Multi-site practice and physician travel burden by oncology specialty.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13513-e13513
Author(s):  
Zachary AK Frosch ◽  
Katherine Hicks-Courant ◽  
Justin E. Bekelman ◽  
Emily Meichun Ko ◽  
Genevieve P. Kanter
Keyword(s):  
Geographic Area ◽  
Geographic Dispersion ◽  
Driving Time ◽  
Medical Oncologists ◽  
Oncology Care ◽  
Specialty Practice ◽  
Using Data ◽  
Time Required ◽  
The Impact

e13513 Background: Having physicians who practice at multiple sites may increase patients’ access to care, but also burden physicians Gynecologic oncologists (GO) are increasingly practicing at more sites across a larger geographic area, but the degree to which medical oncologists (MO), surgical oncologists (SO) or radiation oncologists (RO) are also doing so is unknown. Methods: We conducted a retrospective, observational study using data from the 2020 Physician Compare National Dataset. We included GO, MO, SO, RO, as determined by self-reported specialty. Practice sites with incomplete street addresses were excluded. For each specialty, we calculated the number of practice sites per physician, geographic practice dispersion (median driving distance required to go to each practice site), and temporal practice dispersion (median travel time required to go to each practice site). We used linear regression to compare the number of practice sites, geographic practice dispersion, and temporal practice dispersion by specialty. Results: The number of physicians, mean number of practice sites, along with geographic and temporal practice dispersion by specialty are shown in the table. MO practiced at a smaller number of practice sites compared to GO (p<0.001) and RO (p<0.001). Compared to MO, SO had a smaller geographic dispersion (median driving distance 22 miles vs. 38 miles, p=<0.001) and temporal practice dispersion (median driving time 27 minutes vs. 43 minutes, p<0.001), whereas RO had a larger geographic dispersion (median RO driving distance 58 minutes, p<0.001) and temporal practice dispersion (median RO driving time 63 minutes, p<0.001). Conclusions: Oncologic specialties vary in the number of practice sites and practice dispersion per oncologist. In particular, GO and RO practice at more sites than MO, with MO practices more geographically concentrated than RO practices. While SO practice at a similar number of practice sites compared to MO, their practices are the most geographically concentrated. While these practice patterns may represent increased patient access to specialty oncology care, the impact on quality of care and physician wellness is unknown.[Table: see text]

The Impact of Specialty Practice Nursing Care on Health-Related Quality of Life in Persons With Ostomies

2015 ◽  
Vol 42 (3) ◽  
pp. 257-263 ◽  
Author(s):  
Cristina Coca ◽  
Ignacio Fernández de Larrinoa ◽  
Raquel Serrano ◽  
Helena García-Llana
Keyword(s):  
Quality Of Life ◽  
Nursing Care ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Specialty Practice ◽  
The Impact

Smoking in Italy, 1990-1991

1994 ◽  
Vol 80 (3) ◽  
pp. 175-180 ◽  
Author(s):  
Carlo La Vecchia ◽  
Romano Pagano ◽  
Adriano Decerli ◽  
Monica Ferraroni
Keyword(s):  
Smoking Prevalence ◽  
Geographic Area ◽  
Tobacco Consumption ◽  
National Health Survey ◽  
Italian Population ◽  
Opposite Pattern ◽  
The Difference ◽  
Italian Women ◽  
Using Data ◽  
The Impact

Smoking prevalence and patterns in Italy were analyzed using data from the 1990-1991 Italian National Health Survey, based on a sample of 27, 135 males and 28,854 females aged 15 years or over, randomly selected within strata of geographic area and size of the place of residence and of the household, in order to be representative of the general Italian population. Overall, 26.9% of the Italians aged 15 years or over described themselves as current smokers (37.2% males, 17.4% females), and 14.0% as ex-smokers (22.2% males, 6.4% females). The difference in smoking prevalence between males and females was 65% below age 45, but increased substantially with increasing age up to 5-fold above age 65. Moderate smokers (< 15 cigarettes per day) were 12.6% of males and 10.4% of females, intermediate smokers (15 to 24 cigarettes per day) 17.7% of males and 5.5% of females, and heavy smokers (> 25 cigarettes per day) 6.3% of males and 1.5% of females. Pipe or cigar smokers were 0.6% of males. The averange number of cigarettes per smoker per day was 16.6 (17.9 for males, 14.0 for females). The overall smoking prevalence of 26.9% was the lowest registered since 1949, thus confirming the long-term steady decline of smoking, particularly among males. Smoking prevalence, however, has remained constant over the last 15 years among females, after substantial rises in previous calendar years. These falls in overall self-reported smoking prevalence were reflected in declines of legal sale figures (-15% between 1986 and 1991), although it is difficult to quantify the impact of smuggling on total tobacco consumption. Thus, at least part of the falls in self-reported tobacco consumption is attributable to increased underreporting. In males, but not in females, smoking was less frequent in northern (and wealthier) areas of the country, and in more educated individuals. The opposite pattern was observed in females, indicating that even more educated Italian women have not yet recognized the accumulated evidence on the health consequences of smoking. These patterns in smoking are reflected by recent trends in lung cancer, which show some decline in males but persistent upward trends in females, although still on much lower absolute values.

scholarly journals Four Needles in a Haystack: A Systematic Review Assessing Quality of Health Care in Specialty Practice by Practice Type

2018 ◽  
Vol 55 ◽  
pp. 004695801878704
Author(s):  
Shellie D. Ellis ◽  
Saleema A. Karim ◽  
Rachel R. Vukas ◽  
Daniel Marx ◽  
Jalal Uddin
Keyword(s):  
Quality Of Care ◽  
Organizational Factors ◽  
The United States ◽  
Group Practice ◽  
Inclusion Criteria ◽  
Group Practices ◽  
Specialty Practice ◽  
Multidisciplinary Group ◽  
The Impact

Specialists, who represent 60% of physicians in the United States, are consolidating into large group practices, but the degree to which group practice type facilitates the delivery of high quality of care in specialty settings is unknown. We conducted a systematic literature review to identify the impact of group practice type on the quality of care among specialty providers. The search resulted in 913 articles, of which only 4 met inclusion criteria. Studies were of moderate methodological quality. From the limited evidence available, we hypothesize that solo specialists deliver care that is inferior to their peers in group practice, whether measured by patient satisfaction ratings or adherence to guideline-based care. However, solo specialists and multidisciplinary group specialists may be more likely to provide some specialized services compared with their single-specialty group peers. Insufficient research compares quality of care among different practice types in specialty care. Substantial opportunity exists to test the degree to which organizational factors, whether size of practice or the mix of providers within the practice, influence quality of care in specialty settings.

The Burden Of Illness and Prevalence In Diffuse Large B-Cell (DLBCL) and Follicular (FL) Lymphomas

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5619-5619 ◽  
Author(s):  
Edward J Dulac III ◽  
Karen A Joy ◽  
Roger Ndindjock ◽  
Katharine B Coyle ◽  
Rolin L Wade
Keyword(s):  
One Health ◽  
Burden Of Illness ◽  
Economic Study ◽  
Health Economic Study ◽  
Novel Treatment ◽  
The Us ◽  
Using Data ◽  
The Impact ◽  
Large B Cell

Abstract Introduction In non-Hodgkin lymphoma (NHL), particularly diffuse large B-cell (DLBCL) and follicular (FL) lymphomas, the prevalence, burden of disease, including that of relapse/recurrence, and quality of life (QoL) play a role in how novel treatment strategies are evaluated. We conducted a literature review to identify whether the current understanding of the prevalence, burden of illness (BOI) including QoL in these two predominant NHL histologies is sufficient to support novel treatment and resource allocation decisions. Methods Using EMBASE, PubMed, Cochrane, conference abstracts, treatment guidelines, and government, business and industry literature such as data from the WHO, we identified estimates for prevalence and BOI, defined as disease-related costs and QoL, for DLBCL and FL, from 2005 to 2013 in the US and EU5 (France, Germany, Italy, Spain, UK). In addition to appropriate MeSH (Medical Subject Headings) terms, search terms included, but were not limited to, burden of illness, quality of life, QoL, HRQoL, cost, direct cost, resource use, resource utilization, economic, incidence, prevalence, epidemiology, and mortality. Findings BOI-related information within DLBCL and FL are very limited and antiquated DLBCL Only one health economic study was identified – a US study using data from 1999-2000 in patients with aggressive NHL, including DLBCL (Kutikova et al. Leuk Lymphoma. 2006). Among the patients receiving initial treatment, which did not include the current standard of care R-CHOP, 68% of patients experienced treatment failure. The incremental cost of treatment failure was $14,174 per month, driven by higher initial treatment costs ($13,866 vs $4,754) and the need for secondary and/or palliative care ($5,062). However, these data may not accurately depict relapse rates and costs associated with more current standards of care. For QoL, one study was identified in DLBCL, a US based study in the elderly. The NCI sponsored Surveillance, Epidemiology, and End Results-Medical Health Outcomes Survey database was used to evaluate QoL in elderly DLBCL patients using the Short Form (SF-36) Health Survey. Patients surveyed 0–1 year after the diagnosis of DLBCL had poor QoL scores (physical component [PCS] median=33.6, mental component [MCS] median=40.8, poor self-rated health: 51.6%) (Kelly et al. Blood. 2012). FL Only one health economic study was identified – a US study using data from 2006-2009 which estimated the cost of disease progression. Results showed that mean overall per patient per month (PPPM) costs over the 6-month follow-up were significantly higher for patients with progressive disease (PD) vs non-PD ($3527 vs. $860; difference=$ 2667; p<0.001) (Beveridge et al. Leuk Lymphoma. 2011). One QoL study was identified, a UK study that reported statistically significant differences by disease state using multiple QoL instruments. The total scores derived from the Functional Assessment of Cancer Therapy – Lymphoma (FACT-Lym) questionnaire showed that relapsed patients have lower QoL scores (109.7) than newly diagnosed patients (136.4), those achieving partial (128.81) or complete response (133.28), or when disease free (135.26) (p = 0.001) (Pettengell et al. Ann of Oncol. 2008). Regarding prevalence data, in the EU5, prevalence of DLBCL ranges from 30 – 58% of NHL cases and in the US estimates range from 25 – 35%. Prevalence of FL is lower, ranging from 11 – 19% in the EU5 and 20 – 25% in the US. Regarding the prevalence of relapse/recurrent disease, one-third of DLBCL patients are either relapsed or refractory after standard therapy (Friedberg. Clin Cancer Res. 2011; Abramson et al. Blood. 2005). Conclusions Currently available data related to BOI and prevalence are limited and dated making it difficult to accurately assess the impact of DLBCL and FL on patients and healthcare systems. In the absence of renewed information it may be challenging to quantify the incremental impact that novel regimens may have on clinical outcomes, BOI, and QoL. While NHL mortality has steadily decreased over the past few decades as treatment options have improved, updated and accurate epidemiologic and BOI data are needed to better characterize the impact that novel treatments in development may have on the overall clinical, BOI and patient-reported outcomes in DBLCL and FL. Disclosures: Dulac: Celgene Corporation: Employment. Joy: IMS Health: Employment. Ndindjock: IMS Health: Employment. Coyle: IMS Health: Employment. Wade: IMS Health: Employment, Research Funding.

scholarly journals The impact of angling experience on the efficiency of float fishing using different hook types

2019 ◽  
Vol 27 (1) ◽  
pp. 41-46
Author(s):  
Tomasz K. Czarkowski ◽  
Andrzej Kapusta
Keyword(s):  
The Mean ◽  
Catch Rates ◽  
Time Required ◽  
The Impact ◽  
Mean Time

Abstract The aim of the study was to compare the catch efficiency of novice and experienced anglers float fishing with different hook types. The mortality of fish that were caught and released was determined based on the experience of the angler and the type of hook used. The mean catch rates of the experienced angler was 46.7 fish per hour, while that of the novice angler was 33.7 fish per hour. The landing efficiency of fish using hooks with micro-barbs was higher than that with barbless hooks. Angling experience had a significant impact on the mean time required to unhook caught fish and also on the mortality of the fish released. The lowest mortality was noted in fish caught by experienced anglers fishing with barbless hooks. The results of the study suggest that angling experience does not have a great impact on parameters characterizing the quality of angling catches. The efficiency of float fishing performed by novice and experienced anglers was similar. Differences were noted in the time required to unhook the fish and in the mortality of the fish released.

scholarly journals Online Learning During the COVID-19 Pandemic and Inequality of Access to Education

Federalism ◽  
2020 ◽  
pp. 188-206
Author(s):  
M. L. Agranovich ◽  
Ju. V. Ermachkova ◽  
M. A. Livenets
Keyword(s):  
Online Learning ◽  
Quality Education ◽  
Quality Of Education ◽  
Federal State ◽  
Access To Education ◽  
Using Data ◽  
Online Format ◽  
Equity Of Access ◽  
The Impact

The urgent worldwide shift of school education to online format resulted from the COVID-19 pandemic raised a number of problems of a technical, organizational, methodological, and psychological nature. These problems are surveyed by both the international community and national researchers. Equally important is the assessment of the consequences of education in a remote format for the quality of education and equal access to education. The article considers how the transition to remote education will affect the equity of access to quality education, differentiation of students’ educational results on a territorial and socio-economic basis. Analysis and evaluation were carried out using data collected before the mass transition to online learning: the results of the international survey of the quality of education PISA, surveys of the Federal State Statistics Service, and regular educational statistics. Differentiation of learning conditions, interregional variation, and differences in the ability of households to use ICT to participate in online learning are examined. Preliminary assessments of the impact of the transition to online learning during the COVID-19 pandemic on strengthening differentiation of access to quality education and learning outcomes are made.

Proactive, multidisciplinary approach to supportive medicine: Improving health outcomes and care utilization.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6537-6537
Author(s):  
Brooke Worster ◽  
Valerie P Csik ◽  
Jared Minetola ◽  
Gregory D. Garber ◽  
Alison Petok ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Cancer Patients ◽  
Hospital Admissions ◽  
Care Plan ◽  
Cancer Center ◽  
Care Plans ◽  
Oncology Care ◽  
The Impact

6537 Background: Evidence suggests that cancer patients who receive palliative care early in their disease have improved quality of life, decreased emergency department (ED) visits, and less aggressive end-of-life care. In 2017, the Sidney Kimmel Cancer Center at Jefferson established the Neu Center for Supportive Medicine and Cancer Survivorship (NCSMCS) as a model for integrated care in the outpatient setting for all cancer patients. A multidisciplinary team consisting of palliative care physicians, social work, psychology, and navigation conducts biopsychosocial screening and initiates a personalized care plan for each patient to clarify treatment goals and offer assistance. Objectives: To use biopsychosocial screening at specified time points to identify needs and evaluate the impact of supportive care as part of standardized oncology care regardless of stage. Methods: This assessment utilized Oncology Care Model (OCM) data for Jefferson Medicare patients between 7/1/16 to 7/31/18. Incidence of ED admits ED/Observation and admissions were evaluated as well as ICU utilization and advanced care planning. Poisson regression was used to generate incidence rate ratios (IRR) and 95% confidence intervals (CI) to facilitate the comparison of post- vs. pre- incidence rates of hospitalization. Results: The post-intervention hospital admissions decreased by 31% in NCSMCS (IRR 0.69; 95% CI 0.48-0.98) and by 10% in Non-NCSMCS (IRR 0.90; 0.84-0.96) and advanced care plans were more likely to be on file for NCSMCS (9.0% vs. 4.9%). The intensive care unit (ICU) admissions were decreased by 17% among Non-NCSMCS (IRR 0.83; 95% CI 0.74-0.93). The utilization rates for ED admissions were not statistically different among both the groups. Conclusions: The preliminary data is promising and impact will be monitored as the intervention is expanded. Reducing admissions has benefits from both a cost savings as well as quality of life perspective. Future analyses will consider the impact of the intervention on a patient’s quality of life.

Women’s Advocates and Shelter Residents: Describing Experiences of Working and Living in Domestic Violence Shelters

2017 ◽  
Vol 35 (15-16) ◽  
pp. 3034-3053 ◽  
Author(s):  
Judy Hughes
Keyword(s):  
Domestic Violence ◽  
Qualitative Interviews ◽  
Community Resources ◽  
Intimate Partners ◽  
Domestic Violence Shelters ◽  
Abusive Partners ◽  
Using Data ◽  
The Impact ◽  
The Relationship

Domestic violence shelters are a crucial service for women who have experienced violence and abuse from intimate partners. Despite research that demonstrates the effectiveness of shelter stays, little is known about the practices that occur and the interventions offered. Using data from qualitative interviews with six women’s advocates and six shelter residents, the article explores and documents the advocates’ practices and the impact of the shelter stay on women residents. The women’s advocates report that they provide women residents time to become comfortable, empower them to set their own goals and make their own decisions, and then help them to connect to other community resources. They also stressed that shelters are homes and they want to create environments within their shelters that are nonchaotic and violence free, so that the interactions encountered in these settings are different from women residents’ experiences with their abusive partners. The women residents reported receiving interventions that were similar to the descriptions that the advocates provided about their practice. For these women, being able to feel comfortable, safe, cared for, respected, and not judged was central to feeling helped during their shelter stay. Although the interview accounts revealed the importance of the relationship between advocates and residents, the findings also demonstrate that the environment within these shelters is equally significant to determining the quality of residents’ experiences.

scholarly journals Capacity Estimation of On-Street, Mid-Block, Off-Line Bus Stops Considering Yield-to-Bus Rule

2019 ◽  
Vol 2673 (1) ◽  
pp. 269-278 ◽  
Author(s):  
Faheema Hisham ◽  
Jonathan M. Bunker ◽  
Ashish Bhaskar
Keyword(s):  
Traffic Volume ◽  
Microscopic Simulation ◽  
Additional Time ◽  
Bus Stop ◽  
Traffic Capacity ◽  
Transit Capacity ◽  
Bus Stops ◽  
Time Required ◽  
The Impact

The effectiveness of an on-street bus facility depends on the volume of general traffic sharing the buses’ travel lane. The Transit Capacity and Quality of Service Manual (TCQSM) methodology estimates capacity of a bus facility based on the operation of critical stops. The aim of this study is to understand better the performance of an on-street, mid-block, off-line bus stop by relating bus stop capacity to adjacent lane traffic volume. The contributions of this paper are twofold. First, the TCQSM methodology incorporates the effect of adjacent lane traffic volume on bus stop capacity at mid-block bus stops through its effect on re-entry delay, but it does not consider the impact of the bus stop itself on adjacent lane traffic capacity. This paper introduces a novel methodology to estimate the additional time required to accommodate adjacent lane traffic volume under saturated conditions. Second, the TCQSM methodology does not reflect the effect on re-entry delay of a yield-to-bus (YTB) rule, which is mandatory by law in some jurisdictions. This paper modifies the current TCQSM methodology by allowing for the YTB rule. A microscopic simulation model is developed in order to cross-validate the theoretical model developed.

scholarly journals Surface water quality in the Mastnik stream catchment area: The situation in the Czech countryside

Geografie ◽  
2018 ◽  
Vol 123 (4) ◽  
pp. 479-505
Author(s):  
Luboš Mrkva ◽  
Bohumír Janský
Keyword(s):  
Water Quality ◽  
Surface Water ◽  
Wastewater Treatment Plants ◽  
Stream Water ◽  
Surface Water Quality ◽  
Gradual Improvement ◽  
Stream Flows ◽  
Using Data ◽  
The Impact

Despite major investments into the remediation of wastewater, and the reduction of fertilizers, the quality of small river surface water in agricultural and rural regions of Czechia is still very low. The Mastník stream flows through an agricultural area before combining with the Vltava river; a portion of the Mastník stream water inevitably terminates in the Slapy Reservoir. The quality of the water has been analyzed using data from indicator concentrations from both the Vltava River Basin Authority study profiles, and the author’s monitoring profile. The data show that the steps that have been taken – primarily the construction of wastewater treatment plants – have led to a gradual improvement in the surface water quality by some parameters. Presently, a growing concentration of chlorophyll–α and a lack of dissolved oxygen are influencing the final quality of the water. In the case of the Mastník stream, it is particularly necessary to improve the remediation of wastewater from small households, and to reduce the impact of water erosion on agricultural soil.

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