Variables to Predict Risk of Hospital Readmission

As the healthcare industry transitions toward accountable care and payment reform, creative approaches to healthcare is imperative. Poorly coordinated care and shorter hospital stays have resulted in higher rates of readmissions. This has large implications for hospitals and health systems

A Machine Learning Approach for Predicting Inpatient Discharge at Central Maine Medical Center

Operating with a finite quantity of beds, medical resources, and physicians, hospitals are constantly allocating resources under conditions of scarcity. Misallocation of resources and operational inefficiencies are a substantial driver of the United States’ strikingly high healthcare costs. Accurately forecasting the duration which a specific patient will stay in a hospital, also known as a patient’s length of stay, could assist hospital decision makers in optimizing their workflow and allocating their resources efficiently. This paper demonstrates the superiority of a survival random forest approach over classical econometric techniques and current practice at the Central Maine Medical Center. Included in the discussion is an assessment of the strengths and weaknesses of the model, with the hope of informing the application of machine learning methods in the real world

Prognostic value of a modified surprise question designed for use in the emergency department setting.

OBJECTIVE: Few reliable and valid prognostic tools are available to help emergency physicians identify patients who might benefit from early palliative approaches. We sought to determine if responses to a modified version of the surprise question, Would you be surprised if this patient died in the next 30 days could predict in-hospital mortality and resource utilization for hospitalized emergency department patients. METHODS: For this observational study, emergency physicians responded to the modified surprise question with each admission over a five-month study period. Logistic regression analyses were completed and standard test characteristics evaluated. RESULTS: 6,122 visits were evaluated. Emergency physicians responded negatively to the modified surprise question in 918 (15.1%). Test characteristics for in-hospital mortality were: sensitivity 32%, specificity 85%, positive predictive value 6%, negative predictive value 98%. The risk of intensive care unit use (relative risk [RR], 1.87; 95% confidence interval [CI], 1.45 to 2.40), use of \u27comfort measures\u27 orders (RR, 3.43; 95% CI, 2.81 to 4.18), palliative-care consultation (RR, 3.06; 95% CI, 2.62 to 3.56), and in-hospital mortality (RR, 2.18; 95% CI, 1.72 to 2.76) were greater for patients with negative responses. CONCLUSION: The modified surprise question is a simple trigger for palliative care needs, accurately identifying those at greater risk for in-hospital mortality and resource utilization. With a negative predictive value of 98%, affirmative responses to the modified surprise question provide reassurance that in-hospital death is unlikely

Type 2 Diabetes in Children: Estimates of Epidemiology, Quality of Care, Costs and Resource Utilization in a Medicaid Population

Objective: the primary goal of this study was to assess the current state of diabetes, specifically type 2 diabetes in Mississippi Medicaid enrolled pediatric population. Background: Diabetes is the most prevalent pediatric chronic condition. Recent trends indicate that type 2 diabetes in children is increasing. Epidemiology estimates of type 2 diabetes in children and adolescents are limited. Quality of care and their health care utilization estimates are not available. Methods: 2002 - 2004 Mississippi Medicaid claims data were used for this study. A combination of ICD-9 codes (250.0x - 250.9x, where x=0 or 2) and/or oral hypoglycemic (OHG) drug use were used to identify children with type 2 diabetes. Sociodemographic characteristics, risk factors, comorbidities and complications were assessed for all diabetes children. Medication use/adherence and their association with hospitalization and economic outcomes were explored. We also assessed annual screening rates in the type 2 diabetes population. Annual health care resource utilization and expenditures were assessed and modeled using Poisson regression and GLM with gamma distribution and log link respectively. Results: Overall, a sizeable proportion of children enrolled in Mississippi have diabetes, especially type 2 diabetes. Very few children with type 2 diabetes use oral hypoglycemic and antihypertensive medications, even fewer children use antihyperlipidemics. Among users, adherence was poor. Adherence with annual screenings was also suboptimal in this population indicating poor management of type 2 diabetes overall. Children with both diabetes types have higher healthcare resource utilization and expenditures compared to all Medicaid enrolled children without diabetes and pediatric population with asthma and ADHD. Conclusions: type 2 diabetes is prevalent in children enrolled in Mississippi Medicaid and most of these children don\u27t receive optimal care. Healthcare providers should inform patients and children the implications of mismanagement and Medicaid should offer provider incentives to encourage healthcare providers to implement effective interventions

Robert Wood Johnson Foundation - 2008 Annual Report: The Road to Reform

Contains president's message, year in review, program information, statistical highlights, distribution of funds, and grants list

Caring for High-Need, High-Cost Patients: What Makes for a Successful Care Management Program?

Provider groups taking on risk for the overall costs of care in accountable care organizations are developing care management programs to improve care and thereby control costs. Many such programs target "high-need, high-cost" patients: those with multiple or complex conditions, often combined with behavioral health problems or socioeconomic challenges. In this study we compared the operational approaches of 18 successful complex care management programs in order to offer guidance to providers, payers, and policymakers on best practices for complex care management. We found that effective programs customize their approach to their local contexts and caseloads; use a combination of qualitative and quantitative methods to identify patients; consider care coordination one of their key roles; focus on building trusting relationships with patients as well as their primary care providers; match team composition and interventions to patient needs; offer specialized training for team members; and use technology to bolster their efforts

Assessing Transportation Management Associations (TMAs) In Rural Maine As An Approach To Increase Transportation Options

Maine has the distinction of being a beautiful state defined by natural forests, crystal-clear lakes, and a landscape unblemished by the usual marks of the densely populated regions of the U.S. The downside to this rural beauty is the remoteness of the sparsely populated communities which present challenges to residents who are unable to drive themselves to procure basic services because of physical, legal, or economic conditions. Many rural residents are unable to rely on personally-owned, single driver vehicles. According to the Maine Department of Transportation Bureau of Planning (2013), the Eastern Maine region has an estimated unmet need (number of trips needed compared to available services) of 75% (Penobscot County) and 84% (Piscataquis County). The recent reduction in the cost of gasoline has made travel more affordable, but the reality is that many can’t afford the purchase price tag, insurance, and/or maintenance costs to keep their vehicle on the road. The funding trends at the state and local levels will not support an expansion of public transportation to bring rural residents to hub centers for social services, healthcare, school, employment or other destination points. As noted in the Maine Department of Transportation Final Strategic Plan 2025 (2015, p. 13), federal funding in rural regions has remained at 2012 levels, and there is little local funding support for rural transit systems operating outside the more urban cities of Bangor and Ellsworth. A review of the literature on transportation challenges and barriers, particularly in respect to the sparsely populated region of Eastern Maine, provided the basis for this grounded theory qualitative study. A series of thirteen interviews were performed with study participants living in Eastern Maine who were characterized by one or more of the following traits: Low-income; elderly; medically restricted; student; and commuting worker. The results of the study provide insight into factors contributing to the gap, and whether a transportation management association (TMA) and rideshare boards represent reasonable solutions. The study also suggests methods to encourage use of alternative solutions to get Eastern Maine residents to their destinations

Preparing for a Northwest Passage: A Workshop on the Role of New England in Navigating the New Arctic

Preparing for a Northwest Passage: A Workshop on the Role of New England in Navigating the New Arctic (March 25 - 27, 2018 -- The University of New Hampshire) paired two of NSF\u27s 10 Big Ideas: Navigating the New Arctic and Growing Convergence Research at NSF. During this event, participants assessed economic, environmental, and social impacts of Arctic change on New England and established convergence research initiatives to prepare for, adapt to, and respond to these effects. Shipping routes through an ice-free Northwest Passage in combination with modifications to ocean circulation and regional climate patterns linked to Arctic ice melt will affect trade, fisheries, tourism, coastal ecology, air and water quality, animal migration, and demographics not only in the Arctic but also in lower latitude coastal regions such as New England. With profound changes on the horizon, this is a critical opportunity for New England to prepare for uncertain yet inevitable economic and environmental impacts of Arctic change

Pregnant women's access to maternal health information and its impact on healthcare utilization behaviour in rural Tanzania

Objectives: The purpose of this study was to examine rural women s access to maternal health information and its impact on levels of skilled healthcare utilization. Method: A qualitative study involving twenty five (25) pregnant women,five (5) Skilled healthcare providers and five (5) Traditional Birth Attendants (TBAs) was conducted in Chamwino District in Dodoma Region, Tanzania for a period of six months. Due to time and resource limitation the researcher selected two (2) of the 32 wards in the district where the problem of maternal mortality and non-utilization of skilled healthcare was most prominent. The two selected wards were Msanga and Buigiri wards. The researcher used The Health Belief Model and Theory of Planned Behaviour to develop interview questions and focus group guides as well as the interpretation of the findings. The researcher examined how variable factors e.g. maternal health literacy, individual perceptions, local knowledge and care provider-related factors affect pregnant women s health behaviours and utilization of skilled maternal services. The Data was analysed thematically using the 6-stage guide to thematic data analysis with the help of NVIvo Software. Results: The inadequate conditions of the health facilities and the poor working conditions of the care providers affected the provision of quality of maternal services and health information to pregnant women in the study area. The limited access to skilled maternal health information from skilled healthcare providers and lack of alternative sources of reliable health information led pregnant women to seek health information from their Mothers-in-laws, TBAs and other women in the society. However, there was a shortcoming of information inaccuracy as their health advice was not based on previous expert advice but rather on the personal opinion and attitude towards skilled maternal services. The limited access to maternal health information caused majority of pregnant women to underestimate the risks of pregnancy related complications and how they responded to pregnancy danger signs and other ill-health conditions that raised during pregnancy. The majority of pregnant women reported not to seek and kind of care when experienced a health problem. It was also found that during labour some would go to the TBA for childbirth and later go to the dispensary when the TBA failed while others would just go for TBAs opinion and confirmation that it was real labour then go to the health facility. This delayed women s timely access to obstetric care which is essential for positive outcome when a pregnant woman experiences a pregnancy or childbirth complications. Conclusion: The improvement of the quality of skilled healthcare services in rural areas is a prerequisite for achieving desired outcomes in maternal mortality reduction efforts in Tanzania. However, improvement of quality itself is not a panacea if pregnant women are not aware of the services, hence the healthcare providers should also focus in increasing provision of maternal health information to pregnant women. The findings show that the limited access to skilled maternal health information from healthcare providers and lack of alternative sources for reliable health information has constrained majority of these women from becoming maternal health literate hence affecting their levels of utilization of skilled maternal services. The healthcare providers and policy makers should focus on meeting the health information needs of general rural populations and enable them to become well-informed and knowledgeable to make better and well-informed maternal health decisions

Determinants of Hospital Administrators\u27 Choice of Anesthesia Practice Model

Hospital administrators are being held accountable by patients, insurers, and other stakeholders in evaluating their overall hospital performance to reduce costs and improve efficiency. With the move to alternative payment models and value-based purchasing, hospital administrators must understand the economic viability and value that their specialty services bring to their facility. The purpose of this study was to identify the determinants New England acute care hospital administrators’ utilize in making the choice of anesthesia practice model for their facility. A quantitative, exploratory study of factors hospital administrators use when choosing an anesthesia practice model utilizing a non-experimental, correlational research design was completed. The research was descriptive in nature to determine the factors that influenced a hospital administrator when making decisions about the type of anesthesia practice model that would be the best for their hospital. This research examined seventeen independent variables that were hypothesized to determine hospital administrators’ choice of anesthesia practice model. After the final logistic regression analysis, it was determined that the presence of a hospital being located in a medically underserved area (MUA) alone was a predictor of type of anesthesia practice model utilized. In light of the study limitations and prior literature on the CRNA-only model being present in almost 100% of rural facilities, more exploration is necessary to come to more robust conclusions on predictors of choice of anesthesia practice model determined by hospital administrators. This study showed that there are definitive areas that hospital administrators identify as high importance to the healthy functioning of their facility. By addressing these needs, an anesthesia department could contribute to the overall stability of the hospital, while at the same time, making themselves a more valuable asset overall. Value-driven services offered by anesthesia departments may be the determining factor in choice of anesthesia practice model. By measuring and analyzing anesthesia provider and hospital demographics and hospital administrators’ perceptions of anesthesia services, the objective data collected may assist in defining the most appropriate practice model for a hospital