Physician and Hospital Factors Associated With Mortality of Surgical Patients

Kelly, Joyce V.; Hellinger, Fred J.

doi:10.1097/00005650-198609000-00001

Cited by 171 publications

(66 citation statements)

References 7 publications

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“…[12][13][14][15][16] We previously reported on empirical evidence of the economic benefit of technological advances for SCT from six large referral centers in France and the United States in 1989 and 1990. 17 In that study, the use of hematopoietic colony-stimulating factors for SCT patients was associated with a 1 week shortening of hospitalization and a $10 000 decrease in overall cost.…”

Section: Discussionmentioning

confidence: 99%

Costs of care associated with high-dose therapy and autologous transplantation for non-Hodgkin’s lymphoma: results from the University of Nebraska Medical Center 1989 to 1995

Freeman

Vose

Bennett

et al. 1999

Bone Marrow Transplant

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Summary:The purpose of this paper was to (1) comprehensively analyze transplant-related costs for predicted temporal cost shifting and (2) to evaluate whether previous findings of decreasing costs of care persisted using a cost analysis of 353 NHL patients who received autologous stem cell transplantation (SCT) at the University of Nebraska Medical Center. All transplant-related costs between the patient's initial consult and program dismissal were obtained and inflated to constant 1995 dollars. Homogeneous resources were categorized into six cost-drivers and subdivided into outpatient, transplant, and additional inpatient time periods in order to evaluate resource utilization and cost shifting patterns. Between 1989 and 1991 both the average length of stay and comprehensive costs decreased 4.9 days and 14%, respectively. By 1995 additional decreases of 25.7 days and 51% led to an overall 7 year cost decline of 65%. Percent contributions of the six cost-drivers remained similar demonstrating uniformed suppression in transplant-related resource consumption. In contrast, the timing of resource utilization changed dramatically, with transplant hospitalization costs accounting for 83% of the overall costs in 1989, 71% by 1992, and only 45% in 1995, while total outpatient's contribution was 14%, 26% and 49%. Before 1991 ebbing costs were likely related to the development of new technologies such as hematopoietic growth factors and peripheral SCT, while the three-fold larger improvement in costs reported by 1995 are presumably associated with learning curve effects such as organizational changes, increased use of coordinated outpatient facilities, and the more cost-effective use of laboratory tests and pharmaceuticals. Keywords: NHL; costs; transplant High-dose chemotherapy with autologous bone marrow or peripheral blood stem cell transplantation (SCT) has become the standard of care for many patients with relapsed Our earlier report from the University of Nebraska Medical Center (UNMC) indicated that costs of care for NHL patients decreased by 25% between 1987 and 1991, while the average inpatient stay decreased from 45 days to 38 days. 10 During this evaluation period, the use of hematopoietic colony-stimulating factors was a major reason for shortened periods of neutropenia, earlier discharge, and significant cost savings. More recent data on temporal changes in costs have not been reported, despite continued technological improvements and organizational changes (such as coordinated outpatient centers) for persons undergoing autologous SCT. The current study was undertaken to determine whether improvements in economic outcomes found during the first 5 years of the transplant program at UNMC persisted as the procedure continued to evolve and technological advances became more established. In addition, the possibility of cost shifting was of interest given the increased use of outpatient transplantation since 1991. As technological advances and organization changes facilitated earlier discharges and outpatient transp...

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Section: Discussionmentioning

confidence: 99%

Costs of care associated with high-dose therapy and autologous transplantation for non-Hodgkin’s lymphoma: results from the University of Nebraska Medical Center 1989 to 1995

Freeman

Vose

Bennett

et al. 1999

Bone Marrow Transplant

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“…Four articles (31,58,61,62) found a significant volume-outcome relationship favouring higher-volume hospitals, and three (20,56,60) found no association between volume and outcome, but did not reach statistical significance. …”

Section: Ruptured Aneurysmsmentioning

confidence: 94%

“…A further 11 articles (68 411 patients) were assessed in a systematic review (Appendix 3: available as supplementary material online at www.bjs.co.uk) (19,20,21,32,47,56,58,59,60,61,62) , of which six (19, 32, 47, 58, 59, 61) presented strong evidence for improved results at higher-volume hospitals, four (20,21,56,60) found no association between volume and outcome, and one (62) reported significant results favouring surgery at lowervolume hospitals.…”

Section: Elective Aneurysm Repairmentioning

confidence: 99%

Meta-analysis and systematic review of the relationship between volume and outcome in abdominal aortic aneurysm surgery

Holt

Poloniecki

Gerrard

et al. 2007

British Journal of Surgery

242

139

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“…20 Unfortunately, we have too few observations in the pre-reform period to conduct a meaningful statistical analysis based on patients' type of education. 21 The Western region is assigned the same pre-reform and post-reform periods as the Central region. Table 1.…”

Section: 3mentioning

confidence: 99%

Access to treatment and educational inequalities in cancer survival

Fiva

Hægeland

Rønning

et al. 2014

Journal of Health Economics

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The public health care systems in the Nordic countries provide high quality care almost free of charge to all citizens. However, social inequalities in health persist. Previous research has, for example, documented substantial educational inequalities in cancer survival. We investigate to what extent this may be driven by di erential access to and utilization of high quality treatment options. Quasi-experimental evidence based on the establishment of regional cancer wards indicates that i) highly educated individuals utilized centralized specialized treatment to a greater extent than less educated patients and ii) the use of such treatment improved these patients' survival.

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Physician and Hospital Factors Associated With Mortality of Surgical Patients

Cited by 171 publications

References 7 publications

Costs of care associated with high-dose therapy and autologous transplantation for non-Hodgkin’s lymphoma: results from the University of Nebraska Medical Center 1989 to 1995

Costs of care associated with high-dose therapy and autologous transplantation for non-Hodgkin’s lymphoma: results from the University of Nebraska Medical Center 1989 to 1995

Meta-analysis and systematic review of the relationship between volume and outcome in abdominal aortic aneurysm surgery

Access to treatment and educational inequalities in cancer survival

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