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[PMID]:27207355
[Au] Autor:Asai Y; Tan J; Baibergenova A; Barankin B; Cochrane CL; Humphrey S; Lynde CW; Marcoux D; Poulin Y; Rivers JK; Sapijaszko M; Sibbald RG; Toole J; Ulmer M; Zip C
[Ad] Endereço:Division of Dermatology, Queen's University, Kingston, ON, Canada.
[Ti] Título:Canadian Clinical Practice Guidelines for Rosacea.
[So] Source:J Cutan Med Surg;20(5):432-45, 2016 Sep.
[Is] ISSN:1615-7109
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Rosacea is a chronic facial inflammatory dermatosis characterized by background facial erythema and flushing and may be accompanied by inflammatory papules and pustules, cutaneous fibrosis and hyperplasia known as phyma, and ocular involvement. These features can have adverse impact on quality of life, and ocular involvement can lead to visual dysfunction. The past decade has witnessed increased research into pathogenic pathways involved in rosacea and the introduction of novel treatment innovations. The objective of these guidelines is to offer evidence-based recommendations to assist Canadian health care providers in the diagnosis and management of rosacea. These guidelines were developed by an expert panel of Canadian dermatologists taking into consideration the balance of desirable and undesirable outcomes, the quality of supporting evidence, the values and preferences of patients, and the costs of treatment. The 2015 Cochrane review "Interventions in Rosacea" was used as a source of clinical trial evidence on which to base the recommendations.
[Mh] Termos MeSH primário: Anti-Infecciosos/uso terapêutico
Fármacos Dermatológicos/uso terapêutico
Rosácea/diagnóstico
Rosácea/terapia
[Mh] Termos MeSH secundário: Consenso
Ácidos Dicarboxílicos/uso terapêutico
Doxiciclina/uso terapêutico
Oftalmopatias/tratamento farmacológico
Oftalmopatias/etiologia
Seres Humanos
Terapia de Luz Pulsada Intensa
Isotretinoína/uso terapêutico
Ivermectina/uso terapêutico
Terapia a Laser
Metronidazol/uso terapêutico
Discrepância de GDH
Guias de Prática Clínica como Assunto
Rosácea/complicações
Tetraciclina/uso terapêutico
[Pt] Tipo de publicação:CONSENSUS DEVELOPMENT CONFERENCE; JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Anti-Infective Agents); 0 (Dermatologic Agents); 0 (Dicarboxylic Acids); 140QMO216E (Metronidazole); 70288-86-7 (Ivermectin); EH28UP18IF (Isotretinoin); F2VW3D43YT (azelaic acid); F8VB5M810T (Tetracycline); N12000U13O (Doxycycline)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170714
[Lr] Data última revisão:
170714
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160522
[St] Status:MEDLINE
[do] DOI:10.1177/1203475416650427


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[PMID]:27101502
[Au] Autor:Glance LG; Hannan EL; Fleisher LA; Eaton MP; Dutton RP; Lustik SJ; Li Y; Dick AW
[Ad] Endereço:From the *Department of Anesthesiology, University of Rochester School of Medicine, Rochester, New York; †Department of Health Policy, Management and Behavior, School of Public Health, University at Albany, Albany, New York; ‡Department of Anesthesiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania; §U.S. Anesthesia Partners; ‖Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, New York; and ¶RAND Health, Boston, Massachusetts.
[Ti] Título:Feasibility of Report Cards for Measuring Anesthesiologist Quality for Cardiac Surgery.
[So] Source:Anesth Analg;122(5):1603-13, 2016 May.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In creating the Merit-Based Incentive Payment System, Congress has mandated pay-for-performance (P4P) for all physicians, including anesthesiologists. There are currently no National Quality Forum-endorsed risk-adjusted outcome metrics for anesthesiologists to use as the basis for P4P. METHODS: Using clinical data from the New York State Cardiac Surgery Reporting System, we conducted a retrospective observational study of 55,436 patients undergoing cardiac surgery between 2009 and 2012. Hierarchical logistic regression modeling was used to examine the variation in in-hospital mortality or major complications (Q-wave myocardial infarction, renal failure, stroke, and respiratory failure) among anesthesiologists, controlling for patient demographics, severity of disease, comorbidities, and hospital quality. RESULTS: Although the variation in performance among anesthesiologists was statistically significant (P = 0.025), none of the anesthesiologists in the sample was classified as a high- or low-performance outliers. The contribution of anesthesiologists to outcomes represented 0.51% of the overall variability in patient outcomes (intraclass correlation coefficient [ICC] = 0.0051; 95% confidence interval [CI], 0.002-0.014), whereas the contribution of hospitals to patient outcomes was 2.90% (ICC = 0.029; 95% CI, 0.017-0.050). The anesthesiologist median odds ratio (MOR) was 1.13 (95% CI, 1.08-1.24), suggesting that the variation between anesthesiologist was modest, whereas the hospital MOR was 1.35 (95% CI, 1.25-1.48). In a separate analysis, the contribution of surgeons to overall outcomes represented 1.76% of the overall variability in patient outcomes (ICC = 0.018, 95% CI, 0.010-0.031), and the surgeon MOR was 1.26 (95% CI, 1.19-1.37). Twelve of the surgeons were identified as performance outliers. CONCLUSIONS: The impact of anesthesiologists on the total variability in cardiac surgical outcomes was probably about one-fourth as large as the surgeons' contribution. None of the anesthesiologists caring for cardiac surgical patients in New York State over a 3+ year period were identified as performance outliers. The use of a performance metric based on death or major complications for P4P may not be feasible for cardiac anesthesiologists.
[Mh] Termos MeSH primário: Anestesia/normas
Ponte de Artéria Coronária/normas
Coleta de Dados/normas
Assistência à Saúde/normas
Implante de Prótese de Valva Cardíaca/normas
Avaliação de Processos (Cuidados de Saúde)/normas
Indicadores de Qualidade em Assistência à Saúde/normas
[Mh] Termos MeSH secundário: Idoso
Anestesia/efeitos adversos
Anestesia/economia
Anestesia/mortalidade
Competência Clínica/normas
Comorbidade
Ponte de Artéria Coronária/efeitos adversos
Ponte de Artéria Coronária/economia
Ponte de Artéria Coronária/mortalidade
Coleta de Dados/economia
Bases de Dados Factuais
Assistência à Saúde/economia
Estudos de Viabilidade
Feminino
Implante de Prótese de Valva Cardíaca/efeitos adversos
Implante de Prótese de Valva Cardíaca/economia
Implante de Prótese de Valva Cardíaca/mortalidade
Mortalidade Hospitalar
Seres Humanos
Modelos Logísticos
Masculino
Meia-Idade
New York
Razão de Chances
Discrepância de GDH
Complicações Pós-Operatórias/mortalidade
Padrões de Prática Médica/normas
Avaliação de Processos (Cuidados de Saúde)/economia
Indicadores de Qualidade em Assistência à Saúde/economia
Reembolso de Incentivo/normas
Estudos Retrospectivos
Medição de Risco
Fatores de Risco
Índice de Gravidade de Doença
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1609
[Cu] Atualização por classe:160422
[Lr] Data última revisão:
160422
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:160422
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000001252


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[PMID]:26947413
[Au] Autor:Paul E; Bailey M; Kasza J; Pilcher D
[Ad] Endereço:Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. eldho.paul@monash.edu.
[Ti] Título:The ANZROD model: better benchmarking of ICU outcomes and detection of outliers.
[So] Source:Crit Care Resusc;18(1):25-36, 2016 Mar.
[Is] ISSN:1441-2772
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To compare the impact of the 2013 Australian and New Zealand Risk of Death (ANZROD) model and the 2002 Acute Physiology and Chronic Health Evaluation (APACHE) III-j model as risk-adjustment tools for benchmarking performance and detecting outliers in Australian and New Zealand intensive care units. METHODS: Data were extracted from the Australian and New Zealand Intensive Care Society Adult Patient Database for all ICUs that contributed data between 1 January 2010 and 31 December 2013. Annual standardised mortality ratios (SMRs) were calculated for ICUs using the ANZROD and APACHE III-j models. They were plotted on funnel plots separately for each hospital type, with ICUs above the upper 99.8% control limit considered as potential outliers with worse performance than their peer group. Overdispersion parameters were estimated for both models. Overall fit was assessed using the Akaike information criterion (AIC) and Bayesian information criterion (BIC). Outlier association with mortality was assessed using a logistic regression model. RESULTS: The ANZROD model identified more outliers than the APACHE III-j model during the study period. The numbers of outliers in rural, metropolitan, tertiary and private hospitals identified by the ANZROD model were 3, 2, 6 and 6, respectively; and those identified by the APACHE III-j model were 2, 0, 1 and 1, respectively. The degree of overdispersion was less for the ANZROD model compared with the APACHE III-j model in each year. The ANZROD model showed better overall fit to the data, with smaller AIC and BIC values than the APACHE III-j model. Outlier ICUs identified using the ANZROD model were more strongly associated with increased mortality. CONCLUSION: The ANZROD model reduces variability in SMRs due to casemix, as measured by overdispersion, and facilitates more consistent identification of true outlier ICUs, compared with the APACHE III-j model.
[Mh] Termos MeSH primário: Benchmarking
Cuidados Críticos
[Mh] Termos MeSH secundário: APACHE
Austrália
Seres Humanos
Modelos Teóricos
Nova Zelândia
Avaliação de Resultados (Cuidados de Saúde)
Discrepância de GDH
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1604
[Cu] Atualização por classe:160307
[Lr] Data última revisão:
160307
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160308
[St] Status:MEDLINE


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[PMID]:26803882
[Au] Autor:Centers for Medicare & Medicaid Services (CMS), HHS
[Ti] Título:Medicare Program; Explanation of FY 2004 Outlier Fixed-Loss Threshold as Required by Court Rulings. Clarification.
[So] Source:Fed Regist;81(14):3727-9, 2016 Jan 22.
[Is] ISSN:0097-6326
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:In accordance with court rulings in cases that challenge the federal fiscal year (FY) 2004 outlier fixed-loss threshold rulemaking, this document provides further explanation of certain methodological choices made in the FY 2004 fixed-loss threshold determination.
[Mh] Termos MeSH primário: Medicare/economia
Discrepância de GDH/economia
Sistema de Pagamento Prospectivo/legislação & jurisprudência
[Mh] Termos MeSH secundário: Seres Humanos
Medicare/legislação & jurisprudência
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1601
[Cu] Atualização por classe:160122
[Lr] Data última revisão:
160122
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:160126
[St] Status:MEDLINE


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[PMID]:26517545
[Au] Autor:Mehra T; Müller CT; Volbracht J; Seifert B; Moos R
[Ad] Endereço:Medical Directorate, University Hospital of Zurich, Zürich, Switzerland.
[Ti] Título:Predictors of High Profit and High Deficit Outliers under SwissDRG of a Tertiary Care Center.
[So] Source:PLoS One;10(10):e0140874, 2015.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PRINCIPLES: Case weights of Diagnosis Related Groups (DRGs) are determined by the average cost of cases from a previous billing period. However, a significant amount of cases are largely over- or underfunded. We therefore decided to analyze earning outliers of our hospital as to search for predictors enabling a better grouping under SwissDRG. METHODS: 28,893 inpatient cases without additional private insurance discharged from our hospital in 2012 were included in our analysis. Outliers were defined by the interquartile range method. Predictors for deficit and profit outliers were determined with logistic regressions. Predictors were shortlisted with the LASSO regularized logistic regression method and compared to results of Random forest analysis. 10 of these parameters were selected for quantile regression analysis as to quantify their impact on earnings. RESULTS: Psychiatric diagnosis and admission as an emergency case were significant predictors for higher deficit with negative regression coefficients for all analyzed quantiles (p<0.001). Admission from an external health care provider was a significant predictor for a higher deficit in all but the 90% quantile (p<0.001 for Q10, Q20, Q50, Q80 and p = 0.0017 for Q90). Burns predicted higher earnings for cases which were favorably remunerated (p<0.001 for the 90% quantile). Osteoporosis predicted a higher deficit in the most underfunded cases, but did not predict differences in earnings for balanced or profitable cases (Q10 and Q20: p<0.00, Q50: p = 0.10, Q80: p = 0.88 and Q90: p = 0.52). ICU stay, mechanical and patient clinical complexity level score (PCCL) predicted higher losses at the 10% quantile but also higher profits at the 90% quantile (p<0.001). CONCLUSION: We suggest considering psychiatric diagnosis, admission as an emergency case and admission from an external health care provider as DRG split criteria as they predict large, consistent and significant losses.
[Mh] Termos MeSH primário: Discrepância de GDH/estatística & dados numéricos
Centros de Atenção Terciária/estatística & dados numéricos
[Mh] Termos MeSH secundário: Economia Hospitalar/estatística & dados numéricos
Serviço Hospitalar de Emergência/economia
Serviço Hospitalar de Emergência/estatística & dados numéricos
Feminino
Custos Hospitalares/estatística & dados numéricos
Seres Humanos
Tempo de Internação/economia
Tempo de Internação/estatística & dados numéricos
Masculino
Transtornos Mentais/diagnóstico
Transtornos Mentais/economia
Discrepância de GDH/economia
Sistema de Pagamento Prospectivo/economia
Sistema de Pagamento Prospectivo/organização & administração
Sistema de Pagamento Prospectivo/estatística & dados numéricos
Suíça/epidemiologia
Centros de Atenção Terciária/economia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1606
[Cu] Atualização por classe:170220
[Lr] Data última revisão:
170220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:151031
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0140874


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[PMID]:26497276
[Au] Autor:Pirson M; Van den Bulcke J; Di Pierdomenico L; Martins D; Leclercq P
[Ad] Endereço:Université libre de Bruxelles, école de santé publique, centre de recherche en économie de la santé, gestion des institutions de soins et sciences infirmières, 808, route de Lennik, CP592, 1070 Bruxelles, Belgique. Electronic address: magali.pirson@ulb.ac.be.
[Ti] Título:[Medical and economic evaluation of oncological inpatients in 14 Belgian hospitals].
[Ti] Título:Analyse médico-économique de la patientèle oncologique de 14 hôpitaux belges..
[So] Source:Bull Cancer;102(11):923-31, 2015 Nov.
[Is] ISSN:1769-6917
[Cp] País de publicação:France
[La] Idioma:fre
[Ab] Resumo:INTRODUCTION: A prospective payment system per DRG is announced in Belgium. Is this kind of financing system adequate for oncology? Objectives of this study are: to analyze medical and economical characteristics of oncological inpatients and evaluate the homogeneity of costs and length of stay per DRG. METHODS: The study was realized in 14 Belgian hospitals, with 2010 data. Inpatients with primary diagnosis of neoplasms were selected in medical and administrative databases. Characteristics of patients as well as length of stay and cost (hospital perspective) were analyzed. The homogeneity of costs and length of stay is measured by calculating the coefficient of variation (standard deviation divided by the mean). RESULTS: The length of stay (standard deviation) is 9.72 days (12.64). The variation is high per DRG. The average cost (standard deviation) is 7689.28€ (10,418) and is also variable from one DRG to another one. There are 5% of high-length of stay outliers and 0.2% of low-length of stay outliers. There are 4.7% of high-cost outliers and 0.2% of low-cost outliers. The withdrawal of outliers improves the homogeneity of cost and length of stay per APR-DRG. DISCUSSION AND CONCLUSION: There is a homogeneity of costs and length of stay per DRG and per severity of illness. A prospective payment system per DRG would probably be applicable for these patients. It is however necessary to plan an appropriate and additional financing of all elements susceptible to stimulate innovation in the management of oncology and to stimulate the quality of care by adding financial stimulants.
[Mh] Termos MeSH primário: Custos Hospitalares
Pacientes Internados
Tempo de Internação
Neoplasias/economia
Sistema de Pagamento Prospectivo
[Mh] Termos MeSH secundário: Fatores Etários
Idoso
Idoso de 80 Anos ou mais
Bélgica
Custos e Análise de Custo
Grupos Diagnósticos Relacionados
Feminino
Seres Humanos
Masculino
Meia-Idade
Discrepância de GDH
Fatores Sexuais
[Pt] Tipo de publicação:ENGLISH ABSTRACT; JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1602
[Cu] Atualização por classe:151117
[Lr] Data última revisão:
151117
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:151027
[St] Status:MEDLINE


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[PMID]:26197404
[Au] Autor:Merlanti B; De Chiara B; Maggioni AP; Moreo A; Pileggi S; Romeo G; Russo CF; Rizzo S; Martinelli L; Maseri A; VAR Study Group
[Ad] Endereço:S.C. Cardiochirurgia, Department of Cardiology and Cardiovascular Surgery, Niguarda Ca' Granda Hospital, Milan, Italy.
[Ti] Título:Rationale and design of GISSI OUTLIERS VAR Study in bicuspid aortic valve patients: prospective longitudinal, multicenter study to investigate correlation between surgical, echo distinctive features, histologic and genetic findings in phenotypically homogeneous outlier cases.
[So] Source:Int J Cardiol;199:180-5, 2015 Nov 15.
[Is] ISSN:1874-1754
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BACKGROUND/OBJECTIVES: Bicuspid aortic valve (BAV) is the most common congenital heart disorder, affecting up to 2% of the population. Involvement of aortic root and ascending aorta (aneurysm or, eventually, dissection) is frequent in patients with pathologic or normal functioning BAV. Unfortunately, there are no well-known correlations between valvular and vascular diseases. In VAR protocol, with a new strategy of research, we analysemultiple aspects of BAV disease through correlation between surgical, echo, histologic and genetic findings in phenotypically homogeneous outlier cases. METHODS: VAR protocol is a prospective, longitudinal, multicenter study. It observes 4 homogeneous small groups of BAV surgical patients (15 patients each): isolated aortic regurgitation, isolated ascending aortic aneurysm, aortic regurgitation associated with aortic aneurysm, isolated aortic stenosis in older patients (>60years). Echo analysis is extended to first-degree relatives and, in case of BAV, genetic test is performed. Patients and relatives are enrolled in 10 cardiac surgery/cardiologic centers throughout Italy. CONCLUSIONS: The aim of the study is to identify predictors of favorable or unfavorable evolution of BAV in terms of valvular dysfunction and/or aortic aneurysm. Correlations between different features could help in identification of various BAV risk groups, rationalizing follow-up and treatment.
[Mh] Termos MeSH primário: Aorta/patologia
Valva Aórtica/anormalidades
Doenças das Valvas Cardíacas/diagnóstico por imagem
Doenças das Valvas Cardíacas/genética
Doenças das Valvas Cardíacas/patologia
Doenças das Valvas Cardíacas/cirurgia
Discrepância de GDH/estatística & dados numéricos
Fenótipo
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Aneurisma Aórtico/complicações
Aneurisma Aórtico/etiologia
Valva Aórtica/diagnóstico por imagem
Valva Aórtica/patologia
Valva Aórtica/cirurgia
Insuficiência da Valva Aórtica/cirurgia
Estenose da Valva Aórtica/cirurgia
Procedimentos Cirúrgicos Cardíacos
Dilatação Patológica/complicações
Dilatação Patológica/etiologia
Dilatação Patológica/cirurgia
Feminino
Cardiopatias Congênitas/cirurgia
Seres Humanos
Itália
Masculino
Meia-Idade
Valor Preditivo dos Testes
Estudos Prospectivos
Fatores de Risco
Fatores de Tempo
Ultrassonografia
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1607
[Cu] Atualização por classe:161125
[Lr] Data última revisão:
161125
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:150722
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE


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[PMID]:25991166
[Au] Autor:Prakash G
[Ad] Endereço:CitiusTech Inc, Mumbai, India.
[Ti] Título:Devising outlier-based alerts for medication orders.
[So] Source:Stud Health Technol Inform;210:359-63, 2015.
[Is] ISSN:0926-9630
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:Drugs are chemical substances, which can, on consumption and under certain conditions, be toxic and cause Adverse Drug Reactions (ADRs) in patients. This paper puts forth the proposition of generating a systemic alert to a clinician, at the time of placing a medication order for a patient, when the number of ADRs associated with the selected medication is significantly different from the number of ADRs associated with other drugs approved for the same therapeutic area.
[Mh] Termos MeSH primário: Sistemas de Notificação de Reações Adversas a Medicamentos/organização & administração
Sistemas de Gerenciamento de Base de Dados
Bases de Dados de Produtos Farmacêuticos
Prescrição Eletrônica
Sistemas de Registro de Ordens Médicas/organização & administração
Discrepância de GDH
[Mh] Termos MeSH secundário: Índia
Armazenamento e Recuperação da Informação/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1611
[Cu] Atualização por classe:161230
[Lr] Data última revisão:
161230
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:150521
[St] Status:MEDLINE


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[PMID]:25732007
[Au] Autor:Kim H; Norton EC
[Ad] Endereço:Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR.
[Ti] Título:Effects of the Ten Percent Cap in Medicare Home Health Care on Treatment Intensity and Patient Discharge Status.
[So] Source:Health Serv Res;50(5):1606-27, 2015 Oct.
[Is] ISSN:1475-6773
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To estimate the effect of the 10 percent cap introduced to Medicare home health care on treatment intensity and patient discharge status. DATA SOURCES: Medicare Denominator, Medicare Home Health Claims, and Medicare Provider of Services Files from 2008 through 2010. STUDY DESIGN: We used agency-level variation in the proportion of outlier payments prior to the implementation of the 10 percent cap to identify how home health agencies adjusted the number of home health visits and patient discharge status under the new law. PRINCIPAL FINDINGS: Under the 10 percent cap, agencies dramatically decreased the number of service visits. Agencies also dropped relatively healthy patients and sent sicker patients to nursing homes. CONCLUSIONS: The drastic reduction in the number of service visits and discontinuation of relatively healthy patients from home health care suggest that the 10 percent cap improved the efficiency of home health services as intended. However, the 10 percent cap increased other types of health care expenditures by pushing sicker patients to use more expensive health services.
[Mh] Termos MeSH primário: Serviços de Assistência Domiciliar/organização & administração
Serviços de Assistência Domiciliar/estatística & dados numéricos
Medicare/organização & administração
Medicare/estatística & dados numéricos
Alta do Paciente/estatística & dados numéricos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Feminino
Nível de Saúde
Serviços de Assistência Domiciliar/normas
Seres Humanos
Masculino
Medicare/normas
Discrepância de GDH
Qualidade da Assistência à Saúde
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1601
[Cu] Atualização por classe:161019
[Lr] Data última revisão:
161019
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:150304
[St] Status:MEDLINE
[do] DOI:10.1111/1475-6773.12290


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[PMID]:25273862
[Au] Autor:Estaghvirou SB; Ogutu JO; Piepho HP
[Ad] Endereço:Biostatistics Unit, Institute of Crop Science, University of Hohenheim, 70599 Stuttgart, Germany.
[Ti] Título:Influence of outliers on accuracy estimation in genomic prediction in plant breeding.
[So] Source:G3 (Bethesda);4(12):2317-28, 2014 Oct 01.
[Is] ISSN:2160-1836
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Outliers often pose problems in analyses of data in plant breeding, but their influence on the performance of methods for estimating predictive accuracy in genomic prediction studies has not yet been evaluated. Here, we evaluate the influence of outliers on the performance of methods for accuracy estimation in genomic prediction studies using simulation. We simulated 1000 datasets for each of 10 scenarios to evaluate the influence of outliers on the performance of seven methods for estimating accuracy. These scenarios are defined by the number of genotypes, marker effect variance, and magnitude of outliers. To mimic outliers, we added to one observation in each simulated dataset, in turn, 5-, 8-, and 10-times the error SD used to simulate small and large phenotypic datasets. The effect of outliers on accuracy estimation was evaluated by comparing deviations in the estimated and true accuracies for datasets with and without outliers. Outliers adversely influenced accuracy estimation, more so at small values of genetic variance or number of genotypes. A method for estimating heritability and predictive accuracy in plant breeding and another used to estimate accuracy in animal breeding were the most accurate and resistant to outliers across all scenarios and are therefore preferable for accuracy estimation in genomic prediction studies. The performances of the other five methods that use cross-validation were less consistent and varied widely across scenarios. The computing time for the methods increased as the size of outliers and sample size increased and the genetic variance decreased.
[Mh] Termos MeSH primário: Cruzamento
Genoma de Planta
Plantas/genética
[Mh] Termos MeSH secundário: Genótipo
Modelos Genéticos
Discrepância de GDH
Fenótipo
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1508
[Cu] Atualização por classe:151029
[Lr] Data última revisão:
151029
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:141003
[St] Status:MEDLINE
[do] DOI:10.1534/g3.114.011957



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