Examining the Transitional Impact of ICD-10 on Healthcare Fraud Detection

On October 1st, 2015, the tenth revision of the International Classification of Diseases (ICD-10) will be mandatorily implemented in the United States. Although this medical classification system will allow healthcare professionals to code with greater accuracy, specificity, and detail, these codes will have a significant impact on the flavor of healthcare insurance claims. While the overall benefit of ICD-10 throughout the healthcare industry is unquestionable, some experts believe healthcare fraud detection and prevention could experience an initial drop in performance due to the implementation of ICD-10. We aim to quantitatively test the validity of this concern regarding an adverse transitional impact. This project explores how predictive fraud detection systems developed using ICD-9 claims data will initially react to the introduction of ICD-10. We have developed a basic fraud detection system incorporating both unsupervised and supervised learning methods in order to examine the potential fraudulence of both ICD-9 and ICD-10 claims in a predictive environment. Using this system, we are able to analyze the ability and performance of statistical methods trained using ICD-9 data to properly identify fraudulent ICD-10 claims. This research makes contributions to the domains of medical coding, healthcare informatics, and fraud detection

Navigating Conflict During Periods of Change in Higher Education: Deconstructing Academic Leaders’ Construction of Meaning

Navigating departmental and organizational conflict is an essential function and responsibility of an academic unit leader (dean, associate dean, director, or chair) in higher education institutions (HEIs). During periods of organizational change, conflict tends to increase in complexity and difficulty—in part due to resistance to change—making it more difficult to manage in a constructive manner (Marcus, 2014). Much of the literature that looks at the academic unit leader and conflict focuses on personal conflict styles (or modes), types of conflicts encountered, and training on techniques and skills for conflict resolution and management. Missing from the literature is research that examines academic leaders’ constructive-developmental mindsets (i.e., meaning-making structures) when dealing with and navigating conflict within their division (or institution) and the relationship between one’s developmental mindset and their approach to engaging and navigating complex conflict. This study examines how nine academic unit leaders construct meaning when experiencing and navigating conflict situations amid organizational change (which HEIs experienced at an unprecedented level in 2020 and 2021). Additionally, it examines the relationship between how one constructs meaning and their capacity for constructive engagement and navigation of conflict. The primary finding from this study supports the hypothesis that academic leaders who demonstrate complex developmental mindsets hold a greater capacity to engage and navigate complex conflict situations in more deliberate and potentially constructive ways. Additionally, data from the research supports the notion that as an individual develops an increasingly more complex developmental mindset, their capacity for cognitive empathy (i.e., perspective-taking) increases. The study employed a multimethod approach, incorporating multiple case studies and a modified critical incident technique. Data were collected through the Subject-Object Interview (Lahey et al., 2011), a modified critical incident interview, and a loosely-structured closing interview. Each of the nine leaders participated fully in all three interviews in this order. This exploratory study contributes to the continued scholarly discussion on leaders navigating conflict and change in HEIs. This dissertation is available in open access at AURA (https://aura.antioch.edu) and OhioLINK ETD Center (https://etd.ohiolink.edu)

Southern California Regional Transit Training Consortium: Skills Gap & Needs Assessment

The transit sector grows and evolves quickly with the needs of growing, busy cities. With this growth comes a need for more transit workers and more training to ensure workers can best serve their diverse communities. This report contains a transit training needs assessment and gap analysis to identify the most pressing challenges of the evolving transit workforce served by the Southern California Regional Transit Training Consortium (SCRTTC). Most importantly, this report documents and determines SCRTTC priorities to ensure the incumbent and future transit workforce is equipped with the professional and technological skills required to address the transformational trends affecting the transit sector. The report primarily utilized qualitative methods with the use of a series of interviews, a focus group, a workshop, and an online survey. Above all, this assessment discovered that existing SCRTTC training curriculum is respected, and there is strong demand for additional topics. Transit maintenance professionals consistently endorsed the value and quality of SCRTTC training—they just want more of it. They want it to be developed more efficiently and at a higher volume. They seek more localized and customized delivery methods for training and curriculum. All of those findings compel a question: How can SCRTTC make organizational changes to more rapidly develop curriculum and provide targeted training programs for technicians? This report recommends SCRTTC integrate a suite of digital products into the SCRTTC website to respond to the needs documented in this assessment—namely higher capacity for more training offerings and more online delivery methods while simultaneously enhancing member demands for more customized and location-based training. Implementing the digital platform recommended in this report would empower SCRTTC leadership to foster increased interactivity between transit agencies, training partners, and SCRTTC management. These digital tools would enable SCRTTC to expand its coverage to all of California. This statewide approach to transit training could be used to implement similar consortia in states throughout the U.S

Examining the Feasibility of Ecological Momentary Assessment Using Short Message Service Surveying with Homeless Youth: Lessons Learned

We assessed the feasibility of ecological momentary assessment using short message service (SMS) surveying with 150 homeless youth. We found that on average, participants completed 18.8 days of texts, but 30% of youth (N = 44) had texting data on 28 or more days. The average number of texts answered per day was 8.49 (of a possible 11). Forty-three percent of days had answers to all 11 texts sent that day, and 69.4% of days had answers to eight or more texts. We found significant differences in response rates by phone type. Seventy-three percent of youth reported that responding to our texts was very easy or somewhat easy and 69% endorsed the response option “just enough,” regarding the number of texts sent per day. The 30-day texting period was deemed “about right” by 74% of youth. Details of using SMS with homeless youth are provided, and results indicate that this data collection technique is feasible with this population. (Includes supplementary materials.

Examining the Feasibility of Ecological Momentary Assessment Using Short Message Service Surveying with Homeless Youth: Lessons Learned

We assessed the feasibility of ecological momentary assessment using short message service (SMS) surveying with 150 homeless youth. We found that on average, participants completed 18.8 days of texts, but 30% of youth (N = 44) had texting data on 28 or more days. The average number of texts answered per day was 8.49 (of a possible 11). Forty-three percent of days had answers to all 11 texts sent that day, and 69.4% of days had answers to eight or more texts. We found significant differences in response rates by phone type. Seventy-three percent of youth reported that responding to our texts was very easy or somewhat easy and 69% endorsed the response option “just enough,” regarding the number of texts sent per day. The 30-day texting period was deemed “about right” by 74% of youth. Details of using SMS with homeless youth are provided, and results indicate that this data collection technique is feasible with this population. (Includes supplementary materials.

A comparison of frequency of alcohol and marijuana use using short message service surveying and survey questionnaires among homeless youth

Background: There are several benefits to using short message service surveying (SMS) to gather data on substance use from homeless youth, including capturing data “in the moment” and verifying the timing of one behavior relative to another. Though SMS is a valuable data collection tool with highly mobile populations that otherwise are difficult to longitudinally sample, the reliability of SMS compared with surveys is largely unknown with homeless youth. Examining the reliability of SMS is important because these data can provide a more nuanced understanding of the relationships between various risk behaviors, which may lead to better intervention strategies with these youth. Objectives: We compared past 30-day survey and SMS data for youth’s alcohol and marijuana use. Methods: Interviewed 150 homeless youth (51% female) using surveys and SMS. Results: Past 30-day survey and SMS data revealed moderately strong correlations for alcohol (rs = .563) and marijuana (rs = .564). Regression analysis revealed that independent variables were similarly associated with alcohol and marijuana use when comparing survey and SMS data with two exceptions: heterosexual youth reported less alcohol use in SMS data compared to survey data (β = −.212; p \u3c .05 vs. β = −.006; p \u3e .05, respectively) and youth whose parents had alcohol problems reported less marijuana use in survey data compared to SMS data (β = −.277; p \u3c .01 vs. β = −.150; p \u3e .05, respectively). Conclusion: Findings indicate SMS and surveys are both reliable methods of gathering data from homeless youth on substance use

Understanding Daily Depression, Drinking, and Marijuana Use among Homeless Youth using Short Message Service Surveying

We used short message service surveying (SMS) with 150 homeless youth to examine the time ordering of feeling depressed with drinking alcohol, using marijuana, and using substances with friends. Multilevel binary logistic regression results revealed that youth who were depressed earlier in the day were more likely to drink alcohol later that day. Among depressed youth, heterosexual youth were less likely to drink alcohol than lesbian, gay, and bisexual (LGB) youth. Depressed youth had increased odds of using marijuana by a factor of 1.6, while heterosexual youth, compared to LGB youth, were 80% less likely to use marijuana. Females were 82% less likely and heterosexual youth 75% less likely to use substances with friends compared to males and LGB youth, respectively. These findings improve upon prior retrospective studies by using SMS to understand time ordering between feeling depressed and substance use in the same day

Short Message Service Surveying With Homeless Youth: Findings From a 30-Day Study of Sleeping Arrangements and Well-Being

Little is known about the location and consistency of sleeping arrangements among youth experiencing homelessness (YEH) and how this is linked to their well-being. This study addresses this gap using ecological momentary assessment (EMA) via short message service (SMS) surveying with 150 YEH over 30 days, to examine how various sleeping arrangements are associated with depression, marijuana use, support received, and service utilization. Results revealed that the average number of consecutive days youth stayed at any particular location varied considerably. Youth who stayed more frequently with a friend/partner or in a transitional living facility (TLF) reported fewer days of being depressed, whereas staying with a friend/ partner was associated with using marijuana more frequently. Finally, youth staying with a friend/partner, stranger, or TLF reported using services on fewer days. Because sleeping arrangements change almost daily, on average, this has important public health implications for agencies finding permanent housing for YEH