Trends in Observation‐prone Emergency Department Visits Among Michigan Children, 2007–2011

ObjectivesTo the best of the authors’ knowledge, admission of children under observation status in community hospitals has not been examined. The hypothesis of this study was that there has been an increase in observation charge code use over time and variations in the application of observation charge codes across hospital types.MethodsThis was a cross‐sectional analysis of 5 years (2007 through 2011) of administrative claims data from Michigan residents enrolled in Medicaid, Blue Cross/Blue Shield of Michigan preferred provider organization, and Blue Cross Network health maintenance organization compiled into a single data set. Emergency department (ED) visits to facilities in Michigan made by children (younger than 18 years) were selected. Observation‐prone ED visits were identified based on the presence of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) codes. Counts of observation‐prone ED visits were determined and descriptive statistics were calculated. Changes over time in the proportion of visits with observation charge codes by hospital type were assessed with chi‐square analysis.ResultsThe observation‐prone ICD‐9‐CM codes were identified in 881,622 ED visits made by children to 142 Michigan facilities during the 5‐year study period. Overall, the vast majority of visits (n = 646,499; 91.0%) with the selected ICD‐9‐CM codes resulted in discharge from the ED without associated observation or inpatient charge codes. Among the 64,288 visits that resulted in admission for observation or inpatient care, observation charge codes without inpatient charge codes were applied to 22,933 (35.7%) admissions, observation and inpatient charge codes were applied to 4,756 (7.4%) admissions, and inpatient charge codes without observation charge codes were applied to 36,599 (56.9%) admissions. Hospitals with pediatric ED and inpatient services (Type 1 and Type 2 hospitals) had higher proportions of ED visits that went on to admission for observation or inpatient care (15.9 and 10.7%) than hospitals without pediatric ED services (Type 3 and Type 4 hospitals; 7.2 and 3.7%). The proportion of admissions that had observation charge codes for all hospital types increased over time, most prominently among Type 1 and Type 2 hospitals.ConclusionsThe application of observation charge codes to Michigan children with observation‐prone conditions has increased over time across all hospital types. There is a need to evaluate pediatric observation care in diverse settings to compare the effectiveness of different models.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111217/1/acem12624-sup-0001-DataSupplementS1.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/111217/2/acem12624-sup-0002-DataSupplementS2.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/111217/3/acem12624.pd

Investigating a possible "musician advantage" for speech-in-speech perception: The role of f0 separation

Does listeners' musical experience improve their ability to perceive speech-in-speech? In the present experiment, musicians and nonmusicians heard two sentences played simultaneously: a target and a masker sentence that varied in terms of fundamental frequency (f0) separation. Results reveal that accuracy in identifying the target sentence was highest for younger musicians (relative to younger nonmusicians). No such difference was observed between older musicians and nonmusicians. These results provide support for musicians' purported advantage for speech-in-speech – but the advantage is limited by listener age. This work is relevant to our understanding of cross-domain transfer of nonlinguistic experience on speech perception

Children and adults produce distinct technology- and human-directed speech.

This study compares how English-speaking adults and children from the United States adapt their speech when talking to a real person and a smart speaker (Amazon Alexa) in a psycholinguistic experiment. Overall, participants produced more effortful speech when talking to a device (longer duration and higher pitch). These differences also varied by age: children produced even higher pitch in device-directed speech, suggesting a stronger expectation to be misunderstood by the system. In support of this, we see that after a staged recognition error by the device, children increased pitch even more. Furthermore, both adults and children displayed the same degree of variation in their responses for whether Alexa seems like a real person or not, further indicating that childrens conceptualization of the systems competence shaped their register adjustments, rather than an increased anthropomorphism response. This work speaks to models on the mechanisms underlying speech production, and human-computer interaction frameworks, providing support for routinized theories of spoken interaction with technology

Tele-AAC Resolution.

Approximately 1.3% of all people, or about 4 million Americans, cannot rely on their natural speech to meet their daily communication needs. Telepractice offers a potentially cost-effective service delivery mechanism to provide clinical AAC services at a distance to the benefit of underserved populations in the United States and worldwide. Tele-AAC is a unique cross-disciplinary clinical service delivery model that requires expertise in both telepractice and augmentative and alternative communication (AAC) systems. The Tele-AAC Working Group of the 2012 ISAAC Research Symposium therefore drafted a resolution underscoring the importance of identifying and characterizing the unique opportunities and constraints of Tele-AAC in all aspects of service delivery. These include, but are not limited to: needs assessments; implementation planning; device/system procurement, set-up and training; quality assurance, client progress monitoring, and follow-up service delivery. Tele-AAC, like other telepractice applications, requires adherence to the ASHA Code of Ethics and other policy documents, and state, federal, and international laws, as well as a competent technological infrastructure. The Working Group recommends that institutions of higher education and professional organizations provide training in Tele-AAC service provision. In addition, research and development are needed to create validity measures across Tele-AAC practices (i.e., assessment, implementation, and consultation); determine the communication competence levels achieved by Tele-AAC users; discern stakeholders' perceptions of Tele-AAC services (e.g., acceptability and viability); maximize Tele-AAC's capacity to engage multiple team members in AAC assessment and ongoing service; identify the limitations and barriers of Tele-AAC provision; and develop potential solutions

Rounding frequency and hospital length of stay for children with respiratory illnesses: A simulation study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102158/1/jhm2097.pd

Regional Variation in HIV Clinical Trials Participation in the United States

To ensure generalizability of clinical research results, it is important to enroll a heterogeneous population that is representative of the target clinical population. Earlier studies have found regional variation in participation in human immunodeficiency virus (HIV) clinical trials, with the lowest rates seen in the southern United States. Rates of new HIV diagnoses are highest in the South, highlighting the need for in-depth understanding of disparities in clinical trial participation. We evaluated whether regional variation in study participation remains, and describe factors that facilitate or prevent HIV clinical trial participation by region