Utilization of Laparoscopy in Colorectal Surgery for Cancer at Academic Medical Centers: Does Site of Surgery Affect Rate of Laparoscopy?

2011 ◽  
Vol 77 (10) ◽  
pp. 1300-1304 ◽  
Author(s):  
Joseph C. Carmichael ◽  
Hossein Masoomi ◽  
Steven Mills ◽  
Michael J. Stamos ◽  
Ninh T. Nguyen
Keyword(s):  
Colorectal Surgery ◽  
Length Of Stay ◽  
Laparoscopic Colorectal Surgery ◽  
Right Hemicolectomy ◽  
Academic Medical Centers ◽  
Sigmoid Colectomy ◽  
Colorectal Cancer Surgery ◽  
Medical Centers ◽  
Academic Medical ◽  
The University

Use of laparoscopy in colorectal cancer surgery is still limited. The aim of this study was to determine the rate of use of laparoscopic colorectal surgery for cancer at academic medical centers and to evaluate if the site of surgery influences the rate of use. Clinical data of patients who underwent laparoscopic or open colon and rectal resections for cancer from 2007 to 2009 were obtained from the University HealthSystem Consortium database. Data concerning rate of laparoscopy, length of stay, morbidity, and risk-adjusted mortality were obtained. During the 36-month study period, 22,780 operations were performed. The overall rate for use of laparoscopy was 14.8 per cent. Laparoscopy was most often used for total colectomy (22.6%), sigmoid colectomy (17.3%), cecectomy (17.1%), and right hemicolectomy (17.0%). Laparoscopy was most infrequently used for abdominoperineal resection (8.0%), transverse colectomy (10.0%), and left hemicolectomy (13.1%). Length of stay for laparoscopic colon and rectal procedures was 3.2 days shorter than for open surgery. Although the benefits of laparoscopic colorectal surgery for cancer have been demonstrated, the use of laparoscopy for colorectal resection remains under 20 per cent for colon cancer and under 10 per cent for rectal cancer. Further studies are needed to determine the factors limiting the use of laparoscopy in colorectal surgery.

Hospital Volume is Not a Predictor of Outcomes after Gastrectomy for Neoplasm

2009 ◽  
Vol 75 (10) ◽  
pp. 932-936 ◽  
Author(s):  
Kevin M. Reavis ◽  
Marcelo W. Hinojosa ◽  
Brian R. Smith ◽  
James B. Wooldridge ◽  
Sindhu Krishnan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Gastric Surgery ◽  
National Database ◽  
Medical Centers ◽  
Outcome Relationship ◽  
Academic Medical ◽  
Low Volume ◽  
Poor Outcomes ◽  
The University

Studies have shown conflicting data with regard to the volume and outcome relationship for gastrectomy. Using the University HealthSystem Consortium national database, we examined the influence of the hospital's volume of gastrectomy on outcomes at academic centers between 2004 and 2008. Outcome measures, including length of stay, 30-day readmission, morbidity, and in-hospital mortality, were compared among high- (13 or greater), medium- (6 to 12), and low-volume (five or less) hospitals. There were 10 high- (n = 593 cases), 36 medium- (n = 1076 cases), and 75 low-volume (n = 500 cases) hospitals. There were no significant differences between high- and low-volume hospitals with regard to length of stay, overall complications, 30-day readmission rate, and in-hospital mortality (2.4 vs 4.4%, respectively, P = 0.06). Despite the small number of gastrectomies performed at the low-volume hospitals, these same hospitals performed a large number of other types of gastric surgery such as gastric bypass for the treatment of morbid obesity (102 cases/year). Within the context of academic medical centers, lower annual volume of gastrectomy for neoplasm is not a predictor of poor outcomes which may be explained by the gastric operative experience derived from other types of gastric surgery.

Issues in Developing the Medical Scientist, Part 1: Interview with Dr. Robert W. Schrier, MD

2004 ◽  
Vol 52 (4) ◽  
pp. 242-245
Keyword(s):  
Department Chair ◽  
Academic Medical Centers ◽  
Renal Diseases ◽  
Full Time ◽  
Institute Of Medicine ◽  
University Of Colorado ◽  
Medical Centers ◽  
Academic Medical ◽  
The University ◽  
Time Faculty

The American Federation for Medical Research (AFMR) will present a series of articles that address the challenges faced by academic medical centers and other institutions in developing medical scientists (see the accompanying introduction to the series on page 241). The goal of this series is to assist leaders at academic medical centers in addressing the challenges for training the next generation of health care investigators. In addition, we hope to educate junior investigators and trainees on the many issues that their facilitators and mentors face in developing adequate programs for training and career development.Our first part of this series is an interview with Robert W. Schrier, MD. Dr. Schrier is a professor of medicine and was chairman of the Department of Medicine at the University of Colorado School of Medicine for 26 years and head of the Division of Renal Diseases and Hypertension for 20 years. Dr. Schrier's research accomplishments are enormous. He has had continuous funding for 35 years and has authored over 800 scientific papers and edited 45 books in renal medicine, geriatrics, drug use, and kidney disease. He is an acknowledged leader in academic medicine, as evidenced by his election to the Institute of Medicine of the National Academy of Sciences and presidencies of the Association of American Physicians, the American Society of Nephrology, the National Kidney Foundation, and the International Society of Nephrology. Dr. Schrier is a master of the American College of Physicians and an honorary fellow of the Royal College of Physicians. In addition, he has received the highest awards of several national and international organizations.However, it is not only the personal accomplishments of Dr. Schrier that led to his selection to take part in this series. Although those personal accomplishments are incredible, his work as a department chair, division chief, and research mentor may be greater. During Dr. Schrier's 26 years as chair of the Department of Medicine at the University of Colorado, the full-time faculty increased from approximately 75 to 500. The annual research grants by the department's full-time faculty rose from approximately $3 to $100 million, including the faculties' contributions to the General Clinical Research and Cancer Centers. The housestaff and fellow training programs also became nationally prominent. Thirty endowed research chairs between $1.5 and $2.0 million each were established. Clearly, he is a visionary who can speak to the challenges facing the young medical scientists and their mentors today.Dr. Schrier's responses to a series of questions follow.

Comparison of Laparoscopic vs Open Sigmoid Colectomy for Benign and Malignant Disease at Academic Medical Centers

2007 ◽  
Vol 11 (11) ◽  
pp. 1423-1430 ◽  
Author(s):  
Marcelo W. Hinojosa ◽  
Zuri A. Murrell ◽  
Viken R. Konyalian ◽  
Steven Mills ◽  
Ninh T. Nguyen ◽  
...  
Keyword(s):  
Malignant Disease ◽  
Academic Medical Centers ◽  
Sigmoid Colectomy ◽  
Medical Centers ◽  
Academic Medical

scholarly journals 907. The HCV Care Continuum Among Hospitalized Persons Who Inject Opiates: Missed Opportunities for Screening and Referral to Treatment

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S545-S545
Author(s):  
Irene Kuo ◽  
Jillian S Catalanotti ◽  
Hana Akselrod ◽  
Keanan McGonigle ◽  
William Mai ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Chart Review ◽  
Medical System ◽  
Hcv Infection ◽  
Academic Medical Centers ◽  
Hcv Treatment ◽  
Research Support ◽  
Medical Centers ◽  
Academic Medical ◽  
Research Grant

Abstract Background Despite an effective cure, hepatitis C virus (HCV) remains a major public health problem for persons who inject opiates. Hospitalization provides an opportunity to identify chronic HCV infection and provide referral and linkage to outpatient care upon discharge. We examined the HCV care continuum among hospitalized persons who inject drugs and have opiate use disorder (OUD). Methods The CHOICE Study is a retrospective chart review of adults hospitalized with infectious complications of OUD and injection drug use at four academic medical centers (University of Maryland, George Washington University, University of Alabama, and Emory University). The sample included patients hospitalized between 1/1/2018-12/31/2018, had ICD9/10 diagnosis codes consistent with OUD and acute bacterial/fungal infection, and chart review verification of active infection associated with OUD. Data on HCV antibody (Ab) and RNA testing and referral to HCV treatment within the medical system were abstracted from medical records. Results Of 287 patients, median age was 40 (IQR: 32-52), 59% were male, and 63% were white and 34% black. Overall, 38% (n=108) had known HCV infection at hospitalization; of those with unknown status, only 41% (n=73) were screened for HCV. Among those, 67% were HCV Ab+. Of patients who were HCV Ab+ or had known HCV infection (n=157), only 52% were tested for HCV RNA, of whom 61% had detectable RNA. Only 40% of those with detectable RNA received a treatment referral prior to discharge (Fig. 1). The length of stay of the admission was not associated with treatment referral, but a shorter length of stay was significantly associated with not being screened for HCV Ab or RNA tested (p< 0.05). Of five patients who were referred to care within the medical system, four initiated HCV treatment, and two achieved known sustained viral response. Figure 1. HCV Continuum of care for hospitalized patients who inject drugs with opioid use disorder (OUD) at four academic medical centers in the United States, January 2018-December 2018 Conclusion Hospitalization is a missed opportunity for HCV screening and linkage. Despite opportunities to address HCV infection among this highly impacted population, there were sizeable gaps in the HCV continuum of care among hospitalized persons who inject opiates. Structural reasons such as length of stay may be a factor in implementing HCV testing. Disclosures Sarah Kattakuzhy, MD, Gilead Sciences (Scientific Research Study Investigator, Research Grant or Support) Ellen Eaton, MD , Gilead (Grant/Research Support) Ellen Eaton, MD , Gilead (Individual(s) Involved: Self): Research Grant or Support Greer A. Burkholder, MD, MSPH, Eli Lilly (Grant/Research Support) Elana S. Rosenthal, MD, Gilead Sciences (Research Grant or Support)Merck (Research Grant or Support)

scholarly journals Impact of state medicaid expansion status on length of stay and in-hospital mortality for general medicine patients at US academic medical centers

2016 ◽  
Vol 11 (12) ◽  
pp. 847-852 ◽  
Author(s):  
Mary E. Anderson ◽  
Jeffrey J. Glasheen ◽  
Debra Anoff ◽  
Read Pierce ◽  
Molly Lane ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
General Medicine ◽  
Academic Medical Centers ◽  
Medicaid Expansion ◽  
Medical Centers ◽  
Academic Medical

The Health of the Public Program at the University of Washington: A New Role for Academic Medical Centers

1991 ◽  
Vol 66 (9) ◽  
pp. 499-505 ◽  
Author(s):  
HAROLD I. GOLDBERG ◽  
DIANE P. MARTIN ◽  
DALE B. CHRISTENSEN ◽  
WILLIAM E. NEIGHBOR ◽  
THOMAS S. INUI ◽  
...  
Keyword(s):  
Academic Medical Centers ◽  
University Of Washington ◽  
The Public ◽  
Public Program ◽  
Medical Centers ◽  
Academic Medical ◽  
The University

Can Pediatric Training Manage in Managed Care?

PEDIATRICS ◽  
1995 ◽  
Vol 96 (6) ◽  
pp. 1143-1145
Author(s):  
Laurel K. Leslie
Keyword(s):  
Managed Care ◽  
San Francisco ◽  
Medical Center ◽  
Academic Medical Center ◽  
University Of California ◽  
Academic Medical Centers ◽  
Full Time ◽  
Medical Centers ◽  
Academic Medical ◽  
The University

On January 18, 1995, the University of California convened a special meeting to discuss the business operations of its five academic medical centers in San Francisco, Sacramento, San Diego, Los Angeles, and Irvine. Because of the rapid developments occurring in the maturing and competitive managed care market in California, the academic medical centers are facing unprecedented financial pressures. Charles Townsend, of the accounting firm KPMG Peat Marwick, stated that the medical centers' staff would need to be cut by at least 2500 full-time equivalents, including physicians and nurses, by the year 1999. William Kerr, Director of the University of California San Francisco Medical Center, forecasted a comprehensive restructuring and streamlining of services. Jordan Cohen, president of the Association of American Medical Colleges, described the challenges facing these five academic medical centers and others like them as "truly seismic."1 The rise of managed care medical systems during the last 5 years has led many researchers to question whether the academic medical center will survive in its current state.2-6 Market forces are changing the provision of medical care at an extremely fast pace. By 1998, an estimated 60% of people living in US cities will be covered by managed care health plans. Fewer hospital admissions, shorter hospital stays, and decreased reimbursements associated with managed care have decreased hospitals' operating gains. Academic medical centers, such as those in California, are facing pressure to lower health care delivery costs. The probable decreases in Medicare and research funds under the current Congress also threaten the financial revenues of academic medical centers.

scholarly journals Increasing Burden of Methicillin-Resistant Staphylococcus aureus Hospitalizations at US Academic Medical Centers, 2003–2008

2012 ◽  
Vol 33 (8) ◽  
pp. 782-789 ◽  
Author(s):  
Michael Z. David ◽  
Sofia Medvedev ◽  
Samuel F. Hohmann ◽  
Bernard Ewigman ◽  
Robert S. Daum
Keyword(s):  
Staphylococcus Aureus ◽  
Hospital Discharge ◽  
Hospital Admissions ◽  
Medical Center ◽  
Academic Medical Centers ◽  
University Of Chicago ◽  
Medical Centers ◽  
Academic Medical ◽  
The University ◽  
Chicago Medical

Objective.The incidence of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections in the United States decreased during 2005–2008, but noninvasive community-associated MRSA (CA-MRSA) infections also frequently lead to hospitalization. We estimated the incidence of all MRSA infections among inpatients at US academic medical centers (AMCs) per 1,000 admissions during 2003–2008.Design.Retrospective cohort study.Setting and Participants.Hospitalized patients at 90% of nonprofit US AMCs during 2003–2008.Methods.Administrative data on MRSA infections from a hospital discharge database (University HealthSystem Consortium [UHC]) were adjusted for underreporting of the MRSA V09.0 International Classification of Diseases, Ninth Revision, Clinical Modification code and validated using chart reviews for patients with known MRSA infections in 2004–2005, 2006, and 2007.Results.The mean sensitivity of administrative data for MRSA infections at the University of Chicago Medical Center in three 12-month periods during 2004–2007 was 59.1%. On the basis of estimates of billing data sensitivity from the literature and the University of Chicago Medical Center, the number of MRSA infections per 1,000 hospital discharges at US AMCs increased from 20.9 (range, 11.1–47.7) in 2003 to 41.7 (range, 21.9–94.0) in 2008. At the University of Chicago Medical Center, among infections cultured more than 3 days prior to hospital discharge, CA-MRSA infections were more likely to be captured in the UHC billing-derived data than were healthcare-associated MRSA infections.Conclusions.The number of hospital admissions for any MRSA infection per 1,000 hospital admissions overall increased during 2003–2008. Use of unadjusted administrative hospital discharge data or surveillance for invasive disease far underestimates the number of MRSA infections among hospitalized patients.

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