The Role of Care Coordination in Meeting Quality Performance Measures in Ambulatory Care Settings

The accountable care organization (ACO) is a delivery reform initiative that was devised to focus on care, health, and cost; quality of care within these organizations is determined by a set of defined performance measures. The primary goal of this study was to investigate how a care coordination intervention, targeted to patients assigned to the organization’s ACO, affected patients’ likelihood of meeting performance measures. This is a retrospective longitudinal analysis using a pre post with non-equivalent control group research design. The sample included Medicare patients, age 66 and older, receiving care in a traditional clinic setting (n=718). The intervention took place in 2013, and data from the prior year were used to assess the change in patients’ performance over time. Methods used included grouped logistic regression, logistic regression, and difference in differences analyses. The results of these analyses show a positive association between care coordination and meeting defined performance measures for 1) all measures, 2) process measures, and 3) outcome measures. When comparing the impact of care coordination on process measures and outcome measures, process measures were more readily impacted by this care coordination intervention. Care coordination was positively associated with patients meeting defined performance measures. The results of this study can inform like organizations of an intervention to improve population health that does go beyond a structural change. This study also forced the examination of CMS’ defined performance measures; having one set of measures used for dual purposes may not be an effective performance management strategy. The performance measures have been highly validated for the purpose of improved population health, but are doubling as criteria by which both organization’s and providers’ performance are being assessed. Future research should examine the extent to which the evaluative criteria of defined performance measures are meetable and fair from a performance management purposes

Perceived Risk, Decisional Balance, and HIV Testing Practices in College Students

Previous research has found that college students widely participate in HIV risk behaviors, including inconsistent or lack of condom use, multiple sex partners, and sexual activities while under the influence of alcohol. However, most college students do not perceive themselves at risk for HIV and further, the majority of college students have never been tested for HIV. In an effort to understand the reasons undergraduate students may choose or not choose to get tested for HIV, and elucidate possible points for public health intervention, a survey was administered to undergraduate students at the University of Pittsburgh. Survey data was collected from 440 University of Pittsburgh undergraduate students on the pros and cons of HIV testing, their perceived risk for HIV as well as the number of times they had ever been tested. Chi-square tests were used to determine the relationship between decisional balance items and HIV testing as well as perceived risk and HIV testing. One-way ANOVA was used to determine any association between HIV testing and demographic variables.This study found that only 11.8% of students had ever received an HIV test. The likelihood of testing increased with age, while gender and ethnicity were not significant predictors of HIV testing. Students with high perceived risk were significantly more likely to have received an HIV test in their lifetime. Additionally, decisional balance items around the topics of "security and responsibility" and "fear of needles" were also found to be significant with HIV testing. The low rate of HIV testing in undergraduate college students is of great public health concern given the high prevalence of risk behaviors in this population. Students who participate in risk behaviors and are not tested for HIV limit their own ability to take advantage of efficacious treatments and put sex or drug partners at risk for contracting the virus. Research that helps uncover the behavioral determinants of HIV testing in the college student population and reveals potential points of intervention is of great public health significance

The Role of Care Coordination in Meeting Quality Performance Measures in Ambulatory Care Settings

The accountable care organization (ACO) is a delivery reform initiative that was devised to focus on care, health, and cost; quality of care within these organizations is determined by a set of defined performance measures. The primary goal of this study was to investigate how a care coordination intervention, targeted to patients assigned to the organization’s ACO, affected patients’ likelihood of meeting performance measures. This is a retrospective longitudinal analysis using a pre post with non-equivalent control group research design. The sample included Medicare patients, age 66 and older, receiving care in a traditional clinic setting (n=718). The intervention took place in 2013, and data from the prior year were used to assess the change in patients’ performance over time. Methods used included grouped logistic regression, logistic regression, and difference in differences analyses. The results of these analyses show a positive association between care coordination and meeting defined performance measures for 1) all measures, 2) process measures, and 3) outcome measures. When comparing the impact of care coordination on process measures and outcome measures, process measures were more readily impacted by this care coordination intervention. Care coordination was positively associated with patients meeting defined performance measures. The results of this study can inform like organizations of an intervention to improve population health that does go beyond a structural change. This study also forced the examination of CMS’ defined performance measures; having one set of measures used for dual purposes may not be an effective performance management strategy. The performance measures have been highly validated for the purpose of improved population health, but are doubling as criteria by which both organization’s and providers’ performance are being assessed. Future research should examine the extent to which the evaluative criteria of defined performance measures are meetable and fair from a performance management purposes

What Was Lost: How Dance/Movement Therapy Can Support the Retention and Repair of Cognitive Abilities in Cancer Patients, a Literature Review

This literature review examines research surrounding the effects of chemotherapy on cognitive abilities alongside methods of increasing cognitive functioning throughout treatment. Cancer-related cognitive impairment (CRCI) is seen in many patients undergoing chemotherapy yet has had little attention in cancer research. However, research that has been performed shows that by increasing physical activity during chemotherapy often results in improved cognitive abilities as well as increasing individual’s memory, focus, and multi-tasking abilities. With this connection between physical exercise and cognitive functioning, this author is interested in investigating the idea that dance/movement therapy can assist in the recovery and repair of residual cognitive dysfunction from chemotherapy, working with the mind-body connection to increase cognitive abilities. While there is no research available surrounding the use of dance/movement therapy to assist in cognitive functioning, this literature review will begin to discover where it would benefit an individual undergoing chemotherapy with an increase of cognitive dysfunction

An Examination of the Efficacy of Non-traditional Admissions Criteria on Persistence to Graduation Among Radiography Students

The relationship between non-traditional (a.k.a. non- cognitive) admissions criteria and graduation rates of radiography students was investigated. The population for this study included all radiography program directors responsible for accredited programs in the United States and Puerto Rico (N = 618). All programs are required to maintain records on retention in accordance with the Joint Review Committee on Education in Radiologic Technology (JRCERT) (n.d.). A total of 737 radiography programs are recognized by the American Registry of Radiologic Technologists (ARRT) and of the 737 programs, 618 are programmatically accredited by the JRCERT. Of the 618 programs accredited, the institutions offer either an associate’s degree, a bachelor’s degree, or are considered certificate programs. Two-year programs that utilized non-traditional admissions criteria had higher graduation rates. Ad- mission criteria such as the use of prerequisite courses were positively related to student persistence to program completion, while criteria such as departmental observations were not. These conclusions were drawn from data submitted by program directors that en- compassed two- and four-year radiography programs. An ANOVA demonstrated statistically significant differences (p = .05) between two-year programs that employ non-traditional admissions criteria and programs that rely more exclusively on traditional selection criteria such as GPA, standardized tests, reference letters, and interviews. Radiography program directors should be using prerequisite course performance to reformat their current admissions process to improve graduation rates in their programs

UA3/3/1 Correspondence re: Student Fees

Correspondence regarding the assessment of student fees and the Associated Student Government budget for 1968-1969

The Perfect Formula: Benchmarks that Best Predict Retention in Selective Admissions Programs

This study ascertained the admissions criteria utilized by Radiography programs with high graduation rates and determined whether a relationship exists between admissions criteria and graduation rates. With the high demands for healthcare professionals, preserving the number of students accepted into a cohort throughout the two-year program can be an overwhelming task. These programs should make every effort to admit and graduate those who meet the needs of the public, needs both diverse and subject to change. Radiography program directors and admissions committees are considered the “gatekeepers” of the profession. Yearly, more candidates apply than seats available. Therefore, the directors and committees are faced with the daunting task of selecting students they feel will be successful. Developing a selection system that is fair and equitable to all individuals is a difficult task. Selective admissions measures should be evaluated on the basis of validity, fairness, and feasibility. In the past, a lack of available research has forced program directors to evaluate their admissions process with those in other allied health fields. This research adds to the knowledge sought each year by program directors, who are held accountable for students they admit, as well as those they do not admit. Nine research questions guided this study, which sought to determine the selection criteria utilized by programs with high graduation rates. Results revealed that programs with high graduation rates in both two- and four-year programs utilized more criteria for their selection process than those with moderate to low graduation rates. In addition, a significant difference was seen in criteria utilized for interviews, types of reference letters, and the number and type of prerequisite classes employed as part of the admission criteria by programs with high graduation rates. Radiography program directors can utilize the results to reformat their current admissions process to improve graduation rates in their programs

Analysis of lead oxide (PbO) layers for direct conversion X-ray detection

Lead oxide (PbO) is a candidate direct conversion material for medical X-ray applications. We produced various samples and detectors with thick PbO layers. X-ray performance data such as dark current, charge generation yield and temporal behavior were evaluated on small samples. The influence of the metal contacts was studied in detail. We also covered large a-Si thin-film transistor (TFT)-plates with PbO. Imaging results from a large detector with an active area of 18 cm × 20 cm are presented. The detector has 960 × 1080 pixels with a pixel pitch of 184 ?m. The modulation transfer function at the Nyquist frequency of 2.72 linepairs/mm is 50%. Finally, a full size X-ray image is presented

Chemical Diversity and Defence Metabolism: How Plants Cope with Pathogens and Ozone Pollution

Chemical defences represent a main trait of the plant innate immune system. Besides regulating the relationship between plants and their ecosystems, phytochemicals are involved both in resistance against pathogens and in tolerance towards abiotic stresses, such as atmospheric pollution. Plant defence metabolites arise from the main secondary metabolic routes, the phenylpropanoid, the isoprenoid and the alkaloid pathways. In plants, antibiotic compounds can be both preformed (phytoanticipins) and inducible (phytoalexins), the former including saponins, cyanogenic glycosides and glucosinolates. Chronic exposure to tropospheric ozone (O3) stimulates the carbon fluxes from the primary to the secondary metabolic pathways to a great extent, inducing a shift of the available resources in favour of the synthesis of secondary products. In some cases, the plant defence responses against pathogens and environmental pollutants may overlap, leading to the unspecific synthesis of similar molecules, such as phenylpropanoids. Exposure to ozone can also modify the pattern of biogenic volatile organic compounds (BVOC), emitted from plant in response to herbivore feeding, thus altering the tritrophic interaction among plant, phytophagy and their natural enemies. Finally, the synthesis of ethylene and polyamines can be regulated by ozone at level of S-adenosylmethionine (SAM), the biosynthetic precursor of both classes of hormones, which can, therefore, mutually inhibit their own biosynthesis with consequence on plant phenotype

Congenital rubella syndrome and autism spectrum disorder prevented by rubella vaccination - United States, 2001-2010

<p>Abstract</p> <p>Background</p> <p>Congenital rubella syndrome (CRS) is associated with several negative outcomes, including autism spectrum disorders (ASDs). The objective of this study was to estimate the numbers of CRS and ASD cases prevented by rubella vaccination in the United States from 2001 through 2010.</p> <p>Methods</p> <p>Prevention estimates were calculated through simple mathematical modeling, with values of model parameters determined from published literature. Model parameters included pre-vaccine era CRS incidence, vaccine era CRS incidence, the number of live births per year, and the percentage of CRS cases presenting with an ASD.</p> <p>Results</p> <p>Based on our estimates, 16,600 CRS cases (range: 8300-62,250) were prevented by rubella vaccination from 2001 through 2010 in the United States. An estimated 1228 ASD cases were prevented by rubella vaccination in the United States during this time period. Simulating a slight expansion in ASD diagnostic criteria in recent decades, we estimate that a minimum of 830 ASD cases and a maximum of 6225 ASD cases were prevented.</p> <p>Conclusions</p> <p>We estimate that rubella vaccination prevented substantial numbers of CRS and ASD cases in the United States from 2001 through 2010. These findings provide additional incentive to maintain high measles-mumps-rubella (MMR) vaccination coverage.</p