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MMWR. Morbidity and Mortality Weekly... Nov 2021The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) relies on comprehensive and reliable population data to implement interventions to reduce HIV transmission...
The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) relies on comprehensive and reliable population data to implement interventions to reduce HIV transmission in high-incidence areas among populations disproportionately affected by the HIV epidemic. Adolescent girls and young women in sub-Saharan Africa account for a disproportionate number of new HIV infections compared with their male peers (1). The DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) program includes multisectoral, layered interventions aimed at reducing factors that contribute to vulnerability to HIV infection among adolescent girls and young women in PEPFAR-supported sub-Saharan African countries (1). Namibia, a southern African country with a population of approximately 2.55 million among whom approximately 8% live with HIV infection, had their DREAMS program first implemented in 2017* (2,3). Data from the 2019 Namibia Violence Against Children and Youth Survey (VACS), the most recent and comprehensive nationally representative data source available to study the epidemiology of violence and other HIV risk factors, were used to estimate the percentage of adolescent girls and young women aged 13-24 years who would be eligible for DREAMS program services. The prevalence of individual DREAMS eligibility criteria, which comprise known age-specific risk factors associated with HIV acquisition, were estimated by age group. Among all adolescent girls and young women in Namibia, 62% were eligible for DREAMS based on meeting at least one criterion. Common eligibility criteria included adverse childhood experiences, specifically exposure to physical, emotional, and sexual violence and being an orphan; and high-risk behaviors, such as early alcohol use, recent heavy alcohol use, and infrequent condom use.** Using VACS data to estimate the prevalence of HIV risk factors and identify adolescent girls and young women at elevated risk for HIV acquisition in countries like Namibia with high HIV-incidence can inform programs and policies aimed at improving the well-being of these adolescent girls and young women and help control the HIV epidemics in these countries.
Topics: Adolescent; Eligibility Determination; Epidemics; Female; HIV Infections; Humans; Namibia; Program Evaluation; Risk Factors; Young Adult
PubMed: 34758009
DOI: 10.15585/mmwr.mm7045a2 -
Journal of the American Heart... Nov 2018See Article by Ko et al .
See Article by Ko et al .
Topics: Eligibility Determination; Proprotein Convertase 9
PubMed: 30571392
DOI: 10.1161/JAHA.118.010884 -
AMIA ... Annual Symposium Proceedings.... 2022Successful clinical trials offer better treatments to current or future patients and advance scientific research. Clinical trials define the target population using...
Successful clinical trials offer better treatments to current or future patients and advance scientific research. Clinical trials define the target population using specific eligibility criteria to ensure an optimal enrollment sample. Clinical trial eligibility criteria are often described in unstructured free-text which makes automation of the recruitment process challenging. This contributes to the long-standing problem of insufficient enrollment of clinical trials. This study uses a machine learning approach to extract clinical trial eligibility criteria, and convert them into structured queryable formats using descriptive statistics based on medical entity frequency and binary entity relationships. We present a JSON-based structural representation of clinical trials eligibility criteria for clinical trials to follow.
Topics: Humans; Natural Language Processing; Patient Selection; Machine Learning; Automation; Eligibility Determination
PubMed: 37128426
DOI: No ID Found -
Contraception Sep 2016
Topics: Contraception; Eligibility Determination; Female; Humans; Male; Patient Selection; World Health Organization
PubMed: 27503261
DOI: 10.1016/j.contraception.2016.07.001 -
Research on Aging Jan 2017An aging America presents challenges but also brings social and economic capital. We quantify public revenues from, and public expenditures on, Americans aged 65 and...
An aging America presents challenges but also brings social and economic capital. We quantify public revenues from, and public expenditures on, Americans aged 65 and older, the value of their unpaid, productive activities and financial gifts to family. Using microsimulation, we project the value of these activities, and government revenues and expenditures, under different scenarios of change to the Old Age and Survivors Insurance eligibility age through 2050. We find the value of unpaid productive activities and financial gifts are US$721 billion in 2010, while net (of tax revenues) spending on the 65 years and older is US$984 billion. Five-year delay in the full retirement age decreases federal spending by 10%, while 2-year delay in the early entitlement age increases it by 1.5%. The effect of 5-year delay on unpaid activities and transfers is small: US$4 billion decrease in services and US$4.5 billion increase in bequests and monetary gifts.
Topics: Age Factors; Aged; Aging; Caregivers; Eligibility Determination; Humans; Middle Aged; Retirement; Social Security; Volunteers
PubMed: 28181866
DOI: 10.1177/0164027516656137 -
JCO Clinical Cancer Informatics Jan 2020Less than 5% of patients with cancer enroll in clinical trials, and 1 in 5 trials are stopped for poor accrual. We evaluated an automated clinical trial matching system...
PURPOSE
Less than 5% of patients with cancer enroll in clinical trials, and 1 in 5 trials are stopped for poor accrual. We evaluated an automated clinical trial matching system that uses natural language processing to extract patient and trial characteristics from unstructured sources and machine learning to match patients to clinical trials.
PATIENTS AND METHODS
Medical records from 997 patients with breast cancer were assessed for trial eligibility at Highlands Oncology Group between May and August 2016. System and manual attribute extraction and eligibility determinations were compared using the percentage of agreement for 239 patients and 4 trials. Sensitivity and specificity of system-generated eligibility determinations were measured, and the time required for manual review and system-assisted eligibility determinations were compared.
RESULTS
Agreement between system and manual attribute extraction ranged from 64.3% to 94.0%. Agreement between system and manual eligibility determinations was 81%-96%. System eligibility determinations demonstrated specificities between 76% and 99%, with sensitivities between 91% and 95% for 3 trials and 46.7% for the 4th. Manual eligibility screening of 90 patients for 3 trials took 110 minutes; system-assisted eligibility determinations of the same patients for the same trials required 24 minutes.
CONCLUSION
In this study, the clinical trial matching system displayed a promising performance in screening patients with breast cancer for trial eligibility. System-assisted trial eligibility determinations were substantially faster than manual review, and the system reliably excluded ineligible patients for all trials and identified eligible patients for most trials.
Topics: Adult; Aged; Aged, 80 and over; Artificial Intelligence; Breast Neoplasms; Clinical Trials as Topic; Community Networks; Early Detection of Cancer; Eligibility Determination; Female; Humans; Machine Learning; Middle Aged; Natural Language Processing; Patient Selection
PubMed: 31977254
DOI: 10.1200/CCI.19.00079 -
Inquiry : a Journal of Medical Care... 2019Congress has repeatedly proposed changing Medicaid from an entitlement to a block grant. Each state would receive a fixed amount instead of a Federal payment influenced...
Congress has repeatedly proposed changing Medicaid from an entitlement to a block grant. Each state would receive a fixed amount instead of a Federal payment influenced by state decisions on eligibility, coverage, and pricing. This paper uses existing data series to simulate redistributing the annual $353 billion Federal payment among Medicaid's 56 state (and territorial) programs. Capitation by general population would shift $52 billion, mainly from large Northeastern and West Coast states to large Southern and Mountain states. Capitation by population below the Federal Poverty Line (FPL) would shift $60 billion in a similar pattern. Policymakers should understand likely state-to-state effects when considering Medicaid legislation. States could then prepare for possible changes in their Federal payment for Medicaid.
Topics: Eligibility Determination; Health Policy; Humans; Insurance Benefits; Medicaid; Poverty; Socioeconomic Factors; State Health Plans; United States
PubMed: 31823662
DOI: 10.1177/0046958019892882 -
Association Between State Medicaid Eligibility Thresholds and Deaths Due to Substance Use Disorders.JAMA Network Open Apr 2019The United States is currently facing an epidemic of deaths related to substance use disorder (SUD), with totals exceeding those due to motor vehicle crashes and gun...
IMPORTANCE
The United States is currently facing an epidemic of deaths related to substance use disorder (SUD), with totals exceeding those due to motor vehicle crashes and gun violence. The epidemic has led to decreased life expectancy in some populations. In recent years, Medicaid eligibility has expanded in some states, and the association of this expansion with SUD-related deaths is yet to be examined.
OBJECTIVE
To examine the association between eligibility thresholds for state Medicaid coverage and SUD-related deaths.
DESIGN, SETTING, AND PARTICIPANTS
Economic evaluation study using a retrospective analysis of state-level data between 2002 and 2015 to determine the association between the Medicaid eligibility threshold and SUD-related deaths, controlling for other relevant policies, state socioeconomic characteristics, fixed effects, and a time trend. Policy variables were lagged by 1 year to allow time for associations to materialize. Data were collected and analyzed from 2016 to 2017.
EXPOSURES
The policy of interest was the state Medicaid eligibility threshold, ie, the highest allowed income that qualifies a person for Medicaid, expressed as a percentage of the federal poverty level. State policies related to mental health, overdose treatment, and law enforcement of drug crimes were included as controls.
MAIN OUTCOMES AND MEASURES
The primary outcome was number of SUD-related deaths, obtained from data provided by the Centers for Disease Control and Prevention.
RESULTS
Across 700 state-year observations, the mean (SD) number of SUD-related deaths was 21.15 (6.05) per 100 000 population. Between 2002 and 2015, the national SUD-related death rate increased from 16.0 to 27.5 per 100 000, while the average Medicaid eligibility threshold increased from 87.2% to 97.1% of the federal poverty level. Over this period, every 100-percentage point increase in the Medicaid eligibility threshold (eg, from 50% to 150% of the federal poverty level) was associated with 1.373 (95% CI, -2.732 to -0.014) fewer SUD-related deaths per 100 000 residents, a reduction of 6.50%. In the 22 states with net contractions in eligibility thresholds between 2005 and 2015, an estimated increase of 570 SUD-related deaths (95% CI, -143 to 1283) occurred. In the 28 states that increased eligibility thresholds, an estimated 1045 SUD-related deaths (95% CI, -209 to 2299) may have been prevented.
CONCLUSIONS AND RELEVANCE
These findings suggest that the overall increase in SUD-related deaths between 2002 and 2015 may have been greater had the average eligibility threshold for Medicaid not increased over this period. Broader eligibility for Medicaid coverage may be one tool to help reduce SUD-related deaths.
Topics: Adolescent; Adult; Aged; Eligibility Determination; Female; Health Services Accessibility; Humans; Insurance Coverage; Male; Medicaid; Middle Aged; Patient Protection and Affordable Care Act; Poverty; Retrospective Studies; Substance-Related Disorders; United States; Young Adult
PubMed: 31026034
DOI: 10.1001/jamanetworkopen.2019.3056 -
Journal of General Internal Medicine Feb 2019
Topics: Eligibility Determination; Health Personnel; Humans; Medicaid; Patient Advocacy; United States
PubMed: 30535749
DOI: 10.1007/s11606-018-4743-9 -
Journal of Health Economics Mar 2022While a large share of Disability Insurance recipients in OECD countries are expected to recover, outflow rates from temporary disability schemes are typically...
While a large share of Disability Insurance recipients in OECD countries are expected to recover, outflow rates from temporary disability schemes are typically negligible. We estimate the disincentive effects of disability benefits on the response to a (mental) health improvement using administrative data on all Dutch disability benefit applicants. We compare those below the DI eligibility threshold with those above and find that disincentives significantly reduce work resumption after health improves. Approximately half of the response to recovery is offset by benefits. Estimates from a structural labor supply model suggest that disincentives are substantially larger when the worker's earnings capacity is fully restored.
Topics: Disabled Persons; Eligibility Determination; Humans; Income; Insurance, Disability; Social Security; United States
PubMed: 35184012
DOI: 10.1016/j.jhealeco.2022.102593