Evaluating the impact of financial incentives on inequalities in smoking cessation in primary care

Background: Smoking cessation interventions are underprovided in primary care. This thesis examines the impact of financial incentives on the provision of smoking cessation interventions, and inequalities in provision, in primary care. Methods: • Systematic review of financial incentives for smoking cessation in healthcare. • Cross sectional study using general practice data from Wandsworth, London, using logistic regression to examine associations between ethnicity and disease group with ascertainment of smoking status and provision of cessation advice following the introduction of the UK’s Quality and Outcomes Framework (QOF). • Before-and-after studies using general practice data from Hammersmith & Fulham, London, looking at the impact of a local financial incentive scheme (QOF+) on smoking outcomes for patients without smoking-related diseases (primary prevention), and antenatal patients, using logistic regression to examine inequalities. Results: Introduction of financial incentives was associated with increased recording of smoking status and advice to smokers, most evident for patients with smoking-related diseases compared with patients without smoking-related diseases, for whom there were much smaller incentives for recording smoking status and none for offering stop smoking advice. However, when specific incentives were provided for primary prevention large improvements in smoking outcomes were seen. The youngest and oldest groups of patients were less likely to be asked about smoking. White British patients were more likely to smoke than other ethnic groups, except Black Caribbean men with depression, 62% of whom smoked. Smoking advice was provided relatively equitably, but Black Caribbean men with depression were less likely to receive advice than White British men with depression (59% vs 81%). Disparities in smoking outcomes with respect to age and ethnicity persisted after the financial incentives were introduced. Conclusions: Introduction of financial incentives was associated with increases in recording smoking status and largely equitable provision of cessation advice, but variations in smoking outcomes between groups persisted. Extending financial incentives to include recording of ethnicity and rewarding quit rates may further improve smoking outcomes in primary care.Open Acces

CLADAG 2021 BOOK OF ABSTRACTS AND SHORT PAPERS

The book collects the short papers presented at the 13th Scientific Meeting of the Classification and Data Analysis Group (CLADAG) of the Italian Statistical Society (SIS). The meeting has been organized by the Department of Statistics, Computer Science and Applications of the University of Florence, under the auspices of the Italian Statistical Society and the International Federation of Classification Societies (IFCS). CLADAG is a member of the IFCS, a federation of national, regional, and linguistically-based classification societies. It is a non-profit, non-political scientific organization, whose aims are to further classification research

Laboratory medicine : a national status report

Although the U.S. ranks highest in per capita health care spending, there is overwhelming evidence of gaps between well-founded standards of care and health care practice. The Institute of Medicine reports, To Err is Human: Building a Safer Health System (1999) and Crossing the Quality Chasm: A New Health System for the 21st Century (2001), and other sentinel studies have focused national attention on improving the quality and safety of health care. Stakeholders agree that the quality of care delivered in the U.S. is inadequate and that the organization and delivery of health care must be improved.Given the shortfalls in quality and continued escalation in costs, health care must be assessed continually to inform decision-making, and redesign delivery and incentives as needed, to yield appropriate, high quality care. An integral component of care is laboratory medicine, which extends across research; screening, diagnosis, and treatment; and public health. Appropriate use of laboratory testing is essential for achieving safe, effective, and efficient care to patients.Health care must be informed by data derived from scientific assessment of efficacy and effectiveness of procedures, and must adapt to ongoing changes in science, technology, and practice. Laboratory medicine is not only responding to these changes, but is contributing to them in an environment of demographic, social, and economic change.The Centers for Disease Control and Prevention (CDC) has commissioned this report to contribute to the groundwork for transforming laboratory medicine over the next decade. CDC charged The Lewin Group, under subcontract to Battelle Memorial Institute, with drafting this document, Laboratory Medicine: A National Status Report. The report examines in detail the key factors affecting the laboratory medicine sector, and is organized into chapters on the following main topics:Value of laboratory medicine\ue2\u20ac\ua2 Market profile of the laboratory medicine sector\ue2\u20ac\ua2 Laboratory medicine workforce\ue2\u20ac\ua2 Quality and the total testing process\ue2\u20ac\ua2 Quality systems and performance measurement\ue2\u20ac\ua2 Laboratory information systems\ue2\u20ac\ua2 Federal regulatory oversight of laboratory medicine\ue2\u20ac\ua2 Reimbursement for laboratory medicinePrepared for: Division of Laboratory Systems, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention; prepared by: The Lewin Group under subcontract to Battelle Memorial Institute.Acknowledgments -- Executive summary -- Introduction -- Methods and limitations -- I. The value of laboratory medicine to health care -- II. Market profile of the laboratory medicine sector -- III. Laboratory medicine workforce -- IV. Quality and the total testing process -- V. Quality systems and performance measurement -- VI. Laboratory information systems -- VII. Federal regulatory oversight of laboratory medicine -- VIII. Reimbursement for laboratory medicine -- Appendix A. Desirable characteristics for performance measures -- Appendix B. Summary of selected performance indicators used by stakeholders -- Appendix C. Development of the Medicare payment system

Informatics for Health 2017 : advancing both science and practice

Conference report, The Informatics for Health congress, 24-26 April 2017, in Manchester, UK.Introduction : The Informatics for Health congress, 24-26 April 2017, in Manchester, UK, brought together the Medical Informatics Europe (MIE) conference and the Farr Institute International Conference. This special issue of the Journal of Innovation in Health Informatics contains 113 presentation abstracts and 149 poster abstracts from the congress. Discussion : The twin programmes of “Big Data” and “Digital Health” are not always joined up by coherent policy and investment priorities. Substantial global investment in health IT and data science has led to sound progress but highly variable outcomes. Society needs an approach that brings together the science and the practice of health informatics. The goal is multi-level Learning Health Systems that consume and intelligently act upon both patient data and organizational intervention outcomes. Conclusions : Informatics for Health demonstrated the art of the possible, seen in the breadth and depth of our contributions. We call upon policy makers, research funders and programme leaders to learn from this joined-up approach.Publisher PDFPeer reviewe

Identifying individuals at-risk of developing oesophageal adenocarcinoma through symptom, risk factor and salivary biomarker analysis

Background: Oesophageal adenocarcinoma (OAC) carries a grave prognosis. Existing early detection strategies are flawed predominately because of reliance upon symptoms known to occur late when the disease is often incurable. Detection of individuals with Barrett’s Oesophagus (BO), a known pre-malignant condition, is problematic and the vast majority will not develop OAC. Aim: To explore novel methods of identifying patients with or at risk of OAC through machine learning (ML) techniques and biomarker identification. Materials and Methods: Initial work utilised novel ML on two existing patient symptom and risk factor questionnaire datasets. Additionally, targeted expression analysis was performed to establish whether transcriptomic biomarkers were present in blood and saliva of affected patients. Optimal RNA extraction techniques and saliva collection strategies for sufficient quality and quantity RNA were determined. Whole mRNA sequencing was performed on patient salivary RNA to identify biomarkers for future assessment. Epigenetic analysis was performed on salivary DNA to identify biomarkers. ML techniques analysed these data to derive a risk prediction tool. Results: ML techniques on questionnaire data produced satisfactory sensitivity (90%), but accuracy not appropriate for population screening (AUC 0.77). Blood and saliva extraction and collection methods were established and samples found to contain biomarkers. Targeted transcriptomic expression analysis demonstrated 12 / 22 tested genes were significantly aberrantly expressed in patients. 5 genes, combined with 6 questionnaire data-points, identified those with or at risk of OAC 93% sensitivity, AUC 0.88. Whole mRNA sequencing identified a further 134 genes implicated in OAC pathogenesis requiring future testing. Epigenetic analysis found 25 differentially methylated regions, when combined, identified those with or at risk of OAC to 99.9% accuracy. 5 Conclusion: Utilisation of salivary biomarkers is a potentially effective means to identify individuals with or at risk of OAC. Further work exploring transcriptomic and epigenetic data established in this thesis should be performed

2021 Student Symposium Research and Creative Activity Book of Abstracts

The UMaine Student Symposium (UMSS) is an annual event that celebrates undergraduate and graduate student research and creative work. Students from a variety of disciplines present their achievements with video presentations. It’s the ideal occasion for the community to see how UMaine students’ work impacts locally – and beyond. The 2021 Student Symposium Research and Creative Activity Book of Abstracts includes a complete list of student presenters as well as abstracts related to their works

Diagnostic or Therapeutic Strategies for Pregnancy Complications

It is well known that pregnancy complications, including preeclampsia, preterm birth, stillbirth, and intrauterine growth restriction affect over 12% of all pregnancies worldwide. These complications negatively impact both maternal and neonatal health and have short- and long-term effects such as an increased risk of neurodevelopmental and cardiovascular diseases. Over the past decade, numerous groups have investigated the use of new and/or existing drugs to either prolong gestation, such as in cases of threatened preterm labour; alleviate hypertension in preeclampsia; or promote adequate blood flow and nutrient delivery to the placenta to facilitate growth in IUGR. The overarching goal has been to promote healthier pregnancies and neonatal health, but it has been difficult to translate this work into the clinical setting, with problems in terms of drug delivery, specificity, and importantly, the early diagnostic capacities for complications in pregnancy. This book focuses on the early detection, potential novel therapeutic targets, risk factors, maternal outcomes, and long-term consequences of this critical problem