Healthcare Utilization in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Analysis of US Ambulatory Healthcare Data, 2000–2009

Background: ME/CFS is a complex and disabling illness with substantial economic burden and functional impairment comparable to heart disease and multiple sclerosis. Many patients with ME/CFS do not receive appropriate healthcare, partially due to lack of diagnostic tests, and knowledge/attitudes/beliefs about ME/CFS. This study was to assess the utility of US ambulatory healthcare data in profiling demographics, co-morbidities, and healthcare in ME/CFS.Methods: Data came from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) in the U.S. Weighted analysis was performed. We examined 9.06 billion adult visits from 2000 to 2009 NAMCS/NHAMCS data. ME/CFS-related visits were identified by ICD-9-CM code, 780.71, up to tertiary diagnosis.Results: We estimated 2.9 million (95% CI: 1.8–3.9 million) ME/CFS-related visits during 2000–2009, with no statistical evidence (p-trend = 0.31) for a decline or increase in ME/CFS-related visits. Internists, general and family practitioners combined provided 52.12% of these visits. Patients with ME/CFS-related visits were mostly in their 40 and 50 s (47.76%), female (66.07%), white (86.95%), metropolitan/urban residents (92.05%), and insured (87.26%). About 71% of ME/CFS patients had co-morbidities, including depression (35.79%), hypertension (31.14%), diabetes (20.30%), and arthritis (14.11%). As one quality indicator, physicians spent more time on ME/CFS-related visits than non-ME/CFS visits (23.62 vs. 19.38 min, p = 0.065). As additional quality indicators, the top three preventive counseling services provided to patients with ME/CFS-related visits were diet/nutrition (8.33%), exercise (8.21%), and smoking cessation (7.24%). Compared to non-ME/CFS visits, fewer ME/CFS-related visits included counseling for stress management (0.75 vs. 3.14%, p = 0.010), weight reduction (0.88 vs. 4.02%, p = 0.002), injury prevention (0.04 vs. 1.64%, p < 0.001), and family planning/contraception (0.17 vs. 1.45%, p = 0.037).Conclusions: Visits coded with ME/CFS did not increase from 2000 to 2009. Almost three quarters of ME/CFS-related visits were made by ME/CFS patients with other co-morbid conditions, further adding to complexity in ME/CFS healthcare. While physicians spent more time with ME/CFS patients, a lower proportion of ME/CFS patients received preventive counseling for weight reduction, stress management, and injury prevention than other patients despite the complexity of ME/CFS. NAMCS/NHAMCS data are useful in evaluating co-morbidities, healthcare utilization, and quality indicators for healthcare in ME/CFS

Impact of hospital diagnosis-specific quality measures on patients’ experience of hospital care: Evidence from 14 states, 2009-2011

In order to assess consistency across quality measures for Untied States hospitals, this paper uses patient responses to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for three years (2009-2011) from 1,333 acute-care hospitals in fourteen states to analyze patterns in hospital-reported patient experience-of-care scores by diagnosis-specific process and outcome measures for acute myocardial infarction, heart failure, and pneumonia. We also evaluate how scores have changed over the three-year period. We find significant differences in patient experience-of-care scores for 195 out of 230 relationships between HCAHPS patient experience-of-care scores and 23 diagnosis-specific process and outcomes measures. We find nearly no significant differences in changes in scores from 2009-2011 (8 out of 230) when comparing the same experience-of-care and diagnosis-specific quality measures. For the majority of measures, high scores on the quality metrics were associated with high patient experience-of-care scores

Variations in the patients’ hospital care experience by states’ strategy for Medicaid expansion: 2009-2013

Our investigation evaluates the extent of differences in the patient’s hospital experience due to variations among state strategies to adopt, or not adopt, their Medicaid plans to the 2010 ACA legislation. Using ten HCAHPS measures, we analyze patient hospital experience data for the 2009 - 2013 period for all 50 states and the District of Columbia grouped by those states that (1) did not expand, (2) expanded Medicaid through Section 1115 waivers, (3) expanders early, and (4) expanded Medicaid concurrent with the new ACA legislation. Our findings reveal that those states that opted out of Medicaid expansion typically started with higher patient experience scores in 2009 on all 10 HCAHPS hospital measures and maintained their higher scores levels for all five years over the other three state expansion strategies for most measures. While states that were early expanders and those that expanded concurrent with the ACA implementation generally show higher growth rates over the five-year period for most HCAHPS measures when compared to states that opted out of the Medicaid expansion, our multivariate results indicate that their rates of growth were not statistically superior to those states that opted out of the expansion. We conclude that while there have been concerns that the patients in opt-out states would experience lower levels of satisfaction from their state’s actions, the patient experience scores in these states show that they perform better or as well as those states that expanded early, expanded under waivers, and expanded with the implementation of the ACA legislation

Impact of hospital characteristics on patients’ experience of hospital care: Evidence from 14 states, 2009-2011

This paper uses patient responses to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for three years (2009-2011) from 1,333 acute-care hospitals in fourteen states to analyze patterns in 10 hospital-reported patient experience-of-care scores by 29 characteristics classified as: patient characteristics, payer source, patient severity, hospital characteristics, hospital operations, and market characteristics. We also evaluate how scores have changed over the three-year period. We find significant differences in patient experience-of-care scores by hospital characteristics for 250 out of 290 HCAHPS-hospital characteristic combinations measured. We find fewer significant differences in changes in scores from 2009-2011 (135 out of 290), with hospitals categorized as high scoring also reporting consistently greater improvement. We conclude that patient experience-of-care scores vary by hospital characteristics, although improvements in scores show less variety by hospital categorization

Factors in patients’ experience of hospital care: Evidence from California, 2009–2011

The use of measures of patient-centered care to evaluate hospital care is mandated by The Patient Protection and Affordable Care Act of 2010. Using three years of data from 315 California acute-care hospitals and data collected from patients via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, we seek to evaluate patients’ hospital-care experience by (1) analyzing patients’ experience-of-care scores in light of these hospitals’ patient profiles, structural characteristics, and outcomes in 2011, and (2) determining and analyzing the extent of changes in patients’ experience of care over the three-year period 2009–2011. For 2011, we find significant variation in patients’ experience-of-care scores associated with hospitals’ different patient profiles and structural characteristics. In spite of these single-year differences, virtually all aspects of patients’ experience of care showed improvement over the 2009-2011 period

On the local and global existence of unique solutions to the L??st model

The Magnetohydrodynamics equations (MHD) provide a macroscopic description of a plasma and it provides a relevant description many physical phenomena. However, MHD is deficient in many respect and some of these deficiencies are accounted for by extending Ohm???s law with the momentum equations being usually unchanged. But, this approach does not give conservation of the energy for some cases. In this paper, we take a model proposed by L??st who appears to be the first to correct the generalized Ohm???s law to guarantee conservation of the energy. We first show the existence of unique solutions and establish a blow-up criterion to the L??st model with initial data in . We then prove that this solution is defined globally-in-time and decays algebraically when the initial data is sufficiently small

An Experimental Analysis of Water–Air Two-Phase Flow Pattern and Air Entrainment Rate in Self-Entrainment Venturi Nozzles

For self-entrainment venturi nozzles, the effects of nozzle shapes and operating conditions on the water–air two-phase flow pattern, and the characteristics of the air entrainment rate have been investigated. A rectangular venturi nozzle with width and height dimensions of 3 mm and 0.5 mm was used with a vertically downward flow direction. The pressure ratio, which is the ratio of the inlet and outlet pressures, water flow rate, and diverging angle were set as experimental parameters. From the flow visualization, annular and bubbly flows were observed. In the case of bubbly flow, the more bubbles that are generated with a higher water flow rate, the smaller the pressure ratio. In the case of annular flow, the increased pressure ratio and water flow rate induce the breakup of air core in the diverging area and make the interfacial oscillation stronger, which finally causes the flow transition from annular to bubbly flow, by accompanying a sharp increase in the air entrainment rate. During this flow transition, the frictional pressure drop of the two-phase flow is reduced, showing that a two-phase multiplier gets smaller

Health Information Technology and its Effects on Hospital Costs, Outcomes, and Patient Safety

Underlying many reforms in the Patient Protection and Affordable Care Act (ACA) is the use of electronic medical records (EMRs) to help contain costs. We use MarketScan® claims data and American Hospital Association information technology (IT) data to examine whether EMRs can contain costs in the ACA's reforms to reduce patient safety events. We find EMRs do not reduce the rate of patient safety events. However, once an event occurs, EMRs reduce death by 34%, readmissions by 39%, and spending by $4,850 (16$1.75 per $1 spent on IT capital. Thus, EMRs contain costs by better coordinating care to rescue patients from medical errors once they occur

Global existence and decay rates of solutions to the viscous water-waves system

In this paper, we analyze a nonlinear model of the viscous water-waves equation proposed in Dias et al. (2008). To this end, we first study the linear model in Dias et al. (2008). We then derive a new model which approximates the nonlinear model in Dias et al. (2008). We finally show the existence of a unique global-in-time solution and its decay rates to this new system with small initial data in energy spaces. (C) 2022 Elsevier Ltd. All rights reserved