Reducing Unwarranted Oncology Care Variation Across a Clinically Integrated Network: A Collaborative Physician Engagement Strategy.

Purpose: Addressing unwarranted clinical variation in oncology is a high priority for health systems that aspire to ensure consistent levels of high-quality and cost-effective care. Efforts to improve clinical practice and standardize care have proven challenging. Advocate Physician Partners undertook a patient simulation-based practice measurement and feedback project that was focused on breast and lung cancer to engage oncologists in the care standardization process.

Variation in Diabetes Management: A National Assessment of Primary Care Providers.

Background: Glucose control is monitored primarily through ordering HbA1c levels, which is problematic in patients with glycemic variability. Herein, we report on the management of these patients by board-certified primary care providers (PCPs) in the United States.

Methods: We measured provider practice in a representative sample of 156 PCPs.

Improving Clinical Practice Using a Novel Engagement Approach: Measurement, Benchmarking and Feedback, A Longitudinal Study.

Background: Poor clinical outcomes are caused by multiple factors such as disease progression, patient behavior, and structural elements of care. One other important factor that affects outcome is the quality of care delivered by a provider at the bedside. Guidelines and pathways have been developed with the promise of advancing evidence-based practice.

A note on survival after anoxic brain injury in adolescents and young adults.

Background: Much is known about survival after traumatic brain injury (TBI), yet relatively little about survival after anoxic brain injury (ABI).

Objective: To determine whether long-term survival after ABI is comparable to that after TBI.

Methods: We identified 237 patients with ABI and 1,620 with TBI in California who were aged 15 to 35, survived at least 1 year post injury, and were injured in 1986 or later.

Improvements in long-term survival after spinal cord injury?

Objective: To investigate whether there have been improvements in long-term survival after spinal cord injury in recent decades.

Design: Survival analysis using time-varying covariates. The outcome variable was survival or mortality, and the explanatory variables were age, sex, level and grade of injury, and calendar year.

Mobility, continence, and life expectancy in persons with Asia Impairment Scale Grade D spinal cord injuries.

Objective: Previous research on the life expectancy of persons with American Spinal Injury Association (ASIA) Impairment Scale Grade D spinal cord injury has considered them as a large homogenous group, making no functional or medical distinctions. This study sought to (1) determine how survival in this group depends on ambulatory function and the extent of bowel or bladder dysfunction, (2) compute life expectancies for various subgroups, and (3) examine whether survival has improved over time.

Design: Data were from 8,206 adults with ASIA Impairment Scale Grade D spinal cord injury in the Spinal Cord Injury Model Systems database who were not ventilator dependent and who survived more than 1 yr after injury.

Long-term disability and survival in traumatic brain injury: results from the National Institute on Disability and Rehabilitation Research Model Systems.

Objectives: To document long-term survival in 1-year survivors of traumatic brain injury (TBI); to compare the use of the Disability Rating Scale (DRS) and FIM as factors in the estimation of survival probabilities; and to investigate the effect of time since injury and secular trends in mortality.

Design: Cohort study of 1-year survivors of TBI followed up to 20 years postinjury. Statistical methods include standardized mortality ratio, Kaplan-Meier survival curve, proportional hazards regression, and person-year logistic regression.

Anemia and mortality in older persons: does the type of anemia affect survival?

Anemia is a common condition among community-dwelling older adults. The present study investigates the effect of type of anemia on subsequent mortality. We analyzed data from participants of the Third National Health and Nutrition Survey who were aged ≥50 and had valid hemoglobin levels determined by laboratory measurement.

Cognitive impairment and mortality in the Cardiovascular Health Study.

Cognitive impairment is associated with increased mortality, depending on the severity of impairment. We analyzed data from the Cardiovascular Health Study (CHS), using Cox proportional hazards regression models to quantify the effect of the impairment. After adjustment for age, sex, and medical risk factors, we found the resulting relative risks to range from 1.

Life expectancy and years of life lost in chronic obstructive pulmonary disease: findings from the NHANES III Follow-up Study.

Rationale: Previous studies have demonstrated that chronic obstructive pulmonary disease (COPD) causes increased mortality in the general population. But life expectancy and the years of life lost have not been reported.

Objectives: To quantify mortality, examine how it varies with age, sex, and other risk factors, and determine how life expectancy is affected.

Underwriting the presidents.

The United States has had 43 presidents. We examined whether they survive significantly longer or shorter than their contemporaries. We found that survival was better for presidents elected in the 1789-1841 and 1933-2001 periods (SMRs of 0.

Smoking habit and mortality: a meta-analysis.

Cigarette smoking leads to excess mortality risk. Although it is well known that the risk increases with the number of pack-years of smoking--that is, how much a person smokes, or "habit"--there is apparently no published studies that organize and synthesize the evidence on this topic. This paper provides a meta-analysis of the latest published findings relating to cigarette smoking habit and excess mortality.

Long-term survival after childhood spinal cord injury.

Objective: To determine whether persons who incur a spinal cord injury as children are at increased risk of mortality compared with persons injured as adults given comparable current age, sex, and injury severity.

Methods: A total of 25,340 persons admitted to the National Spinal Cord Injury Statistical Center database or the National Shriners Spinal Cord Injury database who were not ventilator dependent and who survived more than 2 years after injury were included in this study. These persons contributed 274,020 person-years of data, with 3844 deaths, over the 1973-2004 study period.

Long-term survival of persons ventilator dependent after spinal cord injury.

Background/objective: Identify factors related to long-term survival, and quantify their effect on mortality and life expectancy.

Setting: Model spinal cord injury systems of care across the United States.

Study Design: Survival analysis of persons with traumatic spinal cord injury who are ventilator dependent at discharge from inpatient rehabilitation and who survive at least 1 year after injury.

Trends in life expectancy after spinal cord injury.

Objective: To investigate whether there have been improvements in survival after spinal cord injury (SCI) over time, both in the critical first 2 years after injury and in the longer term.

Design: Pooled repeated observations analysis of person-years. For each person-year, the outcome variable is survival and mortality, and the explanatory variables include age, level and grade of injury, and calendar year (the main focus of the analyses).

Computing exact excess death rates from a published mortality study.

We wish to estimate the associated excess death rate (EDR) or mortality ratio (MR) from a published study of persons with a given medical condition. This requires computation of the expected mortality in the study population. If age- and sex-specific person years of data are available, this task is straightforward.