Predicting high utilization of emergency department services among patients with a diagnosis of psychosis in a Medicaid managed care organization

Studies have demonstrated increased utilization of medical services for patients with behavioral health diagnoses. Medicaid managed care organizations (MMCOs) that operate under behavioral health carve-outs face the challenge of effectively targeting disease management initiatives in the absence of information on behavioral diagnoses. This study sought to develop a predictive model of emergency department (ED) utilization for patients where a diagnosis of psychosis could be identified from a claim associated with a medical service provider visit. A retrospective cohort analysis was performed using medical and pharmacy claims from an MMCO in Philadelphia, Pennsylvania, to identify patients known to have a diagnosis of psychosis and to develop the predictive model. Demographics, comorbidities, medical utilization, and medications were assessed as predictor variables. Within the MMCO, 764 members were identified with at least one medical claim having a psychosis diagnosis. Ordinary least squares multiple regression analysis was performed to measure the correlation between independent variables and ED visits. Variables with significant F ratios in the regression analysis were retained as factors in a risk model to evaluate their additive and cumulative effects. Four variables were significant predictors of high ED utilization: prior number of ED visits, prior number of hospitalizations, history of alcohol abuse, and history of depression. ED utilization increased as the number of risk factors increased: With no risk factors, mean ED use was 0.58 visits (per 6 months), while the cumulative effects of all four factors equated to 8.5 ED visits. The model may be useful to other MMCOs, or similar organizations, seeking to risk-stratify their ED-related disease management activities for patients identified with psychosis

Untying the Gordian Knot: The Development of an Immunization Information Exchange

Legislative mandates require the sharing of immunization information among multiple stakeholders. This in turn requires the implementation of interoperable systems across various information systems. A key challenge to system interoperability is the need to integrate healthcare information and processes across different settings. This paper reports work in progress on the development of a student immunization Health Information Exchange (HIE). The system builds on a commercially available platform, appropriately modified on both front and backend, to meet the needs of school health professionals and other stakeholders involved in the production and maintenance of immunization information. We describe the situated change perspective as well as the iterative and incremental development process adopted for the project, and examine some of the lessons learned throughout

Performance of the CMS Regional Calorimeter Trigger

The CMS Regional Calorimeter Trigger (RCT) receives eight-bit energies and a data quality bit from the HCAL and ECAL Trigger Primitive Generators (TPGs). The RCT uses these trigger primitives to find e/γ candidates and calculate regional calorimeter sums that are sent to the Global Calorimeter Trigger (GCT) for sorting and further processing. The RCT hardware consists of one clock distribution crate and 18 double-sided crates containing custom boards, ASICs, and backplanes. The RCT electronics have been completely installed since 2007. The RCT has been integrated into the CMS Level-1 Trigger chain. Regular runs, triggering on cosmic rays, prepare the CMS detector for the restart of the LHC. During this running, the RCT control is handled centrally by CMS Run Control and Monitor System communicating with the Trigger Supervisor. Online Data Quality Monitoring (DQM) evaluates the performance of the RCT during these runs. Offline DQM allows more detailed studies, including trigger efficiencies. These and other results from cosmicray data taking with the RCT will be presented

Measurements of branching fraction ratios and CP-asymmetries in suppressed B^- -> D(-> K^+ pi^-)K^- and B^- -> D(-> K^+ pi^-)pi^- decays

We report the first reconstruction in hadron collisions of the suppressed decays B^- -> D(-> K^+ pi^-)K^- and B^- -> D(-> K^+ pi^-)pi^-, sensitive to the CKM phase gamma, using data from 7 fb^-1 of integrated luminosity collected by the CDF II detector at the Tevatron collider. We reconstruct a signal for the B^- -> D(-> K^+ pi^-)K^- suppressed mode with a significance of 3.2 standard deviations, and measure the ratios of the suppressed to favored branching fractions R(K) = [22.0 \pm 8.6(stat)\pm 2.6(syst)]\times 10^-3, R^+(K) = [42.6\pm 13.7(stat)\pm 2.8(syst)]\times 10^-3, R^-(K)= [3.8\pm 10.3(stat)\pm 2.7(syst]\times 10^-3, as well as the direct CP-violating asymmetry A(K) = -0.82\pm 0.44(stat)\pm 0.09(syst) of this mode. Corresponding quantities for B^- -> D(-> K^+ pi^-)pi^- decay are also reported.Comment: 8 pages, 1 figure, accepted by Phys.Rev.D Rapid Communications for Publicatio

Search for the standard model Higgs boson in the H to ZZ to 2l 2nu channel in pp collisions at sqrt(s) = 7 TeV

A search for the standard model Higgs boson in the H to ZZ to 2l 2nu decay channel, where l = e or mu, in pp collisions at a center-of-mass energy of 7 TeV is presented. The data were collected at the LHC, with the CMS detector, and correspond to an integrated luminosity of 4.6 inverse femtobarns. No significant excess is observed above the background expectation, and upper limits are set on the Higgs boson production cross section. The presence of the standard model Higgs boson with a mass in the 270-440 GeV range is excluded at 95% confidence level.Comment: Submitted to JHE

Search for anomalous t t-bar production in the highly-boosted all-hadronic final state

A search is presented for a massive particle, generically referred to as a Z', decaying into a t t-bar pair. The search focuses on Z' resonances that are sufficiently massive to produce highly Lorentz-boosted top quarks, which yield collimated decay products that are partially or fully merged into single jets. The analysis uses new methods to analyze jet substructure, providing suppression of the non-top multijet backgrounds. The analysis is based on a data sample of proton-proton collisions at a center-of-mass energy of 7 TeV, corresponding to an integrated luminosity of 5 inverse femtobarns. Upper limits in the range of 1 pb are set on the product of the production cross section and branching fraction for a topcolor Z' modeled for several widths, as well as for a Randall--Sundrum Kaluza--Klein gluon. In addition, the results constrain any enhancement in t t-bar production beyond expectations of the standard model for t t-bar invariant masses larger than 1 TeV.Comment: Submitted to the Journal of High Energy Physics; this version includes a minor typo correction that will be submitted as an erratu

Search for New Physics with Jets and Missing Transverse Momentum in pp collisions at sqrt(s) = 7 TeV

A search for new physics is presented based on an event signature of at least three jets accompanied by large missing transverse momentum, using a data sample corresponding to an integrated luminosity of 36 inverse picobarns collected in proton--proton collisions at sqrt(s)=7 TeV with the CMS detector at the LHC. No excess of events is observed above the expected standard model backgrounds, which are all estimated from the data. Exclusion limits are presented for the constrained minimal supersymmetric extension of the standard model. Cross section limits are also presented using simplified models with new particles decaying to an undetected particle and one or two jets

Combined search for the quarks of a sequential fourth generation

Results are presented from a search for a fourth generation of quarks produced singly or in pairs in a data set corresponding to an integrated luminosity of 5 inverse femtobarns recorded by the CMS experiment at the LHC in 2011. A novel strategy has been developed for a combined search for quarks of the up and down type in decay channels with at least one isolated muon or electron. Limits on the mass of the fourth-generation quarks and the relevant Cabibbo-Kobayashi-Maskawa matrix elements are derived in the context of a simple extension of the standard model with a sequential fourth generation of fermions. The existence of mass-degenerate fourth-generation quarks with masses below 685 GeV is excluded at 95% confidence level for minimal off-diagonal mixing between the third- and the fourth-generation quarks. With a mass difference of 25 GeV between the quark masses, the obtained limit on the masses of the fourth-generation quarks shifts by about +/- 20 GeV. These results significantly reduce the allowed parameter space for a fourth generation of fermions.Comment: Replaced with published version. Added journal reference and DO