Nevin Manimala

Am J Manag Care. 2024 Aug 1;30(8):e247-e250. doi: 10.37765/ajmc.2024.89594.

ABSTRACT

Given recent congressional interest in codifying price transparency regulations, it is important to understand the extent to which newly available price transparency data capture true underlying procedure-level prices. To that end, we compared the prices for maternity services negotiated between a large payer and 26 hospitals in Mississippi across 2 separate price transparency data sources: payer and hospital. The degree of file overlap is low, with only 16.3% of hospital-billing code observations appearing in both data sources. However, for the observations that overlap, pricing concordance is high: Corresponding prices have a correlation coefficient of 0.975, 77.4% match to the penny, and 84.4% are within 10%. Exact price matching rates are greater than 90% for 3 of the 4 service lines included in this study. Taken together, these results suggest that although administrative misalignment exists between payers and hospitals, there is a measure of signal amid the price transparency noise.

PMID:39146482 | DOI:10.37765/ajmc.2024.89594

Am J Manag Care. 2024 Aug 1;30(8):e240-e246. doi: 10.37765/ajmc.2024.89593.

ABSTRACT

OBJECTIVES: Hospitals in the US operate under various value-based payment programs, but little is known regarding the strategies they use in this context to improve quality and reduce costs, overall or in voluntary programs including Bundled Payments for Care Improvement Advanced (BPCI-A).

STUDY DESIGN: A survey was administered to hospital leaders at 588 randomly selected acute care hospitals, with oversampling of BPCI-A participants, from November 2020 to June 2021. Twenty strategies and 20 barriers were queried in 4 domains: inpatient, postacute, outpatient, and community resources for vulnerable patients.

METHODS: Summary statistics were tabulated, and responses were adjusted for sampling strategy and nonresponse.

RESULTS: There were 203 respondents (35%), of which 159 (78%) were BPCI-A participants and 44 (22%) were nonparticipants. On average, respondents reported implementing 89% of queried strategies in the inpatient domain, such as care pathways or predictive analytics; 65% of postacute strategies, such as forming partnerships with skilled nursing facilities; 84% of outpatient strategies, such as scheduling close follow-up to prevent emergency department visits/hospitalizations; and 82% of strategies aimed at high-risk populations, such as building connections with community resources. There were no differences between BPCI-A and non-BPCI-A hospitals in 19 of 20 care redesign strategies queried. However, 78.3% of BPCI-A-participating hospitals reported programs aimed at reducing utilization of skilled nursing and inpatient rehabilitation facilities compared with 37.6% of non-BPCI-A hospitals (P < .0001).

CONCLUSIONS: Hospitals pursue a broad range of efforts to improve quality. BPCI-A hospitals have attempted to reduce use of postacute care, but otherwise the strategies they pursue are similar to other hospitals.

PMID:39146481 | DOI:10.37765/ajmc.2024.89593

Am J Manag Care. 2024 Aug 1;30(8):e233-e239. doi: 10.37765/ajmc.2024.89592.

ABSTRACT

OBJECTIVES: To evaluate the FeelBetter machine learning system’s ability to accurately identify older patients with multimorbidity at Brigham and Women’s Hospital at highest risk of medication-associated emergency department (ED) visits and hospitalizations, and to assess the system’s ability to provide accurate medication recommendations for these patients.

STUDY DESIGN: Retrospective cohort study.

METHODS: The system uses medications, demographics, diagnoses, laboratory results, health care utilization patterns, and costs to stratify patients’ risk of ED visits and hospitalizations. Patients were assigned 1 of 22 risk levels based on their system-generated risk percentile of either ED visits or hospitalizations. Logistic regression models were used to estimate the odds of ED visits and hospitalizations associated with each successive risk level compared with the 45th to 50th percentiles. After stratification, 100 high-risk (95th-100th percentiles) and 100 medium-risk (45th-55th percentiles) patients were randomly selected for generation of medication recommendations. Two clinical pharmacists reviewed the system-generated medication recommendations for these patients.

RESULTS: Logistic regression models predicting 3-month utilization showed that compared with the 45th to 50th percentiles, patients in the top 1% risk percentile had ORs of 7.9 and 17.3 for ED visits and hospitalizations, respectively. The first 5 high-priority medications on each patient’s medication list were associated with a mean (SD) of 6.65 (4.09) warnings. Of 1290 warnings reviewed, 1151 (89.2%) were assessed as correct.

CONCLUSIONS: The FeelBetter system effectively stratifies older patients with multimorbidity at risk of ED use and hospitalizations. Medication recommendations provided by the system are largely accurate and can potentially be beneficial for patient care.

PMID:39146480 | DOI:10.37765/ajmc.2024.89592

Am J Manag Care. 2024 Aug 1;30(8):e226-e232. doi: 10.37765/ajmc.2024.89591.

ABSTRACT

OBJECTIVES: Adherence to medications is important for the management of chronic diseases. Although the proportion of days covered (PDC) is a common metric for measuring adherence, it may be insufficient to distinguish relevant differences in medication-taking behavior. Group-based trajectory models (GBTMs) have been used to better represent adherence over time. This study aims to examine adherence patterns 1 year after initiation among users of sodium-glucose cotransporter 2 (SGLT2) inhibitors using GBTMs and evaluate the ability of baseline characteristics to predict adherence trajectory.

STUDY DESIGN: SGLT2 inhibitor new-user cohort study from 2014 to 2018.

METHODS: We calculated 12-month PDC and categorized patients with PDC of 80% or greater as adherent. We performed multivariable logistic regression on adherence status controlling for baseline covariates. GBTMs were fit to identify adherence patterns 12 months following SGLT2 inhibitor initiation. Five multinomial logistic regression models including different subsets of predictors were used to predict adherence trajectory group assignment.

RESULTS: In a cohort of 228,363 SGLT2 inhibitor users, the mean PDC was 57%, with 36% of the cohort being adherent. Overall, women and patients with anxiety or depression were less likely to be adherent. Six patterns of SGLT2 inhibitor adherence were identified with GBTMs: 1 fill (PDC = 0.08), early discontinuation (PDC = 0.22), consistently low adherence (PDC = 0.35), moderate adherence (PDC = 0.48), high adherence (PDC = 0.79), and near-perfect adherence (PDC = 0.95). All prediction models showed poor predictive accuracy (0.35).

CONCLUSIONS: We found wide variation in adherence patterns among SGLT2 inhibitor users in a national cohort. Predictors from a health care claims database were unable to accurately predict adherence trajectory.

PMID:39146479 | DOI:10.37765/ajmc.2024.89591

Chem Biodivers. 2024 Aug 15:e202401383. doi: 10.1002/cbdv.202401383. Online ahead of print.

ABSTRACT

Chuju, a cultivar of Chrysanthemum morifolium, has been traditionally cultivated for over 2000 years in China for both ornamental and medicinal purposes. To date, investigations into the chemical composition of this plant have indicated that it contains compounds with extensive biological activities, although detailed information on the chemical composition of Chuju remains scarce. In the present study, the chemical compositions of Chuju flowers were investigated across five sites in the core Chuju planting area in Anhui province, China. Analytical pyrolysis-gas chromatography/mass spectrometry (Py-GC/MS) was used to explore variations in flower chemical fingerprints from different Chuju planting sites. The study identified approximately 200 components in Chuju flowers and stems, including high levels of fatty acids, lipids, polysaccharides and terpenoids. Multivariate statistical analysis indicated that 16 chemical compounds were influential determinants of the chemical fingerprint and could be used to distinguish two clusters in the five core planting areas. The established Py-GC/MS analytical workflow could provide a basis for determining the chemical fingerprints of Chuju and help elucidate that products contain a reproducible content of bioactive compounds and overall quality for potential development of health and medicinal purposes.

PMID:39146472 | DOI:10.1002/cbdv.202401383

Ophthalmic Epidemiol. 2024 Aug 15:1-9. doi: 10.1080/09286586.2024.2371467. Online ahead of print.

ABSTRACT

PURPOSES: To determine the relationship between carotid artery stenosis (CAS) and the development of open-angle glaucoma (OAG) in the Taiwanese population.

METHODS: This retrospective cohort study was conducted using Chang Gung Research Database. Cox-proportional hazards model was applied to calculate the hazard ratio for OAG between CAS and the control cohort.

RESULTS: Among 19,590 CAS patients, 17,238 had mild CAS (<50%), 1,895 had moderate CAS (50-69%), and 457 had severe CAS (≥70%). The CAS cohort had a higher proportion of several comorbidities. After adjusting for comorbidities, no significant difference in OAG development was found between CAS and control cohorts. Matching for key comorbidities, no significant differences in OAG incidence were found between matched cohorts (P = .869). Subdividing the matched CAS cohort by stenosis severity: mild (<50%), moderate (50-69%), and severe (≥70%), a statistically significantly lower OAG risk was observed in patients with mild CAS stenosis (HR: 1.12, 95% CI = 1.03-1.21, P = .006). Kaplan-Meier analysis revealed reduced OAG incidence in CAS patients who underwent surgical intervention, compared to the control cohort (P <.001). Subgroup analysis revealed that patients in the mild CAS stenosis group, those who underwent surgical intervention exhibited a reduced OAG risk (HR: 0.29, 95% CI = 0.15-0.58, P = .001).

CONCLUSIONS: No statistically significant differences in OAG risk were observed between patients with CAS and the control cohort. The severity of CAS appears to influence OAG risk, with surgical intervention potentially offering protective effects, particularly in patients with mild CAS stenosis (<50%), suggesting that enhanced ocular perfusion post-surgery may act as a protective factor against OAG development.

PMID:39146467 | DOI:10.1080/09286586.2024.2371467

Sex Health. 2024 Aug;21:SH24056. doi: 10.1071/SH24056.

ABSTRACT

Background Sexual transmission accounts for a substantial proportion of HIV infections. Although some countries are experiencing an upward trend in HIV infections, there has been a lack of studies assessing the global burden of HIV/AIDS acquired through sexual transmission. We assessed the global, regional, and national burdens of HIV/AIDS acquired through sexual transmission from 1990 to 2019. Methods Data on deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALY) of HIV/AIDS acquired through sexual transmission in 204 countries and territories from 1990 to 2019 were retrieved from the Global Burden of Disease Study (GBD) 2019. The burdens and trends were evaluated using the age-standardised rates (ASR) and estimated annual percentage change (EAPC). Results Globally, HIV/AIDS acquired through sexual transmission accounted for ~695.8 thousand (95% uncertainty interval 628.0-811.3) deaths, 33.0million (28.7-39.9) YLLs, 3.4million (2.4-4.6) YLDs, and 36.4million (32.2-43.1) DALYs in 2019. In 2019, Southern sub-Saharan Africa (11350.94), Eastern sub-Saharan Africa (3530.91), and Western sub-Saharan Africa (2037.74) had the highest ASR of DALYs of HIV/AIDS acquired through sexual transmission per 100,000. In most regions of the world, the burden of HIV/AIDS acquired through sexual transmission has been increasing from 1990 to 2019, mainly in Oceania (EAPC 17.20, 95% confidence interval 12.82-21.75), South Asia (9.00, 3.94-14.30), and Eastern Europe (7.09, 6.35-7.84). Conclusions HIV/AIDS acquired through sexual transmission results in a major burden globally, regionally, and nationally.

PMID:39146461 | DOI:10.1071/SH24056

J Head Trauma Rehabil. 2024 Aug 12. doi: 10.1097/HTR.0000000000000967. Online ahead of print.

ABSTRACT

OBJECTIVES: Alexithymia an emotional processing deficit that interferes with a person’s ability to recognize, express, and differentiate emotional states. Study objectives were to (1) determine rates of elevated alexithymia among people with moderate-to-severe traumatic brain injury (TBI) 1-year post-injury, (2) identify demographic and injury-related variables associated with high versus low-average levels of alexithymia, and (3) examine associations among alexithymia with other aspects of emotional functioning and life satisfaction.

SETTING: Data were collected during follow-up interviews across four TBI Model System (TBIMS) centers.

PARTICIPANTS: The sample consisted of 196 participants with moderate-to-severe TBI enrolled in the TBIMS. They were predominately male (77%), White (69%), and had no history of pre-injury mental health treatment (66.3%).

DESIGN: Cross-sectional survey data were obtained at study enrollment and 1-year post-injury.

MAIN MEASURES: Toronto Alexithymia Scale-20 (TAS-20) as well as measures of anger, aggression, hostility, emotional dysregulation, post-traumatic stress, anxiety, depression, resilience and life satisfaction. Sociodemographic information, behavioral health history and injury-related variables were also included.

RESULTS: High levels of alexithymia (TAS-20 score > 1.5 standard deviation above the normative mean) were observed for 14.3%. Compared to individuals with low/average levels of alexithymia, the high alexithymia group tended to have lower levels of education. At 1-year follow-up, high TAS-20 scores were strongly associated with emotional dysregulation and post-traumatic stress; moderately associated with anger, hostility, depression, anxiety, lower resilience and lower satisfaction with life; and weakly associated with aggression.

CONCLUSION: These findings provide further evidence that alexithymia is associated with poor emotional functioning and life satisfaction after TBI. Longitudinal studies are needed to determine if alexithymia is a risk factor that precipitates and predicts worse emotional outcomes in the TBI population. This line of work is important for informing treatment targets that could prevent or reduce of psychological distress after TBI.

PMID:39146446 | DOI:10.1097/HTR.0000000000000967

Scand J Clin Lab Invest. 2024 Aug 15:1-6. doi: 10.1080/00365513.2024.2392126. Online ahead of print.

ABSTRACT

Vitamin B1 (thiamine pyrophosphate (TPP)) and B6 (pyridoxal 5′- phosphate (PLP)) deficiencies pose significant health risks. The current measurement method employs High-Performance Liquid Chromatography (HPLC), though, Liquid Chromatography with tandem Mass Spectrometry (LC-MS/MS) is considered a more sensitive and selective analytical method. However, there is a lack of LC-MS/MS-based reference intervals. Moreover, none of the existing reference intervals are established in Danish populations. Therefore, the aim of this study was to establish a reference interval for whole blood concentrations of TPP and PLP in Danish blood donors using LC-MS/MS. Blood samples were collected from healthy Danish blood donors and analysed using the reagent kit, MassChrom^® Vitamins B1 and B6 in whole blood (Chromsystems Instruments & Chemicals GmbH, Munich, Germany) for quantitative determination of both TPP and PLP concentration in whole blood, using LC-MS/MS. Reference intervals were determined with non-parametric methods as the 2.5th and 97.5th percentile and presented with 90% confidence intervals (CI). In total 120 blood donors were included. The concentrations of TTP or PLP were not statistically different between sexes just as age did not affect the concentrations, hence, combined reference intervals were employed. The resulting reference intervals are: TPP, nmol/L: 101.0 (90% CI: 96.4-108.5) – 189.0 (90% CI: 184.7-192.0) and PLP, nmol/L: 64.0 (90% CI: 60.9-66.7) – 211.8 (90% CI: 168.3-231.0). In conclusion, reference intervals for whole blood TTP and PLP in a healthy Danish population were established based on a LC-MS/MS method. Furthermore, the reference intervals were not affected by age or sex.

PMID:39146443 | DOI:10.1080/00365513.2024.2392126

PLoS Biol. 2024 Aug 15;22(8):e3002758. doi: 10.1371/journal.pbio.3002758. Online ahead of print.

ABSTRACT

In disciplines from biology to climate science, a routine task is to compute a correlation between a pair of time series and determine whether the correlation is statistically significant (i.e., unlikely under the null hypothesis that the time series are independent). This problem is challenging because time series typically exhibit autocorrelation and thus cannot be properly analyzed with the standard iid-oriented statistical tests. Although there are well-known parametric tests for time series, these are designed for linear correlation statistics and thus not suitable for the increasingly popular nonlinear correlation statistics. There are also nonparametric tests that can be used with any correlation statistic, but for these, the conditions that guarantee correct false positive rates are either restrictive or unclear. Here, we describe the truncated time-shift (TTS) test, a nonparametric procedure to test for dependence between 2 time series. We prove that this test correctly controls the false positive rate as long as one of the time series is stationary, a minimally restrictive requirement among current tests. The TTS test is versatile because it can be used with any correlation statistic. Using synthetic data, we demonstrate that this test performs correctly even while other tests suffer high false positive rates. In simulation examples, simple guidelines for parameter choices allow high statistical power to be achieved with sufficient data. We apply the test to datasets from climatology, animal behavior, and microbiome science, verifying previously discovered dependence relationships and detecting additional relationships.

PMID:39146390 | DOI:10.1371/journal.pbio.3002758