Agreement Between HEDIS Performance Assessments in the VA and Medicare Advantage: Is Quality in the Eye of the Beholder?

Medicare Advantage (MA) plans and the Veterans Affairs (VA) health care system assess quality of care using standardized Healthcare Effectiveness Data and Information Set (HEDIS) performance measures. Little is known, however, about the relative accuracy of quality indicators for persons receiving care in more than one health care system. Among Veterans dually enrolled in an MA plan, we examined the agreement between MA and VA HEDIS assessments. Our study tested the hypothesis that private health plans underreport quality of care relative to a fully integrated delivery system utilizing a comprehensive electronic health record. Despite assessing the same individuals using identical measure specifications, reported VA performance was significantly better than reported MA performance for all 12 HEDIS measures. The VAs performance advantage ranged from 9.8% (glycosylated hemoglobin [HbA1c] < 7.0% in diabetes) to 54.7% (blood pressure < 140/90 mm Hg in diabetes). The overall agreement between VA and MA HEDIS assessments ranged from 38.5% to 62.6%. Performance rates derived from VA and MA aggregate data were 1.6% to 14.3% higher than those reported by VA alone. This analysis suggests that neither MA plans nor the VA fully capture quality of care information for dually enrolled persons. However, the VAs system-wide electronic health record may allow for more complete capture of quality information across multiple providers and settings

Virtual workplaces : when metaphors breakdown

Thesis (M.S.)--Massachusetts Institute of Technology, Dept. of Architecture, 1998.Includes bibliographical references (leaves 79-81).Our model of work is shaped by the places we choose to work and the tools we choose to work with. As we introduce new technologies and build new environments our model is changing. Today's virtual workplaces are grounded in models of work that have been reformed from our experiences using current technology in physical workspace. However we are discovering opportunities and possibilities for work in collaborative, virtual environments that question physical models. Emerging patterns of distributed collaboration in persistent virtual environments are changing the way we work in time and space, recasting our notion of workplace. Virtual workplaces are interpreted and experienced through metaphors that describe a space of potential for work occurrences. Through the lens of metaphors, this research focuses on breakdowns between collaborative work and the environment in which work occurs. If what we understand and predict is based on what we already know, then by examining the breakdowns between design and use of collaborative environments we can illuminate the space of possibilities for collaborative work.by Thomas W.I. Gallemore.M.S

Varves in Sandusky Bay Sediment

Author Institution: Heidelberg College, Tiffin, Ohi

A Flower For You Mother Dear

Tan cover with bold writinghttps://scholarsjunction.msstate.edu/cht-sheet-music/6681/thumbnail.jp

Using Electronic Drug Monitor Feedback to Improve Adherence to Antiretroviral Therapy Among HIV-Positive Patients in China

Effective antiretroviral therapy (ART) requires excellent adherence. Little is known about how to improve ART adherence in many HIV/AIDS-affected countries, including China. We therefore assessed an adherence intervention among HIV-positive patients in southwestern China. Eighty subjects were enrolled and monitored for 6 months. Sixty-eight remaining subjects were randomized to intervention/control arms. In months 7–12, intervention subjects were counseled using EDM feedback; controls continued with standard of care. Among randomized subjects, mean adherence and CD4 count were 86.8 vs. 83.8% and 297 vs. 357 cells/μl in intervention vs. control subjects, respectively. At month 12, among 64 subjects who completed the trial, mean adherence had risen significantly among intervention subjects to 96.5% but remained unchanged in controls. Mean CD4 count rose by 90 cells/μl and declined by 9 cells/μl among intervention and control subjects, respectively. EDM feedback as a counseling tool appears promising for management of HIV and other chronic diseases.Boston University and the Office of Health and Nutrition of the United States Agency for International Development (GHS-A-00-03-00030-00); World Health Organization; United States Centers for Disease Control; National Institutes of Health, National Institute of Allergy and Infectious Diseases (K23 AI 62208); Mid-Career Mentoring Award (K24 RR020300

PENGALIHAN STATUS PEGAWAI DILINGKUNGAN KOMISI PEMBERANTASAN KORUPSI (Analisis Putusan Nomor 28/PUU-XIX/2021)

The controversy over the Test Wawasan Kebangsaan (TWK) carried out by members of the Komisi Pemberantasan Korupsi (KPK) is currently being highlighted by the Indonesian public and media. The KPK TWK itself emerged as a result of the revision of UU No. 30/2002 which established the KPK as part of the executive power agency. Before being revised, the KPK was an independent institution and was free from the influence of any power. The transfer of the KPK from an independent institution to an executive has made its employees currently officially hold the status of government employee (ASN/Aparatur Sipil Negara), as stated in PP No. 41/2020. Application for Material Examination Ps. 69B paragraph (1) and Ps. 69C UU No. 19/2019 concerning the Second Amendment to UU No. 30/2002 concerning the KPK (UU No. 19/2019) against the Constitution of the Republic of Indonesia 1945 (UUD 1945). This study aims to determine and examine the staffing status of investigators working at the KPK. In addition, this study also aims to examine and analyze the ideal employment status for investigators and investigators at the KPK who support anti-corruption law enforcement. The type of research used in this study is a normative research method. The data in this study include primary data and secondary data, which are then processed qualitatively and analyzed by descriptive prescriptive. The results of this study indicate the fact that the staffing status of investigators who are under the auspices of the KPK, there are two possibilities, namely permanent employees and government employee who are employed. With the status of a permanent employee, if he originally came from a government employee who was employed, he lost his status as a government employee. As for the status of a government employee who is employed and does not wish to become a Permanent Employee of the KPK, he/she does not lose his/her status as a government employee. The problem found in this research is that the status of KPK investigators in UU No. 30/2002 (KPK Law) only regulates investigators as government employee where is employed. The KPK Law still restricts investigators from temporarily leaving their original institutions. Therefore, the KPK Law does not yet regulate the Permanent Dismissal for KPK Employees who come from other institutions. Furthermore, with regard to the ideal employment status for investigators at the KPK who support anti-corruption law enforcement, the provisions of KPK investigators in the KPK Law must be further expanded. In this case, the origin of the investigators and their investigators should also be sourced from institutions other than the police and the prosecutor's office. Thus, their independence is also getting stronger. In order to realize all these things, the KPK Law must be revised.Key World: Corruption Eradication Commission Employee Transfer Status, Corruption Eradication Commission, National Insight Test

Effective Field Theory for Extreme Mass Ratios

We derive an effective field theory describing a pair of gravitationally interacting point particles in an expansion in their mass ratio, also known as the self-force (SF) expansion. The 0SF dynamics are trivially obtained to all orders in Newton's constant by the geodesic motion of the light body in a Schwarzschild background encoding the gravitational field of the heavy body. The corrections at 1SF and higher are generated by perturbations about this configuration -- that is, the geodesic deviation of the light body and the fluctuation graviton -- but crucially supplemented by an operator describing the recoil of the heavy body as it interacts with the smaller companion. Using this formalism we compute new results at third post-Minkowskian order for the conservative dynamics of a system of gravitationally interacting massive particles coupled to a set of additional scalar and vector fields.Comment: 9 pages, 1 figur