Variation In Rates Research Articles

Health Center Characteristics Associated With Hospital Care Among Medicare-Medicaid Dual Enrollees.

Using 2012-2018 Medicare claims and health center data, we identified factors associated with variation in rates of hospital care among Medicare-Medicaid dual enrollees receiving primary care at health centers. In our sample (n =5961 health center-years), we found no evidence that patient-centered medical home designation or other modifiable health center characteristics were associated with reductions in hospital care use, which depends more on health center patient mix. Thus, policymakers should target efforts to health centers serving the most disadvantaged and marginalized communities.

Impact of Heat on Respiratory Hospitalizations among Older Adults in 120 Large US Urban Areas.

Extreme heat exposure is a well-known cause of mortality among older adults. However, the impacts of exposure on respiratory morbidity across US cities and population subgroups is not well understood. A nationwide study to determine the impact of high heat on respiratory disease hospitalizations among older adults (65+) living in the 120 largest US cities between 2000-2017. Daily rates of inpatient respiratory hospitalizations were examined with respect to variations in ZIP-code-level daily mean temperature and heat index. For each city, we estimated cumulative associations (lag-days 0-6) between warm-season heat (June-September) and cause-specific respiratory hospitalizations using time-stratified conditional quasi-Poisson regression with distributed lag non-linear models. We estimated nationwide associations using multivariate meta-regression and updated city-specific associations via best linear unbiased prediction. With stratified models, we explored effect modification by age, sex, and race (Black/white). Results were reported as percent change in hospitalizations at high temperatures (95th percentile) compared to median temperatures for each outcome, demographic group, and metropolitan area. We identified 3,275,033 respiratory hospitalizations among Medicare beneficiaries across 120 large US cites between 2000 and 2017. Nationwide, 7-day cumulative associations at high temperatures, resulted in a 1.2% (0.4%, 2.0%) increase in hospitalizations for primary diagnoses of all-cause respiratory disease, primarily driven by increases in respiratory tract infections [1.8% (0.6%, 3.0%)], and chronic respiratory diseases/respiratory failure [1.2% (0.0%, 2.4%)]. Stronger associations were observed when exposure was defined using the heat index instead of temperature. Across the 120 cities, we observed considerable geographic variation in the relative risk of heat-related respiratory hospitalizations, and we observed disproportionate burdens of heat-related respiratory hospitalizations among the oldest beneficiaries (85+ years), and among Black beneficiaries living in South Atlantic cities. During the 18-year study period, there were an estimated 11,710 excess respiratory hospitalizations due to heat exposure. Results suggest that high temperature and humidity contribute to exacerbation of respiratory tract infections and chronic lung diseases among older adults. Geographic variation in heat-related hospitalization rates suggests that contextual factors largely account for disproportionate burdens, and area-level influences should be further investigated in multi-city studies.

Predicting cancer detection rates from multiparametric prostate MRI

Introduction: Although the Prostate Imaging-Reporting and Data System (PI-RADS) categorization represents the standard method for assessing the risk of prostate cancer using prostate magnetic resonance imaging (MRI), there exists wide variation in cancer detection rates (CDRs) in real-world practice. We therefore evaluated the association of clinical and radiographic features with CDRs and developed a predictive model to improve clinical management. Methods: We identified men aged 18–89 years with elevated prostate-specific antigen (PSA) or on active surveillance for prostate cancer who underwent MRI-ultrasound (US) fusion biopsy or in-bore MRI-targeted biopsy. The associations of features with the per-lesion CDR (Gleason 6–10) and clinically significant (cs) CDR (Gleason 7–10) were examined using logistic regression, and results were operationalized into a predictive model. Results: Targeted biopsy was performed for 347 lesions in 281 patients. Overall, the CDR was 49.0% and the csCDR was 28.0%. On multivariable analysis, increasing PI-RADS category, no prior prostate biopsies, smaller prostate size, and increasing PSA density were independently associated with higher CDR, while 0–1 prior prostate biopsies, and a solitary PI-RADS 3–5 lesion were associated with higher csCDR. A predictive model provided a greater net benefit than a strategy of performing biopsy in all PI-RADS 3–5 lesions across a wide range of threshold probabilities. Conclusions: Several clinical and radiographic features are independently associated with the risk of prostate cancer in men undergoing MRI-targeted biopsy. A predictive model based on these features can improve clinical decisions regarding biopsy compared to the conventional strategy of performing biopsy for all PI-RADS 3–5 lesions.

Implementing universal maternal depression screening in head start: A convergent mixed methods study

AimsImplementing maternal depression screening in child-serving programs can help ensure that more mothers receive mental health services. This study examined the implementation of universal maternal depression screening in community-based Head Start programs. MethodsQuantitative and qualitative data were merged in a convergent mixed method design to assess four domains from the RE-AIM implementation science framework (Reach, Adoption, Implementation, and Maintenance). Qualitative data included interviews with stakeholders and meeting minutes from the implementation period. Quantitative data included intervention outcomes and administrative data. ResultsIn terms of reach, 85% of eligible Head Start mothers were screened for depression, and English-speaking mothers were more likely to refuse screening than Spanish-speaking or bilingual mothers. Barriers to screening included lack of availability, stigma, privacy concerns, lack of interest, and lack of trust. In terms of adoption, all sites and staff adopted screening due to organizational mandates. In terms of implementation, there was wide variation in rates of positive screenings across staff completing the screening (ranging from 0% to 46%), and barriers included concerns about staff role and lack of training. In terms of maintenance, screening was not sustained after the study period due to organizational priorities and lack of buy-in from staff. ConclusionUniversal maternal depression screening has the potential to reach low-income Head Start mothers, but additional efforts should be made to build staff capacity to engage mothers in screening.

Modeling the Energy-dependent Broadband Variability in the Black Hole Transient GX 339–4 Using AstroSat and NICER

We present a spectro-timing analysis of the black hole X-ray transient GX 339–4 using simultaneous observations from AstroSat and the Neutron Star Interior Composition Explorer (NICER) during the 2021 outburst period. The combined spectrum obtained from NICER, Large Area X-ray Proportional Counter and SXT data is effectively described by a model comprising a thermal disk component, hard Comptonization component, and reflection component with an edge. Our analysis of the AstroSat and NICER spectra indicates the source to be in a low/hard state, with a photon index of ∼1.64. The power density spectra obtained from both AstroSat and NICER observations exhibit two prominent broad features at 0.22 Hz and 2.94 Hz. We generated energy-dependent time lag and fractional root mean square (frms) at both frequencies in a broad energy range of 0.5–30 keV and found the presence of hard lags along with a decrease in variability at higher energy levels. Additionally, we discovered that the correlated variations in accretion rate, inner disk radius, coronal heating rate, and the scattering fraction, along with a delay between them, can explain the observed frms and lag spectra for both features.

Health Care Delivery Site- and Patient-Level Factors Associated With COVID-19 Primary Vaccine Series Completion in a National Network of Community Health Centers.

Objectives. To assess multilevel factors associated with variation in COVID-19 vaccination rates in a US network of community health centers. Methods. Using multilevel logistic regression with electronic health record data from ADVANCE (Accelerating Data Value Across a National Community Health Center Network; January 1, 2022-December 31, 2022), we assessed associations between health care delivery site-level (n = 1219) and patient-level (n = 1 864 007) characteristics and COVID-19 primary vaccine series uptake. Results. A total of 1 337 440 patients completed the COVID-19 primary vaccine series. Health care delivery site characteristics were significantly associated with lower series completion rates, including being located in non-Medicaid expansion states and isolated or rural communities and serving fewer patients. Patient characteristics associated with significantly lower likelihood of completing the vaccine series included being Black/African American or American Indian/Alaska Native (vs White), younger age, lower income, being uninsured or publicly insured (vs using private insurance), and having fewer visits. Conclusions. Both health care delivery site- and patient-level factors were significantly associated with lower COVID-19 vaccine uptake. Community health centers have been a critical resource for vaccination during the pandemic. (Am J Public Health. 2024;114(11):1242-1251. https://doi.org/10.2105/AJPH.2024.307773).

Impacts of jet inflow on hydrodynamic performance and waste removal efficiency in recirculating aquaculture system aquaculture tanks based on prototype experiments

Although scaled physical models and numerical simulations have been employed to study the hydrodynamic performance of recirculating aquaculture system (RAS) aquaculture tanks, there remains a paucity of prototype experiments that fully reflect the actual hydrodynamic performance. In this study, a prototype experiment was conducted on RAS aquaculture tanks, utilizing advanced image processing techniques specifically adapted to the prototype scale. This study focused on impacts of various jet inflow parameters, including jet inflow angle (0°, 10°, 20°, 30°, 40°, 45°, 50°, 60°, and 70°), jet inflow rate (150, 180, 210, and 240 l·min−1), jet inflow area (942 and 1884 mm2), and jet inflow location (curved wall and straight wall), on the hydrodynamic performance and waste removal efficiency of RAS aquaculture tanks. The results demonstrated the hydrodynamic performance—specifically average flow velocity, flow field uniformity, and the extent of low-velocity zones conjointly determining waste removal efficiency. The curved wall proved to be the optimal location for inflow pipe placement, while a 45° jet angle yielded the best balance between hydrodynamic performance optimization and waste removal efficiency. Furthermore, reducing the inlet area significantly improved average flow velocity and flow uniformity, whereas variations in inlet flow rate had minimal impact on these factors. Supported by these compelling findings, this study offers theoretical insight and practical guidance for achieving efficient aquaculture in RAS, thereby contributing to the advancement of sustainable aquaculture practices.

Sustainability index and a bibliometric of photovoltaic thermal with rectangular channel

The main challenge associated with solar panels is the need to reduce excessive heat and optimize efficiency to achieve stable conditions. Therefore, a combination of collector and cooling technologies, such as Photovoltaic Thermal (PVT) Technology, is needed to address this problem. This research used water-based rectangular channel to cool the PVT through the Ansys simulation method. A total of nine variations of mass flow rates, which ranged from 0.001 to 0.009 kg/s and six solar intensities between 500 W/m2 and 1000 W/m2 were used to achieve the optimal performance. An energetic analytical method with average Sustainability Index (SI) of 0.001-0.009 kg/s and 1.186 at 1000 W/m2 intensity were incorporated. Furthermore, the maximum average Waste Exergy Rasio (WER) value of 0.854 at a 500 W/m2 intensity was used to determine the flow rate. The highest average Exergetic Ecological Index (EcEI) value recorded was -0.687 at a 1000 W/m2 radiation intensity, while the highest average Improvement Potential (IP) value was 421.145 W. The results showed that the simulation serve as a valuable point of reference in the design and advancement of water-based rectangular channel within future PVT technology.

Environmental and Behavioral Determinants of Septicemia Mortality in Türkiye: A Ten-Year Analysis

This study examines the environmental and behavioral factors associated with variations in septicemia mortality rates across Turkish provinces. Province-level data spanning ten years were analyzed using ordinal logistic regression modeling to determine the predictors of septicemia mortality. Environmental factors such as humidity, temperature, and air pollutants, along with behavioral aspects including alcohol consumption, were evaluated. Analysis of the provided data revealed significant regional variations in septicemia mortality rates across areas with diverse environmental and social characteristics. Higher median humidity and stable environmental conditions (low variability in humidity and temperature) correlated with reduced mortality rates. Alcohol consumption was identified as a risk factor, moderately increasing the risk of septicemia mortality. The findings highlight the intricate relationship between environmental stability, personal behaviors, and septicemia outcomes. The study accentuates the need for targeted public health strategies and suggests that mitigating environmental risks and fostering healthy behaviors could effectively reduce septicemia mortality. Further studies should focus on individual-level data and explore the relationship between these factors in different climatic conditions.

Prevalence and genetic diversity of Anaplasma phagocytophilum in wild small mammals from western Yunnan province, China

Anaplasma phagocytophilum (A. phagocytophilum) is an emerging zoonotic pathogen causing human granulocytic anaplasmosis, linked to small mammal reservoirs that harbor various zoonotic pathogens, underscoring their importance in public health and ecology. This study seeks to determine the prevalence of A. phagocytophilum in small mammals using PCR, then sequence and genotype positive samples, and assess infection risk factors. Small mammals were seasonally captured and a nested polymerase chain reaction (nested-PCR) was conducted targeting the 16S rRNA gene on spleen samples to detect A. phagocytophilum infection from three counties in western Yunnan province, China. Positive samples were sequenced and genotyped, revealing genetic diversity and regional clustering of the pathogen. A total of 1,605 small mammals belonging to 30 species, 18 genera, 6 families, 3 orders were captured seasonally and screened in this region, yielding a 0.93% infection rate with A. phagocytophilum (15/1605). Significant variations in infection rates were observed across different species, counties, and habitats. The 16Sr RNA genes of A. phagocytophilum were categorized into two distinct clades, indicating notable genetic diversity. The identification of genetic variants in spleen samples underscores the potential public health risk and the critical importance of the One Health approach in disease surveillance. Our findings emphasize the necessity for continuous monitoring and highlight the value of nested-PCR testing on spleen samples for accurate prevalence assessment.

Bridging digital divides in Wisconsin: an examination of policy efforts and effectiveness over the past five years

ABSTRACT The digital divide, generally characterized by unequal Internet access, represents the gap between individuals who benefit from the use of digital technologies and those who do not. Many social inequalities are associated with the prevalence of the digital divide, particularly across the rural-urban divide. This research seeks to characterize the status of the digital divide, and related sociodemographic variables, within the context of the US state of Wisconsin. In addition, this research investigates the effectiveness of broadband expansion grants, within the state of Wisconsin, on bridging the digital divide. The findings indicate that, at the county level, variations in education, household income, age, and location on a rural-urban continuum are all associated with variations in county broadband adoption rates. Also, despite increasing broadband funding, the amount of money sent to a county is not associated with the need of that county or the change in county level broadband adoption rates from the year 2017–2021. The findings of this study have theoretical implications as they add to our understanding of how broadband adoption is related to social aspects of life. In addition, there are political implications in terms of how grant funding allocation is determined.

Experimental Investigation of the Combustion Characteristics and Thermal Hazards of Methylsilyl-Modified Silica Aerogels

The thermal safety of hydrophobic silica aerogels (SAs) is essential to thermal insulation applications. Herein, trimethylchlorosilane (TMCS), dimethyldichlorosilane (DMDCS), and methyltrichlorosilane (MTCS) were employed as surface modifiers to prepare three different methylsilyl-modified SAs (i.e., TSA, DSA, and MSA) and their combustion characteristics and thermal hazards were experimentally studied in detail. The cone calorimeter test found that the three SAs have similar combustion processes and the variations in ignition time and fire spread rate with the heat flux obey simple logarithmic and linear relationships, respectively. It further found that TSA has the most methylsilyl groups on silica skeletons and thus has the largest heat release, followed by DSA and MSA in turn, implying that TSA has the greatest fire hazard among the three SAs. These results further demonstrate that the type and quantity of methylsilyl groups on the skeletons of SAs significantly affect the thermal hazard of methylsilyl-modified SAs. In addition, the combustion mechanism of the methylsilyl-modified SAs is discussed. In total, this work experimentally studies the combustion characteristics of methylsilyl-modified SAs and compares their thermal hazards, clarifying the potential fire risk of methylsilyl-modified SAs in practical thermal insulation applications.

Why are some nations more entrepreneurial than others? Investigating the link between cultural tightness–looseness and rates of new firm formation

AbstractResearch SummaryWe evaluate the role of cultural tightness–looseness as an explanation for cross‐cultural variation in new firm formation rates. Modeling cultural tightness–looseness as an antecedent for individual entrepreneurial dispositions and informal institutions, we examine its impact on the number of new limited‐liability companies registered per 1000 people and the rate of new entrepreneurs in the working‐age population. Our findings show that cultural tightness–looseness explains 56% of the variation in new firm formation rates in a sample of 156 nations, and 71% of the variation in the rate of new entrepreneurs in the 50 US states, with greater cultural looseness corresponding to higher rates of entrepreneurship, on average. This effect is robust to various model specifications, measures, and controls for other cultural dimensions.Managerial SummaryOur study examines how cultural tightness–looseness impacts new firm formation rates across nations and US states. We find that cultural looseness, characterized by flexible social norms, significantly influences entrepreneurial activity. Specifically, it explains 56% of the variation in new firm formation rates across 156 nations and 71% of the variation in new entrepreneur rates in the 50 US states. Nations and states with looser cultures tend to have higher rates of entrepreneurship. These findings are robust across different model specifications, measures, and control variables. Managers and policymakers should consider the strength and enforcement of social norms as factors in fostering new firm formation.

Reduction Rate of Uric Acid in Blood During Continuous Renal Replacement Therapy for Acute Kidney Injury: A Multicenter Retrospective Observational Study

Introduction: Continuous renal replacement therapy (CRRT) eliminates these small solutes with equal efficacy under the same conditions. However, variations in the reduction rates of these solutes observed in patients with CRRT are likely influenced by factors other than removal through CRRT. This study evaluated the reduction rates of these small solutes during CRRT and their possible association with mortality. Methods: This study used the data of limited patients registered in the CHANGE study, which is a large retrospective observational study on CRRT management across 18 Japanese ICUs. Reduction rates of three solutes in blood, calculated on the 1st and 2nd days, were compared in patients with acute kidney injury (AKI) treated by CRRT. The potential association between solute reduction rates and mortality during CRRT or within 7 days after the termination of CRRT was evaluated. Results: In total, 163 patients with AKI were included in the analysis. The reductuin rates of uric acid (UA) were significantly higher than those of urea and creatinine for the 1st and 2nd tests in the entire cohort. Receiver operating curve (ROC) analysis revealed that lower UA reduction rates were significantly associated with mortality during CRRT or within 7 days after CRRT termination (area under the ROC curve: 0.62 [95% confidence interval {CI} 0.52–0.71] for the 1st test and 0.63 [95%CI 0.54–0.72] for the 2nd test). After adjusting for age and SOFA score, a significant association was observed between lower UA reduction rates and hospital mortality for both tests. Conclusion: Among the small solutes, UA reduction rates in patients with AKI treated with CRRT were notably higher than those of creatinine and urea. Furthermore, the significant association between lower UA reduction rates and mortality suggests that UA reduction rate may serve as a valuable indicator of insufficient removal of uremic solutes by CRRT, although the decline in UA production must be taken into account.

Comparative linkage mapping to investigate synteny and recombination in social Vespidae

Abstract Genetic linkage maps are valuable resources for investigating chromosomal structure, quantifying karyotype, estimating recombination rates, and improving preexisting genome assemblies. Comparative linkage mapping, in turn, broadens our understanding of the phylogenetic history of these genomic features. Through an assessment of synteny (the conservation of gene order on homologous chromosomes in different species) and variation in recombination rate, we can begin to understand how genomic features change during the evolution of distinct species. Here, we construct high-density genetic linkage maps for 3 Vespidae wasp species from the Vespula genus: Vespula consobrina, Vespula pensylvanica, and Vespula vidua to investigate shared genomic architecture between these 3 yellowjacket wasp species. We show that these species exhibit high levels of collinearity, often in chromosome-length blocks of synteny, with some evidence for small interchromosomal rearrangements. We also identify 2 “inversions” in all 3 species that are likely artifacts from the genome assembly process. In addition, we map genome-wide recombination rates and reveal the recombination landscape to be highly variable on intrachromosomal, interchromosomal, and interspecific scales. Genome-wide recombination rates are high for all three Vespula species, (V. pensylvanica: 22.7 cM/Mb, V. consobrina: 24.3 cM/Mb, and V. vidua: 24.7 cM/Mb), which is consistent with findings of high recombination rates for other eusocial species. Our high-quality linkage maps will be resources for ongoing evolutionary genetics studies interested in the genome evolution of social wasps.

Reducing flow heterogeneity in drip irrigation networks using genetic algorithms

AbstractIrrigation based on non‐compensated drip emitters is extremely common in agriculture, especially due to its simplicity, robustness and competitive cost. Nevertheless, because of friction losses in the pipe, together with irregular terrain, these systems often suffer from uneven water distribution in the drip emitters, which not only results in inefficient use of water resources but also might lead to inadequate irrigation in certain parts of the field. This work proposes to design the topology of the irrigation network to compensate for these discharge differences. To this end, a graph‐based mathematical model is developed to determine the discharge flows at different emitters for any network topology. This model is employed to formulate an integer nonlinear optimization problem, for which a messy genetic algorithm is proposed. The methodology is validated on an example problem, which is based on a rectangular agricultural crop of 49 fruit trees. The results revealed a 70% reduction in the coefficient of variation of the irrigation discharge rates, which was employed as a metric of irrigation uniformity. This caused a 75% reduction in the water excess. The results demonstrate that the uniformity can be improved simply by choosing a proper connectivity layout to build the pipe network.

The ability in managing reactive oxygen species affects Escherichia coli persistence to ampicillin after nutrient shifts.

This research delves into the intriguing realm of bacterial persistence and its profound implications for biofilms, infections, and antibiotic efficacy. The study focuses on Escherichia coli and how the switch from different carbon sources to fatty acids influences the formation of persister-resilient bacterial cells resistant to antibiotics. The findings reveal a striking variation in survival rates, with a significant number of cells surviving ampicillin treatment after transitioning from glucose to oleic acid. The key revelation is the role of reactive oxygen species (ROS) in cell killing, particularly after switching from gluconeogenic carbons. The timing of ROS bursts aligns with the rapid killing phase, highlighting the critical impact of oxidative stress regulation on persistence frequency. This research provides valuable insights into bacterial persistence mechanisms, offering potential avenues for targeted therapeutic interventions to combat bacterial resistance effectively.

A Fundamental Connection: Exchange Rates and Macroeconomic Expectations

Abstract We disprove the exchange rate macroeconomic disconnect puzzle by showing that macroeconomic news can explain most variation in exchange rates at monthly and quarterly frequencies, accounting for up to 91 percent of the quarterly exchange rate variation during US recessions and 65 percent over all periods. The main driver of the reconnect is exchange rates responding to past news—a result inconsistent with the theory of uncovered interest rate parity under full information rational expectations (UIP-FIRE). We discuss theoretical models that can explain this surprising result, including models featuring currency risk premia, regulatory or institutional frictions, or deviation from FIRE.

Implantable cardioverter defibrillators among elderly survivors of out-of-hospital cardiac arrest

Abstract Background Survivors of out-of-hospital cardiac arrest (OHCA) with a shockable rhythm are at increased risk of cardiac arrest, and clinical practice guidelines recommend placement of an implantable cardioverter defibrillator (ICD) in the absence of a reversible cause and an expected meaningful survival of at least one year. Contemporary data on the prevalence of secondary prevention ICD placement among OHCA survivors remain limited. Purpose Examine patterns of secondary prevention ICD implantation in survivors of OHCA due to a shockable rhythm in a large national registry. Methods Using 2013-2019 data from the Cardiac Arrest Registry to Enhance Survival (CARES) linked to Medicare files, we identified 3,226 patients aged >65 years who survived to discharge following OHCA due to an initial shockable rhythm from January 1, 2013 to December 31, 2019. Patients with severe neurological disability, prior history of cancer, and those discharged to hospice were excluded. We calculated cumulative prevalence of ICD implantation at discharge, 90 days, and 6 months post cardiac arrest. Multivariable hierarchical regression models with random hospital effects were used to determine the adjusted association of patient characteristics with ICD implantation and quantify the extent of variation in ICD implantation across sites, using a median odds ratio (OR) and 95% confidence interval (CI). Results Patients’ mean age was 72.2 years; 23.5% were women, 10% were Black and 4% Hispanic. Among 3,226 OHCA patients, 997 (30.9%) received an ICD before discharge; 1,266 (39.2%) received an ICD within 90 days of cardiac arrest, and 1,287 (39.9%) received an ICD by 6 months. After adjusting for differences in demographics and co-morbidities, the odds of receiving an ICD at discharge were significantly lower in patients aged 85 years and older, women, patients with prior history of stroke or diabetes, patients who presented with acute myocardial infarction (P<0.05 for all). There was no significant difference in ICD implantation by race and ethnicity (P=0.94) (Table 1). Even after adjusting for patient demographics, co-morbidities, and presentation with acute myocardial infarction, there was large variation in hospital rate of ICD implantation at discharge, with a median odds ratio of 1.65 (95% CI 1.41-1.86). Conclusion Fewer than 1 in 3 patients with OHCA due to a shockable rhythm are discharged with a secondary prevention ICD. Although implantation of ICD was associated with patient variables, there was no difference in ICD implantation by race and ethnicity. There was large variation across hospitals in ICD implantation even after adjusting for patient variables highlighting an opportunity for improving post-arrest management of cardiac arrest survivors.

Using Unsupervised Learning Methods to Explore the Trajectory of Long-Term Care Service in Taiwan

Abstract Background Understanding the temporal trends in long-term care (LTC) utilization enables more effective planning by government and service providers. This study employed machine learning methods to explore LTC utilization trajectories among care recipients in a southern county of Taiwan. Methods Administrative data from the government-funded LTC programme was utilized, with a total of 24,614 participants included after excluding those with less than six months of data. Daily service utilization records, mainly focusing on caregiving services, were aggregated, and the number of days each participant used LTC services within every 30-day period post-application was calculated. Utilization rates during 6 and 12 months post-application were separately analyzed. K-means clustering, an unsupervised machine learning method, was employed to select the optimal classification and identify LTC utilization trajectories using 10-fold cross validation. Temporal frequency variations of each caregiving service within each trajectory group were visualized using heatmaps. Results In the analysis of LTC utilization within the first 6 months post-application, trajectories were classified into 7 groups; while within 12 months, trajectories were divided into 4 groups. These trajectories can be categorized into 4 distinct patterns: High-Stable (6 mo: 21.3%; 12 mo: 35.7%), Low-Stable (6 mo: 33.1%; 12 mo: 37.2%), High-Decrease (6 mo: 12.8%; 12 mo: 10.7%), and Low-Increase (6 mo: 32.7%; 12 mo: 16.5%). We further explored differences in socio-demographic characteristics and needs factors among trajectory groups. Heatmaps were used to illustrate temporal variations in the utilization rates of specific service items, which played a significant role in determining the trajectories. Conclusions K-means clustering is useful in identifying distinct patterns among LTC users. Tailored service delivery strategies can be designed to meet the diverse needs of these different user groups. Key messages • The unsupervised machine learning method distinguished various temporal dynamic patterns in LTC utilization. • Tailored service delivery strategies can be designed to meet the diverse needs of these different user groups.