Ready to Quit: Predictive Analysis on Member Readiness of Enrolling Smoking Cessation Programs in Kaiser Permanente Southern California

Background/Aims: We describe a predictive analysis to help regional operations engage smoking members with high likelihood of enrollment into smoking cessation services. Methods: A combination of investigation methods was used: 1) data mining and basic free text parsing and recognition; 2) predictive modeling to discover predictors of member enrollment in smoking cessation services and score the future population to identify smoking members with high likelihood of enrollment; and 3) randomized control trial to (a) identify the best protocols to outreach these members, and (b) refine the model and establish a learning cycle to guide operations. Results: We have identified and processed a wide range of predictors including smoking habit, social/economic factors, enrollment history, significant medical conditions, family characteristics, medical utilization history, online interaction and other health/social behaviors. The model performed very well in validation process, with c-stat of 0.76, which provides a good fit and predicts power. The findings of significant predictors were in agreement with many literatures. These predictors include past enrollment, sex and disease burden. We also found that race/ethnicity and online activity, especially patient/physician secure email communication on smoking matter, strongly predict likelihood of enrollment. Discussion: In the Kaiser Permanente Southern California region, approximately 200,000 smokers can be identified through social history and ICD-9 codes in Kaiser Permanente HealthConnect. The top 20% of the modeled population represents 50% of potential enrollees in smoking cessation programs, and this population will be targeted in the outreach effort in a randomized control trial designed as follows. A population of 10,000 will be randomly selected to not participate in phase one, but will be eligible to participate after the first phase. Of this 10,000, 5,000 will receive no intervention and 5,000 will receive only existing auto-dialer outreach, both of which are within the normal standard of care. The remaining 30,000 members (10,000 per month) will be randomized by medical center into three treatment groups of equal size: auto-dialer plus live phone call, auto-dialer plus letter, and auto-dialer plus email

Categorizing Patient-Provider Secure Email Communications to Measure Substitutionary Effect on In-Person Services

Background/Aims: Previous observational studies have reported conflicting results when evaluating patients’ use of secure email and their use of in-person clinical services. Different studies have found that secure email between patients and health care providers may substitute for, increase, or have no impact on the need for in-person clinical services. In this study we used diagnosis codes and order codes associated with emails to categorize the type of email communication. We then evaluated whether particular categories of emails substituted for the need for in-person clinical services. Methods: We used retrospective data from Kaiser Permanente Colorado members over the age of 18 who were continuously enrolled for at least 30 months in 2010–2013. We identified which emails contained diagnosis code(s) and or order code(s). We categorized emails containing diagnosis code(s) into low acuity conditions based on diagnosis-related group categories. We then determined if the patient had a subsequent in-person appointment. Results: Health care providers added a diagnosis code to 19% of secure emails, and 85% of these members did not have a follow-up visit or telephone call in the next 30 days. Health care providers placed a coded order within a secure email encounter 21% of the time, and 85% of these members did not have a follow-up visit or telephone call in the next 30 days. Only 8% of secure emails for low acuity conditions resulted in a follow-up visit within the next 30 days. This is comparable to rate of follow-up office visits for low acuity conditions. Discussion: Secure email communication between patients and health care providers may substitute for the need for in-person clinical services for specific circumstances and conditions

Accounting and taxation aspects of financial leasing in a trading company

The objective of the thesis is to examine and appraise the accounting and taxation aspects of financial leasing in a particular trading company until valid rules of law within the territory of the Czech Republic. All the information gained was elaborated mainly by the combination of text and open excerption methods. Also methods of synthesis and deduction were used. The text of the thesis is joined by charts, model examples and a diagram which illustrates specialization of the leasing within the Czech Republic. Financial leasing is considered as a very flexible instrument for funding of the long term company requisites. Financial leasing is usually translated as a lease which is followed by surrender of a hired object when the period of lease is over. For a leaseholder financial leasing represents a long term commitment, usually a fixed one. The practical section of the thesis is focused on investigation of accounting and taxation aspects and their impact on a business unit. The cost development of financial leasing, bank credit and cash buying is compared among others