An online experiment to assess bias in professional medical coding.

BackgroundMultiple studies have documented bias in medical decision making, but no studies have examined whether this bias extends to medical coding practices. Medical coding is foundational to the US health care enterprise. We evaluate whether bias based on patient characteristics influences specific coding practices of professional medical coders.MethodsThis is an online experimental study of members of a national professional medical coding organization. Participants were randomly assigned a set of six clinical scenarios reflecting common medical conditions and asked to report encounter level of service codes for these clinical scenarios. Clinical scenarios differed by patient demographics (race, age, gender, ability) or social context (food insecurity, housing security) but were otherwise identical. We estimated Ordinary Least Squares regression models to evaluate differences in outcome average visit level of service by patient demographic characteristics described in the clinical scenarios; we adjusted for coders' age, gender, race, and years of coding experience.ResultsThe final analytic sample included 586 respondents who coded at least one clinical scenario. Higher mean level of service was assigned to clinical scenarios describing seniors compared to middle-aged patients in two otherwise identical scenarios, one a patient with type II diabetes mellitus (Coef: 0.28, SE: 0.15) and the other with rheumatoid arthritis (Coef: 0.30, SE: 0.13). Charts describing women were assigned lower level of service than men in patients with asthma exacerbation (Coef: -0.25, SE: 0.13) and rheumatoid arthritis (Coef: -0.20, SE: 0.12). There were no other significant differences in mean complexity score by patient demographics or social needs.ConclusionWe found limited evidence of bias in professional medical coding practice by patient age and gender, though findings were inconsistent across medical conditions. Low levels of observed bias may reflect medical coding workflow and training practices. Future research is needed to better understand bias in coding and to identify effective and generalizable bias prevention practices

The Vehicle, Spring 1970, Vol. 12 no. 2

Vol. 12, No. 2 Table of Contents Prose short storyCarol Jean Baumgartepage 5 essayDan Franklinpage 8 short storyMary Yarbroughpage 21 Poetry Sara Brinkerhoffpage 20 Nick Dagerpage 18 E.S.page 17 Harry Fordpage 20 Melinda Gimbutpage 19 Ann Graffpage 20 Heather Hoebelpage 7 Becky McIntoshpage 20 John Metcalfpage 17 Mary Pipekpage 19 Cynthia C. Yohopage 17 Photography Dennis Hoaglundpages 5, 10, 21 Dale Huberpage 23 Scott Redfieldpages 7, 19 Tribute to the Ordinary Studentpage 11artMike DorseystoryNick Dagerhttps://thekeep.eiu.edu/vehicle/1022/thumbnail.jp

Molecular classification of head and neck squamous cell carcinomas using patterns of gene expression

The prognostication of head and neck squamous cell carcinoma (HNSCC) is largely based upon the tumor size and location and the presence of lymph node metastases. Here we show that gene expression patterns from 60 HNSCC samples assayed on cDNA microarrays allowed categorization of these tumors into four distinct subtypes. These subtypes showed statistically significant differences in recurrence-free survival and included a subtype with a possible EGFR-pathway signature, a mesenchymal-enriched subtype, a normal epithelium-like subtype, and a subtype with high levels of antioxidant enzymes. Supervised analyses to predict lymph node metastasis status were approximately 80% accurate when tumor subsite and pathological node status were considered simultaneously. This work represents an important step toward the identification of clinically significant biomarkers for HNSCC

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Immersion Coefficient for the Marine Optical Buoy (MOBY) Radiance Collectors

The immersion coefficient accounts for the difference in responsivity for a radiometer placed in the air versus water or another medium. In this study, the immersion coefficients for the radiance collectors on the Marine Optical Buoy (MOBY) were modeled and measured. The experiment showed that the immersion coefficient for the MOBY radiance collectors agreed with a simple model using only the index of refraction for water and fused silica. With the results of this experiment, we estimate that the uncertainty in the current value of the immersion coefficient used in the MOBY project is 0.05 % ( = 1)

Identifying Barriers to Successful Completion of Video Telemedicine Visits in Urology.

ObjectiveThe utilization of video telemedicine has dramatically increased due to the COVID-19 pandemic. However, significant social and technological barriers have led to disparities in access. We aimed to identify factors associated with patient inability to successfully initiate a video visit across a high-volume urologic practice.Materials and methodsVideo visit completion rates and patient characteristics were extracted from the electronic medical record and linked with census-level socioeconomic data. Associations between video visit failure were identified using multivariate regression modeling and random forest ensemble classification modeling.ResultsSix thousand eighty six patients and their first video visits were analyzed. On multivariate logistic regression analysis, Hispanic or Latino patients (OR 0.52, 95%CI 0.31-0.89), patients insured by Medicare (OR 0.46, 95%CI 0.26-0.79) or Medicaid (OR 0.50, 95%CI 0.29-0.87), patients of low socioeconomic status (OR 0.98, 95%CI 0.98-0.99), patients with an un-activated MyChart patient portal (OR 0.43, 95%CI 0.29-0.62), and patients unconfirmed at appointment reminder (OR 0.68, 95%CI 0.48-0.96) were significantly associated with video visit failure. Patients with primary diagnosis category of men's health (OR 47.96, 95%CI 10.24-856.35), and lower urinary tract syndromes (OR 2.69, 95%CI 1.66-4.51) were significantly associated with video visit success. Random forest analyses identified insurance status and socioeconomic status as the top predictors of video visit failure.ConclusionAn analysis of a urology video telemedicine cohort reveals clinical and demographic disparities in video visit completion and priorities for future interventions to ensure equity of access. Our study further suggests that specific urologic indications may play a role in success or failure of video visits

Improved shadow correction for the marine optical buoy, MOBY

International audienc

A Method to Extrapolate the Diffuse Upwelling Radiance Attenuation Coefficient to the Surface as Applied to the Marine Optical Buoy (MOBY)

Abstract The upwelling radiance attenuation coefficient KLu in the upper 10 m of the water column can be significantly influenced by inelastic scattering processes and thus will vary even with homogeneous water properties. The Marine Optical Buoy (MOBY), the primary vicarious calibration site for many ocean color sensors, makes measurements of the upwelling radiance Lu at 1, 5, and 9 m, and uses these values to determine KLu and to propagate the upwelling radiance directed toward the zenith, Lu, at 1 m to and through the surface. Inelastic scattering causes the KLu derived from the measurements to be an underestimate of the true KLu from 1 m to the surface at wavelengths greater than 575 nm; thus, the derived water-leaving radiance is underestimated at wavelengths longer than 575 nm. A method to correct this KLu, based on a model of the upwelling radiance including Raman scattering and chlorophyll fluorescence, has been developed that corrects this bias. The model has been experimentally validated, and this technique can be applied to the MOBY dataset to provide new, more accurate products at these wavelengths. When applied to a 4-month MOBY deployment, the corrected water-leaving radiance Lw can increase by 5% (600 nm), 10% (650 nm), and 50% (700 nm). This method will be used to provide additional and more accurate products in the MOBY dataset

An Example Crossover Experiment for Testing New Vicarious Calibration Techniques for Satellite Ocean Color Radiometry

Vicarious calibration of ocean color satellites involves the use of accurate surface measurements of water-leaving radiance to update and improve the system calibration of ocean color satellite sensors. An experiment was performed to compare a free-fall technique with the established MOBY measurement. We found in the laboratory that the radiance and irradiance instruments compared well within their estimated uncertainties for various spectral sources. The spectrally averaged differences between the NIST values for the sources and the instruments were less than 2.5% for the radiance sensors and less than 1.5% for the irradiance sensors. In the field, the sensors measuring the above-surface downwelling irradiance performed nearly as well as they had in the laboratory, with an average difference of less than 2%. While the water-leaving radiance, L(sub w) calculated from each instrument agreed in almost all cases within the combined instrument uncertainties (approximately 7%), there was a relative bias between the two instrument classes/techniques that varied spectrally. The spectrally averaged (400 nm to 600 nm) difference between the two instrument classes/techniques was 3.1 %. However the spectral variation resulted in the free fall instruments being 0.2% lower at 450 nm and 5.9% higher at 550 nm. Based on the analysis of one matchup, the bias in the L(sub w), was similar to that observed for L(sub u)(1 m) with both systems, indicating the difference did not come from propagating L(sub u)(1 m) to L(sub w)