Physician behaviour, malpractice risk and defensive medicine: an investigation of cesarean deliveries.

Analyzing whether physicians use cesarean sections (c-sections) as defensive medicine (DM) has proven difficult. Using natural experiments arising out of Oregon court decisions overturning a state legislative cap on non-economic damages in tort cases, we analyze the impact of patient conditions on estimates of DM. Consistent with theory, we find heterogeneous impacts of tort laws across patient conditions.

Water lead exposure risk in Flint, Michigan after switchback in water source: Implications for lead service line replacement policy.

In February of 2016, the City of Flint, Michigan commenced the FAST start initiative with the aim "to get the lead out of Flint" by replacing lead and galvanized steel service lines throughout the city. An estimated 29,100 parcels are scheduled for service line replacement (SLR) at an expected cost of $172 million. The lead exposure benefits of SLR are evaluated by analyzing Sentinel data on hundreds of repeatedly sampled homes in Flint from February 16, 2016 to July 21, 2017, comparing water lead (WL) in homes with and without lead service lines.

Clinical Capital and the Risk of Maternal Labor and Delivery Complications: Hospital Scheduling, Timing, and Cohort Turnover Effects.

The establishment of interventions to maximize maternal health requires the identification of modifiable risk factors. Toward the identification of modifiable hospital-based factors, we analyze over 2 million births from 2005 to 2010 in Texas, employing a series of quasi-experimental tests involving hourly, daily, and monthly circumstances where medical service quality (or clinical capital) is known to vary exogenously. Motivated by a clinician's choice model, we investigate whether maternal delivery complications (1) vary by work shift, (2) increase by the hours worked within shifts, (3) increase on weekends and holidays when hospitals are typically understaffed, and (4) are higher in July when a new cohort of residents enter teaching hospitals.

Assessment of the Legionnaires' disease outbreak in Flint, Michigan.

The 2014-2015 Legionnaires' disease (LD) outbreak in Genesee County, MI, and the outbreak resolution in 2016 coincided with changes in the source of drinking water to Flint's municipal water system. Following the switch in water supply from Detroit to Flint River water, the odds of a Flint resident presenting with LD increased 6.3-fold (95% CI: 2.