Socioeconomic disparities in the use and success of fertility treatments: analysis of data from a prospective cohort in the United States.

Objective: To determine the effect of income, education, and race on the use and outcomes of infertility care.

Design: Prospective cohort.

Setting: Eight community and academic infertility practices.

Costs of infertility treatment: results from an 18-month prospective cohort study.

Objective: To examine resource use (costs) by women presenting for infertility evaluation and treatment over 18 months, regardless of treatment pursued.

Design: Prospective cohort study in which women were followed for 18 months.

Setting: Eight infertility practices.

Are the uninsured responsible for the increase in emergency department visits in the United States?

Study Objective: The rise in emergency department (ED) use in the United States is frequently attributed to increased visits by the uninsured. We determine whether insurance status is associated with the increase in ED visits.

Methods: Using the national Community Tracking Study Household Surveys from 1996 to 1997, 1998 to 1999, 2000 to 2001, and 2003 to 2004, we determined for each period the proportion of reported adult ED visits according to insurance status, family income, usual source of care, health status, and outpatient (non-ED) visits.

Pilot trial of a computerized decision aid for breast cancer prevention.

This study sought to evaluate a shared decision-making aid for breast cancer prevention care designed to help women make appropriate prevention decisions by presenting information about risk in context. The decision aid was implemented in a high-risk breast cancer prevention program and pilot-tested in a randomized clinical trial comparing standard consultations to use of the decision aid. Physicians completed training with the decision aid prior to enrollment.

Characteristics of frequent users of emergency departments.

Study Objective: We identify frequent users of the emergency department (ED) and determine the characteristics of these patients.

Methods: Using the 2000 to 2001 population-based, nationally representative Community Tracking Study Household Survey, we determined the number of adults (aged 18 and older) making 1 to 7 or more ED visits and the number of visits for which they accounted. Based on the distribution of visits, we established a definition for frequent user of 4 or more visits.

The relationship of insurance status, hospital ownership, and teaching status with interhospital transfers in California in 2000.

Purpose: Public hospitals and academic medical centers may admit more poorly insured transfer patients than do other institutions. The authors investigated the relationship of patient insurance status, hospital ownership, and hospital teaching status with interhospital transfers in California.

Method: In 2003, data were derived from the hospital discharge abstract database for the year 2000 from the California Office of Statewide Health Planning and Development.

Sexual functioning after total compared with supracervical hysterectomy: a randomized trial.

Objective: To compare sexual functioning and health-related quality-of-life outcomes of total abdominal hysterectomy (TAH) and supracervical hysterectomy (SCH) among women with symptomatic uterine leiomyomata or abnormal uterine bleeding refractory to hormonal management.

Methods: We randomly assigned 135 women scheduled to undergo abdominal hysterectomy in 4 U.S.

Hospital resource utilization for primary and revision total hip arthroplasty.

Background: Previous reports have suggested that hospital resource utilization for revision total hip arthroplasty is substantially higher than that for primary total hip arthroplasty. However, current United States Medicare hospital-reimbursement policy does not distinguish between the two procedures. The purpose of this study was to compare primary and revision total hip arthroplasties with regard to actual hospital resource utilization and to identify clinical and demographic factors that are predictive of higher resource utilization associated with these procedures.

Does lack of a usual source of care or health insurance increase the likelihood of an emergency department visit? Results of a national population-based study.

Study Objective: We determined whether having a usual source of care or health insurance is associated with the likelihood of an emergency department (ED) visit.

Methods: This was a multivariate analysis of the 2000 to 2001 nationally representative Community Tracking Study Household Survey to assess the independent association of usual source of care, health insurance, income, and health status with the likelihood of making 1 or more ED visits in the previous year.

Results: Based on a sample of 49,603 adults, an estimated 45.

Resource use for total and supracervical hysterectomies: results of a randomized trial.

Objective: Hysterectomy is the most common major surgical procedure performed in the United States for nonobstetric reasons. Although most hysterectomies include removal of the cervix, the rate of supracervical procedures has increased in recent years. To provide evidence about the outcomes of both types of hysterectomy, we conducted a randomized clinical trial of total (TAH) or supracervical (SCH) hysterectomy (the "TOSH" trial).

Hysterectomy versus expanded medical treatment for abnormal uterine bleeding: clinical outcomes in the medicine or surgery trial.

Objective: To compare clinical outcomes after randomization to hysterectomy versus medical treatment in patients with chronic abnormal uterine bleeding refractory to medroxyprogesterone acetate.

Methods: We randomly assigned 63 premenopausal women with abnormal uterine bleeding refractory to cyclic medroxyprogesterone acetate treatment to receive either a hysterectomy or expanded medical treatment. Within each randomized group, the specific treatment approach was determined by patient and provider preference.

Effect of hysterectomy vs medical treatment on health-related quality of life and sexual functioning: the medicine or surgery (Ms) randomized trial.

Context: Although a quarter of US women undergo elective hysterectomy before menopause, controlled trials that evaluate the benefits and harms are lacking.

Objective: To compare the effect of hysterectomy vs expanded medical treatment on health-related quality of life.

Design, Setting, And Participants: A multicenter, randomized controlled trial (August 1997-December 2000) of 63 premenopausal women, aged 30 to 50 years, with abnormal uterine bleeding for a median of 4 years who were dissatisfied with medical treatments, including medroxyprogesterone acetate.

A randomized comparison of total or supracervical hysterectomy: surgical complications and clinical outcomes.

Objective: To compare surgical complications and clinical outcomes after total versus supracervical abdominal hysterectomy for control of abnormal uterine bleeding, symptomatic uterine leiomyomata, or both.

Methods: We conducted a randomized intervention trial in four US clinical centers among 135 patients who had abdominal hysterectomy for symptomatic uterine leiomyomata, abnormal uterine bleeding refractory to hormonal treatment, or both. Patients were randomly assigned to receive a total or supracervical hysterectomy performed using the surgeon's customary technique.

Primary care: the next renaissance.

Three decades ago, a renaissance helped create the foundations of primary care as we know it today. In recent years, however, new challenges have confronted primary care. We believe that the current challenges can be overcome and may, in fact, present an opportunity for a new renaissance of primary care to address the needs of our population.

Primary care medicine in crisis: toward reconstruction and renewal.

Primary care is in crisis. Despite its proud history and theoretical advantages, the field has failed to hold its own among medical specialties. While the rest of medicine promises technology and sophistication, the basic model of primary care has changed little over the past half-century.

Primary care at a crossroads.

In response to concerns about the future of primary care, the Robert Wood Johnson Foundation sponsored a meeting in October 2001 in Glen Cove, New York, of 45 leaders in primary care and other health sectors. The purpose was to discuss the current and future challenges to primary care and to develop new and innovative ideas about how primary care might meet the needs of our current and future population. The premise of the meeting was that primary care is at a crossroads, which could lead to a new renaissance or a continued decline.

The economic impact of the assisted reproductive technologies.

Thousands of cycles of in vitro fertilization (IVF) are performed each year. In the US, multiple births occur after 39% of IVF cycles, whereas in Europe, the figure is 26%. Indeed, multiple births are a major factor in the costs attributable to IVF.

Implementation of a voluntary hospitalist service at a community teaching hospital: improved clinical efficiency and patient outcomes.

Background: Previous investigations of the effect of the hospitalist model on resource use and patient outcomes have focused on academic medical centers or have used short follow-up periods.

Objective: To determine the effects of hospitalist care on resource use and patient outcomes and whether these effects change over time.

Design: Retrospective cohort study.

Methods to estimate and analyze medical care resource use. An example from liver transplantation.

This paper describes a method to construct a standardized health care resource use database. Billing and clinical data were analyzed for 916 patients who received liver transplantations at three medical centers over a 4-year period. Data were checked for completeness by assessing whether each patient's bill included charges covering specified dates and for specific services, and for accuracy by comparing a sample of bills to medical records.