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Assessing heterogeneity and correlation of paired failure times with the bivariate frailty model

STATISTICS IN MEDICINE 1999年第8期18卷 907-918页

作者： Xue, XN Ding, Y NYU Med Ctr Dept Environm Med Div Epidemiol & Biostat New York NY 10010 USA New York State Dept Hlth Wadsworth Ctr Albany NY 12201 USA

We consider bivariate survival times for heterogeneous populations, where heterogeneity induces deviations in an individual's risk of an event as well as associations between survival times. The heterogeneity is characterized by a bivariate frailty model. We measure the heterogeneity effects through deviations associated with hazard functions and an association function defined through the conditional hazard functions: the cross-ratio function proposed by Oakes. We show how the deviation and association measures are determined by the frailty distribution. A Gibbs sampling method is developed for Bayesian inferences on regression coefficients, frailty parameters and the heterogeneity measures. The method is applied to a mental health care data set. Copyright (C) 1999 John Wiley & Sons, Ltd.

关键词：算法贝叶斯定理计算机模拟数据收集卫生政策住院/统计学和数值数据保险索赔审核/统计学和数值数据住院时间/统计学和数值数据精神障碍/治疗模型生物学蒙特卡罗法危险人类

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Results of provider self-adjudication using the prudent layperson standard compared with the managed care organization's emergency department claim review process

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ANNALS OF EMERGENCY MEDICINE 2000年第3期36卷 212-218页

作者： Shesser, R Holtermann, K Smith, J Braun, J George Washington Univ Dept Emergency Med Washington DC 20037 USA

Study objectives: We compare the results of a provider "self-adjudicating" outpatient emergency department claims using a "presenting symptom-based" system with the managed care organization (MCO) adjudicating the claims using a "final diagnosis-based" system. Methods: All outpatient visits from one MCO to an urban, university hospital between January 1, 1998, and February 28, 1999, were included. Each record was reviewed by 2 methods to determine whether the visit qualified for payment under the MCO's benefit structure. Under the provider adjudication, symptom-based system, all visits with nursing triage levels of immediate/emergency were approved automatically. Those with triage levels of delayed/nonurgent were reviewed by an emergency physician and approved if, in the physician's opinion, the presenting symptoms met the emergency criteria under the District of Columbia's Access to Emergency Services Act. A second claims review, blinded to the first, was performed with the diagnosis-based system used by the MCO before approval of the prudent layperson standard. This review divided the records into "approve," "deny," and "suspend" categories according to the discharge International Classification of Diseases, ninth revision code. The results of the 2 reviews were compared. Results: We reviewed 1,830 records;836 (46%) cases were triaged as immediate/emergency and 994 (54%) as delayed/nonurgent. Of the 994 delayed/nonurgent visits, physician review determined that 607 (61%) met the prudent layperson standard and 387 (39%) did not. Overall, the provider self-adjudication system determined that 1,443 (78.8%) of the 1,830 visits should be approved for insurance coverage. The MCO's system approved 966 (53%), denied 335 (18%), and suspended 529 (29%). Provider self-adjudication using a symptom-based system resulted in the immediate approval of 1,443 (77.8%) visits compared with 966 (52.7%) by a diagnosis-based system (P<.001). Excluding the 529 suspended claims, McNemar's

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Effectiveness of sealant treatment

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JOURNAL OF THE AMERICAN DENTAL ASSOCIATION 2000年第5期131卷 597-605页

作者： Dennison, JB Straffon, LH Smith, RC Univ Michigan Sch Dent Dept Cariol Restorat Sci & Endodont Ann Arbor MI 48109 USA Univ Michigan Sch Dent Dept Orthodont & Pediat Dent Ann Arbor MI 48109 USA Delta Dent Plan Michigan Lansing MI USA

Background, The authors analyzed an insurance claim database to evaluate the use and effectiveness of placing sealants on first and second permanent molars of children in private dental practices. Methods. A retrospective study was conducted using an insured population with sealant coverage at 70 percent of the usual fee in a preferred provider organization plan that limited reapplication to once every three years. Children were selected who were eligible for sealant benefits from July 1, 1990, to June 30, 1991. Two groups were selected for analysis;based on age, as determined by permanent molar eruption dates. Children who received sealants were compared with those who did not to determine post-sealant restorative outcomes after five years. Results, During the full year of coverage, sealants were used in only 16.3 percent of first permanent molars and 11.6 percent of second permanent molars. The five-year incidence of an occlusal restoration having been placed was 13.7 percent and 20.8 percent, respectively, on nonsealed first and second molars and 6.5 percent and 10.4 percent, respectively, on sealed first and second molars. From years three to five, sealant placement provided only nominal additional preventive effect. Conclusions, In the population selected, both the incidence of occlusal caries and the use of sealants were lower than expected for both age groups. However, within these groups, molar occlusal surfaces were only half as likely to have been restored in sealed teeth than in nonsealed teeth after five years. Clinical Implications. Based on the live-year data from a population with a low incidence of caries, the authors found that 15 sealed first permanent molars or 10 sealed second permanent molars prevented placement of one occlusal.. restoration. Therefore, sealants are more effective when placed in patients with risk factors for occlusal caries.

关键词：龋齿/预防和控制牙列恒按诊疗收费计划/统计学和数值数据保险索赔审核/统计学和数值数据保险牙科/统计学和数值数据密执安磨牙窝沟封闭剂/治疗应用回顾性研究时间因素青少年儿童儿童学龄前人类

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Adherence to antiretroviral therapy by pregnant women infected with human immunodeficiency virus: A pharmacy claims-based analysis

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OBSTETRICS AND GYNECOLOGY 2000年第2期95卷 167-173页

作者： Laine, C Newschaffer, CJ Zhang, DZ Cosler, L Hauck, WW Turner, BJ Thomas Jefferson Univ Jefferson Med Coll Div Gen Internal Med Ctr Res Med Educ & Hlth Care Philadelphia PA 19107 USA Thomas Jefferson Univ Jefferson Med Coll Biostat Sect Div Clin Pharmacol Philadelphia PA 19107 USA New York State Dept Hlth Albany NY USA

Objective: To assess adherence to antiretroviral therapy with the use of Medicaid pharmacy claims data for human immunodeficiency virus (HIV)-infected pregnant women and to identify associated maternal and health care factors. Methods: We retrospectively studied a cohort of 2714 HIV-infected women in New York State who delivered live infants from 1993-96;Among 682 women prescribed antiretroviral therapy in the last two trimesters, we studied 549 who started therapy more than 2 months before delivery. Adherence was defined as adequate if the supplied drug covered at least 80% of the days from the first prescription in the last two trimesters until delivery. Multivariable analyses were used to examine associations between maternal and health care factors and adherence. Results: Only 34.2% of 549 subjects had at least 80% adherence based on pharmacy data, a rate that remained stable over time. The adjusted odds ratios (ORs) of adherence for black (OR 0.47, 95% confidence interval [CI] 0.30, 0.75) and Hispanic (OR 0.49, 95% CI 0.29, 0.82) women were nearly 50% lower than for white women. The OR of adherence was 0.32 (95% CI 0.12, 0.90) for teenagers compared with women aged 25-29 years and 0.56 (95% CI 0.34, 0.92) for women in New York City versus those residing elsewhere. Women on antiretroviral therapy before pregnancy were more likely to adhere (OR 1.55, 95% CI 1.02, 2.35). Conclusion: Teenagers, women of minority groups, and women living in New York City had greater risks of poor antiretroviral adherence, whereas women already prescribed antiretrovirals before pregnancy had better adherence. Our conservative pharmacy data-based measure showed that most HIV -infected women adhered poorly and adherence did not improve over the 4-year study. (C) 2000 by The American College of Obstetricians and Gynecologists.

关键词：非洲裔美国人年龄因素抗HIV药/治疗应用队列研究置信区间 HIV感染/药物疗法 HIV感染/人种学西班牙裔美国人保险索赔审核/统计学和数值数据 Medicaid/统计学和数值数据少数民族多元分析纽约/流行病学比值比病人依从/人种学病人依从/统计学和数值数据药学服务/经济学药学服务/统计学和数值数据妊娠并发症感染性/药物疗法妊娠并发症感染性/人种学回顾性研究美国市区人口妇女卫生青少年成年人女(雌)性人类妊娠

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Effect of a home monitoring system on hospitalization and resource use for patients with heart failure

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AMERICAN HEART JOURNAL 1999年第4期138卷 633-640页

作者： Heidenreich, PA Ruggerio, CM Massie, BM Dept Vet Affairs Med Ctr Cardiol Sect Palo Alto CA 94304 USA Univ Calif San Francisco Sch Nursing San Francisco CA 94143 USA Univ Calif San Francisco Dept Med San Francisco CA USA Univ Calif San Francisco Cardiovasc Res Inst San Francisco CA 94143 USA Dept Vet Affairs Med Ctr Div Cardiol San Francisco CA USA

Background Heart failure has a large medical and economic impact on the elderly. Pair studies have shown that high-intensity multidisciplinary interventions at academic medical centers can reduce future hospitalizations. Our pilot study examined the effects of a low-intensity monitoring program on hospitalizations and cost of care for patients with heart failure treated by community physicians. Methods we enrolled 68 patients with heart failure (mean age 73 +/- 13 years, 53% merle) monitored by 31 physicians in a multidisciplinary program of patient education, daily self-monitoring, and physician notification of abnormal weight gain, vital signs, and symptoms. Comparisons of medical claims were made between the patients who received the intervention and a control group of 86 patients matched to the intervention group on medical claims during the preceding year. Results Compared with the prior year, medical claims per year decreased in the intervention group ($8500 +/- $13,000 to $7400 +/- $11,400), whereas they increased in the control group ($9200 +/- $15,000 to $18,800 +/- $34,000, P < .05). Similar differences were observed for hospitalizations and total hospital days.. The program's effectiveness was unrelated to age, sex, or type of left ventricular dysfunction. Conclusions These findings suggest that a multidisciplinary program of patient education, monitoring, and physician notification can reduce resource use in patients with heart failure managed in a community setting.

关键词：病例对照研究卫生资源/经济学卫生资源/利用住院/统计学和数值数据保险索赔审核/统计学和数值数据监测便携式/方法生活质量存活率电话老年人女(雌)性人类男(雄)性

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Comparing claims data and self-reported data with the medical record for Pap smear rates

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EVALUATION & THE HEALTH PROFESSIONS 1997年第3期20卷 324-342页

作者： Fowles, JB Fowler, E Craft, C McCoy, CE [o_1]Institute for Research and Education

The objective of this study war to assess and compare the relative accuracy of claims data and patient self-reported information with medical records for Pap smear rates. A retrospective analysis of information obtained from administrative claims files, patient medical records, and a telephone survey was performed of 400 women age 19 through 75 years who were randomly selected for participation in the study. The data were obtained from a large multispecialty group practice in Minneapolis, Minnesota for the study years 1991 through 1993. Information from administrative claims regarding Pap smear status corresponded highly with information in the medical record (sensitivity 95% or higher;specificity 95% or higher;kappa 0.896 or better). Self-reported information from the telephone survey did not correspond well with medical record information nor with results in administrative claims.

关键词：数据收集/方法保险索赔审核/统计学和数值数据病案/统计学和数值数据明尼苏达可重复性结果回顾性研究阴道涂片/统计学和数值数据成年人老年人女(雌)性人类中年人

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Risk issues in claims reported by 85 small hospitals.

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Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management 1993年第3期13卷 31-37页

作者： Brown, B.S. Clause, M.A. Virginia Insurance Reciprocal Richmond United States

According to one business adage, 20 percent of one's activity reflects 80 percent of one's success. Although few managers in small hospitals spend more than 20 percent of their time on credentialing and peer review, those activities are likely to have the most impact on preventing claims in small hospitals. Other strategies that may enhance these activities include redefining the types of services offered when professional staff, resources for new services, and staff education are scarce. Help with developing sound peer review and credentialing practices can be found through networking within professional organizations, in documents published by national organizations, and by using professional risk management services available through liability carriers. Devoting time to improving providers' documentation skills, monitoring key technical skills of health care providers, and analyzing patient flows from provider to provider and service to service are also likely to have an impact on losses in small hospitals.

关键词：数据收集评价研究费用和收费/统计学和数值数据卫生服务研究医院病床数 100张以下医院社区/经济学医院社区/统计学和数值数据保险索赔审核/统计学和数值数据保险责任/经济学保险责任/统计学和数值数据责任法律危险处理/经济学危险处理/统计学和数值数据美国东南部

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Use of malpractice data in medical staff credentialing.

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Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management 1996年第3期16.0卷 16-20页

作者： Shostek, K.M. Pendrak, R.F. PHICO Group Inc. Mechanicsburg PA United States

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