Determinants of the New Entry of HMOs into A Medicare Risk Contract: A Resource Dependence-Diversification Model

The purpose of this study is to examine the determinants of the new entry of an HMO into a Medicare risk contract using a resource dependence—diversification model. This study is conducted through a non-experimental, panel design With one year time lag. An HMO’s market is defined as the service area. The primary sample for this study is composed of 440 HMOS that do not have a Medicare risk contract as of January 1994. Data for the variables are extracted from the 1994 and 1995 InterStudy and Group Health Association of America (GHAA) directories, the 1996 Area Resource File, the 1994 County and City Data Book, the 1993 County Business Patterns. Additional supplementary data on adjusted average per capita cost (AAPCC) and county-level Medicare beneficiaries are obtained from the Health Care Financing Administration. The dependent variable is discrete indicating an HMO’s market entry. Independent variables are grouped into four categories: market structure, resource munificence, market price, and organizational attributes. Twelve hypotheses are tested using multivariate logistic regression. This analysis reveals that HMO enrollment size is a predominant, positive factor in predicting a new market entry. HMOs are also sensitive to the level of AAPCC rates in making a market entry decision. Results from hypothesis testing suggest that competition encourages a new market entry. The importance of resource munificence is not statistically supported. This study demonstrates the appropriateness of a panel design to verify a cause-effect relationship and the applicability of the service area as an HMO’s market. This study also contributes to the theoretical understanding of an HMO’s market entry

Assessing uncertainty in outsourcing clinical services at tertiary health centers

When tertiary health centers face capacity constraint, one feasible strategy to meet service demand is outsourcing clinical services to qualified community providers. Clinical outsourcing enables tertiary health centers to meet the expectations of service timeliness and provides good opportunities to collaborate with other health care providers. However, outsourcing may result in dependence and loss of control for the tertiary health centers. Other parties involved in clinical outsourcing such as local partners, patients, and payers may also encounter potential risks as well as enjoy benefits in an outsourcing arrangement. Recommendations on selecting potential outsourcing partners are given to minimize the risks associated with an outsourcing contract. Copyright © 2006 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/56139/1/858_ftp.pd

Functional pathway mapping analysis for hypoxia-inducible factors

Background: Hypoxia-inducible factors (HIFs) are transcription factors that play a crucial role in response to hypoxic stress in living organisms. The HIF pathway is activated by changes in cellular oxygen levels and has significant impacts on the regulation of gene expression patterns in cancer cells. Identifying functional conservation across species and discovering conserved regulatory motifs can facilitate the selection of reference species for empirical tests. This paper describes a cross-species functional pathway mapping strategy based on evidence of homologous relationships that employs matrix-based searching techniques for identifying transcription factorbinding sites on all retrieved HIF target genes. Results: HIF-related orthologous and paralogous genes were mapped onto the conserved pathways to indicate functional conservation across species. Quantitatively measured HIF pathways are depicted in order to illustrate the extent of functional conservation. The results show that in spite of the evolutionary process of speciation, distantly related species may exhibit functional conservation owing to conservative pathways. The novel terms OrthRate and ParaRate are proposed to quantitatively indicate the flexibility of a homologous pathway and reveal the alternative regulation of functional genes. Conclusion: The developed functional pathway mapping strategy provides a bioinformatics approach for constructing biological pathways by highlighting the homologous relationships between various model species. The mapped HIF pathways were quantitatively illustrated and evaluated by statistically analyzing their conserved transcription factor-binding elements

Effect of motorcycle helmet types on head injuries: evidence from eight level-I trauma centres in Taiwan

BackgroundMotorcycle full-coverage helmet use may reduce fatalities and head injuries.MethodsThis retrospective cohort study extracted injury data from eight level-I trauma centres in Taiwan and performed a questionnaire survey to investigate injuries sustained by motorcyclists for the period between January 2015 and June 2017.ResultsAs many as 725 patients participated in the questionnaire survey and reported their helmet types or phone use during crashes. The results of multivariate logistic models demonstrated that nonstandard helmet (half or open-face helmet) use was associated with an increased risk of head injuries and more severe injuries (injury severity score ≥ 8). Drunk riding and phone use appeared to be two important risk factors for head injuries and increased injury severity. Anaemia was also found to be a determinant of head injuries.”ConclusionsCompared to full-coverage helmets, nonstandard provide less protection against head injuries and increased injury severity among motorcyclists

The relationship between diabetes mellitus and 30-day readmission rates

Abstract Background It is estimated that 9.3% of the population in the United States have diabetes mellitus (DM), 28% of which are undiagnosed. The high prevalence of DM makes it a common comorbid condition in hospitalized patients. In recent years, government agencies and healthcare systems have increasingly focused on 30-day readmission rates to determine the complexity of their patient populations and to improve quality. Thirty-day readmission rates for hospitalized patients with DM are reported to be between 14.4 and 22.7%, much higher than the rate for all hospitalized patients (8.5–13.5%). The objectives of this study were to (1) determine the incidence and causes of 30-day readmission rates for patients with diabetes listed as either the primary reason for the index admission or with diabetes listed as a secondary diagnosis compared to those without DM and (2) evaluate the impact on readmission of two specialized inpatient DM services: the Hyperglycemic Intensive Insulin Program (HIIP) and Endocrine Consults (ENDO). Methods For this study, DM was defined as any ICD-9 discharge diagnosis (principal or secondary) of 250.xx. Readmissions were defined as any unscheduled inpatient admission, emergency department (ED) visit, or observation unit stay. We analyzed two separate sets of patient data. The first pilot study was a retrospective chart review of all patients with a principle or secondary admission diagnosis of diabetes admitted to any adult service within the University of Michigan Health System (UMHS) between October 1, 2013 and December 31, 2013. We then did further uncontrolled analysis of the patients with a principal admitting diagnosis of diabetes. The second larger retrospective study included all adults discharged from UMHS between October 1, 2013 and September 30, 2014 with principal or secondary discharge diagnosis of DM (ICD-9-CM: 250.xx). Results In the pilot study of 7763 admissions, the readmission rate was 26% for patients with DM and 22% for patients without DM. In patients with a primary diagnosis of DM on index admission, the most common cause for readmission was DM-related. In the larger study were 37,702 adult inpatient discharges between October 1, 2013 and September 30, 2014. Of these, 20.9% had DM listed as an encounter diagnosis. Rates for all encounters (inpatient, ED and Observation care) were 24.3% in patients with DM compared to 17.7% in those without DM (p < 0.001). The most common cause for readmission in patients with DM as a secondary diagnosis to the index admission was infection-related. During the index hospital stay, only a small proportion of patients with DM (approximately 12%) received any DM service consult. Those who received a DM consult had a higher case mix index compared to those who did not. Despite the higher acuity, there was a lower rate of ED /observation readmission in patients followed by the DM services (6.6% HIIP or ENDO vs. 9.6% no HIIP or ENDO, p = 0.0012), though no difference in the inpatient readmission rates (17.6% HIIP or ENDO vs. 17.4% no HIIP or ENDO, p = 0.89) was noted. Conclusions Patients with both a primary or secondary diagnosis of DM have higher readmission rates. The reasons for readmission vary; patients with a principal diagnosis of DM have more DM related readmissions and those with secondary diagnosis having more infection-related readmissions. DM services were used in a small proportion of patients and may have contributed to lower DM related ED revisits. Further prospective studies evaluating the role of these services in terms of glucose management, patient education and outpatient follow up on readmission are needed to identify interventions important to reducing readmission rates.https://deepblue.lib.umich.edu/bitstream/2027.42/136189/1/40842_2016_Article_40.pd

Use of Ceftriaxone in Treating Cognitive and Neuronal Deficits Associated With Dementia With Lewy Bodies

Dementia with Lewy bodies (DLB) is caused by accumulation of Lewy bodies, destruction of mitochondria, and excess of glutamate in synapses, which eventually leads to excitotoxicity, neurodegeneration, and cognitive impairments. Ceftriaxone (CEF) reduces excitotoxicity by increasing glutamate transporter 1 expression and glutamate reuptake. We investigated whether CEF can prevent cognitive decline and neurological deficits and increase neurogenesis in DLB rats. Male Wistar rats infused with viral vector containing human alpha-synuclein (α-syn) gene, SNCA, in the lateral ventricle were used as a rat model of DLB. CEF (100 mg/kg/day, i.p.) was injected in these rats for 27 days. The active avoidance test and object recognition test was performed. Finally, the brains of all the rats were immunohistochemically stained to measure α-syn, neuronal density, and newborn cells in the hippocampus and substantia nigra. The results revealed that DLB rats had learning and object recognition impairments and exhibited cell loss in the nigrostriatal dopaminergic system, and hippocampal CA1, and dentate gyrus (DG). Additionally, DLB rats had fewer newborn cells in the DG and substantia nigra pars reticulata and more α-syn immune-positive cells in the DG. Treatment with CEF improved cognitive function, reduced cell loss, and increased the number of newborn cells in the brain. To our knowledge, this is the first study showing that CEF prevents loss of neurogenesis in the brain of DLB rats. CEF may therefore has clinical potential for treating DLB