scholarly journals Elective hospital admissions: secondary data analysis and modelling with an emphasis on policies to moderate growth

2017 ◽  
Vol 5 (7) ◽  
pp. 1-186
Author(s):  
Martin Chalkley ◽  
Barry McCormick ◽  
Robert Anderson ◽  
Maria Jose Aragon ◽  
Nazma Nessa ◽  
...  
Keyword(s):  
Secondary Data ◽  
Cost Effective ◽  
Period Effect ◽  
Full Time ◽  
Data Set ◽  
Moderate Growth ◽  
Health Loss ◽  
Cost Effective Treatment ◽  
Patient Reported ◽  
The Impact

BackgroundThe English NHS faces financial pressures that may render the growth rates of elective admissions seen between 2001/2 and 2011/12 unsustainable. A better understanding of admissions growth, and the influence of policy, are needed to minimise the impact on health gain for patients.ObjectivesThis project had several objectives: (1) to better understand the determinants of elective activity and policy to moderate growth at minimum health loss for patients; (2) to build a rich data set integrating health, practice and local area data to study general practitioner (GP) referrals and resulting admissions; (3) to predict patients whose treatment is unlikely to be cost-effective using patient-reported outcomes and to examine variation in provider performance; and (4) to study how policies that aim to reduce elective admissions may change demand for emergency care. The main drivers of elective admissions growth have increased either supply of or demand for care, and could include, for example, technical innovations or increased awareness of treatment benefits. Of the factors studied, neither system reform nor population ageing appears to be a key driver. The introduction of the prospective payment tariff ‘Payment by Results’ appears to have led to primary care trusts (PCTs) having increasingly similar lengths of stay. In deprived areas, increasing GP supply appears to moderate elective admissions. Reducing the incidence of single-handed practices tends to reduce referrals and admissions. Policies to reduce referrals are likely to reduce admissions but treatments may be particularly reduced in the lowest referring practices, in which resulting health loss may be greatest. In this model, per full-time equivalent, female and highly experienced GPs identify more patients admitted by specialists.ResultsIt appears from our studies that some patient characteristics are associated with not achieving sufficient patient gain to warrant cost-effective treatment. The introduction of independent sector treatment centres is estimated to have caused an increase in emergency activity rates at local PCTs. The explanations offered for increasing elective admissions indicate that they are manageable by health policy.ConclusionsFurther work is required to understand some of the results identified, such as whether or not high-volume Clinical Commissioning Groups are fulfilling unmet need; why some practices refer at low rates relative to admissions; why the period effect, which results from factors that equally affect all in the study at a point in time, dominates in the age–period–cohort analysis; and exactly how the emergency and elective sections of hospital treatment interact. This project relies on the analysis of secondary data. This type of research does not easily facilitate the important input of clinical experts or service users. It would be beneficial if other methods, including surveys and consultation with key stakeholders, could be incorporated into future research now that we have uncovered important questions.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals PROMIS Scales for Assessment of Persistent Post-COVID Symptoms: A Cross Sectional Study

2021 ◽  
Vol 12 ◽  
pp. 215013272110304
Author(s):  
Ravindra Ganesh ◽  
Aditya K. Ghosh ◽  
Mark A. Nyman ◽  
Ivana T. Croghan ◽  
Stephanie L. Grach ◽  
...  
Keyword(s):  
Health Status ◽  
Social Roles ◽  
Disease Process ◽  
Cross Sectional Study ◽  
Large Sample Size ◽  
Sectional Study ◽  
Cross Sectional ◽  
Data Set ◽  
Patient Reported ◽  
The Impact

Objective Persistent post-COVID symptoms are estimated to occur in up to 10% of patients who have had COVID-19. These lingering symptoms may persist for weeks to months after resolution of the acute illness. This study aimed to add insight into our understanding of certain post-acute conditions and clinical findings. The primary purpose was to determine the persistent post COVID impairments prevalence and characteristics by collecting post COVID illness data utilizing Patient-Reported Outcomes Measurement Information System (PROMIS®). The resulting measures were used to assess surveyed patients physical, mental, and social health status. Methods A cross-sectional study and 6-months Mayo Clinic COVID recovered registry data were used to evaluate continuing symptoms severity among the 817 positive tested patients surveyed between March and September 2020. The resulting PROMIS® data set was used to analyze patients post 30 days health status. The e-mailed questionnaires focused on fatigue, sleep, ability to participate in social roles, physical function, and pain. Results The large sample size (n = 817) represented post hospitalized and other managed outpatients. Persistent post COVID impairments prevalence and characteristics were determined to be demographically young (44 years), white (87%), and female (61%). Dysfunction as measured by the PROMIS® scales in patients recovered from acute COVID-19 was reported as significant in the following domains: ability to participate in social roles (43.2%), pain (17.8%), and fatigue (16.2%). Conclusion Patient response on the PROMIS® scales was similar to that seen in multiple other studies which used patient reported symptoms. As a result of this experience, we recommend utilizing standardized scales such as the PROMIS® to obtain comparable data across the patients’ clinical course and define the disease trajectory. This would further allow for effective comparison of data across studies to better define the disease process, risk factors, and assess the impact of future treatments.

Economic evaluation of 5-HT3 receptor antagonists in combination with dexamethasone for the prevention of ‘overall’ nausea and vomiting following highly emetogenic chemotherapy in Chinese adult patients

2016 ◽  
Vol 23 (6) ◽  
pp. 403-412 ◽  
Author(s):  
Qiong Du ◽  
Qing Zhai ◽  
Bin Zhu ◽  
Xiao-Le Xu ◽  
Bo Yu
Keyword(s):  
Economic Evaluation ◽  
Cost Effective ◽  
Emetogenic Chemotherapy ◽  
Adult Patients ◽  
Nausea And Vomiting ◽  
Phase Iii ◽  
Highly Emetogenic Chemotherapy ◽  
Chinese Adult ◽  
Cost Effective Treatment ◽  
The Impact

Background Two pivotal Phase III trials compared the efficacy of palonosetron, ondansetron and granisetron, combined with dexamethasone, for the prevention of nausea and vomiting following highly emetogenic chemotherapy. However, an economic evaluation of these three regimens in the real-world setting of Chinese adult patients has not been determined. Objectives To estimate, from the perspective of the Chinese healthcare system, which of these frequently used strategies consisting of 0.25 mg palonosetron (0.25P), 16 mg ondansetron (Onda), and 3 mg granisetron (Gran), is the most cost-effective option in patients following highly emetogenic chemotherapy. Methods A Markov decision-analytic model was developed. The health and economic outcomes of the three strategies; 0.25P, Onda, and Gran were investigated. The clinical and utility data were taken from published studies. The cost data were calculated according to current local Chinese practices. Sensitivity analyses were performed to determine the impact of uncertainty regarding the results. Results The base-case analysis showed that the 0.25P strategy yielded maximum health benefits compared with the other two strategies. However, the probabilistic sensitivity analysis demonstrated that the Gran strategy was the most cost-effective approach when the willingness-to-pay threshold was not more than US$22,515/quality-adjusted life year. Moreover, palonosetron is not cost-effective in preventing ‘overall’ nausea and vomiting following highly emetogenic chemotherapy in Chinese patients. Conclusions Our analysis suggests that, compared with palonosetron and ondansetron, 3 mg granisetron may be a cost-effective treatment option in the current Chinese healthcare setting.

scholarly journals Spoken words as biomarkers: using machine learning to gain insight into communication as a predictor of anxiety

2020 ◽  
Vol 27 (6) ◽  
pp. 929-933
Author(s):  
George Demiris ◽  
Kristin L Corey Magan ◽  
Debra Parker Oliver ◽  
Karla T Washington ◽  
Chad Chadwick ◽  
...  
Keyword(s):  
Machine Learning ◽  
Secondary Data ◽  
Health Indicators ◽  
Machine Learning Algorithms ◽  
Standardized Assessments ◽  
Learning Tools ◽  
Data Set ◽  
Problem Solving Therapy ◽  
Audio Communication ◽  
The Impact

Abstract Objective The goal of this study was to explore whether features of recorded and transcribed audio communication data extracted by machine learning algorithms can be used to train a classifier for anxiety. Materials and Methods We used a secondary data set generated by a clinical trial examining problem-solving therapy for hospice caregivers consisting of 140 transcripts of multiple, sequential conversations between an interviewer and a family caregiver along with standardized assessments of anxiety prior to each session; 98 of these transcripts (70%) served as the training set, holding the remaining 30% of the data for evaluation. Results A classifier for anxiety was developed relying on language-based features. An 86% precision, 78% recall, 81% accuracy, and 84% specificity were achieved with the use of the trained classifiers. High anxiety inflections were found among recently bereaved caregivers and were usually connected to issues related to transitioning out of the caregiving role. This analysis highlighted the impact of lowering anxiety by increasing reciprocity between interviewers and caregivers. Conclusion Verbal communication can provide a platform for machine learning tools to highlight and predict behavioral health indicators and trends.

scholarly journals Social Media Applied to Tourism and Hospitality

2020 ◽  
pp. 270-294 ◽  
Author(s):  
Luís Pacheco ◽  
Fernando Moreira
Keyword(s):  
Social Media ◽  
Metropolitan Area ◽  
Secondary Data ◽  
Social Knowledge ◽  
Data Set ◽  
Consumer Reviews ◽  
Social Media Tools ◽  
Tourism And Hospitality ◽  
Online Travel ◽  
The Impact

Online hotel reviews, ratings, or opinions have gained importance with the growth of social media tools. The objective of this chapter is to study the impact of specific satisfaction attributes on overall satisfaction. It is used a secondary data set obtained from three of the most influential online travel platforms, being analyzed the guests' average ratings for around 130 hotel units, distributed by four quality segments, located in the Porto metropolitan area. The application of this methodology to a large sample of Portuguese hotels has not been done before, been that the main contribution of this study. It is evidenced that the different platforms, while all incorporating consumer reviews as primary social knowledge, are distinct from each other on some aspects. The three platforms present roughly the same supply of hotels, albeit presenting some differences in terms of volume of data. In terms of specific attributes, with the exception of “service,” the three platforms present significant differences that may reflect the different user bases on these platforms.

scholarly journals WHAT IS THE IMPACT OF AFFECTIVE DISPOSITION ON 4TH-GRADE NAEP READING SCORES?

2021 ◽  
Vol 9 (10) ◽  
pp. 211-228
Author(s):  
Christina Peterson ◽  
Mingyuan Zhang
Keyword(s):  
Positive Impact ◽  
Secondary Analysis ◽  
Secondary Data ◽  
Fourth Grade ◽  
Reading Scores ◽  
Great Effort ◽  
Data Set ◽  
Fourth Grade Students ◽  
Affective Disposition ◽  
The Impact

This study presented a secondary analysis of the National Assessment of Educational Progress (NAEP) dataset. The paper examined the impact of affective disposition on 2019 NAEP reading scores of fourth-grade students. In order to gain a better understanding of the impact of affective disposition on the reading achievement of fourth-grade students, this study used a quantitative descriptive research design to analyze secondary data extracted from the 2019 NAEP data set.  The results found in this study showed that students’ affective disposition in the areas of making a great effort after making a mistake, continuing to work hard even when they felt like quitting, paying attention and resisting distractions, and feeling happy at school had positive impact on their 2019 NAEP reading assessments scores when the students strongly agreed with the statements. The findings may indicate that improving affective disposition in students may increase reading scores.

scholarly journals N07 Patient reported outcome measures collected from patients using a digital tablet: early benefits

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S660-S661
Author(s):  
P Avery ◽  
K Blackmore ◽  
C Angel
Keyword(s):  
Disease Activity ◽  
Outcome Measures ◽  
Disease Activity Score ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Activity Score ◽  
Data Set ◽  
Patient Reported ◽  
The Impact ◽  
Digital Tablet

Abstract Background At a district general hospital (DGH) on the south coast of England the inflammatory bowel disease (IBD) nurse led service introduced an eHealth system in 2015 linked to the IBD registry but limited to access via a desktop limiting flexibility. In liaison with the IBD registry and the software developer the lead nurse instigated an upgrade to the system. This allows patients access both remotely and via a digital tablet in outpatients. Discussion is being had about the best way to collect patient reported outcome measures (PROMS) both for large data analyse and local patient benefit. This presentation of the first 3 months collection of the PROMS seeks to show the benefit of these data locally Methods PROMS were gathered from both Consultant and Nurse led clinics from July 2019 to the 22 October 2019. Patients were asked to fill in the IBD control PROM (this PROM forms part of the IBD registry Data set) on a tablet before entering the consultation room. Additionally a disease activity score either the Harvey Bradshaw Score (HBI) or the Simple Clinical Colitis activity index (SCCAI) is collected at the same time. These scores were then extracted from the system and evaluated using a descriptive data analysis approach. Results After Data cleansing 200 records are shown in Table 1 covering all disease sub-types. Fatigue was the most commonly reported complication of IBD in addition,126 patients who attended outpatients reported a wellness score of above 75 out of 100 isolating the wellness score from the PROM score allowed a comparison with the corresponding disease activity score in these patients and correlated in 95% of UC Patients and CD 84% (see Table 2). Conclusion Fatigue is a widely reported symptom of IBD as well as pain and anxiety or depression. These data confirm this trend but also present the first local population information for the IBD service at this DGH. When looking at the impact of these scores there is an opportunity to identify patients that may need medically optimising. The patients that remain could then be targeted with support services and a business case for counselling is now planned. In addition to this together with self-testing with IBDoc ® the PROMs and disease activity scores provide opportunity for remote management of some patients. These PROMs collected from patients using a tablet in outpatients at a DGH show promising value for service development.

Impact of R&D activities on the financial performance: empirical evidence from Indian pharmaceutical companies

2022 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Mithun Nandy
Keyword(s):  
Financial Performance ◽  
Stock Exchange ◽  
Secondary Data ◽  
Pharmaceutical Companies ◽  
Financial Returns ◽  
Data Set ◽  
Content Type ◽  
Return On Equity ◽  
Performance Framework ◽  
The Impact

Purpose This paper aims to study the impact of research and development (R&D) activities on the financial performance of Indian pharmaceutical companies listed with the national stock exchange (NSE) of India by conceptualizing R&D’s impact and financial performance framework (RDiFPF). Design/methodology/approach Strongly balanced panel data set was used for the period of 1999–2020 on the basis of secondary data subscribed from a reputable Capitalline, a corporate database as well as individual company-wise annual report extract for cross-validation. Findings The paper presents a novel conceptualized framework called RDiFPF with the help of financial performance related variables: sales turnover, return on assets, return on equity and market capitalization, where R&D impacts in a significant manner on the financial performance of the NSE-listed Indian pharmaceutical companies. The paper finally establishes a link between R&D activities and financial performance with respect to the Indian pharmaceutical companies listed with the NSE. Research limitations/implications The suggested framework opens new dimension of research with respect to R&D, innovative practices in the pharmaceutical business and financial performance. The research can also be used in teaching and may be beneficial for framing public policy. Though the study has been carried out in Indian context, it might have implications in the emerging economies. Practical implications To achieve financial returns, pharmaceutical companies need to adopt appropriate endeavour to invest substantial amount on R&D to bring innovation in the pharmaceutical business. Social implications A better allocation of R&D expenditure has the potential for bringing new medicine, which can cure unknown diseases and impact on the lives of the patient fraternities. Originality/value The contributions of the paper are twofold: on the one hand, the author proposes a framework where emphasis has been provided on the R&D investment in the pharmaceutical business and, on the other hand, significant financial performance has been shown which motivates every R&D-centric pharmaceutical companies. Notably, the novel RDiFPF framework, which has been proposed in this study, may ignite and inspire the pharmaceutical business leaders as well as entrepreneurs to take R&D and innovation in pharmaceutical business for impacting human lives as well as to enjoy significant financial returns by providing health-care solution for treating novel diseases and disorders.

Impact of a central review oncology clinical pharmacist in a community oncology practice.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 68-68
Author(s):  
Julianna Kula ◽  
Shannon Hough ◽  
Josh Howell
Keyword(s):  
Clinical Pharmacist ◽  
Cost Effective ◽  
Cost Of Care ◽  
Financial Impact ◽  
Full Time ◽  
Community Oncology ◽  
Medication Dose ◽  
Oncology Practice ◽  
Clinical Changes ◽  
The Impact

68 Background: The impact and role of a clinical pharmacist in a community oncology setting is not well-described in the literature. The US Oncology Network recently implemented a central clinical pharmacist review program (ClinReview) to offer oncology remote clinical pharmacist services to practices. Methods: An oncology-trained clinical pharmacist electronically reviewed recently placed or modified chemotherapy regimen orders within a community oncology practice. The ClinReview pharmacist identified opportunities to modify ordered therapy based on clinical components, waste reduction, or financial stewardship. Recommendations were discussed with the treating oncologist at the practice or modified if permitted by approved practice policy. The pharmacist was appointed at 0.5 full-time equivalents (FTE). Financial and workload metrics were tracked to monitor the impact of the pharmacist work. Results: In 10 weeks, 388 reviews were documented and 191 (49.2%) required a modification by the pharmacist. Recommended modifications included dose rounding (n=90, 47%), a clinical change (n=72, 38%), or product substitution (n=29, 15%). The most common clinical changes included modifications to supportive care (n=32, 44%), recommendations for additional monitoring (n=19, 26%), or modifications to anti-cancer medication dose or frequency (n=18, 25%). The financial impact of the pharmacist resulted in margin improvements totaling $106,043 and a $462,305 reduction in the total cost of care in medication expenses (Table). The expense of the pharmacist during this period was $18,095. The return on investment for the pharmacist compared to margin improvement was 590%. Conclusions: An oncology clinical pharmacist is a cost-effective and valuable member of the care team in community oncology practice. The pharmacist identified opportunities to improve medication safety, regimen optimization, and demonstrated significant financial impact for the practice, payers, and patients.[Table: see text]

Are hospital admissions reduced by Acute Medicine consultant telephone triage of medical referrals?

2015 ◽  
Vol 14 (1) ◽  
pp. 10-13
Author(s):  
Christopher Westall ◽  
◽  
Robert Spackman ◽  
Channa Vasanth Nadarajah ◽  
Nicola Trepte ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Cost Effective ◽  
Acute Hospital ◽  
Full Time ◽  
Telephone Triage ◽  
Full Time Equivalent ◽  
Acute Medicine ◽  
General Management ◽  
Nurse Coordinator ◽  
The Impact

The NHS in England is facing well-documented pressures related to increasing acute hospital admissions at a time when the acute medical bed-base is shrinking, doctors working patterns are increasingly fragmented and many acute hospital trusts are operating a financial deficit. Novel strategies are required to reduce pressure on the acute medical take. We conducted a prospective cohort study to assess the impact of acute medicine consultant triage of referrals to the acute medical take on the number of acute hospital admissions as compared to a historical control cohort. The introduction of an acute medicine consultant telephone triage service was associated with a 21% reduction in acute medical admissions during whole the study period. True admission avoidance was achieved for 28.5% of referrals triaged by an acute medicine consultant. The greatest benefit was seen for consultant-triage of GP referrals; 43% of all GP referrals resulted in a decision not to admit and in 25% the referral was avoided by giving advice alone. Consultant telephone triage of referrals to the acute medical take substantially reduces the number of acute medical admissions as compared to triage by a trained band 6 or higher nurse coordinator. Our service is cost effective and can be job-planned using 6 full-time equivalent acute medicine consultants. The telephone triage service also provides additional benefits to admission numbers beyond its hours of operation and the general management of the acute medical take.

scholarly journals Did the Affordable Care Act Young Adult Provision Affect Labor Market Outcomes? Analysis Using Tax Data

ILR Review ◽  
2017 ◽  
Vol 71 (5) ◽  
pp. 1154-1178 ◽  
Author(s):  
Bradley Heim ◽  
Ithai Lurie ◽  
Kosali Simon
Keyword(s):  
Young Adults ◽  
Labor Market ◽  
Young Adult ◽  
Affordable Care Act ◽  
Labor Market Outcomes ◽  
Full Time ◽  
Market Outcomes ◽  
Data Set ◽  
The Affordable Care Act ◽  
The Impact

Using a data set of US tax records spanning 2008 to 2013, the authors study the impact of the Affordable Care Act (ACA) young adult dependent coverage requirement on labor market–related outcomes, including measures of employment status, job characteristics, and postsecondary education. They find that the ACA provision did not result in substantial changes in labor market outcomes. Results show that employment and self-employment are not statistically significantly affected. Although some evidence supports the increased likelihood of young adults earning lower wages, not receiving fringe benefits, enrolling as full-time or graduate students, and young men being self-employed, the magnitudes imply extremely small impacts on these outcomes in absolute terms and when compared to other estimates in the literature. The authors find these results to be consistent with health insurance being less salient to young adults, compared to other populations, when making labor market decisions.

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