomes in the US.

scholarly journals Nativity Status and Poly Tobacco Use among Young Adults in the United States

2021 ◽  
Author(s):  
Peace C. Okpala ◽  
Carrie Rosario ◽  
Melissa J. Dupont-Reyes ◽  
Michelle Y. Martin Romero ◽  
Md Towfiqul Alam ◽  
...  
Keyword(s):  
United States ◽  
Young Adults ◽  
Tobacco Use ◽  
Regression Models ◽  
The United States ◽  
Foreign Born ◽  
Tobacco Products ◽  
Targeted Interventions ◽  
Nativity Status ◽  
The Us

Introduction: Young adults are the second largest segment of the immigrant population in the United States (US). Given recent trends in later age of initiation of tobacco use, we examined variation in use of tobacco products by nativity status for this population group. Methods: Our study included young adults 18-30 years of age sampled in the National Health Interview Survey (2015-2019), a nationally representative sample of the US population. We calculated prevalence of use of any and 2 or more tobacco products (cigarettes, cigars, pipes, e-cigarettes, and smokeless tobacco) for foreign-born (n=3,096) and US-born (n=6,811) young adults. Logistic regression models adjusted for age, sex, race-ethnicity, education, and poverty, while accounting for the complex survey design. Results: Foreign-born young adults were significantly less likely to use any tobacco product (Cigarette = 7.3% vs 10.7%; Cigar= 1.8% vs 4.8%; E-cigarette= 2.3% vs 4.5%, respectively; p&lt;0.01) or poly tobacco use (1.9% vs. 4.2%; p&lt;0.01) than US-born young adults. Adjusted regression models showed lower odds of poly tobacco use among the foreign-born than their US-born counterparts (Odds Ratio = 0.41, (95% Confidence Interval: 0.26-0.63)). Conclusion: Findings highlight the importance of targeted interventions by nativity status and further tobacco prevention efforts needed for the US-born.

scholarly journals Measuring Job Creation, Growth, and Survival among the Universe of Start-ups in the United States Using a Combined Start-up Panel Data Set

ILR Review ◽  
2019 ◽  
Vol 72 (5) ◽  
pp. 1262-1277 ◽  
Author(s):  
Robert W. Fairlie ◽  
Javier Miranda ◽  
Nikolas Zolas
Keyword(s):  
United States ◽  
Panel Data ◽  
The United States ◽  
Future Research ◽  
Data Set ◽  
Growth And Survival ◽  
Start Up ◽  
The Us ◽  
Start Ups ◽  
The Universe

The field of entrepreneurship is growing rapidly and expanding into new areas. This article presents a new compilation of administrative panel data on the universe of business start-ups in the United States, which will be useful for future research in entrepreneurship. To create the US start-up panel data set, the authors link the universe of non-employer firms to the universe of employer firms in the Longitudinal Business Database (LBD). Start-up cohorts of more than five million new businesses per year, which create roughly three million jobs, can be tracked over time. To illustrate the potential of the new start-up panel data set for future research, the authors provide descriptive statistics for a few examples of research topics using a representative start-up cohort.

scholarly journals Assisted Reproductive Techniques and Catholicism(s) in the US

2019 ◽  
Vol 9 (2) ◽  
pp. 147-169
Author(s):  
María Cecilia Johnson
Keyword(s):  
United States ◽  
Health Care ◽  
Reproductive Rights ◽  
The United States ◽  
Assisted Reproductive Techniques ◽  
Documentary Analysis ◽  
The Us ◽  
Reproductive Techniques ◽  
Health Organization ◽  
Reproductive Healthcare

Abstract Assisted Reproductive Techniques (ART s) have proposed a new way of understanding notions of sexuality, reproduction, gestation, and family, and these transformations have arguably been a challenge in the religious field. This study aims to analyze the stances taken within the Catholic spectrum in the United States on ART s. Catholicism in the United States is an internally heterogeneous space, and different agents have taken diverse stances on ART s, with an impact on health care regulations, Catholic facilities administrations, and Catholics’ and non-Catholics’ reproductive rights. Drawing from a qualitative, interpretive, and documentary analysis of three organizations (the US Conference of catholic bishops, the Catholic Health Organization, and Catholics for Choice), this article proposes some guidelines to analyze and understand the arguments and strategies of various Catholics actors in the United States regarding reproductive healthcare and ART s in the United States.

scholarly journals Snapshot Impact of COVID-19 on Mental Wellness in Nonphysician Otolaryngology Health Care Workers: A National Study

OTO Open ◽  
2020 ◽  
Vol 4 (3) ◽  
pp. 2473974X2094883 ◽  
Author(s):  
Aman Prasad ◽  
Alyssa M. Civantos ◽  
Yasmeen Byrnes ◽  
Kevin Chorath ◽  
Seerat Poonia ◽  
...  
Keyword(s):  
Mental Health ◽  
United States ◽  
Health Care ◽  
High Risk ◽  
Health Care Workers ◽  
The United States ◽  
Assessment Tools ◽  
Care Providers ◽  
Event Scale ◽  
Care Workers

Objective Nonphysician health care workers are involved in high-risk patient care during the COVID-19 pandemic, placing them at high risk of mental health burden. The mental health impact of COVID-19 in this crucial population has not been studied thus far. Thus, the objective of this study is to assess the psychosocial well-being of these providers. Study Design National cross-sectional online survey (no control group). Setting Academic otolaryngology programs in the United States. Subjects and Methods We distributed a survey to nonphysician health care workers in otolaryngology departments across the United States. The survey incorporated a variety of validated mental health assessment tools to measure participant burnout (Mini-Z assessment), anxiety (Generalized Anxiety Disorder–7), distress (Impact of Event Scale), and depression (Patient Health Questionnaire–2). Multivariable logistic regression analysis was performed to determine predictive factors associated with these mental health outcomes. Results We received 347 survey responses: 248 (71.5%) nurses, 63 (18.2%) administrative staff, and 36 (10.4%) advanced practice providers. A total of 104 (30.0%) respondents reported symptoms of burnout; 241 (69.5%), symptoms of anxiety; 292 (84.1%), symptoms of at least mild distress; and 79 (22.8%), symptoms of depression. Upon further analysis, development of these symptoms was associated with factors such as occupation, practice setting, and case load. Conclusion Frontline otolaryngology health care providers exhibit high rates of mental health complications, particularly anxiety and distress, in the wake of COVID-19. Adequate support systems must be put into place to address these issues.

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