bluuebunny/crossref_metadata_2025_split huggingface dataset:
Integration of continuous improvement strategies with Industry 4.0: a systematic review and agenda for further research
Authors: Vinodh S. , Antony Jiju , Agrawal Rohit , Douglas Jacqueline Ann 
Published: August 2020

PurposeThe purpose of this paper is to provide a review of the history, trends and needs of continuous improvement (CI) and Industry 4.0. Four strategies are reviewed, namely, Lean, Six Sigma, Kaizen and Sustainability.Design/methodology/approachDigitalization and CI practices contribute to a major transformation in industrial practices. There exists a need to amalgamate Industry 4.0 technologies with CI strategies to ensure significant benefits. A systematic literature review methodology has been followed to review CI strategy and Industry 4.0 papers (n = 92).FindingsVarious frameworks of Industry 4.0, their advantages and disadvantages were explored. A conceptual framework integrating CI strategies and Industry 4.0 is being presented in this paper.Practical implicationsThe benefits and practical application of the developed framework has been presented.Originality/valueThe article is an attempt to review CI strategies with Industry 4.0. A conceptual framework for the integration is also being presented.
The Mental Health Effects of the First Two Months of Lockdown during the COVID‐19 Pandemic in the UK*
Authors: Banks James , Xu Xiaowei 
Published: August 2020

AbstractIn this paper, we estimate the effects of the COVID‐19 pandemic on mental health in the UK. We use longitudinal micro data for the UK over the period 2009–20 to control for pre‐existing trends in mental health and construct individual‐specific counterfactual predictions for April 2020, against which the COVID‐19 mental health outcomes can be assessed. Our analysis reveals substantial effects at the population level, approximately equal in magnitude to the pre‐pandemic differences between the top and bottom quintiles of the income distribution. This overall effect was not distributed equally in the population – the pandemic had much bigger effects for young adults and for women, which are groups that already had lower levels of mental health before COVID‐19. Hence inequalities in mental health have been increased by the pandemic. Even larger effects are observed for measures of mental health that capture the number of problems reported or the fraction of the population reporting any frequent or severe problems, which more than doubled. Pre‐existing health vulnerabilities had no predictive power for subsequent changes in mental health.
Rural‐Urban Differences in Survival and Health care Utilization Among Medicare Beneficiaries Diagnosed with Alzheimer’s Disease and Related Dementias
Authors: Rahman M. , White E. , Thomas K. , Jutkowitz E. 
Published: August 2020

Research ObjectiveThere is poor understanding as to how survival and health care utilization vary among older adults living with Alzheimer’s disease and related dementias (ADRD) in rural versus urban areas of the United States. The objective of this study was to describe survival and trajectories of hospital, nursing home, and home health care use in the six years following a new diagnosis of ADRD among rural and urban Medicare beneficiaries.Study DesignProspective cohort study using 2008‐2015 Medicare claims linked with nursing home and home health assessment data.Population Studied1 203 897 Medicare fee‐for‐service beneficiaries who were newly diagnosed with ADRD in 2008 or 2009. 77% (n = 921 853) resided in metropolitan counties, 14% (n = 162 857) in micropolitan counties, and 10% (n = 119 187) in rural counties.Principal FindingsThe average age at ADRD diagnosis was about six months younger for beneficiaries residing in rural counties compared to metropolitan counties. Beneficiaries residing in metropolitan counties survived a mean of 1211 days (median 1188 days) after diagnosis. Adjusting for individual demographic and clinical characteristics, beneficiaries in rural and micropolitan counties survived 29.2 fewer days (95% CI −34.0, −24.4) and 31.9 fewer days (95% CI −36.1, −27.7) than metropolitan residents, respectively. Compared with metropolitan residents, rural residents spent an adjusted 82.9 fewer days (95% CI −87.6, −78.2) in the community without home health care services, received 3.0 fewer days of home health care services (95% CI −3.5, −2.5), and spent 59.8 more days (95% CI 56.7, 63.0) in nursing homes. We found similar patterns in health care utilization for micropolitan vs. metropolitan residents, though the magnitude of the differences was smaller. Differences between groups became more pronounced the greater the time from diagnosis.ConclusionsUrban‐dwelling older adults with ADRD are significantly more likely to remain in the community and less likely to use nursing homes than individuals in rural and micropolitan counties, particularly in later disease stages.Implications for Policy or PracticeDifferences in health care utilization and survival between rural and urban Medicare beneficiaries with ADRD likely reflect geographic differences in health care access for timely diagnosis, proximity to informal caregivers, and availability of formal support services offered by home health agencies and other community‐based long‐term care providers.Primary Funding SourceNational Institutes of Health.
Medicaid Expansion Resulted in Decreased Odds of Frequent Emergency Department Use Among Medicaid Beneficiaries and the Uninsured in New York
Authors: Giannouchos T. , Kum H.‐C. , Ohsfeldt R. , Gary J. , Morrisey M. 
Published: August 2020

Research ObjectiveFrequent emergency department (ED) use has been often cited as a marker of fragmented health care provision and is an indicator of poor quality of care. The Affordable Care Act (ACA) attempted to address the rising costs related to the utilization of ED services, among others, by expanding insurance coverage, by fortifying primary care, by supporting the development of integrated health care delivery models, and by introducing alternative quality‐adjusted payment models. The objective of this study is to describe and to compare frequent ED users before and after the Medicaid expansion under the ACA and to estimate the policy’s effect on the likelihood of frequent ED utilization in New York.Study DesignWe used the 2011 to 2016 Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) and State Inpatient Databases (SID) for New York. The number of ED visits per patient was calculated using a patient identifier across the HCUP SEDD and SID data. We defined frequent ED use as four or more visits in one year. Multivariate logistic regression was used to estimate the changes in the likelihood of frequent ED use in the post‐Medicaid expansion period. We conducted sensitivity analyses using alternative definitions of frequent use and falsification analyses examining only pre‐expansion years.Population StudiedIn‐state residents aged 18‐64, who had Medicaid or private coverage or were uninsured.Principal FindingsFrequent users represented 7.1% of all ED patients before and 7.3% after the policy implementation and accounted for 26.1% and 27.0% of all ED visits, respectively. Frequent users were mostly covered through Medicaid across all years (69% vs 35%, P < .001) and had higher rates of comorbidities and chronic conditions compared with infrequent users. After controlling for patient and county‐level characteristics, the policy implementation was associated with 4% (P < .001) and 12% (P < .001) reductions in the likelihood of being a frequent ED user among Medicaid beneficiaries and the uninsured, respectively, while the likelihood of frequent use increased by 9% (P < .001) for private insurance enrollees. Beyond the policy, high ED reliance was continuously associated with patients who had multiple comorbidities and chronic conditions, including mental health, substance, and alcohol use, as well as conditions that could be prevented and treated in non‐ED settings.ConclusionsAfter New York expanded Medicaid in 2014, the likelihood of frequent ED use declined among Medicaid beneficiaries and those remaining uninsured.Implications for Policy or PracticeThe high share of frequent users in Medicaid plans indicates the continuous need to address social determinants of health at community level, particularly for Medicaid patients.
A Comparison on Quality of Care and Practice Patterns of Primary Care Physicians, Nurse Practitioners, and Physician Assistants for Medicaid Patients in New York
Authors: Wang S. , Martiniano R. 
Published: August 2020

Research ObjectiveCurrently, services for Medicaid patients in ambulatory care are predominantly delivered by primary care physicians (PCMDs). This study compared the quality of care and practice patterns among primary care physicians, nurse practitioners (NPs), and physician assistants (PAs) in ambulatory care settings to indicate gaps in services that could be filled if primary care services were delivered by NPs and PAs.Study DesignUsing Medicaid claims data of the New York State Medicaid Data Warehouse from 2016 to 2018, multivariate regression analyses were conducted to estimate the impact of receiving primary care by NPs/PAs versus receiving primary care by PCMDs.Literature reviews were conducted to select 7 patient‐level outcome variables, including 3 quality of care indicators (smoking cessation, depression, and hyperlipidemia) and 4 practice pattern indicators (general examination, ultrasonography, medication, and referral). Both design‐based and model‐based inferences were utilized to test on 7 key outcome variables (software SPSS 25 and Hierarchical Linear and Nonlinear Modeling (HLM) 7, respectively).Effects of practitioner type on quality of care and practice patterns were examined using weighted regressions and presented as adjusted odds ratios (AORs) for each outcome.In addition to the AORs, predictive margin modeling was also used to estimate the probability of each outcome occurring among PCMDs, NPs, and PAs while controlling for other outcomes.Population StudiedAnalyses included over 23 million Medicaid claims from 21,392 PCMDs, 3,492 NPs, and 1,951 PAs on more than 6 million unique Medicaid patients in New York State from 2016 to 2018.Principal FindingsThe distribution of practitioners’ characteristics was largely similar across practitioner type, although a greater proportion of NPs were female compared with PCMDs and PAs.On 4 of the 7 outcomes—depression treatment, hyperlipidemia treatment, general examination, and medication—no statistically significant differences were detected in NP/PA‐provided primary care compared with PCMD‐provided.On the remaining outcomes, Medicaid patients seen by NPs were more likely to receive smoking cessation treatments than those seen by PCMDs (P ≤ .05). Medicaid patients seen by PAs were more likely to receive primary care ultrasounds and physician referrals than those seen by PCMDs (P ≤ .01).ConclusionsAmong the outcomes studied, primary care services provided by PCMDs, NPs, and PAs are comparable in ambulatory care settings in New York for Medicaid patients.Implications for Policy or PracticeA greater use of NPs and PAs is likely to produce equivalent quality primary care services and may improve primary care in underserved areas where have difficulties hiring primary care physicians.
Factors Associated with Reduced Medicare Spending in the Accountable Care Organization (ACO) Investment Model
Authors: Trombley M. , Fout B. , Zhou C. , Brodsky S. , Morefield B. , McWilliams M. , Nyweide D. 
Published: August 2020

Research ObjectiveThe ACO Investment Model (AIM) was designed to encourage providers in rural or underserved areas to participate in the Medicare Shared Savings Program (SSP) by providing up‐front financial support for care transformation. In the second performance year, there were 41 ACOs that continued participation in AIM, with 423,434 beneficiaries assigned them. Our research objective was to determine whether the significant reductions in total Medicare spending we found in the first performance year were sustained in the second year, and whether specific ACO or market characteristics were associated with spending in both performance years.Study DesignWe utilized a difference‐in‐differences evaluation design to estimate differences in total spending between Medicare fee‐for‐service (FFS) beneficiaries attributed to AIM ACOs and comparison beneficiaries, before versus after the start of AIM. The comparison group included beneficiaries residing in each AIM ACO’s market who were eligible but not attributed to an ACO. Regression and weighting were used to adjust for demographic characteristics and health status. We stratified first and second performance year results based on ACO and market characteristics, including whether an ACO used a management company; partnered with a hospital; had fewer than 6,500 enrolled beneficiaries; was in the top quartile of rurality among AIM markets; had a discontinuous market; or had total Medicare spending at baseline that was above the median among all AIM markets.Population StudiedMedicare FFS beneficiaries attributed to ACOs in AIM, which targeted ACO formation in rural/underserved areas in 2016 and 2017.Principal FindingsAcross all 41 AIM ACOs, we estimated a significant reduction in total spending of $36.94 per beneficiary per month (PBPM) in the second performance year—a reduction of 3.5% and similar to findings from the first performance year. There were no significant differences in AIM impacts based on any of our six stratifications, but results across the two performance years suggest that greater reductions were achieved by ACOs working with a management company.ConclusionsACOs participating in AIM sustained reductions in total Medicare spending across the first two performance years and across diverse ACO and market characteristics.Implications for Policy or PracticeResults from the second performance year strengthen the evidence that ACOs can help reduce Medicare spending in rural or underserved areas. Among AIM markets, variations in market‐level baseline spending, market dispersion, and high rurality were not barriers to achieving spending reductions. ACOs locating in rural or underserved areas may benefit through partnership with a management company.Primary Funding SourceCenters for Medicare and Medicaid Services.
Rhetoric or Reality: Are Health Systems Redesigning How Health Care Is Delivered?
Authors: Scanlon D. 
Published: August 2020

Despite strong evidence about deficiencies in quality and safety, and abundant rhetoric about moving from volume‐based to value‐based care, to date, little systematic research has examined whether and how health systems are reengineering the way health care is organized and delivered. We adopt the term care delivery redesign (CDR) to capture the variety of tools and organizational change processes used by health systems to pursue the Triple Aim. We answer the following research questions.Are health systems motivated to engage in CDR? What factors are driving these efforts?What CDR strategies and activities are health systems using?Key informant interviews with 162 executives in 24 health systems as part of the Agency for Healthcare Research and Quality’s Comparative Health System Performance Initiative. Interviews were audio‐recorded and transcribed, and global codes were applied using the Dedoose qualitative software based on a systematic codebook developed by the study team. Study investigators and analysts reviewed transcripts and coded text to arrive at study findings using a team‐based qualitative analytic approach.Purposive sample of health systems in four states (California, Minnesota, Washington, and Wisconsin). Health systems in each state were selected to provide variation across a number of dimensions including size, profit status, geography served, and financial condition.We report seven motivating factors reported by health systems for engaging in CDR, including intrinsic factors (organizational priorities; organizational culture; fiscal health) and extrinsic factors (public policy and price and quality transparency, alternative payment models, community and population needs, current scientific guidelines). We also present and discuss five categories of CDR activities health systems are pursuing (consistency and efficiency of care; care coordination and management; consumer‐centric care; patient in environment; and evidence, data, analytics, and technology). We provide specific examples of each area and use case examples to qualitatively illustrate the variation across systems in both motivating factors and CDR activities).The breadth and depth of CDR activities in our health system sample varied. Systems with executives who reported having strong intrinsic motivation for their efforts appear to be on a more well‐defined path than systems with executives who report strong extrinsic motivation. Health systems are engaging in a wide range of activities, with some systems focusing only on small‐scale or incremental changes and others focusing on a broad range of activities that fit within a larger vision of CDR. The variation that exists on CDR activities may be useful for developing a systematic measurement approach for CDR activity in a broader sample of health systems.Currently, researchers are not able to validly and reliably measure CDR activities, preventing quantification of the impact these activities have on the Triple Aim outcomes.Agency for Healthcare Research and Quality.
SOCIAL DETERMINANTS AND SOCIAL NEEDS
Authors: Gottlieb L. , Joe S. , Cadet T. , Bibbins‐Domingo K. 
Published: August 2020

Over the last thirty years, consistent and compelling evidence has documented strong associations between socio‐economic risk factors and health outcomes. This has led to a growing number of payment and practice innovations across the health care sector related to identifying and addressing patient social risks alongside more traditional biomedical care. In 2018, the National Academies of Sciences, Engineering, and Medicine (NASEM) convened a one‐year national expert committee charged with examining the potential for integrating social care and health care services to achieve better health outcomes and to help overcome major challenges facing the U.S. health care system.Over the course of 2018‐2019, the NASEM Consensus Study Committee conducted multiple literature reviews and held several open meetings to gather evidence related to the charge.Though much of the innovation in this field relates to primary care, evidence was also reviewed from other health disciplines.The final committee report highlights five health care sector approaches to providing social care and to strengthening the social resources landscape, including increasing awareness about patients’ social risks; making adjustments to clinical care based on social needs; providing assistance to more consistently and effectively link patients with community‐based social resources; better aligning health care resources with community social care activities; and ensuring the health care system is involved in advocacy activities to strengthen social resources. The report also explores the workforce demands of social and medical care integration; health information and technology needs of social and medical care integration; payment models that can support integration; and other major barriers to integration.The NASEM report articulates concrete approaches for the health care sector to address social needs as one part of comprehensive strategies to improve patient and population health and health equity.Key policy recommendations based on the report findings include designing a health care system to accommodate the five approaches; recruiting and training a workforce able to provide social care; developing financing mechanisms that support integrated care activities; improving an interoperable digital infrastructure across health and social care sectors; and funding, conducting, and translating research on effectiveness and implementation of integrated care activities.40 funders convened to support the NASEM consensus study.
Guidance on infection control and plume management with Laser and Energy‐Based Devices taking into consideration COVID‐19
Authors: Sullivan John R , Rademaker Marius , Goodman Greg , Bekhor Philip , Al‐Niaimi Firas 
Published: August 2020

AbstractBackgroundThe COVID‐19 pandemic has disrupted the practice of medicine. Dermatologic laser and energy‐based device (EBD) treatments carry a potential risk for the transmission of SARS‐CoV‐2 both for the patient and the practitioner. These risks include close practitioner to patient proximity, the treatment of higher viral load areas such as the face, the potential for infective bioparticles being carried by generated plumes and aerosols, and the direct contact between device, practitioner and patient.ObjectivesSARS‐CoV‐2 is a highly infective respiratory pathogen transmitted by respiratory droplets, respiratory/mucosal secretions, medically generated aerosols and via its transfer from contaminated fomites. This requires a review of the appropriateness of infection control protocols in regard to dermatologic laser and energy‐based device treatments.MethodsA critical evaluation of patient skin preparation including skin asepsis, device disinfection, laser and electrosurgical plume management and PPE in regard to SARS‐CoV‐2 was performed.ResultsThe adherence to a high standard of skin preparation and asepsis, device disinfection, laser and electrosurgical plume and aerosol management and appropriate PPE should help mitigate or reduce some of the inherent treatment risks. Head and neck treatments along with aerosol and laser plume generating treatments likely carry greater risk.ConclusionsCOVID‐19 needs to be considered in the clinic set‐up along with the planning, treatment and post‐treatment care of patients utilising EBD procedures. Some of these treatment precautions are COVID‐19 specific; however, most represent adherence to good infectious disease and established laser and EBD safety precautions.
The Uneven Geographies of Politicisation: The Case of the Undocumented Immigrant Youth Movement in the United States
Authors: Nicholls Walter J. 
Published: August 2020

AbstractThis paper examines the uneven geographies of politicisation through the case of the undocumented immigrant youth movement in the United States, known as the Dreamers. Engaging the “urban political” literature, the paper maintains that politicisation involves the constitution of a subject that disrupts the order through claims for equality. The paper identifies the process of transforming highly marginalised and repressed people into an actual disruptive political subject. It suggests a three‐stage, spatially mediated process. First, “free spaces” are frontline sites that allow marginalised and risk‐averse groups like undocumented immigrants to meet with others, forge emotional bonds, and construct transgressive collective identities. Second, the potential of free spaces to politicise marginalised groups varies by geographical setting. Geographical settings, like large central cities, with high levels of organisational density and some ideological support facilitate politicisation more than settings with low organisational density and high hostility. Third, the uneven geographies of politicisation results in a political subject that is constituted and divided by core–periphery relations.