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Tying Things Together
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
Regulatory requirements addressing malnutrition also exist outside the acute care setting. The minimum data set (MDS) is an assessment required by CMS as well as Medicaid-certified long-term care facilities for all residents.23 The MDS is completed by various members of the interdisciplinary team, including the RDN. Nutrition-specific information in the MDS includes swallowing function, weight loss or gain, and nutrition interventions.23 In the community setting, an addition to the Older Americans Act (OAA) in 2020 specifically addresses malnutrition. Malnutrition reduction is a focus of OAA nutrition programs with nutrition screening included as a routine part of program participation.24
Exploratory Data Analysis with Unsupervised Machine Learning
Published in Altuna Akalin, Computational Genomics with R, 2020
MDS is a set of data analysis techniques that displays the structure of distance data in a high-dimensional space into a lower dimensional space without much loss of information (Cox and Cox, 2000). The overall goal of MDS is to faithfully represent these distances with the lowest possible dimensions. The so-called “classical multi-dimensional scaling” algorithm, tries to minimize the following function:
Challenges Facing the American Healthcare System
Published in Kant Patel, Mark Rushefsky, Healthcare Politics and Policy in America, 2019
Physicians are the most important component of the healthcare workforce. There are 990,688 professional active physicians in the United States. This includes both allopathic (MDs) and osteopathic (DOs) physicians. MDs typically treat disease, while DOs focus on the musculoskeletal system and emphasize preventive medicine and take a more holistic approach to health. Of the total, 518,128 (52 percent) are specialists while 472,560 (48 percent) are primary-care physicians. Of the total primary-care physicians, around 41 percent are concentrated in the field of internal medicine, 29 percent in family or general practice, 18 percent in pediatrics, and 11 percent in obstetrics and gynecology. Primary care is the most fundamental element of the US healthcare system and primary-care physicians act as gatekeepers to specialized care. Primary care is critical in ensuring access to healthcare for all Americans. The top five fields of practice among specialists include psychiatry and emergency medicine (11 percent each), surgery and anesthesiology (10 percent each), and emergency medicine (10 percent). The rest practice in the fields of radiology, cardiology, oncology, endocrinology and others (Kaiser Family Foundation 2018a).
Healthcare resource utilization and costs in patients with myelodysplastic syndromes treated with hypomethylating agents: a SEER-Medicare analysis
Published in Journal of Medical Economics, 2021
Eytan M. Stein, Gaetano Bonifacio, Dominick Latrémouille-Viau, Sherry Shi, Annie Guérin, Eric Q. Wu, Islam Sadek, Xiting Cao
While HMA remain the standard of care for patients with MDS, new treatments are currently under investigation. Given the limited response in patients with MDS treated with HMA, a comprehensive understanding of the most recent available real-world data on HMA-treatment outcomes, including the healthcare resource utilization (HRU) and costs based on HMA-treatment success or failure in patients with MDS, is necessary. This study builds on a previous model suggested by Cogle et al.21 and refines the algorithm used for identifying HMA-treatment success and failure based on claims data, with additional consideration for the presence and sequence of important indicators of treatment success and failure derived from observations in clinical practice. This assessment will provide important context for identifying opportunities to evaluate the potential benefits of upcoming treatment options for MDS.
Lifecycle evidence requirements for high-risk implantable medical devices: a European perspective
Published in Expert Review of Medical Devices, 2020
Rosanna Tarricone, Oriana Ciani, Aleksandra Torbica, Werner Brouwer, Georges Chaloutsos, Michael F Drummond, Nicolas Martelli, Ulf Persson, Reiner Leidl, Les Levin, Laura Sampietro-Colom, Rod S Taylor
It is generally accepted that appropriate clinical evidence must be generated to inform licensing, coverage, and reimbursement decisions for medical devices (MDs) in publicly funded healthcare systems. However, what constitutes ‘appropriate’ clinical evidence at each stage of the technology development process, in different jurisdictions and for different purposes, is still a matter of debate. Moreover, the application of the Medical Device Regulations 2017/745 [1] in 2021 and 2017/746 [2] and the proposal for a regulation of health technology assessment (HTA) [3] in the European Union, are further disrupting the regulatory and market access ecosystem for medical devices, especially for those for which clinical evidence is considered to be particularly important, such as the high-risk implantable medical devices.
Increased Reporting of Exclusionary Diagnoses Inflate Apparent Reductions in Long-Stay Antipsychotic Prescribing
Published in Clinical Gerontologist, 2019
Jonathan D. Winter, J. William Kerns, Katherine M. Winter, Roy T. Sabo
Antipsychotic use in long-stay facilities has decreased since the initiatives debut. CMS’s initial goal of a 15% nationwide reduction was achieved in the final quarter of 2013 when antipsychotic prescribing in nursing homes decreased from a 2011 baseline of 23.8% to 20.2%, a reduction of 3.6%. Excluded from reporting to the CMS quality measure however were antipsychotics ‘appropriately’ prescribed to patients with Huntington’s disease, Tourette’s syndrome, or schizophrenia (“Data show National Partnership to Improve Dementia Care exceeds goals to reduce unnecessary antipsychotic medications in nursing homes,” 2014). Although antipsychotics are approved by the FDA to treat not only schizophrenia and Tourette’s syndrome, but also bipolar disorder, depression, and autism, only schizophrenia, Tourette’s, and Huntington’s are permitted exclusionary diagnoses for CMS quality measure reporting (“Antipsychotic Medication Reference,” 2012; “Atypical Antipsychotic Drug Information,” 2016). Since the National Partnership’s introduction, CMS has trended not only the rate of antipsychotic use for nursing home residents but also the rates of these exclusionary diagnoses as well (“Interim report on the CMS Nationial Partnership to Improve Dementia Care in Nursing Homes: Q4 2011- Q1 2014,” 2014). The CMS source for this information is via facility self-reporting through the Minimum Data Set, or MDS. The MDS is a federally mandated clinical assessment for all nursing home residents that facilities complete at required intervals and transmit to the MDS database at CMS (“Minimum Data Set 3.0 Public Reports,” 2012).