The hospitalist model of care has gained favour in many hospital systems for the value, cost-effectiveness and quality of care that hospitalists provide. Hospitalists are experts in high-acuity medical problems of patients and they are intimately knowledgeable about hospital operations that enable efficiency of patient care. This results in tremendous cost-savings for institutions especially since hospitalists are also obligated to be involved in quality and practice improvement initiatives. The University of Texas MD Anderson Cancer Center employs oncology-hospitalists for many of their patients with cancer needing inpatient services. This physician team has expertise in both cancer-related and comorbidity-related reasons for hospitalisation. In September 2015, the thoracic and head and neck medical oncology team started a collaboration with the Oncology Hospitalist team whereby a proportion of patients with thoracic malignancies were directly admitted to hospitalists for inpatient care. To determine the value of this collaboration, a pre- and post- implementation study was done to compare quality outcomes such as readmission rates and length of stay (LOS) between the two groups. Adjusted outcomes showed that readmission rates were similar for both physician groups both at baseline and after implementation of the collaborative (p=0.680 and p=0.840, respectively). Median LOS was similar for both groups at baseline (4 days) and was not significantly different post-implementation (4vs5 days, p=0.07). The adjusted cost of a hospitalisation was also similar for hospitalist encounters and thoracic oncology encounters. This initial study showed that quality of care remained comparable for patients with lung cancer who were admitted to either service. With possibly shorter LOS but comparable readmission outcomes and adjusted cost for patients discharged from the hospitalist service, there is a strong value benefit for the implemented Thoracic Oncology-Hospitalist inpatient collaborative.
Background
The cost of thyroidectomy varies across the USA, while the causes of this variation are poorly understood. We examined the cost of inpatient thyroidectomy among National Cancer Institute‐designated cancer centers nationwide to determine why it differs.
Methods
A retrospective study of inpatient thyroidectomies was performed using the Vizient Clinical Data Base. Fifty‐two of 70 eligible hospitals were grouped into five geographic regions (Mid‐Atlantic and New England, East Central, South Atlantic, West Central, and Mountain and Pacific). We identified drivers of cost variation in the five geographic regions and used risk adjustment model to evaluate the rationality of cost from each hospital.
Results
Male sex, more extended hospital stays, and occurrence of complications were consistently associated with increased costs in all regions. Also, the cost was significantly lower in the Mid‐Atlantic and New England region. The higher than expected costs did not correlate well with the case mix index among hospitals (p = 0.289), but the lower than expected costs were more common in high‐volume hospitals. The average length of stay was the shortest in high‐volume hospitals, which might account for the lower cost in the Mid‐Atlantic and New England region; however, the overages of costs still varied widely among hospitals in all regions even if the length of stay was adjusted.
Conclusions
Cost variation may result from both patient‐related factors and volume‐related practice pattern differences among hospitals. A more standard of care and charge transparency is still needed for patients seeking affordable care at cancer centers.
Children need to learn to persist through challenges, yet adults sometimes step in to solve problems for them. Here, we looked at how adult taking over related to children’s persistence. In an observational study (N=34, ages 4-8), we found that parents who took over more often during a challenging puzzle task rated their children as dispositionally less persistent. To establish whether taking over can cause reduced persistence, we ran two preregistered experiments (N=150, ages 4-5). Children assigned to a taking over condition persisted less on a subsequent task compared to those in a teaching or a baseline condition. Reframing the context did not ameliorate the negative impact of taking over. The results suggest that taking over impairs children’s persistence.
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