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JAMA Otolaryngology-- Head & Neck... Jul 2020The Merit-Based Incentive Payment System (MIPS) for Medicare is the largest pay-for-performance program in the history of health care. Although the Centers for Medicare...
IMPORTANCE
The Merit-Based Incentive Payment System (MIPS) for Medicare is the largest pay-for-performance program in the history of health care. Although the Centers for Medicare & Medicaid Services (CMS) launched the MIPS in 2017, the participation and performance of otolaryngologists in this program remain unclear.
OBJECTIVE
To characterize otolaryngologist participation and performance in the MIPS in 2017.
DESIGN, SETTING, AND PARTICIPANTS
Retrospective cross-sectional analysis of otolaryngologist participation and performance in the MIPS from January 1 through December 31, 2017, using the publicly available CMS Physician Compare 2017 eligible clinician public reporting database.
MAIN OUTCOMES AND MEASURES
The number and proportion of active otolaryngologists who participated in the MIPS in 2017 were determined. Overall 2017 MIPS payment adjustments received by participants were determined and stratified by reporting affiliation (individual, group, or alternative payment model [APM]). Payment adjustments were categorized based on overall MIPS performance scores in accordance with CMS methodology: penalty (<3 points), no payment adjustment (3 points), positive adjustment (between 3 and 70 points), or bonus for exceptional performance (≥70 points).
RESULTS
In 2017, CMS required 6512 of 9526 (68.4%) of active otolaryngologists to participate in the MIPS. Among these otolaryngologists, 5840 (89.7%) participated; 672 (10.3%) abstained and thus incurred penalties (-4% payment adjustment). The 6512 participating otolaryngologists reported MIPS data as individuals (1990 [30.6%]), as groups (3033 [46.6%]), and through CMS-designated APMs (964 [14.8%]). The majority (4470 of 5840 [76.5%]) received bonuses (maximum payment adjustment, +1.9%) for exceptional performance, while a minority received only a positive payment adjustment (1006 of 5840 [17.2%]) or did not receive an adjustment (364 of 5840 [6.2%]). Whereas nearly all otolaryngologists reporting data via APMs (936 of 964 [97.1%]) earned bonuses for exceptional performance, fewer than 70% of otolaryngologists reporting data as individuals (1124 of 1990 [56.5%]) or groups (2050 of 3033 [67.6%]) earned such bonuses. Of note, nearly all otolaryngologists incurring penalties (658 of 672 [97.9%]) were affiliated with groups.
CONCLUSIONS AND RELEVANCE
Most otolaryngologists participating in the 2017 MIPS received performance bonuses, although variation exists within the field. As CMS continues to reform the MIPS and raise performance thresholds, otolaryngologists should consider adopting measures to succeed in the era of value-based care.
Topics: Cross-Sectional Studies; Humans; Medicare; Otolaryngologists; Reimbursement, Incentive; Relative Value Scales; Retrospective Studies; United States
PubMed: 32437498
DOI: 10.1001/jamaoto.2020.0847 -
Early Childhood Research QuarterlyEven with rapid and widespread expansion of states' quality rating and improvement systems (QRIS)-tiered frameworks that assess, communicate, and improve early childhood...
Even with rapid and widespread expansion of states' quality rating and improvement systems (QRIS)-tiered frameworks that assess, communicate, and improve early childhood education (ECE) quality-there exists no population-level information regarding which providers choose to participate in these primarily voluntary systems. We use a nationally representative survey of ECE centers to examine how the characteristics of ECE centers and the communities in which they are located predict participation in QRIS to understand the scope of QRIS policy implementation and the extent to which QRIS may be equity enhancing. We find that approximately one-third of centers nationwide participated in QRIS in 2012. Selection model results reveal that participation is more likely among centers that blend multiple funding sources and who are NAEYC accredited, and in communities with high poverty rates. However, QRIS participation is less likely in communities with relatively higher proportions of Black residents. Findings raise questions about how QRISs can equitably engage programs in all communities.
PubMed: 33041498
DOI: 10.1016/j.ecresq.2020.09.005 -
Supportive Care in Cancer : Official... Nov 2020This study examined the Sense of Coherence (SOC) of patients participating in the randomized controlled 'Optimal Training for Women with Breast Cancer' (OptiTrain) study... (Randomized Controlled Trial)
Randomized Controlled Trial
Sense of coherence and its relationship to participation, cancer-related fatigue, symptom burden, and quality of life in women with breast cancer participating in the OptiTrain exercise trial.
PURPOSE
This study examined the Sense of Coherence (SOC) of patients participating in the randomized controlled 'Optimal Training for Women with Breast Cancer' (OptiTrain) study and assessed how patient characteristics were associated with SOC. Secondary aims were to assess the association between SOC and patients' participation in this study and to determine whether SOC moderates the effect of the 16-week exercise intervention on fatigue, quality of life (QoL), and symptom burden in women with breast cancer undergoing chemotherapy.
METHODS
Modified Poisson regression analyses were conducted to determine the relative risk of weak-normal SOC versus strong SOC in terms of exercise session attendance, study and intervention dropout, and long absence rates. Analyses of covariance were performed to assess whether SOC moderated the effect of the exercise intervention (p ≤ 0.10).
RESULTS
Two hundred and forty women with early breast cancer (mean age 53 ± 10) participated in the OptiTrain study. Women with strong SOC reported less fatigue, lower symptom burden, and higher QoL. Women with weak-normal SOC were significantly more likely to drop out from the OptiTrain study and tended to have slightly poorer exercise session attendance. Women with breast cancer and weaker SOC benefitted as much from the exercise intervention, in terms of fatigue and QoL, as those with stronger SOC (p > 0.10).
CONCLUSIONS
Strong SOC appears to be associated with a more positive subjective state of health. Women with weak-normal SOC may need additional support to encourage participation and adherence in exercise trials. Assessing SOC may assist clinicians to identify and provide extra support for participants with weak SOC, who may be less inclined to participate in exercise programs.
Topics: Adult; Antineoplastic Agents; Breast Neoplasms; Combined Modality Therapy; Cost of Illness; Exercise; Exercise Therapy; Fatigue; Female; Humans; Middle Aged; Patient Participation; Quality of Life; Sense of Coherence; Sweden
PubMed: 32140973
DOI: 10.1007/s00520-020-05378-0 -
Computational Intelligence and... 2022With the gradual expansion of the book logistics market and the year-on-year increase in book publications, the incidence of book reverse logistics continues to...
With the gradual expansion of the book logistics market and the year-on-year increase in book publications, the incidence of book reverse logistics continues to increase, and the problem of book companies' inventory backlog has become increasingly prominent. To effectively alleviate the current backlog of book returns and exchanges, this paper constructs a two-party game model of "book publisher-book retailer," analyzes the evolution process of book publishers and book retailers' participation strategies and the influence of parameter changes on stable strategies through theoretical analysis and numerical simulation, and draws the following conclusions. (1) Whether book publishers and book retailers choose to participate in the reverse logistics optimization of book returns and exchanges is closely related to their benefits and costs, and it also depends on whether the other party participates in the reverse logistics optimization of books. (2) When the cost of participating in book reverse logistics reaches a certain condition, the probability of both parties participating in the optimization is the greatest.
Topics: Books; Computer Simulation; Public Opinion
PubMed: 35341187
DOI: 10.1155/2022/3324312 -
Technical Innovations & Patient Support... Mar 2024Clinical trials lead the progress in healthcare. To ensure reliable research conclusions, it is essential to enroll diverse patient groups. Identifying and understanding...
INTRODUCTION
Clinical trials lead the progress in healthcare. To ensure reliable research conclusions, it is essential to enroll diverse patient groups. Identifying and understanding patient-reported barriers to clinical trials may help enhance recruitment among diverse patient groups.The clinical potential of proton therapy (PT) to reduce late effects is being investigated in clinical trials worldwide. Thus, for some patients, PT is only accessible by participating in clinical trials.Individuals with smoking-related head and neck cancer (HNC) are sometimes socioeconomically deprived, leading to barriers to trial participation. This study aims to identify barriers to their participation in a randomised controlled trial (RCT) involving PT.
METHOD
Interviews were conducted with 14 HNC patients declining participation in an RCT involving PT. The interviews were transcribed and systematically analysed using an inductive approach identifying categories and themes.
RESULTS
The identified barriers to RCT-participation are: (1) existential distress, which influenced participants' mental and cognitive capacities, (2) insufficient RCT-related knowledge arising from information overload during clinical consultations, (3) the wish for safety and familiarity during the treatment trajectory, particularly for participants needing accommodation during radiotherapy, and (4) the motivation for study participation was impacted by uncertainty due to randomisation and clinical equipoise. Existential distress is identified as an overarching theme because it influences and amplifies the other three themes.
CONCLUSION
Existential distress is a central theme that influences and amplifies other participation barriers in PT RCTs. It affects participants' comprehension of trial information, their preference for familiar environments, and their motivation to participate in clinical trials.
PubMed: 38186677
DOI: 10.1016/j.tipsro.2023.100230 -
Health Policy (Amsterdam, Netherlands) Apr 2018This study is an in-depth examination of at whose initiative (participant, physician or screening programme) individuals participate in cervical, breast and colorectal... (Review)
Review
This study is an in-depth examination of at whose initiative (participant, physician or screening programme) individuals participate in cervical, breast and colorectal cancer screening across the EU-28. Special attention is paid to (1) the association with educational attainment and (2) the country's cancer screening strategy (organised, pilot/regional or opportunistic) for each type of cancer screened. Data were obtained from Eurobarometer 66.2 'Health in the European Union' (2006). Final samples consisted of 10,186; 5443 and 9851 individuals for cervical, breast, and colorectal cancer, respectively. Multinomial logistic regressions were performed. Surprisingly, even in countries with organised screening programmes, participation in screenings for cervical, breast and colorectal cancer was most likely to be initiated by the general practitioner (GP) or the participant. In general, GPs were found to play a crucial role in making referrals to screenings, regardless of the country's screening strategy. The results also revealed differences between educational groups with regard to their incentive to participate in cervical and breast cancer screening and, to a lesser extent, in colorectal cancer screening. People with high education are more likely to participate in cancer screening at their own initiative, while people with less education are more likely to participate at the initiative of a physician or a screening programme. Albeit, the results varied according to type of cancer screening and national screening strategy.
Topics: Adult; Aged; Breast Neoplasms; Colorectal Neoplasms; Early Detection of Cancer; Educational Status; European Union; Female; Humans; Male; Mass Screening; Middle Aged; Motivation; Physicians; Uterine Cervical Neoplasms
PubMed: 29454541
DOI: 10.1016/j.healthpol.2018.02.001 -
BMC Public Health Aug 2016Participation in sport can contribute to health-enhancing levels of leisure-time physical activity. There are recent reports that participation in sport in Australia is...
BACKGROUND
Participation in sport can contribute to health-enhancing levels of leisure-time physical activity. There are recent reports that participation in sport in Australia is decreasing. However, these studies are limited to ages 15 years and over.
METHODS
This study integrates sports club membership data from five popular team sports and investigates sport participation across the lifespan (4-100 years) by sex and region (metropolitan/non-metropolitan).
RESULTS
Overall participant numbers per annum increased from 414,167 in 2010 to 465,403 in 2012 corresponding to a rise in the proportion of Victorian's participating in these sports from 7.5 % in 2010 to 8.3 % in 2012. The highest proportion of participants was in the 10-14 year age range, with participation rates of 36 % in 2010 and 40 % in 2012. There was a considerably lower participation rate in the 15-19 year age group compared to the 10-14 age group, in all three years studied, and the decline continued progressively with increasing age. Male and female age profiles of participation were generally similar in shape, but the female peak at age 10-14 was sharper than for the males, and conversely there were very few 4 year old female participants. Participation rates were generally higher in non-metropolitan than metropolitan areas; the difference increased with increasing age from 4 to 34 years, then steadily declined, reaching parity at around 60 years of age.
CONCLUSIONS
It is a positive sign that participation in these popular sports increased by over 50,000 participants from 2010 to 2012. Large proportions of the population aged 5-14 participate in club based sport. Participation rates decline sharply in late adolescence, particularly for females, and while this may not be a concern from a broad health perspective so long as they transition into other forms of physical activity, it is certainly a matter of concern for the sport sector. It is recommended that sport policy places a higher priority on grass-roots participation and that sporting organisations are supported to prioritise the retention issues occurring during adolescence, particularly for females so as to maximise the potential for sport to maintain its positive contribution to population wellbeing.
Topics: Adolescent; Adult; Age Distribution; Australia; Child; Child, Preschool; Community Participation; Female; Humans; Male; Middle Aged; Organizations; Sex Distribution; Sports; Young Adult
PubMed: 27506922
DOI: 10.1186/s12889-016-3463-5 -
Kidney Medicine Sep 2023The development of new therapies for autosomal dominant polycystic kidney disease requires clinical trials to be conducted efficiently. In this study, the factors...
RATIONALE & OBJECTIVE
The development of new therapies for autosomal dominant polycystic kidney disease requires clinical trials to be conducted efficiently. In this study, the factors affecting the recruitment and retention of participants enrolled in a 3-year randomized controlled trial in autosomal dominant polycystic kidney disease were investigated.
STUDY DESIGN
Qualitative study.
SETTING & PARTICIPANTS
All participants (N=187) were invited to complete a 16-item questionnaire at the final study visit of the primary trial. Participants were recruited to complete a semistructured interview using purposeful sampling according to age, self-reported gender, and randomization group.
ANALYTICAL APPROACH
Descriptive statistics were used for demographic data and questionnaires. The interview transcripts underwent inductive thematic coding.
RESULTS
One hundred and forty-six of the 187 randomized participants (79%) completed the post-trial questionnaire, and 31 of the 187 participants (21%) completed the interview. Most participants (94%) rated their global satisfaction with the trial as high (a score of 8 or more out of 10). Altruism, knowledge gain, and access to new treatments were the main motivators for recruitment. The main reasons for considering leaving the study were concerns about the risk of intervention and family or work issues. Strategies that favored retention included flexibility in attending different study sites, schedule flexibility, staff interactions, and practical support with parking and reminders. The main burden was time away from work with lost wages, and burden associated with magnetic resonance imaging scans and 24-hour urine output collections.
LIMITATIONS
The study population was restricted to participants in a single nondrug clinical trial, and the results could be influenced by selection and possible social desirability bias.
CONCLUSIONS
Participants reported high levels of satisfaction that occurred as a function of the trial meeting participants' expectations. Furthermore, retention was a balance between the perceived benefits and burden of participation. Consideration of these perspectives in the design of future clinical trials will improve their efficiency and conduct.
PLAIN-LANGUAGE SUMMARY
Advances in the clinical practice of autosomal dominant polycystic kidney disease (ADPKD) require affected individuals to voluntarily participate in long-term multicenter randomized controlled trials (RCTs). In this qualitative post hoc study of a 3-year RCT of increased water intake in ADPKD, altruism, knowledge gain, and access to a nondrug treatment positively influenced the decision to volunteer. Ongoing participation was enabled by building flexibility into the study protocol and staff prioritizing a participant's needs during study visits. Although participants completed the required tests, most were considered burdensome. This study highlights the importance of incorporating protocol flexibility into trial design; the preference for interventions with a low risk of adverse effects; and the urgent requirement for robust surrogate noninvasive biomarkers to enable shorter RCTs in ADPKD.
PubMed: 37602144
DOI: 10.1016/j.xkme.2023.100691 -
Eastern Mediterranean Health Journal =... May 2020Clinical trials are important to improve public health care. However, recruiting participants for trials can be difficult.
BACKGROUND
Clinical trials are important to improve public health care. However, recruiting participants for trials can be difficult.
AIMS
This study assessed public knowledge of and willingness to participate in clinical trials in Jordan and examine the sociodemographic characteristics associated with knowledge and willingness and the reasons behind unwillingness to participate.
METHODS
The questions were part of a representative, population-based survey in 2011 that included 3196 Jordanian individuals. In a home-based interview, participants were asked about: sociodemographic characteristics, and knowledge of and participation in clinical trials.
RESULTS
Only 21.8% of respondents knew what a clinical trial was and (1.2%) had participated in a trial. About 25% of respondents indicated their willingness to enrol in a trial. Significantly more men (24.1%) than women (19.3%) knew what clinical trials were (P < 0.001), whereas more women (4.3%) than men (2.9%) said they would be very likely to agree to participate in trials. People aged 40-49 years had better knowledge of and greater willingness to participate in trials than other age groups. Income was positively associated with knowledge of trials but negatively associated with willingness to participate. Higher education was positively correlated with knowledge of and willingness to take part in trials. The main reasons for not participating in trials were concern about the risk to own health (61.1%) and not being convinced about the outcome and benefits of clinical trials (29.7%).
CONCLUSION
The low level of knowledge of and willingness to participate in clinical trials indicates that strategies are needed to educate the public about the nature and importance of clinical trials.
Topics: Adolescent; Adult; Age Factors; Attitude to Health; Clinical Trials as Topic; Female; Health Knowledge, Attitudes, Practice; Humans; Jordan; Male; Middle Aged; Research Subjects; Sex Factors; Surveys and Questionnaires; Young Adult
PubMed: 32538447
DOI: 10.26719/2020.26.5.539 -
Computational Intelligence and... 2022As an important part of the modern sports industry system, the quality and level of its development are related to whether China's sports industry can successfully...
As an important part of the modern sports industry system, the quality and level of its development are related to whether China's sports industry can successfully become a pillar industry of the national economy. Therefore, the development of the ice and snow sports industry is to promote the expansion of China's sports industry scale high quality development of the national economy and an important way to build sports power. Participative sports consumption is the most important part of sports consumption and the development of the sports industry. The sports industry separated from participative sports consumption is water without source and tree without roots, while participative sports consumption demand is the power source of participative sports consumption. At present, there is no systematic and complete research on participation sports consumption demand. In order to understand the causes and demand state of residents' participation sports consumption demand and provide entry points for enterprises to formulate marketing strategies, this study constructs an organic system with participation sports service products as consumption objects, centering on the demanding state of participation sports consumers. In the system, on the theory of supply and demand, under the guidance of consumption economics theory, adhere to the combination of theoretical research and empirical analysis, the combination of macroplanning and microdesign, the combination of qualitative analysis and quantitative analysis, through the empirical investigation and receipt collection of residents' participation sports consumption demand, the use of systematic analysis, literature method, and survey method, through mathematical analysis, and other research methods, the paper explores the main causes and demand conditions of residents' participation sports consumption demand in different consumption states and excavates the main causes and demand conditions of participating sports consumption demand in different consumption states under different sports levels.
Topics: Algorithms; China; Ice; Industry; Snow Sports; Social Identification
PubMed: 35814582
DOI: 10.1155/2022/2174910