Using Alzheimer's disease blood tests to accelerate clinical trial enrollment.

Introduction: Screening potential participants in Alzheimer's disease (AD) clinical trials with amyloid positron emission tomography (PET) is often time consuming and expensive.

Methods: A web-based application was developed to model the time and financial cost of screening for AD clinical trials. Four screening approaches were compared; three approaches included an AD blood test at different stages of the screening process.

Making Meaningful Use of Price Transparency Data: Describing Price Variation of Spine Surgery and Imaging in a Single System.

Price transparency is an increasingly popular solution for high healthcare expenditures in the United States, but little is known about its potential to facilitate patient price shopping. Our objective was to analyze interhospital and interpayer price variability in spine surgery and spine imaging using newly public payer-specific negotiated charges (PNCs). We selected a subset of billing codes for spine surgery and spine imaging at 12 hospitals within a Saint Louis metropolitan area healthcare system.

Health, Human Capital and Domestic Violence.

We treat health as a form of human capital and hypothesize that women with more human capital face stronger incentives to make costly investments with future payoffs, such as avoiding abusive partners and reducing drug use. To test this hypothesis, we exploit the unanticipated introduction of an HIV treatment, HAART, which dramatically improved HIV+ women's health. We find that after the introduction of HAART HIV+ women who experienced increases in expected longevity exhibited a decrease in domestic violence of 15% and in drug use of 1520%.

Health Care Access, Costs, and Treatment Dynamics: Evidence from In Vitro Fertilization.

We study public policies designed to improve access and reduce costs for in vitro fertilization (IVF). High out-of-pocket prices can deter potential patients from IVF, while active patients have an incentive to risk costly high-order pregnancies to improve their odds of treatment success. We analyze IVF's rich choice structure by estimating a dynamic model of patients' choices within and across treatments.

Use of Quantile Regression to Determine the Impact on Total Health Care Costs of Surgical Site Infections Following Common Ambulatory Procedures.

Objective: To determine the impact of surgical site infections (SSIs) on health care costs following common ambulatory surgical procedures throughout the cost distribution.

Background: Data on costs of SSIs following ambulatory surgery are sparse, particularly variation beyond just mean costs.

Methods: We performed a retrospective cohort study of persons undergoing cholecystectomy, breast-conserving surgery, anterior cruciate ligament reconstruction, and hernia repair from December 31, 2004 to December 31, 2010 using commercial insurer claims data.

Profiling Individual Surgeon Performance Using Information from a High-Quality Clinical Registry: Opportunities and Limitations.

Background: There is increasing interest in profiling the quality of individual medical providers. Valid assessment of individuals should highlight improvement opportunities, but must be considered in the context of limitations.

Study Design: High quality clinical data from the American College of Surgeons NSQIP, gathered in accordance with strict policies and specifications, was used to construct individual surgeon-level assessments.

The effects of insurance mandates on choices and outcomes in infertility treatment markets.

For the 10% to 15% of American married couples who experience reproductive problems, in vitro fertilization (IVF) is the leading technologically advanced treatment procedure. However, IVF's expense may prevent many couples from receiving treatment, and those who are treated may take an overly aggressive approach to reduce the probability of failure. Aggressive treatment, which occurs through an increase in the number of embryos transferred during IVF, can lead to medically dangerous multiple births.

The importance of assessing both inpatient and outpatient surgical quality.

Objective: We aimed to determine whether hospital-level surgical performance was similar across outpatient and inpatient settings.

Background: The majority of surgical procedures in the United States are performed in an outpatient setting but most quality improvement focuses on inpatient care.

Methods: Using data from the 2006 to 2008 American College of Surgeons- National Surgical Quality Improvement Program, risk-adjusted hospital observed to expected ratios for morbidity and mortality were compared for inpatient and outpatient cases.

Improving American College of Surgeons National Surgical Quality Improvement Program risk adjustment: incorporation of a novel procedure risk score.

Background: Risk-adjusted evaluation is a key component of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). The purpose of this study was to improve standard ACS NSQIP risk adjustment using a novel procedure risk score.

Study Design: Current Procedural Terminology codes (CPTs) represented in ACS NSQIP data were assigned to 136 procedure groups.

Missing data in the American College of Surgeons National Surgical Quality Improvement Program are not missing at random: implications and potential impact on quality assessments.

Background: Studying risk-adjusted outcomes in health care relies on statistical approaches to handling missing data. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) provides risk-adjusted assessments of surgical programs, traditionally imputing certain missing data points using a single round of multivariable imputation. Such imputation assumes that data are missing at random-without systematic bias-and does not incorporate estimation uncertainty.

Attributable costs of surgical site infection and endometritis after low transverse cesarean delivery.

Background: Accurate data on costs attributable to hospital-acquired infections are needed to determine their economic impact and the cost-benefit of potential preventive strategies.

Objective: To determine the attributable costs of surgical site infection (SSI) and endometritis (EMM) after cesarean section by means of 2 different methods.

Design: Retrospective cohort.

Time-of-day effects on surgical outcomes in the private sector: a retrospective cohort study.

Background: Surgical care is delivered around the clock. Elective cases within the Veterans Affairs health system starting after 4 pm appear to have an elevated risk of morbidity, but not mortality, compared with earlier cases. The relationship between operation start time and patient outcomes is not described in private-sector patients or for emergency cases.

Does surgical quality improve in the American College of Surgeons National Surgical Quality Improvement Program: an evaluation of all participating hospitals.

Background/objective: The National Surgical Quality Improvement Program (NSQIP) has demonstrated quality improvement in the VA and pilot study of 14 academic institutions. The objective was to show that American College of Surgeons (ACS)-NSQIP helps all enrolled hospitals.

Methods: ACS-NSQIP data was used to evaluate improvement in hospitals longitudinally over 3 years (2005-2007).

A preliminary analysis of the receipt of mental health services consistent with national standards among children in the child welfare system.

Objectives: We sought to examine the extent to which children in the child welfare system receive mental health care consistent with national standards.

Methods: We used data from 4 waves (3 years of follow-up) of the National Survey of Child and Adolescent Well-Being, the nation's first longitudinal study of children in the child welfare system, and the Area Resource File to examine rates of screening, assessment, and referral to mental health services among 3802 youths presenting to child welfare agencies. Weighted population-averaged logistic regression models were used to identify variables associated with standards-consistent care.

The impact of surgeon specialization on patient mortality: examination of a continuous Herfindahl-Hirschman index.

Objective: To examine the effect of surgeon specialization on patient outcomes, controlling for volume.

Background: There is great interest in the degree to which surgical specialization affects outcomes, particularly considering drives to measure and reward quality in healthcare. Although surgical specialization has been previously analyzed with respect to outcomes, most studies have treated it as a dichotomous variable based on academic credentials.

Employee choice of flexible spending account participation and health plan.

Despite the fact that flexible spending accounts (FSAs) are becoming an increasingly popular employer-provided health benefit, there has been very little empirical study of FSA use among employees at the individual level. This study contributes to the literature on FSAs using a unique data set that provides three years of employee-level-matched benefits data. Motivated by the theoretical model of FSA choice presented in Cardon and Showalter (J.

Thyroid and parathyroid operations in veterans affairs and selected university medical centers: results of the patient safety in surgery study.

Background: There is increasing interest in surgical outcomes. The Patient Safety in Surgery (PSS) Study database was examined about thyroid and parathyroid procedures to determine risk factors for adverse outcomes and outcomes rates. Relative outcomes performance for the Veterans Affairs (VA) and private-sector populations was compared after risk adjustment.

Impact of isolated clinical performance feedback on clinical productivity of an academic surgical faculty.

Background: There is increasing financial pressure to maximize clinical productivity for academic physicians. We examined whether clinical performance feedback alone could contribute to improving the clinical productivity of surgeons in an academic department of surgery.

Study Design: We implemented a clinical performance feedback program in January 2003.

Evaluating individual surgeons based on total hospital costs: evidence for variation in both total costs and volatility of costs.

Background: There is increasing interest in evaluating quality in health care, extending to the assessment of outcomes, including costs, for individual surgeons.

Study Design: Surgical patients entered in the private sector National Surgical Quality Improvement Program at the University of Michigan Medical Center between September 2003 and September 2004 were included. Patient level characteristics and outcomes measures were combined with internal hospital cost data.

Impact of resident duty-hour reform on faculty clinical productivity.

Objective: Prior data have shown that resident duty-hour reform has not affected faculty work hours; yet the preservation of faculty hours may have been at the expense of productivity. We sought to examine change in clinical productivity.

Design: Anonymous survey and analysis of faculty relative value units (RVU) database.

The assembly of organic radical anions between metal-borate scaffolds.

Metal-organic frameworks based on the Pb[B(Im)(4)](+) unit form layered structures analogous to those observed in clays and double layered hydroxide minerals. These layers can act as scaffolds for the organization of anionic organic guests. In this report, we use this scaffold to assemble TEMPO and PROXYL carboxylates in the interlayer spacings of Pb[B(Im)(4)](4-carboxy-TEMPO) 1 and Pb[B(Im)(4)](3-carboxy-PROXYL)(H(2)O)2, respectively.

Sequestering perrhenate with a borate-based coordination polymer: a model for pertechnetate separation.

Crystals of the layered metal organic framework solid Pb[B(Im)4](NO3)(nH2O) can undergo exchange of the nitrate for perrhenate, a model for pertechnetate, forming Pb[B(Im)4](ReO4). We can monitor this reaction by 207Pb solid-state NMR and can isolate single crystals of the resultant material through growth in the presence of an excess of perrhenate. Such a synthetic metal-organic framework solid represents a new candidate for pertechnetate-sequestering materials.