Billing Data Research Articles

A retrospective multi-site examination of chronic kidney disease using longitudinal laboratory results and metadata to identify clinical and financial risk

BackgroundA retrospective observational study was conducted at 3 health care organizations to identify clinical gaps in care for patients with stage 3 or 4 chronic kidney disease (CKD), and financial opportunity from U.S. risk adjustment payment systems. Lack of evaluation for CKD in patients with diabetes was also assessed.MethodsOutpatient longitudinal laboratory results and patient metadata available in the electronic medical record, laboratory information system, and/or laboratory billing or facility claims data for the calendar year 2021 were evaluated. Laboratory results were compared to billing data (ICD-10 codes) and risk adjustment scores including Hierarchical Condition Categories (HCC) to determine if laboratory-identified CKD was coded as a disease condition in the electronic medical record. Adults 18 to 75 years of age were included; inpatient laboratory results and pregnant individuals were excluded.ResultsAt the 3 institutions, 12,478 of 16,063 (78%), 487 of 1511 (32%) and 19,433 of 29,277 (66%) of patients with laboratory evidence of stage 3 or 4 CKD did not have a corresponding ICD-10 or HCC code for CKD in the electronic medical record. For patients at the 3 institutions with diabetes on the basis of an HbA1c value of ≥ 6.5%, 34,384 of 58,278 (59%), 2274 of 2740 (83%) and 40,378 of 52,440 (77%) had not undergone guideline-recommended laboratory testing for CKD during the same 12 months. Using publicly available data for calendar year 2021, an estimated 3246 of 32,398 patients (9.9%) at the 3 institutions with undocumented CKD stages 3–4 would be enrolled in Medicare Advantage or Affordable Care Act Marketplace programs. The imputed lost reimbursement under risk-adjusted payment systems for under-documentation of CKD in this subset of patients was $2.85 M for the three institutions combined, representing lost opportunity for both identification and proactive clinical management of these patients, and financial recovery for the costs of providing that care.ConclusionsClinical laboratories can provide value beyond routine diagnostics, helping to close gaps in care for identification and management of CKD, stratifying subgroups of patients to identify risk, and capturing missed reimbursement through risk adjustment factors.

Machine-learning-based identification of patients with IgA nephropathy using a computerized medical billing database.

The billing database of the universal healthcare system in Japan potentially includes large-cohort data of patients with immunoglobulin A nephropathy, diagnosis codes aimed at billing should not be directly used for clinical research because of the risk of misdiagnosis. To solve this problem, we aimed to develop a novel method for identifying patients with immunoglobulin A nephropathy from billing data using machine learning. The medical records and bills of 3,743 patients who consulted nephrologists at a single center were extracted. Patients were labeled to have been diagnosed with immunoglobulin A nephropathy through a review of medical records. A manual analysis of the diagnostic accuracy and machine learning was performed. For machine learning, the datasets were preprocessed in three patterns and assigned to the XGBoost program using five-fold cross-validation. Of all the participants, 437 were labeled as having been diagnosed with immunoglobulin A nephropathy. Bill codes for immunoglobulin A nephropathy were provided to approximately half of them. The manually created criteria consisting of the recommended examinations and treatments in the Japanese guidelines for immunoglobulin A nephropathy showed both specificity and sensitivity < 0.8. In contrast, with the receiver operating characteristic curve analysis, the machine learning process yielded area under the curve values over 0.9 with preprocessing from the clinical viewpoint. Applying machine learning technology to a dataset preprocessed from a clinical viewpoint achieved a high performance in detecting patients with immunoglobulin A nephropathy. This methodology contributes to the construction of a disease-specific cohort using big bill data.

Challenges in the Implementation of Technology in effective Hospital Management System: A quantitative study

To provide excellent care to patients and to maintain seamless functioning of healthcare facilities it is crucial to have effective hospital management system. Hospital management system presently is incorporating analytical approach to optimize work flow, for enhancement of resource utilization, and for providing comprehensive insurance assistance to patients. The technologies are highly crucial for workflow optimization, allocation of resources, scheduling of patients, and management of finances. There are various challenges faced by hospital management system like integration of data from diversified sources like billing system, administrative database, EHRs, and data accuracy and consistency. Safeguarding of data security is highly important that need strong security and adhering to rules and regulation as per the “Health Insurance Portability and Accountability Act.” The importance of Information Technology is reducing rising costs of healthcare and improving quality of services. There is a need to address such challenges and identify the best way of technology implementation. A sample of 249 was collected from different departments in Hospital. The factors that identify the Challenges in the Implementation of Technology in effective Hospital Management System are High Initial Costs, Resistance to Change, Training and Skill Development, and Regulatory and Compliance Challenges.

Significant increase in newly diagnosed hepatitis B and C cases in Germany due to screening

In 2016, the World Health Organization (WHO) decided on an initiative to identify 90% of the world's existing hepatitis B and C virus infections by 2030, treat 80% and reduce the mortality by 65%. In 2016, the federal government endorsed these goals. From Oct 1, 2021, the G-BA included a one-time screening for hepatitis B and C in the health examination (GU) for people aged 35 and over who have statutory health insurance. The previous participation rates in the GU were evaluated and the effectiveness of the program is documented using the reporting data on hepatitis B and C of Robert Koch Institute (RKI).Notifications from Central Institute of Statutory Health Insurance (ZI) and Scientific Institute of the local health insurance companies (WIdO) were compiled with regard to the GU, the reporting data from the RKI were collected and analyzed using SURVSTAT@RKI 2.0 as well as billing data from the Association of Statutory Health Insurance Physicians (KBV).Between 2007 and 2021, around 83% of all insured persons took part in a GU at least once. From the fourth quarter of 2021, the number of newly diagnosed cases of hepatitis B and C increased. In 2022, the increase for hepatitis B was 91.9% and for hepatitis C 68%. This trend continued in 2023, with new diagnoses of hepatitis B increasing by 160% (to 22,795 cases) and hepatitis C increasing by 121% (to 10,508 cases) compared to 2021. The analysis of the KBV billing data showed that the increase in new diagnoses shows a strong correlation between the number of new diagnoses within the GU and the total number of diagnoses.The decision of the Federal Joint Committee (G-BA) to include hepatitis B and C screening in the GU seems to be a success in detecting previously undetected cases of the disease. Based on the billing data from the KBV, a high level of agreement could be demonstrated between the number of new diagnoses within the GU and the increase in the total number of diagnoses. The goals of the WHO may be achievable.

System Dynamics Modeling of Caries Severity States in Long-Term Care.

Dental caries among long-term care (LTC) residents is a persistent and complex problem driven by social and structural factors. Systems thinking may be useful in considering novel approaches to reducing disease. This study aimed to develop a system dynamics model to simulate the progression of dentate older adults in LTC through caries severity states and estimate the effects of 3 intervention scenarios on the progression of caries: preventive topical fluoride (TF), arrest of caries with silver diamine fluoride (SDF), and a combination of TF and SDF. Dentate older adults in LTC were categorized into 4 caries severity states by their number of untreated carious lesions. The model assumed that changes in severity states were consistent with incidence rates reported in the literature and available billing data for dental care and that individuals move in and out of the system by entering and exiting the facility or experiencing edentulism. For all scenarios, the proportion of dentate older adults in LTC with 1 or more untreated lesions stays stable, the distribution of disease shifts from a high severity state, and the system approaches equilibrium after 4 y. The TF intervention predicts minimal impacts on decreasing the proportion of dentate older adults with 1 or more untreated lesions (2.5% decrease), while the SDF intervention and the combination interventions were most disruptive. There was a 29.6% and 33.6% decrease, respectively. Given the specific population dynamics in LTC, these findings suggest that long-term (greater than 4 y) interventions should be designed to address both the management of existing lesions and their incidence. This system dynamics model allows researchers to render institution-specific data points from LTCs to estimate the effects of proposed interventions at the respective site.

Does becoming amother make you ill?-Frequency of mental health diagnoses in postpartum mothers compared to childless women based on BARMER billing data

Around 700,000 children are born in Germany every year. Many mothers are under great pressure and strain due to prevailing role models and social expectations. Up to 15% of mothers in Germany are said to be affected by postpartum depression. The available studies, however, are mainly based on surveys, are older and vary widely in their results. This study brings another data source into play and asks how frequently diagnoses of mental illness are found in mothers after childbirth compared to childless women in the billing data of alarge health insurance company. Aretrospective matched cohort study was conducted with health insurance data from 2017-2022, comparing mothers and childless women with the same age and the same medical and socioeconomic characteristics with regard to depression, exhaustion and burnout, and anxiety and stress disorder outcomes. The modelling was carried out using Poisson regression. Mothers were less likely than childless women to receive adiagnosis of amental disorder within five years after childbirth. In the long run, however, the frequency of diagnoses equalised. Becoming amother does not lead to more diagnoses of mental disorders compared to childless women, at least in the first five years after giving birth. However, the interpretation of the data is difficult. Possible influence of external factors on making the diagnosis is not seen in the data, such as the social expectation of a"happy mother" or achange in the utilisation of medical care due to maternity.

Abstract 4144549: Proof of Concept of a Novel Culinary Medicine Service Line to Address Diet-Related Cardiovascular Disease Risk Factors

Background: Poor diet has emerged as a top contributor to cardiovascular disease (CVD) in the United States. Evidence-based dietary strategies have been shown to decrease CVD risk by addressing comorbid conditions such as hypertension and diabetes, and there is a growing demand for practical nutrition guidance from health providers. However, implementation of nutrition support in healthcare settings remains limited due to lack of time, expertise, and reimbursement, necessitating creative interprofessional collaboration. Culinary Medicine (CM) combines medical nutrition education with culinary literacy and holds promise to address these challenges. Our study reports on the cascade implementation of a 3-prong CM service line which includes a CM eConsult, 1:1 CM specialty clinic, and shared medical appointment (group visit) in a teaching kitchen at a large, academic medical center from 2021 to 2024. Methods: A CM-specific eConsult was designed and launched on August 1 st 2021 utilizing existing eConsult workflows in the electronic health record. Next, an in-person, interprofessional CM specialty clinic launched at a community-based satellite clinic December 4 th 2022 open to referrals from physicians and patients. In April 2024, established patients in the CM clinic were invited to participate in six, biweekly cooking classes billed as shared medical appointments. A Microsoft PowerBI dashboard was developed to track patient demographics, referrals and participation, associated diagnoses, and billing data for the service line for continuous quality improvement. Results: In the first year of eConsults, 25 eConsults were completed with 19 (76%) reimbursed by insurance. In the first year from launch of the CM specialty clinic, 96 patients completed initial visits with a 100% insurance collections rate. In the recent launch of shared medical appointments, the initial cohort included 17 unique patients with 58% completing at least 4 of 6 classes. Referrals to the CM clinic included hypertension, hyperlipidemia, coronary artery disease, and type 2 diabetes as the top 4 associated diagnoses. Conclusions: We demonstrated proof-of-concept of a novel CM service line as an interprofessional, financially sustainable preventive strategy to target patients with diet-sensitive CVD risk factors such as diabetes, hypertension, and obesity. Future study will investigate the impact on biomarkers of CVD health for patients served by the CM service line.

Delirium risk profiles in a population-based study of United States older adults undergoing common noncardiac surgeries.

Older adults often require surgical care and are at elevated risk of delirium. We explored delirium risk profiles across the population of U.S. older adults who underwent one of 10 common noncardiac surgeries. We analyzed Health and Retirement Study (HRS) participants linked with Medicare billing data who underwent the following 10 noncardiac surgeries from 2000 to 2018 at age 65 or more: total knee arthroplasty (TKA), total hip arthroplasty (THA), spine surgery, cholecystectomy, colorectal surgery, hernia repair (ventral, umbilical, or incisional), endarterectomy, prostatectomy, transurethral resection of the prostate (TURP), and hysterectomy. Demographic and health covariates were obtained from the HRS dataset. Latent cognitive ability was calculated from cognitive testing, proxy reports, and demographics at the preoperative HRS interview. We compared standardized differences for delirium risk factors across the 10 surgeries and qualitatively clustered them into phenotypical subgroups. We analyzed 7424 older adults (mean age 76 ± 6 years, 45% male). Endarterectomy patients presented with the highest burden of nearly all health and cognitive factors, implying higher delirium risk (e.g., stroke, 22%; depressive symptoms, 30%; high school or less education, 73%; frailty, 42%; lowest latent cognitive ability). A second "general surgery" phenotype, including cholecystectomy, colorectal, and hernia surgery patients, experienced more frailty (29%-32%) and depressive symptoms (24%-26%), with moderate comorbidity burden. A third "pain" phenotype, which included TKA, THA, and spine surgery patients, commonly reported moderate or severe pain (47%-53%) and impairment in activities of daily living (ADL, 23%-30%), but fewer comorbid medical conditions. The remaining surgery types (hysterectomy, prostatectomy, TURP) were not phenotypically grouped and generally had lower risk features for delirium. In an epidemiological cohort of US older adults, we identified clinically meaningful heterogeneity in delirium risk profiles across different surgical types, which may have implications for delirium risk stratification and delirium prevention or treatment.

Am I attached? A patient-partnered approach to creating infographics about attachment to primary care in Ontario, Canada

BackgroundHaving a primary care provider is associated with better care experiences and lower care costs. In 2021, INSPIRE-PHC released Primary Care Data Reports - publicly available summaries of administrative billing data about how populations in each of Ontario’s 60 health teams use primary care services. Given the characterization of Canadian primary care systems as ‘in crisis’, publicly available data about primary care at the regional level presented a significant opportunity for knowledge mobilization. An understandable resource could ground the public conversation about primary care access in data. Recognizing the role that lived experience plays in ensuring the public understands research findings, a partnership between patient advisors, Ontario Health Team representatives, researchers, and trainees was established to co-produce public-facing infographics based on primary care data.MethodsEvidence-based guidelines for public health infographic creation and elements of transformative action research guided a six-meeting process to engage up to 14 patient advisors, three Ontario Health Team staff and two primary care trainees. Patient advisors were affiliated with a provincial patient-oriented primary health care research group or a Hamilton-based Ontario Health Team. Ninety-minute meetings were conducted virtually, and notes were shared with attendees to ensure they accurately reflected the conversation. Two consultations with Ontario Health Team-affiliated primary care providers provided direction and ensured project outputs aligned with local priorities.ResultsProject partners shared feedback on draft infographics, audience identification, priority elements from Primary Care Data Reports to include in the infographics, and aesthetic features (e.g., headings, colour scheme, charts). Project partners felt the most important metrics to convey to the public were those that simultaneously reinforced the benefits of primary care on individual health outcomes and health system costs.ConclusionsPatient engagement in research is becoming widespread, but co-developing knowledge products with patient and health system partners is less common. Our approach to engaging patients prevented both oversimplification and unnecessary complexity in a public-facing visual about attachment to primary care.

Immediate postplacental intrauterine device placement: retrospective cohort study of expulsion and associated risk factors

BackgroundPostpartum contraception is typically provided during postpartum visits. When desired and accessible, the immediate postpartum period provides an additional opportunity to increase utilization of more effective contraceptive methods to potentially reduce subsequent unintended pregnancy and improve pregnancy outcomes. In New York State, recent policy changes expanded Medicaid coverage to include immediate postplacental IUD insertion. ObjectiveWe investigated clinically documented IUD expulsion within 12 months of placement in patients who depend on state-funded health insurance. Study designThis retrospective cohort study included Medicaid patients with an immediate postplacental intrauterine device placed after third trimester delivery, who delivered between 3/2/17 and 9/2/19. Current Procedural Terminology code billing data was used to identify 238 patients who underwent intrauterine device placement during their delivery admission. Electronic medical record data was analyzed using chi-squared tests, t-tests, and multivariable logistic regression. ResultsThere were 17.6% (42/238) documented intrauterine device expulsions within the first year after placement. After vaginal deliveries, 22.1% (29/131) of intrauterine devices placed had a documented expulsion, while patients who had cesarean deliveries expelled 12.2% (13/107) of their intrauterine devices (p=0.04). Controlling for body mass index, parity, intrauterine device type, and gestational age, patients who delivered vaginally were more likely to experience intrauterine device expulsion within one year compared to cesarean delivery (Adjusted Odds Ratio 2.71, 95% Confidence Interval: 1.27-5.80). Patients with a documented intrauterine device expulsion within one year were more likely to have a subsequent pregnancy prior to October 2020: 35.7% (15/42) as compared to 15.3% (30/196) in the no expulsion group (p=0.002). ConclusionsThe overall percentage of documented intrauterine device expulsion within one year following immediate postplacental placement was 17.6% with a greater percentage of expulsion in patients who underwent vaginal delivery. Patients with a documented intrauterine device expulsion within one year of placement were significantly more likely to experience a subsequent pregnancy.

The prevalence of cystic fibrosis—a comparison of patient registry data and billing data within the German statutory health insurance system

The prevalence of cystic fibrosis—a comparison of patient registry data and billing data within the German statutory health insurance system

Rates of fall injuries across three claims databases, 2019

IntroductionIn 2021, among all age groups, falls ranked as the third leading cause of unintentional injury death in the USA. Unlike fatal data, which rely on death certificates as the...

UBEM calibration method by energy consumption disaggregation using a change-point model

Urban Building Energy Modeling (UBEM) is valuable for analyzing urban energy demand, but uncertainties can create gaps between predictions and actual usage. Calibration often uses utility bill data due to its urban-scale accessibility. However, comparing this data with simulation results for specific energy uses like cooling and heating is challenging. This study introduces a UBEM calibration method using a change-point model to disaggregate energy into heating, cooling, and base load. Applied to 222 office buildings in Seoul, this method provided more appropriate calibration results by considering individual energy consumption characteristics rather than just total consumption. The CVRMSE for base load, heating, and cooling energy decreased compared to uncalibrated simulations. This research highlights the importance of energy disaggregation when calibrating UBEM with utility bill data, offering a more nuanced approach to urban energy modeling.

Management of Plastic Surgery Complications at a Tertiary Medical Center after Aesthetic Procedures.

The aesthetic plastic surgery industry has seen tremendous growth, with Americans spending an estimated 20 billion dollars on procedures in 2020. However, the effect of complications from these procedures on the healthcare system is poorly understood. This study aims to create awareness regarding aesthetic procedure complications through the scope of plastic surgeons at a tertiary medical facility. A retrospective chart review was performed on patients who received care at a single academic tertiary referral center over 5 years for complications from a cash-paid aesthetic procedure at an outside facility. Physician and hospital billing data were analyzed for relevant encounters. Patients in this study (n = 40) presented to the emergency department most frequently with complications secondary to abdominoplasty (35%), breast augmentation (27.5%), and injectable fillers (17.5%). The most common complications were infection (32.5%) and wound dehiscence (22.5%). Of those evaluated, 50% required inpatient admission. Additionally, 42.5% required surgical intervention. The distribution of payors included Medicaid (55%), commercial insurance (30%), and Medicare (7.5%), and 7.5% were uninsured. For physician billing, the total gross collection ratio was 21.3%, whereas the hospital billing total gross collection ratio was 25.16%. Larger referral hospitals are well-suited to support the aesthetic community with complication management; however, the care required to serve this population is resource-intensive. These data advocate for thorough closed-loop patient-surgeon communication regarding risk-benefit analysis and detailed courses of action should complications arise. Likewise, stronger communication between ambulatory surgical centers and tertiary referral centers may also help minimize complications and subsequent healthcare needs.

Opportunities and lessons learned from a retrospective analysis of administrative billing data to understand the language profile of high-risk close contacts of COVID-19 cases in Ontario.

During a public health emergency, it is vital to have access to data sources that can identify communities disproportionately affected and to ensure public health communications are meeting the needs of diverse populations. To explore how administrative billing data for language interpretation services could be used as an additional source of information to understand the language profile of high-risk close contacts of COVID-19 cases. A retrospective descriptive analysis was conducted using administrative billing data from Public Health Ontario's Contact Tracing Initiative from May 2020 to February 2022. Data from the Contact Tracing Initiative were utilized to identify drivers that could have influenced patterns in language interpretation requests. Trends were compared with community language profiles using 2021 Canadian Census data. Interpreters responded to 2,604 requests across 38,518 interpretation minutes and provided information in 50 different languages. The top five requested languages were French, Arabic, Spanish, Punjabi and Mandarin. Five distinct periods were identified of different language predominance including Spanish in spring/summer 2020, French in summer/fall 2020 and Arabic in spring 2021. Overall, these trends aligned with the language profile of health units contributing most submissions. Public health agencies could benefit from using existing secondary data sources to understand the language interpretation needs of their communities. This study also demonstrated how existing data sources could be used to help assess how communities are being disproportionately affected by public health emergencies and how this might change over time.

Assessing the impact of Delta and Omicron in German intensive care units: a retrospective, nationwide multistate analysis

BackgroundThe spread of several severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) variants of concern (VOCs) has repeatedly led to increasing numbers of coronavirus disease 2019 (COVID-19) patients in German intensive care units (ICUs), resulting in capacity shortages and even transfers of COVID-19 intensive care patients between federal states in late 2021. In this respect, there is scarce evidence on the impact of predominant VOCs in German ICUs at the population level.MethodsA retrospective cohort study was conducted from July 01, 2021, to May 31, 2022, using daily nationwide inpatient billing data from German hospitals on COVID-19 intensive care patients and SARS-CoV-2 sequence data from Germany. A multivariable Poisson regression analysis was performed to estimate the incidence rate ratios (IRRs) of transfer (to another hospital during inpatient care), discharge (alive) and death of COVID-19 intensive care patients associated with Delta or Omicron, adjusted for age group and sex. In addition, a multistate approach was used for the clinical trajectories of COVID-19 intensive care patients to estimate their competing risk of transfer, discharge or death associated with Delta or Omicron, specifically concerning patient age.ResultsA total of 6046 transfers, 33256 discharges, and 12114 deaths were included. Poisson regression analysis comparing Omicron versus Delta yielded an estimated adjusted IRR of 1.23 (95% CI 1.16–1.30) for transfers, 2.27 (95% CI 2.20–2.34) for discharges and 0.98 (95% CI 0.94–1.02) for deaths. For ICU deaths in particular, the estimated adjusted IRR increased from 0.14 (95% CI 0.08–0.22) for the 0–9 age group to 4.09 (95% CI 3.74–4.47) for those aged 90 and older compared to the reference group of 60-69-year-olds. Multistate analysis revealed that Omicron was associated with a higher estimated risk of discharge for COVID-19 intensive care patients across all ages, while Delta infection was associated with a higher estimated risk of transfer and death.ConclusionsRetrospective, nationwide comparisons of transfers, discharges and deaths of COVID-19 intensive care patients during Delta- and Omicron-dominated periods in Germany suggested overall less severe clinical trajectories associated with Omicron. Age was confirmed to be an important determinant of fatal clinical outcomes in COVID-19 intensive care patients, necessitating close therapeutic care for elderly people and appropriate public health control measures.

Abstract A157: Age-related disparities in survival following colorectal cancer diagnosis in an underserved community in Georgia

Abstract Background: Significantly higher colorectal cancer (CRC) mortality exists in Augusta-Richmond County of Georgia, an area with a large proportion of underserved African Americans. Although age is one of the most important prognostic factors in cancer survival, age disparities in survival following CRC diagnosis have been understudied within geographic areas of Georgia. Thus, we examined overall survival (OS) rates following CRC diagnosis between 18-49, 50-59, 60-69, and 70+ age groups. We also determined whether age-specific differences were associated with OS and examined factors contributing to OS across these four age groups in a cancer center population in Augusta-Richmond County. Methods: A retrospective cohort analysis was performed using 2012-2022 data from the Georgia Cancer Center cancer registry linked with electronic medical records and billing data. OS following CRC diagnosis was the outcome of interest; those who survived until 2023 were censored. Cox proportional hazard regression was used to examine the mentioned associations in different age groups adjusted for sociodemographic characteristics (gender, race, marital status, insurance, county-level poverty), health-related factors (body mass index, smoking status, alcohol use, chronic disease conditions, family history of CRC/cancer), tumor characteristics (tumor grade, stage at diagnosis, primary site), and diagnosis year. Results: Among 839 CRC patients, OS rates were lowest among patients aged 70+ years (52.8%) followed by 60-69 (61.2%), 18-49 (63.7%), and 50-59 (65.2%) years (p &amp;lt;0.001). In the adjusted analysis, CRC patients aged 70+ years had a 2.1-fold increased risk of death due to all causes compared to those aged 18-49 years (HR, 2.1; 95% CI, 1.2-3.7). Regardless of age groups, CRC patients with a late stage at diagnosis were associated with increased risk of all causes of death by 2.0-5.7 times (18-49 year: HR, 4.9; 95% CI,2.7-8.8; 50-59 year: HR, 5.7; 95% CI,3.6-9.0; 60-69 year: HR, 5.3; 95% CI, 3.5-8.0; 70+ year: HR,2.0; 95% CI,1.3-3.0). Among patients aged 60-69 years, those living in poverty areas had an increased risk of all causes of death by 1.8-times (HR, 1.8; 95% CI, 1.2-2.7). However, having private insurance (HR, 0.3; 95% CI,0.2-0.5) was associated with lower risk of mortality by 69% for 50- 59 age group. Conclusion: Patients aged 70+ years reported lower OS rates. Late stage at diagnosis was strongly associated with increased risk of death regardless of age; significantly greater risk was observed at 50-59 age group followed by 60-69, 18-49, and 70+ age groups. In particular, poverty had an negative impact on the risk of death following CRC diagnosis for the 60-69 age group. The high mortality among patients aged 50 and older emphasizes the need for developing strategies for increasing the screening uptake and starting at earlier ages, particularly among the most vulnerable populations. Equally important are strategies to improve access to screening and treatment resources for patients with limited access to healthcare. Citation Format: Meng-Han Tsai, Jorge Cortes, Marlo Vernon, Elinita Pollard, Steven S. Coughlin, Yanbin Dong, Kenneth J. Vega. Age-related disparities in survival following colorectal cancer diagnosis in an underserved community in Georgia [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A157.

A Single-Center Retrospective Study to Identify Causes of Sex Differences in the Living Kidney Donor Evaluation Process.

Multiple studies have shown that females are living donors for kidney transplantation at higher rates than males. However, the underlying reasons for this observation are not well-understood. We examined the living donor evaluation process to determine the point at which sex imbalance arises. Based on a previous study, we hypothesized that both sexes are equally likely to become approved as living donors, but females are more likely to follow through with donation. Single institution retrospective chart review of self-referrals for living donor evaluation between 1/2009 - 12/2022. Self-referrals identified using the Organ Transplant Tracking Record database and cross referenced with billing data. Exclusion at each stage of evaluation was recorded and compared between sexes using log binomial regression; unadjusted and adjusted (for donor age, race, ethnicity, relationship to recipient, and recipient sex) risk ratios (RRs) with 95% confidence interval (CI) were determined. 1,861 self-referrals were reviewed, including 1,214 (65.2%) females and 647 (34.8%) males, resulting in 146 approvals and 125 donations (76/125, 60.8% females, 49/125 39.2% males). Adjusted RRs indicated no significant differences between sexes in completing medical and/or psychosocial workup, having medical and/or psychosocial contraindications, being approved for donation, and proceeding with donation. The top medical contraindications for both sexes were obesity, hypertension, and nephrolithiasis. Female overrepresentation among living donors is likely due to the 1.9 times higher rate of self-referral for evaluation. After this point, both sexes were equally likely to complete workup, be approved, and follow through with donation. Increased efforts to engage males at the initial self-referral stage has the potential to expand access to living donor kidney transplantation.

Enhancing Hospital Reimbursement Through a Pediatric Surgery Resident Orientation Program: A Focus on Accurate Diagnosis Code Documentation for Acute Appendicitis

BackgroundThe usage of specific ICD-10 diagnosis codes significantly influences hospital reimbursement compared to non-specific codes. This study hypothesized that a formal orientation program for pediatric surgery residents would enhance the selection of accurate and specific diagnosis codes for acute appendicitis such as K35.30 for “Acute appendicitis with localized peritonitis” rather than K35.80 for “Unspecified acute appendicitis,” thereby improving hospital reimbursement. MethodsWe implemented a comprehensive orientation for pediatric surgery residents at our institution in late 2020, a component of which emphasized the importance of having specific ICD-10 diagnosis codes. We conducted a retrospective analysis of laparoscopic appendectomy billing data for pediatric patients, comparing the use of specific versus unspecified diagnosis codes and associated hospital reimbursement rates before (2020) and after (2022) the program's initiation. Patients without payment were excluded. Statistical significance was determined by a two-tailed p-value of ≤0.05. ResultsAnalysis of 267 patient records showed a significant increase in the use of the specific diagnosis code (K35.30) from 3.6% in 2020 to 87.5% in 2022 (p < 0.0001). Adjusted for inflation and billing changes, mean hospital reimbursement per case increased by $661 (from $4414 to $5,075, p = 0.027), totaling an additional $84,616 in 2022, just for a single subset of appendicitis patients. ConclusionsA targeted resident orientation program significantly improves the use of specific ICD-10 codes for acute appendicitis, leading to increased hospital reimbursement. Such programs represent a valuable approach for enhancing the financial outcomes of pediatric surgical care while reinforcing the importance of accurate medical documentation. Study DesignRetrospective. Level of EvidenceIII.

Financial implications of sarcopenia in colorectal cancer surgery: a cost analysis in an Australian public hospital.

Sarcopenia has a detrimental impact on patient outcomes following colorectal surgery, increasing financial strain on the healthcare system. Given the absence of specific Australian data, this study aimed to measure the cost of sarcopenia in the context of colorectal surgery in an Australian public hospital. A retrospective cost analysis, following CHEERS guidelines, was conducted on major elective colorectal cancer surgical cases at the Royal Adelaide Hospital between 2018 and 2022. The cross-sectional psoas area was measured through computed tomography (CT) imaging at the level of the third lumbar vertebrae, and sarcopenia was determined using gender-specific thresholds. Hospital billing data was used to gather costings (AU$). Out of 271 patients, 57 (21.0%) comprised the sarcopenic group (SG). SG patients were older (74 vs. 69 years, P < 0.001), had a higher American Society of Anaesthesiologists (>II, 71.9% vs. 53.7%, P = 0.014) and a lower median body mass index (24.8 vs. 28.7 kg/m2, P < 0.001). The SG exhibited a greater likelihood of complications (84.2 vs. 68.7%, P = 0.020) and prolonged hospital stay by 1 day (median 7 vs. 6 days, P = 0.027). Despite an increased mean total cost of hospital admission, no statistically significant difference was found (AU$37 712 vs. $34 845, P = 0.296). Multivariate analysis revealed hypoalbuminemia, prolonged operative time, postoperative ileus, return to theatre, Clavien-Dindo grade ≥3 complications, and prolonged stay increased overall cost (P < 0.05). Sarcopenia was not associated with a significantly increased cost of colorectal surgery in our institution. Future studies examining the cost-effectiveness of prehabilitation programmes targeting sarcopenia should be considered.