Reliability of the American Community Survey Estimates of Risk-Adjusted Readmission Rankings for Hospitals Before and After Peer Group Stratification

Importance Since the transition to the American Community Survey, data uncertainty has complicated its use for policy making and research, despite the ongoing need to identify disparities in health care outcomes. The US Centers for Medicare & Medicaid Services’ new, stratified payment adjustment method for its Hospital Readmissions Reduction Program may be able to reduce the reliance on data linkages to socioeconomic survey estimates. Objective To determine whether there are differences in the reliability of socioeconomically risk-adjusted hospital readmission rates among hospitals that serve a disproportionate share of low-income populations after stratifying hospitals into peer group–based classification groups. Design, Setting, and Participants This cross-sectional study uses data from the 2014 New York State Health Cost and Utilization Project State Inpatient Database for 96 278 hospital admissions for acute myocardial infarction, pneumonia, and congestive heart failure. The analysis included patients aged 18 years and older who were not transferred to another hospital, who were discharged alive, who did not leave the hospital against medical advice, and who were discharged before December 2014. Main Outcomes and Measures The main outcomes were 30-day hospital readmissions after acute myocardial infarction, pneumonia, and congestive heart failure assessed using hierarchical logistic regression. Results The mean (SD) age of the patients was 69.6 (16.0) years for the safety-net hospitals and 74.9 (14.7) years for the non–safety-net hospitals; 9382 (48.8%) and 7003 (48.5%) patients, respectively, were female. For safety net designations, 20% (3 of 15) of all evaluations concealed and distorted differences in risk, with factors such as poverty failing to identify similar risk of acute myocardial infarction readmission until unreliable estimates were excluded from the analysis (OR, 1.23 [95% CI, 1.00-1.52], P = .02; vs OR, 1.17 [95% CI, 0.94-1.46], P = .15). By comparison, 2 of the 60 models (3%) for the peer group–based classification altered the association between socioeconomic status and readmission risk, concealing similarities in congestive heart failure readmission when adjusted using high school completion rates (OR, 1.27 [95% CI 1.02-1.58], P = .04; vs OR, 1.23 [95% CI, 0.98-1.53], P = .06) and distorting similarities in pneumonia readmissions when accounting for the proportion of lone-parent families (OR, 1.27 [95% CI, 0.98-1.66], P = .07; vs OR, 1.35 [95% CI, 1.02-1.80], P = .04) between the lowest and highest socioeconomic status hospitals in quartile 1. Conclusions and Relevance There was greater precision in socioeconomic adjusted readmission estimates when hospitals were stratified into the new payment adjustment criteria compared with safety net designations. A contributing factor for improved reliability of American Community Survey estimates under the new payment criteria was the merging of patients from low-income neighborhoods with greater homogeneity in survey estimates into groupings similar to those for higher-income patients, whose neighborhoods often exhibit greater estimate variability. Additional efforts are needed to explore the effect of measurement error on American Community Survey–adjusted readmissions using the new peer group–based classification methods

Jobs in Springfield, Massachusetts: understanding and remedying the causes of low resident employment rates

As part of the Federal Reserve Bank of Boston's commitment to supporting efforts to revitalize the economy of Springfield, Massachusetts, this paper explores the causes of and potential remedies for the city's low resident employment rates. When compared to the state as a whole and to other midsize New England cities, the share of employed city residents is low, particularly for residents of downtown Springfield and its nearby neighborhoods. By analyzing the availability of jobs across Springfield's various neighborhoods and in nearby towns and cities, this paper's goal is to learn why so few Springfield residents are employed, and thus to identify policy priorities to increase employment. This study finds that solving Springfield's low resident employment rates will require a combination of new job creation, improved informational and physical access to jobs, and strengthening the citizenry's job skills.Economic conditions - Massachusetts ; Job creation - Massachusetts ; Unemployment - Massachusetts

Greater Springfield employment challenges: findings of employer survey and interviews

This paper presents the findings from in-depth interviews and a survey of employers in the Greater Springfield area regarding (a) employment opportunities for entry-level workers with limited skills and (b) barriers that residents of Springfield's low-income neighborhoods face in accessing these jobs. The survey and interviews indicate that entry-level jobs that do not require college are available in the Springfield area. However, even entry-level jobs require the ability to perform a variety of tasks, and many applicants lack the skills needed to perform these jobs or have work readiness problems. Lack of prior experience and the absence of referral networks limit access to these jobs for residents of Springfield's low-income neighborhoods.Cities and towns - Massachusetts ; Labor market - Massachusetts

Towards a more prosperous Springfield, MA: what jobs exist for people without a college education?

This paper analyzes projections of Massachusetts employment opportunities by occupation to address concerns about a shortage of jobs for those who lack a college education. While occupations requiring a college degree will grow more rapidly over the period 2006-2016 than occupations that do not require college, replacement needs will ensure large numbers of job openings that do not require college. Wage levels in jobs that do not require college are generally low, however. The exceptions usually require meaningful training of another sort, such as long-term on-the-job training or courses in postsecondary schools or community college. Additionally, some individuals who demonstrate the necessary qualities achieve higher wages through promotion. The distribution of occupations in the Springfield metropolitan area is sufficiently similar to that in Massachusetts that inferences from the Massachusetts projections should be relevant to Springfield.Cities and towns - Massachusetts ; Labor market - Massachusetts

Electrolysis of indium oxide in LiCl-KCl based molten salts with a liquid cathode

In this work, the feasibility of extracting of metallic indium from In2O3 and ITO through the direct electrochemical reduction at 450°C in molten salt LiCl-KCl was studied. Cyclic voltammetry was carried out to study the behaviour of indium oxide by the liquid metal indium used as the working electrode. The reduction peak was observed in the cathodic scan for In2O3. The direct de-oxidation of indium oxide and ITO were investigated by using liquid tin cathode. Constant voltage electrolysis was performed at 1.7 V for 2h. The reduction reaction occurred at the interface of the oxide pellets and the cathode. Sn-In alloy was detected after electrolysis. Liquid zinc cathode was also used as cathode taking into account the low melting points of indium and tin. Potentiostatic electrolysis was conducted for the ITO with a liquid zinc cathode. The result showed that indium could be produced at different liquid cathodes.publishedVersio

Reinvigorating Springfield's economy: lessons from resurgent cities

As part of the Federal Reserve Bank of Boston's commitment to supporting efforts to revitalize the economy of Springfield, Massachusetts, this paper analyzes the economic development approaches of other mid-sized manufacturing-oriented cities during the past half century. From among a comparison group of 25 municipalities that were similar to Springfield in 1960, the study identifies 10 "resurgent cities" that have made substantial progress in improving living standards for their residents, and that are recognized as vital communities in a broader sense by experts on urban economic development and policy. These case studies suggest that industry mix, demographic composition, and geographic position are not the key factors distinguishing the resurgent cities from Springfield. Instead, the most important lessons from the resurgent cities concern leadership and collaboration. Initial leadership in these cities came from a variety of key institutions and individuals. In some cases, the turnaround started with efforts on the part of the public sector, while in other cases nongovernmental institutions or private developers were at the forefront. Regardless of who initiated the turnaround, economic redevelopment efforts spanned decades and involved collaborations among numerous organizations and sectors.Cities and towns ; Cities and towns - Massachusetts ; Economic policy - Massachusetts

Surveying Position Based Routing Protocols for Wireless Sensor and Ad-hoc Networks

A focus of the scientific community is to design network oriented position-based routing protocols and this has resulted in a very high number of algorithms, different in approach and performance and each suited only to particular applications. However, though numerous, very few position-based algorithms have actually been adopted for commercial purposes. This article is a survey of almost 50 position-based routing protocols and it comes as an aid in the implementation of this type of routing in various applications which may need to consider the advantages and pitfalls of position-based routing. An emphasis is made on geographic routing, whose notion is clarified as a more restrictive and more efficient type of position-based routing. The protocols are therefore divided into geographic and non-geographic routing protocols and each is characterized according to a number of network design issues and presented in a comparative manner from multiple points of view. The main requirements of current general applications are also studied and, depending on these, the survey proposes a number of protocols for use in particular application areas. This aims to help both researchers and potential users assess and choose the protocol best suited to their interest

FIGO good practice recommendations on delayed umbilical cord clamping

Funding Information: Ana Bianchi reports no conflicts of interest. Ben W. Mol reports an investigator grant from NHMRC; consultancy for ObsEva; and research funding from Guerbet, Ferring, and Merck KGaA. Bo Jacobbson reports research grants from Swedish Research Council, Norwegian Research Council, March of Dimes, Burroughs Wellcome Fund, and the US National Institute of Health; clinical diagnostic trials on NIPT with Ariosa (completed), Natera (ongoing), Vanadis (completed), and Hologic (ongoing) with expenditures reimbursed per patient; clinical probiotic studies with product provided by FukoPharma (ongoing, no funding), and BioGaia (ongoing; also provided a research grant for the specific study); collaboration in IMPACT study where Roche, Perkin Elmer, and Thermo Fisher provided reagents to PLGF analyses; coordination of scientific conferences and meetings with commercial partners such as NNFM 2015, ESPBC 2016, and a Nordic educational meeting about NIPT and pre‐eclampsia screening. Bo Jacobbson is also Chair of the FIGO Working Group for Preterm Birth and the European Association of Perinatal Medicine special interest group on preterm delivery; steering group member of Genomic Medicine Sweden; chairs the Genomic Medicine Sweden complex diseases group; and is Swedish representative in the Nordic Society of Precision Medicine.Peer reviewedPublisher PD