Reducing No-Shows and Late Cancellations in Primary Care

No-shows and late cancellations are a challenge across medical practices, resulting in costly, fragmented care. Many patients do not understand the impact that not showing or cancelling an appointment less than 48 hours prior to a visit can have. While reminding the patient of the appointment has been a known tactic to improve patient’s attendance, the most effective mode of the reminder can vary significantly across patient populations. Just as critical as reminding the patient of the appointment is to ensure they understand the purpose of the visit along with showing respect for their time and any competing priorities. This quality improvement initiative aimed to reduce the no-show rate of 21.4% and late cancellation rate of 21.1% for the MassHealth population by 5%. Learning from previous studies, a hybrid approach to meet this population’s needs included a 7-day reminder call with a Patient Engagement Coordinator (PEC) and a 2-day automated reminder. During the 7-day reminder call the PEC identified barriers to attending the appointment through concrete planning and motivational interviewing strategies. Appointments were rescheduled as needed, additional information was provided to solidify shared goals for the visit, and patient’s time/obligations were validated. The intervention resulted in positive feedback from the majority of patients and revealed concrete planning prompts to be a very effective communication form. The post-intervention data analysis revealed both the no-show and late cancellation results were reduced for the MassHealth population. Due to data and confounding variable limitations this study is recommended to be a basis for future investigation as the principal investigators enter into the next pilot phase of this model

Senior Thesis ST 2011-02

Agriculture in the Arctic is often limited by the low receipt of heat energy, which is often measured in growing degree days (GDD). With the advent of increasingly powerful climate modeling, projection and downscaling techniques, it is becoming possible to examine future climates in high resolution. Recent availability in Alaska has prompted interest in examining the distribution of current and the potential future of local agriculture. The goal of this study was to utilize Scenarios Network for Alaska Planning (SNAP) downscaled, ensemble projections to examine this in terms of GDDs in the Fairbanks North Star Borough of Alaska. Historic and projected monthly mean temperatures were utilized to calculate GDDs and then map the borough at a 4 km2 scale. Additionally, local agriculturalists were interviewed in order to put these theoretical calculations into context. Ultimately, projections of the examined agricultural locations showed an average of a 2% increase in GDD per decade and a 26% increase in GDDs from 1949 to 2099. This project indicated that the North Star Borough will receive increased heat energy due to climate change over the next century that may further enable increased yields and varieties of crops

MANSEE data analysis results

Results of the data reduction and analysis for the Marine Navigation Systems Evaluation Experiment (MANSEE) are presented. Topics discussed include: the MANSEE test; the navigation sensors which were exercised; the ground truth instrumentation and the processing of ground truth data; and the residual statistics for individual navigation sensors. Residuals were calculated by differencing the actual measurements with anticipated measurements computed from the ground truth trajectory. The results obtained by using the SEAMAP program to filter data from the navigation sensors are also presented. The resultant filtered trajectories were differenced with the corresponding ground truth trajectories to obtain navigation position and velocity errors

Understanding soil nitrogen supply: organic matter quality and quantity

The soil organic matter (SOM) contents of organic and conventionally farmed soils were compared. Whilst the quantity of SOM was found to be similar with both systems, the quality of SOM differed in respect of higher amounts of N released by the organic soils under anaerobic incubation. This indicated a greater potential rate of mineralization and suggested that the inherent fertility of the organic soils had been improve

Why Are There Revisions to the Jobs Numbers?

At the beginning of each month, the Bureau of Labor Statistics (BLS) reports the change in payroll employment for the previous month. This estimate of jobs gained or lost over the month is closely watched by policymakers and those who work in financial markets and the media. When the estimate is revised in subsequent months, however, data users sometimes perceive a very different picture of the job market than what was initially reported. Data users frequently ask why the number was revised. The short answer is, the revised estimate includes additional information that was not available at the time of the initial release— information that makes the revised estimate more accurate. This BEYOND THE NUMBERS article explains the data collection process that BLS conducts every month to produce the estimate of U.S. employment. The article also should help clarify why BLS releases revisions to the initial estimate so that users will understand the change, if any, in the data

U.S. Immigration Policy: Family Reunification

This issue brief covers the 1965 Immigration Act, the preference category framework, the immigrant visa petition application and approval process. The author argues that family reunification is in jeopardy, and concludes with possible solutions and recommendations

An assessment of nitrogen fixation in 'organically managed' spring-sown lupins and leaching under a following winter cereal

Three spring-sown species of lupins (Bora, Prima and Wodjil) and peas were compared in terms of N fixation and subsequent leaching under a following winter cereal crop. Although peas out-yielded lupins (5.4 t compared with ca 3.5 t grain, respectively), the yellow lupin (Wodjil) fixed more N than peas (180 compared with 120 kg N ha-1) and all three lupins contained more protein (> 30%) than the peas (22%). Wodjil was the most effective at suppressing weeds, carrying only 12% of the weed burden found in fallow plots, followed by peas (19%). Winter leaching amounted to > 50 kg nitrate-N ha-1 from under the winter cereal, regardless of whether the previous treatment was a legume crop or was left fallow. There were no significant differences in leaching between the three species of lupin. Leachate in the first 350 mm of drainage under the winter cereal exceeded the EU limit on nitrate in drinking water in all treatments. This work is part of a wider collaborative study supported by Defra which covers a range of UK sites

Protecting Eden: Markets or Government?

The majority of species classified as “threatened”, “endangered” or “extinct” by the IUCN are to be found in government controlled parks and legally protected areas in developing countries. Dissatisfaction with the public sector’s record in protecting endangered species has prompted calls for the use of market based instruments and other economic incentives to promote more efficient environmental outcomes. In this paper we examine whether greater reliance on market based incentives would result in improved environmental outcomes in national parks. We address this issue by extending the incomplete contracts framework to the case of a renewable resource. We identify conditions under which private ownership or control of a national park induces more (less) efficient management of protected areas. The paper concludes with a discussion of the limitations of the analysis and the implications of these results for the conservation of biodiversity.