422 results on '"Brook RH"'
Search Results
2. Variations in Cataract Extraction Rates in Medicare Prepaid and Fee-for-Service Settings
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Goldzweig, CL, Mittman, BS, Carter, GM, Donyo, T, Brook, RH, Lee, P, and Mangione, CM
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Aging ,Clinical Research ,Good Health and Well Being ,Age Distribution ,Aged ,Aged ,80 and over ,California ,Cataract Extraction ,Cross-Sectional Studies ,Data Collection ,Diabetes Mellitus ,Fee-for-Service Plans ,Female ,Health Maintenance Organizations ,Humans ,Independent Practice Associations ,Likelihood Functions ,Logistic Models ,Male ,Medicare ,Multivariate Analysis ,Sex Distribution ,United States ,Medical and Health Sciences ,General & Internal Medicine - Abstract
ObjectiveTo compare rates of cataract extraction in 2 prepaid health settings and in traditional fee-for-service (FFS) settings.DesignA cross-sectional analysis using 1993 health maintenance organization (HMO) Medicare claims and encounter files, the Health Care Financing Administration (HCFA) 5% Medicare Part B provider/supplier file, and the HCFA October 1992 100% Medicare population file.SettingSouthern California Medicare FFS settings and the staff-model and independent practice association (IPA) plans of a large California HMO.Patients1993 Medicare beneficiaries aged 65 years and older. The study included 43387 staff-model HMO enrollees, 19050 IPA enrollees, and 47 150 FFS beneficiaries (a 5% sample of all Southern California FFS beneficiaries).Main outcome measureAge and risk-factor adjusted rates of cataract extraction per 1000 beneficiary-years.ResultsAfter controlling for age, sex, and diabetes mellitus status, FFS beneficiaries were twice as likely to undergo cataract extraction as were prepaid beneficiaries (P
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- 1997
3. CLINICAL DECISION-MAKING IN THE EMERGENCY DEPARTMENT — WHOM YOU SEE DETERMINES WHAT YOU GET
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Washington, DL, Stevens, CD, Fink, A, Shekelle, PG, Baker, DW, and Brook, RH
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- 1996
4. WHEN IS IT SAFE TO TRIAGE PATIENTS OUT OF THE EMERGENCY DEPARTMENT?
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Washington, DL, Stevens, CD, Fink, A, Baker, DW, Shekelle, PG, and Brook, RH
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- 1996
5. DRUG USE IN RHEUMATOID ARTHRITIS
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MacLean, CH, Knight, KK, Shekelle, PG, Paulus, HE, and Brook, RH
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- 1996
6. COSTS ATTRIBUTABLE TO ARTHRITIS
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MacLean, CH, Knight, KK, Shekelle, PG, Paulus, HE, and Brook, RH
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- 1996
7. VARIATIONS IN CATARACT EXTRACTION RATES IN HMO AND FFS SETTINGS
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Goldzweig, CL, Mittman, BS, Mangione, CM, Carter, GM, Lee, P, Donyo, T, and Brook, RH
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- 1996
8. Hospital costs by cost center of inpatient hospitalization for medicare patients undergoing major abdominal surgery
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Anne Stey, Brook, Rh, Needleman, J., L Hall, B., Zingmond, Ds, Lawson, Eh, and Ko, Cy
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Male ,Clinical Sciences ,8.1 Organisation and delivery of services ,and over ,Health Services ,Medicare ,United States ,Hospitalization ,Pancreatectomy ,Elective Surgical Procedures ,Clinical Research ,Multivariate Analysis ,80 and over ,Humans ,Cholecystectomy ,Risk Adjustment ,Female ,Surgery ,Patient Safety ,Least-Squares Analysis ,Hospital Costs ,health care economics and organizations ,Colectomy ,Health and social care services research ,Aged - Abstract
© 2015 American College of Surgeons. Background: This study aims to describe the magnitude of hospital costs among patients undergoing elective colectomy, cholecystectomy, and pancreatectomy, determine whether these costs relate as expected to duration of care, patient case-mix severity and comorbidities, and whether risk-adjusted costs vary significantly by hospital. Correctly estimating the cost of production of surgical care may help decision makers design mechanisms to improve the efficiency of surgical care. Study Design: Patient data from 202 hospitals in the ACS-NSQIP were linked to Medicare inpatient claims. Patient charges were mapped to cost center cost-to-charge ratios in the Medicare cost reports to estimate costs. The association of patient case-mix severity and comorbidities with cost was analyzed using mixed effects multivariate regression. Cost variation among hospitals was quantified by estimating risk-adjusted hospital cost ratios and 95% confidence intervals from the mixed effects multivariate regression. Results: There were 21,923 patients from 202 hospitals who underwent an elective colectomy (n=13,945), cholecystectomy (n= 5,569), or pancreatectomy (n= 2,409). Median cost was lowest for cholecystectomy ($15,651) and highest for pancreatectomy ($37,745). Room and board costs accounted for the largest proportion (49%) of costs and were correlated with length of stay, R= 0.89, p < 0.001. The patient case-mix severity and comorbidity variables most associated with cost were American Society of Anesthesiologists (ASA) class IV (estimate 1.72, 95% CI 1.57 to 1.87) and fully dependent functional status (estimate 1.63, 95% CI 1.53 to 1.74). After risk-adjustment, 66 hospitals had significantly lower costs than the average hospital and 57 hospitals had significantly higher costs. Conclusions: The hospital costs estimates appear to be consistent with clinical expectations of hospital resource use and differ significantly among 202 hospitals after risk-adjustment for preoperative patient characteristics and procedure type.
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- 2015
9. Elderly patients' knowledge of drug benefit caps and communication with providers about exceeding caps: Clinical investigations
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Tseng, CW, Dudley, RA, Brook, RH, Keeler, E, Hixon, AL, Manlucu, LR, and Mangione, CM
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OBJECTIVES: Many elderly persons have drug benefits with coverage gaps, such as in Medicare Part D. Because beneficiaries who have such gaps must pay all drug costs, an accurate knowledge of gap thresholds and communication with providers about exceeding caps is important for elderly persons to manage out-of-pocket drug costs. DESIGN: Cross-sectional survey. SETTING: Health plan. PARTICIPANTS: One thousand three hundred eight health plan members aged 65 and older. The study was a 2002 cross-sectional survey of elderly persons with capped drug benefits in a managed care plan in one state. Participants were sampled so that half reached coverage caps and half did not. METHODS: Participants reported cap levels, communication with providers about exceeding caps, and decreased medication use due to cost. RESULTS: Of the 1,308 participants (65.4% response rate), 68.6% did not know their correct cap level. Rates were similar in those who exceeded caps (66.2%), reported difficulty paying for medications (63.9%), or decreased medication use (66%). For participants who exceeded caps, 59.1% did not know beforehand that they were close to exceeding caps and 50.2% did not tell providers afterward. In multivariate analyses accounting for demographics and health, the oldest participants (≥85 vs 65-74) were at greater risk for not knowing cap levels (odds ratio (OR)=2.0, 95% confidence interval (CI)=1.2-3.4) and not telling providers about exceeding caps (OR=2.2, 95% CI=1.1-4.5). CONCLUSIONS: Elderly patients often did not know correct cap levels and did not tell providers about exceeding caps. Providers, plans, and policymakers should actively assess and improve Medicare beneficiaries' knowledge of Part D coverage gaps. © 2009, The American Geriatrics Society.
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- 2009
10. Elderly patients' preferences and experiences with providers in managing their drug costs
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Tseng, CW, Dudley, RA, Brook, RH, Keeler, E, Steers, WN, Alexander, GC, Waitzfelder, BE, and Mangione, CM
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Male ,Physician-Patient Relations ,Prescription Fees ,Medicare drug benefit ,Medicare ,Medical and Health Sciences ,United States ,decision making ,Logistic Models ,Cross-Sectional Studies ,Clinical Research ,Patient Satisfaction ,Geriatrics ,Humans ,patient-provider communication ,Female ,prescription drug costs ,Aged - Abstract
OBJECTIVES: To determine whether elderly patients with high drug expenditures want and receive providers' help in managing drug costs. DESIGN: Cross-sectional survey. SETTING: A Medicare managed care plan (>400,000 members) in one state in 2002. PARTICIPANTS: One thousand one hundred six seniors (62% response rate) sampled so that half exceeded caps on their drug benefits the previous year, and all had total drug expenditures in the top quartile of members in their cap level. MEASUREMENTS: Participants' preferences and experiences with providers discussing costs and participation in choosing medications. RESULTS: Two-thirds reported difficulty paying for medications, and one-fourth decreased medication use because of cost. Most wanted providers to ask about medication affordability (81%), consider cost (86%), offer choices (70%), and to persuade them or decide for them which medication to use (88%), but few said providers asked about affordability (17%), usually or always discussed prices (19%), or offered choices (45%), although nearly all said providers chose their medications (93%). Sixty-two percent had asked providers for help with drug costs, although 34% who used less medication because of cost or had difficulty paying for medications had not asked for help. CONCLUSION: Providers should be aware that elderly patients want their help in managing drug costs but do not always receive it or ask for help when they need it. Providers could improve communication by initiating conversations about cost and by asking patients about preferences when prescribing. © 2007, The American Geriatrics Society.
- Published
- 2007
11. Effect of generic-only drug benefits on seniors' medication use and financial burden
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Tseng, CW, Brook, RH, Keeler, E, Steers, WN, Waitzfelder, BE, and Mangione, CM
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Male ,Drugs ,Generic ,Insurance Coverage ,United States ,Insurance ,Cross-Sectional Studies ,Cost of Illness ,Health ,Health Policy & Services ,Public Health and Health Services ,Humans ,Female ,Financing ,Personal ,Aged - Abstract
Background: Generic-only drug benefits are a way to provide some coverage, as opposed to no coverage. Objective: To examine how switching from brand name to generic-only drug coverage affected seniors' medication use and financial burden. Study Design: Data are from a 2002 cross-sectional survey conducted for a separate study on benefit caps. Participants belonged to a Medicare managed care plan in one state and had $2000 capped brand name benefits in 2001 but generic-only benefits in 2002. Methods: Participants reported their cost-cutting strategies before and after the change to generic-only coverage, the medications affected, and their financial burden. We conducted bivariate and multivariate analyses of cost-cutting strategies and financial burden before and after implementation of generic-only benefits. Results: Among 611 participants (63% response), rates of switching medications increased after discontinuation of brand name coverage (27% vs 8%, P < .001). Switches were from brand name drugs to generic equivalents (14%) (eg, Prozac to fluoxetine hydrochloride), to nonequivalent generics (26%) (eg, Paxil to fluoxetine), and to different brand name drugs (45%) (eg, Paxil to Zoloft). Ninety percent of brand name switches remained in the same therapeutic class (eg, selective serotonin reuptake inhibitors). After discontinuation of brand name coverage, participants reported higher rates of decreased medication use (28% vs 17%) and greater difficulty paying for prescriptions (65% vs 37%) (P < .001 for both). Conclusions: Changing from brand name benefits to generic-only drug coverage led many participants to switch to less expensive medications but also decreased medication use and increased financial burden. Insurers need to actively help patients adjust to a discontinuation of brand name coverage.
- Published
- 2006
12. Variations in cataract extraction rates in Medicare prepaid and fee-for-service settings.
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Mittman, BS, primary, Carter, GM, additional, Donyo, T, additional, Brook, RH, additional, Lee, P, additional, Mangione, CM, additional, and Goldzweig, CL, additional
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- 1997
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13. Underutilization of upper gastrointestinal endoscopy
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Froehlich, F, primary, Pache, I, additional, Burnand, B, additional, Vader, JP, additional, Fried, M, additional, Kosecoff, J, additional, Kolodny, M, additional, DuBois, RW, additional, Brook, RH, additional, and Gonvers, JJ, additional
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- 1997
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14. Suboptimal control of atherosclerotic disease risk factors after cardiac and cerebrovascular procedures.
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Cheng EM, Asch SM, Brook RH, Vassar SD, Jacob EL, Lee ML, Chang DS, Sacco RL, Hsiao AF, Vickrey BG, Cheng, Eric M, Asch, Steve M, Brook, Robert H, Vassar, Stefanie D, Jacob, Erin L, Lee, Martin L, Chang, Donald S, Sacco, Ralph L, Hsiao, An-Fu, and Vickrey, Barbara G
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- 2007
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15. How good is the quality of health care in the United States?
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Schuster MA, McGlynn EA, and Brook RH
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- 2005
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16. Visual acuity following cataract surgeries in relation to preoperative appropriateness ratings.
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Tobacman JK, Zimmerman B, Lee P, Hilborne L, Kolder H, and Brook RH
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The authors initiated this study to consider if the formal preoperative assessment of appropriate or inappropriate utilization of cataract surgery by an expert panel could predict postoperative improvement or decline in visual acuity. They evaluated the association between ratings of appropriateness, as determined by the RAND-UCLA method, and measurements of postoperative visual acuity using Fisher's exact tests for tables greater than 2 x 2. For 768 patients, improvement of at least 2 Snellen chart lines occurred in 89% of surgeries rated as appropriate or appropriate and crucial, 68% rated as uncertain, and 36% rated as inappropriate (P < 0.0001, Fisher's exact test). These results provide evidence supporting the validity of the RAND-UCLA method to assess the appropriateness of surgery. [ABSTRACT FROM AUTHOR]
- Published
- 2003
17. Next-day care for emergency department users with nonacute conditions. A randomized, controlled trial.
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Washington DL, Stevens CD, Shekelle PG, Henneman PL, Brook RH, Washington, Donna L, Stevens, Carl D, Shekelle, Paul G, Henneman, Philip L, and Brook, Robert H
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Background: Because of overcrowding and cost-control efforts, emergency departments are under pressure to refer patients with nonacute conditions to other settings. However, no validated systematic methods exist for safely performing such referrals.Objective: To determine the effects on health status and access to care of systematically referring patients with nonacute conditions to next-day primary care.Design: Randomized, controlled trial.Setting: An emergency department in a public hospital.Patients: 156 adults who used the emergency department on weekdays from 7:00 a.m. to 3:00 p.m. and met criteria for deferred care. The criteria applied to three symptom complexes that account for 33% of U.S. emergency department visits by adults.Intervention: Next-day care at the study site's primary care center or usual same-day care.Measurements: Self-reported health status and use of health services during 1-week follow-up.Results: Patients assigned to next-day care did not demonstrate clinically important disadvantages in health status or physician visits compared with usual care patients. In each group, more than 95% of patients were evaluated at least once by a physician, 4% sought health services after their initial evaluation, and no patients were hospitalized or died. At follow-up, both groups reported improved health status and fewer days in bed or with disability, although the deferred care group reported less improvement on all three measures. The 95% CIs were sufficiently narrow to exclude a clinically significant difference in self-reported health status. However, the possibility of 1 additional day in bed or with disability in the deferred care group could not be excluded.Conclusions: Clinically detailed standardized screening criteria can safely identify patients at public hospital emergency departments for referral to next-day care. However, larger studies are needed to assess the possibility of adverse effects. [ABSTRACT FROM AUTHOR]- Published
- 2002
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18. An English and Spanish Pediatric Asthma Symptom Scale.
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Lara M, Sherbourne C, Duan N, Morales L, Gergen P, Brook RH, Lara, M, Sherbourne, C, Duan, N, Morales, L, Gergen, P, and Brook, R H
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- 2000
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19. Quality-of-life outcomes in men treated for localized prostate cancer.
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Litwin MS, Hays RD, Fink A, Ganz PA, Leake B, Leach GE, Brook RH, Litwin, M S, Hays, R D, Fink, A, Ganz, P A, Leake, B, Leach, G E, and Brook, R H
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Objective: To assess health-related quality of life (HRQOL) in men treated for clinically localized prostate cancer.Design: A cross-sectional analysis of HRQOL after treatment with radical prostatectomy, pelvic irradiation, or observation alone for clinically localized prostatic adenocarcinoma, and in age-matched comparison patients.Setting: A large managed care population in California.Subjects: A total of 528 men, including 214 treated for clinically localized prostate cancer (41 with evidence of metastatic disease were excluded from this analysis) and 273 age-matched, ZIP code-matched comparison patients without prostate cancer. Cancer patients were analyzed in three treatment groups: radical prostatectomy (n = 98), primary pelvic irradiation (n = 56), and observation alone (n = 60).Main Outcome Measures: General HRQOL was measured with the RAND 36-Item Health Survey 1.0. Cancer-specific HRQOL was measured with the CAncer Rehabilitation Evaluation System-Short Form and the Functional Assessment of Cancer Therapy-General form. Disease-targeted quality of life was measured with a new instrument assessing function and bother in three organ systems: sexual, urinary, and bowel.Results: No differences among treatment groups were seen in comparisons of general HRQOL: Significant differences among treatment groups were seen in both function and bother in the prostate-targeted measures of sexual, urinary, and bowel domains. When cancer patients were compared with men of similar age without prostate cancer, differences were seen in the sexual, urinary, and bowel function and bother but not in general HRQOL measures. Although cancer-free men were found not to have full potency or continence, prostate cancer patients treated with surgery or radiation reported significantly worse sexual, urinary, and bowel function than men without cancer. Men who had undergone nerve-sparing prostatectomy did not differ from those who had undergone standard prostatectomy, but the power to detect a difference was low.Conclusions: Although no differences were seen in general HRQOL, three disease-targeted domains were found to differ significantly among the treatment groups and comparison patients. Even after controlling for the sexual and urinary dysfunction experienced by older men without cancer, those receiving therapeutic interventions for their prostate cancer were found to have poorer disease-targeted HRQOL: We conclude that in addition to general HRQOL, disease-targeted measures must be used to assess outcomes of care in men treated for localized prostate cancer. [ABSTRACT FROM AUTHOR]- Published
- 1995
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20. Benefits and costs of screening and treatment for early breast cancer. Development of a basic benefit package.
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Kattlove H, Liberati A, Keeler E, Brook RH, Kattlove, H, Liberati, A, Keeler, E, and Brook, R H
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Objective: To develop a basic benefit package for detection and treatment of early breast cancer by evaluating the effectiveness and costs for screening mammography, primary surgery, adjuvant therapy, and follow-up care.Data Sources: Published articles were retrieved through MEDLINE; additional articles were obtained through searches of their bibliographies. Cancer statistics were taken from Surveillance, Epidemiology, and End Results (SEER) Program data, population statistics were taken from US Census data, and charges from 1993 Southern California Medicare fees were used to represent costs.Study Selection: Studies were selected on the basis of their design. Preference, in decreasing order, was given to meta-analyses of randomized trials, individual randomized clinical trials, prospective cohort studies, retrospective cohort studies, and case series.Data Extraction: Studies were examined for the effect of the intervention on overall survival, disease-free survival, and health-related quality of life. We evaluated effects on survival in terms of number of lives saved at 10 years and average years of life saved. Costs were related to the benefits observed and modeled onto a hypothetical health care organization of 500,000 lives.Results: Based on this analysis, we recommend a basic benefit plan for the detection and treatment of early breast cancer that would include the following: (1) screening mammography only for women aged 50 to 69 years; (2) choice of mastectomy or breast-conserving surgery with radiation therapy for all women with early breast cancer; (3) adjuvant therapy for all women at risk of recurrence; and (4) only clinical follow-up without routine testing for metastatic disease.Conclusions: By choosing which services they provide to specific groups of patients, providers can substantially reduce their expenses and still provide quality health benefits. [ABSTRACT FROM AUTHOR]- Published
- 1995
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21. The medical appropriateness of tympanostomy tubes proposed for children younger than 16 years in the United States.
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Kleinman LC, Kosecoff J, Dubois RW, Brook RH, Kleinman, L C, Kosecoff, J, Dubois, R W, and Brook, R H
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Objective: To describe the clinical reasons tympanostomy tubes are proposed for children and to assess their appropriateness.Design: Analysis of data previously collected prospectively by a national utilization review (UR) firm during a two-step UR process to assess the medical appropriateness of tympanostomy tube placement. Nurses interviewed otolaryngologists' and primary care physicians' office staff to collect clinical data. For a randomly selected subsample of cases found inappropriate, we reviewed subsequent interviews of the otolaryngologists by physician reviewers, who looked for possible extenuating clinical circumstances or additional clinical data that might have changed the appropriateness category.Setting: Otolaryngologists' practices from 49 states and the District of Columbia.Patients: All 6611 children younger than 16 years who were insured by three clients of the UR firm and whose proposal to receive tympanostomy tubes were reviewed by this system from January 1, 1990, through July 31, 1991. The insurance companies in the study insured 5.6 million Americans at the time of the study.Main Outcome Measure: The medical appropriateness of tympanostomy tube surgery according to explicit criteria developed by an expert panel using the RAND/University of California-Los Angeles modified Delphi method.Results: A total of 6429 (97%) of the cases were proposed for recurrent acute otitis media, otitis media with effusion, or both. Making generous clinical assumptions, 41% of the proposals for these reasons had appropriate indications, 32% had equivocal indications, and 27% had inappropriate ones. Considering the additional information available from the subsample review, the proportion appropriate was 42%, equivocal 35%, and inappropriate 23%.Conclusion: About one quarter of tympanostomy tube insertions for children in this study were proposed for inappropriate indications and another third for equivocal ones. [ABSTRACT FROM AUTHOR]- Published
- 1994
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22. Assuring the quality of health care for older persons. An expert panel's priorities.
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Fink A, Siu AL, Brook RH, Park RE, Solomon DH, Fink, A, Siu, A L, Brook, R H, Park, R E, and Solomon, D H
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- 1987
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23. Congruence between decisions to initiate chiropractic spinal manipulation for low back pain and appropriateness criteria in North America.
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Shekelle PG, Coulter I, Hurwitz EL, Genovese B, Adams AH, Mior SA, Brook RH, Shekelle, P G, Coulter, I, Hurwitz, E L, Genovese, B, Adams, A H, Mior, S A, and Brook, R H
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Background: Recent U.S. practice guidelines recommend spinal manipulation for some patients with low back pain. If followed, these guidelines are likely to increase the number of persons referred for chiropractic care. Concerns have been raised about the appropriate use of chiropractic care, but systematic data are lacking.Objective: To determine the appropriateness of chiropractors' decisions to use spinal manipulation for patients with low back pain.Design: Retrospective review of chiropractic office records against preset criteria for appropriateness that were developed from a systematic review of the literature and a nine-member panel of chiropractic and medical specialists. Appropriateness criteria reflect the expected balance between risk and benefit.Setting: 131 of 185 (71%) chiropractic offices randomly sampled from sites in the United States and Canada.Patients: 10 randomly selected records of patients presenting with low back pain from each office (1310 patients total).Measurements: Sociodemographic data on patients and chiropractors; use of health care services by patients; assessment of the decision to initiate spinal manipulation as appropriate, uncertain, or inappropriate.Results: Of the 1310 patients who sought chiropractic care for low back pain, 1088 (83%) had spinal manipulation. For 859 of these patients (79%), records contained data sufficient to determine whether care was congruent with appropriateness criteria. Care was classified as appropriate in 46% of cases, uncertain in 25% of cases, and inappropriate in 29% of cases. Patients who did not undergo spinal manipulation were less likely to have a presentation judged appropriate and were more likely to have a presentation judged inappropriate than were patients who did undergo spinal manipulation (P = 0.01).Conclusions: The proportion of chiropractic spinal manipulation judged to be congruent with appropriateness criteria is similar to proportions previously described for medical procedures; thus, the findings provide some reassurance about the appropriate application of chiropractic care. However, more than one quarter of patients were treated for indications that were judged inappropriate. The number of inappropriate decisions to use chiropractic spinal manipulation should be decreased. [ABSTRACT FROM AUTHOR]- Published
- 1998
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24. The appropriateness of coronary artery bypass graft surgery in academic medical centers. Working Group of the Appropriateness Project of the Academic Medical Center Consortium.
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Leape LL, Hilborne LH, Schwartz JS, Bates DW, Rubin HR, Slavin P, Park RE, Witter DM Jr., Panzer RJ, Brook RH, Working Group of the Appropriateness Project of the Academic Medical Center Consortium, Leape, L L, Hilborne, L H, Schwartz, J S, Bates, D W, Rubin, H R, Slavin, P, Park, R E, Witter, D M Jr, and Panzer, R J
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Objective: To compare the appropriateness of use of coronary artery bypass graft (CABG) surgery in Academic Medical Center Consortium hospitals as judged 1) according to criteria developed by an expert panel, 2) according to revisions of those criteria made by cardiac surgeons from the Academic Medical Center Consortium, and 3) by review of cases by the surgeons responsible for those cases.Design: Retrospective, randomized medical record review.Setting: 12 Academic Medical Center Consortium hospitals.Patients: Random sample of 1156 patients who had had isolated CABG surgery in 1990.Main Outcome Measures: 1) Percentage of patients with indications for which CABG surgery was classified as appropriate, Inappropriate, or of uncertain appropriateness and 2) percentage of cases in which CABG surgery was judged inappropriate or uncertain for which ratings changed after local case review.Results: Data were retrieved from medical records by trained abstractors using an explicit data collection instrument. Cases in which CABG surgery was judged to be inappropriate or uncertain were individually reviewed by the responsible surgeons. According to the expert panel ratings, 83% of the CABG operations (95% CI, 81% to 85%) were necessary, 9% (CI, 8% to 10%) were appropriate, 7% (CI, 5% to 8%) were uncertain, and 1.6% (CI, 0.6% to 2.5%) were inappropriate. These rates are almost identical to those found in a previous study that was done in New York State and that used the same criteria (in that study, 91% of operations were classified as necessary or appropriate, 7% were classified as uncertain, and 2.4% were classified as inappropriate). Rates of inappropriate procedures varied from 0% to 5% among the 12 member hospitals (P = 0.02). The Academic Medical Center Consortium cardiac surgeons revised 568 (24%) of the indications used by the expert panel. However, because those revisions altered the appropriateness ratings in both directions and affected only 50 cases (4%), the net effect of the revisions was slight: The rate of inappropriate CABG surgery increased from 1.6% to 1.9%. Local review found that data collection errors had caused erroneous ratings in 12.5% of 64 cases in which surgery had been classified as inappropriate or uncertain.Conclusions: The Academic Medical Center Consortium hospitals had low rates of inappropriate and uncertain use of CABG surgery, regardless of the criteria used for assessment. Even though surgeons from the Consortium revised the appropriateness ratings extensively, their revisions had a negligible effect on the overall assessment of appropriateness. However, because of potential data collection errors, appropriateness criteria should be used for individual case audits only if supplemented by subsequent physician review. [ABSTRACT FROM AUTHOR]- Published
- 1996
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25. Outcomes of patients with do-not-resuscitate orders. Toward an understanding of what do-not-resuscitate orders mean and how they affect patients.
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Wenger NS, Pearson ML, Desmond KA, Brook RH, and Kahn KL
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- 1995
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26. The appropriateness of use of cardiovascular procedures in women and men.
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Bernstein SJ, Hilborne LH, Leape LL, Park RE, and Brook RH
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- 1994
27. The smoking gun: do clinicians follow guidelines on firearm safety counseling?
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Barkin S, Duan N, Fink A, Brook RH, and Gelberg L
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- 1998
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28. The appropriateness of hysterectomy. A comparison of care in seven health plans. Health Maintenance Organization Quality of Care Consortium.
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Bernstein SJ, McGlynn EA, Siu AL, Roth CP, Sherwood MJ, Keesey JW, Kosecoff J, Hicks NR, Brook RH, Bernstein, S J, McGlynn, E A, Siu, A L, Roth, C P, Sherwood, M J, Keesey, J W, Kosecoff, J, Hicks, N R, and Brook, R H
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Objective: To develop and test a method for comparing the appropriateness of hysterectomy use in different health plans.Design: Retrospective cohort study.Setting: Seven managed care organizations.Patients: Random sample of all nonemergency, non-oncological hysterectomies performed in the seven managed care organizations over a 1-year period. Patients who were not continuously enrolled in a plan for 2 years prior to their hysterectomy were excluded.Main Outcome Measures: Proportion of women undergoing hysterectomy in each plan for inappropriate clinical reasons according to ratings derived from a panel of managed care physicians.Results: Overall, about 16% of women underwent hysterectomy for reasons judged to be clinically inappropriate. Only one plan had significantly more hysterectomies rated inappropriate compared with the group mean (27%, unadjusted). Adjusting for age and race did not affect the rankings of the plans and had little effect on the numeric results.Conclusion: The rates of inappropriate use of hysterectomies are similar to those for other procedures and vary to a small degree among health plans. This information may be useful to purchasers when they consider which health plans to offer their employees. [ABSTRACT FROM AUTHOR]- Published
- 1993
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29. Studying the effects of the DRG-based prospective payment system on quality of care. Design, sampling, and fieldwork.
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Draper D, Kahn KL, Reinisch EJ, Sherwood MJ, Carney MF, Kosecoff J, Keeler EB, Rogers WH, Savitt H, Allen H, Wells KB, Reboussin D, Brook RH, Draper, D, Kahn, K L, Reinisch, E J, Sherwood, M J, Carney, M F, Kosecoff, J, and Keeler, E B
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We have conducted a nationally representative before-after study of the effects of the diagnosis related groups-based prospective payment system (PPS) on quality of in-hospital care for aged Medicare patients. We used a pre-post design with multiple time points in both the pre-PPS (calendar years 1981 and 1982) and post-PPS (July 1985 through June 1986) periods. We gathered clinically detailed data from medical records of patients with one of six diseases and supplemented these data with postdischarge information from Health Care Financing Administration files. We used a stratified multistage cluster sampling design with data gathered on 16,758 patients chosen from 297 hospitals in 30 areas in five states. Our hospital participation rate was 97%; we successfully accessed 96% of the medical records we requested; and our mean item-level reliability score was 0.80. Our sample matches the nation closely on hospital urbanicity, size, teaching status, ownership, and percentages of Medicare and Medicaid patients, and patient demographics and mortality. [ABSTRACT FROM AUTHOR]
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- 1990
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30. The effect of cost sharing on the quality of dental care
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Bailit, HL, Brook, RH, Kamberg, CJ, Goldberg, GA, Spolsky, V, Camp, P, Cantrell, C, Hanley, J, Black, A, and Newhouse, JP
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- 1984
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31. What Is Meant by Agreement
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Brook Rh
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Theoretical physics ,business.industry ,media_common.quotation_subject ,Medicine ,General Medicine ,business ,Agreement ,media_common - Published
- 1976
32. Health systems, heuristics, and comparative effectiveness research.
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Brook RH and Brook, Robert H
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- 2013
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33. Assessing the appropriateness of care--its time has come.
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Brook RH and Brook, Robert H
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- 2009
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34. Population-based assessments of ophthalmologic and audiologic follow-up in children with very low birth weight enrolled in Medicaid: a quality-of-care study.
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Wang CJ, Elliott MN, McGlynn EA, Brook RH, and Schuster MA
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- 2008
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35. Implementing medical guidelines.
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Brook RH and Brook, R H
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- 1995
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36. Seven ideas to improve quality.
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Brook RH
- Published
- 2008
37. Identifying potential health care innovations for the future elderly: prospects for advances in medical research and technology in the first part of the twenty-first century.
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Shekelle PG, Ortiz E, Newberry SJ, Rich MW, Rhodes SL, Brook RH, and Goldman DP
- Abstract
We used a method that combined literature review and expert judgment to assess potential medical innovations for older adults. We evaluated innovations in four domains: cardiovascular disease, cancer, the biology of aging, and neurologic disease. The innovations can be categorized by common themes: improved disease prevention, better detection of subclinical or early clinical disease, and treatments for established disease. We report the likelihood, potential impact, and potential cost implications for thirty-four innovations, and we revisit this forecast five years later. Many of the innovations have the potential to greatly affect the costs and outcomes of health care. [ABSTRACT FROM AUTHOR]
- Published
- 2005
38. The Association Between Risk Aversion of Surgeons and Their Clinical Decision-Making.
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Sacks GD, Dawes AJ, Tsugawa Y, Brook RH, Russell MM, Ko CY, Maggard-Gibbons M, and Ettner SL
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- Clinical Decision-Making, Humans, Postoperative Complications epidemiology, Postoperative Complications etiology, Risk Factors, Surgeons
- Abstract
Background: The extent to which a surgeon's risk aversion influences their clinical decisions remains unknown. We assessed whether a surgeon's attitude toward risk ("risk aversion") influences their surgical decisions and whether the relationship can be explained by differences in surgeons' perception of treatment risks and benefits., Materials and Methods: We presented a series of detailed clinical vignettes to a national sample of surgeons (n = 1,769; 13.4% adjusted response rate) and asked them to complete an instrument that measured how risk averse they are within their clinical practice (scale 6-36; higher number indicates greater risk aversion). For each vignette, participants rated their likelihood of recommending an operation and judged the likelihood of complications or full recovery. We examined whether differences in perceived likelihood of complications versus recovery could explain why risk-averse surgeons may be less likely to recommend an operation., Results: Surgeons varied in their self-reported risk aversion score (median = 25, interquartile range[22,28]). Scores did not differ by level of surgeon experience or gender. Risk-averse surgeons were significantly less likely to recommend an operation for patients with exactly the same condition (65.5% for surgeons in highest quartile of risk aversion versus 62.3% for lowest quartile; P = 0.02). However, after controlling for surgeons' perception of the likelihood of complications versus recovery, there was no longer a significant association between surgeons' risk aversion and the decision to recommend an operation (64.7% versus 64.8%; P = 0.96)., Conclusions: Surgeons vary widely in their self-reported risk aversion. Risk-averse surgeons were significantly less likely to recommend an operation, a finding that was explained by a higher perceived probability of post-operative complications than their colleagues., (Copyright © 2021 Elsevier Inc. All rights reserved.)
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- 2021
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39. Deficits in Advance Care Planning for Patients With Decompensated Cirrhosis at Liver Transplant Centers.
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Patel AA, Ryan GW, Tisnado D, Chuang E, Walling AM, Saab S, Khemichian S, Sundaram V, Brook RH, and Wenger NS
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- Adult, Advance Care Planning statistics & numerical data, Attitude of Health Personnel, Female, Fibrosis physiopathology, Humans, Interviews as Topic methods, Liver Transplantation methods, Male, Middle Aged, Qualitative Research, Severity of Illness Index, Advance Care Planning standards, Fibrosis surgery, Liver Transplantation statistics & numerical data
- Abstract
Importance: The burden of end-of-life care for patients with cirrhosis is increasing in the US, and most of these patients, many of whom are not candidates for liver transplant, die in institutions receiving aggressive care. Advance care planning (ACP) has been associated with improved end-of-life outcomes for patients with other chronic illnesses, but it has not been well-characterized in patients with decompensated cirrhosis., Objective: To describe the experience of ACP in patients with decompensated cirrhosis at liver transplant centers., Design, Setting, and Participants: For this multicenter qualitative study, face-to-face semistructured interviews were conducted between July 1, 2017, and May 30, 2018, with clinicians and patients with decompensated cirrhosis at 3 high-volume transplant centers in California. Patient participants were adults and had a diagnosis of cirrhosis, at least 1 portal hypertension-related complication, and current or previous Model for End-Stage Liver Disease with sodium score of 15 or higher. Clinician participants were health care professionals who provided care during the illness trajectory., Main Outcomes and Measures: Experiences with ACP reported by patients and clinicians. Participants were asked about the context, behaviors, thoughts, and decisions concerning elements of ACP, such as prognosis, health care preferences, values and goals, surrogate decision-making, and documentation., Results: The study included 42 patients (mean [SD] age, 58.2 [11.2] years; 28 men [67%]) and 46 clinicians (13 hepatologists [28%], 11 transplant coordinators [24%], 9 hepatobiliary surgeons [20%], 6 social workers [13%], 5 hepatology nurse practitioners [11%], and 2 critical care physicians [4%]). Five themes that represent the experiences of ACP were identified: (1) most patient consideration of values, goals, and preferences occurred outside outpatient visits; (2) optimistic attitudes from transplant teams hindered the discussions about dying; (3) clinicians primarily discussed death as a strategy for encouraging behavioral change; (4) transplant teams avoided discussing nonaggressive treatment options with patients; and (5) surrogate decision makers were unprepared for end-of-life decision-making., Conclusions and Relevance: This study found that, despite a guarded prognosis, patients with decompensated cirrhosis had inadequate ACP throughout the trajectory of illness until the end of life. This finding may explain excessively aggressive life-sustaining treatment that patients receive at the end of life.
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- 2021
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40. Resuming Elective Surgery during Covid-19: Can Inpatient Hospitals Collaborate with Ambulatory Surgery Centers?
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Squitieri L, Ko CY, Brook RH, and Chung KC
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Little is known about the volume and scope of surgical procedures performed in ambulatory surgery centers (ASCs) and the resources that ASCs may provide to assist local health systems. The purpose of this study was to evaluate elective surgical procedures in the inpatient and outpatient ASC setting using currently available administrative claims data., Methods: We used the 2019 Medicare Point of Service (POS) file to evaluate the geographic distribution of Medicare-certified ASCs in the U.S. To evaluate the volume and scope of elective procedures in the inpatient and outpatient ASC setting, we used the 2016 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) and the 2018 California HHS Open Data Portal ambulatory surgery database. HCUP software programs were used to clinically categorize procedures and determine Elixhauser comorbidity profiles for each patient., Results: Among the 8,540 Medicare certified ASCs in 2019, the majority are freestanding (99.5%) and privately owned (92.9%). In the inpatient setting, 13.3% of elective operating room procedures occur in patients without any Elixhauser comorbidities and require < 2 days of hospital stay. However, the types of elective procedures performed in the inpatient setting are different from the types of procedures routinely performed in ASCs., Conclusions: Current administrative data lack robust facility, provider, and procedure level information to inform surge capacity protocols for elective surgery. Plastic surgeons are uniquely positioned to work with other specialties and local health systems to guide future development of surge capacity protocols that maintain and improve patient care., (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)
- Published
- 2021
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41. Linking Statistics With Testing Policy to Manage COVID-19 in the Community.
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Hilborne LH, Wagner Z, Cabreros I, and Brook RH
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- COVID-19, COVID-19 Testing, Coronavirus Infections epidemiology, Coronavirus Infections prevention & control, Female, Humans, Male, Pandemics prevention & control, Pneumonia, Viral epidemiology, Pneumonia, Viral prevention & control, Prevalence, SARS-CoV-2, Sensitivity and Specificity, Seroepidemiologic Studies, United States epidemiology, Betacoronavirus isolation & purification, Clinical Laboratory Techniques methods, Clinical Laboratory Techniques statistics & numerical data, Coronavirus Infections diagnosis, Health Policy, Health Services Accessibility, Pneumonia, Viral diagnosis, Public Health Surveillance methods
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Objectives: To determine the public health surveillance severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing volume needed, both for acute infection and seroprevalence., Methods: Required testing volumes were developed using standard statistical methods based on test analytical performance, disease prevalence, desired precision, and population size., Results: Widespread testing for individual health management cannot address surveillance needs. The number of people who must be sampled for public health surveillance and decision making, although not trivial, is potentially in the thousands for any given population or subpopulation, not millions., Conclusions: While the contributions of diagnostic testing for SARS-CoV-2 have received considerable attention, concerns abound regarding the availability of sufficient testing capacity to meet demand. Different testing goals require different numbers of tests and different testing strategies; testing strategies for national or local disease surveillance, including monitoring of prevalence, receive less attention. Our clinical laboratory and diagnostic infrastructure are capable of incorporating required volumes for many local, regional, and national public health surveillance studies into their current and projected testing capacity. However, testing for surveillance requires careful design and randomization to provide meaningful insights., (© American Society for Clinical Pathology, 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2020
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42. How Community and Unity Can Help Americans Survive.
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Brook RH, Wang CJ, and Wenger NS
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- Humans, Residence Characteristics, United States, Public Health
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- 2020
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43. Association of a Care Bundle for Early Sepsis Management With Mortality Among Patients With Hospital-Onset or Community-Onset Sepsis.
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Baghdadi JD, Brook RH, Uslan DZ, Needleman J, Bell DS, Cunningham WE, and Wong MD
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- Aged, Aged, 80 and over, Disease Management, Female, Guideline Adherence, Humans, Male, Middle Aged, Retrospective Studies, Sepsis therapy, Shock, Septic therapy, Survival Rate, Hospital Mortality, Patient Care Bundles, Sepsis mortality, Shock, Septic mortality
- Abstract
Importance: The Early Management Bundle for Severe Sepsis/Septic Shock (SEP-1) is a quality metric based on a care bundle for early sepsis management. Published evidence on the association of SEP-1 with mortality is mixed and largely excludes cases of hospital-onset sepsis., Objective: To assess the association of the SEP-1 bundle with mortality and organ dysfunction in cohorts with hospital-onset or community-onset sepsis., Design, Setting, and Participants: This retrospective cohort study used data from 4 University of California hospitals from October 1, 2014, to October 1, 2017. Adult inpatients with a diagnosis consistent with sepsis or disseminated infection and laboratory or vital signs meeting the Sepsis-3 (Third International Consensus Definitions for Sepsis and Septic Shock) criteria were divided into community-onset sepsis and hospital-onset sepsis cohorts based on whether time 0 of sepsis occurred after arrival in the emergency department or an inpatient area. Data were analyzed from April to October 2019. Additional analyses were performed from December 2019 to January 2020., Exposures: Administration of SEP-1 and 4 individual bundle components (serum lactate level testing, blood culture, broad-spectrum intravenous antibiotic treatment, and intravenous fluid treatment)., Main Outcomes and Measures: The primary outcome was in-hospital mortality. The secondary outcome was days requiring vasopressor support, measured as vasopressor days., Results: Among the 6404 patient encounters identified (3535 men [55.2%]; mean [SD] age, 64.0 [18.2] years), 2296 patients (35.9%) had hospital-onset sepsis. Among 4108 patients (64.1%) with community-onset sepsis, serum lactate level testing within 3 hours of time 0 was associated with reduced mortality (absolute difference, -7.61%; 95% CI, -14.70% to -0.54%). Blood culture (absolute difference, -1.10 days; 95% CI, -1.85 to -0.34 days) and broad-spectrum intravenous antibiotic treatment (absolute difference, -0.62 days; 95% CI, -1.02 to -0.22 days) were associated with fewer vasopressor days. Among patients with hospital-onset sepsis, broad-spectrum intravenous antibiotic treatment was the only bundle component significantly associated with any improved outcome (mortality difference, -5.20%; 95% CI, -9.84% to -0.56%). Care that was adherent to the complete SEP-1 bundle was associated with increased vasopressor days in patients with community-onset sepsis (absolute difference, 0.31 days; 95% CI, 0.11-0.51 days) but was not significantly associated with reduced mortality in either cohort (absolute difference, -0.07%; 95% CI, -3.02% to 2.88% in community-onset; absolute difference, -0.42%; 95% CI, -6.77% to 5.93% in hospital-onset)., Conclusions and Relevance: SEP-1-adherent care was not associated with improved outcomes of sepsis. Although multiple components of SEP-1 were associated with reduced mortality or decreased days of vasopressor therapy for patients who presented with sepsis in the emergency department, only broad-spectrum intravenous antibiotic treatment was associated with reduced mortality when time 0 occurred in an inpatient unit. Current sepsis quality metrics may need refinement.
- Published
- 2020
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44. Response to COVID-19 in Taiwan: Big Data Analytics, New Technology, and Proactive Testing.
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Wang CJ, Ng CY, and Brook RH
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- Betacoronavirus, COVID-19, Humans, SARS-CoV-2, Taiwan, Coronavirus Infections, Data Science, Pandemics, Pneumonia, Viral
- Published
- 2020
- Full Text
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45. Injury-specific variables improve risk adjustment and hospital quality assessment in severe traumatic brain injury.
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Dawes AJ, Sacks GD, Needleman J, Brook RH, Mittman BS, Ko CY, and Cryer HG
- Subjects
- Adult, Algorithms, Benchmarking methods, Brain Injuries, Traumatic mortality, Brain Injuries, Traumatic pathology, Female, Humans, Injury Severity Score, Male, Middle Aged, Models, Statistical, Risk Adjustment, Brain Injuries, Traumatic therapy, Hospitals standards, Quality Assurance, Health Care methods
- Abstract
Background: Hospital benchmarking is essential to quality improvement, but its usefulness depends on the ability of statistical models to adequately control for inter-hospital differences in patient mix. We explored whether the addition of injury-specific clinical variables to the current American College of Surgeons-Trauma Quality Improvement Program (TQIP) algorithm would improve model fit., Methods: We analyzed a prospective registry containing all adult patients who presented to a regional consortium of 14 trauma centers between 2010 and 2011 with severe traumatic brain injury (TBI). We used hierarchical logistic regression and stepwise forward selection to develop two novel risk-adjustment models. We then tested our novel models against the current TQIP model and ranked hospitals by their risk-adjusted mortality rates under each model to determine how model selection affects quality benchmarking., Results: Seven hundred thirty-four patients met inclusion criteria. Stepwise selection resulted in two distinct models: one that added three TBI-specific variables (pupil reactivity, cerebral edema, loss of basal cisterns) to the model specification currently used by TQIP and another that combined two TBI-specific variables (pupil reactivity, cerebral edema) with a three-variable subset of TQIP (age, Abbreviated Injury Scale score for the head region, Glasgow Coma Scale motor score). Both novel models outperformed TQIP. Although rankings remained largely unchanged across model configurations, several hospitals moved across quality terciles., Conclusion: The inclusion of injury-specific variables improves risk adjustment for patients with severe TBI. Trauma Quality Improvement Program should consider replacing several of its general patient characteristics with injury-specific clinical predictors to increase efficiency, reduce the risk of overfitting, and improve the accuracy of hospital benchmarking., Level of Evidence: Prognostic and epidemiological, level II.
- Published
- 2019
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46. Understanding Waste in Health Care: Perceptions of Frontline Physicians Regarding Time Use and Appropriateness of Care They and Others Provide.
- Author
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Caloyeras JP, Kanter MH, Ives NR, Kim CY, Kanzaria HK, Berry SH, and Brook RH
- Subjects
- Adult, California, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Attitude of Health Personnel, Delivery of Health Care organization & administration, Efficiency, Organizational standards
- Abstract
Background: Approximately 30% of total US health care spending is thought to be "wasted" on activities like unnecessary and inefficiently delivered services., Objectives: To assess the perceptions of clinic-based physicians regarding their use of time and appropriateness of care provided., Design: Cross-sectional online survey of all Southern California Permanente Medical Group partner and associate physicians (N = 1034) who were primarily providing clinic-based care in 1 of 4 geographically and operationally distinct Kaiser Permanente Southern California Medical Centers., Main Outcome Measures: The proportion of time spent on direct patient care tasks perceived to require the respondent's clinical/specialty training as a physician or another physician who has similar years of clinical training (vs physicians with fewer years of clinical training, nonphysicians, or automated or computerized systems), and the proportion of care provided by the respondent and by other physicians with whom they are familiar that is perceived to be appropriate (vs equivocal or inappropriate)., Results: More than 61% of respondents indicated that 15% of their time spent on direct patient care could be shifted to nonphysicians, and between 10% and 16% of care provided was equivocal or inappropriate., Discussion: The low proportion of care perceived as equivocal or inappropriate indicates there is little room for reducing such care or that physicians have difficulty assessing care appropriateness. The latter suggests that attempts to reduce or to eliminate inappropriate care may be unsuccessful until physician beliefs, knowledge, or behaviors are better understood and addressed., Conclusion: On the basis of these findings, it is apparent that within at least one health care system, the opportunity to increase value through task shifting and avoiding inappropriate care is more narrow than commonly perceived on a national level.
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- 2018
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47. What is Single-Payer Health Care? A Review of Definitions and Proposals in the U.S.
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Liu JL and Brook RH
- Subjects
- Health Care Reform economics, Health Care Reform methods, Humans, Insurance, Health, Patient Protection and Affordable Care Act economics, Single-Payer System economics, United States, Health Care Reform classification, Patient Protection and Affordable Care Act classification, Single-Payer System classification
- Abstract
Background: Single-payer systems have been proposed as a health care reform alternative in the United States. However, there is no consensus on the definition of single-payer. Most definitions characterize single-payer as one entity that collects funds and pays for health care on behalf on an entire population. Increased flexibility for state health care reform may provide opportunities for state-based single-payer systems to be considered., Objective: To explore the concept of single-payer and to describe the contents of single-payer health care proposals., Design: We compared single-payer definitions and proposals. We coded the proposal text for provisions that would change how the health care system functions and could impact health care access, quality, and cost., Main Measures: The share of proposals that include changes to the financing, pooling, purchasing, and delivery of health care; and possible impact on access, quality, and costs., Key Results: We identified 25 proposals for national or state single-payer plans from journal and legislative databases. The proposals typically call for wide-ranging reform; nearly all include changes across the financing, pooling, purchasing, and delivery of health care services. Many provisions aiming to improve access, quality, and cost containment are also included, but the proposals vary in how they plan to achieve these improvements. Common provisions are related to comprehensive benefits, patient choice of providers, little or no cost sharing, the role of private insurance, provider guidelines and standards, periodic reviews of the benefits package, electronic medical records and billing, prescription drug formulary, global budgets, administrative cost thresholds, payment reform and studies, and the authority to implement cost-containment strategies., Conclusions: Single-payer systems are heterogeneous. Acknowledgment of what is considered as single-payer and the characteristics that are variable is important for nuanced policy discussions on specific reform proposals.
- Published
- 2017
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48. National Differences in Trends for Heart Failure Hospitalizations by Sex and Race/Ethnicity.
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Ziaeian B, Kominski GF, Ong MK, Mays VM, Brook RH, and Fonarow GC
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- Black or African American, Aged, Asian, Comorbidity, Databases, Factual, Female, Heart Failure diagnosis, Hispanic or Latino, Humans, Male, Native Hawaiian or Other Pacific Islander, Quality Indicators, Health Care trends, Risk Factors, Sex Factors, Time Factors, United States epidemiology, White People, Healthcare Disparities ethnology, Healthcare Disparities trends, Heart Failure ethnology, Heart Failure therapy, Hospitalization trends, Racial Groups ethnology
- Abstract
Background: National heart failure (HF) hospitalization rates have not been appropriately age standardized by sex or race/ethnicity. Reporting hospital utilization trends by subgroup is important for monitoring population health and developing interventions to eliminate disparities., Methods and Results: The National Inpatient Sample (NIS) was used to estimate the crude and age-standardized rates of HF hospitalization between 2002 and 2013 by sex and race/ethnicity. Direct standardization was used to age-standardize rates to the 2000 US standard population. Relative differences between subgroups were reported. The national age-adjusted HF hospitalization rate decreased 30.8% from 526.86 to 364.66 per 100 000 between 2002 and 2013. Although hospitalizations decreased for all subgroups, the ratio of the age-standardized rate for men compared with women increased from 20% greater to 39% ( P trend=0.002) between 2002 and 2013. Black men had a rate that was 229% ( P trend=0.141) and black women, 240% ( P trend=0.725) with reference to whites in 2013 with no significant change between 2002 and 2013. Hispanic men had a rate that was 32% greater in 2002 and the difference narrowed to 4% ( P trend=0.047) greater in 2013 relative to whites. For Hispanic women, the rate was 55% greater in 2002 and narrowed to 8% greater ( P trend=0.004) in 2013 relative to whites. Asian/Pacific Islander men had a 27% lower rate in 2002 that improved to 43% ( P trend=0.040) lower in 2013 relative to whites. For Asian/Pacific Islander women, the hospitalization rate was 24% lower in 2002 and improved to 43% ( P trend=0.021) lower in 2013 relative to whites., Conclusions: National HF hospitalization rates have decreased steadily during the recent decade. Disparities in HF burden and hospital utilization by sex and race/ethnicity persist. Significant population health interventions are needed to reduce the HF hospitalization burden among blacks. An evaluation of factors explaining the improvements in the HF hospitalization rates among Hispanics and Asian/Pacific Islanders is needed., (© 2017 American Heart Association, Inc.)
- Published
- 2017
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49. Should the Definition of Health Include a Measure of Tolerance?
- Author
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Brook RH
- Subjects
- Health Promotion methods, Health Promotion trends, Humans, Mental Health, Racism, Social Values, Hate, Health, Health Status, Physician's Role, Prejudice psychology
- Published
- 2017
- Full Text
- View/download PDF
50. Impact of a Risk Calculator on Risk Perception and Surgical Decision Making: A Randomized Trial.
- Author
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Sacks GD, Dawes AJ, Ettner SL, Brook RH, Fox CR, Russell MM, Ko CY, and Maggard-Gibbons M
- Subjects
- Adult, Attitude of Health Personnel, Female, Humans, Judgment, Male, Middle Aged, Postoperative Complications, United States, Decision Making, Decision Support Techniques, Risk Assessment methods, Surgeons psychology, Surgical Procedures, Operative adverse effects, Surgical Procedures, Operative mortality
- Abstract
Objective: The aim of this study was to determine whether exposure to data from a risk calculator influences surgeons' assessments of risk and in turn, their decisions to operate., Background: Little is known about how risk calculators inform clinical judgment and decision-making., Methods: We asked a national sample of surgeons to assess the risks (probability of serious complications or death) and benefits (recovery) of operative and nonoperative management and to rate their likelihood of recommending an operation (5-point scale) for 4 detailed clinical vignettes wherein the best treatment strategy was uncertain. Surgeons were randomized to the clinical vignettes alone (control group; n = 384) or supplemented by data from a risk calculator (risk calculator group; n = 395). We compared surgeons' judgments and decisions between the groups., Results: Surgeons exposed to the risk calculator judged levels of operative risk that more closely approximated the risk calculator value (RCV) compared with surgeons in the control group [mesenteric ischemia: 43.7% vs 64.6%, P < 0.001 (RCV = 25%); gastrointestinal bleed: 47.7% vs 53.4%, P < 0.001 (RCV = 38%); small bowel obstruction: 13.6% vs 17.5%, P < 0.001 (RCV = 14%); appendicitis: 13.4% vs 24.4%, P < 0.001 (RCV = 5%)]. Surgeons exposed to the risk calculator also varied less in their assessment of operative risk (standard deviations: mesenteric ischemia 20.2% vs 23.2%, P = 0.01; gastrointestinal bleed 17.4% vs 24.1%, P < 0.001; small bowel obstruction 10.6% vs 14.9%, P < 0.001; appendicitis 15.2% vs 21.8%, P < 0.001). However, averaged across the 4 vignettes, the 2 groups did not differ in their reported likelihood of recommending an operation (mean 3.7 vs 3.7, P = 0.76)., Conclusions: Exposure to risk calculator data leads to less varied and more accurate judgments of operative risk among surgeons, and thus may help inform discussions of treatment options between surgeons and patients. Interestingly, it did not alter their reported likelihood of recommending an operation.
- Published
- 2016
- Full Text
- View/download PDF
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