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https://www.readbyqxmd.com/read/29275460/implementation-of-a-regional-perinatal-data-repository-from-clinical-and-billing-records
#1
Eric S Hall, James M Greenberg, Louis J Muglia, Parth Divekar, Janet Zahner, Jay Gholap, Matt Leonard, Keith Marsolo
Objectives To describe the implementation of the first phase of a regional perinatal data repository and to provide a roadmap for others to navigate technical, privacy, and data governance concerns in implementing similar resources. Methods Our implementation integrated regional physician billing records with maternal and infant electronic health records from an academic delivery hospital. These records, representing births during 2013-2015, constituted a data core supporting linkage to additional ancillary data sets...
December 23, 2017: Maternal and Child Health Journal
https://www.readbyqxmd.com/read/29240000/complete-versus-staged-repair-for-neonates-with-tetralogy-of-fallot-establishment-and-validation-of-a-cohort-of-2235-patients-using-detailed-surgery-sequence-review-of-health-care-administrative-data
#2
Jill J Savla, Brian T Fisher, Jennifer A Faerber, Yuan-Shung V Huang, Laura Mercer-Rosa
BACKGROUND: The surgical strategy for neonates with tetralogy of Fallot (TOF) consists of complete or staged repair. Assessing the comparative effectiveness of these approaches is facilitated by a large multicenter cohort. We propose a novel process for cohort assembly using the Pediatric Health Information System (PHIS), an administrative database that contains clinical and billing data for inpatient and emergency department stays from tertiary children's hospitals. METHODS: A 4-step process was used to identify neonates with TOF: (1) screen neonates in PHIS with International Classification of Diseases-9 (ICD-9) diagnosis or procedure codes for TOF; (2) include patients with TOF procedures before 30 days of age; (3) exclude patients with missing 2-year follow-up data; (4) analyze patients' 2-year surgery sequence patterns, exclude patients inconsistent with a treatment strategy for TOF, and designate patients as complete or staged repair...
December 12, 2017: Medical Care
https://www.readbyqxmd.com/read/29238901/tower-of-babel-problem-in-telehealth-addressing-the-health-information-exchange-needs-of-the-north-carolina-statewide-telepsychiatry-program-nc-step
#3
Sy Atezaz Saeed
Telepsychiatry is a viable option for providing psychiatric care to those who are currently underserved or who lack access to services. While the current technology is adequate for most uses, and continues to advance, there remain barriers to its widespread utilization. One such barrier when working with different healthcare systems is that they utilize different electronic medical record systems (EMRs). This paper describes the experience of the North Carolina Statewide Telepsychiatry Program (NC-STeP) with this problem and how the program successfully resolved it by establishing a web portal that connects participating hospital emergency departments and remote psychiatric providers to share secure electronic health information regarding patient encounters across different EMRs...
December 14, 2017: Psychiatric Quarterly
https://www.readbyqxmd.com/read/29218817/impact-of-a-shared-decision-making-intervention-on-healthcare-utilization-a-secondary-analysis-of-the-chest-pain-choice-multicenter-randomized-trial
#4
Jason T Schaffer, Erik P Hess, Judd E Hollander, Jeffrey A Kline, Carlos A Torres, Deborah B Diercks, Russell Jones, Kelly P Owen, Zachary F Meisel, Michel Demers, Annie Leblanc, Jonathan Inselman, Jeph Herrin, Victor M Montori, Nilay D Shah
BACKGROUND: Patients at low risk for acute coronary syndrome (ACS) are frequently admitted for observation and cardiac testing, resulting in substantial burden and cost to the patient and the healthcare system. OBJECTIVES: The purpose of this investigation was to measure the effect of the Chest Pain Choice decision aid (CPC) on overall healthcare utilization as well as utilization of specific services both during the index emergency department visit and in the subsequent 45 days...
December 8, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29206564/advance-care-planning-in-an-accountable-care-organization-is-associated-with-increased-advanced-directive-documentation-and-decreased-costs
#5
William F Bond, Minchul Kim, Chris M Franciskovich, Jason E Weinberg, Jessica D Svendsen, Linda S Fehr, Amy Funk, Robert Sawicki, Carl V Asche
BACKGROUND: Advance care planning (ACP) documents patient wishes and increases awareness of palliative care options. OBJECTIVE: To study the association of outpatient ACP with advanced directive documentation, utilization, and costs of care. DESIGN: This was a case-control study of cases with ACP who died matched 1:1 with controls. We used 12 months of data pre-ACP/prematch and predeath. We compared rates of documentation with logit model regression and conducted a difference-in-difference analysis using generalized linear models for utilization and costs...
December 5, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29193893/sex-differences-in-healthcare-utilization-end-stage-renal-disease-and-mortality-among-medicaid-beneficiaries-with-incident-lupus-nephritis
#6
Candace H Feldman, Anna Broder, Hongshu Guan, Jinoos Yazdany, Karen H Costenbader
OBJECTIVE: While systemic lupus erythematosus (SLE) and lupus nephritis (LN) disproportionately affect females, prior studies suggest that males may experience poorer outcomes. We investigated sex differences in healthcare utilization, end-stage renal disease (ESRD) and mortality among patients with LN receiving Medicaid, public insurance for low-income individuals. METHODS: Within Medicaid Analytic eXtract (MAX) from 29 states (2000-2010), we used billing claims to identify individuals 5-65 years with incident LN (PPV 80%)...
November 28, 2017: Arthritis & Rheumatology
https://www.readbyqxmd.com/read/29155611/can-chemotherapy-related-acute-care-visits-be-accurately-identified-in-administrative-data
#7
Monika K Krzyzanowska, Katherine Enright, Rahim Moineddin, Lingsong Yun, Melanie Powis, Mohammed Ghannam, Eva Grunfeld
PURPOSE: There is increasing interest in using administrative data to examine treatment-related complications that lead to emergency department (ED) visits or hospitalizations (H). The purpose of this study was to evaluate the reliability of billing codes for identifying chemotherapy-related acute care visits (CRVs) among women with early-stage breast cancer. MATERIALS AND METHODS: The cohort was identified by using deterministically linked health databases and consisted of women who were diagnosed with early-stage breast cancer who started adjuvant chemotherapy between 2007 and 2009 in Ontario, Canada...
November 20, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/29102093/the-effects-of-kentucky-s-comprehensive-opioid-legislation-on-patients-presenting-with-prescription-opioid-or-heroin-abuse-to-one-urban-emergency-department
#8
Kiran A Faryar, Clifford L Freeman, Annuradha K Persaud, Stephen P Furmanek, Brian E Guinn, William A Mattingly, Timothy L Wiemken, Kimberley A Buckner, Martin R Huecker
BACKGROUND: Prescription opioid abuse has increased to epidemic proportions in the United States. Kentucky, along with other states, passed comprehensive legislation to monitor and curb opioid prescribing. OBJECTIVES: This paper characterizes patients who presented to the emergency department (ED) after abusing prescription opioids and heroin prior to and after the passage of House Bill 1 (HB1) in April 2012. METHODS: Based on a retrospective review of ED visits from 2009-2014 in one urban adult facility, patients were included if the chief complaint or diagnosis was directly related to prescription opioid or heroin abuse...
October 25, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29095388/identifying-nonprovider-factors-affecting-pediatric-emergency-medicine-provider-efficiency
#9
Fareed Saleh, Kristen Breslin, Paul C Mullan, Zachary Tillett, James M Chamberlain
OBJECTIVE: The aim of this study was to create a multivariable model of standardized relative value units per hour by adjusting for nonprovider factors that influence efficiency. METHODS: We obtained productivity data based on billing records measured in emergency relative value units for (1) both evaluation and management of visits and (2) procedures for 16 pediatric emergency medicine providers with more than 750 hours worked per year. Eligible shifts were in an urban, academic pediatric emergency department (ED) with 2 sites: a tertiary care main campus and a satellite community site...
October 31, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29084098/psychological-predictors-of-postconcussive-symptoms-following-traumatic-injury
#10
Karen A Sullivan, Shannon L Edmed, Jaimi H Greenslade, Melanie White, Kevin Chu, Bill Lukin, Rael T Lange, Janine K Lurie
OBJECTIVE: To determine the contribution of demographics, injury type, pain, and psychological factors on postconcussive symptoms. SETTING AND PARTICIPANTS: Recently injured (n = 54) and noninjured (n = 184) adults were recruited from a hospital emergency department or the community. Thirty-eight individuals met the diagnostic criteria for a mild traumatic brain injury and 16 individuals received treatment for a minor traumatic non-brain injury. MAIN MEASURES: Standardized tests were administered to assess 4 postconcussion symptom types and theorized predictors including a "physiogenic" variable (injury type) and "psychogenic" variables (symptoms of anxiety, depression, and stress) within 1 month of the injury...
October 27, 2017: Journal of Head Trauma Rehabilitation
https://www.readbyqxmd.com/read/29066070/net-revenue-analysis-of-inpatient-and-emergency-department-thyroid-ultrasound-at-a-us-quaternary-care-center-from-2012-to-2015
#11
Kushal Parikh, Matthew S Davenport
PURPOSE: The aim of this study was to understand the financial ramifications of performing nonemergent inpatient and emergency department (ED) adult thyroid ultrasound studies at a US quaternary care center. METHODS: A HIPAA-compliant, institutional review board-exempt retrospective review of 10,334 thyroid ultrasound studies performed between February 2012 and December 2015 was conducted. Demographic, imaging, clinical, and financial data were reviewed. Labor cost analysis was calculated using national salary data and local scheduling practices...
October 20, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/29064752/improving-clinical-information-on-head-ct-requisitions-from-the-emergency-department-to-aid-interpretation-and-billing-efficiency
#12
Dillon Barron, Thomas Spiegel, Gregory L Katzman, Kateland Haas, Saad Ali
OBJECTIVE: The accuracy of radiologic interpretations is higher when appropriate clinical information is provided, as is the likelihood of reimbursement for the studies. The purpose of this project was to evaluate and improve the quality of clinical information provided on head CT requisitions from an urban emergency department (ED). SUBJECTS AND METHODS: In a prospective study conducted from July 2015 to May 2016, attending neuroradiologists evaluated 1100 randomly selected ED requisitions for unenhanced head CT, grading them for clinical and billing adequacy on a scale of 0-2...
October 24, 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/29054492/a-cost-analysis-of-an-interdisciplinary-pediatric-chronic-pain-clinic
#13
Nicole E Mahrer, Jeffrey I Gold, Michael Luu, Patricia Herman
Chronic pain is characterized by high rates of functional impairment, healthcare utilization, and associated costs. Research supports the use of comprehensive, interdisciplinary treatment approaches. However, many hospitals hesitate to offer this full range of services, especially to Medi-Cal/Medicaid patients whose services are reimbursed at low rates. This cost analysis examines the impact on hospital and insurance costs of patients' enrollment in an interdisciplinary pediatric pain clinic, which includes medication management, psychotherapy, biofeedback, acupuncture, and massage...
October 17, 2017: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/29049488/concentration-of-potentially-preventable-spending-among-high-cost-medicare-subpopulations-an-observational-study
#14
Jose F Figueroa, Karen E Joynt Maddox, Nancy Beaulieu, Robert C Wild, Ashish K Jha
Background: Little is known about whether potentially preventable spending is concentrated among a subset of high-cost Medicare beneficiaries. Objective: To determine the proportion of total spending that is potentially preventable across distinct subpopulations of high-cost Medicare beneficiaries. Design: Beneficiaries in the highest 10% of total standardized individual spending were defined as "high-cost" patients, using a 20% sample of Medicare fee-for-service claims from 2012...
November 21, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29031848/local-national-and-regional-viral-haemorrhagic-fever-pandemic-potential-in-africa-a-multistage-analysis
#15
David M Pigott, Aniruddha Deshpande, Ian Letourneau, Chloe Morozoff, Robert C Reiner, Moritz U G Kraemer, Shannon E Brent, Isaac I Bogoch, Kamran Khan, Molly H Biehl, Roy Burstein, Lucas Earl, Nancy Fullman, Jane P Messina, Adrian Q N Mylne, Catherine L Moyes, Freya M Shearer, Samir Bhatt, Oliver J Brady, Peter W Gething, Daniel J Weiss, Andrew J Tatem, Luke Caley, Tom De Groeve, Luca Vernaccini, Nick Golding, Peter Horby, Jens H Kuhn, Sandra J Laney, Edmond Ng, Peter Piot, Osman Sankoh, Christopher J L Murray, Simon I Hay
BACKGROUND: Predicting when and where pathogens will emerge is difficult, yet, as shown by the recent Ebola and Zika epidemics, effective and timely responses are key. It is therefore crucial to transition from reactive to proactive responses for these pathogens. To better identify priorities for outbreak mitigation and prevention, we developed a cohesive framework combining disparate methods and data sources, and assessed subnational pandemic potential for four viral haemorrhagic fevers in Africa, Crimean-Congo haemorrhagic fever, Ebola virus disease, Lassa fever, and Marburg virus disease...
December 16, 2017: Lancet
https://www.readbyqxmd.com/read/28984514/inpatient-costs-and-blood-transfusion-rates-of-sarcopenic-patients-following-thoracolumbar-spine-surgery
#16
Steven L Bokshan, Alex Han, J Mason DePasse, Stephen E Marcaccio, Adam E M Eltorai, Alan H Daniels
OBJECTIVE Sarcopenia, the muscle atrophy associated with aging and disease progression, accounts for nearly $18.5 billion in health care expenditures annually. Given the high prevalence of sarcopenia in patients undergoing orthopedic surgery, the goal of this study was to assess the impact of sarcopenia on inpatient costs following thoracolumbar spine surgery. METHODS Patients older than 55 years undergoing thoracolumbar spine surgery from 2003 to 2015 were retrospectively analyzed. Sarcopenia was measured using total psoas area at the L-4 vertebra on perioperative CT scans...
October 6, 2017: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/28970260/effectiveness-of-a-financial-incentive-to-physicians-for-timely-follow-up-after-hospital-discharge-a-population-based-time-series-analysis
#17
Lauren Lapointe-Shaw, Muhammad Mamdani, Jin Luo, Peter C Austin, Noah M Ivers, Donald A Redelmeier, Chaim M Bell
BACKGROUND: Timely follow-up after hospital discharge may decrease readmission to hospital. Financial incentives to improve follow-up have been introduced in the United States and Canada, but it is unknown whether they are effective. Our objective was to evaluate the impact of an incentive program on timely physician follow-up after hospital discharge. METHODS: We conducted an interventional time series analysis of all medical and surgical patients who were discharged home from hospital between Apr...
October 2, 2017: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
https://www.readbyqxmd.com/read/28956286/all-cause-and-drug-related-medical-events-associated-with-overuse-of-gabapentin-and-or-opioid-medications-a-retrospective-cohort-analysis-of-a-commercially-insured-us-population
#18
Alyssa M Peckham, Kathleen A Fairman, David A Sclar
INTRODUCTION: Overuse of gabapentin and/or opioids occurs in a small percentage of patients at > 3-fold labeled dosages. Gabapentin may potentiate opioid effects. OBJECTIVE: The aim was to assess patient harm, defined as use of inpatient hospital (IPH) or emergency department (ED) services, associated with overuse of gabapentin with or without concomitant overuse of opioids. DATA SOURCE: Data were sourced from the Truven Health MarketScan(®) Commercial Claims and Encounters database, for the years 2013-2015...
September 27, 2017: Drug Safety: An International Journal of Medical Toxicology and Drug Experience
https://www.readbyqxmd.com/read/28940546/measuring-emergency-department-patient-population-acuity
#19
Maame Yaa A B Yiadom, Christopher W Baugh, Tyler W Barrett, Xulei Liu, Alan B Storrow, Timothy J Vogus, Vikram Tiwari, Corey M Slovis, Stephan Russ, Dandan Liu
BACKGROUND: Emergency department (ED) acuity is the general level of patient illness, urgency for clinical intervention, and intensity of resource use in an ED environment. The relative strength of commonly used measures of ED acuity is not well understood. METHODS: We performed a retrospective cross-sectional analysis of ED-level data to evaluate the relative strength of association between commonly used proxy measures with a full spectrum measure of ED acuity...
September 23, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28936486/the-burden-and-social-determinants-of-asthma-for-adults-in-the-state-of-georgia
#20
Mark Ebell, Christian Marchello, Jean O'Connor
BACKGROUND: Asthma is a serious chronic health condition, and social determinants may affect its prevalence. METHODS: Data from the Behavioral Risk Factors Surveillance Survey (BRFSS), the Georgia Asthma Call-back Survey (ACBS), and the Georgia hospital and emergency department survey for patients with a diagnosis of asthma were used. All data were from the years 2011 through 2014. SAS and SUDAAN software were used to calculate weighted prevalence estimates and to perform univariate and multivariate analyses of the association between social determinants, other risk factors, and asthma outcomes...
2017: Journal of the Georgia Public Health Association
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