A STUDY OF PREVENTABLE HOSPITAL UTILIZATION AMONG MEDICAID-INSURED PEDIATRIC PATIENTS IN NORTH CAROLINA’S FEDERALLY QUALIFIED HEALTH CENTERS

Objective. The goal of this research is to evaluate preventable hospital utilization among Medicaid-insured federally qualified health center (FQHC) patients in North Carolina and to determine organizational factors associated with preventable hospital use. Methods. Using 2013-2015 Medicaid claims data, we applied instrumental variable analysis using two-stage residual inclusion to account for differential patient selection into FQHCs and estimated the association of FQHC use on preventable hospital utilization. Because there is no “gold standard” in performance classification, we applied three different methodologies to rank FQHC organizations according to their relative rates of preventable hospital use and estimated an overall performance ranking that incorporated the results of the three statistical approaches. Finally, we estimated patient-level regression models with FQHC fixed effects and ran organization-level configurational comparative analyses to identify organizational characteristics associated with preventable hospital utilization. Results. Across all model specifications in this study sample, we found that FQHC patients had a significantly higher probability of preventable hospital utilization when compared to patients accessing primary care services from non-FQHC providers. We identified variation in the absolute rankings of FQHC organizations across performance classification methodologies, but the organizations comprising the top- and bottom-performance quartiles remained consistent. We demonstrated that the geometric mean could be used to estimate an overall performance ranking across methodologies. Finally, we found that patients utilizing FQHCs with a broader scope of non-medical services and more of certain non-medical services staff were more likely to experience preventable hospital use even after controlling for patient characteristics. However, these results were associated with significant limitations. Conclusions. The differential effect of FQHC use may be driven by higher emergency department utilization among FQHC patients, as this comprised the majority of hospital use among pediatric asthma patients in this study. Patients using FQHCs with a broader scope of non-medical services and more of certain types of non-medical services staff were more likely to have preventable hospital utilization, but these organization-level factors do not reflect patient-level utilization of services. Children may be accessing non-medical services in FQHCs less frequently than adults, for example. Future research should incorporate FQHCs’ electronic health record data and qualitative interviews to best identify organization structures and processes associated with performance. This research also underscores the need for policymakers and payers to incorporate encounter-level data on non-medical services in claims submissions in order to better measure the effect of non-medical services on health care costs, utilization and outcomes across all provider types.Doctor of Philosoph

Explaining accommodation and resistance in Kentucky

Article written by Rebecca S. Katz and Stephen Whitaker and published in the 2001 issue of Crime, Law & Social Change, pages 295-318

Coincidence analysis: a new method for causal inference in implementation science

Background Implementation of multifaceted interventions typically involves many diverse elements working together in interrelated ways, including intervention components, implementation strategies, and features of local context. Given this real-world complexity, implementation researchers may be interested in a new mathematical, cross-case method called Coincidence Analysis (CNA) that has been designed explicitly to support causal inference, answer research questions about combinations of conditions that are minimally necessary or sufficient for an outcome, and identify the possible presence of multiple causal paths to an outcome. CNA can be applied as a standalone method or in conjunction with other approaches and can reveal new empirical findings related to implementation that might otherwise have gone undetected. Methods We applied CNA to a publicly available dataset from Sweden with county-level data on human papillomavirus (HPV) vaccination campaigns and vaccination uptake in 2012 and 2014 and then compared CNA results to the published regression findings. Results The original regression analysis found vaccination uptake was positively associated only with the availability of vaccines in schools. CNA produced different findings and uncovered an additional solution path: high vaccination rates were achieved by either (1) offering the vaccine in all schools or (2) a combination of offering the vaccine in some schools and media coverage. Conclusions CNA offers a new comparative approach for researchers seeking to understand how implementation conditions work together and link to outcomes.publishedVersio

PANORAMIC - A Pure Parallel Wide Area Legacy Imaging Survey at 1-5 Micron

Where HST has characterized the UV universe to z=6-7 and beyond, JWST is designed to take the crucial next step and characterize the UV universe to z=12-15 (a factor of 2 in expansion rate), at only ~300 Myr after the Big Bang where we expect the first galaxies to form. Additionally, JWST for the first time allows studies of the restframe optical emission to z=10, a huge leap from the current z=3 (HST). To fully capitalize on JWST's unparalleled imaging AND spectroscopic capabilities, it is critical, however, to find the most precious intrinsically luminous candidate galaxies early in the mission. Large area imaging is thus needed from day one. Here, we propose to exploit the unique opportunity offered by pure parallel observing to efficiently obtain such a wide-area reference survey over 0.4 sq degrees in 6 NIRCam filters. By probing 7x larger area than any other currently planned (GTO/ERS) program our survey will probe a unique discovery space with unprecedented imaging at 1-5micron. These data overcome two major outstanding limitations in our current extragalactic census using yet-undiscovered populations: (1) the brightest and most distant sources that ended the cosmic Dark Ages at z>9 and (2) red sources at

Consensus, uncertainties and challenges for perennial bioenergy crops and land-use

Perennial bioenergy crops have significant potential to reduce greenhouse gas (GHG) emissions and contribute to climate change mitigation by substituting for fossil fuels; yet delivering significant GHG savings will require substantial land-use change, globally. Over the last decade, research has delivered improved understanding of the environmental benefits and risks of this transition to perennial bioenergy crops, addressing concerns that the impacts of land conversion to perennial bioenergy crops could result in increased rather than decreased GHG emissions. For policymakers to assess the most cost-effective and sustainable options for deployment and climate change mitigation, synthesis of these studies is needed to support evidence-based decision making. In 2015, a workshop was convened with researchers, policymakers and industry/business representatives from the UK, EU and internationally. Outcomes from global research on bioenergy land-use change were compared to identify areas of consensus, key uncertainties, and research priorities. Here, we discuss the strength of evidence for and against six consensus statements summarising the effects of land-use change to perennial bioenergy crops on the cycling of carbon, nitrogen and water, in the context of the whole life-cycle of bioenergy production. Our analysis suggests that the direct impacts of dedicated perennial bioenergy crops on soil carbon and nitrous oxide are increasingly well understood and are often consistent with significant life cycle GHG mitigation from bioenergy relative to conventional energy sources. We conclude that the GHG balance of perennial bioenergy crop cultivation will often be favourable, with maximum GHG savings achieved where crops are grown on soils with low carbon stocks and conservative nutrient application, accruing additional environmental benefits such as improved water quality. The analysis reported here demonstrates there is a mature and increasingly comprehensive evidence base on the environmental benefits and risks of bioenergy cultivation which can support the development of a sustainable bioenergy industry