Effective weakly supervised semantic frame induction using expression sharing in hierarchical hidden Markov models

We present a framework for the induction of semantic frames from utterances in the context of an adaptive command-and-control interface. The system is trained on an individual user's utterances and the corresponding semantic frames representing controls. During training, no prior information on the alignment between utterance segments and frame slots and values is available. In addition, semantic frames in the training data can contain information that is not expressed in the utterances. To tackle this weakly supervised classification task, we propose a framework based on Hidden Markov Models (HMMs). Structural modifications, resulting in a hierarchical HMM, and an extension called expression sharing are introduced to minimize the amount of training time and effort required for the user. The dataset used for the present study is PATCOR, which contains commands uttered in the context of a vocally guided card game, Patience. Experiments were carried out on orthographic and phonetic transcriptions of commands, segmented on different levels of n-gram granularity. The experimental results show positive effects of all the studied system extensions, with some effect differences between the different input representations. Moreover, evaluation experiments on held-out data with the optimal system configuration show that the extended system is able to achieve high accuracies with relatively small amounts of training data

Resident health-related quality of life in Swiss nursing homes.

BACKGROUND: Health-related quality of life (HRQOL) levels and their determinants in those living in nursing homes are unclear. The aim of this study was to investigate different HRQOL domains as a function of the degree of cognitive impairment and to explore associations between them and possible determinants of HRQOL. METHOD: Five HRQOL domains using the Minimum Data Set - Health Status Index (MDS-HSI) were investigated in a large sample of nursing home residents depending on cognitive performance levels derived from the Cognitive Performance Scale. Large effect size associations between clinical variables and the different HRQOL domains were looked for. RESULTS: HRQOL domains are impaired to variable degrees but with similar profiles depending on the cognitive performance level. Basic activities of daily living are a major factor associated with some but not all HRQOL domains and vary little with the degree of cognitive impairment. LIMITATIONS: This study is limited by the general difficulties related to measuring HRQOL in patients with cognitive impairment and the reduced number of variables considered among those potentially influencing HRQOL. CONCLUSION: HRQOL dimensions are not all linearly associated with increasing cognitive impairment in NH patients. Longitudinal studies are required to determine how the different HRQOL domains evolve over time in NH residents

Cost Trajectories for Cancer Patients

Background: Health care spending is known to be highly skewed, with a small subset of the population consuming a disproportionate amount of health care resources. Patients with cancer are high-cost users because of high incremental health care costs for treatment and the growing prevalence of cancer. The objectives of the present study included characterizing cancer-patient trajectories by cost, and identifying the patient and health system characteristics associated with high health system costs after cancer treatment. Methods: This retrospective cohort study identified Ontario adults newly diagnosed with cancer between 1 April 2009 and 30 September 2010. Costs of health care use before, during, and after cancer episodes were used to develop trajectories of care. Descriptive analyses examined differences between the trajectories in terms of clinical and health system characteristics, and a logistic regression approach identified predictors of being a high-cost user after a cancer episode. Results: Ten trajectories were developed based on whether patients were high- or low-cost users before and after their cancer episode. The most common trajectory represented patients who were low-cost in the year before cancer, survived treatment, and continued to be low-cost in the year after cancer (31.4%); stage ii cancer of the male genital system was the most common diagnosis within that trajectory. Regression analyses identified increases in age and in multimorbidity and low continuity of care as the strongest predictors of high-cost status after cancer. Conclusions: Findings highlight an opportunity to proactively identify patients who might transition to high-cost status after cancer treatment and to remediate that transition

Untangling the inter-relatedness within integrated care programmes for community-dwelling frail older people: a rapid realist review

Objective To identify the relationships between the context in which integrated care programmes (ICPs) for community-dwelling frail older people are applied, the mechanisms by which the programmes do (not) work and the outcomes resulting from this interaction by establishing a programme theory.Design Rapid realist review.Inclusion criteria Reviews and meta-analyses (January 2013–January 2019) and non-peer-reviewed literature (January 2013–December 2019) reporting on integrated care for community-dwelling frail older people (≥60 years).Analysis Selection and appraisal of documents was based on relevance and rigour according to the Realist And Meta-narrative Evidence Syntheses: Evolving Standards criteria. Data on context, mechanisms, programme activities and outcomes were extracted. Factors were categorised into the five strategies of the WHO framework of integrated people-centred health services (IPCHS).Results 27 papers were included. The following programme theory was developed: it is essential to establish multidisciplinary teams of competent healthcare providers (HCPs) providing person-centred care, closely working together and communicating effectively with other stakeholders. Older people and informal caregivers should be involved in the care process. Financial support, efficient use of information technology and organisational alignment are also essential. ICPs demonstrate positive effects on the functionality of older people, satisfaction of older people, informal caregivers and HCPs, and a delayed placement in a nursing home. Heterogeneous effects were found for hospital-related outcomes, quality of life, healthcare costs and use of healthcare services. The two most prevalent WHO-IPCHS strategies as part of ICPs are ‘creating an enabling environment’, followed by ‘strengthening governance and accountability’.Conclusion Currently, most ICPs do not address all WHO-IPCHS strategies. In order to optimise ICPs for frail older people the interaction between context items, mechanisms, programme activities and the outcomes should be taken into account from different perspectives (system, organisation, service delivery, HCP and patient)

Do Canadian Researchers and the Lay Public Prioritize Biomedical Research Outcomes Equally? A Choice Experiment

Purpose: Academic medicine must increasingly measure the ‘return on investment’ ofbiomedical research, and justify these returns to key stakeholders. Whether citizens, and thegovernments that represent them in funding basic, biomedical research, prioritize the samereturns as researchers warrants consideration.Methods: In autumn 2010, through a cross-sectional, national survey of basic biomedicalresearchers funded by Canada’s national health research agency, and a representative sampleof Canadian residents, the authors assessed preferences for research impacts across 5attributes using a discrete choice experiment: advancing scientific knowledge (papers),building research capacity (trainees), informing decisions in the health products industry(patents), targeting economic, health or scientific priorities, and cost. A fractional factorialdesign (18 pairwise choices plus opt-out) was reduced to three blocks of six. Part worthutilities, differences in predicted probabilities, and willingness-to-pay values were computedusing nested logit models.Results: 1,749 researchers (55.17% response rate) and 1,002 internet panellists completedthe survey. Researchers and citizens prioritized high quality scientific outputs (papers,trainees) over other attributes; patents licensed by industry ranked third. Both groupsdisvalued research targeted at economic priorities relative to health priorities. Researchersgranted a premium to proposals targeting scientific priorities.Conclusions: Citizens and researchers shared fundamental preferences for the impacts ofbasic biomedical research. Notably, traditional scientific outputs were prioritized, and thepursuit of economic returns was disvalued. These findings have implications for academicmedicine in incenting and valuing basic health research, and for how biomedical researchersand the public may jointly contribute to research priority setting

Assessing the representativeness of physician and patient respondents to a primary care survey using administrative data

Background: QUALICOPC is an international survey of primary care performance. QUALICOPC data have been used in several studies, yet the representativeness of the Canadian QUALICOPC survey is unknown, potentially limiting the generalizability of findings. This study examined the re

Medicare payment changes and nursing home quality: effects on long-stay residents

The Balanced Budget Act of 1997 dramatically changed the way that Medicare pays skilled nursing facilities, providing a natural experiment in nursing home behavior. Medicare payment policy (directed at short-stay residents) may have affected outcomes for long-stay, chronic-care residents if services for these residents were subsidized through cost-shifting prior to implementation of Medicare prospective payment for nursing homes. We link changes in both the form and level of Medicare payment at the facility level with changes in resident-level quality, as represented by pressure sores and urinary tract infections in Minimum Data Set (MDS) assessments. Results show that long-stay residents experienced increased adverse outcomes with the elimination of Medicare cost reimbursement. Copyright Springer Science+Business Media, LLC 2006Prospective payment, Nursing homes, Medicare, Quality of care, I11, I18, H51,

Primary care performance measurement and reporting at a regional level: Could a matrix approach provide actionable information for policy makers and clinicians?

Objective: Primary care services form the foundation of modern healthcare systems, yet the breadth and complexity of services and diversity of patient populations may present challenges for creating comprehensive primary care information systems. Our objective is to develop regional-level information on the performance of primary care in Canada. Methods: A scoping review was conducted to identify existing initiatives in primary care performance measurement and reporting across 11 countries. The results of this review were used by our international team of primary care researchers and clinicians to propose an approach for regional-level primary care reporting. Results: We found a gap between conceptual primary care performance measurement framework