Using graph visualization to look at the trajectories of events that lead to readmission

Information on specific sequence of healthcare utilization events in heart failure patients may be useful for identifying distinct subpopulations of patients with HF. Knowledge of patient trajectories may help to improve prediction of future readmission which can be used to tailor management to the individual needs of the patient. This research introduces a new approach to mining administrative and clinical datasets by incorporating graph networks to identify & visualize the trajectories of sequences of events

Using Graphs to Characterize Nationwide Physician Referral Networks

AIM: Evaluating physician referral network characteristics can help to understand how physicians and hospitals interact to provide patient services within the US healthcare system and ultimately how this may influence patient outcomes. METHOD: We used the 2012-2013 national Physician Referral data from the Centers for Medicare & Medicaid Services (CMS), which consists of 73,071,804 pairs of referrals from one health provider to another in calendar year 2012 and the first two quarters of year 2013 within 30 days of care. These referrals are from 642,144 national-wide physicians and 4,811 hospitals. We obtained information for each provider, physician or hospital, from CMS. We then generated a nationwide referral network. We described the network with graphs and potential important network characteristics using graph theory and social network theory. Further, we described the sub-network by Exponential random graph models (ERGM). The ERGM coefficients from such models can reflect the properties of the network nodes and help illustrate how the network outcomes are influenced. RESULTS: Our results show that 1) the graphs and characteristics vary substantially across the geographic areas and 2) graphs and the characteristics depicting the same area are strongly associated. The ERGM model shows that physicians in cardiology, diagnostic radiology and geriatric medicine are more likely to send and receive referrals than physicians in family care and internal medicine in certain hospitals. CONCLUSION: We demonstrate the use of graph-based approaches to describe and evaluate nationwide physician referral networks. Further work will study how these network characteristics are associated with hospital outcomes

Health Disparities Between Medicare Beneficiaries In The United States Territories And The 50 States And District Of Columbia

Millions of Americans live in United States territories, but health outcomes and payments among Medicare beneficiaries in these territories are not well characterized. We sought to assess and compare hospitalization rates, outcomes, and Medicare payments between Medicare Fee-for-Service beneficiaries in the territories and the 50 states and District of Columbia (hereafter called “states”) for common medical conditions. Utilizing the Medicare denominator and inpatient files, we conducted a serial cross-sectional analysis of Fee-for-Service Medicare beneficiaries 65 years of age or older hospitalized between 1999 and 2012 for acute myocardial infarction (AMI), heart failure (HF), and pneumonia in the territories and states. Over 14 years, there were 4,350,813 unique beneficiaries in the territories and 402,902,615 in the states. Hospitalization rates for AMI, HF, and pneumonia declined overall and did not differ significantly. However, 30-day mortality rates were higher in the territories for all three conditions: in the most recent time period (2008-2012), the adjusted odds of 30-day mortality were 1.34 (95% CI, 1.21 to 1.48), 1.24 (95% CI, 1.12 to 1.37), and 1.85 (95% CI, 1.71 to 2.00) for AMI, HF, and pneumonia, respectively; adjusted odds of 1-year mortality were also higher. In the most recent study period, inflation-adjusted Medicare in-patient payments, in 2012 dollars, were lower in the territories than the states, at $9234 less (61$4479 less (50% lower), and $4403 less (39% lower) for AMI, HF, and pneumonia hospitalizations, respectively (p\u3c0.001 for all). In conclusion, among Medicare Fee-for-Service beneficiaries, mortality rates were significantly higher, and hospital reimbursements were substantially lower, for patients hospitalized with AMI, HF, and pneumonia in the territories. Improvement of healthcare in the territories and the policies that govern them is needed to ensure health equity for all Americans

The use of google trends in health care research: a systematic review.

BACKGROUND: Google Trends is a novel, freely accessible tool that allows users to interact with Internet search data, which may provide deep insights into population behavior and health-related phenomena. However, there is limited knowledge about its potential uses and limitations. We therefore systematically reviewed health care literature using Google Trends to classify articles by topic and study aim; evaluate the methodology and validation of the tool; and address limitations for its use in research. METHODS AND FINDINGS: PRISMA guidelines were followed. Two independent reviewers systematically identified studies utilizing Google Trends for health care research from MEDLINE and PubMed. Seventy studies met our inclusion criteria. Google Trends publications increased seven-fold from 2009 to 2013. Studies were classified into four topic domains: infectious disease (27% of articles), mental health and substance use (24%), other non-communicable diseases (16%), and general population behavior (33%). By use, 27% of articles utilized Google Trends for casual inference, 39% for description, and 34% for surveillance. Among surveillance studies, 92% were validated against a reference standard data source, and 80% of studies using correlation had a correlation statistic ≥0.70. Overall, 67% of articles provided a rationale for their search input. However, only 7% of articles were reproducible based on complete documentation of search strategy. We present a checklist to facilitate appropriate methodological documentation for future studies. A limitation of the study is the challenge of classifying heterogeneous studies utilizing a novel data source. CONCLUSION: Google Trends is being used to study health phenomena in a variety of topic domains in myriad ways. However, poor documentation of methods precludes the reproducibility of the findings. Such documentation would enable other researchers to determine the consistency of results provided by Google Trends for a well-specified query over time. Furthermore, greater transparency can improve its reliability as a research tool

Most important outcomes research papers on stroke and transient ischemic attack

The following are highlights from the new series, Circulation: Cardiovascular Quality and Outcomes Topic Review. This series will summarize the most important manuscripts, as selected by the Editor, that have published in the Circulation portfolio. The objective of this new series is to provide our readership with a timely, comprehensive selection of important papers that are relevant to the quality and outcomes, and general cardiology audience. The studies included in this article represent the most significant research related to stroke and transient ischemic attack. (Circ Cardiovasc Quality and Outcomes. 2014; 7:191-204.