Billing Data Research Articles

Auswirkungen des Ahrtal-Hochwassers auf die Gesundheit der lokalen Bevölkerung – eine Analyse auf Grundlage von GKV-Routinedaten

ZusammenfassungHintergrundIn den letzten Jahrzehnten traten in Deutschland Hochwasserereignisse auf, die eine Bedrohung für die Gesundheit der lokalen Bevölkerung darstellten. Es existieren allerdings kaum Studien, die die gesundheitlichen Folgen dieser Ereignisse untersuchen. Studienziel war daher die Untersuchung der Assoziationen des Ahrtal-Hochwassers im Jahr 2021 mit der Gesundheit der lokalen Bevölkerung.MethodenDatengrundlage dieser Studie sind bundesweite Abrechnungsdaten (stationär/ambulant) des BKK-Landesverbands Nordwest. Untersuchungsregion war die Region Ahrweiler, Untersuchungszeiträume jeweils das 3. Quartal der Jahre 2020 und 2021. Unter anderem mit Prevalence-Rate-Ratio-Tests wurde auf Grundlage von ICD-10-Kodierungen untersucht, welche Diagnosen (stationär/ambulant) räumlich und zeitlich in Assoziation mit dem Hochwasserereignis standen.ErgebnisseDie Ergebnisse zeigen im stationären Bereich eine deutliche Zunahme abgerechneter Leistungen in einigen Diagnosegruppen gegenüber dem Vorjahr. Verzeichnet wurden insbesondere Zunahmen bestimmter F‑Diagnosen (psychische und Verhaltensstörungen) und S‑Diagnosen (Verletzungen) sowie verschiedener Diagnoseschlüssel innerhalb der Z‑Kodierungen (Faktoren, die den Gesundheitszustand beeinflussen und zur Inanspruchnahme des Gesundheitswesens führen). Im ambulanten Sektor wurde in vielen Diagnosegruppen (F- und Z‑Diagnosen) eine Abnahme identifiziert.DiskussionDie Ergebnisse der Studie deuten darauf hin, dass vor allem die mentale Gesundheit der lokalen Bevölkerung und die Gesundheitsversorgung insgesamt (sektorspezifische Inanspruchnahme) vom Hochwasser beeinträchtigt wurden. Da Hochwasserereignisse zukünftig häufiger und stärker werden können, müssen die Maßnahmen zum Schutz der Bevölkerung und Gesundheitsinfrastruktur entsprechend angepasst werden.

Assessing service usage and protective factors in a pediatric psychiatry clinic during the COVID-19 pandemic.

Youth with developmental and pre-existing mental health conditions have been particularly vulnerable to declines in psychological functioning during the COVID-19 pandemic. This study aimed to first, analyze service usage within an outpatient child and adolescent psychiatry clinic in the months preceding and during the COVID-19 pandemic, and second, to examine associations with potential protective factors against mental health concerns in a treatment-engaged sample. Service usage was examined using clinic billing data, and reports on protective factors were gathered via parent survey of 81 children ages 6-17 years who received mental health treatment in an outpatient psychiatry clinic during the pandemic. Protective factors were assessed at the individual, family, and community levels, and included children's use of coping strategies, parental resilience, and parents' perceived social supports. Study outcomes, including mental health concerns, mental health emergencies, pandemic-related distress, and social impact of the pandemic, were analyzed via Pearson correlations and simultaneous multiple linear regressions. Findings suggest increased service usage and child coping, parental resilience, and social connectedness as factors associated with fewer mental health concerns in youth with psychiatric concerns during the pandemic. This study lends support for expanding psychiatric services with continued use of telemedicine platforms. Further, findings suggest a mental health benefit to optimizing individual, parental, and community-based resources to enhance children's psychological functioning, particularly for youth with pre-existing mental health conditions.

Adipositas Care and Health Therapy (ACHT) after Bariatric-Metabolic Surgery: A Prospective, Non-Randomized Intervention Study

Introduction: Almost 25% of German adults have obesity and numbers are rising, making it an important health issue. Bariatric-metabolic surgery reduces body weight and complications for persons with obesity, but therapeutic success requires long-term postoperative care. Since no German standards for follow-up by family physicians exist, follow-up is provided by surgical obesity centers, but they are reaching their limits. The ACHT study, funded by the German Innovation Fund, is designed to establish and evaluate the follow-up program, with local physicians following patients supported remotely by obesity centers. Methods: ACHT is a multicenter, prospective, non-randomized control group study. The 18-month ACHT follow-up program is a digitally supported, structured, cross-sectoral, and close-to-home program to improve success after bariatric-metabolic surgery. Four groups are compared: intervention group 1 starts the program immediately (3 weeks) after Roux-en-Y gastric bypass or sleeve gastrectomy (months 1–18 postoperatively), intervention group 2 begins the program 18 months after surgery (months 19–36 postoperatively). Intervention groups are compared to respective control groups that had surgery 18 and 36 months previously. In total, 250 patients, enrolled in the intervention groups, are compared with 360 patients in the control groups, who only receive standard care. Results: The primary endpoint to compare intervention and control groups is the adapted King’s score, a composite tool evaluating physical, psychological, socioeconomic, and functional health status. Secondary endpoints include changes in care structures and care processes for the intervention groups. Multivariate regression analyses adjusting for confounders (including the type of surgery) are used to compare intervention and control groups and evaluate determinants in longitudinal analyses. The effect of the intervention on healthcare costs will be evaluated based on health insurance billing data of patients who had bariatric-metabolic surgery in the 3 years prior to the start of the study and of patients who undergo bariatric-metabolic surgery during the study period. Conclusions: ACHT will be the one of the first evaluated structured, close-to-home follow-up programs for bariatric surgery in Germany. It will evaluate the effectiveness of the implemented program regarding improvements in health status, mental health, quality of life, and the feasibility of such a program outside of specialized obesity centers.

Geospatial Evaluation of Disparities in Access to Cervical Spine Fusion in Metropolitan Areas Across the United States.

Retrospective study with epidemiologic analysis of public Medicare data. The purpose of this study is to use geospatial analysis to identify disparities in access to cervical spine fusions in metropolitan Medicare populations. Cervical spine fusion is among the most common elective procedures performed by spine surgeons and is the most common surgical intervention for degenerative cervical spine disease. Although some studies have examined demographic and socioeconomic trends in cervical spine fusion, few have attempted to identify where disparities exist and quantify them at a community level. Center for Medicare and Medicaid Services physician billing and Medicare demographic data sets from 2013 to 2020 were filtered to contain only cervical spine fusion procedures and then combined with US Census socioeconomic data. The Moran Index geospatial clustering algorithm was used to identify statistically significant hotspot and coldspots of cervical spine fusions per 100,000 Medicare members at a county level. Univariate and multivariate analysis was subsequently conducted to identify demographic and socioeconomic factors that are associated with access to care. A total of 285,405 cervical spine fusions were analyzed. Hotspots of cervical spine fusion were located in the South, while coldspots were throughout the Northern Midwest, the Northeast, South Florida, and West Coast. The percent of Medicare patients that were Black was the largest negative predictor of cervical spine fusions per 100,000 Medicare members ( β =-0.13, 95% CI: -0.16, -0.10). Barriers to access can have significant impacts on health outcomes, and these impacts can be disproportionately felt by marginalized groups. Accounting for socioeconomic disadvantage and geography, this analysis found the Black race to be a significant negative predictor of access to cervical spine fusions. Future studies are needed to further explore potential socioeconomic barriers that exist in access to specialized surgical care. Level III-retrospective.

Incidence of glaucoma filtration surgery from disease onset of open-angle glaucoma.

To investigate the rate and risk factors of undergoing glaucoma filtration surgery (GFS) in patients with newly diagnosed open-angle glaucoma (OAG). This is a population-based historic cohort study, consisting of 9420 patients older than 45 years diagnosed with OAG during 1997-2010. Follow-up spanned from 1997 to 2017. We obtained data for trabeculectomy (TRE), deep sclerectomy (DS), and glaucoma drainage implant (GDI) surgeries from national administrative healthcare registers by hospital billing data. We plotted the cumulative incidence of GFS and carried out a multivariate Poisson regression analysis adjusted for age, sex, hospital district, systemic comorbidities, and the number of IOP-lowering drugs. We reported incidence rate ratios (IRR) with 95% confidence intervals (CI) for GFS after the onset of OAG. The cumulative incidence of GFS at 5 years from OAG onset was 3.1% and at 10 years 5.4%. Age over 80 years at baseline was associated with lower GFS incidence (IRR 0.51, CI 0.31-0.84). Thenumber of IOP-lowering drugs in the first 2 years of treatment correlated withthe risk of GFS increasingfrom (IRR 3.23, CI 2.32-4.50) for two drugs, (IRR 7.44, CI 5.28-10.47) for three and to (IRR 14.95, CI 10.38-21.52) for four drugs. This study characterized the treatment path of OAG from diagnosis to surgical intervention refining the role of GFS among glaucoma therapies.

The impact of increase in block pricing on electricity demand responsiveness: Evidence from Ghana

The implementation of Increase in Block Pricing (IBP) policy is premised on the assumption that consumers adjust their behavior to save energy in response to electricity price increases. However, consumers often lack a comprehensive understanding of the pricing schedules, leading to inaccurate consumption predictions. This study utilizes monthly electricity billing data from the administrative records of urban residential consumers of the Electricity Company of Ghana Limited to estimate the causal effect of IBP policy schedules on electricity consumption. To achieve this, we employed the Regression Kink (RK) design identification strategy to explore the kink structure of the policy function. This paper finds an inelastic causal relationship between IBP policy and electricity consumption. The results show a treatment effect of 0.41 KWh with an associated p-value of 0.473 at a robust 95 % confidence interval. Thus, IBP policy has no causal effect on electricity consumption at the 50 KWh lower block threshold. Notably, electricity consumers do not respond significantly to price increments, rendering IBP policy ineffective in achieving energy saving at the lower block threshold. This research contributes to a deeper understanding of the effectiveness of IBP policy in promoting energy savings and informs researchers, policymakers, and stakeholders in the energy sector. Results can be used to develop evidence-based policies that contribute to energy conservation and climate change mitigation.

Regional variation in diagnostic intensity of dementia among older U.S. adults: a cross‐sectional study

AbstractBackgroundAlzheimer’s disease and related dementias (ADRD) are known to be underdiagnosed; but little is understood about how the likelihood of obtaining a diagnosis varies across place or demographic subgroups. Using observed diagnosed cases from national billing data, we report variation by region, age, and race/ethnicity in newly diagnosed dementia cases taking into account underlying population risk.MethodAmong a 20% random sample of fee‐for‐service Medicare beneficiaries, we identified those who received a new ADRD diagnosis in 2019 using billing data. The rate of new ADRD diagnosis was estimated overall and by Hospital Referral Region (HRR) and stratified by age category (65‐74, 75‐84, ≥85) and by race/ethnicity. A measure of ADRD diagnosis intensity across HRRs was calculated as the observed‐to‐expected ratio (O:E ratio) of new cases; expected new ADRD cases for each HRR were estimated using Poisson regression adjusted for regional measures of education, population health (diabetes, obesity, and smoking), and diagnostic intensity for chronic illness. Among older Americans, the probability of receiving an ADRD diagnosis was estimated according to regional ADRD diagnosis intensity.Result3.0% (143,029 of 4,842,034) of older adults received a new ADRD diagnosis in 2019 and ranged from 1.7‐5.4% across HRRs (Figure 1). The unadjusted mean ADRD diagnosis rate was 2.9 per 100 and differed by age (age ≥ 85 = 8.8/100, 75‐84 = 3.4/100, and 65‐74 = 1.0/100, p<.001) and race (White = 2.9/100, Black 3.4/100, and Hispanic 2.8/100, p<.001). Variability across HRRs was largest among the youngest age category, Black, and Latino groups. In adjusted analyses, all the regional characteristics explained 33% of the variation in new ADRD diagnosis (pseudo‐R2 = 0.33). Adjusted for regional characteristics, the ADRD diagnosis intensity (i.e., O:E ratio) varied from 0.7 to 1.4 across HRRs overall (Figure 2) and was most variable among the youngest age category (65‐74), Black, and Latino groups. These groups also had the greatest difference in the likelihood of diagnosis if residing in low versus high ADRD diagnosis intensity (Figure 3).ConclusionThe likelihood of receiving an ADRD diagnosis varies across the U.S., particularly among those 65‐74 years of age, and Black, and Latino groups.

EPH44 Temporary Soft Tissue Coverage in Burn Patients - Which Materials Are Used - and By Whom? Analysis of German Billing Data

EPH44 Temporary Soft Tissue Coverage in Burn Patients - Which Materials Are Used - and By Whom? Analysis of German Billing Data

2275. No "One-Size-Fits All": Chronic "Carryover" Diagnoses Dilute Antibiotic Prescribing Metrics in Primary Care

Abstract Background International Classification of Diseases, Tenth Revision (ICD-10) encounter coding is used to identify sub-optimal outpatient antibiotic use, but the utility of a popular billing data based metric, antibiotic prescribing rate (APR), for diagnoses which antibiotics are situationally indicated remain unexplored. We assessed the impact of different ICD-10 groupings on outpatient sinusitis APR to characterize its use. Methods We included all adult telemedicine and office encounters from January 2021 to March 2022 with an acute or chronic sinusitis ICD-10 from two academic urgent care and eight academic primary care clinics. We calculated an APR (encounters with antibiotics/all encounters) by sinusitis ICD10 code, ICD10 group (acute vs. chronic) and clinic type (Table 1). We then reviewed 100 urgent and 182 randomly selected primary care sinusitis encounters conducted in 2021 to assess symptom documentation and guideline adherence (Table 2). This quality improvement project was deemed non-human subjects research. Results We included 987 sinusitis encounters of 821 unique patients with an overall APR of 56.5% (Table 3). The APR for acute sinusitis encounters was higher than chronic (72.7% vs 22.0%), with a larger difference in primary care (65.5% vs 10.4%) compared to urgent care (76.9% vs 54.2%). Upon chart review, 42.3% (77/182) of primary care sinusitis encounters had no active symptoms (60/77) or did not address sinusitis (17/77); the majority used chronic sinusitis ICD-10s (66/77) (Table 4). Antibiotic prescriptions were guideline adherent for 32.8% of primary care (23/70) compared to 58.0% (40/69) of urgent care encounters (Figure 1). Conclusion Combining acute and chronic sinusitis ICD10 codes yielded lower APR than acute sinusitis ICD10s alone, predominately in primary care, suggesting a dilution effect. Compared to urgent care, lack of documentation of active symptoms for chronic sinusitis encounters was common in primary care, hindering the assessment of antibiotic appropriateness. Until there is improved ICD10 utilization with methods to control for ‘carryover’ ICD-10s in primary care, acute and chronic sinusitis ICD-10 categories should likely be analyzed separately to increase the usefulness of sinusitis APR as a metric. Disclosures All Authors: No reported disclosures

Diverticulitis patient care during the Covid-19 pandemic in Germany—a retrospective nationwide population-based cohort study

PurposeCoronavirus disease 2019 (COVID-19) impacted health care systems around the world. Despite a decrease in emergency admissions, an increased number of complicated forms of diverticulitis was reported. It was the aim of this study to analyze the pandemic impact on diverticulitis management in Germany.MethodsThis is a retrospective population-wide analysis of hospital billing data (2012–2021) of diverticulitis in Germany. Patients were identified based on diagnosis (ICD10) and procedural codes to stratify by conservative and operative management. Primary outcome of interest was admission rates, secondary outcomes were rates of surgical vs conservative treatment and fraction of complicated clinical courses during the pandemic.ResultsOf a total of 991,579 cases, 66,424 (6.7%) were admitted during pandemic lockdowns. Conservative treatment was the most common overall (66.9%) and higher during lockdowns (70.7%). Overall admissions and population adjusted rates of surgically treated patients decreased, the latter by 12.7% and 11.3%, corrected to estimated rates, in the two lockdowns. Surgery after emergency presentation decreased by 7.1% (p=0.053) and 11.1% (p=0.002) in the two lockdowns with a higher rate of ostomy and/or revision (+5.6%, p=0.219, and +10.2%, p=0.030). In-hospital mortality was increased in lockdown periods (1.64% vs 1.49%). In detail, mortality was identical in case of conservative treatment during lockdown periods (0.5%) but was higher in surgically treated patients (4.4% vs 3.6%).ConclusionDuring lockdowns, there was an overall decrease of admissions for diverticulitis, especially non-emergency admissions in Germany, and treatment was more likely to be conservative. In case of surgery, however, there was increased risk of a complicated course (ostomy, re-surgery), possibly due to patient selection.

Sex Disparities in Operating Room use Among Cataract Surgeons: A 10-Year Retrospective Population-Based Analysis

To evaluate sex differences in operating room (OR) time and case volumes among comprehensive cataract surgeons in Ontario, Canada's most populated province. Retrospective, population-based cohort study. Physician billing data of active comprehensive cataract surgeons between 2010 and 2019 were analyzed to identify all cataract surgeries in this timeframe. The number of OR days and case volume were the primary outcomes. Data were stratified by surgeon sex and career stage. Between 2010 and 2019, approximately 1.05 million cataract surgeries were performed in Ontario. There were an average of 195 ± 3 comprehensive cataract surgeons per year, of which 39 ± 5 were female. The proportion of female surgeons increased from 16.8% of all surgeons in 2010 to 24.4% in 2019. The greatest proportion of male surgeons were in the late phase of their career, whereas the greatest proportion of female surgeons were in the early stage of their career. On average, male surgeons had 44.9 ± 1.90 OR days per year and females had 32 ± 1.90 OR days per year, resulting in female surgeons averaging 12.45 ± 1.90 fewer OR days per year. This OR distribution remained consistent across career stages. Average case volumes per OR day were similar across sexes, but male surgeons performed on average 172.7 ± 30.6 more surgeries per year. Despite performing similar average case volumes per OR day, female surgeons had less OR time compared to their male counterparts per year, and this remained consistent across career stages and over the 10-year period. Metrics for OR allocation and use should be well defined and transparent.

E-DPNCT: an enhanced attack resilient differential privacy model for smart grids using split noise cancellation

High frequency reporting of energy consumption data in smart grids can be used to infer sensitive information regarding the consumer’s life style and poses serious security and privacy threats. Differential privacy (DP) based privacy models for smart grids ensure privacy when analysing energy consumption data for billing and load monitoring. However, DP models for smart grids are vulnerable to collusion attack where an adversary colludes with malicious smart meters and un-trusted aggregator in order to get private information from other smart meters. We first show the vulnerability of DP based privacy model for smart grids against collusion attacks to establish the need of a collusion resistant privacy model. Then, we propose an Enhanced Differential Private Noise Cancellation Model for Load Monitoring and Billing for Smart Meters (E-DPNCT) which not only provides resistance against collusion attacks but also protects the privacy of the smart grid data while providing accurate billing and load monitoring. We use differential privacy with a split noise cancellation protocol with multiple master smart meters (MSMs) to achieve collusion resistance. We propose an Enhanced Differential Private Noise Cancellation Model for Load Monitoring and Billing for Smart Meters (E-DPNCT) to protect the privacy of the smart grid data using a split noise cancellation protocol with multiple master smart meters (MSMs) to provide accurate billing and load monitoring and resistance against collusion attacks. We did extensive comparison of our E-DPNCT model with state of the art attack resistant privacy preserving models such as EPIC for collusion attack. We simulate our E-DPNCT model with real time data which shows significant improvement in privacy attack scenarios. Further, we analyze the impact of selecting different sensitivity parameters for calibrating DP noise over the privacy of customer electricity profile and accuracy of electricity data aggregation such as load monitoring and billing.

Cluster analysis-based energy performance assessment for office building stock

To achieve carbon neutrality at the national or city level, the energy performance and conservation measures of large buildings should be evaluated. However, the assessment of the energy performance of existing building stock is often based on annual energy use intensity calculated from energy bill data due to data acquisition limitations. This approach has limitations in analyzing seasonal effects and establishing effective energy conservation strategies. In this paper, we propose a novel energy performance assessment method for existing office building stock. Our method classifies monthly electricity, gas, and heat energy use patterns using clustering algorithms without requiring additional database construction beyond the National Building Energy Database in Korea. We discuss the clustering results and provide an application method to assist policymakers through a case study.

The Queensland Virtual Integrated Practice (VIP) partnership program pilot study: an Australian-first model of care to support rural general practice

BackgroundThere is a critical lack of medical workforce internationally, and this is particularly notable in rural and remote Australia where strategies to address workforce shortages are urgently required. This pilot study aimed to implement and evaluate a Virtual Integrated Practice (VIP) Program in the Australian rural primary care setting.MethodsThe VIP model was developed using co-creation methodology and involves an urban GP joining a rural general practice team to provide ongoing care to patients remotely via secure telehealth. The pilot study was conducted in two western Queensland general practices, commencing in October 2021 with one rural practice and extending to an additional rural practice from November 2022. Evaluation included a retrospective review of service, billing and cost data, and an online survey for patients. Ethical approval was obtained from the University of Queensland Human Research Ethics Committee (Project number: 2021/HE002434).ResultsThere were 1468 services provided through to December 2022, including general consults (n = 1197), therapeutic procedures (n = 68), mental health treatment plans (n = 68) and chronic disease management plans (n = 59). Patients were predominantly female (73.1%) and did not have their appointment at the practice (57.8%). Among 1282 occasions of service, less than 20% of consultations (n = 224) required support from staff (e.g., a nurse), and more than half were repeat patient encounters (53.0%). Survey respondents (n = 45) indicated that they were satisfied (9.3%) or highly satisfied (90.7%) with the care provided, and importantly, 95.5% of respondents reported that the service improved their access to the GP. More than 20% of respondents indicated that they would attend the Emergency Department if virtual care was not available.ConclusionsData from this pilot study has informed translation to an additional 20 vulnerable rural general practices in three further rural regions in Queensland in 2023 and evaluation is ongoing. This pilot study demonstrates the feasibility and acceptability of an innovative, digitally supported community-focussed, healthcare initiative to arrest the decline in rural general practice workforce, improve patient care access and support rural practice viability.

Chi phí chẩn đoán và điều trị cho người bệnh Viêm gan vi rút C mạn tính tại bệnh viện A Thái Nguyên, năm 2021

Objective: To calculate the average cost of outpatient chronic hepatitis C diagnosis and treatment from the view of Vietnam Social Security (VSS), A Thai Nguyen Hospital, in 2021; Methods: Cross-sectional descriptive study. Study is based on retrospective billing data from hospital discharge records with 257 Hepatitis C outpatients who completed treatment from May 2021 to Dec 2021 at Thai Nguyen A Hospital. Main findings: The average cost per case of diagnosis and treatment for chronic HCV patients in the non-cirrhotic stage or compensated cirrhosis is 30 million VND and 58 million VND for patients with decompensated cirrhosis. Drug costs account for more than 90% of the total cost of diagnosis and treatment of chronic HCV. Conclusions: The study provided evidence on the cost of diagnosis and treatment for VGC outpatients from the point of view of Vietnam Social Security at A Thai Nguyen hospital. The average total cost of diagnosis and treatment for 01 patient in the late stage with decompensated cirrhosis is double price for 01 patient in the early stages (no cirrhosis/compensated cirrhosis). In addition, drug costs account for more than 90% of the cost of diagnosis and treatment. Thai Nguyen province promote screening and treatment programs for HCV at an early stage such as without cirrhosis or with compensated cirrhosis. At the same time, implementing methods of drug procurement to reduce prices and continue to lobby for funding for the diagnosis and treatment of HCV to help reduce the burden of HCV in the locality. Keywords: Costing, Hepatities C, A Thai Nguyen Hospital

Direct medical costs of globe salvage in group C-E retinoblastoma and implications for cost-effectiveness

To determine the direct medical costs and cost-effectiveness of globe salvage compared with primary enucleation in patients with advanced retinoblastoma. Patients with International Classification of Retinoblastoma groups C-E retinoblastoma at a single institution from 2001 to 2021 were categorized into two groups: primary enucleation and globe salvage. Hospital visits and treatments were compared to determine differences in care utilization. Costs per encounter were derived from billing data and multiplied by number of encounters to determine total costs in the first year of treatment. Groups were stratified by unilateral or bilateral retinoblastoma, and visual acuity-based utility values were used to compare quality-adjusted life years to determine cost-effectiveness. Of 74 group C-E eyes of 70 patients, 55 eyes underwent primary enucleation and 19 eyes underwent globe salvage, 12 of which ultimately underwent secondary enucleation. Patients who underwent globe salvage had higher usage of systemic chemotherapy (P=0.001), more examinations under anesthesia (P < 0.001), fewer outpatient visits (P= 0.03), and a higher total cost of care (301,151 vs 104,764 USD [P < 0.001]) in the first year of treatment compared with the primary enucleation group. At an average life expectancy of 76 years, the incremental cost-effectiveness ratio was 118,347 USD per QALY in unilateral retinoblastoma and 32,987 USD per QALY in bilateral retinoblastoma, meeting the <150,000 USD/QALY threshold of cost-effectiveness. Incurring additional costs may save the eye in advanced retinoblastoma, but the possibility of secondary enucleation should be disclosed for informed decision making. Despite this risk, globe salvage was cost-effective in unilateral and bilateral retinoblastoma.

Constructing within and between hospital physician social networks for modeling physician research participation

BackgroundPhysician participation in clinical trials is essential for the progress of modern medicine. However, the demand for physician research partners is outpacing physicians’ interest in participating in scientific studies. Understanding the factors that influence physician participation in research is crucial to addressing this gap.MethodsIn this study, we used a physician’s social network, as constructed from patient billing data, to study if the research choices of a physician’s immediate peers influence their likelihood to participate in scientific research. We analyzed data from 348 physicians across 40 hospitals. We used logistic regression models to examine the relationship between a physician’s participation in clinical trials and the participation of their social network peers, adjusting for age, years of employment, and influences from other hospital facilities.ResultsWe found that the likelihood of a physician participating in clinical trials increased dramatically with the proportion of their social network-defined colleagues at their primary hospital who were participating (OR=1.05 for a 1% increase in the proportion of participating peers, p=1.05times 10^{-7}). Additionally, physicians who work regularly at multiple facilities were more likely to participate (OR=7.28, p=0.03) and increasingly so as the extent to which they have social network ties to colleagues at hospitals other than their primary hospital increases (OR=1.12, p=0.05). These findings suggest an inter-hospital peer participation process.ConclusionOur study provides evidence that the social structure of a physician’s work-life is associated with their decision to participate in scientific research. The results suggest that interventions aimed at increasing physician participation in clinical trials could leverage the social networks of physicians to encourage participation. By identifying factors that influence physician participation in research, we can work towards closing the gap between the demand for physician research partners and the number of physicians willing to participate in scientific studies.

Skin cancer screening in the aging population in Saxony-Anhalt : Utilization, facilitating, and hindering factors

Statutory skin cancer screening (gHKS) can counteract severe courses of various types of skin cancer. The example of malignant melanoma shows that screening is important for older adults in view of the average age of onset of this disease: 62 (women) and 68years (men). For Saxony-Anhalt (ST), as astate particularly affected by demographic change, little gHKS data are available regarding its usage. For the study, gHKS participation rates for persons aged 55 and older are presented for ST in comparison to the rest of Germany. Reasons for and barriers to participation from those eligible as well as possible fields of action are shown. For the target group, outpatient billing data from the Central Institute for Statutory Health Insurance Physicians in Germany (Zi) on gHKS from 2011-2020 are cross-sectionally and longitudinally analysed. Guideline-based telephone interviews with 18residents using qualitative content analysis according to Kuckartz serve to identify reasons for and barriers to the use of gHKS. The gHKS was rarely and irregularly used in ST and other federal states of Germany from 2011-2020; the annual utilisation rate was about8.0% (national average: 8.4%). Between 2011 and 2020, 50% of eligible people aged 55years and older did not participate in the gHKS. The highest utilisation rates were among men aged 70-79years. In addition to district-specific differences, which indicate possible gaps in care, information deficits appear to be the main reason for low participation. The low utilisation of gHKS, partly due to alack of information among those entitled to it, requires target group-specific information services.

Predicting energy consumption of chiller plant using WOA-BiLSTM hybrid prediction model: A case study for a hospital building

It is important to study building energy consumption considering the current state of global climate and its close relationship with building energy consumption. This study proposes a hybrid Whale Optimization Algorithm-Bidirectional Long Short-Term Memory (WOA-BiLSTM) model to predict energy consumption using a hospital building located in Beijing as a case study. First, a simulation is performed using building simulation software and the model is calibrated using energy bill and electricity meter data. Subsequently, the energy consumption of the calibrated model is decomposed to determine the energy consumption of the chillers and pumps. Finally, a BiLSTM model is established and the WOA is employed to enhance the generalization and performance of the BiLSTM model. Results show 1) for hour scale, the Mean Absolute Percentage Error (MAPE) of the WOA-BiLSTM model is reduced by 2.93 % and 0.75 % over the WOA-LSTM and BiLSTM models, respectively. 2) the time-lag effect of energy consumption is discussed and the results show that the optimal window size is approximately 18 h. 3) the optimization results of different iterations and population size of WOA show that performance is optimal when 400 iterations and a population size of 5, and larger datasets require more iterations based on a comparison of two datasets (hour and day scales).

Differences in personal characteristics and health outcomes between ambulatory and non-ambulatory adults with traumatic spinal cord injury

Objective: To identify differences in personal characteristics, health outcomes, and hospital utilization as a function of ambulatory status among adults with chronic SCI. Design: Prospective cohort study linked to state administrative billing data. Setting: Population-based SCI Registry from the Southeastern United States. Participants: 1,051 adults (>18 years old) with chronic (>1-year), traumatic SCI. Outcome Measures: The self-report assessment (SRA) included demographic, injury and disability characteristics, health status, psychological and behavioral factors, and participation and quality of life (QOL) variables. We linked cases to administrative billing data to assess hospital utilization, including Emergency Department (ED) visits and inpatient (IP) admissions (through the ED and direct IP) in non-federal state hospitals within the year following the SRA. Results: There were 706 ambulatory and 345 non-ambulatory participants. We found significant differences across all sets of factors and significant differences in hospital utilization metrics. Ambulatory adults had fewer ED visits (36% vs 44%), IP admissions through the ED (11% vs 25%) and IP only admissions (9% vs 19%) and spent fewer days in the hospital for both admissions through the ED (0.9 vs 4.6 days) and IP only admissions (0.7 vs 3.1 days). They also reported having fewer past year ED visits (44% vs 62%) and IP admissions (34% vs 52%). Conclusions: We identified differences in personal characteristics, ED visits and IP admissions between ambulatory and non-ambulatory adults with SCI, providing a better understanding of the characteristics of those with SCI. The findings suggest the need for separate analyses based on ambulatory status when assessing long-term health outcomes including hospital utilization.