Cost of health care utilization among homeless frequent emergency department users

Research demonstrates that homelessness is associated with frequent use of emergency department (ED) services, yet prior studies have not adequately examined the relationship between frequent ED use and utilization of non-ED health care services among those experiencing homelessness. There has also been little effort to assess heterogeneity among homeless individuals who make frequent use of ED services. To address these gaps, the present study used Medicaid claims data from 2010 to estimate the association between the number of ED visits and non-ED health care costs for a cohort of 6,338 Boston Health Care for the Homeless Program patients, and to identify distinct subgroups of persons in this cohort who made frequent use of ED services based on their clinical and demographic characteristics. A series of gamma regression models found more frequent ED use to be associated with higher non-ED costs, even after adjusting for demographic and clinical characteristics. Latent class analysis was used to examine heterogeneity among frequent ED users, and the results identified 6 characteristically distinct subgroups among these persons. The subgroup of persons with trimorbid illness had non-ED costs that far exceeded members of all 5 other subgroups. Study findings reinforce the connection between frequent ED use and high health care costs among homeless individuals and suggest that different groups of homeless frequent ED users may benefit from interventions that vary in terms of their composition and intensity

mbasaka – A Web 2.0 Initiative in the Indian Higher Education Sector

mbasaka is a unique Web 2.0 initiative that aims to tackle the problem of quality higher education in India (especially for the MBA) by aiding learning amongst students through its array of subscription and ad-revenue based online streaming lecture videos by professional lecturers and professors. The growing need for quality education in India, the lack of government infrastructure and the easy reach of the internet have created the perfect environment for mbasaka to be born. mbasaka will require a total investment of Rs. 8816000. Rs 2500000 will be made available by the Owner and Director at mbasaka leaving a sum of Rs 6316000 for investment for a period of 4 years by the Venture Capitalist. Financial forecast predicts a break-even in Year 3. mbasaka is prepared to give away 25% stake of its business for this investment. Two exit options are provided to the Investor at the end of this period. However, the company does not aim to go public in the near future. The organization is headquartered in Himachal Pradesh, which guarantees tax free holiday for 5 years. This results in substantial savings for the firm. The cost of Operation will be Rs. 2204000 on an average across the 4 years and at the end of it the net profit obtained will be Rs 9204000. The firm’s key criteria are to bond with the customer, to synonymise itself with quality in the field of education and to bridge the gap between the consumer and the supplier

Identifying An Appropriate Strategy To Overcome Barriers Facing Hi-tech Start-ups in the Indian Education Sector

This report aims at arriving at a winning strategy for a start-up hi-tech firm in the Indian Educational Sector. The report is a prelude to a business plan that follows the report and builds upon the inference of this report. For this purpose, both theoretical and practical aspects of start-up businesses have been identified and pitted against each other to obtain an inference. The report answers why it is lucrative to enter the Indian education market by studying the scenario in the country. It also analyzes key theories of start-up firms. Some entrepreneurs have been interviewed and their statements examined. Key business issues, challenges and strategies of these entrepreneurial firms have been looked into. The report concludes by pairing the results of the literature review or theory with those obtained from practical inference by means of entrepreneurial interviews and combining the best of both worlds, a winning strategy for the start-up firm is introduced towards the end. Research cites that strategies such as Differentiation, Resource Based View and Dynamic Capability building are key to modern day hi-tech start-up businesses. The Indian education sector is opening up for growth with more than 50% players in the market being private and the government’s key focus for the next 5 year plan being education. The added woes of paucity of the number of colleges, lecturers and quality study material is a window of opportunity that can be exploited for exponential growth in this industry in India, at this point of time

Identifying An Appropriate Strategy To Overcome Barriers Facing Hi-tech Start-ups in the Indian Education Sector

This report aims at arriving at a winning strategy for a start-up hi-tech firm in the Indian Educational Sector. The report is a prelude to a business plan that follows the report and builds upon the inference of this report. For this purpose, both theoretical and practical aspects of start-up businesses have been identified and pitted against each other to obtain an inference. The report answers why it is lucrative to enter the Indian education market by studying the scenario in the country. It also analyzes key theories of start-up firms. Some entrepreneurs have been interviewed and their statements examined. Key business issues, challenges and strategies of these entrepreneurial firms have been looked into. The report concludes by pairing the results of the literature review or theory with those obtained from practical inference by means of entrepreneurial interviews and combining the best of both worlds, a winning strategy for the start-up firm is introduced towards the end. Research cites that strategies such as Differentiation, Resource Based View and Dynamic Capability building are key to modern day hi-tech start-up businesses. The Indian education sector is opening up for growth with more than 50% players in the market being private and the government’s key focus for the next 5 year plan being education. The added woes of paucity of the number of colleges, lecturers and quality study material is a window of opportunity that can be exploited for exponential growth in this industry in India, at this point of time

mbasaka – A Web 2.0 Initiative in the Indian Higher Education Sector

mbasaka is a unique Web 2.0 initiative that aims to tackle the problem of quality higher education in India (especially for the MBA) by aiding learning amongst students through its array of subscription and ad-revenue based online streaming lecture videos by professional lecturers and professors. The growing need for quality education in India, the lack of government infrastructure and the easy reach of the internet have created the perfect environment for mbasaka to be born. mbasaka will require a total investment of Rs. 8816000. Rs 2500000 will be made available by the Owner and Director at mbasaka leaving a sum of Rs 6316000 for investment for a period of 4 years by the Venture Capitalist. Financial forecast predicts a break-even in Year 3. mbasaka is prepared to give away 25% stake of its business for this investment. Two exit options are provided to the Investor at the end of this period. However, the company does not aim to go public in the near future. The organization is headquartered in Himachal Pradesh, which guarantees tax free holiday for 5 years. This results in substantial savings for the firm. The cost of Operation will be Rs. 2204000 on an average across the 4 years and at the end of it the net profit obtained will be Rs 9204000. The firm’s key criteria are to bond with the customer, to synonymise itself with quality in the field of education and to bridge the gap between the consumer and the supplier

Investigating Gender Disparities in Internal Medicine Residency Awards

Background: Significant gender disparities persist in career advancement for physicians. Studies have highlighted the lack of female representation in awards from both academic institutions and professional societies; these awards play a role in promotions, making them a fundamental building block of success. Objectives: We aim to explore the gender breakdown among resident awards presented by several Internal Medicine residency programs across the United States in this pilot study. Our ultimate goals are to define disparities in award selection, determine what variables contribute to these disparities, and work to mitigate these variables. Methods/Research: We generated a survey in REDCap to collect retrospective data about resident award selection from academic Internal Medicine residency programs across the country. This survey gathered awards data from 2009-2019 and included variables such as gender breakdown of the program, gender of resident award recipients, and details about how awards are selected. Eight programs completed the survey; these programs were from six different states in various geographic regions. Overall 43.1 percent of residents were female. Across all residency programs and years, there were 51 distinct resident awards with 290 (39.7%) female winners. Of the 51 distinct awards, there were 10 which were awarded to female residents with the same or higher frequency as males; 6 of these mentioned words that have been differentially associated with women in medicine such as “ambulatory,” “community,” “compassion,” and “humanism.” In the 41 awards favoring males, there was only a single mention of the word “compassion,” and no mention of the others. Conclusions/Impact: This data shows a concerning disparity in gender of award winners. In the future we will collect data from more residency programs and perform a thorough investigation of selection mechanisms that may help mitigate bias in order to ultimately propose strategies to reduce these gender disparities.https://jdc.jefferson.edu/sexandgenderhealth/1007/thumbnail.jp

Improving Colon Cancer Screening Rates in an Ambulatory Resident Clinic

In the US, colorectal cancer (CRC) is the third leading cause of cancer-related deaths. According to the 2018 CDC Behavioral Risk Factor Surveillance System survey, 68.8% of US adults between 50 and 75 were up to date on colorectal screening (CRCS) across all screening modalities. In light of the COVID-19 pandemic, screening has dropped even further and is still 50% below pre-pandemic levels. At Jefferson, our CRCS rate is below the national average at 55.4%. Given the importance of regular screening for CRC prevention, this is clearly inadequate. There are several barriers to completing an invasive screening modality like a colonoscopy, but FIT testing may be a more feasible option. Our aim was to increase the colonoscopy screening rate at JHAP by 15% over a period of eight months (September-April)

IM with Her: Fostering Career Advancement of Female Internal Medicine Residents

Background: Despite the rising number of matriculating female medical students, a gender gap favoring men exists in multiple arenas within academic medicine. Prior studies suggest that gender-specifc professional networking groups increase the likelihood of women attaining leadership positions. Objectives: Our goal was to create a multidisciplinary group with a flat hierarchy within the Internal Medicine Department in order to foster mentorship, sponsorship, allyship, and scholarship to ultimately improve professional advancement opportunities for female internal medicine residents. Methods/Research: A group named “IM with Her” was created at Thomas Jefferson University Hospital in July 2018. IM with Her is composed of internal medicine residents and faculty of all genders. The group has hosted monthly onehour conferences called “Monday Mentors” that pair a resident with a faculty member to host a discussion surrounding a topic of their choosing related to adversity and disparity faced by female physicians. Additionally, the group has held periodic evening sessions discussing topics such as salary and contract negotiation. Conclusions/Impact: The IM with Her group has made significant progress toward its goals. The pairing of a resident and faculty member for Monday Mentors discussions allows for one-on-one mentorship regarding both personal and professional topics. These sessions also provide dedicated time for networking amongst residents and faculty, facilitating sponsorship and allyship. Additionally, the sessions often lead to further initiatives spearheaded by IM with Her members including scholarly projects and examinations of institutional policies (for example those surrounding sexual harassment and lactation room accessibility). In the future, IM with Her will focus on continuing to foster mentorship, sponsorship, and allyship, on advancing research related to gender disparities in medicine, and on developing institutional changes.https://jdc.jefferson.edu/sexandgenderhealth/1008/thumbnail.jp

Early Immersion in Team-Based Event Review: Experiential Patient Safety Education for PGY 1 Internal Medicine Residents

INTRODUCTION: In recent years, there has been a national push to incorporate high-fidelity quality improvement and patient safety (QIPS) education into physician training programs. In fact, integration of robust patient safety education became an Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirement for residency programs in 2017. We developed a curriculum to not only fulfill the ACGME\u27s requirement but also provide PGY 1 internal medicine residents with the skills needed to become active participants in ongoing patient safety work throughout their training and careers. METHODS: Our patient safety curriculum was woven into residents\u27 existing protected educational time and supported by a standardized facilitator guide and participant workbook. It combined didactic prework with the review of recent near-miss or low-harm patient safety events, empowering residents to identify root causes and propose interventions. RESULTS: We successfully delivered our patient safety curriculum to 80 PGY 1 residents over the course of 2 academic years. Residents rated the curriculum as a valuable educational experience, and the event reviews they completed met most of the criteria for high-quality patient safety reviews according to the Strong String Assessment. DISCUSSION: Implementation of this standardized curriculum has allowed us to reliably and consistently incorporate experiential patient safety education into the first year of training for internal medicine residents. Unlike purely didactic sessions, our curriculum encourages active learning, building muscle memory for event reviews that enables future engagement in patient safety activities

A classification model of homelessness using integrated administrative data: Implications for targeting interventions to improve the housing status, health and well-being of a highly vulnerable population

Homelessness is poorly captured in most administrative data sets making it difficult to understand how, when, and where this population can be better served. This study sought to develop and validate a classification model of homelessness. Our sample included 5,050,639 individuals aged 11 years and older who were included in a linked dataset of administrative records from multiple state-maintained databases in Massachusetts for the period from 2011-2015. We used logistic regression to develop a classification model with 94 predictors and subsequently tested its performance. The model had high specificity (95.4%), moderate sensitivity (77.8%) for predicting known cases of homelessness, and excellent classification properties (area under the receiver operating curve 0.94; balanced accuracy 86.4%). To demonstrate the potential opportunity that exists for using such a modeling approach to target interventions to mitigate the risk of an adverse health outcome, we also estimated the association between model predicted homeless status and fatal opioid overdoses, finding that model predicted homeless status was associated with a nearly 23-fold increase in the risk of fatal opioid overdose. This study provides a novel approach for identifying homelessness using integrated administrative data. The strong performance of our model underscores the potential value of linking data from multiple service systems to improve the identification of housing instability and to assist government in developing programs that seek to improve health and other outcomes for homeless individuals