Primary Uterine Cancer in Maryland: Impact of Distance on Access to Surgical Care at High-Volume Hospitals

2013 ◽  
Vol 23 (7) ◽  
pp. 1244-1251 ◽  
Author(s):  
Camille C. Gunderson ◽  
Ana I. Tergas ◽  
Aimee C. Fleury ◽  
Teresa P. Diaz-Montes ◽  
Robert L. Giuntoli
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Uterine Cancer ◽  
Multivariable Analysis ◽  
Community Setting ◽  
Surgical Care ◽  
High Volume ◽  
High Volume Hospital ◽  
To Receive ◽  
Zip Code

ObjectiveTo evaluate the influence of distance on access to high-volume surgical treatment for patients with uterine cancer in Maryland.MethodsThe Maryland Health Services Cost Review Commission database was retrospectively searched to identify primary uterine cancer surgical cases from 1994 to 2010. Race, type of insurance, year of surgery, community setting, and both surgeon and hospital volume were collected. Geographical coordinates of hospital and patient’s zip code were used to calculate primary independent outcomes of distance traveled and distance from nearest high-volume hospital (HVH). Logistic regression was used to calculate odds ratios and confidence intervals.ResultsFrom 1994 to 2010, 8529 women underwent primary surgical management of uterine cancer in Maryland. Multivariable analysis demonstrated white race, rural residence, surgery by a high-volume surgeon and surgery from 2003 to 2010 to be associated with both travel 50 miles or more to the treating hospital and residence 50 miles or more from the nearest HVH (allP< 0.05). Patients who travel 50 miles or more to the treating hospital are more likely to have surgery at a HVH (odds ratio, 6.03; 95% confidence interval, 4.67–7.79) In contrast, patients, who reside ≥50 miles from a HVH, are less likely to have their surgery at an HVH. (odds ratio, 0.37; 95% confidence interval, 0.32–0.42).ConclusionIn Maryland, 50 miles or more from residence to the nearest HVH is a barrier to high-volume care. However, patients who travel 50 miles or more seem to do so to receive care by a high-volume surgeon at an HVH. In Maryland, Nonwhites are more likely to live closer to an HVH and more likely to use these services.

scholarly journals Comparing Telephone Counseling With Reminding to Promote On-Time Repeated Mammography: A Randomized Trial in a Cohort With 4 Years Follow-Up

2019 ◽  
Vol 47 (1) ◽  
pp. 37-46
Author(s):  
Mary E. Costanza ◽  
Roger Luckmann ◽  
Christine Frisard ◽  
Mary Jo White ◽  
Caroline Cranos
Keyword(s):  
Confidence Interval ◽  
Randomized Trial ◽  
Odds Ratio ◽  
Multivariable Analysis ◽  
Telephone Counseling ◽  
Long Term Effects ◽  
Time Points ◽  
Reminder Call ◽  
Screening Mammograms

Background. Long-term continuous adherence to biennial screening mammograms as guidelines recommend remains low. Limited evidence suggests that reminder calls may increase short-term adherence as much as telephone counseling, but research is needed comparing the long-term effects of these two approaches. Purpose. To compare the impacts of two telephone outreach interventions and mailed reminders on 4-year continuous mammography adherence. Method. A cohort of 3,215 women, age 50 to 81 years, was selected from 30,160 women from a 4-year randomized trial of three interventions to promote biennial mammography: reminder letter only (LO), letter plus reminder call (RC), and two letters plus educational material and a counseling call (CC). Women selected remained eligible for the trial all 4 years and received annual interventions as needed. The proportion with a mammogram in the last 24 months was determined at baseline and four annual time points. Results. Continuous adherence at all four time points was higher in the RC (78.8%) and CC arms (78.8%) than in the LO arm (75.1%; p < .001). Multivariable analysis confirmed this finding: CC (odds ratio = 1.27; 95% confidence interval = [1.01, 1.61]) and RC (odds ratio = 1.23; 95% confidence interval = [0.98, 1.56]). Only 27.8% of women eligible for an initial counseling call actually received counseling. Conclusions. Compared with letters alone, outreach calls can modestly increase continuous mammography adherence among insured women with consistent primary care. Telephone counseling was no more effective than a reminder call, possibly due to limited acceptance of counseling calls by women who may find them unwelcome or unnecessary.

scholarly journals Accessing surgical care for esophageal cancer: patient travel patterns to reach higher volume center

2020 ◽  
Vol 33 (7) ◽  
Author(s):  
Adrian Diaz ◽  
Sarah Burns ◽  
Desmond D’Souza ◽  
Peter Kneuertz ◽  
Robert Merritt ◽  
...  
Keyword(s):  
Health Planning ◽  
Surgical Care ◽  
High Volume ◽  
Travel Patterns ◽  
Care Access ◽  
Patient Travel ◽  
High Volume Hospital ◽  
High Volume Center ◽  
Low Volume ◽  
Esophagectomy For Cancer

SUMMARY While better outcomes at high-volume surgical centers have driven the regionalization of complex surgical care, access to high-volume centers often requires travel over longer distances. We sought to evaluate the travel patterns among patients undergoing esophagectomy to assess willingness of patients to travel for surgical care. The California Office of Statewide Health Planning database was used to identify patients who underwent esophagectomy between 2005 and 2016. Total distance traveled, as well as whether a patient bypassed the nearest hospital that performed esophagectomy to get to a higher volume center, was assessed. Overall 3,269 individuals underwent an esophagectomy for cancer in 154 hospitals; only five hospitals were high volume according to Leapfrog standards. Median travel time to a hospital that performed esophagectomy was 26 minutes (IQR: 13.1–50.7). The overwhelming majority of patients (85%) bypassed the nearest providing hospital to seek care at a destination hospital. Among patients who bypassed a closer hospital, only 36% went to a high-volume hospital. Of the 2,248 patients who underwent esophagectomy at a low-volume center, 1,491 patients had bypassed a high-volume hospital. Of the remaining 757 patients who did not bypass a high-volume hospital, half of the individuals would have needed to travel less than an additional hour to reach a high-volume center. Nearly two-thirds of patients undergoing an esophagectomy for cancer received care at a low-volume center; 85% of patients either bypassed a high-volume hospital or would have needed to travel less than an additional hour to reach a high-volume center.

Clinical and socio-economic predictors of work participation in adult CHD patients

2020 ◽  
Vol 30 (8) ◽  
pp. 1081-1085
Author(s):  
Lauren A. Sarno ◽  
Lindsay Cortright ◽  
Tiara Stanley ◽  
Dmitry Tumin ◽  
Jennifer S. Li ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Employment Status ◽  
Heart Defects ◽  
Multivariable Analysis ◽  
Population Based ◽  
Work Participation ◽  
Surveillance Network ◽  
The North ◽  
Economic Predictors

AbstractBackground:Adults with CHD have reduced work participation rates compared to adults without CHD. We aimed to quantify employment rate among adult CHD patients in a population-based registry and to describe factors and barriers associated with work participation.Methods:We retrospectively identified adults with employment information in the North Carolina Congenital Heart Defects Surveillance Network. Employment was defined as any paid work in a given year. Logistic regression was used to examine patients’ employment status during each year.Results:The registry included 1,208 adult CHD patients with a health care encounter between 2009 and 2013, of whom 1,078 had ≥1 year of data with known employment status. Overall, 401 patients (37%) were employed in their most recent registry year. On multivariable analysis, the odds of employment decreased with older age and were lower for Black as compared to White patients (odds ratio = 0.78; 95% confidence interval: 0.62, 0.98; p = 0.030), and single as compared to married patients (odds ratio = 0.50; 95% confidence interval: 0.39, 0.63; p < 0.001).Conclusion:In a registry where employment status was routinely captured, only 37% of adult CHD patients aged 18–64 years were employed, with older patients, Black patients, and single patients being less likely to be employed. Further work is needed to consider how enhancing cardiology follow-up for adults with CHD can integrate support for employment.

scholarly journals Association of hemoglobin with incidence of in-hospital cardiac arrest in patients with acute coronary syndrome complicated by cardiogenic shock

2019 ◽  
Vol 47 (9) ◽  
pp. 4151-4162
Author(s):  
Tiancheng Xu ◽  
Dongjie Liang ◽  
Shengjie Wu ◽  
Xiaodong Zhou ◽  
Ruiyu Shi ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Arrest ◽  
Confidence Interval ◽  
Cardiogenic Shock ◽  
Odds Ratio ◽  
Protective Factor ◽  
Multivariable Analysis ◽  
Hemoglobin Concentration ◽  
Coronary Syndrome ◽  
Hospital Cardiac Arrest

Objective This study was performed to investigate the association of the admission hemoglobin level with the incidence of in-hospital cardiac arrest (IHCA) in patients with acute coronary syndrome (ACS) complicated by cardiogenic shock (CS). Methods In this retrospective study, we reviewed the medical records of consecutive patients with ACS complicated by CS admitted to the coronary care unit from January 2014 to October 2017. Logistic regression models were carried out to evaluate the association between hemoglobin and the incidence of IHCA. Interaction and subgroup analyses were also performed. Results In total, 211 patients were included in the study, and 61 (28.9%) patients developed IHCA. In the multivariable analysis, hemoglobin was a strong independent predictor of IHCA (odds ratio, 0.971; 95% confidence interval, 0.954–0.989). In the fully adjusted model, patients in the higher hemoglobin tertile were less likely to develop IHCA than patients in the lowest hemoglobin tertile (odds ratio, 0.194; 95% confidence interval, 0.071–0.530). The relationship remained stable in most subgroups except patients aged ≥70 years. Conclusion In patients with ACS complicated by CS, the incidence of IHCA is related to the hemoglobin concentration, and a high hemoglobin concentration is a protective factor against the development of IHCA.

Gastroenteritis in older people living in the community: results of two Australian surveys

2012 ◽  
Vol 140 (11) ◽  
pp. 2028-2036 ◽  
Author(s):  
M. D. KIRK ◽  
G. V. HALL ◽  
N. BECKER
Keyword(s):  
Food Safety ◽  
Confidence Interval ◽  
Older People ◽  
Elderly People ◽  
Odds Ratio ◽  
Multivariable Analysis ◽  
The Elderly ◽  
The State ◽  
National Surveys

SUMMARYWe analysed two large national surveys conducted in 2001 and 2008 to examine incidence and outcomes of gastroenteritis in older Australians. A case was someone reporting ⩾3 loose stools or ⩾1 episode of vomiting in 24 h, excluding non-infectious causes. We compared cases arising in the elderly (⩾65 years) and in other adults (20–64 years). Elderly people experienced 0·33 [95% confidence interval (CI) 0·24–0·42] episodes of gastroenteritis/person per year, compared to 0·95 (95% CI 0·74–1·15) in other adults. Elderly cases reported less stomach cramps, fever and myalgia than younger cases, and were more likely to be hospitalized, although this was not statistically significant. In multivariable analysis, gastroenteritis in elderly people was associated with travelling within the state (odds ratio 1·35, 95% CI 1·07–1·71). Elderly people were less concerned about food safety than other adults. Older Australians were less likely to report gastroenteritis and experienced different symptoms and outcomes from other adults.

Development and Validation of a Simple and Easy-to-Employ Electronic Algorithm for Identifying Clinical Methicillin-Resistant Staphylococcus aureus Infection

2014 ◽  
Vol 35 (6) ◽  
pp. 692-698 ◽  
Author(s):  
Westyn Branch-Elliman ◽  
Judith Strymish ◽  
Kalpana Gupta
Keyword(s):  
Staphylococcus Aureus ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Multivariable Analysis ◽  
Simple Algorithm ◽  
Electronic System ◽  
Surveillance Systems ◽  
Methicillin Resistant ◽  
Sterile Site ◽  
Mrsa Infection

Background.With growing demands to track and publicly report and compare infection rates, efforts to utilize automated surveillance systems are increasing. We developed and validated a simple algorithm for identifying patients with clinical methicillin-resistant Staphylococcus aureus (MRSA) infection using microbiologic and antimicrobial variables. We also estimated resource savings.Methods.Patients who had a culture positive for MRSA at any of 5 acute care Veterans Affairs hospitals were eligible. Clinical infection was defined on the basis of manual chart review. The electronic algorithm defined clinical MRSA infection as a positive non-sterile-site culture with receipt of MRSA-active antibiotics during the 5 days prior to or after the culture.Results.In total, 246 unique non-sterile-site cultures were included, of which 168 represented infection. The sensitivity (43.4%–95.8%) and specificity (34.6%–84.6%) of the electronic algorithm varied depending on the combination of antimicrobials included. On multivariable analysis, predictors of algorithm failure were outpatient status (odds ratio, 0.23 [95% confidence interval, 0.10–0.56]) and respiratory culture (odds ratio, 0.29 [95% confidence interval, 0.13–0.65]). The median cost was $2.43 per chart given 4.6 minutes of review time per chart.Conclusions.Our simple electronic algorithm for detecting clinical MRSA infections has excellent sensitivity and good specificity. Implementation of this electronic system may streamline and standardize surveillance and reporting efforts.Infect Control Hosp Epidemiol 2014;35(6):692–698

scholarly journals Predictors of Early Neurological Deterioration in Stroke Due to Vertebrobasilar Occlusion

2021 ◽  
Vol 12 ◽  
Author(s):  
Seungyon Koh ◽  
Sung Eun Lee ◽  
Woo Sang Jung ◽  
Jin Wook Choi ◽  
Jin Soo Lee ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Confidence Interval ◽  
Endovascular Therapy ◽  
Odds Ratio ◽  
Multivariate Analyses ◽  
Multivariable Analysis ◽  
Posterior Circulation ◽  
Neurological Deterioration ◽  
Early Neurological Deterioration ◽  
Basilar Occlusion

Background and Aims: This study explores the predictors of early neurological deterioration (END) in patients with vertebrobasilar occlusion (VBO) in both primary endovascular therapy (EVT) and medical management (MM) groups.Methods: Patients diagnosed with VBO from 2010 to 2018 were included. Comparative and multivariate analyses were used to identify predictors of all-cause END in the EVT group, and END due to ischemia progression (END-IP) in the MM group.Results: In 174 patients with VBO, 43 had END. In the primary EVT group (N = 66), 17 all-cause END occurred. Distal basilar occlusion (odds ratio (OR), 14.5 [95% confidence interval (CI), 1.4–154.4]) and reperfusion failure (eTICI &lt; 2b67 (OR, 5.0 [95% CI, 1.3–19.9]) were predictive of END in multivariable analysis. In the MM group (N=108), 17 END-IP occurred. Higher systolic blood pressure (SBP) at presentation (per 10 mmHg increase, OR, 1.5 [95% CI, 1.1–2.0]), stroke onset-to-door time &lt;24 h (OR, 5.3 [95% CI, 1.1–2.0]), near-total occlusions (OR, 4.9 [95% CI, 1.2–19.6]), lower posterior circulation-Alberta Stroke Program Early CT scores (OR, 1.6 [95% CI, 1.0–2.5]), and lower BATMAN collateral scores (OR, 1.6 [95% CI, 1.1–2.2]) were predictive of END-IP.Conclusions: In patients with stroke due to VBO, potential predictors of END can be identified. In the primary EVT group, failure to achieve reperfusion and distal basilar occlusion were associated with all-cause END. In the MM group, higher SBP at presentation, onset-to-door time less than 24 h, incomplete occlusions, larger infarct cores, and poorer collaterals were associated with END-IP.

scholarly journals Volume-Based Care among Young Women Diagnosed with Uterine Cancer

ISRN Surgery ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-6
Author(s):  
Teresa P. Diaz-Montes ◽  
Robert L. Giuntoli
Keyword(s):  
Young Women ◽  
Regression Models ◽  
Uterine Cancer ◽  
Surgical Care ◽  
High Volume ◽  
Service Cost ◽  
Health Service Cost ◽  
Logistic Regression Models ◽  
Adjusted Cost ◽  
Low Volume

Purpose. To characterize volume-based care of uterine cancer among women aged ≤50 years. Methods. The Maryland Health Service Cost Review Commission database was accessed for uterine cancer surgical cases from 1994 to 2005. Cross-tabulations and logistic regression models were used to evaluate for significant associations among volume-based care and other variables comparing women ≤50 years with those aged >50 years. Results. Women ≤50 years comprised 13.6% of the cases. Women ≤50 years were less likely to be managed by high-volume surgeons (31.6% versus 35.1%, ). For women ≤50 years, there was a trend toward management at low-volume hospitals (52.0% versus 54.0%, ). No deaths were reported among the group of women ≤50 years treated by high-volume providers or at high-volume centers. Women ≤50 years managed by high-volume surgeons had longer length of stay () and higher adjusted cost of hospital-related care (). Women ≤50 years managed at high-volume centers had higher adjusted cost of hospital-related care (). Conclusion. Primary surgical care of young women with uterine cancer is often performed by low-volume providers.

Factors Predictive of 90-Day Morbidity, Readmission, and Costs in Patients Undergoing Pelvic Exenteration

2018 ◽  
Vol 28 (5) ◽  
pp. 975-982 ◽  
Author(s):  
Giorgio Bogani ◽  
Mauro Signorelli ◽  
Antonino Ditto ◽  
Fabio Martinelli ◽  
Jvan Casarin ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Confidence Interval ◽  
Patient Selection ◽  
Odds Ratio ◽  
Pelvic Exenteration ◽  
Multivariable Analysis ◽  
High Rate ◽  
Vein Thrombosis ◽  
Improve Patient Selection ◽  
Anterior Posterior

ObjectivePelvic exenteration for recurrent gynecological malignancies is characterized by a high rate of severe complications. Factors predictive of morbidity, readmission, and cost were analyzed.MethodsData of consecutive patients undergoing pelvic exenteration between January 2007 and December 2016 were prospectively evaluated.ResultsFifty-eight patients were included in the analysis. Anterior, posterior, and total exenterations were executed in 39 (67%), 9 (16%), and 10 (17%) patients, respectively. Ten (15.5%) severe complications occurred: 8 (20.5%), 0 (0%), and 1 (10%) after anterior, posterior, and total exenterations, respectively. Radiotherapy dosage, time between radiotherapy and surgery, and previous administration of chemotherapy did not influence 90-day complications and readmission. At multivariable analysis, albumin levels less than 3.5 g/dL (odds ratio, 16.2 [95% confidence interval, 2.85–92.8]; P = 0.002) and history of deep vein thrombosis (odds ratio, 9.6 [95% confidence interval, 0.93–98.2]; P = 0.057) were associated with 90-day morbidity. Low albumin levels independently correlated with readmission (P = 0.011). The occurrence of 90-day postoperative complications and readmission increased costs of a median of +12,500 and +6000 euros, respectively (P < 0.05).ConclusionsPreoperative patient selection is a key point for the reduction of postoperative complications after pelvic exenteration. Further prospective studies are warranted to improve patient selection.

In-Pipeline Stenosis

Neurosurgery ◽  
2015 ◽  
Vol 77 (6) ◽  
pp. 875-879 ◽  
Author(s):  
Nohra Chalouhi ◽  
Adam Polifka ◽  
Badih Daou ◽  
David Kung ◽  
Guilherme Barros ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Confidence Interval ◽  
Internal Carotid Artery ◽  
Odds Ratio ◽  
Internal Carotid ◽  
Multivariable Analysis ◽  
Artery Aneurysm ◽  
Multivariable Logistic Regression Analysis ◽  
Anterior Circulation ◽  
Internal Carotid Artery Aneurysm

BACKGROUND: The Pipeline Embolization Device is a widely utilized flow diverter in the treatment of intracranial aneurysms. OBJECTIVE: To assess the incidence, clinical significance, predictors, and outcomes of in-Pipeline stenosis (IPS). METHODS: Angiographic studies in 139 patients treated between 2011 and 2013 were independently reviewed by 2 authors for the presence of IPS. Multivariable logistic regression analysis was conducted to determine predictors of IPS. RESULTS: A total of 21 (15.8%) patients demonstrated some degree of IPS during the follow-up period at a mean time point of 6.7 months (range, 3–24 months). The stenosis was mild (&lt;50%) in 11 patients, moderate (50%-75%) in 5, and severe (&gt;75%) in 6. None were symptomatic or required further intervention. Sixteen of these 22 patients (73%) had IPS detected within 6 months. IPS was noted in 7.6% (1/13) of patients with posterior circulation aneurysms vs 16.7% (21/126) of those with anterior circulation aneurysms (P = .03). The rate of IPS was 60% (3/5) in patients who did not receive aspirin vs only 14.2% (19/134) in those who received aspirin (P = .02). In multivariable analysis, no aspirin therapy (odds ratio, 10.0; 95% confidence interval, 1.4–67.7; P = .02) and internal carotid artery aneurysm location (odds ratio, 3.1; 95% confidence interval, 1.1–8.8; P = .03) were strong independent predictors of IPS. CONCLUSION: IPS is a common, early, and mostly benign complication. Patients with internal carotid artery aneurysms are more likely to develop IPS. Aspirin plays a key role in preventing IPS. The results of this study further support the safety of flow diverters.

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