275 results match your criteria: "Center for Clinical Effectiveness[Affiliation]"

Variation in commercial prices for thyroidectomy and parathyroidectomy at US hospitals.

Am J Surg

November 2024

Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA; Patient-Reported Outcomes, Value, and Experience (PROVE) Center, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, USA.

Background: The 2021 Hospital Price Transparency Rule mandated hospitals to publicly disclose their service prices to improve competition and lower healthcare costs. Our aim was to characterize commercial price variation for thyroidectomy and parathyroidectomy.

Methods: We performed a national cross-sectional study of hospital price variation in 2022 and 2023 using the Turquoise Health dataset.

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Background: Peripheral vascular interventions (PVIs) performed under procedural sedation and analgesia (PSA) can be associated with anxiety and poor compliance with patient instructions during surgery. Mind-body interventions (MBIs) such as meditation have demonstrated the potential to decrease perioperative anxiety, though this area is understudied, and no tailored interventions have been developed for the vascular surgical patient population.

Objectives: We aimed to design a perioperative MBI that specifically targeted vascular surgical patients undergoing PVIs under PSA.

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Background: Venous thromboembolism (VTE) in pregnancy is a major cause of maternal morbidity and mortality, and the use of preventive low-molecular-weight heparin (LMWH) can be challenging. Clinical guidelines recommend eliciting pregnant individuals' preferences towards the use of daily injections of LMWH and discussing the best option through a shared decision-making (SDM) approach. Our aim was to identify individuals' preferences concerning each of the main clinical outcomes, and categorize attributes influencing the use of LMWH during pregnancy.

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Disparities in timely surgery among Asian American women with breast cancer.

Am J Surg

August 2024

Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA.

Background: We investigated the likelihood of timely surgery for breast cancer patients among diverse Asian subgroups.

Methods: We analyzed the National Cancer Database from 2010 to 2019 and included White and Asian women diagnosed with stage I-III breast cancer. Patients with multiple cancers, patients who received chemotherapy, and those diagnosed and treated at different hospitals were excluded.

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Background: Cardiovascular disease is the leading cause of mortality in patients with kidney failure, and their risk of cardiovascular events is 10 to 20 times higher as compared with the general population.

Methods And Results: We evaluated 508 822 patients who initiated dialysis between January 1, 2005 and December 31, 2014 using the United States Renal Data System with linked Medicare claims. We determined hospitalization rates for cardiovascular events, defined by acute coronary syndrome, heart failure, and stroke.

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Does routine upper gastrointestinal swallow study after metabolic and bariatric surgery lead to earlier diagnosis of leak?

Surg Obes Relat Dis

August 2024

Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Duke University, Durham, North Carolina. Electronic address:

Background: It is unclear whether routine upper gastrointestinal swallow study (SS) in the immediate postoperative period is associated with earlier diagnosis of gastrointestinal leak after bariatric surgery.

Objective: To investigate the relationship between routine SS and time to diagnosis of postoperative gastrointestinal leak.

Setting: MBSAQIP-accredited hospitals in the United States and Canada.

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Background: Health-related quality-of-life (HRQoL) is one of the most important outcomes to metabolic and bariatric surgery (MBS) patients but was not measured by the Metabolic and Bariatric Surgery Accreditation Quality Improvement Program (MBSAQIP). A patient-reported outcome measures (PROMs) program pilot started in 2016 with MBSAQIP implementation in 2019.

Objectives: To measure how MBS impacts patient HRQoL 1 and 2 years after primary laparoscopic Roux-en-Y gastric bypass (bypass) or laparoscopic sleeve gastrectomy (sleeve).

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Article Synopsis
  • Venous thromboembolism (VTE) during pregnancy is a serious health risk, and low-molecular-weight heparin (LMWH) is commonly used to prevent it, but there are challenges in patient care that necessitate shared decision-making (SDM).
  • The study involved 22 healthcare professionals who were split into three groups, with each group receiving varying amounts of information and support related to the SDM process to assess its effectiveness on decision-making quality.
  • Results indicated that more comprehensive SDM interventions led to better decision-making experiences, though statistical differences were not significant, highlighting ongoing challenges in applying these strategies effectively in clinical settings.
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Background: Disparities in obstetric care have been well documented, but disparities in the within-hospital population have not been as extensively explored. The objective is to assess cesarean delivery rate disparities at the hospital level in a nationally recognized low risk of cesarean delivery group.

Methods: An observational study using a national population-based database, Nationwide Inpatient Sample, from 2008 to 2011 was conducted.

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Importance: Retaining female physicians in the academic health care workforce is necessary to serve the needs of sociodemographically diverse patient populations.

Objective: To investigate differences in rates of leaving academia between male and female physicians.

Design, Setting, And Participants: This cohort study used Care Compare data from the Centers for Medicare & Medicaid Services for all physicians who billed Medicare from teaching hospitals from March 2014 to December 2019, excluding physicians who retired during the study period.

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Article Synopsis
  • The study investigates how travel distance affects outcomes and costs for patients undergoing complex aortic surgery in the U.S., focusing on the increased burden on patients as surgical care becomes more centralized.
  • A retrospective analysis was conducted on data from 8,782 patients who underwent various types of complex aortic repairs between 2011 and 2018, considering travel distances and demographic factors.
  • The findings indicate that patients who travel longer distances for surgery may face increased costs and higher rates of reintervention, with specific demographic trends observed among patients traveling the farthest.
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Time to surgery: A health equity metric in breast cancer patients.

Am J Surg

October 2023

55 Fruit St, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 55 Fruit St, Breast Section, Division of GI and Oncologic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address:

Article Synopsis
  • The study aimed to assess whether the time it takes for patients to undergo surgery based on their race can serve as an indicator of health equity in access to surgical care.
  • Using data from the National Cancer Database involving nearly 887,000 women with stage I-III breast cancer, the research found that Black patients were significantly more likely to experience surgery delays compared to White patients.
  • The findings underscore the need to address systemic factors contributing to this inequity in cancer treatment, suggesting that timely surgery access for Black patients should be a priority for intervention efforts.
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External validation of the Codman score in colorectal surgery: a pragmatic tool to drive quality improvement.

Colorectal Dis

June 2023

Department of General Surgery, Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.

Aim: The simple six-variable Codman score is a tool designed to reduce the complexity of contemporary risk-adjusted postoperative mortality rate predictions. We sought to externally validate the Codman score in colorectal surgery.

Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) participant user file and colectomy targeted dataset of 2020 were merged.

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Objectives: To gain insight into formal methods of integrating patient preferences and clinical evidence to inform treatment decisions, we explored patients' experience with a personalised decision analysis intervention, for prophylactic low-molecular-weight heparin (LMWH) in the antenatal period.

Design: Mixed-methods explanatory sequential pilot study.

Setting: Hospitals in Canada (n=1) and Spain (n=4 sites).

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Objective: Recently evolving practice patterns in complex aortic surgery have led to regionalization of care within fewer centers in the United States, and thus patients may have to travel farther for complex aortic care. Travel distance has been associated with inferior outcomes after non-vascular surgery, particularly non-index readmission. This study aims to assess the impact of patient travel distance on perioperative outcomes and readmissions after complex aortic surgery.

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Article Synopsis
  • The study evaluated the agreement between patient-reported outcomes (PROs) and clinical registry data one year after bariatric surgery.
  • Ninety-five percent of patients' reported weights were within 13 pounds of registry records, indicating that patient reports were generally reliable, particularly for diabetes and hypertension.
  • The findings suggest that using patient reports can reduce the data-collection burden while providing accurate information for postoperative follow-up.
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Gender Homophily in Interphysician Referrals to Surgeons.

J Surg Res

March 2023

Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts; Pediatric Surgery Trials and Outcomes Research Center, MassGeneral Hospital for Children, Boston, Massachusetts. Electronic address:

Introduction: The literature on gender homophily has mostly been focused on patient-physician relationship but not on interprofessional referrals. The goal of this study is to quantify interphysician gender homophily of referring physicians in surgical referrals.

Methods: An observational study of the referral data at a large academic center was performed.

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Background: Venous thromboembolism (VTE) in pregnancy is an important cause of maternal morbidity and mortality. Low-molecular-weight heparin (LMWH) is the cornerstone of prophylaxis and treatment of thrombotic events during pregnancy. LMWH has fewer adverse effects than other anticoagulants, does not cross the placenta, and is safe for the fetus.

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Goal: For decades, hospitals performing cardiac surgery have carried the cost of implementing quality improvement activities and reporting quality outcomes. However, the financial return of such investments is unclear, which weakens the incentive for hospitals to invest in quality improvement activities. This study explored the relationship between a hospital's measured quality and its financial performance.

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Background: Patients with end-stage kidney disease (ESKD) wait roughly 4 years for a kidney transplant. A potential way to reduce wait times is using hepatitis C virus (HCV)-viremic kidneys.

Objective: As preparation for developing a shared decision-making tool to assist patients with ESKD with the decision to accept an HCV-viremic kidney transplant, our initial goal was to assess the feasibility of using The Gambler II, a health utility assessment tool, in an ambulatory dialysis clinic setting.

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Background: Sampling of ≥10 lymph nodes during lobectomy for non-small cell lung cancer (NSCLC) was a previous surveillance metric and potential quality metric of the American College of Surgeons Commission on Cancer. We sought to determine guideline adherence and its relationship to hospital lobectomy volume within The Society of Thoracic Surgeons General Thoracic Surgery Database.

Methods: Participant centers providing elective lobectomy for NSCLC within The Society of Thoracic Surgeons General Thoracic Surgery Database (2012-2019) were divided into tertiles according to annual volume.

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Atrial fibrillation (AF) is common in primary care patients. Many patients who could benefit from anticoagulation do not receive it. The objective of this study was to describe anticoagulation prescribing by primary care physicians.

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Background: High-quality care is a clear objective for hospital leaders, but hospitals must balance investing in quality with financial stability. Poor hospital financial health can precipitate closure, limiting patients' access to care. Whether hospital quality is associated with financial health remains poorly understood.

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