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https://www.readbyqxmd.com/read/28726751/an-adaptive-feature-learning-model-for-sequential-radar-high-resolution-range-profile-recognition
#1
Xuan Peng, Xunzhang Gao, Yifan Zhang, Xiang Li
This paper proposes a new feature learning method for the recognition of radar high resolution range profile (HRRP) sequences. HRRPs from a period of continuous changing aspect angles are jointly modeled and discriminated by a single model named the discriminative infinite restricted Boltzmann machine (Dis-iRBM). Compared with the commonly used hidden Markov model (HMM)-based recognition method for HRRP sequences, which requires efficient preprocessing of the HRRP signal, the proposed method is an end-to-end method of which the input is the raw HRRP sequence, and the output is the label of the target...
July 20, 2017: Sensors
https://www.readbyqxmd.com/read/28717900/elements-of-program-design-in-medicare-s-value-based-and-alternative-payment-models-a-narrative-review
#2
Karen E Joynt Maddox, Aditi P Sen, Lok Wong Samson, Rachael B Zuckerman, Nancy DeLew, Arnold M Epstein
Increasing emphasis on value in health care has spurred the development of value-based and alternative payment models. Inherent in these models are choices around program scope (broad vs. narrow); selecting absolute or relative performance targets; rewarding improvement, achievement, or both; and offering penalties, rewards, or both. We examined and classified current Medicare payment models-the Hospital Readmissions Reduction Program (HRRP), Hospital Value-Based Purchasing Program (HVBP), Hospital-Acquired Conditions Reduction Program (HACRP), Medicare Advantage Quality Star Rating program, Physician Value-Based Payment Modifier (VM) and its successor, the Merit-Based Incentive Payment System (MIPS), and the Medicare Shared Savings Program (MSSP) on these elements of program design and reviewed the literature to place findings in context...
July 17, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28710221/trends-in-readmission-rates-for-safety-net-hospitals-and-non-safety-net-hospitals-in-the-era-of-the-us-hospital-readmission-reduction-program-a-retrospective-time-series-analysis-using-medicare-administrative-claims-data-from-2008-to-2015
#3
Amy M Salerno, Leora I Horwitz, Ji Young Kwon, Jeph Herrin, Jacqueline N Grady, Zhenqiu Lin, Joseph S Ross, Susannah M Bernheim
OBJECTIVE: To compare trends in readmission rates among safety net and non-safety net hospitals under the US Hospital Readmission Reduction Program (HRRP). DESIGN: A retrospective time series analysis using Medicare administrative claims data from January 2008 to June 2015. SETTING: We examined 3254 US hospitals eligible for penalties under the HRRP, categorised as safety net or non-safety net hospitals based on the hospital's proportion of patients with low socioeconomic status...
July 13, 2017: BMJ Open
https://www.readbyqxmd.com/read/28657950/national-trends-in-readmission-following-inpatient-surgery-in-the-hospital-readmissions-reduction-program-era
#4
Winta T Mehtsun, Irene Papanicolas, Jie Zheng, E John Orav, Keith D Lillemoe, Ashish K Jha
OBJECTIVE: The aim of this study was to investigate whether the Hospital Readmissions Reduction Program, a national program that introduced financial penalties for high readmission rates for certain medical conditions, had a "spillover" effect on surgical conditions. SUMMARY BACKGROUND DATA: During the past decade, there have been multiple national efforts to improve surgical care. Readmission rates are a key metric for assessing surgical quality. Whether surgical readmission rates have declined, and whether the Hospital Readmissions Reduction Program has had an influence is unclear...
June 27, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28647442/the-impact-of-the-transition-from-volume-to-value-on-heart-failure-care-implications-of-novel-payment-models-and-quality-improvement-initiatives
#5
REVIEW
Dushyanth Srinivasan, Nihar R Desai
In response to wide variation in quality and outcomes as well as escalating health care costs, the U.S. health care system is transitioning away from a volume based payment system to a quality- and value-based system. Medicare, the largest insurer and payer of healthcare, has accelerated the movement towards value-based care with the development and implementation of myriad alternative payment models and pay for performance programs as part of the Affordable Care Act. Given that heart failure affects a significant number of Medicare patients and these patients account for a disproportionate amount of healthcare utilization and spending, heart failure has become a focal point for these initiatives...
June 21, 2017: Journal of Cardiac Failure
https://www.readbyqxmd.com/read/28480598/further-evidence-on-the-system-wide-effects-of-the-hospital-readmissions-reduction-program
#6
Berna Demiralp, Fang He, Lane Koenig
OBJECTIVE: To investigate the potential spillover effects of the Hospital Readmissions Reduction Program (HRRP) on readmissions for nontargeted conditions and patient populations. We examine HRRP effects on nontargeted conditions separately and on non-Medicare populations in Florida and California. DATA SOURCES: From 2007-2013, 100 percent Medicare inpatient claims data, 2007-2013 State Inpatient Database (SID) for Florida, and 2007-2011 SID for California. STUDY DESIGN: We conducted an interrupted time series analysis to estimate the change in 30-day all-cause unplanned readmission trends after the start of HRRP using logistic regression...
May 8, 2017: Health Services Research
https://www.readbyqxmd.com/read/28471510/centers-for-medicare-and-medicaid-services-readmission-reports-inaccurately-describe-an-institution-s-decompensated-heart-failure-admissions
#7
Zachary L Cox, Pikki Lai, Connie M Lewis, Daniel J Lenihan
Hospitals typically use Center for Medicare and Medicaid Services' (CMS) Hospital Readmission Reduction Program (HRRP) administrative reports as the standard of heart failure (HF) admission quantification. We aimed to evaluate the HF admission population identified by CMS HRRP definition of HF hospital admissions compared with a clinically based HF definition. We evaluated all hospital admissions at an academic medical center over 16 months in patients with Medicare fee-for service benefits and age ≥65 years...
May 4, 2017: Clinical Cardiology
https://www.readbyqxmd.com/read/28461357/most-hospitals-received-annual-penalties-for-excess-readmissions-but-some-fared-better-than-others
#8
Michael P Thompson, Teresa M Waters, Cameron M Kaplan, Yu Cao, Gloria J Bazzoli
The Hospital Readmissions Reduction Program (HRRP) initiated by the Affordable Care Act levies financial penalties against hospitals with excess thirty-day Medicare readmissions. We sought to understand the penalty burden over the program's first five years, focusing on characteristics of hospitals that received penalties during all five years, how penalties changed over time, and the relationship between baseline and subsequent performance. More than half of participating hospitals were penalized by the Centers for Medicare and Medicaid Services in all five years of the program...
May 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28395006/association-between-hospitals-engagement-in-value-based-reforms-and-readmission-reduction-in-the-hospital-readmission-reduction-program
#9
Andrew M Ryan, Sam Krinsky, Julia Adler-Milstein, Cheryl L Damberg, Kristin A Maurer, John M Hollingsworth
Importance: Medicare is experimenting with numerous concurrent reforms aimed at improving quality and value for hospitals. It is unclear if these myriad reforms are mutually reinforcing or in conflict with each other. Objective: To evaluate whether hospital participation in voluntary value-based reforms was associated with greater improvement under Medicare's Hospital Readmission Reduction Program (HRRP). Design, Setting, and Participants: Retrospective, longitudinal study using publicly available national data from Hospital Compare on hospital readmissions for 2837 hospitals from 2008 to 2015...
June 1, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28027367/association-between-hospital-penalty-status-under-the-hospital-readmission-reduction-program-and-readmission-rates-for-target-and-nontarget-conditions
#10
COMPARATIVE STUDY
Nihar R Desai, Joseph S Ross, Ji Young Kwon, Jeph Herrin, Kumar Dharmarajan, Susannah M Bernheim, Harlan M Krumholz, Leora I Horwitz
Importance: Readmission rates declined after announcement of the Hospital Readmission Reduction Program (HRRP), which penalizes hospitals for excess readmissions for acute myocardial infarction (AMI), heart failure (HF), and pneumonia. Objective: To compare trends in readmission rates for target and nontarget conditions, stratified by hospital penalty status. Design, Setting, and Participants: Retrospective cohort study of Medicare fee-for-service beneficiaries older than 64 years discharged between January 1, 2008, and June 30, 2015, from 2214 penalty hospitals and 1283 nonpenalty hospitals...
December 27, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28024302/readmission-rates-after-passage-of-the-hospital-readmissions-reduction-program-a-pre-post-analysis
#11
Jason H Wasfy, Corwin Matthew Zigler, Christine Choirat, Yun Wang, Francesca Dominici, Robert W Yeh
Background: Whether hospitals with the highest risk-standardized readmission rates (RSRRs) subsequently experienced the greatest improvement after passage of the Medicare Hospital Readmissions Reduction Program (HRRP) is unknown. Objective: To evaluate whether passage of the HRRP was followed by acceleration in improvement in 30-day RSRRs after hospitalizations for acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia and whether the lowest-performing hospitals had faster acceleration in improvement after passage of the law than hospitals that were already performing well...
March 7, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/27929411/a-robust-range-grating-lobe-suppression-method-based-on-image-contrast-for-stepped-frequency-sar
#12
Wen-Bin Gao, Teng Long, Ze-Gang Ding, Yi-Rong Wu
The magnitude error and phase error (MEPE) in the transfer function of a stepped-frequency synthetic aperture radar (SAR) system results in a periodic MEPE in the synthesized wideband waveform (SWW), which induces the grating lobes in the high-resolution range profile (HRRP). In this paper, a robust data-driven grating lobe suppression (GLS) method is proposed. Based on a contrast-based error estimation method and the grating lobes of the brightest scatterers in the SAR image, the periodic MEPE can be robustly estimated using the proposed method...
December 6, 2016: Sensors
https://www.readbyqxmd.com/read/27908393/association-of-30-day-readmission-metric%C3%A2-for-heart-failure-under-the-hospital%C3%A2-readmissions-reduction-program%C3%A2-with-quality-of-care-and%C3%A2-outcomes
#13
Ambarish Pandey, Harsh Golwala, Haolin Xu, Adam D DeVore, Roland Matsouaka, Michael Pencina, Dharam J Kumbhani, Adrian F Hernandez, Deepak L Bhatt, Paul A Heidenreich, Clyde W Yancy, James A de Lemos, Gregg C Fonarow
OBJECTIVES: This study sought to determine whether processes of care and long-term clinical outcomes for heart failure (HF) admissions across Get With The Guidelines-Heart Failure (GWTG-HF) program participating centers differ according to HF-specific risk-adjusted 30-day readmission rates (excess readmission ratio [ERR]) as determined by the Hospital Readmission Reduction Program (HRRP). BACKGROUND: HRRP penalizes hospitals with higher than expected risk-adjusted 30-day readmission rates (ERR >1) for common conditions including HF...
December 2016: JACC. Heart Failure
https://www.readbyqxmd.com/read/27766634/reliability-of-30-day-readmission-measures-used-in-the-hospital-readmission-reduction-program
#14
Michael P Thompson, Cameron M Kaplan, Yu Cao, Gloria J Bazzoli, Teresa M Waters
OBJECTIVE: To assess the reliability of risk-standardized readmission rates (RSRRs) for medical conditions and surgical procedures used in the Hospital Readmission Reduction Program (HRRP). DATA SOURCES: State Inpatient Databases for six states from 2011 to 2013 were used to identify patient cohorts for the six conditions used in the HRRP, which was augmented with hospital characteristic and HRRP penalty data. STUDY DESIGN: Hierarchical logistic regression models estimated hospital-level RSRRs for each condition, the reliability of each RSRR, and the extent to which socioeconomic and hospital factors further explain RSRR variation...
December 2016: Health Services Research
https://www.readbyqxmd.com/read/27755392/the-hospital-score-predicts-potentially-preventable-30-day-readmissions-in-conditions-targeted-by-the-hospital-readmissions-reduction-program
#15
MULTICENTER STUDY
Robert E Burke, Jeffrey L Schnipper, Mark V Williams, Edmondo J Robinson, Eduard E Vasilevskis, Sunil Kripalani, Joshua P Metlay, Grant S Fletcher, Andrew D Auerbach, Jacques D Donzé
BACKGROUND/OBJECTIVES: New tools to accurately identify potentially preventable 30-day readmissions are needed. The HOSPITAL score has been internationally validated for medical inpatients, but its performance in select conditions targeted by the Hospital Readmission Reduction Program (HRRP) is unknown. DESIGN: Retrospective cohort study. SETTING: Six geographically diverse medical centers. PARTICIPANTS/EXPOSURES: All consecutive adult medical patients discharged alive in 2011 with 1 of the 4 medical conditions targeted by the HRRP (acute myocardial infarction, chronic obstructive pulmonary disease, pneumonia, and heart failure) were included...
March 2017: Medical Care
https://www.readbyqxmd.com/read/27733074/financial-impact-of-ivabradine-on-reducing-heart-failure-penalties-under-the-hospital-readmission-reduction-program
#16
Anuraag R Kansal, Stanimira Krotneva, Ali Tafazzoli, Harshali K Patel, Jeffrey S Borer, Michael Böhm, Michel Komajda, Juan Maya, Luigi Tavazzi, Ian Ford, Adrian Kielhorn
OBJECTIVE: The introduction of the Hospital Readmission Reduction Program (HRRP) has led to renewed interest in developing strategies to reduce 30 day readmissions among patients with heart failure (HF). In this study, a model was developed to investigate whether the addition of ivabradine to a standard-of-care (SoC) treatment regimen for patients with HF would reduce HRRP penalties incurred by a hypothetical hospital with excess 30 day readmissions. RESEARCH DESIGN: A model using a Monte Carlo simulation framework was developed...
February 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/27732093/action-is-the-foundational-key-to-all-success
#17
Elena Barengolts
CMS = Centers for Medicare and Medicaid Services COPD = chronic obstructive pulmonary disease H2H = Hospital-to-Home HF = heart failure HRRP = Hospital Re-admissions Reduction Program.
October 2016: Endocrine Practice
https://www.readbyqxmd.com/read/27556831/opinions-on-the-hospital-readmission-reduction-program-results-of-a-national-survey-of-hospital-leaders
#18
Karen E Joynt, Jose E Figueroa, John Oray, Ashish K Jha
OBJECTIVES: To determine the opinions of US hospital leadership on the Hospital Readmissions Reduction Program (HRRP), a national mandatory penalty-for-performance program. STUDY DESIGN: We developed a survey about federal readmission policies. We used a stratified sampling design to oversample hospitals in the highest and lowest quintile of performance on readmissions, and hospitals serving a high proportion of minority patients. METHODS: We surveyed leadership at 1600 US acute care hospitals that were subject to the HRRP, and achieved a 62% response rate...
August 1, 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27551097/disulfide-cross-linking-influences-symbiotic-activities-of-nodule-peptide-ncr247
#19
Mohammed Shabab, Markus F F Arnold, Jon Penterman, Andrew J Wommack, Hartmut T Bocker, Paul A Price, Joel S Griffitts, Elizabeth M Nolan, Graham C Walker
Interactions of rhizobia with legumes establish the chronic intracellular infection that underlies symbiosis. Within nodules of inverted repeat-lacking clade (IRLC) legumes, rhizobia differentiate into nitrogen-fixing bacteroids. This terminal differentiation is driven by host nodule-specific cysteine-rich (NCR) peptides that orchestrate the adaptation of free-living bacteria into intracellular residents. Medicago truncatula encodes a family of >700 NCR peptides that have conserved cysteine motifs. NCR247 is a cationic peptide with four cysteines that can form two intramolecular disulfide bonds in the oxidized forms...
September 6, 2016: Proceedings of the National Academy of Sciences of the United States of America
https://www.readbyqxmd.com/read/27503972/accounting-for-patients-socioeconomic-status-does-not-change-hospital-readmission-rates
#20
Susannah M Bernheim, Craig S Parzynski, Leora Horwitz, Zhenqiu Lin, Michael J Araas, Joseph S Ross, Elizabeth E Drye, Lisa G Suter, Sharon-Lise T Normand, Harlan M Krumholz
There is an active public debate about whether patients' socioeconomic status should be included in the readmission measures used to determine penalties in Medicare's Hospital Readmissions Reduction Program (HRRP). Using the current Centers for Medicare and Medicaid Services methodology, we compared risk-standardized readmission rates for hospitals caring for high and low proportions of patients of low socioeconomic status (as defined by their Medicaid status or neighborhood income). We then calculated risk-standardized readmission rates after additionally adjusting for patients' socioeconomic status...
August 1, 2016: Health Affairs
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