Zeitschriftenartikel: „Medicare Assignment“

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Culbertson, Richard A. „The Medicare Assignment Controversy“. Journal of Aging & Social Policy 3, Nr. 4 (09.03.1992): 47–68. http://dx.doi.org/10.1300/j031v03n04_05.

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Holahan, John, und Stephen Zuckerman. „Medicare Mandatory Assignment: An Unnecessary Risk?“ Health Affairs 8, Nr. 1 (Januar 1989): 65–79. http://dx.doi.org/10.1377/hlthaff.8.1.65.

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3

Davidoff, Amy J., Lindsey Enewold, Courtney Williams, Manami Bhattacharya und Janeth I. Sanchez. „Reliability of cancer registry primary payer information and implications for policy research.“ Journal of Clinical Oncology 40, Nr. 16_suppl (01.06.2022): 1587. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.1587.

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1587 Background: Researchers commonly use “Primary Payer at Diagnosis” measured in cancer registry data to assess the impact of health policy, such as the Affordable Care Act, on insurance, and the impact of insurance on cancer care and outcomes. Measurement error may bias estimated effect size and significance. Little is known about patterns of Medicaid or Medicare misreporting in registry databases commonly used for policy analysis. Methods: We used the National Cancer Institute’s Surveillance, Epidemiology and End Results registry data for adults aged 19-64 years at diagnosis with known cancer stage, linked to most recently available (2007-2011) CMS records on Medicaid and Medicare enrollment at diagnosis month. We recoded the registry Primary Payer variable into 6 categories: private/managed care, Medicare, Medicaid, other government, status unknown, uninsured. State-year policy data regarding Medicaid eligibility and managed care enrollment were also linked. We compared the registry data to Medicaid and/or Medicare enrollment data, and calculated underreporting rates by patient characteristics and state policy. Results: The linked sample (N = 896,031) was 68% non-Hispanic white, 49% male. Overall, the registry data reported 7.8% Medicare and 10.1% Medicaid, while enrollment was 5.5% Medicare, 10.4% Medicaid, and 3.4% dual Medicare-Medicaid. The registry data concordantly identified 61.4% and 57.7% of persons identified per enrollment data to be Medicaid-only and Medicare-only, respectively (Table). Most Medicaid-only enrollees without concordant registry information were reported to have private insurance or be uninsured. Medicaid underreporting (39% overall), was higher for males (43%) vs females (37%), in low (46%) vs high (38%) poverty areas, for Medicaid poverty expansion or waiver enrolled (50%) vs cash assistance related eligibility (33%), and in states with large managed care enrollment, all at p<.001. If Medicaid and Medicare enrollment data were used to edit the registry data, 8% of persons would switch insurance assignment. Conclusions: Primary Payer data reported by cancer registries are subject to measurement error and may result in biased estimates of insurance-related policy impacts. Enhancement with objective Medicaid and Medicare enrollment data will reduce measurement error and may result in unbiased estimates necessary to support policy assessment. [Table: see text]

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Burney, Ira, und Julia Paradise. „Trends In Medicare Physician Participation And Assignment“. Health Affairs 6, Nr. 2 (Januar 1987): 107–20. http://dx.doi.org/10.1377/hlthaff.6.2.107.

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5

Ross, Stacey L. „The effect of mandatory Medicare assignment on health care“. Journal of Legal Medicine 10, Nr. 3 (September 1989): 527–44. http://dx.doi.org/10.1080/01947648909513583.

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Zhang, Mingliang. „Physician Case-by-Case Assignment and Participation in Medicare“. Journal of Aging & Social Policy 9, Nr. 2 (16.07.1997): 19–35. http://dx.doi.org/10.1300/j031v09n02_03.

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Einav, Liran, Amy Finkelstein, Yunan Ji und Neale Mahoney. „Randomized trial shows healthcare payment reform has equal-sized spillover effects on patients not targeted by reform“. Proceedings of the National Academy of Sciences 117, Nr. 32 (27.07.2020): 18939–47. http://dx.doi.org/10.1073/pnas.2004759117.

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Changes in the way health insurers pay healthcare providers may not only directly affect the insurer’s patients but may also affect patients covered by other insurers. We provide evidence of such spillovers in the context of a nationwide Medicare bundled payment reform that was implemented in some areas of the country but not in others, via random assignment. We estimate that the payment reform—which targeted traditional Medicare patients—had effects of similar magnitude on the healthcare experience of nontargeted, privately insured Medicare Advantage patients. We discuss the implications of these findings for estimates of the impact of healthcare payment reforms and more generally for the design of healthcare policy.

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Trinh, Quoc-Dien, Christian Meyer, Anna Krasnova, Jesse Sammon, Stuart R. Lipsitz, Joel S. Weissman und Maxine Sun. „Accountable care organizations and the use of prostate cancer screening and breast cancer screening.“ Journal of Clinical Oncology 35, Nr. 15_suppl (20.05.2017): e18308-e18308. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e18308.

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e18308 Background: Accountable Care Organizations (ACOs) were established under the Affordable Care Act as a new payment model intended to impose greater responsibility on all stakeholders for cost control and quality improvement. Preventive services are an ideal target to monitor the effectiveness of new health care delivery models. We sought to examine and compare the prevalence of breast cancer screening (BCa-S), and prostate cancer screening (PCa-S) between ACO and traditional Medicare beneficiaries. We hypothesized that the use of BCa-S is higher among beneficiaries attributed to an ACO, whereas the use of PCa-S, a non-recommended test, would be unaffected by ACO assignment. Methods: Using a random 20% sample of Medicare beneficiaries, we assessed BCa-S in women aged < 75, (evidence-based cancer screening), and PCa-S in men < 75 (non-recommended cancer screening) between January 1, 2013 and December 31, 2013 with appropriate exclusion criteria following the review of guideline recommendations. ACO coverage was ascertained from the quarterly assignment in the Shared Savings Program ACO Beneficiary-level file. Propensity-score weighting was performed to balance out patient and sociodemographic covariates. Results: Following propensity-score weighting, our final cohorts of ACO and traditional Medicare beneficiaries included 52,987 and 526,063 women for BCa-S; 86,936 and 814,221 men for PCa-S, respectively. The prevalence of screening in ACO vs. traditional Medicare were 35.0% vs. 25.2% for BCa-S, and 54.6% vs. 41.7% for PCa-S (all p < 0.001) Conclusions: The ACO model appears to have a salutary effect on preventive service utilization. Our findings vis-à-vis PCa-S among ACOs are likely a reflection of improved health care access rather than vetted screening practices. There is hope that such nonrecommended screening will decrease if more ACOs are required to move towards a “two-sided” risk shared savings and loss model.

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Hasnain, Romana, Judith H. Hibbard und Edward C. Weeks. „Determinants of Physician Acceptance of Assignment: An Examination of Medicare Beneficiary Characteristics“. Medical Care 30, Nr. 1 (Januar 1992): 58–66. http://dx.doi.org/10.1097/00005650-199201000-00005.

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Tomkins, Julia. „Medicare Assignment and Participation: Excerpts From Practical Tips for the Oncology Practice“. Journal of Oncology Practice 6, Nr. 5 (September 2010): 253–54. http://dx.doi.org/10.1200/jop.000119.

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Higuera, Lucas, Eleni Ismyrloglou, Xiaoxiao Lu, Jennifer Hinnenthal und Reece Holbrook. „Collection of economic data using UB-04s: Is it worth the effort? Evidence from two clinical trials“. PLOS ONE 17, Nr. 11 (17.11.2022): e0277685. http://dx.doi.org/10.1371/journal.pone.0277685.

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Cost collection using UB-04 forms for economic evaluation is challenging, as UB-04 collection is time and effort intensive and compliance is imperfect. Alternative data sources could overcome those challenges. The objective of this study is to determine the usefulness of UB-04 data in estimating hospital costs compared to clinical case report form (CRF) data. Health care utilization costs were compared from financial information in UB-04s and from an assignment process using CRF data, from the WRAP-IT (23 infections) and the Micra IDE trials (61 adverse events and 108 implants). Charge-based costs were calculated by multiplying charges in UB-04s and hospital-specific Cost-to-Charge ratios from the Centers for Medicare and Medicaid Services cost reports. The cost assignment process used clinical information to find comparable encounters in real world data and assigned an average cost. Paired difference tests evaluated whether both methods yield similar results. The mean difference in total infection related costs between methods in the WRAP-IT trial was $152 +/-$22,565. In the Micra IDE trial, the mean difference in total adverse event related costs between methods was -$355 +/-$8,298 while the mean difference in total implant related costs between methods was $-3,488 +/-$13,859. Wilcoxon tests and generalized linear models could not reject the difference in costs between methods in the first two cases. Cost assignment methods achieve results similar to costs obtained through UB-04s, without the additional investment in time and effort. The use of UB-04 information for services that are not mature in a health care system may present unexpected challenges, necessitating a tradeoff with other methods of cost assignment.

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Brenner, Zara R., und Nancy S. Iafrati. „Incorporating Best Practices Into Undergraduate Critical Care Nursing Education“. Critical Care Nurse 34, Nr. 1 (01.02.2014): 61–65. http://dx.doi.org/10.4037/ccn2014174.

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Incorporation of best clinical practices into the baccalaureate critical care nursing curriculum is important. At The College at Brockport, best clinical practices are introduced early in the semester and are reinforced throughout the semester in both class and clinical settings. Among the best clinical practices included are those recommended by the American Association of Critical-Care Nurses, The Centers for Medicare and Medicaid Services, the Institute for Healthcare Improvement, The Joint Commission, Quality and Safety Education for Nurses, the Surviving Sepsis Campaign, and the Institute for Safe Medication Practices. The culminating assignment of the semester requires students to focus on patient safety. Students describe the use of the National Patient Safety Goals and other best practices in the critical care setting. The role of the nurse leader and exploration of near-miss and work-around events also are described. Nursing students need to provide safe competent nursing care by incorporating best practices into their clinical practice now and in the future when they become registered professional nurses.

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Koenig, Lane, Samuel A. Soltoff, Berna Demiralp, Akinluwa A. Demehin, Nancy E. Foster, Caroline Rossi Steinberg, Christopher Vaz, Scott Wetzel und Susan Xu. „Complication Rates, Hospital Size, and Bias in the CMS Hospital-Acquired Condition Reduction Program“. American Journal of Medical Quality 32, Nr. 6 (19.12.2016): 611–16. http://dx.doi.org/10.1177/1062860616681840.

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In 2016, Medicare’s Hospital-Acquired Condition Reduction Program (HAC-RP) will reduce hospital payments by $364 million. Although observers have questioned the validity of certain HAC-RP measures, less attention has been paid to the determination of low-performing hospitals (bottom quartile) and the assignment of penalties. This study investigated possible bias in the HAC-RP by simulating hospitals’ likelihood of being in the worst-performing quartile for 8 patient safety measures, assuming identical expected complication rates across hospitals. Simulated likelihood of being a poor performer varied with hospital size. This relationship depended on the measure’s complication rate. For 3 of 8 measures examined, the equal-quality simulation identified poor performers similarly to empirical data (c-statistic approximately 0.7 or higher) and explained most of the variation in empirical performance by size (Efron’s R2 > 0.85). The Centers for Medicare & Medicaid Services could address potential bias in the HAC-RP by stratifying by hospital size or using a broader “all-harm” measure.

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Wilcock, Andrew D., Sushant Joshi, José Escarce, Peter J. Huckfeldt, Teryl Nuckols, Ioana Popescu und Neeraj Sood. „Luck of the draw: Role of chance in the assignment of medicare readmissions penalties“. PLOS ONE 16, Nr. 12 (21.12.2021): e0261363. http://dx.doi.org/10.1371/journal.pone.0261363.

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Pay-for-performance programs are one strategy used by health plans to improve the efficiency and quality of care delivered to beneficiaries. Under such programs, providers are often compared against their peers in order to win bonuses or face penalties in payment. Yet luck has the potential to affect performance assessment through randomness in the sorting of patients among providers or through random events during the evaluation period. To investigate the impact luck can have on the assessment of performance, we investigated its role in assigning penalties under Medicare’s Hospital Readmissions Reduction Policy (HRRP), a program that penalizes hospitals with excess readmissions. We performed simulations that estimated program hospitals’ 2015 readmission penalties in 1,000 different hypothetical fiscal years. These hypothetical fiscal years were created by: (a) randomly varying which patients were admitted to each hospital and (b) randomly varying the readmission status of discharged patients. We found significant differences in penalty sizes and probability of penalty across hypothetical fiscal years, signifying the importance of luck in readmission performance under the HRRP. Nearly all of the impact from luck arose from events occurring after hospital discharge. Luck played a smaller role in determining penalties for hospitals with more beds, teaching hospitals, and safety-net hospitals.

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Castillo, Daniel J., J. Brent Myers, Jonathan Mocko und Eric H. Beck. „Mobile Integrated Healthcare: Preliminary Experience and Impact Analysis with a Medicare Advantage Population“. Journal of Health Economics and Outcomes Research 4, Nr. 2 (26.09.2016): 172–87. http://dx.doi.org/10.36469/9819.

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Background: Mobile Integrated Healthcare (MIH) is a novel, patient-centered approach to population management. This concept creates a needs-matched, time appropriate assignment of one or more members of a multi-professional clinical team to care for patients on a scheduled or unscheduled basis. The selection of the site of care for scheduled interventions is driven by patient choice and, most often occurs in the patient’s home; unscheduled interventions are guided by a 5-point triage system and, based on acuity, may be treated in the home, primary care office, urgent care or, rarely, in an emergency department. Methods: An MIH team was assigned to deliver a care coordination program for a Medicare Advantage PPO (MAPPO) population (55% female, 71.2 years mean age), with risk assignment and interventions designed to affect potentially avoidable utilization of Emergency Medical Services (EMS), emergency department, and medical inpatient admissions. Patients participating in the MIH program were compared with contemporaneous, risk-matched non-participants as well as to actuarially expected cost and utilization based on historical claim experience. Results: All measured trends demonstrated favorable results for patients participating in the MIH program when compared against a matched cohort: 19% decrease in emergency department per member per month (PMPM) cost, 21% decrease in emergency department utilization, 37% decrease in inpatient PMPM cost, 40% decrease inpatient utilization, all measures reached statistical significance. Member experience satisfaction scores and patient activation measures also showed favorable preliminary trends. Conclusion: This initial impact analysis of a MIH care coordination program for this MAPPO population demonstrates promising trends regarding utilization, cost, member experience and patient activation. These preliminary findings indicate both that implementation of such a program is feasible and strongly suggest meritorious impacts upon the health, experience and cost of care for the population.

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Bailey, Michelle Stegman, und Robert R. Weathers. „The Accelerated Benefits Demonstration: Impacts on the Employment of Disability Insurance Beneficiaries“. American Economic Review 104, Nr. 5 (01.05.2014): 336–41. http://dx.doi.org/10.1257/aer.104.5.336.

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We use data from the Accelerated Benefits demonstration to estimate the impacts of providing newly entitled disability insurance (DI) beneficiaries with health insurance and additional services during the DI program's 24-month Medicare waiting period. While health insurance alone did not increase employment, the additional employment services appeared to have positive short-term impacts on labor market activity. We find a statistically significant increase in employment and earnings in the second calendar year after random assignment; although these findings disappear in the third calendar year. Our results may have implications for disability reform proposals and provisions within the Affordable Care Act.

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Zhang, Yuting, Seo Hyon Baik und Joseph P. Newhouse. „Use Of Intelligent Assignment To Medicare Part D Plans For People With Schizophrenia Could Produce Substantial Savings“. Health Affairs 34, Nr. 3 (März 2015): 455–60. http://dx.doi.org/10.1377/hlthaff.2014.1227.

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Herrel, Lindsey A., Phyllis Yan, Parth Modi, Julia Adler-Milstein, Andrew M. Ryan und John M. Hollingsworth. „Association of Medicare Beneficiary and Hospital Accountable Care Organization Alignment With Surgical Cost Savings“. JAMA Health Forum 3, Nr. 12 (22.12.2022): e224817. http://dx.doi.org/10.1001/jamahealthforum.2022.4817.

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ImportanceAlthough Medicare accountable care organizations (ACOs) account for half of program expenditures, whether ACOs are associated with surgical spending warrants further study.ObjectiveTo assess whether greater beneficiary-hospital ACO alignment was associated with lower surgical episode costs.Design, Setting, and ParticipantsThis retrospective cohort study was conducted between 2020 and 2022 using US Medicare data from a 20% random sample of beneficiaries. Individuals 18 years of age and older and without kidney failure who had a surgical admission between 2008 and 2015 were included. For each study year, distinction was made between beneficiaries assigned to an ACO and those who were not, as well as between admissions to ACO-participating and nonparticipating hospitals.ExposuresTime-varying binary indicators for beneficiary ACO assignment and hospital ACO participation and an interaction between them.Main Outcomes and MeasuresNinety-day, price-standardized total episode payments. Multivariable 2-way fixed-effects models were estimated.ResultsDuring the study period, 2 797 337 surgical admissions (6% of which involved ACO-assigned beneficiaries) occurred at 3427 hospitals (17% ACO participating). Total Medicare payments for 90-day surgical episodes were lowest when ACO-assigned beneficiaries underwent surgery at a hospital participating in the same ACO as the beneficiary ($26 635 [95% CI, $26 426-$26 844]). The highest payments were for unassigned beneficiaries treated at participating hospitals ($27 373 [95% CI, $27 232-$27 514]) or nonparticipating hospitals ($27 303 [95% CI, $27 291-$27 314]). Assigned beneficiaries treated at hospitals participating in a different ACO and assigned beneficiaries treated at nonparticipating hospitals had similar payments (for participating hospitals, $27 003 [95% CI, $26 739-$27 267] and for nonparticipating hospitals, $26 928 [95% CI, $26 796-$27 059]). A notable factor in the observed differences in surgical episode costs was lower spending on postacute care services.Conclusions and RelevanceIn this cohort study evaluating hospital and beneficiary ACO alignment and surgical spending, savings were noted for beneficiaries treated at hospitals in the same ACO. Allowing ACOs to encourage or require surgical procedures in their own hospitals could lower Medicare spending on surgery.

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McNutt, Robert, Tricia J. Johnson, Richard Odwazny, Zachary Remmich, Kimberly Skarupski, Steven Meurer, Samuel Hohmann und Brian Harting. „Change in MS-DRG Assignment and Hospital Reimbursement as a Result of Centers for Medicare & Medicaid Changes in Payment for Hospital-Acquired Conditions“. Quality Management in Health Care 19, Nr. 1 (Januar 2010): 17–24. http://dx.doi.org/10.1097/qmh.0b013e3181ccbd07.

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Lam, Clara J. K., Lindsey Enewold, Timothy S. McNeel, Dolly P. White, Joan L. Warren und Angela B. Mariotto. „Estimating Chemotherapy Use Among Patients With a Prior Primary Cancer Diagnosis Using SEER-Medicare Data“. JNCI Monographs 2020, Nr. 55 (01.05.2020): 14–21. http://dx.doi.org/10.1093/jncimonographs/lgaa005.

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Abstract Cancer treatment studies commonly exclude patients with prior primary cancers due to difficulties in ascertaining for which site treatment is intended. Surveillance, Epidemiology, and End Results-Medicare patients 65 years and older diagnosed with an index colon or rectal cancer (CRC) or female breast cancer (BC) between 2004 and 2013 were included. Chemotherapy, defined as “any chemotherapy” and more restrictively as “chemotherapy with confirmatory diagnoses,” was ascertained based on claims data within 6 months of index cancer diagnosis by prior cancer history. Any chemotherapy use was slightly lower among patients with a prior cancer (CRC: no prior = 17.4%, prior = 16.1%; BC: no prior = 12.9%, prior = 12.0%). With confirmatory diagnoses required, estimates were lower, especially among patients with a prior cancer (CRC: no prior = 16.8%, prior = 13.6%; BC: no prior = 12.6%, prior = 11.0%). These findings suggest that patients with prior cancers can be included in studies of chemotherapy use; requiring confirmatory diagnoses can increase treatment assignment confidence.

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Khanani, Arshad M., Pravin U. Dugel, Julia A. Haller, Alan L. Wagner, Benedicte Lescrauwaet, Ralph Schmidt und Craig Bennison. „Cost–effectiveness analysis of ocriplasmin versus watchful waiting for treatment of symptomatic vitreomacular adhesion in the US“. Journal of Comparative Effectiveness Research 9, Nr. 4 (März 2020): 287–305. http://dx.doi.org/10.2217/cer-2019-0117.

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Aim: Evaluate the cost–effectiveness of ocriplasmin in symptomatic vitreomacular adhesion (VMA) with or without full-thickness macular hole ≤400 μm versus standard of care. Methods: A state-transition model simulated a cohort through disease health states; assignment of utilities to health states reflected the distribution of visual acuity. Efficacy of ocriplasmin was derived from logistic regression models using Ocriplasmin for Treatment for Symptomatic Vitreomacular Adhesion Including Macular Hole trial data. Model inputs were extracted from Phase III trials and published literature. The analysis was conducted from a US Medicare perspective. Results: Lifetime incremental cost–effectiveness ratio was US$4887 per quality-adjusted life year gained in the total population, US$4255 and US$10,167 in VMA subgroups without and with full-thickness macular hole, respectively. Conclusion: Ocriplasmin was cost effective compared with standard of care in symptomatic VMA.

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Shehab, Nadine, Robert Ziemba, Kyle N. Campbell, Andrew I. Geller, Ruth N. Moro, Brian F. Gage, Daniel S. Budnitz und Tsu-Hsuan Yang. „Assessment of ICD-10-CM code assignment validity for case finding of outpatient anticoagulant-related bleeding among Medicare beneficiaries“. Pharmacoepidemiology and Drug Safety 28, Nr. 7 (29.05.2019): 951–64. http://dx.doi.org/10.1002/pds.4783.

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Quinn, Joan L., Mary Prybylo und Patricia Pannone. „Community Care Management Across the Continuum: Study Results From a Medicare Health Maintenance Plan“. Care Management Journals 1, Nr. 4 (Januar 1999): 223–31. http://dx.doi.org/10.1891/1521-0987.1.4.223.

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A large national health plan piloting a community care management (CCM) model for its highrisk, chronically ill, Medicare population has demonstrated a significant reduction in overall medical costs for its participants. The key elements include: the proactive identification and risk stratification of members; assignment of advanced practice nurses to physicians with highvolume high-risk members; and ongoing clinical management across the continuum, establishing a continuous relationship with the member. The results are derived from a retrospective study comparing 6 months of claim data prior to the member entering CCM, with 6 months of claim data while participants received community, care management. Members in the pilot study experienced both a 42% reduction in institutional days and a 53% reduction in admissions to acute care settings. In addition, physician and specialists fees were reduced by 37%. This resulted in a 6-month net savings of $3,602 per participant. To be extremely conservative, the savings were reduced by 50% to reflect the possible impact of regression to the mean. Even accounting for this, the program’s projected cost savings are $1,801 per participant in 6 months. The total projected savings for community care managed members in a fully implemented program divided by the entire enrolled population of 27,000 is $6.60 per member per month (PM/PM). The results of this study of care management across the continuum signal a new approach for medical management at a time when health care and the needs of the population are changing.

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Johnson, Tricia, Jason M. Kane, Richard Odwazny und Robert McNutt. „Association of the position of a hospital-acquired condition diagnosis code with changes in medicare severity diagnosis-related group assignment“. Journal of Hospital Medicine 9, Nr. 11 (11.09.2014): 707–13. http://dx.doi.org/10.1002/jhm.2253.

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Gandesbery, Benjamin, Krista Dobbie, Emer Joyce, Laura Hoeksema, Silvia Perez Protto und Eiran Z. Gorodeski. „Surgical Versus Medical Team Assignment and Secondary Palliative Care Services for Patients Dying in a Cardiac Hospital“. American Journal of Hospice and Palliative Medicine® 36, Nr. 4 (13.12.2018): 316–20. http://dx.doi.org/10.1177/1049909118819462.

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Background: Secondary palliative care (SPC) provides several benefits for patients with cardiovascular disease, but historically, it has been underutilized in this population. Prior research suggests a low rate of SPC consultation by surgical teams in general, but little is known about how surgical teams utilize SPC in the setting of severe cardiovascular disease. Aim: To determine if surgical team assignment affects the probability of SPC for inpatients dying of cardiovascular disease. Design: Retrospective, cohort study. Methods: We identified all inpatients at a large cardiac hospital who had anticipated death under the care of a cardiology, cardiac surgery, or vascular surgery team in 2016. Our primary outcome was referral to SPC, including palliative medicine consultation or inpatient hospice care. Informed by univariate analysis, we created a multivariable logistic regression model, the significance of which was assessed with the Wald test. Results: Two hundred thirty-seven patients were included in our analysis: 93 (39%) received SPC and 144 (61%) were “missed opportunities.” Secondary palliative care was less frequent in patients assigned to a surgical, versus medical, team (11% vs 47%, P < .001). On multivariate analysis, surgical versus medical team assignment was the strongest risk-adjusted predictor of SPC (odds ratio [OR]: 0.10, P < .001). Other predictors of SPC included do not resuscitate status on admission (OR: 14, P < .001), length of stay (OR = 1.05/day, P < .001), and having Medicare (OR = 3.9, P = .002). Conclusions: Primary inpatient care by a surgical team had a strong inverse relationship with SPC. This suggests a possible cultural barrier within surgical disciplines to SPC.

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Luo, Nancy, Bradley Hammill, Adam DeVore, Haolin Xu, Gregg Fonarow, Adrian Hernandez, Roland Matsouaka, Nancy Albert, Clyde Yancy und Robert Mentz. „ASSOCIATION BETWEEN ASSIGNMENT TO AN ACCOUNTABLE CARE ORGANIZATION AND QUALITY OF CARE AND OUTCOMES AMONG MEDICARE BENEFICIARIES HOSPITALIZED FOR HEART FAILURE“. Journal of the American College of Cardiology 73, Nr. 9 (März 2019): 913. http://dx.doi.org/10.1016/s0735-1097(19)31520-7.

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Govil, Mithi, Carla Wood und Thomas R. Barr. „Achieving Meaningful Use and Operational Efficiency“. Journal of Oncology Practice 8, Nr. 2 (März 2012): 70. http://dx.doi.org/10.1200/jop.2011.000443.

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Purpose: The Centers for Medicare and Medicaid Services (CMS), through the Electronic Health Record (EHR) Incentive Program, are providing incentive payments to eligible professionals as they demonstrate meaningful use of certified EHR technology. Eligible professionals can receive up to $44,000 over a 5-year period for Medicare participation if they successfully demonstrate the ability to automatically generate, transmit, and meet thresholds for specific reporting elements from the EHR. Meeting the meaningful use requirement involves a reorganization of workflow within the clinical setting so that the data elements necessary to produce the relevant measurements are documented in the electronic medical record (EMR) as they are delivered. A by-product of this is operational efficiency improvement in three areas: coordination of data input throughout the care team to reduce or remove bottlenecks, assignment of responsibility for specific activity, and real-time objective monitoring of the work process. Methods: Using the reporting system functionality of a certified EMR deployed in a two-physician medical oncology practice at the New London Cancer Center, the objective measurement of the ability of each of the eligible providers in the clinic to improve their individual MU scores was tracked. Analysis of the progress of each provider revealed gaps. Process issues were identified by work group: secretaries, laboratory preparation and phlebotomy staff, nurses, and clinicians. The designated physician leader met with each group to discuss the sections relevant to that particular group. Results: By discovering and addressing work processes that were not utilizing the ability of the EHR to capture and document (ie, meaningful use of the EHR), rapid progress that affected all of the eligible providers and all patients cared for was made. Changes resulted in increased clarity of clinical and administrative responsibilities during patient processing and clinical care provision. Meaningful use attestation was completed in 14 weeks. Conclusion: Completion of the documentation necessary to meet the requirements of the EHR Incentive Program led to the discovery of systemic inefficiencies in administrative and clinical workflows. Addressing these bottlenecks, along with using the reporting capability of the EHR to measure the impact of workflow changes, enabled the administrative and care teams to make changes quickly and effectively. The certified EHR provided guidance and status-reporting capabilities that allowed the practice to achieve the meaningful use requirement.

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Ahmad, Faraz S., Luke V. Rasmussen, Stephen D. Persell, Joshua E. Richardson, David T. Liss, Pauline Kenly, Isabel Chung et al. „Challenges to electronic clinical quality measurement using third-party platforms in primary care practices: the healthy hearts in the heartland experience“. JAMIA Open 2, Nr. 4 (20.09.2019): 423–28. http://dx.doi.org/10.1093/jamiaopen/ooz038.

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Abstract Third-party platforms have emerged to support small primary care practices for calculating and reporting electronic clinical quality measures (eCQM) for federal programs like The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and Merit-based Incentive Payment System (MIPS). Yet little is known about the capabilities and limitations of electronic health record systems (EHRs) to enable data access for these programs. We connected 116 small- to medium-sized practices with seven different EHRs to popHealth, an open-source eCQM platform. We identified the prevalence of following problems with eCQM data for data extraction in seven different EHRs: (1) Lack of coded data in five of seven; (2) Incorrectly categorized data in four of seven; (3) Isosemantic data (data within the incorrect context) in four of seven; (4) Coding that could not be directly evaluated in six of seven; (5) Errors in date assignment and labeled as historical values in five of seven; and (6) Inadequate data to assign the correct code in two of seven. We recommend specific enhancements to EHR systems that can promote effective eCQM implementation and reporting to MACRA and MIPS.

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Thompson, Stephen F., Sheikh Usman Iqbal, Sarah Naoshy, Daniel B. Ng, Michael L. Andria, Steven A. Sherman, Elisabetta Malangone, Lee Stern und Magdaliz Gorritz-Kindu. „Current practices in 1st- (1L), 2nd- (2L), and 3rd-line (3L) treatment for metastatic colorectal cancer (mCRC).“ Journal of Clinical Oncology 30, Nr. 15_suppl (20.05.2012): e14028-e14028. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e14028.

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e14028 Background: Up-to-date information concerning the optimal regimen assignment and sequencing of therapies is lacking for the treatment of mCRC patients. By tracking trends in treatment choice, this retrospective, observational study assesses current treatment patterns in mCRC patients by line of therapy. Methods: Using electronic medical record data from one of the largest US oncology databases (SDI), treatment regimens for 1L, 2L, and 3L were assessed for patients age ≥18 yrs diagnosed with mCRC from 1/1/04-7/31/11 who received anticancer agents. Results: 1,793 stage IV patients were identified in 1L, 1,050 in 2L, and 504 in 3L. Overall mean age was 60.4 yrs, and 54.6% were men. The most common comorbidities were hypertension (18.0%), lipid metabolism disorders (10.6%), and diabetes (8.6%). 47.8% had commercial insurance, 37.2% Medicare, 8.5% Medicaid, and 4.6% self pay. 1,026 patients received bevacizumab (B) in 1L, 583 in 2L, and 204 in 3L. Patients were more likely to receive FOLFOX (FX) + B in 1L and 2L. The top 3 regimens are shown in the table below. For patients who began treatment with B and continued B in a subsequent regimen, mean dose of B increased from 443.7 mg/kg (1L) to 567.0 mg/kg (2L) and 618.1 mg/kg (3L). Conclusions: FX is the regimen of choice in mCRC. In terms of biologics, B is more commonly used in 1L/2L than 3L. Given that approximately half the mCRC patients progressed to 2L/3L treatment, this likely reflects an unmet need for advanced therapies for the effective treatment of the disease. Furthermore, consistent dose escalation with continued B use across 2L/3L was seen despite that use of B in 3L mCRC is inconsistent with NCCN guidelines. Additional research on outcomes implications is needed, including mortality, patient toxicity, and costs. [Table: see text]

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Lord, Justin C., Ganisher K. Davlyatov, Akbar Ghiasi und Robert Weech-Maldonado. „THE IMPACT OF CULTURE CHANGE ON FINANCIAL PERFORMANCE OF HIGH MEDICAID NURSING HOMES“. Innovation in Aging 3, Supplement_1 (November 2019): S156. http://dx.doi.org/10.1093/geroni/igz038.560.

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Abstract This study examines the association between culture change artifacts and financial performance among under-resourced nursing homes (70% or higher Medicaid census). Culture change represents a transformational process to become person-centered, through staff and resident empowerment. Cultural artifacts represent the physical evidences that culture change is occurring. In this study, we focus on the workplace (nurse staffing consistent assignments) and leadership (residents engagement) artifacts to assess the relationship between culture change practices and performance. Survey data came from 387 nursing home directors from 2016- 2018, merged with secondary data from LTCFocus, Area Health Resource File, and Medicare Cost Reports. The dependent variable consisted of the total profit margin (%), while the independent variables comprised composite scores for leadership (0-25) and workplace artifacts (0-15). Control variables included organizational-level (ownership, chain affiliation, size, occupancy rate, and Medicare and Medicaid payer mix), and county-level factors (Medicare Advantage penetration, per capita income, educational level, unemployment rate, poverty level and competition). Multivariate regression was used to model the relationship between cultural change artifacts and financial performance. Workplace artifacts in nursing homes were found to be associated with significantly higher profit margin (β = 0.30, p < 0.05), while leadership artifacts were not. Culture change practices aimed at improving nursing staff consistent assignments are associated with better financial performance. Given increasing nursing home market competition and declining resources for high Medicaid nursing homes, facilities with a greater emphasis on workplace culture may be able to perform better financially among these under-resourced facilities.

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Borrenpohl, Dylan, Brian Kaluf und Matthew J. Major. „Survey of U.S. Practitioners on the Validity of the Medicare Functional Classification Level System and Utility of Clinical Outcome Measures for Aiding K-Level Assignment“. Archives of Physical Medicine and Rehabilitation 97, Nr. 7 (Juli 2016): 1053–63. http://dx.doi.org/10.1016/j.apmr.2016.02.024.

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Weismann, Miriam, Sue Ganske und Osmel Delgado. „Cleveland Clinic Florida “pay-for performance” reimbursement: why the best care does not always make the happiest patients“. CASE Journal 16, Nr. 5 (01.10.2020): 625–63. http://dx.doi.org/10.1108/tcj-02-2019-0011.

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Theoretical basis The assignment is to design a plan that aligns patient satisfaction scores with quality care metrics. The instructor’s manual (IM) introduces models for designing and implementing a strategic plan to approach the quality improvement process. Research methodology This is a field research case. The author(s) had access to the Chief Operating Officer (COO) and other members of the management team, meeting with them on numerous occasions. Cleveland Clinic Florida (CCF) provided the data included in the appendices. Additionally, relevant hospital data, also included in the appendices, is required to be made public on Centers for Medicare and Medicaid Services (CMS) databases. Accordingly, all data and information are provided by original sources. Case overview/synopsis Osmel “Ozzie” Delgado, MBA and COO of CCF was faced with a dilemma. Under the new CMS reimbursement formula, patient satisfaction survey scores directly impacted hospital reimbursement. However, the CCF patient satisfaction surveys revealed some very unhappy patients. Delgado pondered these results that really made no sense to him because CCF received the highest national and state rankings for its clinical quality at the same time. Clearly, patients were receiving the best medical care, but they were still unhappy. Leaning back in his chair, Delgado shook his head and wondered incredulously how one of the most famous hospitals in the world could deliver such great care but receive negative patient feedback on CMS surveys. What was going wrong and how was the hospital going to fix it? Complexity academic level This case is designed for graduate Master’s in Business Administration (MBA), Master’s in Health Sciences Administration (MHSA) and/or Public Health (PA) audiences. While a healthcare concentration is useful, the case raises the generic business problems of satisfying the customer to increase brand recognition in the marketplace and displacing competition to increase annual revenues. Indeed, the same analysis can be applied in other heavily regulated industries also suffering from a change in liquidity and growth occasioned by regulatory change.

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Panattoni, Laura Elizabeth, Qin Sun, Catherine R. Fedorenko, Karma L. Kreizenbeck und Scott David Ramsey. „Washington State Community Cancer Care Report: Implications for value-based purchasing.“ Journal of Clinical Oncology 36, Nr. 30_suppl (20.10.2018): 104. http://dx.doi.org/10.1200/jco.2018.36.30_suppl.104.

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104 Background: As quality reports are released for regions and individual clinics, an important question is whether those reports can be used for value based purchasing, particularly for community oncology clinics. We evaluated the reliability of select quality measures and estimated the likelihood that a clinic’s performance would be incorrectly categorized (misclassified) in the top quartile. Methods: We linked 2014-2016 cancer registry records for patients with enrollment and claims from Medicare and two major commercial insurers in Washington State. We calculated risk standardized rates (RSRs) for ED and hospital use during treatment and 3 quality measures for end of life care. Reliability (0-1 scale: 0-unreliabile, > 0.7 good reliability, 1 perfectly reliable) was calculated as signal/(signal + statistical noise) from hierarchical logistic regression modeling for each metric. Misclassification was characterized as the probability of false negative and false positive assignment of clinics to the top quartile of performers in the region. We generated results for 3 and 1 year performance periods. Results: Over the 3 year period, the hospitalization metrics included 7,373 patients, 25 clinics; end of life metrics included 8,165 patients; 24 clinics. Conclusions: Although these metrics had fairly high levels of reliability, approximately one-third of clinics could be incorrectly identified as a top quartile performer. Use of these metrics in value based purchasing should account for potential misclassification to minimize unintended consequences.[Table: see text]

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Dillon, Michael P., Matthew J. Major, Brian Kaluf, Yuri Balasanov und Stefania Fatone. „Predict the Medicare Functional Classification Level (K-level) using the Amputee Mobility Predictor in people with unilateral transfemoral and transtibial amputation: A pilot study“. Prosthetics and Orthotics International 42, Nr. 2 (23.05.2017): 191–97. http://dx.doi.org/10.1177/0309364617706748.

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Background: While Amputee Mobility Predictor scores differ between Medicare Functional Classification Levels (K-level), this does not demonstrate that the Amputee Mobility Predictor can accurately predict K-level. Objectives: To determine how accurately K-level could be predicted using the Amputee Mobility Predictor in combination with patient characteristics for persons with transtibial and transfemoral amputation. Study design: Prediction. Method: A cumulative odds ordinal logistic regression was built to determine the effect that the Amputee Mobility Predictor, in combination with patient characteristics, had on the odds of being assigned to a particular K-level in 198 people with transtibial or transfemoral amputation. Results: For people assigned to the K2 or K3 level by their clinician, the Amputee Mobility Predictor predicted the clinician-assigned K-level more than 80% of the time. For people assigned to the K1 or K4 level by their clinician, the prediction of clinician-assigned K-level was less accurate. The odds of being in a higher K-level improved with younger age and transfemoral amputation. Conclusion: Ordinal logistic regression can be used to predict the odds of being assigned to a particular K-level using the Amputee Mobility Predictor and patient characteristics. This pilot study highlighted critical method design issues, such as potential predictor variables and sample size requirements for future prospective research. Clinical relevance This pilot study demonstrated that the odds of being assigned a particular K-level could be predicted using the Amputee Mobility Predictor score and patient characteristics. While the model seemed sufficiently accurate to predict clinician assignment to the K2 or K3 level, further work is needed in larger and more representative samples, particularly for people with low (K1) and high (K4) levels of mobility, to be confident in the model’s predictive value prior to use in clinical practice.

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Zarkowsky, Devin S., Besma Nejim, Itay Hubara, Caitlin W. Hicks, Philip P. Goodney und Mahmoud B. Malas. „Deep Learning and Multivariable Models Select EVAR Patients for Short-Stay Discharge“. Vascular and Endovascular Surgery 55, Nr. 1 (10.09.2020): 18–25. http://dx.doi.org/10.1177/1538574420954299.

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Objectives: We sought to develop a prediction score with data from the Vascular Quality Initiative (VQI) EVAR in efforts to assist endovascular specialists in deciding whether or not a patient is appropriate for short-stay discharge. Background: Small series describe short-stay discharge following elective EVAR. Our study aims to quantify characteristics associated with this decision. Methods: The VQI EVAR and NSQIP datasets were queried. Patients who underwent elective EVAR recorded in VQI, between 1/2010-5/2017 were split 2:1 into test and analytic cohorts via random number assignment. Cross-reference with the Medicare claims database confirmed all-cause mortality data. Bootstrap sampling was employed in model. Deep learning algorithms independently evaluated each dataset as a sensitivity test. Results: Univariate outcomes, including 30-day survival, were statistically worse in the DD group when compared to the SD group (all P < 0.05). A prediction score, SD-EVAR, derived from the VQI EVAR dataset including pre- and intra-op variables that discriminate between SD and DD was externally validated in NSQIP (Pearson correlation coefficient = 0.79, P < 0.001); deep learning analysis concurred. This score suggests 66% of EVAR patients may be appropriate for short-stay discharge. A free smart phone app calculating short-stay discharge potential is available through QxMD Calculate https://qxcalc.app.link/vqidis. Conclusions: Selecting patients for short-stay discharge after EVAR is possible without increasing harm. The majority of infrarenal AAA patients treated with EVAR in the United States fit a risk profile consistent with short-stay discharge, representing a significant cost-savings potential to the healthcare system.

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Pulluri, Bhargavi, Benjamin Littenberg, Inder Lal, Chris E. HOlmes und Steven Ades. „Risk Factors for Venous Thromboembolism in Metastatic Colon Cancer Patients in the Contemporary Treatment Era: A SEER-Medicare Data Analysis“. Blood 128, Nr. 22 (02.12.2016): 2598. http://dx.doi.org/10.1182/blood.v128.22.2598.2598.

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Abstract Background:The relationship between metastatic colorectal cancer (CRC) and venous thromboembolism (VTE) is not well defined in the modern treatment era. Previous population-based studies date back to a period marked by inpatient intravenous heparin therapy and inferior survival due to paucity of therapeutic anti-cancer options, and before the advent of newer therapies including oxaliplatin, irinotecan, and anti-angiogenic treatment with bevacizumab. The objectives of this retrospective study were to examine the impact of multiple putative risk factors on VTE incidence in a large representative modern cohort of older patients with metastatic CRC. Methods:We performed a retrospective analysis of SEER-Medicare data on elderly patients with metastatic CRC diagnosed in 2004-2011. VTE and associated risk factors were analyzed using multivariate Cox proportional hazards models adjusted for sex, age at diagnosis, race, ethnicity, tumor anatomy (left/right/unknown), calendar year of diagnosis, Charlson comorbidity score, location of SEER registry and urban residence, with time-varying covariates for use of cancer therapies. Results:Of 339,778 records, 11,086 metastatic colon cancer cases were identified. 1,338 cases had VTE with a cumulative incidence of 13% at 1 year and 19% at 3 years. The mean age was 77.9 years (range 65-106). 49.7% were women and 83.5% white. 60.5% had a Charlson comorbidity score of zero at diagnosis; 6% had scores of 6-18. Significant predictors of VTE included female sex (Hazard Ratio (HR) 1.22; 95% Confidence Interval (CI) 1.10, 1.36; P<0.001), younger age at diagnosis (HR 1.25 per decade of age; CI 1.15, 1.37; P<0.001), urban residence (HR 1.20; CI 1.03, 1.40; P=0.02), right sided colon cancers (HR 1.19; CI, 1.06, 1.33 P=0.003), and current use of 5-fluorouracil (HR 1.33; CI 1.04, 1.70; P=0.02). The risk of VTE was significantly reduced when on bevacizumab (HR 0.77; CI 0.63, 0.93; P=.006), or irinotecan therapy (HR 0.59; CI 0.47, 0.75; P<0.001) and in those with more comorbid conditions (HR 0.97 per point of Charlson score; CI 0.935, 0.998; P=0.04). Conclusion: The higher incidence of VTE seen in right sided colon cancers may be related to biologically aggressive tumors associated with poor survival as reported in recent studies. The lower risk of VTE in older, sicker patients was unexpected and may reflect the effect of competing mortality. In this large contemporary cohort, anti-angiogenic therapy was not associated with a higher risk of VTE; the apparent protective effects of bevacizumab and irinotecan may represent treatment assignment bias. Disclosures No relevant conflicts of interest to declare.

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Yang, Tsu-Hsuan, Robert Ziemba, Nadine Shehab, Andrew I. Geller, Karan Talreja, Kyle N. Campbell und Daniel S. Budnitz. „Assessment of International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) Code Assignment Validity for Case Finding of Medication-related Hypoglycemia Acute Care Visits Among Medicare Beneficiaries“. Medical Care 60, Nr. 3 (März 2022): 219–26. http://dx.doi.org/10.1097/mlr.0000000000001682.

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Burke, James F., Chunyang Feng und Lesli E. Skolarus. „Divergent poststroke outcomes for black patients“. Neurology 93, Nr. 18 (25.09.2019): e1664-e1674. http://dx.doi.org/10.1212/wnl.0000000000008391.

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ObjectiveTo explore racial differences in disability at the time of first postdischarge disability assessment.MethodsThis was a retrospective cohort study of all Medicare fee-for-service beneficiaries hospitalized with primary ischemic stroke (ICD-9,433.x1, 434.x1, 436) or intracerebral hemorrhage (431) diagnosed from 2011 to 2014. Racial differences in poststroke disability were measured in the initial postacute care setting (inpatient rehabilitation facility, skilled nursing facility, or home health) with the Pseudo-Functional Independence Measure. Given that assignment into postacute care setting may be nonrandom, patient location during the first year after stroke admission was explored.ResultsA total of 390,251 functional outcome assessments (white = 339,253, 87% vs black = 50,998, 13%) were included in the primary analysis. At the initial functional assessment, black patients with stroke had greater disability than white patients with stroke across all 3 postacute care settings. The difference between white and black patients with stroke was largest in skilled nursing facilities (black patients 1.8 points lower than white patients, 11% lower) compared to the other 2 settings. Conversely, 30-day mortality was greater in white patients with stroke compared to black patients with stroke (18.4% vs 12.6% [p < 0.001]) and a 3 percentage point difference in mortality persisted at 1 year. Black patients with stroke were more likely to be in each postacute care setting at 30 days, but only very small differences existed at 1 year.ConclusionsBlack patients with stroke have 30% lower 30-day mortality than white patients with stroke, but greater short-term disability. The reasons for this disconnect are uncertain, but the pattern of reduced mortality coupled with increased disability suggests that racial differences in care preferences may play a role.

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Neller, Todd, Laura Brown, Roger West, James Heliotis, Sean Strout, Ivona Bezáková, Bikramjit Banerjee und Daniel Thompson. „Model AI Assignments 2014 Laura E. Brown Michigan Technological University lebrown@mtu.edu“. Proceedings of the AAAI Conference on Artificial Intelligence 28, Nr. 3 (27.07.2014): 3054–55. http://dx.doi.org/10.1609/aaai.v28i3.19038.

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The Model AI Assignments session seeks to gather and disseminate the best assignment designs of the Artificial Intelligence (AI) Education community. Recognizing that assignments form the core of student learning experience, we here present abstracts of five AI assignments from the 2014 session that are easily adoptable, playfully engaging, and flexible for a variety of instructor needs. Assignment specifications and supporting resources may be found at http://modelai.gettysburg.edu.

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Neller, Todd W., Nathan Sprague, John Maraist, Lisa Zhang, Pouria Fewzee, Duri Long, Jonathan Moon et al. „Model AI Assignments 2021“. Proceedings of the AAAI Conference on Artificial Intelligence 35, Nr. 17 (18.05.2021): 15705–6. http://dx.doi.org/10.1609/aaai.v35i17.17850.

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The Model AI Assignments session seeks to gather and disseminate the best assignment designs of the Artificial Intelligence (AI) Education community. Recognizing that assignments form the core of student learning experience, we here present abstracts of six AI assignments from the 2021 session that are easily adoptable, playfully engaging, and flexible for a variety of instructor needs. Assignment specifications and supporting resources may be found at http://modelai.gettysburg.edu.

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Neller, Todd W., Jazmin Collins, Daniel Schneider, Yim Register, Christopher Brooks, Chiawei Tang, Chaolin Liu et al. „Model AI Assignments 2022“. Proceedings of the AAAI Conference on Artificial Intelligence 36, Nr. 11 (28.06.2022): 12863–64. http://dx.doi.org/10.1609/aaai.v36i11.21569.

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The Model AI Assignments session seeks to gather and disseminate the best assignment designs of the Artificial Intelligence (AI) Education community. Recognizing that assignments form the core of student learning experience, we here present abstracts of six AI assignments from the 2022 session that are easily adoptable, playfully engaging, and flexible for a variety of instructor needs. Assignment specifications and supporting resources may be found at http://modelai.gettysburg.edu.

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Neller, Todd, Laura Brown, John Earnest, Jason Hiebel und Douglas Turnbul. „Model AI Assignments 2012“. Proceedings of the AAAI Conference on Artificial Intelligence 26, Nr. 3 (04.10.2021): 2377–78. http://dx.doi.org/10.1609/aaai.v26i3.18957.

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The Model AI Assignments session seeks to gather and disseminate the best assignment designs of the Artificial Intelligence (AI) Education community. Recognizing that assignments form the core of student learning ex- perience, we here present abstracts of three AI assignments from the 2012 session that are easily adoptable, playfully engaging, and flexible for a variety of instructor needs. Assignment specifications and supporting resources may be found at http://modelai.gettysburg.edu.

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Elsolh, K., D. Tham, M. A. Scaffidi, R. Bansal, J. Li, Y. Verma, N. Gimpaya, R. Khan und S. C. Grover. „A161 PREVALENCE OF FINANCIAL CONFLICTS OF INTEREST (FCOI) AMONG PROPENSITY-SCORE MATCHED RETROSPECTIVE STUDIES EVALUATING BIOLOGIC THERAPEUTICS FOR IBD“. Journal of the Canadian Association of Gastroenterology 4, Supplement_1 (01.03.2021): 168–70. http://dx.doi.org/10.1093/jcag/gwab002.159.

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Abstract Background Inflammatory Bowel Disease (IBD) studies have commonly relied on real-world evidence to evaluate different therapies. An emerging idea has been the use of propensity score matching as a statistical method to account for baseline characteristics in IBD patients. In retrospective studies, propensity score matching of patients helps reduce treatment assignment bias and mimic the effects of randomization. Recently, propensity-score matching has become an important tool in IBD studies comparing biologic therapeutics. Biologic medications are among the highest-grossing drugs worldwide, and their pharmaceutical producers make considerable payments to physicians to market them. In spite of this, there is a lack of evidence examining the role of undue industry influence among propensity-score matched comparative studies evaluating biologic therapeutics for IBD. Aims Given the documented association between IBD biologics and FCOI, we hypothesize a high burden of FCOI in propensity-score matched studies. The aim of this study was to evaluate the prevalence of disclosed & undisclosed financial conflicts of Interest (FCOI) in propensity-score matched comparison studies evaluating biologics for IBD. Methods We developed & ran a librarian-reviewed systematic search on EMBASE, MEDLINE, and Cochrane Library databases for all propensity-score matched retrospective studies comparing biologics for the treatment of IBD. Full-text retrieval & screening was performed on all studies in duplicate. 16 articles were identified. Industry payments to authors were only considered FCOI if they were made by a company producing a biologic that was included in the comparison study. Disclosed FCOI were identified by authors’ interests disclosures in full-texts. Any undisclosed FCOI among US authors were identified using the Centre for Medicare and Medicaid Services (CMS) Open Payments Database, which collects industry payments to physicians. Results Based on a preliminary analysis of 16 studies, there was at least one author with a relevant FCOI in 14 (88%) of the 16 studies. 14 studies (88%) had at least one disclosed FCOI, while 6 studies (37.5%) had at least one undisclosed FCOI. Among studies with disclosed FCOI, a mean of 40.2% (SD = 23.4%) of authors/study reported FCOI. Among studies with undisclosed FCOI, a mean of 18.8% (SD = 7.0%) of authors/study reported FCOI. The total dollar value of FCOIs was $1,974,328.3. The median conflict dollar value was $5,576.6 (IQR: $321.6 to $36,394.9). Conclusions We found a high burden of undisclosed FCOI (37.5%) among authors of propensity-score matched studies evaluating IBD biologics. Given the potential for undue industry influence stemming from such payments, authors should ensure better transparency with industry relationships. Funding Agencies None

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Ramotsisi, Johnson, Mompoloki Kgomotso und Lone Seboni. „An Optimization Model for the Student-to-Project Supervisor Assignment Problem-The Case of an Engineering Department“. Journal of Optimization 2022 (31.10.2022): 1–11. http://dx.doi.org/10.1155/2022/9415210.

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Purpose. Empirical studies on the topic of assigning university project students to supervisors are currently underexplored. Such studies are critical to success of both the students and the university. Whilst extant research on this topic has contributed to an understanding of student assignments, what appears to be missing is application of a comprehensive framework to inform formulation and validation of a robust solution approach that takes account of both student and supervisor preferences, to optimize a real-life student-to-project supervisor assignment problem. Methodology. Questionnaire and interview surveys with project coordinators, project supervisors, head of department and students were conducted to identify factors surrounding the student-to-project supervisor assignment, through a case study approach in a university department offering engineering degree programs. This study not only develops a framework to understand an effective student-to-project supervisor assignment decision but also applies it in practice, through a case study in a University department offering engineering degree programs. An integer linear programming model was developed and implemented in an optimization software to optimize the student-to-project supervisor assignment, using data from the case study. Findings. Using OpenSolver, validated model results show improvements in matching both students and project supervisors’ preferences, whilst complying with supervisors’ workloads. These results also reveal an improvement in minimizing the project coordinator’s time in doing the assignment by introducing a standardized approach that concurrently considers all variables in a consistent manner. Originality. The contribution lies in: (1) development of a robust framework for student-to-supervisor assignments, (2) explicit consideration of contextual factors that recognize different assignment scenarios, (3) identification of feedback loops to recognize not only the need for continuous improvement in student-to-supervisor assignments but also links to performance in final year projects, (4) unique insights to guide project coordinators in relation to an efficient, effective, comprehensive, and standardized approach to the student-to-project supervisor assignment, and (5) a deeper understanding of a comprehensive range of factors that play a role in student-to-project supervisor assignments in higher education institutions.

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Neller, Todd, John DeNero, Dan Klein, Sven Koenig, William Yeoh, Xiaoming Zheng, Kenny Daniel et al. „Model AI Assignments“. Proceedings of the AAAI Conference on Artificial Intelligence 24, Nr. 3 (15.07.2010): 1919–21. http://dx.doi.org/10.1609/aaai.v24i3.18837.

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The Model AI Assignments session seeks to gather and disseminate the best assignment designs of the Artificial Intelligence (AI) Education community. Recognizing that assignments form the core of student learning experience, we here present abstracts of eight AI assignments that are easily adoptable, playfully engaging, and flexible for a variety of instructor needs.

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Wages, Nolan A., und Evan Bagley. „Evaluation of irrational dose assignment definitions using the continual reassessment method“. Clinical Trials 16, Nr. 6 (23.09.2019): 665–72. http://dx.doi.org/10.1177/1740774519873316.

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Background: This article studies the notion of irrational dose assignment in Phase I clinical trials. This property was recently defined by Zhou and colleagues as a dose assignment that fails to de-escalate the dose when two out of three, three out of six, or four out of six patients have experienced a dose-limiting toxicity event at the current dose level. The authors claimed that a drawback of the well-known continual reassessment method is that it can result in irrational dose assignments. The aim of this article is to examine this definition of irrationality more closely within the conduct of the continual reassessment method. Methods: Over a broad range of assumed dose-limiting toxicity probability scenarios for six study dose levels and a variety of target dose-limiting toxicity rates, we simulated 2000 trials of n = 36 patients. For each scenario, we counted the number of irrational dose assignments that were made by the continual reassessment method, according to the definitions of Zhou and colleagues. For each of the irrational decisions made, we classified the dose assignment as an underdose assignment, a target dose assignment, or an overdose assignment based on the true dose-limiting toxicity probability at that dose. Results: Across eight dose-toxicity scenarios, there were a total of 181,581 dose assignments made in the simulation study. Of these assignments, 8165 (4.5%) decisions were made when two out of three, three out of six, or four out of six patients had experienced a dose-limiting toxicity at the current dose. Of these 8165 decisions, 1505 (18.4%) recommended staying at the current dose level and would therefore be classified as irrational by Zhou and colleagues. Among the irrational decisions, 41.2% were misclassified, meaning they were made either at the true target dose (17.9%) or at a true underdose (23.3%). The remaining 58.8% were made at a true overdose and therefore truly irrational. Overall, irrational dose assignments comprised <1% of the total dose assignments made during the simulation study. Similar findings are reported in simulations across 100 randomly generated dose-toxicity scenarios from a recently proposed family of curves. Conclusion: Zhou and colleagues argue that the behavior of the continual reassessment method is disturbing due to its ability to make irrational dose assignments. These definitions are based on rules that mimic the popular 3 + 3 design, which should not be the benchmark used to construct guidelines for trial conduct of modern Phase I methods. Our study illustrates that these dose assignments occur very seldom in the continual reassessment method and that even when they do occur, they can often be considered sensible when accounting for all accumulated data in the study.

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Neller, Todd, Marie DesJardins, Tim Oates und Matthew Taylor. „Model AI Assignments 2011“. Proceedings of the AAAI Conference on Artificial Intelligence 25, Nr. 3 (01.10.2021): 1746. http://dx.doi.org/10.1609/aaai.v25i3.18843.

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The Model AI Assignments session seeks to gather and disseminate the best assignment designs of the Artificial Intelligence (AI) Education community. Recognizing that assignments form the core of student learning experience, we here present abstracts of three AI assignments from the 2011 session that are easily adoptable, playfully engaging, and flexible for a variety of instructor needs.

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Eapen, Mary, Donna S. Neuberg, Adam M. Mendizabal, Kristen E. Stevenson, Joseph H. Antin, Nancy DiFronzo, Fuad A. El Rassi et al. „A Phase II Trial to Compare Allogeneic Transplant Vs. Standard of Care for Severe Sickle Cell Disease: Blood and Marrow Transplant Clinical Trials Network (BMT CTN) Protocol 1503“. Blood 134, Supplement_1 (13.11.2019): 4592. http://dx.doi.org/10.1182/blood-2019-126793.

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Background: Allogeneic hematopoietic cell transplantation (HCT) is a curative treatment for sickle cell disease (SCD). A pilot trial confirmed the suitability of a myeloablative conditioning regimen (busulfan/fludarabine/r-ATG) for HLA-matched sibling and unrelated donor HCT for severe SCD. This led to the current phase II trial funded by the NHLBI. The primary aim is to determine the efficacy of treatment options (HCT vs. standard of care) for adolescents and young adults with severe SCD (NCT02766465). Study design and Treatment: This is a "biologic assignment" trial in which subjects with an HLA-matched sibling or HLA-matched unrelated donor are assigned to a donor arm (expected to receive HCT). Those without a suitable donor are assigned to a no-donor arm and expected to receive current therapies for SCD at the discretion of their provider. Although randomization is the gold standard for comparing treatments, such an approach for a rare disease is not feasible for the following reasons: 1) timely completion of the trial (~30% expected to identify a matched sibling and ~20%, a matched unrelated donor) and 2) accrual is challenging when the two arms of a randomized trial have markedly disparate treatments (i.e., one arm is an intervention with about 10-20% upfront mortality vs. the other arm also expected to have mortality risks but accepted as a consequence of disease). While we expect some to decline HCT (donor arm) or proceed to a mismatched related or unrelated donor HCT (no-donor arm), through education /counselling prior to consent, we anticipate <5% cross-over. Major Inclusion Criteria: Age 15 - 40 years with SCD (stroke or neurologic deficit, recurrent vaso-occlusive crisis, acute chest syndrome, high impact chronic pain or tricuspid regurgitant jet velocity ≥2.7m/second. Subjects who already have a suitable donor are excluded. Statistical Methods: Subjects are screened for eligibility and enrolled without knowing their biological assignment. HLA typing of the subject and donor search can be undertaken only after enrollment. Treatment arm assignment, (donor or no-donor arm) has to occur within 6 months of enrollment. We hypothesize that subjects on the donor arm will exert an early impact on survival and that survival will plateau by 1-year. Those on the no-donor arm are expected to follow the natural history of their disease with risk of premature mortality. A non-inferiority framework was chosen to test the non-inferiority of the donor arm compared to the no donor arm. The non-inferiority margin of 0.20 was chosen to establish that the difference in the proportion of subjects surviving at 2 years between the donor arm is no more than 0.20 worse than the no donor arm. If we reject the non-inferiority null hypothesis with a one-sided test, we will declare that the non-inferiority margin is met and that the difference in the probability of 2-year survival between the donor and no-donor arm is no more than 20%. Endpoints: The primary endpoint is the estimate of overall survival at 2-years after enrollment. Regardless of treatment received subjects will remain in their assigned treatment arm for analysis of survival (intent-to-treat principle). Secondary endpoints include comparison of occurrence of sickle related events in both treatment groups over 2 years (pulmonary hypertension, cerebrovascular, renal, avascular necrosis, leg ulcer), and functional assessment (6-minute walk distance test, 28-day e-pain diary [mean pain intensity] and HRQoL. Exact logistic regression will be used to estimate an odds ratio of such events, assuming that at least one such event occurs on study in each of the treatment arms, controlling for other patient-related characteristics and individual history of the event of interest. The trial is on-going and has met ~55% of projected accrual. Obstacles to accrual include: physician bias, subjects were not aware of a curative option for their disease, payment for HCT on a clinical trial in some US states despite meeting the Center for Medicare/Medicaid Services (CMS) requirement for coverage with evidence determination (CED), prior HLA typing and knowledge regarding donor availability, competing treatment options and the fact that substantial numbers of potentially eligible subjects are followed in the community and lack access to academic sites. Overcoming obstacles took ~2 years. The trial is now at "steady state accrual" and expected to complete accrual in ~18-24 months. Disclosures Neuberg: Celgene: Research Funding; Pharmacyclics: Research Funding; Madrigal Pharmaceuticals: Equity Ownership. Stevenson:Celgene: Research Funding. Waller:Pharmacyclics: Other: Travel expenses, Research Funding; Cerus Corporation: Other: Stock, Patents & Royalties; Chimerix: Other: Stock; Cambium Oncology: Patents & Royalties: Patents, royalties or other intellectual property ; Amgen: Consultancy; Kalytera: Consultancy; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding. Walters:Editas Medicine: Consultancy; TruCode: Consultancy; AllCells, Inc: Consultancy.

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Ferber, Joel D. „Auto-Assignment and Enrollment in Medicaid Managed Care Programs“. Journal of Law, Medicine & Ethics 24, Nr. 2 (1996): 99–107. http://dx.doi.org/10.1111/j.1748-720x.1996.tb01842.x.

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In the face of escalating Medicaid costs and anticipated reductions in federal Medicaid spending, states are increasingly converting from fee-for-service (FFS) to managed health care systems. The interrelated issues of enrollment and auto-assignment are fundamental to the overall success or failure of Medicaid managed care programs. The purpose of this article is to suggest how policy makers, consumer advocates, and providers should address these issues. My major premise is that implementation of managed care will proceed more smoothly if states adopt enrollment strategies that promote voluntary selection of health plans by Medicaid consumers, minimize the likelihood of auto-assignment, and mitigate the negative consequences of mandatory assignment of consumers to managed care organizations (MCOs).States seeking to implement Medicaid managed care must apply for a waiver from the secretary of the Department of Health and Human Services (DHHS). Two different types of waivers are available to implement Medicaid managed care.

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Kohn, Christine G., Jonathan T. Caranfa, Molly Brewer, Meghana Singh, Craig I. Coleman und Olivia S. Costa. „Do differences in baseline clinical severity of ovarian cancer patients with thrombosis predict treatment with rivaroxaban versus low molecular-weight heparin?“ Journal of Clinical Oncology 39, Nr. 15_suppl (20.05.2021): e18748-e18748. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e18748.

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e18748 Background: Prescribers use direct oral anticoagulants and low molecular-weight heparin (LMWH) for the acute treatment and secondary prevention of cancer-associated thrombosis (CAT). We sought to identify predictors impacting the use rivaroxaban versus LMWH for CAT in patients with ovarian cancer. Methods: Using US Surveillance, Epidemiology and End Result-Medicare linked data from 2013-2016, we evaluated adults with ovarian cancer, undergoing hospitalization/emergency department admission for CAT and prescribed rivaroxaban or LMWH for outpatient anticoagulation. Univariate analysis was performed to examine the association between covariates and clinicians’ choice to use rivaroxaban or LMWH. Variables with a p-value < 0.20 upon univariate analysis were deemed significant and subsequently included into a stepwise, backwards multivariable logistic regression model to obtain adjusted odd ratios (ORs) of treatment assignment. Results: Of the 125 ovarian cancer patients included in our analysis, 26% received rivaroxaban and 74% LMWH. All patients had stage 3 or 4 ovarian cancer, 36% were ≥75 years-of-age, 78% were white, and 18% were below the poverty line (p ≥ 0.25). Upon univariate analysis, rural community, time between cancer diagnosis and VTE ≥ 1 year, index VTE without evidence of pulmonary embolism, and CKD ≥ stage 3 were found to be significant predictors of rivaroxaban use when compared to LMWH (p ≤ 0.14 for all). Upon multivariable regression, CKD ≥ stage 3 (OR = 3.13) was shown to be independently associated with rivaroxaban versus LMWH use (p≤0.01). Conclusions: In routine practice, patients were more likely to receive rivaroxaban if they had CKD and lived in a rural area. These differences in prescribing practices may be due to less availability of LMWH in rural areas and less tolerance of injections in CKD patients. Univariate analysis also suggest that low VTE burden (i.e., DVT only) and VTE event ≥ 1 year after cancer diagnosis were also associated with rivaroxaban use over LMWH, which may be due to LMWH therapy as the long-established standard of care for patients with cancer. Large observational studies are needed to confirm these results. [Table: see text]

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