The impact of a fast-track questionnaire in pediatric paradoxical vocal fold motion disorder (PVFMD).

OBJECTIVE: PVFMD is a frequent cause of dyspnea in the healthy adolescent. When PVFMD is suspected, the current standard of care includes referral to an otolaryngologist (ENT) prior to beginning laryngeal control therapy (LCT) with a speech language pathologist (SLP). We hypothesize that a "fast-track" screening questionnaire will improve time to treatment and decrease patient charges. METHODS: Patients (n = 258, group 1) who received traditional referral and were evaluated in pediatric voice clinic with a diagnosis of PVFMD between 11/2013 and 11/2017 were identified and compared with 66 patients (group 2) from 10/2018 to 11/2019 who were prospectively studied and placed into a fast-tracked subgroup for LCT without preceding ENT evaluation if they scored 8/10 or higher on a designed screening questionnaire. RESULTS: Female gender (group 1: 81%, group 2: 83%, p = 0.73) and median age (group 1:14 years IQR 4; group 2:14 years IQR 3, p = 0.83) were similar. The median duration from symptom onset to LCT was shorter for group 2 (group 1: 12 months, IQR 18; group 2: 8.5 months, IQR 8)(p = 0.02). Time from referral to LCT was shorter for group 2 at 3 weeks (IQR 3) compared to group 1 at 4 weeks (IQR 3.5, p < 0.01). The minimum single patient charge for group 1 was estimated at $5123 and $1649 for group 2, yielding a potential reduction of charges of over $3000. CONCLUSION: Using a fast-track screening questionnaire for pediatric PVFMD patients significantly decreases the time to treatment without altering the response rate of LCT.

Do hierarchical condition category model scores predict hospitalization risk in newly enrolled Medicare advantage participants as well as probability of repeated admission scores?

OBJECTIVES: To compare how well hierarchical condition categories (HCC) and probability of repeated admission (P(RA)) scores predict hospitalization. DESIGN: Longitudinal cohort study with 12-month follow-up. SETTING: A Medicare Advantage (MA) plan. PARTICIPANTS: Four thousand five hundred six newly enrolled beneficiaries. MEASUREMENT: HCC scores were identified from enrollment files. The P(RA) tool was administered by mail and telephone. Inpatient admissions were based on notifications. The Mann-Whitney test was used to compare HCC scores of P(RA) responders and nonresponders. The receiver operating characteristic curve provided the area under the curve (AUC) for each score. Admission risk in the top 5% of scores was evaluated using logistic regression. RESULTS: Within 60 days of enrollment, 45.1% of the 3,954 beneficiaries with HCC scores completed the P(RA) tool. HCC scores were lower for the 1,783 P(RA) respondents than the 2,171 nonrespondents (0.71 vs 0.81, P<.001). AUCs predicting hospitalization with regard to HCC and P(RA) were similar (0.638, 95% confidence interval (CI)=0.603-0.674; 0.654, 95% CI=0.618-0.690). Individuals identified in the top 5% of scores using both tools, using HCC alone, or using P(RA) alone had higher risk for hospitalization than those below the 95th percentile (odds ratio (OR)=8.5, 95% CI=3.7-19.4, OR=3.8, 95% CI=2.3-6.3, and OR=3.9, 95% CI=2.3-6.4, respectively). CONCLUSION: HCC scores provided to MA plans for risk adjustment of revenue can also be used to identify hospitalization risk. Additional studies are required to evaluate whether a hybrid approach incorporating administrative and self-reported models would further optimize risk stratification efforts.

National health data warehouse: issues to consider.

A national data warehouse that links public and private data could be used to monitor trends in healthcare costs, utilization, quality of care, and adherence to quality guidelines and changes in treatment protocols. The development of the data warehouse, however, would require overcoming a number of political and technical challenges to gain access to private insurance data. This article outlines recommendations from a national conference sponsored by the Agency for Healthcare Research and Quality (AHRQ) on the private sector's role in quality monitoring and provides an operational outline for the development of a national private sector health data warehouse.

The role of the private sector in monitoring health care quality and patient safety.

BACKGROUND: As payers, purchasers, and providers, both the public and private sectors have a stake in developing sound methods of measuring health care quality and patient safety. However, the role of the private sector in a national quality monitoring system remains largely underdeveloped. PRIVATE SECTOR ROLE IN HEALTH CARE QUALITY MONITORING: There have been some attempts to pool private-sector data through health care industry efforts to measure and monitor the quality of health care services. Yet despite a number of public/private partnerships, no standard method exists for measuring and monitoring health care quality and safety across public and private payers. THE AHRQ WORKSHOP ON PRIVATE-SECTOR QUALITY MONITORING: The Agency for Healthcare Research and Quality (AHRQ) sponsored a workshop in fall 2000 to address the private sector's role in monitoring quality in the health care system. National experts developed a conceptual framework and recommendations on the design and scope of a private-sector data monitoring system. Ten key attributes of the monitoring system, such as timeliness of reports, flexibility, efficiency, and linkability, were identified. Barriers and gaps to the development of such a system include the cost of data collection, the diversity of the units of data collection, data privacy, and limitations of administrative data elements. SUMMARY: A comprehensive, public/private data collection system would address the multidimensional nature of quality and use data to effectively represent this complexity to the extent possible.