Prospective payment for inpatient psychiatric care : a system to be developed for Switzerland

Oral PresentationObjectives: Inpatient psychiatric care in Switzerland is currently reimbursed by uniform per-diem rates. The new Health Insurance Act mandates the introduction of a national tariff system which reflects differences in resource use across patients based on observable patient characteristics. In this study we develop a prospective payment system (PPS). Data: Primary data on patient characteristics, cost per episode and daily time spent by medical staff were collected in a survey of 18’385 patients from 20 inpatient psychiatric facilities in 2014, representing roughly one third of the annual total. Patient characteristics include the main psychiatric diagnosis (ICD-10) and a weekly assessment of the severity of illness using the Health of Nations Outcome Scales questionnaire (HoNOS). Methods: Predictors of per-diem cost are examined with a multivariate linear regression model. Explanatory variables include the main psychiatric diagnosis, HoNOS scores, socio-demographic characteristics, type of insurance plan, compulsory hospitalization, emergency hospitalization, and hospital fixed effects. Furthermore, a staggered progression of per-diem cost over time is modelled. Different variants of the tariff structure are evaluated, some of which include intentional deviation of the tariff from the true distribution of costs in order to set incentives. Goodness-of-fit is evaluated by an out-of-sample evaluation of several statistical measures of the deviation of hypothetical revenues and observed costs, such as the mean absolute percentage error (MAPE). Results: Compared to the uniform per-diem tariff presently in operation in Switzerland, the PPS are capable of improving the accuracy of the tariff from a MAPE value of 25.2% to approximately 21.0%. The analysis yields several variants of PPS which are equivalent in terms of goodness-of-fit, but differ in terms of the patient characteristics used and with respect to financial incentives for hospitals. The main model constitutes a per-diem payment which is differentiated over three phases of treatment; the first week, days 8 to 60, and from the 61-st day onward. The payment is further determined by 11 diagnostic groups, scores in three out of the 12 dimensions of the HoNOS questionnaire (aggression, non-accidental self-injury, somatic comorbidity), and three age-related groups. Discussion: The proposed PPS combines incentives for an appropriate provision of care with incentives for a reduction of length of stay. Policy makers should take into account the different incentives implied by the alternative variants. While the PPS yields a set of adjusting factors for the payment, the Swiss system requires hospital-specific per-diem base rates to be negotiated between the mental health facilities and the insurers

Prospective payment for inpatient psychiatric care : a system to be developed for Switzerland

Objectives: Inpatient psychiatric care in Switzerland is currently reimbursed by uniform per-diem rates. The new Health Insurance Act mandates the introduction of a national tariff system which reflects differences in resource use across patients based on observable patient characteristics. In this study we develop a prospective payment system (PPS). Data: Primary data on patient characteristics, cost per episode and daily time spent by medical staff were collected in a survey of 18’385 patients from 20 inpatient psychiatric facilities in 2014, representing roughly one third of the annual total. Patient characteristics include the main psychiatric diagnosis (ICD-10) and a weekly assessment of the severity of illness using the Health of Nations Outcome Scales questionnaire (HoNOS). Methods: Predictors of per-diem cost are examined with a multivariate linear regression model. Explanatory variables include the main psychiatric diagnosis, HoNOS scores, socio-demographic characteristics, type of insurance plan, compulsory hospitalization, emergency hospitalization, and hospital fixed effects. Furthermore, a staggered progression of per-diem cost over time is modelled. Different variants of the tariff structure are evaluated, some of which include intentional deviation of the tariff from the true distribution of costs in order to set incentives. Goodness-of-fit is evaluated by an out-of-sample evaluation of several statistical measures of the deviation of hypothetical revenues and observed costs, such as the mean absolute percentage error (MAPE). Results: Compared to the uniform per-diem tariff presently in operation in Switzerland, the PPS are capable of improving the accuracy of the tariff from a MAPE value of 25.2% to approximately 21.0%. The analysis yields several variants of PPS which are equivalent in terms of goodness-of-fit, but differ in terms of the patient characteristics used and with respect to financial incentives for hospitals. The main model constitutes a per-diem payment which is differentiated over three phases of treatment; the first week, days 8 to 60, and from the 61-st day onward. The payment is further determined by 11 diagnostic groups, scores in three out of the 12 dimensions of the HoNOS questionnaire (aggression, non-accidental self-injury, somatic comorbidity), and three age-related groups. Discussion: The proposed PPS combines incentives for an appropriate provision of care with incentives for a reduction of length of stay. Policy makers should take into account the different incentives implied by the alternative variants. While the PPS yields a set of adjusting factors for the payment, the Swiss system requires hospital-specific per-diem base rates to be negotiated between the mental health facilities and the insurers

Impact of mislabelling on deep learning methods and strategies for improvement

This contribution revolves around classifying football player actions with 1-dimensional convolutional neural networks (CNNs) based on 6-channel inertial motion unit (IMU) data arising from tracking devices worn by the players. Our training and test data consist of eight games, where humans labelled ball actions by inspecting video records. Unfortunately, these labels are far from perfect due to various reasons (e.g., sloppiness, not all players respectively ball actions visible in the record, ambiguity what a ball action is, etc.). Such mislabelled data provide challenges on several levels. First, performance evaluation with poorly annotated data can be strongly misleading, indicating inferior performance than what is truly achieved. Second, the question is what amount of mislabelled data deep artificial neural networks can tolerate before they break down. We try to shed some light on the magnitude of these effects by simulation studies on the football data, as well as some standard machine learning datasets such as MNIST (numbers) and Fashion-MNIST (clothes). Third, we present some efficient strategies to overcome the issue with imperfect labels and aim to provide some guidelines how to efficiently invest effort in labelling data

Machine learning for position detection in football

In recent years, analytics became increasingly important in sports. Newly developed, wearable tracking devices allow football players to log position and motion data during a game. These data can be exploited for enhancing the performance of individual players and entire teams. We present different machine learning approaches to predict spatial football player positions, which serve for advanced tactical analyses

The impact of tinnitus distress on cognition

Tinnitus is the chronic perception of a phantom sound with different levels of related distress. Past research has elucidated interactions of tinnitus distress with audiological, affective and further clinical variables. The influence of tinnitus distress on cognition is underinvestigated. Our study aims at investigating specific influences of tinnitus distress and further associated predictors on cognition in a cohort of n = 146 out-ward clinical tinnitus patients. Age, educational level, hearing loss, Tinnitus Questionnaire (TQ) score, tinnitus duration, speech in noise (SIN), stress, anxiety and depression, and psychological well-being were included as predictors of a machine learning regression approach (elastic net) in three models with scores of a multiple choice vocabulary test (MWT-B), or two trail-making tests (TMT-A and TMT-B), as dependent variables. TQ scores predicted lower MWT-B scores and higher TMT-B test completion time. Stress, emotional, and psychological variables were not found to be relevant predictors in all models with the exception of small positive influences of SIN and depression on TMT-B. Effect sizes were small to medium for all models and predictors. Results are indicative of specific influence of tinnitus distress on cognitive performance, especially on general or crystallized intelligence and executive functions. More research is needed at the delicate intersection of tinnitus distress and cognitive skills needed in daily functioning

Clozapine-induced agranulocytosis is associated with rare HLA-DQB1 and HLA-B alleles

Clozapine is a particularly effective antipsychotic medication but its use is curtailed by the risk of clozapine-induced agranulocytosis/granulocytopenia (CIAG), a severe adverse drug reaction occurring in up to 1% of treated individuals. Identifying genetic risk factors for CIAG could enable safer and more widespread use of clozapine. Here we perform the largest and most comprehensive genetic study of CIAG to date by interrogating 163 cases using genome-wide genotyping and whole-exome sequencing. We find that two loci in the major histocompatibility complex are independently associated with CIAG: a single amino acid in HLA-DQB1 (126Q) (P=4.7×10−14, odds ratio, OR=0.19, 95% CI 0.12–0.29) and an amino acid change in the extracellular binding pocket of HLA-B (158T) (P=6.4×10−10, OR=3.3, 95% CI 2.3–4.9). These associations dovetail with the roles of these genes in immunogenetic phenotypes and adverse drug responses for other medications, and provide insight into the pathophysiology of CIAG

Unification of Treatments and Interventions for Tinnitus Patients (UNITI): a study protocol for a multi-center randomized clinical trial

Background Tinnitus represents a relatively common condition in the global population accompanied by various comorbidities and severe burden in many cases. Nevertheless, there is currently no general treatment or cure, presumable due to the heterogeneity of tinnitus with its wide variety of etiologies and tinnitus phenotypes. Hence, most treatment studies merely demonstrated improvement in a subgroup of tinnitus patients. The majority of studies are characterized by small sample sizes, unstandardized treatments and assessments, or applications of interventions targeting only a single organ level. Combinatory treatment approaches, potentially targeting multiple systems as well as treatment personalization, might provide remedy and enhance treatment responses. The aim of the present study is to systematically examine established tinnitus therapies both alone and in combination in a large sample of tinnitus patients. Further, it wants to provide the basis for personalized treatment approaches by evaluating a specific decision support system developed as part of an EU-funded collaborative project (Unification of treatments and interventions for tinnitus patients; UNITI project). Methods/study design This is a multi-center parallel-arm randomized clinical trial conducted at five different clinical sites over the EU. The effect of four different tinnitus therapy approaches (sound therapy, structured counseling, hearing aids, cognitive behavioral therapy) applied over a time period of 12 weeks as a single or rather a combinatory treatment in a total number of 500 chronic tinnitus patients will be investigated. Assessments and interventions are harmonized over the involved clinical sites. The primary outcome measure focuses on the domain tinnitus distress assessed via the Tinnitus Handicap Inventory. Discussion Results and conclusions from the current study might not only provide an essential contribution to combinatory and personalized treatment approaches in tinnitus but could also provide more profound insights in the heterogeneity of tinnitus, representing an important step towards a cure for tinnitus. Trial registration ClinicalTrials.gov NCT04663828. Registered on 11 December 2020

Unification of Treatments and Interventions for Tinnitus Patients (UNITI): a study protocol for a multi-center randomized clinical trial

Background: Tinnitus represents a relatively common condition in the global population accompanied by various comorbidities and severe burden in many cases. Nevertheless, there is currently no general treatment or cure, presumable due to the heterogeneity of tinnitus with its wide variety of etiologies and tinnitus phenotypes. Hence, most treatment studies merely demonstrated improvement in a subgroup of tinnitus patients. The majority of studies are characterized by small sample sizes, unstandardized treatments and assessments, or applications of interventions targeting only a single organ level. Combinatory treatment approaches, potentially targeting multiple systems as well as treatment personalization, might provide remedy and enhance treatment responses. The aim of the present study is to systematically examine established tinnitus therapies both alone and in combination in a large sample of tinnitus patients. Further, it wants to provide the basis for personalized treatment approaches by evaluating a specific decision support system developed as part of an EU-funded collaborative project (Unification of treatments and interventions for tinnitus patients; UNITI project). Methods/study design: This is a multi-center parallel-arm randomized clinical trial conducted at five different clinical sites over the EU. The effect of four different tinnitus therapy approaches (sound therapy, structured counseling, hearing aids, cognitive behavioral therapy) applied over a time period of 12 weeks as a single or rather a combinatory treatment in a total number of 500 chronic tinnitus patients will be investigated. Assessments and interventions are harmonized over the involved clinical sites. The primary outcome measure focuses on the domain tinnitus distress assessed via the Tinnitus Handicap Inventory. Discussion: Results and conclusions from the current study might not only provide an essential contribution to combinatory and personalized treatment approaches in tinnitus but could also provide more profound insights in the heterogeneity of tinnitus, representing an important step towards a cure for tinnitus