Publications by authors named "Zaojun Ye"
Objective: To evaluate the stability of physician-specific episode payments for prostatectomy, nephrectomy, and cystectomy in the context of value-based purchasing programs, such as the merit-based incentive payment system.
Methods: We utilized Surveillance, Epidemiology and End Results-Medicare data to identify patients aged 66-99 who underwent a prostatectomy, nephrectomy, or cystectomy from 2008 to 2012. We calculated each surgeon's average 90-day episode payment by procedure.
Purpose: Policy reforms in the Affordable Care Act encourage health care integration to improve quality and lower costs. We examined the association between system-level integration and longitudinal costs of cancer care.
Methods: We used linked SEER-Medicare data to identify patients age 66 to 99 years diagnosed with prostate, bladder, esophageal, pancreatic, lung, liver, kidney, colorectal, breast, or ovarian cancer from 2007 to 2012.
Background: Integrated delivery systems (IDSs) are postulated to reduce spending and improve outcomes through successful coordination of care across multiple providers. Nonetheless, the actual impact of IDSs on outcomes for complex multidisciplinary care such as major cancer surgery is largely unknown.
Methods: Using 2011-2013 Medicare data, this study identified patients who underwent surgical resection for prostate, bladder, esophageal, pancreatic, lung, liver, kidney, colorectal, or ovarian cancer.
Objective: To investigate payment variation for 3 common urologic cancer surgeries and evaluate the potential for applying bundled payment programs to these procedures.
Methods: Using 2008-2011 Surveillance, Epidemiology, and End Results-Medicare linked data, we identified all beneficiaries aged greater than 65 years who underwent cystectomy, prostatectomy, or nephrectomy for cancer. Total episode payments were determined by aggregating hospital, professional, and post-acute care claims from the index surgical hospitalization through 90 days post discharge.
Objective: The aim of this study was to investigate whether patient satisfaction, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, is associated with short-term outcomes after major cancer surgery.
Materials And Methods: We first used national Medicare claims to identify patients who underwent a major extirpative cancer surgery from 2011 to 2013. Next, we used Hospital Compare data to assign the HCAHPS score to the hospital where the patient underwent surgery.
Objectives: To determine whether a needle disinfectant step during transrectal ultrasonography (TRUS)-guided prostate biopsy is associated with lower rates of infection-related hospitalisation.
Patients And Methods: We conducted a retrospective analysis of all TRUS-guided prostate biopsies taken across the Michigan Urological Surgery Improvement Collaborative (MUSIC) from January 2012 to March 2015. Natural variation in technique allowed us to evaluate for differences in infection-related hospitalisations based on whether or not a needle disinfectant technique was used.
Background: Both the Centers for Medicare and Medicaid Services' (CMS) Hospital Compare star rating and surgical case volume have been publicized as metrics that can help patients to identify high-quality hospitals for complex care such as cancer surgery. The current study evaluates the relationship between the CMS' star rating, surgical volume, and short-term outcomes after major cancer surgery.
Methods: National Medicare data were used to evaluate the relationship between hospital star ratings and cancer surgery volume quintiles.
Introduction: As the nation's population ages and the number of practicing urologists per capita declines, characterization of practice patterns is essential to understand the current state of the urological workforce and anticipate future needs. Accordingly, we examined trends in adult inpatient urological surgery practice patterns over a five-year period.
Methods: We used the Nationwide Inpatient Sample (NIS) data from 2005 through 2009 to identify both surgeons and urological surgeries.
Utilization and Outcomes of Inpatient Surgery at Safety-Net Hospitals.
J Health Care Poor Underserved
April 2018
Funding changes enacted with health care reform may compromise care and outcomes for vulnerable populations undergoing surgery in safety-net hospitals (SNHs). We performed a retrospective cohort study of surgical patients from 2007 through 2011. We examined the distribution of surgical procedures for SNHs (quartile of hospitals with the highest proportion of Medicaid plus self-pay discharges) vs.
View Article and Find Full Text PDFBackground: Accountable care organizations (ACOs) were established to improve care and outcomes for beneficiaries requiring highly coordinated, complex care. The objective of this study was to evaluate the association between hospital ACO participation and the outcomes of major surgical oncology procedures.
Methods: This was a retrospective cohort study of Medicare beneficiaries older than 65 years who were undergoing a major surgical resection for colorectal, bladder, esophageal, kidney, liver, ovarian, pancreatic, lung, or prostate cancer from 2011 through 2013.
Background: The potential harms of a prostate cancer (PCa) diagnosis may outweigh its benefits in elderly men.
Objective: To assess the use of prostate biopsy in men with limited life expectancy (LE) within the practices comprising the Michigan Urological Surgery Improvement Collaborative (MUSIC).
Design, Setting, And Participants: MUSIC is a consortium of 42 practices and nearly 85% of the urologists in Michigan.
Objective: To understand the current role of urologists in Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs) and the organizational characteristics of ACOs with participating urologists.
Materials And Methods: Using 2012-2013 Medicare data and the National Provider Identifier Database, we classified each urologist in the U.S.
Background: To anticipate the effects of accountable care organizations (ACOs) on surgical care, we examined pre-enrollment utilization, outcomes, and costs of inpatient surgery among hospitals currently enrolled in Medicare ACOs vs nonenrolling facilities.
Methods: Using the Nationwide Inpatient Sample (2007 to 2011), we compared patient and hospital characteristics, distributions of surgical specialty care, and the most common inpatient surgeries performed between ACO-enrolling and nonenrolling hospitals before implementation of Medicare ACOs. We used multivariable regression to compare pre-enrollment inpatient mortality, length of stay (LOS), and costs.
Objective: To examine the magnitude and sources of inpatient cost variation for kidney transplantation.
Methods: We used the 2005-2009 Nationwide Inpatient Sample to identify patients who underwent kidney transplantation. We first calculated the patient-level cost of each transplantation admission and then aggregated costs to the hospital level.
Purpose: We used data from MUSIC (Michigan Urological Surgery Improvement Collaborative) to evaluate the performance of published selection criteria for active surveillance in diverse urology practice settings.
Materials And Methods: For several active surveillance guidelines we calculated the proportion of men meeting each set of selection criteria who actually entered active surveillance, defined as the sensitivity of the guideline. After identifying the most sensitive guideline for the entire cohort we compared demographic and tumor characteristics between patients who met this guideline and entered active surveillance, and those who received initial definitive therapy.
Purpose: Because proposed funding cuts in the Patient Protection and Affordable Care Act may impact care for urological patients at safety net hospitals, we examined the use, outcomes and costs of inpatient urological surgery at safety net vs nonsafety net facilities prior to health care reform.
Materials And Methods: Using the Nationwide Inpatient Sample we performed a retrospective cohort study of patients who underwent inpatient urological surgeries from 2007 through 2011. We defined the safety net burden of each hospital based on the proportion of Medicaid and self-pay discharges.
Purpose: Recent data suggest that increasing rates of hospitalization after prostate biopsy are mainly due to infections from fluoroquinolone-resistant bacteria. We report the initial results of a statewide quality improvement intervention aimed at reducing infection related hospitalizations after transrectal prostate biopsy.
Materials And Methods: From March 2012 through May 2014 data on patient demographics, comorbidities, prophylactic antibiotics and post-biopsy complications were prospectively entered into an electronic registry by trained abstractors in 30 practices participating in the MUSIC.
Objective: To identify clinical variables associated with a positive computed tomography (CT) scan and estimate the performance of imaging recommendations in patients from a diverse sample of urology practices.
Materials And Methods: This study comprised 2380 men with newly diagnosed prostate cancer seen at 28 practices in the Michigan Urological Surgery Improvement Collaborative from March 2012 through September 2013. Data included age, prostate-specific antigen (PSA) level, Gleason score (GS), clinical T stage, total number of positive biopsy cores, whether or not the patient received a staging abdominal and/or pelvic CT scan, and CT scan result.
Background: Active surveillance (AS) has been proposed as an effective strategy to reduce overtreatment among men with lower risk prostate cancers. However, historical rates of initial surveillance are low (4-20%), and little is known about its application among community-based urology practices.
Objective: To describe contemporary utilization of AS among a population-based sample of men with low-risk prostate cancer.
Objective: To evaluate the performance of published guidelines compared with that of current practice for radiographic staging of men with newly diagnosed prostate cancer.
Materials And Methods: Using data from the Michigan Urological Surgery Improvement Collaborative clinical registry, we identified 1509 men diagnosed with prostate cancer from March 2012 through June 2013. Clinical data included age, prostate-specific antigen (PSA) level, Gleason score (GS), clinical trial stage, number of biopsy cores, and bone scan (BS) results.
Importance: There is growing interest in the use of health care resources by critical access hospitals (CAHs), key providers of medical care for many rural populations.
Objective: To evaluate discharge practice patterns and use of post-acute care after surgical admissions at CAHs.
Design, Setting, And Participants: We used data from the Nationwide Inpatient Sample (2005-2009) and American Hospital Association to perform a retrospective cohort study of patients undergoing common inpatient surgical procedures at CAHs or non-CAHs.
Objective: To assess the effectiveness of a feedback and educational intervention to increase documentation of clinical tumor-node-metastasis (TNM) stage among urologists in a statewide quality improvement collaborative.
Methods: The Michigan Urological Surgery Improvement Collaborative (MUSIC) is a consortium of urology practices that aims to improve the quality and cost-efficiency of prostate cancer care. In pilot data collection activities, trained abstractors recorded medical record documentation of clinical TNM stage by participating urologists.
Background: With nearly 53 million ambulatory procedures performed annually, future efforts to achieve greater value in surgical care should include a focus on outpatient surgery. To inform such efforts, a better understanding of specialty-specific trends in outpatient surgery is required.
Objectives: To assess the prevalence and distribution of outpatient surgery across specialties.