Tier Ranking Research Articles

Chinese city tier ranking scheme as special spatial factor of innovations diffusion

Chinese city tier ranking scheme as special spatial factor of innovations diffusion

Tiered Physician Network Plans and Patient Choices of Specialist Physicians

Tiered physician network (TPN) health plans sort physicians into tiers based on their cost and quality, and patients pay lower copays for visits with physicians in the lower-cost and better-quality tiers. When the plans are first introduced, they lead patients to seek care from higher-value physicians. To examine whether TPNs are associated with patient choice of physician when the plans have been in place for 8 to 12 years and whether there are inequities in patient out-of-pocket costs associated with inequities in access to physicians in lower-copay tiers. This cross-sectional study comprising 46 645 physicians and 585 399 patients in TPNs, including 54 683 patients who had a new patient visit with a physician in a TPN, used health insurance claims data from a large employer purchaser from July 1, 2014, to June 30, 2019. Statistical analysis was performed from November 2020 to August 2023. Evaluation and management visit with a physician in a TPN. Main outcomes were new patient market share per physician-carrier-zip code-year, distance from centroid of patient zip code to centroid of zip code of nearest low- or medium-copay physician, and mean TPN physician office visit copay per patient. A regression discontinuity design was used to estimate the association of a physician's tier ranking, and a difference-in-differences analysis was used to estimate the association of copayment differences across tiers with market share among new patients. Equity in access was measured by comparing travel distance to the nearest physician in a low-copay or medium-copay tier and mean copayments across patient incomes. The main analysis sample included 46 645 physician-carrier-zip code-year observations, 9506 (20.4%) of which were in the low-copay tier, 31 798 (68.2%) in the medium-copay tier, and 5341 (11.5%) in the high-copay tier. The 54 683 new patients in the sample had a mean (SD) age of 46.4 (16.7) years and included 33 542 women (61.3%). There was no association of having a worse tier ranking (0.045 percentage points [95% CI, -0.058 to 0.148 percentage points]) or of copayment differences between tiers (0.001 percentage points [95% CI, -0.002 to 0.004 percentage points]) with physician market share among new patients. The patients with the lowest income paid slightly lower mean (SD) copayments for office visits to a TPN physician than the patients with high income ($48.08 [$16.42] vs $51.59 [$16.79], a 6.8% difference). In this cross-sectional study of TPN health plans, there was no association between physician tier ranking and physician market share among any group of patients. These findings suggest there are limitations in TPNs' steering of patients toward high-value physicians. These plans were not associated with exacerbated health inequity in this setting.

Faculty Scoring of General Surgery Residency Interviewees: A Comparison of In-Person and Virtual Interview Formats

With new rules regarding social distancing and non-essential travel bans, we sought to determine if faculty scoring of general surgery applicants would differ between the in-person interview (IPI) and virtual interview (VI) platforms. A single institution, retrospective review comparing faculty evaluation scores of applicant interviewees in the 2019 and 2020 MATCH® application cycles (IPIs) and the 2021 and 2022 application cycle (VIs) was conducted. Faculty scored applicants using a 5-point Likert scale in 7 areas of assessment and assigned each student to 1 of 4 tiers (tier 1 highest). A composite score for the 7 assessments (maximum score 35) was calculated. Mean and composite scores and tiers were compared between VI and IPI cycles and adjusted for within-interviewer correlations. The variance of the 2 groups were also compared. Harbor-UCLA Medical Center, an academic, tertiary care hospital. General Surgery applicants for the 2019 to 2022 MATCH® application cycles. Four hundred forty-one faculty IPI ratings of General Surgery applicants were compared to 531VI ratings. No difference in mean composite scores, individual assessments, or tier ranking. Less variance was identified in the VI group for academic credentials (0.6 vs 0.6, p = 0.01), strength of letters (0.7 vs 0.4, p = 0.005), communication skills (0.4 vs 0.6, p = 0.01), personal qualities (0.2 vs 0.5, p = 0.02), overall sense of fit for program (0.6 vs 0.9, p = 0.01), and tier ranking (0.3 vs 0.4, p = 0.004). Faculty ratings of General Surgery applicants in the VI format appear to be similar to IPI. However, faculty ratings of VI applicants demonstrated less variability in scores in most assessments. This finding is potentially concerning, as it may suggest an inability of VI to detect subtle differences between applicants as comparted to IPI.

Empirical Analysis of the US State Department’s Annual Trafficking in Persons Report – Insights for Policy-Makers

ABSTRACT The State Department’s annual Trafficking in Persons (TIP) Report is the U.S. Government’s principal diplomatic tool to engage foreign governments on human trafficking. Each year, the report evaluates efforts to counter human trafficking, assigning each country to a tier level. We evaluate the relative role of various factors predictive of tier-level assignments, including (a) legislated changes to the ranking system, (b) party to the Palermo Protocol, (c) reported numbers of convictions, prosecutions, and identified victims, (d) independent estimates of prevalence, and (e) sample indicators of governance and economic development. We use singular-value decomposition to identify the relative influence among multiple inter-related factors across a matrix of tier rankings for twelve years and 189 nations. Our analysis indicates that investments in democratic institutions and individual rights may be significantly more influential than law enforcement, and the traditional economic theory for TIP vulnerability may be an oversimplification. Most significantly, the large number of attributes with small but statistically significant correlations with TIP tier levels confirms that TIP has many causal relationships. We affirm the need for Countering TIP (CTIP) strategies to apply an ecosystem approach with geographically targeted interventions consistent with Situational Crime Prevention.

Accounting PhD Programs in the United States

As Department Chairperson at The University of Texas at El Paso, I am often asked for advice regarding how to become an accounting professor. Recently, the University attained R1 designation in the Carnegie Classification of Institutions of Higher Education, which indicates top tier doctoral university status with very high research activity (“UTEP Attains National Research Top Tier Ranking”, 2019). This means UTEP is among 4.5%, 130 out of 2,883 universities, of four-year higher education institutions across the United States to earn this R1 distinction (“UTEP Attains National Research Top Tier Ranking”, 2019). This emphasis on research, UTEP’s mission surrounding Access and Excellence, and my own path to becoming an accounting professor were the catalyst behind an editorial geared towards international students interested in exploring a Ph.D. in the United States. We believe the role of an accounting professor is comprised of: 1.) enriching the global business and accounting community through research contributions, 2.) facilitating career readiness to students seeking higher education, and 3.) serving as an ambassador and advocate for students, programs, profession, and research. We hope this editorial helpful and we encourage you to create your own success story.

Social preferences of future physicians

We measure the social preferences of a sample of US medical students and compare their preferences with those of the general population sampled in the American Life Panel (ALP). We also compare the medical students with a subsample of highly educated, wealthy ALP subjects as well as elite law school students and undergraduate students. We further associate the heterogeneity in social preferences within medical students to the tier ranking of their medical schools and their expected specialty choice. Our experimental design allows us to rigorously distinguish altruism from preferences regarding equality-efficiency tradeoffs and accurately measure both at the individual level rather than pooling data or assuming homogeneity across subjects. This is particularly informative, because the subjects in our sample display widely heterogeneous social preferences in terms of both their altruism and equality-efficiency tradeoffs. We find that medical students are substantially less altruistic and more efficiency focused than the average American. Furthermore, medical students attending the top-ranked medical schools are less altruistic than those attending lower-ranked schools. We further show that the social preferences of those attending top-ranked medical schools are statistically indistinguishable from the preferences of a sample of elite law school students. The key limitation of this study is that our experimental measures of social preferences have not yet been externally validated against actual physician practice behaviors. Pending this future research, we probed the predictive validity of our experimental measures of social preferences by showing that the medical students choosing higher-paying medical specialties are less altruistic than those choosing lower-paying specialties.

Validity and reliability of an application review process using dedicated reviewers in one stage of a multi-stage admissions model

IntroductionWith increased emphasis placed on non-academic skills in the workplace, a need exists to identify an admissions process that evaluates these skills. This study assessed the validity and reliability of an application review process involving three dedicated application reviewers in a multi-stage admissions model. MethodsA multi-stage admissions model was utilized during the 2014–2015 admissions cycle. After advancing through the academic review, each application was independently reviewed by two dedicated application reviewers utilizing a six-construct rubric (written communication, extracurricular and community service activities, leadership experience, pharmacy career appreciation, research experience, and resiliency). Rubric scores were extrapolated to a three-tier ranking to select candidates for on-site interviews. Kappa statistics were used to assess interrater reliability. A three-facet Many-Facet Rasch Model (MFRM) determined reviewer severity, candidate suitability, and rubric construct difficulty. ResultsThe kappa statistic for candidates’ tier rank score (n = 388 candidates) was 0.692 with a perfect agreement frequency of 84.3%. There was substantial interrater reliability between reviewers for the tier ranking (kappa: 0.654–0.710). Highest construct agreement occurred in written communication (kappa: 0.924–0.984). A three-facet MFRM analysis explained 36.9% of variance in the ratings, with 0.06% reflecting application reviewer scoring patterns (i.e., severity or leniency), 22.8% reflecting candidate suitability, and 14.1% reflecting construct difficulty. Discussion and conclusionsUtilization of dedicated application reviewers and a defined tiered rubric provided a valid and reliable method to effectively evaluate candidates during the application review process. These analyses provide insight into opportunities for improving the application review process among schools and colleges of pharmacy.

Abstract 2598: Paradigm to ensure curation transparency and consistency of a cancer genomic database - the JAX Clinical Knowledgebase (CKB)

Abstract In the era of personalized medicine, comprehensive cancer genomic databases represent critical tools for interpreting gene variants and their relevant therapies. As the number of cancer genomic databases grow, it is challenging for users to compare and assess the data integrity and validity of such databases. The lack of disclosure of curation processes makes it difficult to cross reference different databases. The JAX Clinical Knowledgebase (CKB) is a comprehensive relational database providing evidence-based information on gene variants, targeted therapies, efficacy evidence, and clinical trials. At the Jackson Laboratory for Genomic Medicine, we have developed a curation paradigm to ensure curation transparency and consistency of the JAX-CKB. First, to ensure standardization of nomenclature, we have integrated standard nomenclature and ontologies, including HGNC approved nomenclatures for genes, HGVS guidelines for variants, and the Disease Ontology for indications/tumor types. Second, we implemented decision matrices to maintain uniformity of our evaluation of scientific and clinical data. For example, evaluation of the effect of gene variants on protein function is solely based on changes in the intrinsic activity of the protein instead of downstream pathway activation or the effects on pathogenesis; the response type of gene variants to therapies are classified based on the evidence of targeting specificity; and the efficacy evidence are further classified as actionable, diagnostic, prognostic, risk factor, emerging, or not active centered on the response type and the strength of the evidence. Third, to provide convenient evaluation of the clinical relevance of efficacy data, we further developed a tier ranking system based on emerging consensus guidelines, which takes response type, evidence type, and approval status into consideration. Finally, all decision matrices are clearly outlined on the JAX-CKB open access website for users’ reference. In summary, we have curated a highly structured and semantically consistent cancer genomic database following a set of specific curation guidelines. As a result, JAX-CKB open access has become a valuable resource for both the clinical and research communities, and is utilized by numerous independent groups for variant interpretation. Citation Format: Taofei Yin, Sara E. Patterson, Cara M. Statz, Anuradha Lakshminarayana, Daniel Durkin, Susan M. Mockus. Paradigm to ensure curation transparency and consistency of a cancer genomic database - the JAX Clinical Knowledgebase (CKB) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2598. doi:10.1158/1538-7445.AM2017-2598

A tiered model of substance use severity and life complexity: Potential for application to needs-based planning

ABSTRACTBackground: In order to improve long-term outcomes for individuals with substance use problems, one approach is to adopt a system planning model that considers both addiction severity and life complexities. The tiered approach has been developed and tested to describe systems-level need based on levels of risk and problem severity. Methods: An existing tiered model was modified to accommodate Australian data, incorporating substance use severity and life complexity. The hypothesis was that tiers would reflect differences in well-being amongst help seekers such that an increase in tier would be associated with a reduction in well-being, suggesting the need for more intensive (and integrated) interventions. The model was tested using 2 data sets of screening data, collected from face-to-face alcohol and other drug (AOD) service (n = 430) and online help (n = 309) seekers, drawn from a larger sample of 2,766 screens. The screen included demographic information and substance use, mental health, and quality of life measures. Results: There was a significant relationship between well-being and tier ranking, suggesting that the model adequately captured elements of severity and complexity that impact on well-being. There were notable differences between the help-seeking populations with a higher proportion of online respondents allocated to lower tiers and more face-to-face respondents allocated to higher tiers. However, there was an overlap in these populations, with more than half of online respondents classified as higher tiers and one fifth of face-to-face respondents classified as lower tiers. This suggests that the model can be used both to assess unmet need in out-of-treatment groups and demand in the absence of dependence in a subpopulation of the face-to-face treatment population. Conclusions: The tiered model provides a method to understand levels of AOD treatment need and, as part of needs-based planning, may be used to optimize treatment responses and resourcing.

The Trafficking in Persons Report: a game of risk

The State Department ranks countries on adherence to minimum standards set forth by the Trafficking Victims Protection Act 2000. The Trafficking in Persons Report (TIP) is updated annually and failure to enact changes to combat trafficking results in higher tier rankings. This paper evaluates the TIP by situating this tool in light of special features of the modern era, such as globalization and risk. Through a survey of the theoretical literature on risk and on trafficking risk factors, we devise six preliminary risk clusters and discuss how the TIP could incorporate governments’ response to trafficking risk factors into the ranking system. Our intentions are to spark debate about how risk factors could be incorporated in the TIP, to provide a preliminary model and to encourage further research in this area.

A Principal Components Analysis Of The U.S. News & World Report Tier Rankings Of National Liberal Arts Colleges

<p class="MsoNormal" style="text-align: justify; margin: 0in 37.8pt 0pt 0.5in;"><span style="font-family: "CG Times","serif"; font-size: 10pt; mso-bidi-font-style: italic;">Analyzing the relative contribution of eleven ranking criteria used to construct the 1999 </span><strong><span style="font-family: "CG Times","serif"; font-size: 10pt;">U.S. News & World Report</span></strong><span style="font-family: "CG Times","serif"; font-size: 10pt; mso-bidi-font-style: italic;"> (</span><span style="font-family: "CG Times","serif"; font-size: 10pt;">USNWR)<span style="mso-bidi-font-style: italic;"> tier rankings of national universities, Webster (2000) found by utilizing principal components analysis the actual contributions differed significantly from the explicit USNWR weighting scheme.<span style="mso-spacerun: yes;">  </span>This difference was due to the presence of severe and pervasive multicollinearity.<span style="mso-spacerun: yes;">  </span>Although </span>USNWR<span style="mso-bidi-font-style: italic;"> assigns the greatest explicit weight to academic reputation, Webster found that the most significant ranking criterion was average SAT (Scholastic Aptitude Test) scores of enrolled students. This paper extends Webster's study to the </span>USNWR<span style="mso-bidi-font-style: italic;"> tier rankings of national liberal arts colleges.<span style="mso-spacerun: yes;">  </span>The results of this study reinforces Webster's findings about the importance of academically related ranking criteria, although academic reputation appears to carry greater weight for national liberal arts colleges than for national universities.</span></span></p>

The Efficacy of the Trafficking in Persons Report

Anti-trafficking efforts have been adopted globally to curb human trafficking, yet many nations have failed to put initiatives into practice. As a consequence, the U.S. Department of State implemented the Trafficking in Persons (TIP) Report to monitor and increase efforts worldwide and serve as a guide to funding anti-trafficking programs aboard. This exploratory study investigates the efficacy of this policy initiative by means of a longitudinal assessment of the TIP Report’s tier classifications, a system that grades countries based on anti-trafficking initiatives, and determines if U.S. funded anti-trafficking initiatives internationally target those countries in need. The findings suggest that tier ranking has not improved over time, and the United States has failed to systematically allocate funds based on the recommendations of the tier classification system. Policy recommendations and implications for future research are discussed.

Physician tiering by health plans in Massachusetts.

Physician tiering is an emerging health-care strategy that purports to grade physicians on the basis of cost-efficiency and quality-performance measures. We investigated the consistency of tiering of orthopaedic surgeons by examining tier agreement between health plans and physician factors associated with top-tier ranking. Health plan tier, demographic, and training data were collected on 615 licensed orthopaedic surgeons who accepted one or more of three health plans and practiced in Massachusetts. We then computed the concordance of physician tier rankings between the health plans. We further examined the factors associated with top-tier ranking, such as malpractice claims and socioeconomic conditions of the practice area. The concordance of physician tiering between health plans was poor to fair (range, 8% to 28%, κ = 0.06 to 0.25). The percentage of physicians ranked as top-tier varied widely among the health plans, from 21% to 62%. Thirty-eight percent of physicians were not rated top-tier by any of the health plans, whereas only 5.2% of physicians were rated top-tier by all three health plans. Multivariate analysis showed that board certification, accepting Medicaid, and practicing in a suburban location were the independent factors associated with being ranked in the top tier. More years in practice or fewer malpractice claims were not related to tier. Current methods of physician tiering have low consistency and manifest evidence of geographic and demographic biases.

Citation analysis and peer ranking of Australian social science journals

Citation analyses were performed for Australian social science journals to determine the differences between data drawn from Web of Science and Scopus. These data were compared with the tier rankings assigned by disciplinary groups to the journals for the purposes of a new research assessment model, Excellence in Research for Australia (ERA), due to be implemented in 2010. In addition, citation-based indicators including an extended journal impact factor, the h-index, and a modified journal diffusion factor, were calculated to assess whether subsequent analyses influence the ranking of journals. The findings suggest that the Scopus database provides higher number of citations for more of the journals. However, there appears to be very little association between the assigned tier ranking of journals and their rank derived from citations data. The implications for Australian social science researchers are discussed in relation to the use of citation analysis in the ERA.

A principal component analysis of the U.S. News & World Report tier rankings of colleges and universities

This paper utilizes principal component regression analysis to examine the relative contributions of 11 ranking criteria used to construct the U.S. News & World Report (USNWR) tier rankings of national universities. The main finding of this study is that the actual contributions of the 11 ranking criteria examined differ substantially from the explicit USNWR weighting scheme because of severe and pervasive multicollinearity among the ranking criteria. USNWR assigns the greatest weight to academic reputation. However, generated first principal component eigenvalues of tier rankings indicate that the most significant ranking criterion is the average SAT scores of enrolled students. This result is significant since admission requirements are policy variables that indirectly affect, for example, admission applications, yields, enrollment, retention, tuition-based revenues, and alumni contributions.

Rating Journals in Health Care Administration

The perceived quality of a journal is often a heavily weighted factor in the appraisal of faculty performance. We developed a listing of 53 prominent journals in the field of health care administration and surveyed the chairpersons of the 52 accredited graduate programs in the United States, Canada, and Puerto Rico, asking each to rate the level of achievement of a faculty member who published in each journal. Using the chi-square goodness-of-fit method for a multinomial experiment, we were able to identify six distinct "tiers" of journals and show a relationship between the subject category of a journal and its tier ranking. The implications of the study findings for faculty members are addressed, followed by a discussion of the data limitations and suggestions for future research.