scholarly journals Impact of a Family Medicine Minor Procedure Service on Cost of Care for a Health Plan

2020 ◽  
Vol 52 (6) ◽  
pp. 417-421
Author(s):  
Ian Nelligan ◽  
Tamara Montacute ◽  
Michael-Anne Browne ◽  
Steven Lin
Keyword(s):  
Family Medicine ◽  
Health Plan ◽  
Average Cost ◽  
Primary Care Physicians ◽  
Health Spending ◽  
Cost Of Care ◽  
Care Organization ◽  
Data Set ◽  
The Impact ◽  
Minor Procedure

Background and Objectives: Academic medical centers (AMC) are among some of the most expensive places to provide care. One way to cut costs is by decreasing unnecessary referrals to specialists for procedures that can be provided by well-trained primary care physicians. Our goal is to measure the financial impact of an office-based minor procedure service driven entirely by family physicians. Methods: We examined claims data for procedures performed on patients insured under our AMC’s home-grown accountable care organization-style health plan (Stanford Health Care Alliance [SHCA]). Descriptive statistics was used to compare the volume and cost of procedures performed by family medicine (FM) versus specialty care (SC). We preformed a subanalysis of SC procedures to explore the degree to which consultation and facility fees increased costs for SC. We used mathematical modeling to estimate the impact on cost of care if procedures were shifted from SC to FM and to calculate a return on investment (ROI). Results: Our data set examined 6,974 outpatient procedures performed on SHCA patients from 2016-2018 at a cost of $5,263,720 to SHCA. FM performed 6% of procedures at an average cost of $236 per procedure, while SC performed 94% of procedures at an average cost of $787 per procedure. FM saved money for all 12 types of skin, musculoskeletal, and reproductive procedures assessed; the average saved per procedure was $551. This represents a 70% cost savings. ROI was 2.33; for every $1 spent on FM procedures, SHCA saved $2.33. Conclusion: A family medicine minor procedure service significantly lowered health spending at our AMC.

scholarly journals Impact of Public Debt on Health and Education in SAARC Countries

2021 ◽  
Vol 2 (2) ◽  
pp. 52-58
Author(s):  
Hassan Tasleem
Keyword(s):  
External Debt ◽  
Health Spending ◽  
Fixed Effect Model ◽  
Education Spending ◽  
Data Set ◽  
Explanatory Variables ◽  
Education And Health ◽  
Effect Model ◽  
The Social ◽  
The Impact

The present study has done to investigate the impact of external debt servicing on health and education spending for the panel of selected SAARC countries (Bangladesh, India, Pakistan and Sri Lanka) are basically developing countries of Asia. This study uses two models of education spending and the other is for health spending by using the data set for 1990-2016 and estimations are carried out by using fixed effect model. Beside other explanatory variables debt servicing is the most important determinant of education spending and health spending and confirm the literature view that high external debt leads to increase in debt servicing liabilities and government do repayment of debt servicing by cutting its expenditure especially on health and education spending as it is easy for government to cut down the social sector spending rather than other sector spending. Other variable Tax revenue and Gross Capital Formation also effect the health and education spending but debt servicing liability effect more. It is best for SAARC countries to use and organize their own resources efficiently and less dependence on external debt and on foreign borrowing and give high attention to education and health spending.

Evolution, Current Structure, and Role of a Primary Care Clinical Pharmacy Service in an Integrated Managed Care Organization

2013 ◽  
Vol 47 (1) ◽  
pp. 124-131 ◽  
Author(s):  
Rachel MF Heilmann ◽  
Stephanie M Campbell ◽  
Beverly A Kroner ◽  
Jenel R Proksel ◽  
Sarah J Billups ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Pharmacy ◽  
Primary Care Physicians ◽  
Vital Role ◽  
Clinical Pharmacy Service ◽  
Care Organization ◽  
Full Time ◽  
Current Structure ◽  
The Impact

The impact of the declining number of primary care physicians is exacerbated by a growing elderly population in need of chronic disease management. Primary care clinical pharmacy specialists, with their unique knowledge and skill set, are well suited to address this gap. At Kaiser Permanente of Colorado (KPCO), primary care clinical pharmacy specialists have a long history of integration with medical practices and are located in close proximity to physicians, nurses, and other members of the health care team. Since 1992, Primary Care Clinical Pharmacy Services (PCCPS) has expanded from 4 to 30 full-time equivalents (FTEs) to provide services in all KPCO medical office buildings. With this growth in size, PCCPS has evolved to play a vital role in working with primary care medical teams to ensure that drug therapy is effective, safe, and affordable. In addition, PCCPS specialists provide ambulatory teaching sites for pharmacy students and pharmacy residents. There is approximately 1 specialist FTE for every 13,000 adult KPCO members and every 9 clinical FTEs of internal medicine and family medicine physicians. All clinical pharmacy specialists in the pharmacy department are required to have a PharmD degree, to complete postgraduate year 2 residencies, and, as a condition of employment, to become board certified in an applicable specialty. The evolution, current structure, and role of PCCPS at KPCO, including factors facilitating successful integration within the medical team, are highlighted. Patient and nonpatient care responsibilities are described.

Age at Exposure to Parental Suicide and the Subsequent Risk of Suicide in Young People

Crisis ◽  
2018 ◽  
Vol 39 (1) ◽  
pp. 27-36 ◽  
Author(s):  
Kuan-Ying Lee ◽  
Chung-Yi Li ◽  
Kun-Chia Chang ◽  
Tsung-Hsueh Lu ◽  
Ying-Yeh Chen
Keyword(s):  
Young People ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Birth Registry ◽  
Data Set ◽  
Parental Suicide ◽  
The Impact ◽  
Age At Exposure

Abstract. Background: We investigated the age at exposure to parental suicide and the risk of subsequent suicide completion in young people. The impact of parental and offspring sex was also examined. Method: Using a cohort study design, we linked Taiwan's Birth Registry (1978–1997) with Taiwan's Death Registry (1985–2009) and identified 40,249 children who had experienced maternal suicide (n = 14,431), paternal suicide (n = 26,887), or the suicide of both parents (n = 281). Each exposed child was matched to 10 children of the same sex and birth year whose parents were still alive. This yielded a total of 398,081 children for our non-exposed cohort. A Cox proportional hazards model was used to compare the suicide risk of the exposed and non-exposed groups. Results: Compared with the non-exposed group, offspring who were exposed to parental suicide were 3.91 times (95% confidence interval [CI] = 3.10–4.92 more likely to die by suicide after adjusting for baseline characteristics. The risk of suicide seemed to be lower in older male offspring (HR = 3.94, 95% CI = 2.57–6.06), but higher in older female offspring (HR = 5.30, 95% CI = 3.05–9.22). Stratified analyses based on parental sex revealed similar patterns as the combined analysis. Limitations: As only register-­based data were used, we were not able to explore the impact of variables not contained in the data set, such as the role of mental illness. Conclusion: Our findings suggest a prominent elevation in the risk of suicide among offspring who lost their parents to suicide. The risk elevation differed according to the sex of the afflicted offspring as well as to their age at exposure.

State Medical Boards' Perceptions of a Minimum Data Set and Current Practices for Collecting Physician Information

2013 ◽  
Vol 99 (4) ◽  
pp. 40-45 ◽  
Author(s):  
Aaron Young ◽  
Philip Davignon ◽  
Margaret B. Hansen ◽  
Mark A. Eggen
Keyword(s):  
Media Coverage ◽  
The United States ◽  
Minimum Data Set ◽  
Direct Patient Care ◽  
Physician Workforce ◽  
Data Set ◽  
Minimum Data ◽  
State Medical Boards ◽  
The Impact ◽  
Current Practices

ABSTRACT Recent media coverage has focused on the supply of physicians in the United States, especially with the impact of a growing physician shortage and the Affordable Care Act. State medical boards and other entities maintain data on physician licensure and discipline, as well as some biographical data describing their physician populations. However, there are gaps of workforce information in these sources. The Federation of State Medical Boards' (FSMB) Census of Licensed Physicians and the AMA Masterfile, for example, offer valuable information, but they provide a limited picture of the physician workforce. Furthermore, they are unable to shed light on some of the nuances in physician availability, such as how much time physicians spend providing direct patient care. In response to these gaps, policymakers and regulators have in recent years discussed the creation of a physician minimum data set (MDS), which would be gathered periodically and would provide key physician workforce information. While proponents of an MDS believe it would provide benefits to a variety of stakeholders, an effort has not been attempted to determine whether state medical boards think it is important to collect physician workforce data and if they currently collect workforce information from licensed physicians. To learn more, the FSMB sent surveys to the executive directors at state medical boards to determine their perceptions of collecting workforce data and current practices regarding their collection of such data. The purpose of this article is to convey results from this effort. Survey findings indicate that the vast majority of boards view physician workforce information as valuable in the determination of health care needs within their state, and that various boards are already collecting some data elements. Analysis of the data confirms the potential benefits of a physician minimum data set (MDS) and why state medical boards are in a unique position to collect MDS information from physicians.

The Impact of Green Labels on U.S. Hotel Net Operating Income: Operating Statements Analyses

2019 ◽  
Vol 11 (1) ◽  
pp. 156-173
Author(s):  
Spenser Robinson ◽  
A.J. Singh
Keyword(s):  
Environmental Design ◽  
Green Buildings ◽  
Small Sample ◽  
Sample Survey ◽  
Data Set ◽  
Operating Income ◽  
Energy Star ◽  
The Impact ◽  
Industry Professionals

This paper shows Leadership in Energy and Environmental Design (LEED) certified hospitality properties exhibit increased expenses and earn lower net operating income (NOI) than non-certified buildings. ENERGY STAR certified properties demonstrate lower overall expenses than non-certified buildings with statistically neutral NOI effects. Using a custom sample of all green buildings and their competitive data set as of 2013 provided by Smith Travel Research (STR), the paper documents potential reasons for this result including increased operational expenses, potential confusion with certified and registered LEED projects in the data, and qualitative input. The qualitative input comes from a small sample survey of five industry professionals. The paper provides one of the only analyses on operating efficiencies with LEED and ENERGY STAR hospitality properties.

Does Tax Increment Financing Pass the “But-for” Test in Missouri?

2019 ◽  
Vol 33 (3) ◽  
pp. 187-202
Author(s):  
Ahmed Rachid El-Khattabi ◽  
T. William Lester
Keyword(s):  
Economic Development ◽  
Kansas City ◽  
Time Series Data ◽  
Local Level ◽  
Conclusive Evidence ◽  
Series Data ◽  
Tax Increment Financing ◽  
Data Set ◽  
Development Indicators ◽  
The Impact

The use of tax increment financing (TIF) remains a popular, yet highly controversial, tool among policy makers in their efforts to promote economic development. This study conducts a comprehensive assessment of the effectiveness of Missouri’s TIF program, specifically in Kansas City and St. Louis, in creating economic opportunities. We build a time-series data set starting 1990 through 2012 of detailed employment levels, establishment counts, and sales at the census block-group level to run a set of difference-in-differences with matching estimates for the impact of TIF at the local level. Although we analyze the impact of TIF on a wide set of indicators and across various industry sectors, we find no conclusive evidence that the TIF program in either city has a causal impact on key economic development indicators.

Evaluation of the Aging Behavior of High Density Polyethylene in Thermal Oxidative Environment by Principal Component Analysis

2017 ◽  
Vol 727 ◽  
pp. 447-449 ◽  
Author(s):  
Jun Dai ◽  
Hua Yan ◽  
Jian Jian Yang ◽  
Jun Jun Guo
Keyword(s):  
Principal Component Analysis ◽  
Impact Strength ◽  
High Density Polyethylene ◽  
Tensile Modulus ◽  
Principal Component ◽  
Component Analysis ◽  
High Density ◽  
Aging Behavior ◽  
Data Set ◽  
The Impact

To evaluate the aging behavior of high density polyethylene (HDPE) under an artificial accelerated environment, principal component analysis (PCA) was used to establish a non-dimensional expression Z from a data set of multiple degradation parameters of HDPE. In this study, HDPE samples were exposed to the accelerated thermal oxidative environment for different time intervals up to 64 days. The results showed that the combined evaluating parameter Z was characterized by three-stage changes. The combined evaluating parameter Z increased quickly in the first 16 days of exposure and then leveled off. After 40 days, it began to increase again. Among the 10 degradation parameters, branching degree, carbonyl index and hydroxyl index are strongly associated. The tensile modulus is highly correlated with the impact strength. The tensile strength, tensile modulus and impact strength are negatively correlated with the crystallinity.

scholarly journals Investigating the impact of pre-processing techniques and pre-trained word embeddings in detecting Arabic health information on social media

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Yahya Albalawi ◽  
Jim Buckley ◽  
Nikola S. Nikolov
Keyword(s):  
Social Media ◽  
Deep Learning ◽  
Comprehensive Evaluation ◽  
Classification Problem ◽  
Data Sets ◽  
Word Embeddings ◽  
Data Set ◽  
Lower Accuracy ◽  
Health Related ◽  
The Impact

AbstractThis paper presents a comprehensive evaluation of data pre-processing and word embedding techniques in the context of Arabic document classification in the domain of health-related communication on social media. We evaluate 26 text pre-processings applied to Arabic tweets within the process of training a classifier to identify health-related tweets. For this task we use the (traditional) machine learning classifiers KNN, SVM, Multinomial NB and Logistic Regression. Furthermore, we report experimental results with the deep learning architectures BLSTM and CNN for the same text classification problem. Since word embeddings are more typically used as the input layer in deep networks, in the deep learning experiments we evaluate several state-of-the-art pre-trained word embeddings with the same text pre-processing applied. To achieve these goals, we use two data sets: one for both training and testing, and another for testing the generality of our models only. Our results point to the conclusion that only four out of the 26 pre-processings improve the classification accuracy significantly. For the first data set of Arabic tweets, we found that Mazajak CBOW pre-trained word embeddings as the input to a BLSTM deep network led to the most accurate classifier with F1 score of 89.7%. For the second data set, Mazajak Skip-Gram pre-trained word embeddings as the input to BLSTM led to the most accurate model with F1 score of 75.2% and accuracy of 90.7% compared to F1 score of 90.8% achieved by Mazajak CBOW for the same architecture but with lower accuracy of 70.89%. Our results also show that the performance of the best of the traditional classifier we trained is comparable to the deep learning methods on the first dataset, but significantly worse on the second dataset.

scholarly journals Efficacy and safety of nintedanib in patients with idiopathic pulmonary fibrosis who are elderly or have comorbidities

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ian Glaspole ◽  
Francesco Bonella ◽  
Elena Bargagli ◽  
Marilyn K. Glassberg ◽  
Fabian Caro ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Adverse Events ◽  
Treatment Discontinuation ◽  
Efficacy And Safety ◽  
Data Set ◽  
Proactive Management ◽  
Comorbidity Burden ◽  
Rate Of Decline ◽  
The Impact

Abstract Background Idiopathic pulmonary fibrosis (IPF) predominantly affects individuals aged > 60 years who have several comorbidities. Nintedanib is an approved treatment for IPF, which reduces the rate of decline in forced vital capacity (FVC). We assessed the efficacy and safety of nintedanib in patients with IPF who were elderly and who had multiple comorbidities. Methods Data were pooled from five clinical trials in which patients were randomised to receive nintedanib 150 mg twice daily or placebo. We assessed outcomes in subgroups by age < 75 versus ≥ 75 years, by < 5 and ≥ 5 comorbidities, and by Charlson Comorbidity Index (CCI) ≤ 3 and > 3 at baseline. Results The data set comprised 1690 patients. Nintedanib reduced the rate of decline in FVC (mL/year) over 52 weeks versus placebo in patients aged ≥ 75 years (difference: 105.3 [95% CI 39.3, 171.2]) (n = 326) and < 75 years (difference 125.2 [90.1, 160.4]) (n = 1364) (p = 0.60 for treatment-by-time-by-subgroup interaction), in patients with < 5 comorbidities (difference: 107.9 [95% CI 65.0, 150.9]) (n = 843) and ≥ 5 comorbidities (difference 139.3 [93.8, 184.8]) (n = 847) (p = 0.41 for treatment-by-time-by-subgroup interaction) and in patients with CCI score ≤ 3 (difference: 106.4 [95% CI 70.4, 142.4]) (n = 1330) and CCI score > 3 (difference: 129.5 [57.6, 201.4]) (n = 360) (p = 0.57 for treatment-by-time-by-subgroup interaction). The adverse event profile of nintedanib was generally similar across subgroups. The proportion of patients with adverse events leading to treatment discontinuation was greater in patients aged ≥ 75 years than < 75 years in both the nintedanib (26.4% versus 16.0%) and placebo (12.2% versus 10.8%) groups. Similarly the proportion of patients with adverse events leading to treatment discontinuation was greater in patients with ≥ 5 than < 5 comorbidities (nintedanib: 20.5% versus 15.7%; placebo: 12.1% versus 10.0%). Conclusions Our findings suggest that the effect of nintedanib on reducing the rate of FVC decline is consistent across subgroups based on age and comorbidity burden. Proactive management of adverse events is important to reduce the impact of adverse events and help patients remain on therapy. Trial registration: ClinicalTrials.gov NCT00514683, NCT01335464, NCT01335477, NCT02788474, NCT01979952.

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