Specialty Codes Research Articles

P-1697. Antibiotic prescribing patterns among outpatients with acute sinusitis in Michigan

Abstract Background Acute sinusitis is a common presenting illness in the outpatient setting. While antibiotics are often prescribed, they are infrequently indicated in adults. Limited data are available assessing prescribing practices. This study aimed to describe statewide antibiotic prescribing for sinusitis among outpatients in Michigan to identify opportunities for antimicrobial stewardship (AMS) interventions for clinical and public health partners.Figure 1:Outpatient antibiotic prescribing practices for sinusitis in Michigan, 2019-2021 Methods The Michigan Department of Health and Human Services received medical and pharmacy claims data from IQVIA from 2019 – 2021. Outpatients with medical claims data with a diagnosis code (J01) for acute sinusitis were included, while those with concomitant upper respiratory tract, urinary tract, or skin and soft tissue infectious diagnoses codes were excluded. Patients with a J01 diagnosis in their medical claims were linked to their corresponding antibiotic prescriptions from pharmacy claims based on patient identifier, prescription date, ordering provider, and antibiotic utilized. Prescribing patterns of antibiotics (frequency of prescription, agent selection, and duration of therapy) were analyzed for the overall cohort and stratified by place of service, provider specialty, year of service, patient zip code, age, and gender.Figure 2:Frequency of acute sinusitis encounters with an antibiotic prescription by 3-digit zip code Results From 2019 - 2021 there were 560,255 unique encounters from 424,684 patients for acute sinusitis in Michigan within the IQVIA medical claims database. Antibiotics were prescribed in 66% of these cases. Amoxicillin-clavulanic acid (33%), azithromycin (25%), and amoxicillin (20%) were the most prescribed antibiotics, with median durations of 10 days, 5 days, and 10 days, respectively. The prescription patterns among different groups are shown in Figures 1 and 2. Prescription rates, agent selection, and durations were remarkably consistent across calendar year, age group, sex, place of service, provider specialty, and patient zip code. Conclusion The study revealed a concerning pattern of high antibiotic prescription rates, inappropriate antibiotic selection, and prolonged durations of therapy in the outpatient management of acute sinusitis in Michigan. These findings were consistent in all subgroups analyzed and emphasize the need to prioritize outpatient AMS practices for sinusitis. Disclosures jason M. Pogue, PharmD, Entasis: Advisor/Consultant|GSK: Advisor/Consultant|Melinta: Advisor/Consultant|Melinta: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|Venatorx: Advisor/Consultant

Impact of Rank, Provider Specialty, and Unit Sustainment Training Frequency on Military Critical Care Air Transport Team Readiness.

The Critical Care Air Transport (CCAT) Advanced Course utilizes fully immersive high-fidelity simulations to assess personnel readiness for deployment. This study aims to determine whether simple well-defined demographic identifiers can be used to predict CCAT students' performance at CCAT Advanced. CCAT Advanced student survey data and course status (pass/fail) between March 2006 and April 2020 were analyzed. The data included students' Air Force Specialty Code (AFSC), military status (active duty and reserve/guard), CCAT deployment experience (yes/no), prior CCAT Advanced training (yes/no), medical specialty, rank, and unit sustainment training frequency (never, frequency less often than monthly, and frequency at least monthly). Following descriptive analysis and comparative tests, multivariable regression was used to identify the predictors of passing the CCAT Advanced course for each provider type. A total of 2,576 student surveys were analyzed: 694 (27%) physicians (MDs), 1,051 (40%) registered nurses (RNs), and 842 (33%) respiratory therapists (RTs). The overall passing rates were 92.2%, 90.3%, and 85.4% for the MDs, RNs, and RTs, respectively. The students were composed of 579 (22.5%) reserve/guard personnel, 636 (24.7%) with CCAT deployment experience, and 616 (23.9%) with prior CCAT Advanced training. Regression analysis identified groups with lower odds of passing; these included (1) RNs who promoted from Captain to Major (post-hoc analysis, P = .03), (2) RTs with rank Senior Airman, as compared to Master Sergeants (post-hoc analysis, P = .04), and (3) MDs with a nontraditional AFSC (P = .0004). Predictors of passing included MDs and RNs with CCAT deployment experience, odds ratio 2.97 (P = .02) and 2.65 (P = .002), respectively; and RTs who engaged in unit CCAT sustainment at least monthly (P = .02). The identifiers prior CCAT Advanced training or reserve/guard military status did not confer a passing advantage. Our main result is that simple readily available metrics available to unit commanders can identify those members at risk for poor performance at CCAT Advanced readiness training; these include RNs with rank Major or above, RTs with rank Senior Airman, and RTs who engage in unit sustainment training less often than monthly. Finally, MD specialties which are nontraditional for CCAT have significantly lower CCAT Advanced passing rates, reserve/guard students did not outperform active duty students, there was no difference in the performance between different RN specialties, and for MD and RN students' previous deployment experience was a strong predictor of passing.

Building the conversion table of semantic match between researchers specialty codes for Section 1 Natural Sciences of HAC Classification and GRNTI subject headings

The authors discuss the results of building interreflections (matches) of research specialty codes and GRNTI subject headings based on the comparative intellectual analysis. The current master version of the State Rubricator of Scitech Information (SRSTI, GRNTI) and the verified version of the Higher Attestation Commission (HAC, VAK) are compared. The interreflection of specialty codes of these two classifications are defined as the relations of logical match, inclusion and overlapping of extensions within the subject scope of studies as indicated in the profiles of specialties and corresponding GRNTI subject headings. To illustrate the algorithm of the HAC and GRNTI classifications comparative analysis and building the conversion table of code matches, the authors provide the example of sematic matches between the specialty codes within Section 1.1.6 Hydrobiology and GRNTI subject headings. The study to form the aggregate of interreflections of codes is accomplished in full for every group of research specialties within Section 1 Natural Sciences of the HAS Classification. In total, 97 researcher specialty codes are indexed with 1,958 matches assigned; the comparison with GRNTI thematic structure is accomplished for 1,755 study areas as indicated in 128 profiles of 6 specialty groups. The general and specific patterns of semantic match distribution between HAS codes and GRNTI subject headings are identified for Section 1 Natural Sciences.

Trends in Spinal Orthosis Utilization Among Patients Insured Through Medicare Part B.

Retrospective population-based database analysis from the Physician/Supplier Procedure Summary Medicare/Medicaid Data Set. To provide a comprehensive analysis of trends in spinal orthosis utilization over a 12-year period. Widespread prescription of spinal orthosis persists, despite evidence suggesting equivocal efficacy in many spinal conditions. The utilization of spinal orthosis on a national level, including prescribing specialty data, has not been previously analyzed. Health care common procedure coding system codes for cervical (CO), thoracic-lumbar-sacral (TLSO), lumbar (LO), lumbar-sacral (LSO), and cervical-thoracic-lumbar-sacral (CTLSO) orthosis were used to determine spinal orthosis utilization from 2010 to 2021. Provider specialty codes were utilized to compare trends between select specialties. In addition, a neurosurgical CO analysis based on subclassifications of cervical bracing was performed. Linear trendlines were implemented to elucidate and present trends by slope (β). Among 332,241 claims, decreases in CO (β=-0.3387), TLSO (β=-0.0942), LO (β=-0.3485), and LSO (β=-0.1545) per 100,000 Medicare Part B enrollees and CTLSO (β=-0.052) per 1,000,000 Medicare Part B enrollees were observed. Decreases among neurosurgery (β=-7.9208), family medicine (β=-1.0097), emergency medicine (β=-2.1958), internal medicine (β=-1.1151), interventional pain management (β=-5.0945), and chiropractic medicine (β=-49.012), and increases among orthopedic surgery (β=5.5891), pain management (β=30.416), physical medicine and rehabilitation (β=4.6524), general practice (β=79.111), and osteopathic manipulative medicine (β=45.303) in total spinal orthosis use per 100,000 specialty claims were observed. Analysis of subclassifications of cervical orthosis among neurosurgeons revealed decreases in flexible (β=-1.7641), semirigid (β=-0.6157), and collar bracing (β=-2.7603), and an increase in multipost collar bracing (β=2.2032) per 100 neurosurgical cervical orthosis claims. While utilization of spinal orthosis decreased between 2010 and 2021, increased utilization was observed among a subset of specialties. Identifying these specialties allows for focused research and educational efforts to minimize unnecessary durable medical equipment use for effective health care spending.

Patterns of multispecialty care for low- and intermediate-risk prostate cancer in the use of active surveillance.

Multidisciplinary models of care have been advocated for prostate cancer (PC) to promote shared decision-making and facilitate quality care. Yet, how this model applies to low-risk disease where the preferred management is expectant remains unclear. Accordingly, we examined recent practice patterns in specialty visits for low/intermediate-risk PC and resultant use of active surveillance (AS). Using SEER-Medicare, we ascertained whether patients saw urology and radiation oncology (i.e., multispecialty care) versus urology alone, based on self-designated specialty codes, for newly diagnosed PC from 2010 to 2017. We also examined the association with AS, defined as the absence of treatment within 12 months of diagnosis. Time trends were analyzed using Cochran-Armitage test. Chi-squared and logistic regression analyses were applied to compare sociodemographic and clinicopathologic characteristics between these models of care. The proportion of patients seeing both specialists was 35.5% and 46.5% for low- and intermediate-risk patients respectively. Trend analysis showed a decline in multispecialty care in low-risk patients (44.1% to 25.3% years 2010-2017; P < 0.001). Between 2010 and 2017, the use of AS increased 40.9% to 68.6% (P < 0.001) and 13.1% to 24.6% (P < 0.001) for patients seeing urology and those seeing both specialists respectively. Age, urban residence, higher education, SEER region, co-morbidities, frailty, Gleason score, predicted receipt of multispecialty care (all P < 0.02). Uptake of AS among men with low-risk PC has occurred primarily under the purview of urologists. While selection is certainly at play, these data suggest that multispecialty care may not be required to promote the utilization of AS for men with low-risk PC.

Vascular Surgery Training Positions and Applicant 10-Year Trends with Consideration for Further Expansion

There is a significant shortage of vascular surgeons in the United States and projections for these practicing surgical specialists continue to worsen. Annual appraisal of our workforce recruitment and growth is imperative. Retrospective data were analyzed using the National Resident Matching Program from 2012-2022 applicant appointment years (specialty code for vascular surgery 450). Simple linear trend analysis was performed for the number of positions available and the number of applicants, stratified by fellowship or residency. Over the 10-year study period, the total vascular surgery trainee positions expanded from 161 to 202. Integrated residency positions increased (41 positions in 2012 vs. 84 in 2022) while available fellowship positions remained stagnant (120 in 2012 vs. 118 in 2022). Total applicants rose as well, from 213 to 311. In 2022, unmatched applicants have increased for both paradigms (25 fellowship and 84 residency applicants) and 100% of programs filled. On average, the number of residency positions offered increased by 4 each year (P<0.0001) and the number of fellowship positions increased by 0.5 each year (P=0.1617). The number of integrated residency applicants increased by approximately 9 per year (P=0.001), while the number of fellowships applicants increased by approximately 1.5 per year (P=0.121). Applicants for both vascular tracks have increased since 2012 indicating successful recruitment; however, all 2022 programs filled, leaving many applicants unmatched. Residency positions have continued to expand while fellowship positions have not. With the demonstrated surge among applicants, the disproportionate lack of increasing training positions, and the existing shortage of vascular surgeons, there is an urgency to meet the increasing demand. A concerted effort should be made toward adding additional residency and fellowship positions where feasible.

Military occupation and testicular germ cell tumour risk among US Air Force servicemen

ObjectivesTesticular germ cell tumours (TGCTs) are the most commonly diagnosed malignancy among active duty US military servicemen. Occupational risk factors may play a role in TGCT aetiology, although the evidence...

MAIN TRENDS IN RESEARCH OF TEMPOROMANDIBULAR JOINT PATHOLOGY IN UKRAINE

The multifactorial concept of the origin of temporomandibular disorders implies a multidisciplinary approach to the diagnosis, treatment, and prevention of this pathology. The aim of the work was to determine the main trends in the study of diagnosis and treatment of temporomandibular joint diseases in Ukraine. A content analysis of the results of scientific research in professional publications of Ukraine by specialty code 221 “Dentistry” for the period from 2017 to 2021 years on the etiology, pathogenesis, diagnosis, and treatment of temporomandibular joint diseases was carried out. During the state period, 55 scientific sources were identified and analyzed in accordance with the purpose of the research in 13 publications (9 literature reviews and 46 articles with the results of the author’s research). All publications by specialty were distributed as follows: orthopedic stomatology – 34 sources (61,8 %), orthodontics – 6 (10,9 %), surgical stomatology – 8 (14,6 %) and team research – 7 (12,7 %). According to the results of the analysis of the thematic materials in the professional journals of Ukraine, studies devoted to the development of a complex and interdisciplinary approach to the diagnosis and treatment of temporomandibular disorders prevail. The conducted content analysis of the results of scientific research determined that despite the active implementation of the latest technologies for the diagnosis and treatment of temporomandibular disorders, a number of issues in this field remain unsolved and require revision in the dental community and doctors of related specialties. Among the debatable issues is the use of questionnaires and classifications of temporomandibular joint diseases. In order to promote a broad discussion and exchange of scientific achievement, it is urgent, according to the researchers, to study the world experience of creating and using unified questionnaires, diagnostic protocols, and classifications of temporomandibular joint diseases. Also, research results need to be systematized and generalized to create practical recommendations for improving teamwork among doctors of various specialties and patient motivation.

Comparison of the Scope of Practice of the Army Combat Medic Specialist and Civilian National EMS Certification Levels

Introduction The transition of Army Combat Medic Specialists (Military Occupational Specialty Code: 68W) from military to civilian emergency medical services (EMS) is challenging, and the pathway is not clearly defined. Our objective was to evaluate the current military requirements for 68W and how they compare to the 2019 EMS National Scope of Practice Model (SoPM) for the civilian emergency medical technician (EMT) and advanced emergency medical technician (AEMT). Methods This was a cross-sectional evaluation of the 68W skill floor as defined by the Soldier’s Manual and Trainer’s Guide Healthcare Specialist and Medical Education and Demonstration of Individual Competence in comparison to the 2019 SoPM, which categorizes EMS tasks into seven skill categories. Military training documents were reviewed and extracted for specific information on military scope of practice and task-specific training requirements. Descriptive statistics were calculated. Results Army 68Ws were noted to perform all (59/59) tasks that coincide with the EMT SoPM. Further, Army 68W practiced above scope in the following skill categories: airway/ventilation (3 tasks); medication administration route (7 tasks); medical director approved medication (6 tasks); intravenous initiation maintenance fluids (4 tasks); and miscellaneous (1 task). Army 68W perform 96% (74/77) of tasks aligned with the AEMT SoPM, excluding tracheobronchial suctioning of an intubated patient, end-tidal CO2 monitoring or waveform capnography, and inhaled nitrous oxide monitoring. Additionally, the 68W scope included six tasks that were above the SoPM for AEMT; airway/ventilation (2 tasks); medication administration route (2 tasks); and medical director approved medication (2 tasks). Conclusions The scope of practice of U.S. Army 68W Combat Medics aligns well with the civilian 2019 Scope of Practice Model for EMTs and AEMTs. Based on the comparative scope of practice analysis, transitioning from Army 68W Combat Medic to civilian AEMT would require minimal additional training. This represents a promising potential workforce to assist with EMS workforce challenges. Although aligning the scope of practice is a promising first step, future research is needed to assess the relationship of Army 68Ws training with state licensure and certification equivalency to facilitate this transition.

Transformation of dental services from a governmental model to a revenue-generation model of operation in a tertiary care hospital: a health economics assessment.

Healthcare in Saudi Arabia is under transformation from a national free health service to a system paid either by insurance or governmental funds. This change will impact the model of operation including dental services. Estimate the revenue of the Department of Dentistry based on an insurance-based billing system. Medical record review SETTING: An academic tertiary care hospital in Riyadh PATIENT AND METHODS: Data on outpatient visits for the period 2015-2019 was extracted from the electronic health records. The billing data was categorized by specialty and current procedure terminology (CPT) code. The revenue stream for each CPT code was estimated and compared between the actual cost of service for each CPT code billed price, and average price of the market leaders in private practice. Revenue generated by the department. 339 421 outpatient visits for 22 056 patients. Female and males made 179 555 (52.9%) and 159 858 (47.1%) outpatient visits, respectively. Outpatient divided by the age groups: ≤14,15-65, >65 years were 58 868 (17.3%), 251 552 (74.1%), 29 001 (8.5%), respectively. The visits divided by specialty were as follows: general dentistry 28.1%, pedodontics 12.5%, orthodontics 7.1%, endodontics 7.0%, oral and maxillofacial surgery 6.9%, prosthodontics 4.4% and periodontics 3.3%. Outpatient visits to the nursing clinic and hygienist amounted to 30.7%. The median number of visits per patient per year was 5 (range, 1-63), which increased to 6 (range, 1-110) in 2019. The annual revenue plateaued in 2019 at 13 983 538 SAR (3 728 943 USD) with only a 2.2% of increase from 2018. Out of 292 CPT codes, 44.8% were priced below the actual cost. Moreover, 28.4% showed pricing below actual cost, but higher than the price of the market leaders. There was an annual loss of revenue of 10.1% due to incorrect pricing of CPT codes. Average productivity of the dentist and hygienist amounted to 2263 and 760 visits per year, respectively. There is a need for improvement in delivery of care, cost-containment, productivity and amendment of charge description master pricing. The sample did not include data from the period 2020-2022 due to the restriction of dental services due to the COVID-19 epidemic. None.

National Cost Comparisons Between Orthopaedics and Podiatry in Ankle Fracture Fixation

Category: Trauma; Ankle; Sports; Other Introduction/Purpose: Increasing overlap exists between surgical care provided by orthopedic foot and ankle surgeons and podiatrists. Use of either specialty depends on numerous factors including perceived costs. Unfortunately, large scale cost comparisons between the two are lacking. Such data is increasingly important given the current climate of payment reform and cost containment in healthcare. Using national Medicare claims data, we therefore aimed to compare per-case Medicare payments between orthopedic foot and ankle surgeons and podiatrists for ankle fracture fixation. We additionally aimed to describe any differences between groups that may drive differences in payments. Methods: This IRB-exempt retrospective study included patients undergoing either unimalleolar, bimalleolar, or trimalleolar ankle fracture repair as recorded in the national Medicare Limited Data Set (2013-2019). Type of surgeon (orthopedic foot and ankle surgeon or podiatric surgeon) was determined using publicly available healthcare provider taxonomy information available from the Washington Publishing Company ( www.wpc-edi.com ) and maintained by the National Uniform Claim Committee ( www.nucc.org ); crosswalks between Medicare Specialty Code and Provider Taxonomy are publicly available. The primary outcome was total Medicare payments specific to the procedure, as a surrogate for cost (inflation-adjusted to 2019 US dollars). Additionally, patient demographics and hospital characteristics were compared between groups to determine if any specific factors associated with costs may influence group differences. Univariable tests (chi-squared and t-tests; non-parametric tests where appropriate) assessed significance of group differences. Results: Overall, 16,927 unimalleolar; 17,244 bimalleolar; and 11,717 trimalleolar fracture repairs were included. Of these, orthopedic surgeons performed more procedures than podiatrists (86.7% vs 13.3% for uni-; 92.4% and 7.6% for bi-; 92.2% and 7.8% for trimalleolar fracture repairs respectively). The mean and median age (71.6 - 72.7 [70-71] years) as well as the mean and median Charlson-Deyo Comorbidity Index (0.6 - 0.7 [0]) did not significantly differ between patients treated by an orthopedic surgeon or podiatrist (p = 0.157 and p = 0.890 respectively). Regionally, podiatrists saw patients more often in the West and Midwest whereas providers in the South were more often orthopedic surgeons (p &lt; 0.001). Median procedure-specific Medicare payments for all three categories of ankle fracture repairs were significantly lower for orthopedic surgeons compared to podiatrists: $4,156 vs $4,300 for uni-, $4,205 vs $4,379 for bi-, and $4,396 vs $4,525 for trimalleolar, respectively (all p &lt; 0.001). Conclusion: In this analysis comparing Medicare payments between orthopedic foot and ankle surgeons and podiatrists we found that ankle fracture fixation procedures performed by the orthopedic surgeons were less expensive and that cost differences do not appear to be driven by patient characteristics. Additionally, we were able to discern geographic differences regarding practice location of both surgeon types. These data will inform future discussions on how to optimize costs of foot and ankle surgical care.

Machine Learning in Infectious Disease for Risk Factor Identification and Hypothesis Generation: Proof of Concept Using Invasive Candidiasis.

Machine learning (ML) models can handle large data sets without assuming underlying relationships and can be useful for evaluating disease characteristics, yet they are more commonly used for predicting individual disease risk than for identifying factors at the population level. We offer a proof of concept applying random forest (RF) algorithms to Candida-positive hospital encounters in an electronic health record database of patients in the United States. Candida-positive encounters were extracted from the Cerner HealthFacts database; invasive infections were laboratory-positive sterile site Candida infections. Features included demographics, admission source, care setting, physician specialty, diagnostic and procedure codes, and medications received before the first positive Candida culture. We used RF to assess risk factors for 3 outcomes: any invasive candidiasis (IC) vs non-IC, within-species IC vs non-IC (eg, invasive C. glabrata vs noninvasive C. glabrata), and between-species IC (eg, invasive C. glabrata vs all other IC). Fourteen of 169 (8%) variables were consistently identified as important features in the ML models. When evaluating within-species IC, for example, invasive C. glabrata vs non-invasive C. glabrata, we identified known features like central venous catheters, intensive care unit stay, and gastrointestinal operations. In contrast, important variables for invasive C. glabrata vs all other IC included renal disease and medications like diabetes therapeutics, cholesterol medications, and antiarrhythmics. Known and novel risk factors for IC were identified using ML, demonstrating the hypothesis-generating utility of this approach for infectious disease conditions about which less is known, specifically at the species level or for rarer diseases.

Rheumatologic inpatient treatment-more than a complex treatment : Data reflecting services and structures

Zur Bestandsaufnahme und Vorbereitung auf bevorstehende Reformen wurden Daten aus dem Institut für das Entgeltsystem im Krankenhaus(InEK)-Datenbrowser und den strukturierten Qualitätsberichten für die akutstationäre Rheumatologie ausgewertet. Die Versorgung ist sowohl in Bezug auf die Diagnosen als auch die Strukturen sehr vielschichtig. Unterschiedliche Formen der Spezialisierung können identifiziert werden. Dabei ist die rheumatologische Komplexbehandlung (RKB) nur eine davon, die im Mittel in knapp über 10 % der Fälle durchgeführt wird. 2020 gingen die Fallzahlen bei ausgewählten rheumatologischen Diagnosen um mehr als 20 % im Vergleich zu 2019 zurück. Bei der RKB war der Rückgang mit über 30 % noch ausgeprägter. Hinweise auf eine höhere Krankheitsschwere fanden sich in den verfügbaren Daten nicht. Es bleibt abzuwarten, ob das Fallzahlniveau der Vor-Corona-Zeit in den nächsten Jahren wieder erreicht wird. Es wurden 146 Organisationseinheiten (OE) mit mehr als 20 Hauptdiagnosen (HD) einer rheumatoiden Arthritis (RA) im Jahr 2019 identifiziert; 47 (32 %) davon haben mehr als 10-mal, 29 (20 %) mehr als 100-mal eine RKB kodiert. Alle 23 OE mit mehr als 300 HD RA sind Mitglieder im Verband rheumatologischer Akutkliniken (VRA); 15 davon nahmen am KOBRA-Qualitätsprojekt teil und tragen das VRA-Gütesiegel. Von den 116 internistischen OE weisen nur 55 (47 %) einen spezifischen rheumatologischen Fachabteilungsschlüssel nach § 301 SGB V auf. Angaben zur fachärztlichen Ausstattung waren zum Teil widersprüchlich. Wie viele Fälle mit entzündlich-rheumatischen Erkrankungen in fachlich spezialisierten Strukturen behandelt werden, kann mit den verfügbaren Daten nicht beantwortet werden. Dennoch können die verfügbaren Daten für die fachlichen, strukturellen und organisatorischen Weiterentwicklungen in der akutstationären Rheumatologie genutzt werden.

Patterns and outcomes of neurosurgery in England over a five-year period: A national retrospective cohort study

BackgroundNeurosurgical practice has seen major changes over several decades. There are no recent evaluations of national neurosurgical practice. The aim of this observational study was to describe neurosurgical practice in England and to use outcomes to assess and benchmark the quality of care in neurosurgery. Material and methodsThis national retrospective cohort study analysed Hospital Episode Statistics (HES) data from April 2013 to March 2018 for all adult admissions with a specialty code for neurosurgery. The epidemiology of patients and RCS Charlson comorbidities were derived and procedure incidence rates per 100,000 person-years calculated. Post-operative outcomes for elective and non-elective patients included: median length of stay, the proportion of patients requiring additional inpatient neurosurgical procedures, the proportion of patients discharged to their usual address, and in-hospital mortality rates. ResultsDuring the 5-year study period, there were 371,418 admissions to neurosurgery. The proportion of admissions involving a neurosurgical procedure was 77.3% (n = 287,077). Of these, 45% were for cranial surgery and 37% for spinal. Overall, 68.3% were elective procedures. The incidence rates of most procedures were low (<20 per 100,000 person-years). Following elective neurosurgical procedures, in-hospital mortality rates for cranial and spinal surgery were 0.5% (95% CI, 0.5–0.6) and 0.1% (95% CI, 0.04–0.1), respectively. After non-elective neurosurgery, mortality rates were 7.4% (95% CI, 7.2–7.6) and 1.3% (95% CI, 1.2–1.5) for cranial and spinal surgery, respectively. Approximately 1 in 4 patients had additional procedures following non-elective cranial surgery (24%; 95% CI, 23.6–24.3). Outcomes were highly variable across different subspecialty areas. ConclusionsThe incidence rates of neurosurgical procedures are low within England, and neurosurgical units have a high volume of non-surgical admissions. In-hospital mortality rates after elective neurosurgery are low but there may be opportunities for quality improvement programmes to improve outcomes for non-elective surgery as well as ensuring equitable access to treatment.

Occupational Therapy Service Delivery Among Medicaid-Enrolled Children and Adults on the Autism Spectrum and With Other Intellectual Disabilities.

Rates of occupational therapy service utilization among people with autism spectrum disorder (ASD) or intellectual disability (ID) have not been explored in population-based samples. To describe occupational therapy services delivered to Medicaid-eligible persons younger than age 65 yr identified as having ASD, ID, or both and to evaluate demographic factors associated with occupational therapy service utilization in this population. Retrospective, case-control, cohort study using claims records from Medicaid Analytic eXtract files (2009-2012). Data from all 50 states and Washington, DC. Beneficiaries identified as having ASD only, ASD+ID, or ID only who were younger than age 18 yr (N = 664,214) and ages 18-64 yr (N = 702,338). Outcomes and Measures: We analyzed Current Procedural Terminology® and Healthcare Common Procedure Coding System procedure codes, Medicaid Statistical Information System type of service codes, and Center for Medicare & Medicaid Services provider specialty codes. Only 3.7% to 6.3% of eligible adult beneficiaries received occupational therapy; in contrast, 20.5% to 24.2% of children received occupational therapy. Significant predictors of service use varied by group; however, differences by race-ethnicity, eligibility on the basis of poverty, and geographic location were observed. Among children, the most frequent billing code was for "therapeutic activities" (43%-60%); among adults, it was "community/work reintegration training" (29%-39%). Billed procedure code patterns do not consistently reflect the unique occupational focus that occupational therapy providers deliver to people with developmental disabilities. Disparities in occupational therapy receipt warrant further attention to understand the social and structural factors affecting service delivery. What This Article Adds: Occupational therapy services paid for by Medicaid are used more frequently by children with ASD and ID than by adults with these diagnoses. Greater understanding of the intersectional factors that drive service delivery and disparities is needed.

National medicare trends in the utilization of fMRI

PurposeWe aim to assess the functional magnetic resonance (fMRI) utilization trends among the Medicare population from 2007-2018. Materials and methodsMedicare Part B Physician/Supplier Procedure Summary master files from 2010-2018 and Part B National Summary Data Files from 2007-2018 were analyzed for all Current Procedural Terminology, version 4 (CPT-4) codes related to fMRI (70554, 70555, and 96020). The files provided total procedure volume and Medicare payments. Medicare specialty codes were used to determine provider specialty. Medicare place-of-service codes were used to identify locations where services were provided. ResultsThe total utilization rate and payment of functional neuroradiology services within the Medicare population increased by 192% and 216% from 2007 to 2018, respectively. Volume, utilization, and payments peaked in 2014, with a 278% utilization rate increase since 2007. This peak is mainly attributable to neurologists holding a significant growth and the majority share of CPT code 96020 claims (neuro-functional testing selection and administration during noninvasive imaging) during 2013-2014.Neurologists' share was 61% in 2014, under 96020 claims. In 2018, radiologists and psychologists (59% and 40% respectively) most contributed to the 96020 claims, and neurologists' share bottomed at 1%.Radiologists consistently hold more than a 90% share of CPT code 70554/70555 claims (functional brain MRI without/with physician or psychologist administration) for the past decade. There has been a steady rise of services at inpatient fMRI. ConclusionThe utilization of fMRI has increased mainly due to introducing the CPT codes, and radiologists are the largest provider specialty.

Associations of SARS-CoV-2 serum IgG with occupation and demographics of military personnel.

BackgroundCountries across the globe have mobilized their armed forces in response to COVID-19, placing them at increased risk for viral exposure. Humoral responses to SARS-CoV-2 among military personnel serve as biomarkers of infection and provide a basis for disease surveillance and recognition of work-related risk factors.MethodsEnzyme-linked immunosorbent assays (ELISA) were used to measure SARS-CoV-2 spike antigen-specific IgG in serum obtained from N = 988 US National Guard soldiers between April-June 2020. Occupational information, e.g. military operating specialty (MOS) codes, and demographic data were obtained via questionnaire. Plaque assays with live SARS-CoV-2 were used to assess serum neutralizing capacity for limited subjects (N = 12).ResultsThe SARS-CoV-2 IgG seropositivity rate among the study population was 10.3% and significantly associated with occupation and demographics. Odds ratios were highest for those working in MOS 2T-Transportation (3.6; 95% CI 0.7–18) and 92F-Fuel specialist/ground and aircraft (6.8; 95% CI 1.5–30), as well as black race (2.2; 95% CI 1.2–4.1), household size ≥6 (2.5; 95% CI 1.3–4.6) and known COVID-19 exposure (2.0; 95% CI 1.2–3.3). Seropositivity tracked along major interstate highways and clustered near the international airport and the New York City border. SARS-CoV-2 spike IgG+ serum exhibited low to moderate SARS-CoV-2 neutralizing capacity with IC50s ranging from 1:15 to 1:280. In limited follow-up testing SARS-CoV-2 serum IgG levels remained elevated up to 7 months.ConclusionsThe data highlight increased SARS-CoV-2 seroprevalence among National Guard vs. the local civilian population in association with transportation-related occupations and specific demographics.

Referral patterns for gynecologic oncology consultation

Objectives: To identify delays in access to gynecologic oncology (GO) consultation through a detailed characterization of patients’ interactions with the healthcare system prior to GO evaluation. Methods: Medical records of 50 consecutive patients were reviewed from each of 6 academic cancer centers beginning in January, 2018. Clinical and demographic characteristics were abstracted with dates of: first evaluation, testing ordered, testing resulted, diagnosis, referral, and treatment. Degree, specialty, and clinic ZIP code were collected from providers referring to GO, as well as up to two providers previously evaluating the patient for the same complaint (Figure). Primary outcomes were 1) total time in healthcare for a complaint prior to GO referral; 2) first evaluation by referrer #1 to GO referral; and 3) GO referral to treatment start. Intervals >1 year were preliminarily excluded, pending case review. Chi-square and Kruskal-Wallis tests were used for groupwise comparisons of categorical and continuous variables, respectively. Results: 300 cases were analyzed. Mean age was 57.8 years (SD 14.7); patients were predominantly White (77.5%), or Black (17.2%); 89.1% were non-Hispanic. Primary disease sites were uterine corpus (45.8%), ovary (31%), cervix (12.9%) and vulva (5.5%). Final pathology was malignant in 61.9% of cases, borderline/hyperplastic/dysplastic in 13.5%, and benign/unknown in 24.5%.5 patients (1.6%) were evaluated by 3 providers before GO referral; 74 (24%) by 2 providers, and 227 (74%) by 1 provider. GO referral was commonly initiated by OB/GYN (71%), family medicine (9%) and internal medicine (6%). Mean time from first healthcare encounter to GO evaluation was 50.6 days (SD=65); time from first evaluation by referrer #1 to GO referral was 26.8 days (SD=46.8). The longest average interval identified was between first evaluation and diagnostic testing by referrer #1; mean=21.8 days, (SD=48.4). Mean time from GO referral to treatment initiation was 20.7 days (SD=27.5) Mean distance from residence to GO was 41.0 miles (SD=53.7), and was >50mi in 27.8% of all cases. Patients evaluated by 3 providers spent substantially more time in the healthcare system than those evaluated by 1 or 2 providers prior to GO referral (mean 91.0 vs 49.6 and 50.8 days, respectively; p 50 miles compared to patients residing Download : Download high-res image (40KB) Download : Download full-size image Conclusions: We identified two areas amenable to intervention to improve access to GO consultation. First, patients residing >50 miles from the nearest GO experienced delays in treatment. Interventions, including telemedicine, should be developed to address this geographic disparity in care. Second, there was substantial variation in time between patients’ initial evaluation and diagnostic testing by the referring provider. Educational and systems interventions are needed to ensure that signs and symptoms of gynecologic cancers are evaluated appropriately.

Abstract No. 233 Practice patterns in the United States for ablation of osseous tumors using Medicare claims analysis

To describe national practice trends in bone radiofrequency ablation (RFA) and cryoablation for osseous lesions by physician specialty and site-of-service from 2015 to 2018. This study used data from the US Centers for Medicare and Medicaid Services public use files for 2015 to 2018. Current Procedural Terminology (CPT) codes for bone RFA (20982) and cryoablation (20983) were analyzed. Based on the specialty code, the specialty was sorted into five categories: radiology (diagnostic and interventional), orthopedic surgery, neurosurgery, pain management (pain management, anesthesiology, physical medicine and rehabilitation, and interventional pain management), and all others. Annual volume of billed services was additionally evaluated by site of service (inpatient, outpatient, office-based). Aggregate claims dramatically increased from 2015 to 2018. The enrollment adjusted overall growth averaged 45.2% year-over-year, strongly driven by growth in RFA. Annual market share for radiology decreased slightly from 80.6% to 73.3% with neurosurgery making the largest gain, increasing from 4.7% to 11.3% from 2015 to 2018. Clinical site-of-service analysis demonstrated that outpatient is the main site-of-service for ablation (62.7% cumulatively from 2015 to 2018). Growth rates of outpatient and inpatient services are about the same over this time. There has been significant growth in osseous ablation between 2015 and 2018, with the growth dominated by radiology, although the overall growth rate and the market share of radiology are declining as the growth is outstripped by neurosurgery and orthopedics. Further consideration of these trends will be important for interventional radiologists to assure their involvement and expertise in ablation procedures.

Abstract No. 553 The growth of clinical interventional radiology: increasing interventional radiology evaluation and management charges over time

To determine whether interventional radiology (IR) evaluation and management (E&M) charges have increased and to compare with charges from vascular surgery (VS) E&M claims were compared for IR and vascular surgery (VS) using the Medicare Physician Supplier Procedure Summary Master Files 2010 to 2018. IR and VS were identified by specialty codes. E&M was defined by relevant CPT codes. The number of E&M claims per year per 100,000 Medicare beneficiaries and E&M as a percentage of all Medicare charges were compared for each specialty using linear regression modeling. Subgroup analysis by practice setting (inpatient vs. outpatient) and patient type (new vs. established patient) was performed for IR. Between 2010 and 2018, IR E&M encounters increased from 177 to 412 claims per 100,000 beneficiaries (+133%, P < 0.001, R2 = 0.94). VS E&M encounters increased from 4954 claims per 100,000 beneficiaries to 5373 claims per 100,000 beneficiaries (+8%, P = 0.005, R2 = 0.71). E&M accounted for 1.9% of IR Medicare revenue in 2010 and increased to 2.7% in 2018 (40% relative increase). E&M declined from 7.6% of VS Medicare revenue in 2010 to 5.1% in 2018 (33% relative decrease). For IR, E&M growth was higher for outpatients (+178%) vs. inpatients (+25%) and established patients (+138%) vs. new patients (+122%). Driven primarily by outpatient and established patient encounters, IR E&M claims more than doubled between 2010 and 2018, implying that more IRs are embracing a longitudinal care model that involves pre- and post-procedure outpatient evaluations. Although IR E&M revenue was lower than VS, the rate of increase in E&M revenue was much greater for IR than VS.