The Effect of Performance-Based Financial Incentives on Improving Patient Care Experiences: A Statewide Evaluation

Patient experience measures are central to many pay-for-performance (P4P) programs nationally, but the effect of performance-based financial incentives on improving patient care experiences has not been assessed. The study uses Clinician & Group CAHPS data from commercially insured adult patients (n = 124,021) who had visits with 1,444 primary care physicians from 25 California medical groups between 2003 and 2006. Medical directors were interviewed to assess the magnitude and nature of financial incentives directed at individual physicians and the patient experience improvement activities adopted by groups. Multilevel regression models were used to assess the relationship between performance change on patient care experience measures and medical group characteristics, financial incentives, and performance improvement activities. Over the course of the study period, physicians improved performance on the physician-patient communication (0.62 point annual increase, p < 0.001), care coordination (0.48 point annual increase, p < 0.001), and office staff interaction (0.22 point annual increase, p = 0.02) measures. Physicians with lower baseline performance on patient experience measures experienced larger improvements (p < 0.001). Greater emphasis on clinical quality and patient experience criteria in individual physician incentive formulas was associated with larger improvements on the care coordination (p < 0.01) and office staff interaction (p < 0.01) measures. By contrast, greater emphasis on productivity and efficiency criteria was associated with declines in performance on the physician communication (p < 0.01) and office staff interaction (p < 0.001) composites. In the context of statewide measurement, reporting, and performance-based financial incentives, patient care experiences significantly improved. In order to promote patient-centered care in pay for performance and public reporting programs, the mechanisms by which program features influence performance improvement should be clarified

How risky is caring for emergency patients at risk of malpractice litigation: a population based epidemiological study of Taiwan's experiences

<p>Abstract</p> <p>Background</p> <p>Emergency medicine has generally been considered a high risk specialty. The purpose of this study is to assess the risk of being sued in the district courts for caring emergency room (ER) patients from the perspective of epidemiology.</p> <p>Methods</p> <p>This research was designed to be a retrospective population based cohort study. We intended to find out the incidence of litigations arising from ER patients and that of birth inpatients in Taiwan, and computed their relative risks. The inclusion criterion was set to be incidents transpired in the time period of 1998 to 2002. The study materials included the reimbursement claim dataset of the National Health Insurance from 1998 to 2002, and the district court decision database of the Judicial Yuan from 1999 to 2006.</p> <p>Results</p> <p>The average annual incidence rate of becoming a plaintiff for ER patients is 0.86 per million, and for birth patients is 33.5 per million. There is a statistically significant difference between birth patients and ER patients. The relative risk comparing ER patients against birth inpatients is 0.03.</p> <p>Conclusion</p> <p>The findings of this population based study indicate that the patient population emergency physicians are facing in Taiwan have relatively lower risks of developing litigation in comparison with the patients that come to give birth. Due to the large volume of ER patients, malpractice still pose a major threat in the emergency department, and misdiagnosis remains the major complaint of plaintiffs in subsequent litigations.</p

Genome-wide analysis of ivermectin response by Onchocerca volvulus reveals that genetic drift and soft selective sweeps contribute to loss of drug sensitivity

Treatment of onchocerciasis using mass ivermectin administration has reduced morbidity and transmission throughout Africa and Central/South America. Mass drug administration is likely to exert selection pressure on parasites, and phenotypic and genetic changes in several Onchocerca volvulus populations from Cameroon and Ghana-exposed to more than a decade of regular ivermectin treatment-have raised concern that sub-optimal responses to ivermectin's anti-fecundity effect are becoming more frequent and may spread.Pooled next generation sequencing (Pool-seq) was used to characterise genetic diversity within and between 108 adult female worms differing in ivermectin treatment history and response. Genome-wide analyses revealed genetic variation that significantly differentiated good responder (GR) and sub-optimal responder (SOR) parasites. These variants were not randomly distributed but clustered in ~31 quantitative trait loci (QTLs), with little overlap in putative QTL position and gene content between the two countries. Published candidate ivermectin SOR genes were largely absent in these regions; QTLs differentiating GR and SOR worms were enriched for genes in molecular pathways associated with neurotransmission, development, and stress responses. Finally, single worm genotyping demonstrated that geographic isolation and genetic change over time (in the presence of drug exposure) had a significantly greater role in shaping genetic diversity than the evolution of SOR.This study is one of the first genome-wide association analyses in a parasitic nematode, and provides insight into the genomics of ivermectin response and population structure of O. volvulus. We argue that ivermectin response is a polygenically-determined quantitative trait (QT) whereby identical or related molecular pathways but not necessarily individual genes are likely to determine the extent of ivermectin response in different parasite populations. Furthermore, we propose that genetic drift rather than genetic selection of SOR is the underlying driver of population differentiation, which has significant implications for the emergence and potential spread of SOR within and between these parasite populations

Investing in Threatened Species Conservation: Does Corruption Outweigh Purchasing Power?

In many sectors, freedom in capital flow has allowed optimization of investment returns through choosing sites that provide the best value for money. These returns, however, can be compromised in countries where corruption is prevalent. We assessed where the best value for money might be obtained for investment in threatened species that occur at a single site, when taking into account corruption. We found that the influence of corruption on potential investment decisions was outweighed by the likely value for money in terms of pricing parity. Nevertheless global conservation is likely to get best returns in terms of threatened species security by investing in “honest” countries than in corrupt ones, particularly those with a high cost of living

Periodic eclipses of the young star PDS 110 discovered with WASP and KELT photometry

We report the discovery of eclipses by circumstellar disc material associated with the young star PDS 110 in the Ori OB1a association using the SuperWASP and Kilodegree Extremely Little Telescope surveys. PDS 110 (HD 290380, IRAS 05209-0107) is a rare Fe/Ge-type star, an similar to 10 Myr-old accreting intermediate-mass star showing strong infrared excess (L-IR/L-bol similar or equal to 0.25). Two extremely similar eclipses with a depth of 30 per cent and duration similar to 25 d were observed in 2008 November and 2011 January. We interpret the eclipses as caused by the same structure with an orbital period of 808 +/- 2 d. Shearing over a single orbit rules out diffuse dust clumps as the cause, favouring the hypothesis of a companion at similar to 2 au. The characteristics of the eclipses are consistent with transits by an unseen low-mass (1.8-70M(Jup)) planet or brown dwarf with a circumsecondary disc of diameter similar to 0.3 au. The next eclipse event is predicted to take place in 2017 September and could be monitored by amateur and professional observatories across the world

Can teaching agenda-setting skills to physicians improve clinical interaction quality? A controlled intervention

<p>Abstract</p> <p>Background</p> <p>Physicians and medical educators have repeatedly acknowledged the inadequacy of communication skills training in the medical school curriculum and opportunities to improve these skills in practice. This study of a controlled intervention evaluates the effect of teaching practicing physicians the skill of "agenda-setting" on patients' experiences with care. The agenda-setting intervention aimed to engage clinicians in the practice of initiating patient encounters by eliciting the full set of concerns from the patient's perspective and using that information to prioritize and negotiate which clinical issues should most appropriately be dealt with and which (if any) should be deferred to a subsequent visit.</p> <p>Methods</p> <p>Ten physicians from a large physician organization in California with baseline patient survey scores below the statewide 25th percentile participated in the agenda-setting intervention. Eleven physicians matched on baseline scores, geography, specialty, and practice size were selected as controls. Changes in survey summary scores from pre- and post-intervention surveys were compared between the two groups. Multilevel regression models that accounted for the clustering of patients within physicians and controlled for respondent characteristics were used to examine the effect of the intervention on survey scale scores.</p> <p>Results</p> <p>There was statistically significant improvement in intervention physicians' ability to "explain things in a way that was easy to understand" (p = 0.02) and marginally significant improvement in the overall quality of physician-patient interactions (p = 0.08) compared to control group physicians. Changes in patients' experiences with organizational access, care coordination, and office staff interactions did not differ by experimental group.</p> <p>Conclusion</p> <p>A simple and modest behavioral training for practicing physicians has potential to positively affect physician-patient relationship interaction quality. It will be important to evaluate the effect of more extensive trainings, including those that work with physicians on a broader set of communication techniques.</p

Phosphate solubilizers enhance NPK fertilizer use efficiency in rice and legume cultivation

It has been reported that phosphate solubilizing bacteria (PSB) are the most promising bacteria among the plant growth promoting rhizobacteria (PGPR); which may be used as biofertilizers for plant growth and nutrient use efficiency. Moreover, these soil micro-organisms play a significant role in regulating the dynamics of organic matter decomposition and the availability of plant nutrients such as nitrogen (N), phosphorus (P), potassium (K) and other nutrients. Through this study, the management of nutrient use efficiency by the application of PSB was targeted in order to make the applied nutrients more available to the plants in the rice (Oryza sativa) and yardlong bean (Vigna unguiculata) cultivation. Results have shown that the treatments with PSB alone or in the form of consortia of compatible strains with or without the external application of chemical NPK gave more germination index (G. I.) from 2.5 to 5 in rice and 2.7 to 4.8 in bean seeds. They also showed a higher growth in both shoot and root length and a higher biomass as compared to the control. This gives us an idea about the potentiality of these PSB strains and their application in rice and yardlong bean cultivation to get a better harvest index. Their use will also possibly reduce the nutrient runoff or leaching and increase in the use efficiency of the applied fertilizers. Thus, we can conclude that the NPK uptake and management can be improved by the use of PSB in rice and yardlong bean cultivation, and their application may be much more beneficial in the agricultural field

Measurement of the Relative Branching Fraction of Υ(4S)\Upsilon(4S) to Charged and Neutral B-Meson Pairs

We analyze 9.7 x 10^6 B\bar{B}$ pairs recorded with the CLEO detector to determine the production ratio of charged to neutral B-meson pairs produced at the Y(4S) resonance. We measure the rates for B^0 -> J/psi K^{(*)0} and B^+ -> J/psi K^{(*)+} decays and use the world-average B-meson lifetime ratio to extract the relative widths f+-/f00 = Gamma(Y(4S) -> B+B-)/Gamma(Y(4S) -> B0\bar{B0}) = = 1.04 +/- 0.07(stat) +/- 0.04(syst). With the assumption that f+- + f00 = 1, we obtain f00 = 0.49 +/- 0.02(stat) +/- 0.01(syst) and f+- = 0.51 +/- 0.02(stat) +/- 0.01(syst). This production ratio and its uncertainty apply to all exclusive B-meson branching fractions measured at the Y(4S) resonance.Comment: 11 pages postscript, also available through http://w4.lns.cornell.edu/public/CLN