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Ann Arbor, MI, United States

Smith D.M.,Truven Health Analytics | Faddy M.J.,Queensland University of Technology
Journal of Statistical Software | Year: 2016

This article describes the R package CountsEPPM and its use in determining maximum likelihood estimates of the parameters of extended Poisson process models. These provide a Poisson process based family of flexible models that can handle both underdispersion and overdispersion in observed count data, with the negative binomial and Poisson distributions being special cases. Within CountsEPPM models with mean and variance related to covariates are constructed to match a generalized linear model formulation. Use of the package is illustrated by application to several published datasets. © 2016, American Statistical Association. All rights reserved. Source


Owens P.L.,Agency for Healthcare Research and Quality | Barrett M.L.,ML Barrett Inc. | Raetzman S.,Truven Health Analytics | Maggard-Gibbons M.,RAND Corporation | And 2 more authors.
JAMA - Journal of the American Medical Association | Year: 2014

IMPORTANCE: Surgical site infections can result in substantial morbidity following inpatient surgery. Little is known about serious infections following ambulatory surgery. OBJECTIVE: To determine the incidence of clinically significant surgical site infections (CS-SSIs) following low- to moderate-risk ambulatory surgery in patients with low risk for surgical complications. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of ambulatory surgical procedures complicated by CS-SSIs that require a postsurgical acute care visit (defined as subsequent hospitalization or ambulatory surgical visit for infection) using the 2010 Healthcare Cost and Utilization Project State Ambulatory Surgery and State Inpatient Databases for 8 geographically dispersed states (California, Florida, Georgia, Hawaii, Missouri, Nebraska, New York, and Tennessee) representing one-third of the US population. Index cases included 284 098 ambulatory surgical procedures (general surgery, orthopedic, neurosurgical, gynecologic, and urologic) in adult patients with low surgical risk (defined as not seen in past 30 days in acute care, length of stay less than 2 days, no other surgery on the same day, and discharged home and no infection coded on the same day). MAIN OUTCOMES AND MEASURES: Rates of 14- and 30-day postsurgical acute care visits for CS-SSIs following ambulatory surgery. RESULTS: Postsurgical acute care visits for CS-SSIs occurred in 3.09 (95% CI, 2.89-3.30) per 1000 ambulatory surgical procedures at 14 days and 4.84 (95% CI, 4.59-5.10) per 1000 at 30 days. Two-thirds (63.7%) of all visits for CS-SSI occurred within 14 days of the surgery; of those visits, 93.2% (95% CI, 91.3%-94.7%) involved treatment in the inpatient setting. All-cause inpatient or outpatient postsurgical visits, including those for CS-SSIs, following ambulatory surgery occurred in 19.99 (95% CI, 19.48-20.51) per 1000 ambulatory surgical procedures at 14 days and 33.62 (95% CI, 32.96-34.29) per 1000 at 30 days. CONCLUSIONS AND RELEVANCE: Among patients in 8 states undergoing ambulatory surgery, rates of postsurgical visits for CS-SSIs were low relative to all causes; however, they may represent a substantial number of adverse outcomes in aggregate. Thus, these serious infections merit quality improvement efforts to minimize their occurrence. Copyright 2014 American Medical Association. All rights reserved. Source


Nagasako E.M.,University of Washington | Reidhead M.,Missouri Hospital Association Hospital Industry Data Institute | Waterman B.,Truven Health Analytics | Claiborne Dunagan W.,Center for Clinical Excellence at HealthCare
Health Affairs | Year: 2014

To better understand the degree to which risk-standardized thirty-day readmission rates may be influenced by social factors, we compared results for hospitals in Missouri under two types of models. The first type of model is currently used by the Centers for Medicare and Medicaid Services for public reporting of condition-specific hospital readmission rates of Medicare patients. The second type of model is an "enriched" version of the first type of model with census tract-level socioeconomic data, such as poverty rate, educational attainment, and housing vacancy rate. We found that the inclusion of these factors had a pronounced effect on calculated hospital readmission rates for patients admitted with acute myocardial infarction, heart failure, and pneumonia. Specifically, the models including socioeconomic data narrowed the range of observed variation in readmission rates for the above conditions, in percentage points, from 6.5 to 1.8, 14.0 to 7.4, and 7.4 to 3.7, respectively. Interestingly, the average readmission rates for the three conditions did not change significantly between the two types of models. The results of our exploratory analysis suggest that further work to characterize and report the effects of socioeconomic factors on standardized readmission measures may assist efforts to improve care quality and deliver more equitable care on the part of hospitals, payers, and other stakeholders. © 2014 Project HOPE. Source


White C.,Studying Health System Change | Yee T.,Truven Health Analytics
Health Affairs | Year: 2013

The Affordable Care Act permanently slows the growth in Medicare hospital prices. To better understand the effects of those price cuts, we used data from ten states for the period 1995-2009 to examine the market-level relationship between Medicare prices and hospital utilization among the elderly. Regression analyses indicate that a 10 percent reduction in the Medicare price was associated with a 4.6 percent reduction in discharges among the elderly. This volume response to price cuts appears to be accomplished through hospitals' reduction in their numbers of staffed beds. They did not leave beds empty; instead, they reduced their scale of operations. Based on our results, we conclude that the Affordable Care Act will help reduce inpatient hospital utilization in the future. From a federal budgetary standpoint, lower utilization is good news, but the implications for patient care and health outcomes are not yet clear. © 2013 Project HOPE-The People-to-People Health Foundation, Inc. Source


A system for providing medical providers with medical records accessible from a mobile terminal in one embodiment comprises reformatting the information in a medical record database to be used with large, ergonomic icons allowing easy transitions between pages of information in the medical record. Docking stations or wireless networks may enable the mobile terminal to access the medical records. Thus, the medical provider may have bedside access to the information in the medical records to make informed decisions about treatment regimens.

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