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Abbreviations CT Computed tomography ED Emergency Department MRI Magnetic resonance imaging NHI National Health Insurance OECD Organisation for Economics Co-operation and Development Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. We also found increasing trends of uncoded CT scans in emergency patients and self-pay CT scans in outpatients. This could lead to confusion that Taiwan had a low CT utilization rate in ED setting compared to other countries. For instance, in the emergency department (ED) setting, the reported rates of CT use in Taiwan ranged from 116 to 177 per 1000 ED visits during 2005-2013 [[2]-[4]], compared to rates reported in other countries ranging from 34 to 245 per 1000 ED visits (as summarized in Table 1) [[5]-[11]]. [Extracted from the article]

This could lead to confusion that Taiwan had a low CT utilization rate in ED setting compared to other countries. We also found increasing trends of uncoded CT scans in emergency patients and self-pay CT scans in outpatients. For instance, in the emergency department (ED) setting, the reported rates of CT use in Taiwan ranged from 116 to 177 per 1000 ED visits during 2005-2013 [[2]-[4]], compared to rates reported in other countries ranging from 34 to 245 per 1000 ED visits (as summarized in Table 1) [[5]-[11]]. Abbreviations CT Computed tomography ED Emergency Department MRI Magnetic resonance imaging NHI National Health Insurance OECD Organisation for Economics Co-operation and Development Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. [Extracted from the article]

Background: Most studies on the physician code creep (i.e., changes in case mix record-keeping practices to improve reimbursement) have focused on episodes (inpatient hospitalizations or outpatient procedures). Little is known regarding changes in diagnostic coding practices for better reimbursement among a fixed cohort of patients with chronic diseases.Methods: To examine whether physicians in tertiary medical centers changed their coding practices after the initiation of the Outpatient Volume Control Program (OVCP) in Taiwan, we conducted a retrospective observational study of four patient cohorts (two interventions and two controls) from January 2016 to September 2017 in Taiwan. The main outcomes were the number of outpatient visits with four coding practices: 1) OVCP monitoring code recorded as primary diagnosis; 2) OVCP monitoring code recorded as secondary diagnosis; 3) non-OVCP monitoring code recorded as primary diagnosis; 4) non-OVCP monitoring code recorded as secondary diagnosis.Results: The percentage change of the number of visits with coding practice 1 between 2016Q1 and 2017Q3 was - 74% for patients with hypertension and - 73% with diabetes in tertiary medical centers and - 23% and - 17% in clinics, respectively. By contrast, the percentage changes of coding practice 3 were + 73% for patients with hypertension and + 46% for patients with diabetes in tertiary medical centers and - 19% and - 2% in clinics, respectively.Conclusions: Physician code creep occurred after the initiation of the OVCP. Education regarding appropriate outpatient coding for physicians will be relatively effective when proper coding is related to reimbursement. [ABSTRACT FROM AUTHOR]

The moderator effect of retention in care on late presenters in HIV patients has not been well evaluated. A nationwide cohort study focusing on HIV-infected patients with new engagement in care was conducted by using the Taiwan National Health Insurance Research Database. Retention in care was defined based on the healthcare utilization in the first year after engaging in HIV care. Then, the impact of late presentation, retention in care, and their interaction on the risk of subsequent hospitalizations due to opportunistic infections (OIs-hospitalizations) in the second year were examined. More than half (59.38%) of the total patients (n = 9112) were retained in care in the first year, 8.63% were late presenters, and 110 (1.21%) patients had subsequent hospitalization in the second year. Late presentation and non-retention were independent predictors of OIs-hospitalizations in the second year (OR: 2.58 and OR: 3.27, respectively) and the interaction between them was statistically significant (non-retention in care × late presentation, OR: 3.82). This study showed that retention in care in the first year is a moderator providing a stronger protective effect for late presenters than early presenters. Our findings call for policymakers to develop different strategies for early or late presenters. [ABSTRACT FROM AUTHOR]

Background: This study assessed international variations in changes in drowning mortality rates and the quality of reporting specific information in death certificates over the past decade.Methods: Drowning mortality data of 61 countries were extracted from the World Health Organization Mortality Database. We calculated the percentage change (PC) in age-standardized drowning mortality rates and percentage of drowning deaths reported with unspecified codes between 2004 and 2005 and 2014-2015.Results: Of the 61 countries studied, 50 exhibited a reduction in drowning mortality rates from 2004 to 2005 to 2014-2015. Additionally, five countries-Lithuania, Moldova, Kyrgyzstan, Romania, and El Salvador-with a high mortality rate in 2004-2005 (> 40 deaths per 100,000) showed improvement (PC < - 32%). By contrast, four countries-South Africa, Guyana, Morocco, and Guatemala-exhibited a more than twofold increase in mortality rates. Regarding the quality of reporting, 34 countries exhibited a decrease in the percentage of unspecified codes. Additionally, three countries-Paraguay, Serbia, and Croatia-with moderate and high percentages of unspecified codes (> 40%) exhibited a marked reduction (PC < - 60%), whereas three countries-Malaysia, Belgium, and Nicaragua-exhibited a notable increase.Conclusions: Large international variations in the extent of changes in drowning mortality rates and the quality of reporting specific information on the death certificate were observed during the study period. [ABSTRACT FROM AUTHOR]

Aiming at the constraint of operation times of all switches and the inefficiency of harmony search algorithm, the improved optimal fuzzy C-means clustering technology and the improved harmony search algorithm were proposed. The former was applied to classify the operation state in a time interval according to load data that the dynamic reconfiguration of distribution network was converted to the multiple static reconfigurations that take the corresponding cluster center as the representative load. The latter was applied to solve the static reconfiguration. The optimal network structure at any time was determined by the corresponding cluster center's reconfiguration result, at the same time, the reconfiguration time and the operated switches were known. On the basis of IEEE-33bus system's load data, one day's load data was constructed and the dynamic reconfiguration was carried out. The results indicate that the proposed method can strictly limit operation times of switches and improve the efficiency of harmony search algorithm. [ABSTRACT FROM AUTHOR]

Purpose: Cluster analysis has been proposed to examine phenotypic heterogeneity in chronic obstructive pulmonary disease (COPD). The aim of this study was to use cluster analysis to define COPD phenotypes and validate them by assessing their relationship with mortality. Methods: Male subjects with COPD were recruited to identify and validate COPD phenotypes. Seven variables were assessed for their relevance to COPD, age, FEV % predicted, BMI, history of severe exacerbations, mMRC, SpO, and Charlson index. COPD groups were identified by cluster analysis and validated prospectively against mortality during a 4-year follow-up. Results: Analysis of 332 COPD subjects identified five clusters from cluster A to cluster E. Assessment of the predictive validity of these clusters of COPD showed that cluster E patients had higher all cause mortality (HR 18.3, p < 0.0001), and respiratory cause mortality (HR 21.5, p < 0.0001) than those in the other four groups. Cluster E patients also had higher all cause mortality (HR 14.3, p = 0.0002) and respiratory cause mortality (HR 10.1, p = 0.0013) than patients in cluster D alone. Conclusion: COPD patient with severe airflow limitation, many symptoms, and a history of frequent severe exacerbations was a novel and distinct clinical phenotype predicting mortality in men with COPD. [ABSTRACT FROM AUTHOR]

The case-control study is a simple and an useful method to characterize the effect of a gene, the effect of an exposure, as well as the interaction between the two. The control-free case-only study is yet an even simpler design, if interest is centered on gene-environment interaction only. It requires the sometimes plausible assumption that the gene under study is independent of exposures among the non-diseased in the study populations. The Hardy-Weinberg equilibrium is also sometimes reasonable to assume. This paper presents an easy-to-implement approach for analyzing case-control and case-only studies under the above dual assumptions. The proposed approach, the 'conditional logistic regression with counterfactuals', offers the flexibility for complex modeling yet remains well within the reach to the practicing epidemiologists. When the dual assumptions are met, the conditional logistic regression with counterfactuals is unbiased and has the correct type I error rates. It also results in smaller variances and achieves higher powers as compared with using the conventional analysis (unconditional logistic regression). Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

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