Browsing by Author "Zou, Jian"

Now showing 1 - 6 of 6
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    Electronic Health Record (EHR)-Based Community Health Measures: An Exploratory Assessment of Perceived Usefulness by Local Health Departments
    (BMC, 2018-05-22) Comer, Karen F.; Gibson, P. Joseph; Zou, Jian; Rosenman, Marc; Dixon, Brian E.; Health Policy and Management, School of Public Health
    BACKGROUND: Given the widespread adoption of electronic health record (EHR) systems in health care organizations, public health agencies are interested in accessing EHR data to improve health assessment and surveillance. Yet there exist few examples in the U.S. of governmental health agencies using EHR data routinely to examine disease prevalence and other measures of community health. The objective of this study was to explore local health department (LHD) professionals' perceptions of the usefulness of EHR-based community health measures, and to examine these perceptions in the context of LHDs' current access and use of sub-county data, data aggregated at geographic levels smaller than county. METHODS: To explore perceived usefulness, we conducted an online survey of LHD professionals in Indiana. One hundred and thirty-three (133) individuals from thirty-one (31) LHDs participated. The survey asked about usefulness of specific community health measures as well as current access to and uses of sub-county population health data. Descriptive statistics were calculated to examine respondents' perceptions, access, and use. A one-way ANOVA (with pairwise comparisons) test was used to compare average scores by LHD size. RESULTS: Respondents overall indicated moderate agreement on which community health measures might be useful. Perceived usefulness of specific EHR-based community health measures varied by size of respondent's LHD [F(3, 88) = 3.56, p = 0.017]. Over 70% of survey respondents reported using community health data, but of those < 30% indicated they had access to sub-county level data. CONCLUSION: Respondents generally preferred familiar community health measures versus novel, EHR-based measures that are not in widespread use within health departments. Access to sub-county data is limited but strongly desired. Future research and development is needed as LHD staff gain access to EHR data and apply these data to support the core function of health assessment.
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    Glucocorticoid Receptor β Acts As a Co-activator of T-Cell Factor 4 and Enhances Glioma Cell Proliferation
    (Springer, 2015-12) Wang, Qian; Lu, Pei-Hua; Shi, Zhi-Feng; Xu, Yan-Juan; Xiang, Jie; Wang, Yan-Xia; Deng, Ling-Xiao; Xie, Ping; Yin, Ying; Zhang, Bin; Mu, Hui-Jun; Qiao, Wei-Zhen; Cui, Hua; Zou, Jian; Department of Neurological Surgery, IU School of Medicine
    We previously reported that glucocorticoid receptor β (GRβ) regulates injury-mediated astrocyte activation and contributes to glioma pathogenesis via modulation of β-catenin/T-cell factor/lymphoid enhancer factor (TCF/LEF) transcriptional activity. The aim of this study was to characterize the mechanism behind cross-talk between GRβ and β-catenin/TCF in the progression of glioma. Here, we reported that GRβ knockdown reduced U118 and Shg44 glioma cell proliferation in vitro and in vivo. Mechanistically, we found that GRβ knockdown decreased TCF/LEF transcriptional activity without affecting β-catenin/TCF complex. Both GRα and GRβ directly interact with TCF-4, while only GRβ is required for sustaining TCF/LEF activity under hormone-free condition. GRβ bound to the N-terminus domain of TCF-4 its influence on Wnt signaling required both ligand- and DNA-binding domains (LBD and DBD, respectively). GRβ and TCF-4 interaction is enough to maintain the TCF/LEF activity at a high level in the absence of β-catenin stabilization. Taken together, these results suggest a novel cross-talk between GRβ and TCF-4 which regulates Wnt signaling and the proliferation in gliomas.
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    Hospital Length of Stay and Readmission Rate for Neurosurgical Patients
    (Oxford, 2018-02) Ansari, Shaheryar F.; Yan, Hong; Zou, Jian; Worth, Robert M.; Barbaro, Nicholas M.; Neurological Surgery, School of Medicine
    BACKGROUND Hospital readmission rate has become a major indicator of quality of care, with penalties given to hospitals with high rates of readmission. At the same time, insurers are increasing pressure for greater efficiency and reduced costs, including decreasing hospital lengths of stay (LOS). OBJECTIVE To analyze the authors’ service to determine if there is a relationship between LOS and readmission rates. METHODS Records of patients admitted to the authors’ institution from October 2007 through June 2014 were analyzed for several data points, including initial LOS, readmission occurrence, admitting and secondary diagnoses, and discharge disposition. RESULTS Out of 9409 patient encounters, there were 925 readmissions. Average LOS was 6 d. Univariate analysis indicated a higher readmission rate with more diagnoses upon admission (P < .001) and an association between insurance type and readmission (P < .001), as well as decreasing average yearly LOS (P = .0045). Multivariate analysis indicated statistically significant associations between longer LOS (P = .03) and government insurance (P < .01). CONCLUSION A decreasing LOS over time has been associated with an increasing readmission rate at the population level. However, at the individual level, a prolonged LOS was associated with a higher risk of readmission. This was attributed to patient comorbidities. However, this increasing readmission rate may represent many factors including patients’ overall health status. Thus, the rate of readmission may represent a burden of illness rather than a valid metric for quality of care.
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    Impact of the 2006 Massachusetts health care insurance reform on neurosurgical procedures and patient insurance status
    (2017-01) Villeli, Nicolas W.; Das, Rohit; Yan, Hong; Huff, Wei; Zou, Jian; Barbaro, Nicholas M.; Neurological Surgery, School of Medicine
    OBJECTIVE The Massachusetts health care insurance reform law passed in 2006 has many similarities to the federal Affordable Care Act (ACA). To address concerns that the ACA might negatively impact case volume and reimbursement for physicians, the authors analyzed trends in the number of neurosurgical procedures by type and patient insurance status in Massachusetts before and after the implementation of the state's health care insurance reform. The results can provide insight into the future of neurosurgery in the American health care system. METHODS The authors analyzed data from the Massachusetts State Inpatient Database on patients who underwent neurosurgical procedures in Massachusetts from 2001 through 2012. These data included patients' insurance status (insured or uninsured) and the numbers of procedures performed classified by neurosurgical procedural codes of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Each neurosurgical procedure was grouped into 1 of 4 categories based on ICD-9-CM codes: 1) tumor, 2) other cranial/vascular, 3) shunts, and 4) spine. Comparisons were performed of the numbers of procedures performed and uninsured patients, before and after the implementation of the reform law. Data from the state of New York were used as a control. All data were controlled for population differences. RESULTS After 2008, there were declines in the numbers of uninsured patients who underwent neurosurgical procedures in Massachusetts in all 4 categories. The number of procedures performed for tumor and spine were unchanged, whereas other cranial/vascular procedures increased. Shunt procedures decreased after implementation of the reform law but exhibited a similar trend to the control group. In New York, the number of spine surgeries increased, as did the percentage of procedures performed on uninsured patients. Other cranial/vascular procedures decreased. CONCLUSIONS After the Massachusetts health care insurance reform, the number of uninsured individuals undergoing neurosurgical procedures significantly decreased for all categories, but more importantly, the total number of surgeries performed did not change dramatically. To the extent that trends in Massachusetts can predict the overall US experience, we can expect that some aspects of reimbursement may be positively impacted by the ACA. Neurosurgeons, who often treat patients with urgent conditions, may be affected differently than other specialists.
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    The Impact of the 2006 Massachusetts Healthcare Reform on Spine Surgery Patient Payer-Mix and Age
    (AANS, 2017-12) Villelli, Nicolas W.; Yan, Hong; Zou, Jian; Barbaro, Nicholas M.; Neurological Surgery, School of Medicine
    OBJECTIVE Several similarities exist between the Massachusetts health care reform law of 2006 and the Affordable Care Act (ACA). The authors’ prior neurosurgical research showed a decrease in uninsured surgeries without a significant change in surgical volume after the Massachusetts reform. An analysis of the payer-mix status and the age of spine surgery patients, before and after the policy, should provide insight into the future impact of the ACA on spine surgery in the US. METHODS Using the Massachusetts State Inpatient Database and spine ICD-9-CM procedure codes, the authors obtained demographic information on patients undergoing spine surgery between 2001 and 2012. Payer-mix status was assigned as Medicare, Medicaid, private insurance, uninsured, or other, which included government-funded programs and workers’ compensation. A comparison of the payer-mix status and patient age, both before and after the policy, was performed. The New York State data were used as a control. RESULTS The authors analyzed 81,821 spine surgeries performed in Massachusetts and 248,757 in New York. After 2008, there was a decrease in uninsured and private insurance spine surgeries, with a subsequent increase in the Medicare and “other” categories for Massachusetts. Medicaid case numbers did not change. This correlated to an increase in surgeries performed in the age group of patients 65–84 years old, with a decrease in surgeries for those 18–44 years old. New York showed an increase in all insurance categories and all adult age groups. CONCLUSIONS After the Massachusetts reform, spine surgery decreased in private insurance and uninsured categories, with the majority of these surgeries transitioning to Medicare. Moreover, individuals who were younger than 65 years did not show an increase in spine surgeries, despite having greater access to health insurance. In a health care system that requires insurance, the decrease in private insurance is primarily due to an increasing elderly population. The Massachusetts model continues to show that this type of policy is not causing extreme shifts in the payer mix, and suggests that spine surgery will continue to thrive in the current US health care system.
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    Systematic Exploration of Associations Between Select Neural and Dermal Diseases in a Large Healthcare Database
    (2022-03) Kirbiyik, Uzay; Dixon, Brian E.; Nan, Hongmei; Grannis, Shaun J.; Janga, Sarath Chandra; Zou, Jian
    In the age of big data, better use of large, real-world datasets is needed, especially ultra-large databases that leverage health information exchange (HIE) systems to gather data from multiple sources. Promising as this process is, there have been challenges analyzing big data in healthcare due to big data attributes, mainly regarding volume, variety, and velocity. Thus, these health data require not only computational approaches but also context-based controls.In this research, we systematically examined associations among select neural and dermal conditions in an ultra-large healthcare database derived from an HIE, in which computational approaches with epidemiological measures were used. After a systematic cleaning, a binary logistic model-based methodology was used to search for associations, controlling for race and gender. Age groups were chosen using an algorithm to find the highest incidence rates for each condition pair. A binomial test was conducted to check for significant temporal direction among conditions to infer cause and effect. Gene-disease association data were used to evaluate the association among the conditions and assess the shared genetic background. The results were adjusted for multiple testing, and network graphs of significant associations were created. Findings among methodologies were compared to each other and with prior studies in the literature. In the results, seemingly distant neural and dermal conditions had an extensive number of associations. Controlling for race and gender tightened these associations, especially for racial factors affecting dermal conditions, like melanoma, and gender differences on conditions like migraine. Temporal and gene associations helped explain some of the results, but not all. Network visualizations summarized results, highlighting central conditions and stronger associations. Healthcare data are confounded by many factors that hide associations of interest. Triangulating associations with separate analyses helped with the interpretation of results. There are still numerous confounders in these data that bias associations. Aside from what is known, our approach with limited variables may inform hypothesis generation. Using additional variables with controlled-computational methods that require minimal external input may provide results that can guide healthcare, health policy, and further research.