A simulation model approach to analysis of the business case for eliminating health care disparities

<p>Abstract</p> <p>Background</p> <p>Purchasers can play an important role in eliminating racial and ethnic disparities in health care. A need exists to develop a compelling "business case" from the employer perspective to put, and keep, the issue of racial/ethnic disparities in health care on the quality improvement agenda for health plans and providers.</p> <p>Methods</p> <p>To illustrate a method for calculating an employer business case for disparity reduction and to compare the business case in two clinical areas, we conducted analyses of the direct (medical care costs paid by employers) and indirect (absenteeism, productivity) effects of eliminating known racial/ethnic disparities in mammography screening and appropriate medication use for patients with asthma. We used Markov simulation models to estimate the consequences, for defined populations of African-American employees or health plan members, of a 10% increase in HEDIS mammography rates or a 10% increase in appropriate medication use among either adults or children/adolescents with asthma.</p> <p>Results</p> <p>The savings per employed African-American woman aged 50-65 associated with a 10% increase in HEDIS mammography rate, from direct medical expenses and indirect costs (absenteeism, productivity) combined, was $50. The findings for asthma were more favorable from an employer point of view at approximately$1,660 per person if raising medication adherence rates in African-American employees or dependents by 10%.</p> <p>Conclusions</p> <p>For the employer business case, both clinical scenarios modeled showed positive results. There is a greater potential financial gain related to eliminating a disparity in asthma medications than there is for eliminating a disparity in mammography rates.</p

Quantum Spacetime Phenomenology

I review the current status of phenomenological programs inspired by quantum-spacetime research. I stress in particular the significance of results establishing that certain data analyses provide sensitivity to effects introduced genuinely at the Planck scale. And my main focus is on phenomenological programs that managed to affect the directions taken by studies of quantum-spacetime theories.Comment: 125 pages, LaTex. This V2 is updated and more detailed than the V1, particularly for quantum-spacetime phenomenology. The main text of this V2 is about 25% more than the main text of the V1. Reference list roughly double

Growth, Development and Temporal Variation in the Onset of Six Chironex fleckeri Medusae Seasons: A Contribution to Understanding Jellyfish Ecology

Despite the worldwide distribution, toxicity and commercial, industrial and medical impacts jellyfish present, many aspects of their ecology remain poorly understood. Quantified here are important ecological parameters of Chironex fleckeri medusae, contributing not only to the understanding of an understudied taxon, the cubozoa, but also to the broader understanding of jellyfish ecology. C. fleckeri medusae were collected across seven seasons (1999, 2000, 2003, 2005–07 and 2010), with growth rates, temporal variation in the medusae season onset and differences in population structure between estuarine and coastal habitats quantified. With a mean of 2 September ±2 d (mean ±95% confidence limits), the earliest date of metamorphosis was temporally constrained between seasons, varying by only 7 d (30 August to 5 September). Juvenile medusae appeared to be added over an extended period, suggesting polyp metamorphosis was an ongoing process once it commenced. At a maximum of 3±0.2 mm d(−1) IPD, medusae growth to an asymptotic size of ∼190 mm IPD was rapid, yet, with the oldest medusae estimated to be ∼78 d in age, medusae did not appear to accumulate along the coastline. Furthermore, a greater proportion of juveniles were observed along the coastline, with estuarine populations typified by larger medusae. With key aspects of C. fleckeri's ecology now quantified, medusae season management protocols can be further developed

Insurance and Quality of Care for Adults with Acute Asthma

OBJECTIVE: The relationship between health care insurance and quality of medical care remains incompletely studied. We sought to determine whether type of patient insurance is related to quality of care and subsequent outcomes for patients who arrive in the emergency department (ED) for acute asthma. DESIGN: Using prospectively collected data from the Multicenter Airway Research Collaboration, we compared measures of quality of pre-ED care, acute severity, and short-term outcomes across 4 insurance categories: managed care, indemnity, Medicaid, and uninsured. SETTING AND PARTICIPANTS: Emergency departments at 57 academic medical centers enrolled 1,019 adults with acute asthma. RESULTS: Patients with managed care ranked first and uninsured patients ranked last on all 7 unadjusted quality measures. After controlling for covariates, uninsured patients had significantly lower quality of care than indemnity patients for 5 of 7 measures and had lower initial peak expiratory flow rates than indemnity insured patients. Patients with managed care insurance were more likely than indemnity-insured patients to identify a primary care physician and report using inhaled steroids in the month prior to arrival in the ED. Patients with Medicaid insurance were more likely than indemnity-insured patients to use the ED as their usual source of care for problems with asthma. We found no differences in patient outcomes among the insurance categories we studied. CONCLUSIONS: Uninsured patients had consistently poorer quality of care and than insured patients. Despite differences in indicators of quality of care between types of insurance, we found no differences in short-term patient outcomes by type of insurance

EDGE: Explorer of diffuse emission and gamma-ray burst explosions

How structures of various scales formed and evolved from the early Universe up to present time is a fundamental question of astrophysics. EDGE will trace the cosmic history of the baryons from the early generations of massive stars by Gamma-Ray Burst (GRB) explosions, through the period of galaxy cluster formation, down to the very low redshift Universe, when between a third and one half of the baryons are expected to reside in cosmic filaments undergoing gravitational collapse by dark matter (the so-called warm hot intragalactic medium). In addition EDGE, with its unprecedented capabilities, will provide key results in many important fields. These scientific goals are feasible with a medium class mission using existing technology combined with innovative instrumental and observational capabilities by: (a) observing with fast reaction Gamma-Ray Bursts with a high spectral resolution (R ~ 500). This enables the study of their (star-forming) environment and the use of GRBs as back lights of large scale cosmological structures; (b) observing and surveying extended sources (galaxy clusters, WHIM) with high sensitivity using two wide field of view X-ray telescopes (one with a high angular resolution and the other with a high spectral resolution). The mission concept includes four main instruments: a Wide-field Spectrometer with excellent energy resolution (3 eV at 0.6 keV), a Wide- Field Imager with high angular resolution (HPD 15") constant over the full 1.4 degree field of view, and a Wide Field Monitor with a FOV of 1/4 of the sky, which will trigger the fast repointing to the GRB. Extension of its energy response up to 1 MeV will be achieved with a GRB detector with no imaging capability. This mission is proposed to ESA as part of the Cosmic Vision call. We will briefly review the science drivers and describe in more detail the payload of this mission