Anthrofest 2011

The University of Pennsylvania anthropology annual undergraduate research conference known as ANTHROFEST brings together undergraduates involved in research across all concentrations in anthropology, as well as faculty and the broader undergraduate and graduate community. Each year, select students present and discuss their original research to the community at Penn. The conference is open to the public

Foreign educated nurses and patient care experience in England and the United States

Background & Significance: For decades, to counter nursing shortages, hospitals in developed countries have hired nurses from abroad. Although the certification and licensure process of foreign educated nurses aims to assure competency in educational training and language skills, systematic research evaluating the relationship between healthcare quality and hospital employment of foreign educated nurses has been lacking. Considering an increase in attention to the patient care experience and an increase in qualified applicants to nursing schools in England and the U.S., it is a prime time to examine the relationship between foreign educated nurses and patient experiences of care. Methods: The approach used here is an independent replications analysis using similar cross-sectional secondary data in two countries. Data were gleaned from three 2009-2010 English sources and three 2006-2008 U.S. sources and included nurse survey data, hospital organizational data, and patient care experience data. The main outcomes of interest were measures of patient care experience from patient surveys. The analytic sample consisted of 31 hospitals in England and 407 hospitals in four states in the U.S. and nurses and patients at the participating hospitals. Nurses provided information about country of education and the organizational context that was aggregated to the hospital level. The sample was descriptively analyzed using chi-square tests and analysis of variance. Regression models estimated the effect of a higher proportion of foreign educated nurses on patient care experience in hospitals in England and the U.S., before and after taking hospital and modifiable organizational characteristics into account. Results: Hospitals in England and the U.S. employing higher proportions of foreign educated nurses had lower global ratings of patient care experience and lower ratings of experience related to nursing care. Controlling for nurse and structural and organizational hospital characteristics slightly attenuated the strength and significance of the relationship between a higher proportion of foreign educated nurses and poorer patient experiences of care in England; it had no effect on this relationship in the U.S. Conclusion: These findings reveal that in both England and the U.S., patients cared for in hospitals with a substantial proportion of nurses educated abroad rate the quality of their care lower than do patients in hospitals with fewer foreign educated nurses. Implications: National and institutional Investment in a sufficient domestic workforce could contribute to better patient care experiences for patients

Impact of the COVID‐19 pandemic on care disruptions, outcomes, and costs in patients receiving pulmonary arterial hypertension‐specific therapy in the United States of America: An observational study

Abstract Regular expert follow‐up, risk assessment, and early therapeutic intervention minimize worsening of pulmonary arterial hypertension (PAH). COVID‐19 lockdown measures were challenging for chronic disease management. This retrospective, longitudinal analysis used US claims data (January 12, 2016 to September 11, 2021) for patients treated with PAH‐specific medication to compare in‐person outpatient and specialist visits, telemedicine visits, and PAH‐related tests during 6‐month assessment periods pre‐ and immediately post‐COVID‐19. Hospitalizations, costs, and outcomes were compared in patients with and without care disruptions (no in‐person or telemedicine outpatient visits in immediate post‐COVID‐19 period). Patients in the immediate post‐COVID‐19 (N = 599) versus the pre‐COVID‐19 period (N = 598) had fewer in‐person outpatient visits (mean 1.27 vs. 2.12) and in‐person specialist visits (pulmonologist, 22.9% vs. 37.0% of patients; cardiologist, 27.5% vs. 33.8%); and more telemedicine visits (mean 0.45 vs. 0.02). In the immediate post‐COVID‐19 period, patients were less likely to have a PAH‐related test versus the pre‐COVID‐19 period (incidence rate ratio: 0.700; 95% confidence interval: 0.615−0.797), including electrocardiograms (41.7% vs. 54.2%) and 6‐minute walk distance tests (16.2% vs. 24.9%). In the immediate post‐COVID‐19 period, 48 patients had care disruptions and, in the following year, required more hospital days than those without care disruptions (N = 240) (median 10 vs. 5 days in total) and had higher overall hospitalization costs (median US$34,755 vs. US$20,090). Our findings support the need for minimizing care disruptions to potentially avoid incremental post‐disruption healthcare utilization and costs among patients with serious chronic diseases such as PAH

A Systematic Review on Healthcare Analytics: Application and Theoretical Perspective of Data Mining

The growing healthcare industry is generating a large volume of useful data on patient demographics, treatment plans, payment, and insurance coverage—attracting the attention of clinicians and scientists alike. In recent years, a number of peer-reviewed articles have addressed different dimensions of data mining application in healthcare. However, the lack of a comprehensive and systematic narrative motivated us to construct a literature review on this topic. In this paper, we present a review of the literature on healthcare analytics using data mining and big data. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a database search between 2005 and 2016. Critical elements of the selected studies—healthcare sub-areas, data mining techniques, types of analytics, data, and data sources—were extracted to provide a systematic view of development in this field and possible future directions. We found that the existing literature mostly examines analytics in clinical and administrative decision-making. Use of human-generated data is predominant considering the wide adoption of Electronic Medical Record in clinical care. However, analytics based on website and social media data has been increasing in recent years. Lack of prescriptive analytics in practice and integration of domain expert knowledge in the decision-making process emphasizes the necessity of future research

Effects of Regulation and Payment Policies on Nurse Practitioners’ Clinical Practices

Barnes H, Maier CB, Altares Sarik D, Germack HD, Aiken LH, McHugh MD. Effects of Regulation and Payment Policies on Nurse Practitioners’ Clinical Practices. Medical Care Research and Review. 2017;74(4):431-451.Increasing patient demand following health care reform has led to concerns about provider shortages, particularly in primary care and for Medicaid patients. Nurse practitioners (NPs) represent a potential solution to meeting demand. However, varying state scope of practice regulations and Medicaid reimbursement rates may limit efficient distribution of NPs. Using a national sample of 252,657 ambulatory practices, we examined the effect of state policies on NP employment in primary care and practice Medicaid acceptance. NPs had 13% higher odds of working in primary care in states with full scope of practice; those odds increased to 20% if the state also reimbursed NPs at 100% of the physician Medicaid fee-for-service rate. Furthermore, in states with 100% Medicaid reimbursement, practices with NPs had 23% higher odds of accepting Medicaid than practices without NPs. Removing scope of practice restrictions and increasing Medicaid reimbursement may increase NP participation in primary care and practice Medicaid acceptance

Economic burden of illness among patients with pulmonary arterial hypertension (PAH) associated with connective tissue disorders (CTD)

Abstract Pulmonary arterial hypertension (PAH) is commonly associated with connective tissue disorders (CTDs). This study provides a contemporary assessment of the economic burden of CTD + PAH and PAH in the United States. Eligible adult patients identified from Optum's deidentified Clinformatics® Data Mart Database (10/01/2015‐09/30/2021) were classified into mutually exclusive cohorts based on recorded diagnoses: (1) CTD + PAH, (2) PAH, (3) CTD, (4) control without CTD/PAH. The index date was a randomly selected diagnosis date for PAH (CTD + PAH, PAH cohorts) or CTD (CTD cohort), or a random date (control cohort). Entropy balancing was used to balance characteristics across cohorts. Healthcare costs and healthcare resource utilization (HRU) per patient per month (PPPM) were assessed for ≤12 months postindex and compared among balanced cohorts. A total of 552,900 patients were included (CTD + PAH: n = 1876; PAH: n = 8177; CTD: n = 209,156; control: n = 333,691). Average total all‐cause costs were higher for CTD + PAH than PAH cohort ($16,854 vs.$15,686 PPPM; p = 0.02); both cohorts incurred higher costs than CTD and control cohorts ($4476 and$2170 PPPM; all p  0.05), while CTD and control cohorts incurred less HRU (inpatient stay: 0.07 and 0.03, outpatient visits: 2.67 and 1.69; all p < 0.001). CTD + PAH and PAH are associated with a substantial economic burden. The incremental burden attributable to PAH versus the general population and patients with CTD without PAH highlights significant unmet needs among PAH patients