Kharrazi H.,Health Management Technology
Medical Care | Year: 2017
BACKGROUND:: There is an increasing demand for electronic health record (EHR)–based risk stratification and predictive modeling tools at the population level. This trend is partly due to increased value-based payment policies and the increasing availability of EHRs at the provider level. Risk stratification models, however, have been traditionally derived from claims or encounter systems. This study evaluates the challenges and opportunities of using EHR data instead of or in addition to administrative claims for risk stratification. METHODS:: This study used the structured EHR records and administrative claims of 85,581 patients receiving outpatient care at a large integrated provider system. Common data elements for risk stratification (ie, age, sex, diagnosis, and medication) were extracted from outpatient EHR records and administrative claims. The performance of a validated risk-stratification model was assessed using data extracted from claims alone, EHR alone, and claims and EHR combined. RESULTS:: EHR-derived metrics overlapped considerably with administrative claims (eg, number of chronic conditions). The accuracy of the model, when using EHR data alone, was acceptable with an area under the curve of ∼0.81 for hospitalization and ∼0.85 for identifying top 1% utilizers using the concurrent model. However, when using EHR data alone, the predictive model explained a lower amount of variation in utilization-based outcomes compared with administrative claims. DISCUSSION:: The results show a promising performance of models predicting cost and hospitalization using outpatient EHR’s diagnosis and medication data. More research is needed to evaluate the benefits of other EHR data types (eg, lab values and vital signs) for risk stratification. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Ali M.M.,University of Toledo |
Dwyer D.S.,Health Management Technology
Journal of Adolescence | Year: 2011
In this paper we seek to empirically quantify the role of peer social networks in influencing sexual behavior among adolescents. Using data of a nationally representative sample of adolescents we utilize a multivariate structural model with school-level fixed effects to account for the problems of contextual effects, correlated effects and peer selections to purge the potential biases from the estimates of peer influence. Our peer group measures are drawn not only from the nomination of close friends, but also from classmates. Controlling for parent level characteristics, and other demographic parameters, we find that a 10% increase in the proportion of close friends who initiates sex increases the probability that an individual chooses to initiate sex by 5% and a 10% increase in number of sexual partners among close friends increases an individual's sexual partner by 5%. The influence of classmates however, diminishes in magnitude after accounting for unobserved environmental confounders. © 2009 The Association for Professionals in Services for Adolescents.
Ali M.M.,University of Toledo |
Dwyer D.S.,Health Management Technology
Addictive Behaviors | Year: 2010
In this paper we seek to empirically quantify the role of peer social networks in explaining drinking behavior among adolescents. Using data from a nationally representative sample of adolescents we utilize a multivariate structural model with school-level fixed effects to account for the problems of contextual effects, correlated effects and peer selection to purge the potential biases from the estimates of peer influence. Our peer group measures are drawn not only from the nomination of close friends, but also from classmates. Drinking behavior among the peer groups was constructed using the peers' own report of their alcohol consumption. Controlling for parent level characteristics, and other demographic parameters, we find that a 10% increase in the proportion of classmates who drink will increase the likelihood of drinking participation and frequency by approximately four percentage points. We also find evidence to show that the influence of close friends, while still significant, diminishes in magnitude after accounting for unobserved environmental confounders. Our findings support the literature that peer effects are important determinants of drinking behavior even after controlling for potential biases. Effective policy aimed at reducing alcohol consumption among adolescents would consider these significant peer effects. © 2009 Elsevier Ltd. All rights reserved.
Lopez A.,Health Management Technology
Work | Year: 2011
Resilience and vulnerability refer to an individual's capacity to persevere in the face of adversity. Resiliency and vulnerability are distinctive personal characteristics influenced by environmental factors such as socio-cultural and institutional contexts. Resiliency and vulnerability are not absolute; they are psychosocial constructs of a phenomenological continuum. Hence, a resilient individual is not invincible to all life events but has the capacity to endure in most circumstances. Clients who sustain traumatic injuries or witness traumatic events have a greater vulnerability to stress disorders like posttraumatic stress disorder (PTSD). Occupational therapy practitioners should be cognizant of a client's resilient and adaptive capacities when providing services to a client who has endured a traumatic event. This paper explores resilience theory and its application to occupational therapy practice. © 2011 - IOS Press and the authors. All rights reserved.
Ozegowski S.,Health Management Technology
Journal of Health Services Research and Policy | Year: 2013
Objectives: To explore the effectiveness of four different policy mechanisms in achieving a more equitable geographical distribution of general practitioners (GPs) in European countries. The following mechanisms were analysed: (1) interventions during medical training; (2) financial incentives; (3) quotas to allocate GPs to regions and (4) capitation-based remuneration. Methods: A macro-comparative method, namely, fuzzy set qualitative comparative analysis, was employed to explore the distributional effectiveness of the four mechanisms. A literature review yielded information on the use of these mechanisms in the 21 European countries included, while country-specific equity in the geographic GP distribution served as the outcome variable. Results: Quotas determining the number of GPs per region proved to be highly effective in producing an equitable GP distribution if calculated based on health care needs. Remunerating GPs largely through capitation payments also proved to be an effective policy mechanism. Financial bonuses to GPs practising in under-served areas and interventions during medical training had little or no impact. Conclusion: Several high income countries have a maldistribution of primary care physicians to the detriment of rural or socially deprived areas. Policy makers have instituted a variety of policies to counter this. This study helps to identify mechanisms which are likely to be more and less effective. © The Author(s) 2013.
Hale A.,Health Management Technology |
Hale A.,Technical University of Delft |
Borys D.,University of Ballarat
Safety Science | Year: 2013
The paper reviews the literature from 1986 on the management of those safety rules and procedures which relate to the workplace level in organisations. It contrasts two different paradigms of how rules and their development and use are perceived and managed. The first is a top-down classical, rational approach in which rules are seen as static, comprehensive limits of freedom of choice, imposed on operators at the sharp end and violations are seen as negative behaviour to be suppressed. The second is a bottom-up constructivist view of rules as dynamic, local, situated constructions of operators as experts, where competence is seen to a great extent as the ability to adapt rules to the diversity of reality. The paper explores the research underlying and illustrating these two paradigms, drawn from psychology, sociology and ethnography, organisational studies and behavioural economics. In a separate paper following on from this review (Hale and Borys, this issue) the authors propose a framework of rule management which attempts to draw the lessons from both paradigms. It places the monitoring and adaptation of rules central to its management process. © 2012 Elsevier Ltd.
Vanner E.A.,Health Management Technology |
Stewart M.W.,Mayo Medical School
American Journal of Ophthalmology | Year: 2011
Purpose: To evaluate the effect of vitrectomy timing on outcomes for patients with crystalline retained lens fragments receiving vitrectomy 3+ days after cataract surgery. Design: Systematic review and meta-analysis of retrospective interventional cases series. Methods: Searches of MEDLINE (English, 1/1/85 through 7/30/2010) and article reference lists. Articles were screened for patients with crystalline retained lens fragments after surgery for age-related cataracts, discussion of vitrectomy timing, and, for the meta-analysis, patient totals for at least 1 outcome and multiple time periods, 10+ patients, and mean follow-up <3 months. Outcomes included visual acuity, retinal detachment, increased intraocular pressure, intraocular infection/inflammation, cystoid macular edema, and corneal edema. Data extraction was performed twice and quality assessed. Logistic regression estimated study-level odds ratios for each additional 1-week vitrectomy delay. Meta-analysis estimated summary odds ratios using random-effects models. Results: Of 257 articles identified, there were 43 unique studies (53 articles) for the systematic review, including 27 (31 articles) for the meta-analysis. Early vitrectomies were statistically significantly associated with better outcomes for not good visual acuity (odds ratio: 1.13; 95% CI: 1.041.22, P =.005); bad visual acuity (odds ratio: 1.05; 95% CI: 1.011.09, P =.009); previtrectomy retinal detachment (odds ratio: 1.29; 95% CI: 1.011.65, P =.038); postvitrectomy retinal detachment (odds ratio: 1.13; 95% CI: 1.021.26, P =.024); increased intraocular pressure (odds ratio: 1.23; 95% CI: 1.071.41, P =.003); and intraocular infection/inflammation (odds ratio: 1.20; 95% CI: 1.011.42, P =.041). Results were robust to sensitivity analyses. Conclusions: This systematic review and meta-analysis found significantly better outcomes (visual acuity, retinal detachment, increased intraocular pressure, intraocular infection/inflammation) with earlier vitrectomy for retained lens fragments. Reduced vitrectomy delays may yield better patient outcomes. © 2011 Elsevier Inc.
Lamberg E.M.,Health Management Technology |
Muratori L.M.,Health Management Technology
Gait and Posture | Year: 2012
Cell phone use among pedestrians leads to increased cognitive distraction, reduced situation awareness and increases in unsafe behavior. Performing a dual-task, such as talking or texting with a cell phone while walking, may interfere with working memory and result in walking errors. At baseline, thirty-three participants visually located a target 8. m ahead; then vision was occluded and they were instructed to walk to the remembered target. One week later participants were assigned to either walk, walk while talking on a cell phone, or walk while texting on a cell phone toward the target with vision occluded. Duration and final location of the heel were noted. Linear distance traveled, lateral angular deviation from the start line, and gait velocity were derived. Changes from baseline to testing were analyzed with paired . t-tests. Participants engaged in cell phone use presented with significant reductions in gait velocity (texting: 33% reduction, . p=. 0.01; talking: 16% reduction, . p=. 0.02). Moreover, participants who were texting while walking demonstrated a 61% increase in lateral deviation (. p=. 0.04) and 13% increase in linear distance traveled (. p=. 0.03). These results suggest that the dual-task of walking while using a cell phone impacts executive function and working memory and influences gait to such a degree that it may compromise safety. Importantly, comparison of the two cell phone conditions demonstrates texting creates a significantly greater interference effect on walking than talking on a cell phone. © 2011 Elsevier B.V..
Sundmacher L.,Health Management Technology
Health Policy | Year: 2013
All developed nations use indicators to monitor the health of their populations, but few nations provide a systematic monitoring of indicators for small regional units. The present study aims to contribute to the literature a single graph that provides a quick and comprehensive overview of the level of and trend in avoidable mortality in each German district as compared to the national average and development. Using mortality data from the German Federal Statistical Office, I calculated the age-standardized number of avoidable deaths, separately for men and women, in each of the 413 local districts in Germany between 2000 and 2008.For men, the graph illustrates that the districts with the highest rates of avoidable mortality are still located in the former East German states, but that some of these districts have improved significantly between the years 2000 and 2008 and are approaching the nationwide average. The graph for women shows slightly different results. Here, many urban areas show high rates of avoidable mortality with both favorable and unfavorable trends.Health professionals could use the graph to establish realistic benchmarks that are based on countrywide comparisons of districts to a national average and trend, which may in turn help them to identify local districts in need of primary or secondary prevention programs or a more effective provision of health care. © 2012 Elsevier Ireland Ltd.
News Article | February 16, 2017
Technology-Enabled Consulting in Health Care - Heisenberg II Publishes Its Much Awaited Paper This publication from Heisenberg II talks about why self-disruption is so critical and why outmoded business models just cant keep up, especially in complex sectors like health care. This publication from Heisenberg II talks about why self-disruption is so critical and why outmoded business models just can’t keep up, especially in complex sectors like health care. “Self-disruption – incorporating technological deployments into management consulting – is critical for the industry to continue to provide value to health care organizations,” say authors of the paper, Furthermore, the authors feel that technology firms can deliver analytics, but not insights. The technology deployed only executes the strategy and it’s the right blend of technology and consulting that determines success. The paper "Technology-Enabled Consulting in Health Care," has also been published in the reputed Health Management Technology and can be downloaded from this About Heisenberg II Heisenberg II is an artificially intelligent, cloud-based software that allows health systems and physician groups to ensure compliance, empower transparency, and enable validation throughout their physician compensation process. It delivers the tools needed to efficiently manage, evaluate, and adjudicate physician compensation plans. http://www.heisenbergii.com About Hallmark Healthcare Solutions Hallmark Healthcare Solutions is a global healthcare solution and information technology firm with offices located in New Jersey, New York, Michigan, and India. Hallmark offers a unique approach inclusive of both strategy and technology to achieve the desired outcome. http://hallmarkhealthcareit.com Media Contact - Alicia Boggs, email@example.com, (614) 284-1486 Mt. Laurel, NJ, February 16, 2017 --( PR.com )-- Heisenberg II, a revolutionary physician compensation platform developed by Hallmark Healthcare Solutions, LLC. , has published its much awaited paper - Technology-Enabled Consulting in Health Care.This publication from Heisenberg II talks about why self-disruption is so critical and why outmoded business models just can’t keep up, especially in complex sectors like health care.“Self-disruption – incorporating technological deployments into management consulting – is critical for the industry to continue to provide value to health care organizations,” say authors of the paper, Isaac Ullatil Principal and CEO, Hallmark Healthcare Solutions and Josh Willeford Vice President, Consulting, Advisory Board.Furthermore, the authors feel that technology firms can deliver analytics, but not insights. The technology deployed only executes the strategy and it’s the right blend of technology and consulting that determines success.The paper "Technology-Enabled Consulting in Health Care," has also been published in the reputed Health Management Technology and can be downloaded from this link About Heisenberg IIHeisenberg II is an artificially intelligent, cloud-based software that allows health systems and physician groups to ensure compliance, empower transparency, and enable validation throughout their physician compensation process. It delivers the tools needed to efficiently manage, evaluate, and adjudicate physician compensation plans. http://www.heisenbergii.comAbout Hallmark Healthcare SolutionsHallmark Healthcare Solutions is a global healthcare solution and information technology firm with offices located in New Jersey, New York, Michigan, and India. Hallmark offers a unique approach inclusive of both strategy and technology to achieve the desired outcome. http://hallmarkhealthcareit.comMedia Contact - Alicia Boggs, firstname.lastname@example.org, (614) 284-1486