Healthcare Utilization Disparities Among Lung Cancer Patients in US Hospitals During 2010-2014: Evidence from the US Hispanic Population's Hospital Charges and Length of Stay.

PURPOSE: There is a lack of research focused on understanding the differences in the healthcare utilization of lung cancer patients between ethnic groups. This study aims to characterize disparities in healthcare utilization for Hispanic lung cancer patients compared to non-Hispanic patients. METHODS: National Inpatient Sample was used to identify nationwide lung cancer patients (n=141,675, weighted n=702,878) from 2010 to 2014. We examined the characteristics of the study sample by race (Hispanic vs non-Hispanic) and its association with healthcare utilization, measured by discounted hospital charges and length of stay. Multivariate survey regression models were used to identify predictors by racial groups. RESULTS: Among 702,878 lung cancer patients, 5.1% were Hispanic. Descriptive statistics showed that Hispanics have higher hospital charges and length of stay. Survey regression results also suggested that Hispanic lung cancer patients were associated with higher hospital charges (26.6%) and length of stay (3.5%) than non-Hispanic lung cancer patients. Subgroup analysis displayed a similar trend to the full model. CONCLUSION: Healthcare utilization disparities may exist for lung cancer Hispanic patients due to insurance status and early detection. Thus, our findings support providing financial assistance and targeted programs for minority patients. Future health policy consideration should be given to those vulnerable populations where limited healthcare resources are available.

Return on Investment of Free Colorectal Cancer Screening Tests in a Primarily Rural Uninsured or Underinsured Population in Northeast Texas.

BACKGROUND: Colorectal cancer (CRC) is the third most common cancer in the USA. Its economic impact is extensive, and preventive screening services are warranted to help prevent it. OBJECTIVE: We sought to examine the return on investment, in terms of reduced costs attributed to cancer prevention, of a CRC screening outreach program providing education and screening in a primarily rural region targeting the uninsured and underinsured. METHODS: The expenditures of the Northeast Texas CRC screening program were calculated for the years of 2016 and 2017. Prices ($US) were adjusted for inflation and converted to year 2017 values. The costs saved were calculated using the estimated costs of CRC care present in the literature. RESULTS: For fiscal years 2016 and 2017, the program provided an average return of $US1.46-2.06 for every tax dollar spent. Estimated cost avoidance was $US165,080 per avoided case and estimated cost avoidance of $US245,601 among early-stage cancer cases detected, resulting in potential savings ranging from $US3,893,676 to $US4,837,923. CONCLUSION: A CRC outreach program providing education and screening operating in less densely populated regions yields a positive return on investment.

Potential predictors of hospital length of stay and hospital charges among patients with all-terrain vehicle injuries in rural Northeast Texas.

BACKGROUND: All-Terrain Vehicles (ATVs) have become popular for recreation use in recent years. Texas has had more ATV related fatalities than any other state in the nation, with rural Northeast Texas having even higher rates of injuries. There is limited data examining the relationship between ATV injuries and the length of hospital stay, as well as hospital costs. This paper examines both issues in children as well as adults. METHODS: The regional trauma registry was analyzed for all ATV related injuries between January 2011- October 2016. Injury Severity Score, Glasgow Coma Scale and if they are seen at a Level I Trauma center are predictive for both hospital length of stay and charges. RESULTS: Length of Stay was predicted positively by Injury Severity Score, Emergency Department Respiration Rate and facility at which patients were treated and negatively by Glasgow Coma Scale. Hospital charges were predicted positively by age, Injury Severity Score, facility of treatment, means of transportation, and Emergency Department pulse and negatively by Glasgow Coma Scale. CONCLUSIONS: The study found that vital signs can be useful in predicting length of stay and hospital charges. This study not only confirms the findings of other studies regarding what predictors can be used, but expands the research into rural traumatic injuries. It is hoped that this data can help contribute to the development of algorithms to predict which patients will be most likely to require resource intensive treatment.

Individual and organizational factors associated with professional quality of life in Florida fire personnel.

OBJECTIVE: The purpose of this study was to determine a baseline level of compassion satisfaction, burnout, and secondary traumatic stress (STS) in firefighters, as well as to examine how these constructs related to perceived organizational support, perceived coworker support, psychological resilience, and debriefing in the fire personnel. DESIGN: This was done through a voluntary nonrandom, cross-sectional administration of surveys. SETTING: The study was carried out in the state of Florida. SUBJECTS, PARTICIPANTS: Surveys were e-mailed out to state firefighters. Two hundred seventy surveys were completed by active firefighting personnel across the state. MAIN OUTCOME MEASURE(S): The Professional Quality of Life: Compassion Satisfaction and Compassion Fatigue Version 5 was also sent to establish self-reported levels of compassion satisfaction, burnout, and STS. The Survey of Perceived Organizational Support, Perceived Organizational Support Survey, and the Brief Resilience Survey were also used in addition to questions regarding debriefing activities. RESULTS: Gender, race, and education levels were significantly related to compassion satisfaction in the regression analysis. Organizational support was associated with higher compassion satisfaction as well as lower burnout and STS. Coworker support was associated with higher compassion satisfaction. Psychological resilience was positively associated with higher levels of compassion satisfaction and lower burnout and STS. Those who participated in informal debriefing methods had higher compassion satisfaction as well as lower burnout. Firefighters working at agencies that did not provide mental health professional's services had lower compassion satisfaction. CONCLUSIONS: Fire agencies have multiple avenues and policy options to improve the professional quality of life for firefighters.

Comparison of Multiple Chronic Obstructive Pulmonary Disease (COPD) Indices in Chinese COPD Patients.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a serious chronic condition with a global impact. Symptoms of COPD include progressive dyspnea, breathlessness, cough, and sputum production, which have a considerable impact on the lives of patients. In addition to the human cost of living with COPD and the resulting death, COPD entails a huge economic burden on the Chinese population, with patients spending up to one-third of the average family income on COPD management in some regions is clinically beneficial to adopt preventable measures via prudent COPD care utilization, monetary costs, and hospitalizations. METHODS: Toward this end, this study compared the relative effectiveness of six indices in predicting patient healthcare utilization, cost of care, and patient health outcome. The six assessment systems evaluated included the three multidimensional Body mass index, Obstruction, Dyspnea, Exercise capacity index, Dyspnea, Obstruction, Smoking, Exacerbation (DOSE) index, and COPD Assessment Test index, or the unidimensional measures that best predict the future of patient healthcare utilization, cost of care, and patient health outcome among Chinese COPD patients. RESULTS: Multiple linear regression models were created for each healthcare utilization, cost, and outcome including a single COPD index and the same group of demographic variables for each of the outcomes. CONCLUSION: We conclude that the DOSE index facilitates the prediction of patient healthcare utilization, disease expenditure, and negative clinical outcomes. Our study indicates that the DOSE index has a potential role beyond clinical predictions.

Efficacy of SmartLoss, a smartphone-based weight loss intervention: results from a randomized controlled trial.

OBJECTIVE: Test the efficacy of SmartLoss, a smartphone-based weight loss intervention, in a pilot study. DESIGN AND METHODS: A 12-week randomized controlled trial. Adults (25 ≤ BMI ≤ 35 kg/m2) were randomized to SmartLoss (n = 20) or an attention-matched Health Education control group (n = 20). SmartLoss participants were prescribed a 1,200 to 1,400 kcal/d diet and were provided with a smartphone, body weight scale, and accelerometer that wirelessly transmitted body weight and step data to a website. In the SmartLoss Group, mathematical models were used to quantify dietary adherence based on body weight and counselors remotely delivered treatment recommendations based on these objective data. The Health Education group received health tips via smartphone. A mixed model determined if change in weight and other endpoints differed between the groups (baseline was a covariate). RESULTS: The sample was 82.5% female. Mean ± SD baseline age, weight (kg), and BMI were 44.4 ± 11.8 years, 80.3 ± 11.5 kg, and 29.8 ± 2.9 kg/m2, respectively. One participant was lost to follow-up in each group before week 4. Weight loss was significantly (P < 0.001) larger in the SmartLoss (least squares mean ± SEM: -9.4 ± 0.5%) compared with the Health Education group (-0.6 ± 0.5%). CONCLUSIONS: SmartLoss efficaciously promote clinically meaningful weight loss compared with an attention-matched control group. Smartphone-based interventions might prove useful in intervention dissemination.

Increased sensory feedback in Tourette syndrome.

Tourette syndrome (TS) is a neuro-psychiatric disorder being characterized by motor and phonic tics typically preceded by sensory urges. Given the latter the role of the sensory system and sensorimotor interaction in TS has recently gained increased attention. 12 TS patients and 12 matched control subjects performed two tasks, requiring simple finger movements: a Go/NoGo task and a self paced movement task. Neurophysiological data was recorded using magnetoencephalography (MEG). Event related responses around movement onset, i.e. motor field (MF) occurring directly prior to the movement and movement evoked field (MEF) immediately after movement onset were analyzed using dipole modeling. MF peak amplitudes did not differ between groups in either task. In contrast, in both tasks MEF peak amplitudes were increased in TS patients. Moreover, larger MEF amplitudes during self paced movements were inversely correlated with motor tic frequency and severity. Enlarged MEF amplitudes as a marker of early sensory feedback of one's own movements probably represent enlarged sensory input from the periphery resulting from altered subcortical gating. We conclude that TS patients exhibit altered sensory-motor processing involved in voluntary movement control, which might also be successful in tic control.