We document a wide variation in quality among 188 surgeons at 35 hospitals in New York state that perform mitral valve surgery. Our analysis shows that patients of different demographics and levels of acuity benefit differently from elite surgeons. However, existing healthcare provider quality information is based on population averages and so does not differentiate patients of different medical conditions. This implies that patient-centric quality information, which calibrates outcome statistics by patient demographics and acuity, can increase the ability of patients to choose the most appropriate surgeon. In this paper, we develop an approach for computing patient-centric information from outcome data and evaluate the potential health benefits from using such information to guide patients to surgeons. We estimate that the total societal benefits from using patient-centric information are comparable to those achievable by enabling the best surgeons to treat 40% more patients under population-average information.
Lung opacity increases immediately after initiation of ECMO. Increased opacity corresponds to decreased pulmonary function, and severe opacity correlates strongly with mortality.
Pulmonary artery (PA) mixed venous saturation (SvO2) has become a crucial monitor in the adult intensive care unit, but is not used in neonates because of the difficulty in PA catheterization. We evaluated the possibility of utilizing the right atrial venous oxygen saturation (RAvO2), which is easily accessed in the neonate, as a monitor of the effects of mechanical ventilation and intravascular volume in an animal model selected to be the size of the human neonate. A continuous RAvO2 monitoring catheter was placed into the right atrium of 16 normal rabbits (2.2 to 4.1 kg). Oxygen delivery was manipulated by alterations in peak inspiratory pressure (PIP) (n = 6), positive end-expiratory pressure (PEEP) (n = 6), or by progressive hypovolemia (n = 4). RAvO2 decreased with onset of mechanical ventilation alone from 69% +/- 6% to 61% +/- 5% (P < .01). As the PIP was increased from 12 to 21 cm H2O, the RAvO2 progressively decreased from 59% +/- 4% to 49% +/- 6% (P < .05). As the PEEP was increased from 3 to 9 cm H2O, the RAvO2 progressively decreased from 64% +/- 5% to 33% +/- 16% (P < .01). RAvO2 approached baseline after return to continuous positive airway pressure (CPAP) of 3 cm H2O. Progressive phlebotomy to a total of 10 mL/kg resulted in a decrease in RAvO2 from 70% +/- 6% to 27% +/- 5% (P < .001). Volume resuscitation resulted in an increase in RAvO2 to near baseline. Peripheral arterial oxygen saturation remained at a constant 100% throughout each protocol.(ABSTRACT TRUNCATED AT 250 WORDS)
BACKGROUNDThe 2014 American Heart Association/American College of Cardiology Valvular Heart Disease Guidelines state that mitral valve diseases should be repaired at a Center of Excellence (CoE).We evaluate the cost-effectiveness of such referrals.
METHODSWe estimate patients' life expectancy based on projected survival of patients after mitral valve surgery and develop a cost model to calculate short-and long-term benefits and costs to both patients and payers. Benefits include increased life expectancy and avoidance of medical complications for patients. Short-term costs include all upfront payments by patients and payers at the time of discharge. Long-term costs include all payments associated with the condition that prompted the surgical procedure incurred during the remainder of a patient's life. We assess cost-effectiveness of treating patients with various ages and major comorbidities at CoEs vs non-CoEs.
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