Objectives: Using predictive modeling techniques, we developed and compared appointment no-show prediction models to better understand appointment adherence in underserved populations. Methods and Materials: We collected electronic health record (EHR) data and appointment data including patient, provider and clinical visit characteristics over a 3-year period. All patient data came from an urban system of community health centers (CHCs) with 10 facilities. We sought to identify critical variables through logistic regression, artificial neural network, and naïve Bayes classifier models to predict missed appointments. We used 10-fold cross-validation to assess the models’ ability to identify patients missing their appointments. Results: Following data preprocessing and cleaning, the final dataset included 73811 unique appointments with 12,392 missed appointments. Predictors of missed appointments versus attended appointments included lead time (time between scheduling and the appointment), patient prior missed appointments, cell phone ownership, tobacco use and the number of days since last appointment. Models had a relatively high area under the curve for all 3 models (e.g., 0.86 for naïve Bayes classifier). Discussion: Patient appointment adherence varies across clinics within a healthcare system. Data analytics results demonstrate the value of existing clinical and operational data to address important operational and management issues. Conclusion: EHR data including patient and scheduling information predicted the missed appointments of underserved populations in urban CHCs. Our application of predictive modeling techniques helped prioritize the design and implementation of interventions that may improve efficiency in community health centers for more timely access to care. CHCs would benefit from investing in the technical resources needed to make these data readily available as a means to inform important operational and policy questions.
Introduction: Approximately 74,000 Americans are diagnosed with Non-Hodgkin Lymphoma (NHL) each year, approximately one-third of whom have diffuse large B-cell lymphoma (DLBCL). Historically, there have been limited curative treatment options for most patients with DLBCL who relapse or have refractory disease. Recently, autologous anti-CD19 chimeric antigen receptor T-Cell (CAR T) therapies were approved for the treatment of patients with relapsed or refractory large B cell lymphoma with ≥ 2 prior systemic therapies. Objectives: To describe the demographic and clinical characteristics of Medicare patients receiving CAR T therapy (axicabtagene ciloleucel or tisagenlecleucel), and compare healthcare utilization, costs, and outcomes pre- and post-CAR T therapy. Methods: The study utilized a single-group pre-test/post-test design. Data were derived from the Center for Medicare and Medicaid Services (CMS) 100% Medicare Fee-for-Service (FFS) Part A and B claims data. Part D data for the study period were not yet available, so pharmacy claims for oral medications were not evaluated. Patients were included in the study if they had an indicated lymphoma diagnosis and received CAR T therapy between 10/1/2017 and 9/30/2018. The index episode of care was defined as the initial CAR T infusion and associated inpatient stay, if any. To allow for evaluation of patient characteristics and treatments pre- and post-CAR T, patients must have been continuously enrolled in Medicare FFS for 6 months prior to and 100 days after the index date. Baseline demographic and clinical characteristics included age, gender, census region, dual eligibility status, original reason for entitlement to Medicare, specific B-cell lymphoma diagnosis, comorbidities, and prior history of certain conditions. Measures of utilization and cost pre- and post-CAR T (standardized as per patient per month to account for different follow-up durations) included hospitalizations, intensive care unit (ICU) transfers, and emergency department (ED) visits. Pre- and post-CAR T statistical analyses excluded the index episode of care itself. Results: 177 patients met all inclusion criteria. Data are summarized in Table 1. The average age was 70 years, 58.8% were male, and 87.6% were white. The vast majority were non-dual-eligible (91.5%) and qualified for Medicare because of age (87.6%) rather than disability. Clinically, 91.5% had a primary diagnosis of DLBCL. Patients had multiple co-morbidities and 74.6% had a Charlson Comorbidity Index score ≥ 3. Fewer than 5% of patients had a previous autologous stem cell transplant. Forty-three percent of patients had one or more comorbidities that would have disqualified them from CAR T clinical trials (e.g. renal failure, heart failure, recent history of DVT/PE.) Over half of all patients (52%) received intravenous chemotherapy (CTX) in the 6 months prior to CAR T, and 60% received outpatient lymphodepletion. Patients spent a median of 16 days (IQR = 10) in the hospital during their index episode of care for CAR T infusion and nearly half (45.5%) were transferred to the ICU during their post-CAR T infusion stay. During the 6-month pre-index period, over half the patients had ≥ 1 hospitalization, and nearly 20% had ≥ 3. Of these, 27.1% were re-admitted during the post-index period. For those hospitalized, the median length of stay (LOS) pre- and post-index was 7 and 5 days, respectively. The number of patients with an ED visit was reduced by one-half during post- vs. pre-index (15.8% vs. 29.9%). None of the patients expired during the post-index period, but a small percentage (<5%) were admitted to hospice care. There was no clear evidence of subsequent CTX use during the 100-day post-index period (which would suggest disease progression) although claims for the period may lag for some patients. Exclusive of index episode of care costs, median total healthcare costs during the pre-index period were $51,999 (mean=58,820, SD=45,701) and $14,014 post-index (mean=23,738, SD=29,698), which translates into $9,749 pre- vs. $7,121 post-index per patient per month, a 27% decrease. Conclusions: The results of this real-world study indicate that older patients with multiple comorbidities can be treated successfully with CAR T therapy, and that post-index care was associated with lower hospitalization rates, bed days, ED visits, and lower total costs during this period. Disclosures Kilgore: Kite Pharma: Research Funding. Mohammadi:Kite Pharma: Research Funding. Schroeder:Kite Pharma: Research Funding. Teigland:Kite Pharma: Research Funding. Purdum:Kite Pharma: Employment. Shah:Janssen Pharmaceutica: Research Funding; Amgen: Research Funding.
Background and objective: A variety of diseases, including obesity, type ӀӀ diabetes, and cardiovascular diseases are associated with obstructive sleep apnea syndrome (OSAS), and decreased adiponectin levels have been shown to be associated with an increased risk of these diseases. However, the association of blood levels of adiponectin in OSAS patients is a challenging and unknown issue with conflicting results. Therefore, we performed a systematic review and a meta-analysis to evaluate plasma/serum adiponectin levels in adult patients with OSAS. Materials and methods: A comprehensive search in four databases (PubMed/Medline, Web of Science, Scopus, and Cochrane Library) was performed in literature dated older than 12 March 2022, to retrieve the relevant articles. Effect sizes were calculated to show the standardized mean difference (SMD) along with a 95% confidence interval (CI) of plasma/serum of adiponectin between the OSAS patients and controls. The software RevMan 5.3, NCSS 21.0.2, CMA 2.0, trial sequential analysis (TSA) 0.9.5.10 beta, and GetData Graph Digitizer 2.26 were used for data synthesis in the meta-analysis. Results: A total of 28 articles including 36 studies were entered into the meta-analysis. The results showed that pooled SMD was −0.71 (95% CI: −0.92, 0.50; p < 0.00001; I2 = 79%) for plasma/serum levels of adiponectin in OSAS cases compared to the controls. The subgroup analyses showed that the geographical region and the Apnea-Hypopnea-Index (AHI) could be confounding factors in the pooled analysis of plasma/serum adiponectin levels. The sensitivity analysis showed the stability of the results. The radial and L’Abbé plots confirmed evidence of heterogeneity. Trial sequential analysis showed sufficient cases in the meta-analysis. Conclusions: With sufficient cases and stable results, the main finding of the meta-analysis identified significantly reduced plasma/serum levels of adiponectin in OSAS cases compared with the controls. This result suggests a potential role of adiponectin in the pathogenesis of OSAS.
BackgroundTemporomandibular disorders (TMDs) are musculoskeletal conditions that can inhibit the normal function of temporomandibular joints (TMJs) and affect the patient’s quality of life, negatively. Arthrocentesis (AC) is a minimally invasive surgical procedure used for treating TMDs. The aim of present paper is to evaluate the advantages of administrating corticosteroid (CS) during AC by reviewing high quality released articles.Material and MethodsSearching on Cochrane Library, Web of Science, Google Scholar, PubMed, ProQuest, and Scopus databases were performed with focusing on proper key words. Related titles and abstracts, up to December 2017, were screened and selected based on inclusion criteria. The full text of all randomized controlled trials (RCTs) was extensively read and subjected to quality assessments.ResultsAfter initial search, a total of 2067 articles were included into the study. Finally, 7 studies were reliable enough in methodology and randomization to be included into the study. All of the observed studies showed improvements in jaw functions and pain relief with no statistical differences in both AC and control groups. One study reported painless maximum incisal opening in CS group than the control group.ConclusionsBased on available RCTs, the AC of TMJ with CS seems to result in similar findings to other therapeutic drugs, with no significant differences. Key words:Arthrocentesis, corticosteroid, temporomandibular joints, temporomandibular joint disorders.
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