Adjustment For Variables Research Articles

Hospital COVID-19 Burden and Adverse Event Rates

The COVID-19 pandemic introduced stresses on hospitals due to the surge in demand for care and to staffing shortages. The implications of these stresses for patient safety are not well understood. To assess whether hospital COVID-19 burden was associated with the rate of in-hospital adverse effects (AEs). This cohort study used data from the Agency for Healthcare Research and Quality's Quality and Safety Review System, a surveillance system that tracks the frequency of AEs among selected hospital admissions across the US. The study sample included randomly selected Medicare patient admissions to acute care hospitals in the US between September 1, 2020, and June 30, 2022. The main outcome was the association between frequency of AEs and hospital-specific weekly COVID-19 burden. Observed and risk-adjusted rates of AEs per 1000 admissions were stratified by the weekly hospital-specific COVID-19 burden (daily mean number of COVID-19 inpatients per 100 hospital beds each week), presented as less than the 25th percentile (lowest burden), 25th to 75th percentile (intermediate burden), and greater than the 75th percentile (highest burden). Risk adjustment variables included patient and hospital characteristics. The study included 40 737 Medicare hospital admissions (4114 patients [10.1%] with COVID-19 and 36 623 [89.9%] without); mean (SD) patient age was 73.8 (12.1) years, 53.8% were female, and the median number of Elixhauser comorbidities was 4 (IQR, 2-5). There were 59.1 (95% CI, 54.5-64.0) AEs per 1000 admissions during weeks with the lowest, 77.0 (95% CI, 73.3-80.9) AEs per 1000 admissions during weeks with intermediate, and 97.4 (95% CI, 91.6-103.7) AEs per 1000 admissions during weeks with the highest COVID-19 burden. Among patients without COVID-19, there were 55.7 (95% CI, 51.1-60.8) AEs per 1000 admissions during weeks with the lowest, 74.0 (95% CI, 70.2-78.1) AEs per 1000 admissions during weeks with intermediate, and 79.3 (95% CI, 73.7-85.3) AEs per 1000 admissions during weeks with the highest COVID-19 burden. A similar pattern was seen among patients with COVID-19. After risk adjustment, the relative risk (RR) for AEs among patients admitted during weeks with high compared with low COVID-19 burden for all patients was 1.23 (95% CI, 1.09-1.39; P < .001), with similar results seen in the cohorts with (RR, 1.33; 95% CI, 1.03-1.71; P = .03) and without (RR, 1.23; 95% CI, 1.08-1.39; P = .002) COVID-19 individually. In this cohort study of hospital admissions among Medicare patients during the COVID-19 pandemic, greater hospital COVID-19 burden was associated with an increased risk of in-hospital AEs among both patients with and without COVID-19. These results illustrate the need for greater hospital resilience and surge capacity to prevent declines in patient safety during surges in demand.

초등학생이 지각한 부모의 교육지원활동이 학교생활적응, 학업참여, 과학학습만족에 미치는 영향

The purpose of this study was to examine the direct and indirect effects of parental educational support activities, school adjustment, and academic engagement variables on elementary school students' perceived satisfaction with science learning and to identify the structural relationships among the variables. To this end, 230 students in grades 4-6 at S Elementary School in a metropolitan city were surveyed to examine the causal relationships among the variables. The results showed that elementary school students' perceived parental educational support activities, school life adjustment, and academic engagement had a direct effect on science learning satisfaction, and parental educational support activities had a direct effect on school life adjustment and academic engagement. In addition, parental educational support activities had an indirect effect on science learning satisfaction through school life adjustment and academic engagement. Therefore, it is necessary to educate elementary school students from a comprehensive perspective that considers parental educational support activities, school adjustment, and academic engagement in order to foster science learning satisfaction.

Indirect Effects of Municipal Public Health Nurse Workforce on Cancer Standardized Mortality Ratios Mediated by Cancer Screening Rates.

This study examined the indirect effects of the number of Japanese municipal public health nurses (PHNs) on cancer standardized mortality ratios (SMRs), using cancer screening and diagnostic follow-up rates as mediators. Ecological study using municipalities as the unit of analysis MEASUREMENTS: Aggregate, municipal-level government data were analyzed using a linear model with empirical Bayes estimates of SMRs (EBSMRs) for gastric, colorectal, and lung cancers as the dependent variables, and the number of PHNs, cancer screening rate, diagnostic follow-up rate, and adjustment variables as independent variables. Structural equation modeling (SEM) was used to examine the indirect effects of PHNs. Cancer screening rates were significantly negatively associated with EBSMR, except for gastric cancer in women. No significant association was observed between the EBSMR and diagnostic follow-up rates. SEM revealed a significant indirect effect of the number of PHNs, most of which was due to the cancer screening rate. From a population-based public health perspective, increasing the number of PHNs and focusing on improving cancer screening rates may effectively reduce cancer SMRs.

Churning the tides of care: when nurse turnover makes waves in patient access to primary care

BackgroundTeam-based primary care (PC) enhances the quality of and access to health care. The Veterans Health Administration (VHA) implements team-based care through Patient Aligned Care Teams (PACTs), consisting of four core members: a primary care provider, registered nurse (RN) care manager, licensed vocational nurse, and scheduling clerk. RNs play a central role: they coordinate patient care, manage operational needs, and serve as a patient point of contact. Currently, it is not known how varying levels of RN staffing on primary care teams impact patient outcomes.ObjectiveThis study aims to empirically assess how the stability of RN staffing within team-based primary care affects patient access to care.MethodsA retrospective database review using clinical and administrative data from the VHA over 24 months. Participants included 5,897 PC PACTs across 152 VHA healthcare facilities in the United States and its territories. The stability of personnel in the RN role was categorized as: RN continuous churn, RN staffing instability and RN vacancy. All 3 categories were compared to teams with RN stability (i.e., same person in the role for the entire 24-month period). Access measures included: average third-next-available appointment, established patient average wait time in days, urgent care utilization, emergency room utilization, and total inbound-to-outbound PC secure messages ratio.ResultsRN continuous churn within PACTs had a significant impact on third-next-available appointment (b = 3.70, p < 0.01). However, RN staffing instability and vacancy had no significant relationship with any of the access measures. Several risk adjustment variables, including team full-time equivalency, team stability, relative team size, and average team size, were significantly associated with access to health care.ConclusionsTeams are impacted by churn on the team. Adequate staffing and team stability significantly predict patient access primary care services. Healthcare organizations should focus on personnel retention and strategies to mitigate the impact(s) of continuous RN turnover. Future research should examine the relative impact of turnover and stability of other roles (e.g., clerks) and how team members adapt to personnel changes.

Antisocial behaviors at school: Analysis of normative and at-risk groups

School plays a crucial role in adolescent development and in the prevention of antisocial behaviors. This study focuses on five common antisocial behaviors within the school environment. Analysis was conducted with various groups of adolescents aged 11–16, including a normative sample of Spanish adolescents, and two samples of adolescents from high psychosocial risk areas: Polígono Sur (Seville, Spain), and IV Municipalità (Naples, Italy). The normative sample consisted of a representative group of Spanish adolescents who responded to the 2014 HBSC questionnaire, whereas data from Polígono Sur and IV Municipalità were collected specifically from these populations. The prevalence of each antisocial behavior was analyzed according to reference group, age, sex, and two key school adjustment variables: feelings about school and perceived school pressure. Additional analysis explored how these variables and their interactions contribute to variations in antisocial behavior. The findings offer valuable insight for designing prevention and intervention programs aimed at addressing antisocial behaviors within the school context.

Spatiotemporal Characteristics and Influencing Factors of the Synergistic Effect of Pollution Reduction and Carbon Reduction in China

Based on the use of the coupling coordination model to calculate the coupling coordination degree of carbon emission and pollutant control, the national, regional, and provincial spatiotemporal characteristics of the synergistic effect of pollution control and carbon emissions reduction in China were further analyzed, facilitating the crucial to identification of key areas. The fixed effects regression models and provincial panel data from 2006 to 2020 were used to explore factors contributing to better synergizing the reduction of pollution and carbon emissions in China. On this basis, the adjustment variable of R&D investment intensity was introduced, and the regulation effect model was constructed to further explore the influence mechanism of the synergistic effect of pollution reduction and carbon reduction. The results showed that： synergy exists between carbon emission reduction and the air pollution control system, the evolution of the synergistic effect of pollution reduction and carbon reduction in China presented an inverted "U"-shaped trend from 2006 to 2020, and there was spatial aggregation and a spatial spillover effect in pollution reduction and carbon reduction. The synergistic governance of carbon emission and pollutant control was still at a relatively low level. The carbon emission and air pollutant emission systems were still in an unstable and uncoordinated state. The results showed that： The degree of coordination of eastern China, central China, and western China decreased in turn. At the national level, energy consumption structure, per capita GDP, and the proportion of green investment were the main factors affecting the synergistic effect of pollution reduction and carbon. The heterogeneity of the influencing factors existed in the central, eastern, and western regions on industrial structure, energy consumption structure, energy utilization efficiency, per capita GDP, urbanization rate, the proportion of green investment, and transportation structure. The intensity of R&D played a significant moderating effect in the whole country, eastern, and central regions. However, no significant moderating effect was identified in the western region. In the eastern region, the urbanization rate, the proportion of green investment, and the transportation structure could not have a significant effect on the synergistic effect of pollution reduction and carbon reduction alone, and it must be coordinated with the intensity of R&D.

Can algorithms Replace Expert Knowledge for Causal Inference? A Case Study on Novice Use of Causal Discovery.

With growing interest in causal inference and machine learning among epidemiologists, there is increasing discussion of causal discovery algorithms for guiding covariate selection. We present a case study of novice application of causal discovery tools and attempt to validate the results against a well-established causal relationship. As a case study, we attempted causal discovery of relationships relevant to the effect of adherence on mortality in the placebo arm of the Coronary Drug Project (CDP) dataset. We used four algorithms available as existing software implementations and varied several model inputs. We identified 15 adjustment sets from 17 model parameterizations. When applied to a baseline covariate adjustment analysis, these 15 adjustment sets returned effect estimates with similar magnitude and direction of bias as prior published results. When using methods to control for time-varying confounding, there was generally more residual bias than compared to expert-selected adjustment sets. Although causal discovery algorithms can perform on par with expert knowledge, we do not recommend novice use of causal discovery without the input of experts in causal discovery. Expert support is recommended to aid in choosing the algorithm, selecting input parameters, assessing underlying assumptions, and finalizing selection of the adjustment variables.

Bipartite consensus for multi-agent systems over signed networks: A novel dynamic event-triggered mechanism

This paper is concerned with the problem of dynamic event-triggered bipartite consensus control for nonlinear multi-agent systems based on signed networks. A new dynamic event-triggered control mechanism is proposed, whereby an adjustment variable is introduced to dynamically schedule the triggering frequency, enabling the minimization of the triggering times while ensuring system performance. Based on the designed event-triggered control algorithm, sufficient conditions are derived to guarantee that bipartite consensus can be reached by the considered nonlinear multi-agent system. Furthermore, it is proved that Zeno behavior will not occur. Numerical examples are provided in this paper to verify the effectiveness of the proposed control algorithm. The simulation results reveal that, compared with the static event-triggered mechanism and the traditional dynamic event-triggered mechanism, the proposed event-triggered algorithm can further reduce the triggering times and enhance the flexibility of the event-triggered mechanism.

Association between physical function and parameters of hip structural analysis in patients with hip fracture.

The current study sought to investigate whether physical function and activity were associated with hip structural analysis (HSA) parameters on the non-fracture side of patients with hip fractures. Participants were patients with unilateral hip fracture treated by surgery. HSA of the proximal femur was conducted based on dual-energy x-ray absorptiometry data. HSA parameters in the narrow neck region included cross-sectional area (CSA), cross-sectional moment of inertia (CSMI), section modulus (SM), and buckling ratio (BR). Hierarchical multiple regression analysis was conducted to identify predictors of HSA. Except for the adjustment variables, age, gender and BMI, other variables were extracted. Hierarchical multiple regression analysis (standardised partial regression coefficients) identified movement control during one-leg standing on the non-fractured side (0.15) as factors associated with CSA. Hierarchical multiple regression analysis (standardised partial regression coefficients) identified hand grip (0.12, 0.23) as factors associated with CSMI and SM, respectively. Hierarchical multiple regression analysis (standardised partial regression coefficients) identified presence of steroid (0.23) and cerebrovascular disease (0.19) as factors associated with BR. The coefficients of determination adjusted for degrees of freedom (R2) were 0.545, 0.331, 0.401, and 0.148 for CSA, CSMI, SM, and BR, respectively. Our results indicate that movement control during 1-leg standing and muscle strength may be important for maintaining and improving bone strength.

Factors Influencing Discharges to Hospice for Patients With Late-Stage Huntington's Disease.

Background: Hospice services for patients with Huntington's disease (HD) are likely beneficial in relieving significant burdens and minimizing costly hospitalizations at the end of life, though there has been little study or clinical guidance on hospice enrollment for patients with HD. Objectives: The primary objective of this study was to identify clinical, sociodemographic, and system-level factors associated with discharges to hospice compared to other dispositions for hospitalized patients with late-stage HD. Methods: These analyses used data from the Nationwide Inpatient Sample between the years 2007 and 2011. Weighted logistic regression with a forward selection approach was performed to identify factors associated with discharge to hospice compared to discharge to home, facility, other locations, and death in hospital. Results: These analyses included 6544 hospitalizations of patients with late-stage HD. There was a significant increasing trend in discharges to hospice over the study period (P < 0.001). After adjustment, multiple clinical, sociodemographic, and system-level variables were identified as being associated with discharges to hospice. Patients with aspiration pneumonia and non-aspiration pneumonias had lower odds of being discharged to hospice compared to dying in the hospital. When comparing to discharges to facilities and home, weight loss and palliative care consultation were associated with greater odds of discharge to hospice. Conclusions: Our findings serve as a foundation for future studies on these factors, and thus help clinician decision-making on when to start advance care planning or end-of-life care for patients with HD. These results also support studies developing hospice referral criteria specific to patients with HD.

Comparative Effectiveness of Bimekizumab and Risankizumab in Patients with Psoriatic Arthritis at 52 Weeks Assessed Using a Matching-Adjusted Indirect Comparison.

The relative efficacy of bimekizumab and risankizumab in patients with PsA who were biologic disease-modifying anti-rheumatic drug naïve (bDMARD naïve) or with previous inadequate response or intolerance to tumor necrosis factor inhibitors (TNFi-IR) was assessed at 52weeks (Wk52) using matching-adjusted indirect comparisons (MAIC). Relevant trials were systematically identified. For patients who were bDMARD naïve, individual patient data (IPD) from BE OPTIMAL (NCT03895203; N = 431) were matched with summary data from KEEPsAKE-1 (NCT03675308; N = 483). For patients who were TNFi-IR, IPD from BE COMPLETE (NCT03896581; N = 267) were matched with summary data from the TNFi-IR patient subgroup in KEEPsAKE-2 (NCT03671148; N = 106). To adjust for cross-trial differences, patients from the bimekizumab trials were re-weighted to match the baseline characteristics of patients in the risankizumab trials. Adjustment variables were selected based on expert consensus (n = 5) and adherence to established MAIC guidelines. Recalculated bimekizumab Wk52 outcomes for American College of Rheumatology (ACR) 20/50/70 response criteria and minimal disease activity (MDA) index (non-responder imputation) were compared with risankizumab outcomes via non-placebo-adjusted comparisons. In patients who were bDMARD naïve, bimekizumab had a significantly greater likelihood of response than risankizumab at Wk52 for ACR50 (odds ratio [95% confidence interval]: 1.52 [1.11, 2.09]) and ACR70 (1.80 [1.29, 2.51]). In patients who were TNFi-IR, bimekizumab had a significantly greater likelihood of response than risankizumab at Wk52 for ACR20 (1.78 [1.08, 2.96]), ACR50 (3.05 [1.74, 5.32]), ACR70 (3.69 [1.82, 7.46]), and MDA (2.43 [1.37, 4.32]). Using MAIC, bimekizumab demonstrated a greater likelihood of efficacy in most ACR and MDA outcomes than risankizumab in patients with PsA who were bDMARD naïve and TNFi-IR at Wk52. NCT03895203, NCT03896581, NCT03675308, NCT03671148.

Comparative Effectiveness of Bimekizumab and Ustekinumab in Patients with Psoriatic Arthritis at 52 Weeks Assessed Using a Matching-Adjusted Indirect Comparison.

A matching-adjusted indirect comparison (MAIC) was conducted to assess the relative efficacy at 52weeks (Wk52) of bimekizumab 160mg every 4weeks (Q4W) and ustekinumab 45 or 90mg every 12weeks (Q12W) in patients with psoriatic arthritis (PsA) who were biologic disease-modifying anti-rheumatic drug naïve (bDMARD naïve) or who had a previous inadequate response or an intolerance to tumor necrosis factor inhibitors (TNFi-IR). Relevant trials were systematically identified. Individual patient data from the bimekizumab trials BE OPTIMAL (NCT03895203; N = 431) and BE COMPLETE (NCT03896581; N = 267) were matched with summary data on patients receiving ustekinumab in the PSUMMIT 1 trial (NCT01009086; 45mg, N = 205; 90mg; N = 204) and a subgroup of TNFi-IR patients receiving ustekinumab in the PSUMMIT 2 trial (NCT01077362; 45mg, N = 60; 90mg, N = 58), respectively. Patients from the bimekizumab trials were re-weighted using propensity scores to match the baseline characteristics of the ustekinumab trial patients. Adjustment variables were selected based on expert consensus (n = 5) and adherence to established MAIC guidelines. Non-placebo-adjusted comparisons of recalculated bimekizumab and ustekinumab outcomes for the American College of Rheumatology (ACR) 20/50/70 response criteria (non-responder imputation) were analyzed. In patients who were bDMARD naïve, bimekizumab had a greater likelihood of response than ustekinumab at Wk52 for ACR20 (odds ratio [95% confidence interval] 45mg: 2.14 [1.35, 3.40]; 90mg: 1.98 [1.24, 3.16]), ACR50 (45mg: 2.74 [1.75, 4.29]; 90mg: 2.29 [1.48, 3.55]), and ACR70 (45mg: 3.33 [2.04, 5.46]; 90mg: 3.05 [1.89, 4.91]). In patients who were TNFi-IR, bimekizumab had a greater likelihood of response than ustekinumab at Wk52 for ACR20 (45mg: 4.17 [2.13, 8.16]; 90mg: 4.19 [2.07, 8.49]), ACR50 (45mg: 5.00 [2.26, 11.05]; 90mg: 3.86 [1.70, 8.79]), and ACR70 (45mg: 9.85 [2.79, 34.79]; 90mg: 6.29 [1.98, 20.04]). Using MAIC, bimekizumab showed greater efficacy than ustekinumab in achieving all ACR responses in patients with PsA who were bDMARD naïve and TNFi-IR at Wk52. NCT03895203, NCT03896581, NCT01009086, NCT01077362.

Effects of antipsychotic treatment on cardio-cerebrovascular related mortality in schizophrenia: A subanalysis of a systematic review and meta-analysis with meta-regression of moderators

To further explore the role of different antipsychotic treatments for cardio-cerebrovascular mortality, we performed several subgroup, sensitivity and meta-regression analyses based on a large previous meta-analysis focusing on cohort studies assessing mortality relative risk (RR) for cardio-cerebrovascular disorders in people with schizophrenia, comparing antipsychotic treatment versus no antipsychotic. Quality assessment through the Newcastle-Ottawa Scale (NOS) and publication bias was measured. We meta-analyzed 53 different studies (schizophrenia patients: n = 2,513,359; controls: n = 360,504,484) to highlight the differential effects of antipsychotic treatment regimens on cardio-cerebrovascular-related mortality in incident and prevalent samples of patients with schizophrenia. We found first generation antipsychotics (FGA) to be associated with higher mortality in incident samples of schizophrenia (oral FGA [RR=2.20, 95 %CI=1.29–3.77, k = 1] and any FGA [RR=1.70, 95 %CI=1.20–2.41, k = 1]). Conversely, second generation antipsychotics (SGAs) and clozapine were associated with reduced cardio-cerebrovascular-related mortality, in prevalent samples of schizophrenia. Subgroup analyses with NOS score ≥7 (higher quality) demonstrated a significantly increased cardio-cerebrovascular disorder-related mortality, among those exposed to FGAs vs SGAs. Meta-regression analyses demonstrated a larger association between antipsychotics and decreased risk of mortality with longer follow-up, recent study year, and higher number of adjustment variables. Overall, this subanalysis of a systematic review contributes to the evolving understanding of the complex role of antipsychotic treatment for cardio-cerebrovascular mortality in schizophrenia, paving the way for more targeted interventions and improved patient outcomes.

DS based 2-DOF PID controller for various integrating processes with time delay

This study proposes a direct synthesis-based two-degree-of-freedom (2-DOF) controller for various types of integrating processes with time delays. This 2-DOF controller includes a proportional-integral-derivative (PID) controller to enhance load disturbance rejection performance and a set-point filter to improve servo response performance. The main PID controller parameters are expressed as process model parameters and a single adjustment variable, while the set-point filter is composed of PID controller parameters with weighted factors. The adjustment variable is tuned to achieve an optimal balance between response performance and robustness, based on the maximum magnitude of the sensitivity function (Ms). Controller parameters for various Ms values and guidelines for setting these parameters are provided in a consistent formulaic form using a curve-fitting method. These parameter-setting formulas facilitate the accurate implementation of PID controllers with specified Ms values and allow the controller design to be extended to processes with larger dimensionless time delays for a given Ms value. Although a 2-DOF controller was proposed, the adjustment variable for setting the parameters of the main PID controller and the set-point filter was solely the desired time constant. The proposed method was applied to various integrating processes with time delays, and its performance was compared with existing methods reported in the literature, based on performance indices such as settling time, overshoot, integral of absolute error, total variation in input usage, and global performance index. Simulations were conducted using six examples of various integrating processes with time delays to verify the effectiveness and applicability of the proposed controller.

Aqueous alternating electrolysis prolongs electrode lifespans under harsh operation conditions

It is vital to explore effective ways for prolonging electrode lifespans under harsh electrolysis conditions, such as high current densities, acid environment, and impure water source. Here we report alternating electrolysis approaches that realize promptly and regularly repair/maintenance and concurrent bubble evolution. Electrode lifespans are improved by co-action of Fe group elemental ions and alkali metal cations, especially a unique Co2+-Na+ combo. A commercial Ni foam sustains ampere-level current densities alternatingly during continuous electrolysis for 93.8 h in an acidic solution, whereas such a Ni foam is completely dissolved in ~2 h for conventional electrolysis conditions. The work not only explores an alternating electrolysis-based system, alkali metal cation-based catalytic systems, and alkali metal cation-based electrodeposition techniques, and beyond, but demonstrates the possibility of prolonged electrolysis by repeated deposition-dissolution processes. With enough adjustable experimental variables, the upper improvement limit in the electrode lifespan would be high.

Personality Traits as Moderating Variables for Cross-Cultural Adjustment and Psychological Well-Being

Personality Traits as Moderating Variables for Cross-Cultural Adjustment and Psychological Well-Being

The relative validity of nutrition assessment methods for estimating infant carotenoid intake differs by assessment tool, nutrient database, and milk carotenoid adjustment method

Validated carotenoid assessment methods are needed to study infant carotenoid nutrition. This is a secondary analysis of repeated diet assessments of healthy participants collected at 4- (n = 21), 6- (n = 12), and 8- (n = 9) months of age in Houston, TX between April 2019 and June 2020. Intake was assessed with 3 assessment tools, analyzed with 3 nutrient databases, and underwent 3 adjustments to account for milk composition variability. We hypothesized that manual adjustment of milk carotenoid intake based on laboratory measurements would improve the validity of all assessment approaches and that using a database with greater coverage of infant food carotenoid compositions would improve accuracy. Generalized linear mixed models assessed associations between tool, nutrient database, age, and milk carotenoid adjustment variables with carotenoid, energy, fruit, and vegetable intakes. The effect of the number of food diary days on intake estimate precision was evaluated by testing the correlation between intake estimates derived from 1, 3, or 5, vs. 7 days. Visit age influenced energy intake estimates (p = .029), along with assessment tool (p = .020). Estimates of vegetable intake were influenced by tool (p = .009). Combined fruit and vegetable intake differed by nutrient database (p = .007). Carotenoid intake differed by age (p =<.0001), tool (p = .002), and nutrient database (p = .004). A minimum of 3 food diary days strongly correlated (rho = 0.79-1) with reference estimates across ages. Milk carotenoid adjustment was most influential in estimating 4-month olds’ carotenoid intake, while nutrient database and tool were important for 6- and 8-month-olds’, highlighting the dynamic nature of infant diet assessment validity across feeding stages.

Incorporating Medicare Advantage Admissions Into the CMS Hospital-Wide Readmission Measure

Medicare Advantage (MA) enrollment is rapidly expanding, yet Centers for Medicare & Medicaid Services (CMS) claims-based hospital outcome measures, including readmission rates, have historically included only fee-for-service (FFS) beneficiaries. To assess the outcomes of incorporating MA data into the CMS claims-based FFS Hospital-Wide All-Cause Unplanned Readmission (HWR) measure. This cohort study assessed differences in 30-day unadjusted readmission rates and demographic and risk adjustment variables for MA vs FFS admissions. Inpatient FFS and MA administrative claims data were extracted from the Integrated Data Repository for all admissions for Medicare beneficiaries from July 1, 2018, to June 30, 2019. Measure reliability and risk-standardized readmission rates were calculated for the FFS and MA cohort vs the FFS-only cohort, overall and within specialty subgroups (cardiorespiratory, cardiovascular, medicine, surgery, neurology), then changes in hospital performance quintiles were assessed after adding MA admissions. Risk-standardized readmission rates. The cohort included 11 029 470 admissions (4 077 633 [37.0%] MA; 6 044 060 [54.8%] female; mean [SD] age, 77.7 [8.2] years). Unadjusted readmission rates were slightly higher for MA vs FFS admissions (15.7% vs 15.4%), yet comorbidities were generally lower among MA beneficiaries. Test-retest reliability for the FFS and MA cohort was higher than for the FFS-only cohort (0.78 vs 0.73) and signal-to-noise reliability increased in each specialty subgroup. Mean hospital risk-standardized readmission rates were similar for the FFS and MA cohort and FFS-only cohorts (15.5% vs 15.3%); this trend was consistent across the 5 specialty subgroups. After adding MA admissions to the FFS-only HWR measure, 1489 hospitals (33.1%) had their performance quintile ranking changed. As their proportion of MA admissions increased, more hospitals experienced a change in their performance quintile ranking (147 hospitals [16.3%] in the lowest quintile of percentage MA admissions; 408 [45.3%] in the highest). The combined cohort added 63 hospitals eligible for public reporting and more than 4 million admissions to the measure. In this cohort study, adding MA admissions to the HWR measure was associated with improved measure reliability and precision and enabled the inclusion of more hospitals and beneficiaries. After MA admissions were included, 1 in 3 hospitals had their performance quintile changed, with the greatest shifts among hospitals with a high percentage of MA admissions.

Gender disparities in incidence of psychological disorder among patients with breast cancer: A national cohort study.

e23285 Background: Male breast cancer (MBC) is rare. The features of MBC shares similar characteristics with female breast cancer, often resembling postmenopausal breast cancer. However, there are notable differences between male and female breast cancer, especially regarding gender and age, which can have distinct psychological impacts on male patients. In this study, we investigated whether the psychological distress experienced upon a diagnosis of breast cancer differs according to gender. Methods: Data were obtained from the National Health Insurance claims database of the Health Insurance Review and Assessment Service in South Korea. This study focused on the three most common psychological disorders: sleep disorders, anxiety disorders, and depression. Diagnosis confirmation relied on diagnostic codes based on the International Code of Disease, 10th revision, alongside breast cancer diagnoses. Propensity score matching was used in a 1:5 ratio, and adjustment variables included age, endocrine therapy, chemotherapy, HER2-targeted treatment, and Charlson Comorbidity Index score. Results: After excluding patients with previous psychological disorder, there were a total of 75,936 patients, and 281 (0.4%) male patients. Male patients were diagnosed at an older age, had a higher prevalence of hormone receptor-positive status, higher comorbidities, and lower rates of anxiety disorders, while sleep disorders and depressive disorders showed similar incidences. The Cox proportional hazard regression model exhibited that being female was a risk factor for anxiety disorder (after matching, multivariable, HR 1.498, 95% CI 1.057-2.123, p = 0.023). However, gender did not significantly influence the development of sleep or depressive disorders, despite these conditions typically having a higher incidence in females. During the acute phase shortly after diagnosis, women tend to have more distress, as seen on the cumulative incidence curves. Conclusions: MBC patients experienced similar levels of psychological distress related to sleep and depression disorders as female patients. These results suggested that both genders require an equal support system and psychological care to maintain mental well-being after a breast cancer diagnosis.

Clarifying Causal Effects of Interest and Underlying Assumptions in Randomized and Nonrandomized Clinical Trials in Oncology Using Directed Acyclic Graphs and Single-World Intervention Graphs.

Recent clinical trials in oncology have used increasingly complex methodologies, such as causal inference methods for intercurrent events, external control, and covariate adjustment, posing challenges in clarifying the estimand and underlying assumptions. This article proposes expressing causal structures using graphical tools-directed acyclic graphs (DAGs) and single-world intervention graphs (SWIGs)-in the planning phase of a clinical trial. It presents five rules for selecting a sufficient set of adjustment variables on the basis of a diagram representing the clinical trial, along with three case studies of randomized and single-arm trials and a brief tutorial on DAG and SWIG. Through the case studies, DAGs appear effective in clarifying assumptions for identifying causal effects, although SWIGs should complement DAGs due to their limitations in the presence of intercurrent events in oncology research.