Otolaryngology practice patterns in pediatric tonsillectomy: The impact of the codeine boxed warning

2017 ◽  
Vol 128 (1) ◽  
pp. 264-268 ◽  
Author(s):  
Julie L. Goldman ◽  
Craig Ziegler ◽  
Elizabeth M. Burckardt
Keyword(s):  
Practice Patterns ◽  
Boxed Warning ◽  
The Impact

scholarly journals Educating Physicians-in-Training About Resource Utilization and Their Own Outcomes of Care in the Inpatient Setting

2010 ◽  
Vol 2 (2) ◽  
pp. 175-180 ◽  
Author(s):  
C. Jessica Dine ◽  
Jean Miller ◽  
Alexander Fuld ◽  
Lisa M. Bellini ◽  
Theodore J. Iwashyna
Keyword(s):  
Health Care ◽  
Resource Utilization ◽  
Resource Use ◽  
Practice Patterns ◽  
Action Plan ◽  
Inpatient Setting ◽  
Health Care Market ◽  
Outcomes Of Care ◽  
Attending Physician ◽  
The Impact

Abstract Background Despite significant policy concerns about the role of inpatient resource utilization on rising medical costs, little information is provided to residents regarding their practice patterns and the effect on resource use. Improved knowledge about their practice patterns and costs might reduce resource utilization and better prepare physicians for today's health care market. Methods We surveyed residents in the internal medicine residency at the Hospital of the University of Pennsylvania. Based on needs identified via the survey, discussions with experts, and a literature review, a curriculum was created to help increase residents' knowledge about benchmarking their own practice patterns and using objective performance measures in the health care market. Results The response rate to our survey was 67%. Only 37% of residents reported receiving any feedback on their utilization of resources, and only 20% reported receiving feedback regularly. Even fewer (16%) developed, with their attending physician, a concrete improvement plan for resource use. A feedback program was developed that included automatic review of the electronic medical record to provide trainee-specific feedback on resource utilization and outcomes of care including number of laboratory tests per patient day, laboratory cost per patient day, computed tomography scan ordering rate, length of stay, and 14-day readmission rate. Results were benchmarked against those of peers on the same service. Objective feedback was provided biweekly by the attending physician, who also created an action plan with the residents. In addition, an integrated didactic curriculum was provided to all trainees on the hospitalist service on a biweekly basis. Conclusions Interns and residents do not routinely receive feedback on their resource utilization or ways to improve efficiency. A method for providing objective data on individual resource utilization in combination with a structured curriculum can be implemented to help improve resident knowledge and practice. Ongoing work will test the impact on resource utilization and outcomes.

The Impact of the COVID-19 Pandemic and Telemedicine Implementation on Practice Patterns and Electronic Health Record Utilization in an Academic Rheumatology Practice

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Mithu Maheswaranathan ◽  
Philip Chu ◽  
Andrew Johannemann ◽  
Lisa Criscione-Schreiber ◽  
Megan Clowse ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Practice Patterns ◽  
Health Record ◽  
Electronic Health ◽  
The Impact ◽  
Rheumatology Practice

Comparing practice patterns and outcomes for early-stage hormone receptor-positive and node-positive breast cancer patients with high-intermediate-risk Oncotype Dx scores in the National Cancer Database.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e12520-e12520
Author(s):  
Keerthi Tamragouri ◽  
Ethan M. Ritz ◽  
Ruta D. Rao ◽  
Cristina O'Donoghue
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Predictive Value ◽  
Practice Patterns ◽  
Early Stage ◽  
Oncotype Dx ◽  
Breast Cancer Patients ◽  
Node Positive ◽  
The Impact ◽  
Positive Breast Cancer

e12520 Background: Oncotype Dx (ODX) is a commercial diagnostic test primarily used to predict the likely benefit from chemotherapy in ER+, HER2-, and node negative breast cancer. The prognostic value (recurrence risk) has also been demonstrated to apply to early stage lymph node positive (LN+) disease in a number of retrospective and prospective studies. The ongoing RxPONDER trial aims to clarify the predictive value of RS in LN+ population. In light of the initial results, we analyzed the practice patterns and outcomes for HR+/Her2 -/node positive breast cancer patients receiving ODX testing in the years from 2010-2017 with RS 14-25 in a retrospective observational study of the NCDB. Methods: Women with HR+/Her2 -/node positive breast cancer receiving ODX testing from 2010-2017 were identified in the NCDB using TAILORx and RxPONDER patients’ inclusion criteria: ages 18-75, 6-50mm invasive tumors, N1, M0, ER+/HER2 -. The impact of ODX results in the high-intermediate range (14-25) and other clinico-pathologic variables on the receipt of chemotherapy were compared. Additionally, we examined the impact of chemotherapy on overall survival (OS). Frequencies, Kaplain-Meier analysis, and changepoint analysis using the Contal and O’Quigley method were utilized. Results: There were 109,652 T1-2 and N1 patients of whom 32,506 (29.6%) received ODX testing. 13,461 (41.4%%) women had scores in the high-intermediate (14-25) range. The majority tended to have only 1 LN involved (1LN: 77.2%, 2LNs: 17.5%, 3LNs: 5.3%), had a mean age of 57.8y, were Caucasian (86.4%), and were preferentially tested at academic or comprehensive community cancer programs (79.2%). 6,610 (49.3%) patients were recommended chemotherapy, the median ODX score for all women who were recommended chemotherapy was 20 compared to 17 for those whom chemotherapy was not recommended. 5,068 (76.7%) women had documentation of receiving chemotherapy which correlated with improved OS regardless of age. Conclusions: In the group of women with HR+/Her2 -/node positive breast cancer, clinicians appear to utilize ODX testing in less than one-third of patients, possibly finding RS to be most useful in guiding adjuvant therapy recommendations when only 1LN is involved. Both the recommendation and receipt of chemotherapy correlated linearly with increasing RS, as expected based on the current NCCN guideline recommendations. We identified an OS benefit when chemotherapy was administered, regardless of patient age. Long-term follow-up in the RxPONDER trial will likely continue to clarify the predictive value of RS < 25 in the ER+/HER2-/node positive breast cancer population.

scholarly journals The Impact of Changes in Clinical Guideline on Practice Patterns and Healthcare Utilizations for Kawasaki Disease in Japan

2020 ◽  
Vol 8 ◽  
Author(s):  
Yusuke Okubo ◽  
Masaru Miura ◽  
Tohru Kobayashi ◽  
Naho Morisaki ◽  
Nobuaki Michihata ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Clinical Guideline ◽  
Practice Patterns ◽  
The Impact

The Gender Divide: The Impact of Surgeon Gender on Surgical Practice Patterns in Urology

2016 ◽  
Vol 196 (5) ◽  
pp. 1522-1526 ◽  
Author(s):  
Daniel T. Oberlin ◽  
Amanda X. Vo ◽  
Laurie Bachrach ◽  
Sarah C. Flury
Keyword(s):  
Practice Patterns ◽  
Surgical Practice ◽  
Gender Divide ◽  
The Impact

Sources of variation in follow-up expenditure after radical cystectomy.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 335-335
Author(s):  
Goutham Vemana ◽  
Joel Vetter ◽  
Ling Chen ◽  
Gurdarshan Singh Sandhu ◽  
Seth A. Strope
Keyword(s):  
Radical Cystectomy ◽  
Practice Patterns ◽  
Care Delivery ◽  
Total Variance ◽  
Office Visits ◽  
Recommended Care ◽  
Patient Level ◽  
Follow Up Care ◽  
The Impact

335 Background: Follow-up care after radical cystectomy is poorly defined with extensive variation in practice patterns. We sought to determine sources of these variations in care as well as examine the economic impact of standardization of care to guideline recommended care. Methods: Using linked SEER-Medicare data from 1992 to 2007, we determined follow-up care expenditures (time and geography standardized) for 24 months after surgery. Accounted costs included office visits, imaging studies, urine tests and blood work. A multilevel model was implemented to determine the impact of region, surgeon, and patient factors on care delivery. We then compared the actual expenditures on care in the Medicare system (interquartile range) to the expenditures if patients received care recommended by current clinical guidelines. Results: Expenditures over 24 months of follow-up were calculated per month and per patient. The mean and median monthly expenditures were $33 and $21 respectively (minimum $0, maximum $429, 25th to 75th percentile $9 to $43). The total variance of expenditure situated at the surgeon-level and SEER region-level was 9.9% and 4.0% respectively. After accounting for the region, the total variance of expenditure situated at the patient-level and surgeon-level was 14.95% and 7.81% respectively. The assessed cost of guideline follow-up recommendations varied from 0.78-9.05 times the calculated Medicare costs. The guideline recommended cost of follow-up was higher than actual Medicare expenditures in all but one category. Conclusions: While some regional and surgeon-level variations in care were found, most variation in expenditure on follow-up care was at the patient-level, largely based on comorbidity, node positivity, chemotherapy status, readmission rates, and final cancer stage. Standardization of care to current established guidelines would create larger expenditures for the Medicare system than current practice patterns.

Practice patterns in radiation therapy for bone metastases in multiple histologies.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 151-151
Author(s):  
Trent N Taylor ◽  
Catherine Lee Kinchen ◽  
Candice Aitken Johnstone ◽  
Jared R. Robbins
Keyword(s):  
Radiation Therapy ◽  
Practice Patterns ◽  
Background Radiation ◽  
Patient Comfort ◽  
Remaining Life ◽  
Treatment Regimens ◽  
More Care ◽  
Multiple Treatments ◽  
Metastatic Sites ◽  
The Impact

151 Background: Radiation therapy (RT) is a common palliative treatment for bone metastasis. Despite copious evidence of palliative equipoise between single and multiple fractions, practice patterns vary widely amongst physicians. We evaluate practice patterns and the impact of treatment regimens on percentage of remaining life spent receiving RT (PRLSRT) and overall survival. Methods: Patients with metastases from Prostate, Lung, Breast, and Kidney to the bone who received RT were identified from the National Cancer Database. The percentage of remaining life spent receiving RT (PRLSRT) was calculated by dividing the elapse days of RT by the number of days they survive from starting RT to death. Results: 43516 patients met the inclusion criteria. The majority were non-small cell lung (64.7%), while breast (13.5%), prostate (11.0%), and kidney (10.8%) had almost equal amounts. Median patient age was 67 years old (18-90). Treated metastatic sites included the spine (61.9%), hip/pelvis (11.2%), and extremity (8.13%). A higher percentage of patients had a PRLSRT over 50% depending on the primary site of their cancer: Lung was the highest (14.4%), followed by kidney (8.9%), breast (6.2%), and prostate (1.4%). Prostate cancer was most often treated with 11+ treatments (38.4%), followed by breast (34.1%), Kidney (33.1%), and finally lung (28.5%) PRLSRT was highest in those who received multiple treatments, with 11.4% of patients receiving 11+ fractions and 11.5% of those receiving 6-10 treatments with a PRLSRT above 50% compared to 1.2% of those receiving a single treatment. Conclusions: Despite the increased burden on patients with more fractions of therapy and the lack of clinical benefit, multiple fractionations remains a common practice , which can impact the way patients spend the end of their lives. More care should be taken to reduce fractionation whenever possible to allow for patient comfort and autonomy.

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