Privacy Protection and Aggregate Health Data: A Review of Tabular Cell Suppression Methods (Not) Employed in Public Health Data Systems

Public health research often relies on individuals’ confidential medical data. Therefore, data collecting entities, such as states, seek to disseminate this medical data as widely as possible while still maintaining the privacy of the individual for legal and ethical reasons. One common way in which this medical data is released is through the use of Web-based Data Query Systems (WDQS). In this article, we examined WDQS listed in the National Association for Public Health Statistics and Information Systems (NAPHSIS) specifically reviewing them for how they prevent statistical disclosure in queries that produce a tabular response. One of the most common methods to combat this type of disclosure is through the use of suppression, that is, if a cell count in a table is below a certain threshhold, the true value is suppressed. This technique does work to prevent the direct disclosure of small cell counts, however, primary suppression by itself is not always enough to preserve privacy in tabular data. Here, we present several real examples of tabular response queries that employ suppression, but we are able to infer the values of the suppressed cells, including cells with 1 counts, which could be linked to auxiliary data sources and thus has the possibility to create an identity disclosure. We seek to stimulate awareness of the potential for disclosure of information that individuals may wish to keep private through an online query system. This research is undertaken in the hope that privacy concerns can be dealt with preemptively rather than only after a major disclosure has taken place. In the wake of a such an event, a major concern is that state and local officials would react to this by permanently shutting down these sites and cutting off a valuable source of research data

Dental practice satisfaction with preferred provider organizations

<p>Abstract</p> <p>Background</p> <p>Despite their increasing share of the dental insurance market, little is known about dental practices' satisfaction with preferred provider organizations (PPOs). This analysis examined practice satisfaction with dental PPOs and the extent to which satisfaction was a function of communications from the plan, claims handling and compensation.</p> <p>Methods</p> <p>Data were collected through telephone surveys with dental practices affiliated with MetLife between January 2002 and December 2004. Each respondent was asked a series of questions related to their satisfaction with a systematically selected PPO with which they were affiliated. Six different PPO plans had sufficient observations to allow for comparative analysis (total n = 4582). Multiple imputation procedures were used to adjust for item non-response.</p> <p>Results</p> <p>While the average level of overall satisfaction with the target plan fell between "very satisfied" and "satisfied," regression models revealed substantial differences in overall satisfaction across the 6 PPOs (p < .05). Statistically significant differences between plans in overall satisfaction were largely explained by differences in the perceived adequacy of compensation. However, differences in overall satisfaction involving two of the PPOs were also driven by satisfaction with claims handling.</p> <p>Conclusion</p> <p>Results demonstrate the importance of compensation to dental practice satisfaction with PPOs. However, these results also highlight the critical role of service-related factors in differentiating plans and suggest that there are important non-monetary dimensions of PPO performance that can be used to recruit and retain practices.</p

The impact of screening, brief intervention and referral for treatment in emergency department patients\u27 alcohol use: a 3-, 6- and 12-month follow-up

AIMS: This study aims to determine the impact of Screening, Brief Intervention and Referral for Treatment (SBIRT) in reducing alcohol consumption in emergency department (ED) patients at 3, 6, and 12 months following exposure to the intervention. METHODS: Patients drinking above the low-risk limits (at-risk to dependence), as defined by National Institute of Alcohol Abuse and Alcoholism (NIAAA), were recruited from 14 sites nationwide from April to August 2004. A quasi-experimental comparison group design included sequential recruitment of intervention and control patients at each site. Control patients received a written handout. The Intervention group received the handout and participated in a brief negotiated interview with direct referral for treatment if indicated. Follow-up surveys were conducted at 3, 6, and 12 months by telephone using an Interactive Voice Response (IVR) system. RESULTS: Of the 1132 eligible patients consented and enrolled (581 control, 551 intervention), 699 (63%), 575 (52%) and 433 (38%) completed follow-up surveys via IVR at 3, 6, and 12 months, respectively. Regression analysis adjusting for the clustered sampling design and using multiple imputation procedures to account for subject attrition revealed that those receiving SBIRT reported roughly three drinks less per week than controls (B = -3.00, SE = 1.06, P \u3c 0.05) and the level of maximum drinks per occasion was approximately three-fourths of a drink less than controls (B = -0.76, SE = 0.29, P \u3c 0.05) at 3 months. At 6 and 12 months post-intervention, these effects had weakened considerably and were no longer statistically or substantively significant. CONCLUSION: SBIRT delivered by ED providers appears to have short-term effectiveness in reducing at-risk drinking, but multi-contact interventions or booster programs may be necessary to maintain long-term reductions in risky drinking