bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medicare Advantage Chart Reviews Are Associated With Billions in Additional Payments for Some Plans
Authors: Meyers David J. , Trivedi Amal N. 
Published: September 2020

Background:
In the Medicare Advantage (MA) program, private plans receive capitated payments that are adjusted based on their enrollees’ number and type of clinical conditions. Plans have the ability to review charts to identify additional conditions that are not present in claims data, thereby increasing risk-adjusted payments. Recently the Government Accountability Office released a report raising concerns about the use of these chart reviews as a potential tool for upcoding.

Objectives:
To measure the extent to which plans receive additional payments for chart reviews, and the variation in chart reviews across plans.

Research Design:
In this cross-sectional study we use 2015 MA Encounter data to calculate how many additional diagnoses codes were added for each enrollee using chart reviews. We then calculate how these additional diagnosis codes translate to additional reimbursements across plans.

Subjects:
A total of 14,021,692 beneficiaries enrolled in 510 MA contracts in 2015.

Measures:
Individual and contract level hierarchical condition category codes, total plan reimbursement.

Results:
Chart reviews were associated with a $2.3 billion increase in payments to plans, a 3.7% increase in Medicare spending to MA plans. Just 10% of plans accounted for 42% of the $2.3 billion in additional spending attributed to chart review. Among these plans, the relative increase in risk score from chart review was 17.2%. For-profit plans engaged in chart reviews substantially more frequently than nonprofit plans.

Conclusions:
Given the substantial and highly variable increase in payments attributable to chart review, further investigation of the validity of this practice and its implications for Medicare spending is needed.
A Comparative Analysis of Online Medical Record Utilization and Perception by Cancer Survivorship
Authors: Khan Saira , Lewis-Thames Marquita W. , Han Yunan , Fuzzell Lindsay , Langston Marvin E. , Moore Justin X. 
Published: September 2020

Background:
Cancer survivors face many challenges including coordinating care across multiple providers and maintaining medical records from multiple institutions. Access and utilization of online medical records could help cancer survivors manage this complexity. Here, we examined how cancer survivors differ from those without a history of cancer with regards to utilization and perception of medical records.

Methods:
We conducted a cross-sectional study of 3491 respondents, from the Health Information National Trends survey 5, cycle 2. The association of medical record utilization and perceptions with cancer survivorship was assessed using survey-weighted logistic regression.

Results:
Cancer survivors (n=593) were more likely to report that a provider maintains a computerized medical record [adjusted odds ratio (AOR)=2.05; 95% confidence (CI), 1.24–3.41] and were more likely to report confidence in medical record safeguards (AOR=1.44; 95% CI, 1.03–2.03). However, cancer survivors were no more likely to access online medical records than those without a history of cancer (AOR=1.13; 95% CI, 0.69–1.86). Cancer survivors were no more likely to report privacy concerns as a reason for not accessing online medical records, however, survivors were more likely to report a preference for speaking directly with a provider as a reason for not accessing online medical records (AOR=2.24; 95% CI, 0.99–5.05).

Conclusions:
Although cancer survivors are more likely to trust medical record safe guards and do not express increased concerns about online medical record privacy, a preference to speak directly with provider is a barrier of use.
Correlates of Homelessness Among Patients in Methadone Maintenance Treatment
Authors: Gaeta Marina , Beitel Mark , Oberleitner Lindsay M.S. , Oberleitner David E. , Madden Lynn M. , Tamberelli Joseph F. , Barry Declan T. 
Published: September 2020

Background:
Although homelessness and opioid use disorder (OUD) are important public health issues, few studies have examined their cooccurrence.

Objectives:
The aim of this study was to evaluate the correlates of homelessness among patients enrolled in low-barrier-to-treatment-access methadone maintenance treatment (MMT) programs for OUD.

Methods:
Demographic, diagnosis-related, and treatment-related correlates were assessed by self-report for 164 patients in MMT. Correlates of past-month homelessness were investigated with logistic regression.

Results:
Twenty-four percent of patients reported homelessness in the past month. Bivariate analyses initially identified 7 statistically significant (P<0.05) correlates of homelessness: gender; Latinx ethnicity; symptoms of depression, anxiety, and somatization; self-criticism; and duration of MMT. In the final logistic regression model, which included significant independent variables from the bivariate logistic regressions, patients in MMT who were homeless (vs. domiciled) were more likely to be male (odds ratio 2.54; confidence interval, 1.01–6.36) and report higher symptoms of depression (odds ratio 1.07; confidence interval, 1.01–1.15).

Conclusions:
Low-barrier-to-treatment-access programs can attract people who are homeless with OUD into MMT. These programs also have an important public health role in addressing both depression and OUD among people who are homeless.
Variation in Hospice Patient and Admission Characteristics by Referral Location
Authors: Furuno Jon P. , Noble Brie N. , McPherson Mary L. , Lapane Kate L. , Sera Leah , Izumi Shigeko , Tjia Jennifer 
Published: September 2020

Background:
Little is known regarding differences between patients referred to hospice from different care locations.

Objective:
The objective this study was to describe the associations between hospice referral locations and hospice patient and admission characteristics.

Research Design:
Cross-sectional analysis of hospice administrative data.

Subjects:
Adult (age older than 18 y) decedents of a national, for-profit, hospice chain across 19 US states who died between January 1, 2012, and December 31, 2016.

Measures:
Patients’ primary hospice diagnosis, hospice length stay, and hospice care site. We also determined the frequency of opioid prescriptions with and without a bowel regimen on hospice admission.

Results:
Among 78,647 adult decedents, the mean age was 79.2 (SD=13.5) years, 56.4% were female, and 69.9% were a non-Hispanic White race. Most hospice referrals were from the hospital (51.9%), followed by the community (21.9%), nursing homes (17.4%), and assisted living (8.8%). Cancer (33.6%) was the most prevalent primary hospice diagnosis; however, this varied significantly between referral locations (P<0.001). Similarly, home hospice (32.8%) was the most prevalent site; however, this also varied significantly between referral locations (P<0.001). More hospital-referred patients (55.6%) had a hospice length of stay <7 days compared with patients referred from nursing homes (30.3%), the community (28.9%), or assisted living (18.7%), P<0.001. Hospital-referred patients also had the lowest frequency (58.4%) of coprescribed opioids and bowel regimen on hospice admission compared with other referral locations.

Conclusion:
We observed significant differences in hospice patient and admission characteristics by referral location.
Correlates of Transitions Into Housing Instability Among Veterans Accessing Veterans Health Administration Health Care
Authors: Montgomery Ann E. , Rahman Fazlur A.K.M. , Cusack Meagan , Varley Allyson , Byrne Thomas 
Published: September 2020

Background:
Prior research has explored the patterns and dynamics of homelessness; such an understanding is necessary to improve policy and programmatic responses and prevent new episodes of housing instability.

Objectives:
The objectives of this study are to identify correlates of veterans’ transitions into housing instability and inform initiatives aimed to address their needs, with a focus on how to prevent new episodes of housing instability.

Methods:
The cohort for this study includes 4,633,069 veterans who responded to the Veterans Health Administration’s universal screen for housing instability at least twice between October 1, 2012, and September 30, 2016; 1.2% reported recent housing instability and 98.8% reported ongoing housing stability. The χ2 or Fisher exact tests, as appropriate, compared veterans’ characteristics by housing status. A multivariate logistic regression identified independent risk factors associated with recent housing instability, controlling for sociodemographic, military service, diagnostic, and health services use variables.

Results:
Sociodemographic and health services use variables increased veterans’ odds of transitioning into housing instability. The diagnoses with the greatest effect sizes were drug use disorder (adjusted odds ratio=1.50, 95% confidence interval: 1.45–1.55) and opioid use disorder, which was associated with a >2-fold increase in the odds of experiencing recent housing instability (adjusted odds ratio=2.22, 95% confidence interval: 2.04–2.41).

Conclusions:
The present study provides evidence to inform existing and future interventions to prevent new episodes of housing instability. Veterans with opioid use disorder were at greatest risk of becoming unstably housed; increasing access to medication-assisted treatment in homeless-focused services is needed.
Utilization of Social Determinants of Health ICD-10 Z-Codes Among Hospitalized Patients in the United States, 2016–2017
Authors: Truong Hannah P. , Luke Alina A. , Hammond Gmerice , Wadhera Rishi K. , Reidhead Mat , Joynt Maddox Karen E. 
Published: September 2020

Background:
The inclusion of Z-codes for social determinants of health (SDOH) in the 10th revision of the International Classification of Diseases (ICD-10) may offer an opportunity to improve data collection of SDOH, but no characterization of their utilization exists on a national all-payer level.

Objective:
To examine the prevalence of SDOH Z-codes and compare characteristics of patients with and without Z-codes and hospitals that do and do not use Z-codes.

Research Design:
Retrospective cohort study using 2016 and 2017 National Inpatient Sample.

Participants:
Total of 14,289,644 inpatient hospitalizations.

Measures:
Prevalence of SDOH Z-codes (codes Z55–Z65) and descriptive statistics of patients and hospitals.

Results:
Of admissions, 269,929 (1.9%) included SDOH Z-codes. Average monthly SDOH Z-code use increased across the study period by 0.01% per month (P<0.001). The cumulative number and proportion of hospitals that had ever used an SDOH Z-code also increased, from 1895 hospitals (41%) in January 2016 to 3210 hospitals (70%) in December 2017. Hospitals that coded at least 1 SDOH Z-code were larger, private not-for-profit, and urban teaching hospitals. Compared with admissions without an SDOH Z-code, admissions with them were for patients who were younger, more often male, Medicaid recipients or uninsured. A higher proportion of admissions with SDOH Z-codes were for mental health (44.0% vs. 3.3%, P<0.001) and alcohol and substance use disorders (9.6% vs. 1.1%, P<0.001) compared with those without.

Conclusions:
The uptake of SDOH Z-codes has been slow, and current coding is likely poorly reflective of the actual burden of social needs experienced by hospitalized patients.
Satisfaction With Quality of Health Care Among Medicare Beneficiaries With Functional Hearing Loss
Authors: Reed Nicholas S. , Boss Emily F. , Lin Frank R. , Oh Esther S. , Willink Amber 
Published: September 2020

Background/Objectives:
Nearly 38 million Americans have hearing loss. Understanding how sensory deficits such as hearing loss, which limit communication, impact satisfaction has implications for Medicare value-based reimbursement mechanisms. The aim of this study was to characterize the association of functional hearing loss and dissatisfaction with quality of health care over the past year among Medicare beneficiaries.

Methods:
Cross-sectional study of satisfaction with quality of health care among Medicare beneficiaries with self-reported trouble hearing from the 2015 Medicare Current Beneficiaries Survey. There were 11,441 Medicare beneficiaries representing a 48.6 million total weighted nationally representative sample.

Results:
Forty-eight percent of Medicare beneficiaries reported a little or a lot of trouble hearing. Medicare beneficiaries with a little trouble hearing (odds ratio=1.496; 95% confidence interval, 1.079–2.073; P=0.016) and a lot of trouble hearing (odds ratio=1.769; 95% confidence interval, 1.175–2.664; P=0.007) had 49.6% and 76.9% higher odds of being dissatisfied with the quality of their health care over the previous year, respectively.

Conclusions:
Medicare beneficiaries with functional hearing loss had higher odds of dissatisfaction with health care over the past year compared to those without functional hearing loss. Given Medicare’s reliance on patient satisfaction as a value-based measure for hospital reimbursement, interventions to address hearing loss in the health care system are needed.
Magnet Hospitals and 30-Day Readmission and Mortality Rates for Medicare Beneficiaries
Authors: Hamadi Hanadi Y. , Martinez Dayana , Palenzuela Julia , Spaulding Aaron C. 
Published: September 2020

Background:
US hospitals are penalized for excess 30-day readmissions and mortality for select conditions. Under the Centers for Medicare and Medicaid Services policy, readmission prevention is incentivized to a greater extent than mortality reduction. A strategy to potentially improve hospital performance on either measure is by improving nursing care, as nurses provide the largest amount of direct patient care. However, little is known as to whether achieving nursing excellence, such as Magnet status, is associated with improved hospital performance on readmissions and mortality.

Objective:
The purpose of this study was to examine the relationship between hospitals’ Magnet status and performance on readmission and mortality rates for Medicare beneficiaries.

Research Design:
This is a cross-sectional analysis of Medicare readmissions and mortality reduction programs from 2013 to 2016. A propensity score–matching approach was used to take into account differences in baseline characteristics when comparing Magnet and non-Magnet hospitals.

Subjects:
The sample was comprised of 3877 hospitals.

Measures:
The outcome measures were 30-day risk-standardized readmission and mortality rates.

Results:
Following propensity score matching on hospital characteristics, we found that Magnet hospitals outperformed non-Magnet hospitals in reducing mortality; however, Magnet hospitals performed worse in reducing readmissions for acute myocardial infarction, coronary artery bypass grafting, and stroke.

Conclusions:
Magnet hospitals performed better on the Hospital Value-Based Purchasing Mortality Program than the Hospital Readmissions Reduction Program. The results of this study suggest the need for The Magnet Recognition Program to examine the role of nurses in postdischarge activities as a component of its evaluation criteria.
Gastric vascular abnormalities: diagnosis and management
Authors: Awadalla Mohanad , Mahmoud Mohamed , McNamara Philip , Wassef Wahid 
Published: September 2020

Purpose of review
Gastric vascular abnormalities are a well known cause of gastrointestinal bleeding. Due to their recurrent bleeding tendency and potential to cause life-threatening blood loss, gastric vascular abnormalities can result in significant morbidity and cost.

Recent findings
There have been novel advances in medical and endoscopic management of gastric vascular lesions. New data suggest that endoscopic band ligation and ablation may be comparable, or even superior, to argon plasma coagulation (APC) for management of gastric antral vascular ectasia (GAVE). A creative, highly sensitive and specific computer-assisted tool has been developed to facilitate reading video capsule endoscopies for the detection of angiodysplasias, paving the way for artificial intelligence incorporation in vascular lesions diagnostics. Over-the-scope clipping is a relatively new technology that shows promising results in controlling bleeding from Dieulafoy's lesions.

Summary
In this article, we will broadly review the management of the most prevalent gastric vascular lesions, focusing on the most recent areas of research.
Duodenal chemosensory system: enterocytes, enteroendocrine cells, and tuft cells
Authors: Akiba Yasutada , Hashimoto Sayuri , Kaunitz Jonathan D. 
Published: September 2020

Purpose of review
The gut barrier serves as the primary interface between the environment and host in terms of surface area and complexity. Luminal chemosensing is a term used to describe how small molecules in the gut lumen interact with the host through surface receptors or via transport into the subepithelial space. In this review, we have summarized recent advances in the understanding of the luminal chemosensory system in the gastroduodenal epithelium consisting of enterocytes, enteroendocrine, and tuft cells, with particular emphasis on how chemosensing affects mucosal protective responses and the metabolic syndrome.

Recent findings
Recent single-cell RNA sequencing provides detailed cell type-specific expression of chemosensory receptors and other bioactive molecules as well as cell lineages; some are similar to lingual taste cells whereas some are gut specific. Gut luminal chemosensing is not only important for the local or remote regulation of gut function, but also contributes to the systemic regulation of metabolism, energy balance, and food intake. We will discuss the chemosensory mechanisms of the proximal intestine, in particular to gastric acid, with a focus on the cell types and receptors involved in chemosensing, with emphasis on the rare chemosensory cells termed tuft cells. We will also discuss the chemosensory functions of intestinal ectoenzymes and bacterial components (e.g., lipopolysaccharide) as well as how they affect mucosal function through altering the gut–hormonal–neural axis.

Summary
Recent updates in luminal chemosensing by different chemosensory cells have provided new possibilities for identifying novel molecular targets for the treatment of mucosal injury, metabolic disorders, and abnormal visceral sensation.
Advances in chimeric antigen receptor T cells
Authors: Beyar-Katz Ofrat , Gill Saar 
Published: September 2020

Purpose of review
To discuss the important advances in CAR T cell therapy over the past year, focusing on clinical results where available.

Recent findings
Approximately 30 years after they were first conceived of and 15 years after the first small-scale single-center clinical trials, the past 3 years represent a major milestone in the development of CAR T cells. In the United States, the Food and Drug Administration (FDA) approved Tisagenlecleucel for the treatment of relapsed/refractory B-ALL and Axicabtagene Ciloleucel, for adults with relapsed/refractory diffuse large B cell lymphoma (R/R DLBCL) in 2017. Tisagenlecleucel received a second indication in adults with R/R DLBCL in 2018. Regulatory approval for CAR T cells was then granted in Europe, Canada, Australia, and Japan. Most recently, in July 2020 the FDA granted regulatory approval to a third CAR T cell product, Brexucabtagene Autoleucel for mantle cell lymphoma. All products target the CD19 antigen but differ in the costimulatory molecule within the CAR construct. Currently, it is unknown whether there are any differences in clinical activity or toxicity between these products.

Summary
The CAR T cell the platform is evolving at a rapid pace and is expected to further improve the therapeutic outcomes of hematological malignancies.
Mixed Phenotype Acute Leukemia, B/Myeloid (Bilineal and Biphenotypic), With t(2;22)(q35;q12);EWSR1-FEV
Authors: Montgomery-Goecker Crystal , Koduru Prasad , Botten Giovanni , Xu Jian , Ghisoli Maurizio , Goldman Stanton C. , Krueger JoEllen , Bhushan Vikas , Fuda Franklin , Chen Weina 
Published: September 2020

Background:
Ewing sarcoma breakpoint region 1 gene (EWSR1) rearrangements are largely associated with the Ewing sarcoma family of tumors.

Observations:
We report the first case of infantile, mixed phenotype acute leukemia, B/myeloid (bilineal and biphenotypic [B-lymphoid and B-lymphoid/myeloid]), with a t(2;22)(q35;q12). The EWSR1-fifth Ewing variant gene fusion and nonsense mutation in STAG2 were detected by next-generation sequencing and markedly high expression of fifth Ewing sarcoma variant mRNA detected by quantitative reverse transcription polymerase chain reaction. The patient was treated with a combined myeloid/lymphoid leukemia regimen followed by allogeneic stem cell transplant and was in complete remission at 3.8-year follow-up.

Conclusions:
Our case study underscores the importance of a comprehensive evaluation of acute leukemia and provides insights into the phenotype of EWSR1 rearranged neoplasms in the context of partner genes and cell type.
Pain in Children and Adolescents With Sickle Cell Disease: Multidimensional Assessment
Authors: Abadesso Clara , Pacheco Susana , Machado Maria Céu , Finley Gordon Allen 
Published: September 2020

Background:
Patients with sickle cell disease (SCD) suffer from recurrent painful vaso-occlusive episodes with a significant impact on their quality of life. The aim of this study was to perform a multidimensional assessment of pain in Portuguese children and adolescents with SCD.

Methods:
Subjects were children and adolescents and their parents recruited from the outpatient pediatric hematology clinic in a Portuguese Hospital. Pain frequency and a broader multidimensional evaluation was performed using the Pediatric Pain Questionnaire (PedsQL) (that includes Visual Analog Scales, color indicators, qualitative descriptors of pain [open question] and body diagram) and a structured questionnaire (PQ2), that included a term list of the Adolescent Pediatric Pain Tool, among other questions.

Results:
Included 60 children and adolescents (36 boys and 24 girls) with a mean age of 11±4.0 years (range, 5 to 18). The majority of children (83.1%) reported no present pain and 57.6% reported pain last month, with several degrees of pain intensity. Abdomen, thorax, and limbs were the most frequent localizations. Red was the color most chosen to describe “severe pain,” whereas blue and green were more used to describe “no pain.” The number of pain descriptors is different using an open-ended question (2.1±1.5) than a given list of terms (15.3±8.1). The most frequent terms used in the open question were “strong/very strong,” “hurts a lot,” “makes cry,” and “horrible.” Parents used similar pain descriptors. “Makes cry,” “horrible,” “tiring,” “unbearable,” and “uncomfortable” were the most frequent terms chosen in the PQ2. Pain interfered variably with daily activities for most of the patients.

Conclusion:
Pain experienced in SCD has a broad range of intensity levels, localization, and frequency. There are a number of pain descriptors and socio-emotional factors related to the pain experience. A comprehensive multidimensional assessment that includes both child’s and parents’ perspective seem to be the most adequate strategy to assess pain.