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Gajjar AA, Covell MM, Prem Kumar R, Tang OY, Ranganathan S, Muzyka L, Mualem W, Rehman I, Patel SV, Lavadi RS, Mitha R, Lieber BA, Hamilton DK, Agarwal N. Evidence Against a Traumatic Brain Injury "July Effect": An Analysis of 3 160 452 Patients From the National Inpatient Sample. Neurosurgery 2024:00006123-990000000-01281. [PMID: 38990004 DOI: 10.1227/neu.0000000000003099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/29/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The "July Effect" hypothesizes increased morbidity and mortality after the addition of inexperienced physicians at the beginning of an academic year. However, the impact of newer members on neurosurgical teams managing patients with traumatic brain injury (TBI) has yet to be examined. This study conducted a nationwide analysis to evaluate the existence of the "July Effect" in the setting of patients with TBI. METHODS The Healthcare Cost and Utilization Project Central Distributor's National Inpatient Sample data set was queried for patients with TBI using International Classification of Diseases (ICD)-9 and ICD-10 codes. Discharges were included for diagnoses of traumatic epidural, subdural, or subarachnoid hemorrhages. Only patients treated at teaching hospitals were included to ensure resident involvement in care. Patients were grouped into July admission and non-July admission cohorts. A subgroup of patients with neurotrauma undergoing any form of cranial surgery was created. Perioperative variables were recorded. Rates of different complications were assayed. Groups were compared using χ2 tests (qualitative variables) and t-tests or Mann-Whitney U-tests (quantitative variables). Logistic regression was used for binary variables. Gamma log-linked regression was used for continuous variables. RESULTS The National Inpatient Sample database yielded a weighted average of 3 160 452 patients, of which 312 863 (9.9%) underwent surgical management. Patients admitted to the hospital in July had a 5% decreased likelihood of death (P = .027), and a 5.83% decreased likelihood of developing a complication (P < .001) compared with other months of the year. July admittance to a hospital showed no significant impact on mean length of stay (P = .392) or routine discharge (P = .147). Among patients with TBI who received surgical intervention, July admittance did not significantly affect the likelihood of death (P = .053), developing a complication (P = .477), routine discharge (P = .986), or mean length of stay (P = .385). CONCLUSION The findings suggested that there is no "July Effect" on patients with TBI treated at teaching hospitals in the United States.
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Affiliation(s)
- Avi A Gajjar
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michael M Covell
- School of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Rohit Prem Kumar
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Oliver Y Tang
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Logan Muzyka
- Department of Neurosurgery, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - William Mualem
- Department of General Surgery, Temple University, Philadelphia, Pennsylvania, USA
| | - Inaya Rehman
- Department of Biology, San Jose State University, San Jose, California, USA
| | - Shrey V Patel
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Raj Swaroop Lavadi
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rida Mitha
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Bryan A Lieber
- Department of Neurosurgery, Dr. Kiran C. Patel College of Allopathic Medicine Nova Southeastern University Davie, Fort Lauderdale, Florida, USA
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Neurological Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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Mascitelli JR. Management of wide-neck aneurysms in 2024: how does one make the best treatment decision when there are so many good options? J Neurointerv Surg 2024; 16:433-434. [PMID: 38653525 DOI: 10.1136/jnis-2024-021732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Justin R Mascitelli
- Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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El Naamani K, Chen CJ, Jabre R, Saad H, Grossberg JA, Dmytriw AA, Patel AB, Khorasanizadeh M, Ogilvy CS, Thomas A, Monteiro A, Siddiqui A, Cortez GM, Hanel RA, Porto G, Spiotta AM, Piscopo AJ, Hasan DM, Ghorbani M, Weinberg J, Nimjee SM, Bekelis K, Salem MM, Burkhardt JK, Zetchi A, Matouk C, Howard BM, Lai R, Du R, Abbas R, Sioutas GS, Amllay A, Munoz A, Atallah E, Herial NA, Tjoumakaris SI, Gooch MR, Rosenwasser RH, Jabbour P. Direct Versus Indirect Revascularization for Moyamoya: a Large Multicenter Study. J Neurol Neurosurg Psychiatry 2024; 95:256-263. [PMID: 37673641 DOI: 10.1136/jnnp-2022-329176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/22/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Moyamoya is a chronic occlusive cerebrovascular disease of unknown etiology causing neovascularization of the lenticulostriate collaterals at the base of the brain. Although revascularization surgery is the most effective treatment for moyamoya, there is still no consensus on the best surgical treatment modality as different studies provide different outcomes. OBJECTIVE In this large case series, we compare the outcomes of direct (DR) and indirect revascularisation (IR) and compare our results to the literature in order to reflect on the best revascularization modality for moyamoya. METHODS We conducted a multicenter retrospective study in accordance with the Strengthening the Reporting of Observational studies in Epidemiology guidelines of moyamoya affected hemispheres treated with DR and IR surgeries across 13 academic institutions predominantly in North America. All patients who underwent surgical revascularization of their moyamoya-affected hemispheres were included in the study. The primary outcome of the study was the rate of symptomatic strokes. RESULTS The rates of symptomatic strokes across 515 disease-affected hemispheres were comparable between the two cohorts (11.6% in the DR cohort vs 9.6% in the IR cohort, OR 1.238 (95% CI 0.651 to 2.354), p=0.514). The rate of total perioperative strokes was slightly higher in the DR cohort (6.1% for DR vs 2.0% for IR, OR 3.129 (95% CI 0.991 to 9.875), p=0.052). The rate of total follow-up strokes was slightly higher in the IR cohort (8.1% vs 6.6%, OR 0.799 (95% CI 0.374 to 1.709) p=0.563). CONCLUSION Since both modalities showed comparable rates of overall total strokes, both modalities of revascularization can be performed depending on the patient's risk assessment.
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Affiliation(s)
- Kareem El Naamani
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ching-Jen Chen
- Neurosurgery, The University of Texas Health Science Center, Houston, Texas, USA
| | - Roland Jabre
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Hassan Saad
- Neurosurgery, Emory University, Atlanta, Georgia, USA
| | | | - Adam A Dmytriw
- Neuroradiology and Neurointervention Service, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medical Imaging, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Aman B Patel
- Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - Ajith Thomas
- Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Andre Monteiro
- Neurosurgery, University at Buffalo, Buffalo, New York, USA
| | - Adnan Siddiqui
- Neurosurgery, University at Buffalo, Buffalo, New York, USA
| | - Gustavo M Cortez
- Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
| | - Ricardo A Hanel
- Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
| | - Guilherme Porto
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alejandro M Spiotta
- Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Anthony J Piscopo
- Neurosurgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - David M Hasan
- Neurosurgery, Duke University, Durham, North Carolina, USA
| | - Mohammad Ghorbani
- Neurosurgery, Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Joshua Weinberg
- Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Shahid M Nimjee
- Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kimon Bekelis
- Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Mohamed M Salem
- Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jan-Karl Burkhardt
- Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Akli Zetchi
- Neurosurgery, Yale University, New Haven, Connecticut, USA
| | - Charles Matouk
- Neurosurgery, Yale University, New Haven, Connecticut, USA
| | - Brian M Howard
- Neurological Surgery, Emory University, Atlanta, Georgia, USA
| | - Rosalind Lai
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rose Du
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rawad Abbas
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Georgios S Sioutas
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Abdelaziz Amllay
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Alfredo Munoz
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Elias Atallah
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Nabeel A Herial
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | | | - Michael Reid Gooch
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Robert H Rosenwasser
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Pascal Jabbour
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Hovsepian VE, Sloane DM, Muir KJ, McHugh MD. Mortality Among the Dementia Population in Not-For-Profit Hospitals with Better Nursing Resources. J Aging Soc Policy 2024:1-15. [PMID: 38293888 PMCID: PMC11289165 DOI: 10.1080/08959420.2023.2297596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/23/2023] [Indexed: 02/01/2024]
Abstract
The dementia population has higher rates of mortality during hospital stays than those without dementia. The aim of this study is to examine the relationship between ownership status (i.e. for-profit vs. not-for-profit) and nursing resources (i.e. nurse work environment, nurse-to-patient staffing, and nurse education) on 30-day mortality among post-surgical older adults with dementia. A cross-sectional analysis of linked American Hospital Association, Medicare claims, and nurse survey data was conducted using multi-level logistic regression models. We examined these models to assess the relationship between ownership status and 30-day mortality after adjusting patient and hospital characteristics. We also analyzed the relationship between the hospital ownership status and the 30-day mortality, after considering the three nursing resources. Older adults with dementia who received care in hospitals with not-for-profit status were less likely to die within 30 days of admission following surgery compared to those treated in hospitals with for-profit hospital status (i.e. odds ratio 0.82, 95% confidence interval 0.73-0.92, p = <.001). In addition, the odds ratios estimating the association between ownership and mortality were similar across the different models of the three nursing resources with and without those controls (i.e. 0.88 vs. 0.83 vs. 0.82). Surgical patients with dementia had better outcomes when cared for in not-for-profit hospitals, particularly with greater levels of nurse education and nurse staffing. The relationship between profit status and mortality was partly explained by the lower levels of nurse staffing and education in for-profit vs. not-for-profit hospitals.
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Affiliation(s)
- Vaneh E. Hovsepian
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Douglas M. Sloane
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - K. Jane Muir
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, PA
| | - Matthew D. McHugh
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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Alzerwi NAN. Effect of the Profit and Teaching Status of Hospitals on the Patterns and Outcomes of Abdominal Aorta and Inferior Vena Cava Injuries after Severe Abdominal Trauma. Emerg Med Int 2023; 2023:5616007. [PMID: 37599812 PMCID: PMC10438973 DOI: 10.1155/2023/5616007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/21/2023] [Accepted: 07/29/2023] [Indexed: 08/22/2023] Open
Abstract
Background The inferior vena cava (IVC) and the abdominal aorta (AA) are two important blood vessels located in the abdomen. The outcomes of such injuries rely heavily on the experience, expertise, and resources available at the hospital where the patient is treated. However, our current understanding of the potential impact of the hospital profit and teaching status on surgical outcomes in the context of traumatic injuries to the IVC and AA remains limited, making it important to investigate the potential association between these hospital characteristics and patient outcomes to enhance the quality of care and optimize treatment strategies. Objective This study aimed to compare demographics, trauma characteristics, and outcomes between nonprofit status (NPSH) and for-profit hospital status (FPSH), as well as among community hospitals (CHs), nonteaching hospitals (NTHs), and university hospitals (UHs), in patients with severe abdominal trauma and abdominal aorta injury (AAI), inferior vena cava injury (IVCI), and both (AAI + IVCI). Methods Demographics, trauma, and outcome measures associated with AAI, IVCI, and AAI + IVCI were compared between the different profit and teaching status groups using NTDB. Multivariate regression was used to identify independent factors associated with death under care (DUC). Results In the 2017 NTDB-RDS, 1,479 patients met the inclusion criteria, resulting in an overall incidence of 0.17% for AAI, IVCI, and AAI + IVCI after severe abdominal trauma. More patients died under care in the FPSH group than in the NPSH group (nonprofit vs. for-profit: 60.3% vs. 47.2%; P < 0.001). The results indicated that FPSH independently affected DUC. NTH had no significant effect on DUC; although the in-hospital complication rate varied with NTH, no independent association was observed. Conclusions The study findings demonstrated that in patients with severe abdominal trauma, including injuries to AAI, IVCI, or both (AAI + IVCI), the profit status of hospitals, rather than the teaching status, had a substantial influence on DUC. Future studies should examine differences in the volume of cases and levels of trauma centers to better understand how to improve patient outcomes in FPSH.
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Affiliation(s)
- Nasser A. N. Alzerwi
- Department of Surgery, College of Medicine, Majmaah University, Ministry of Education, P. O. Box 66, Al-Majmaah 11952, Riyadh, Saudi Arabia
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Lassner JW, Ahn J, Martin S, McQueen A, Kukulski P. Quantifying For-Profit Outcomes in GME: A Multispecialty Analysis of Board Certifying Examination Pass Rates in For-Profit Affiliated Residency Programs. J Grad Med Educ 2022; 14:431-438. [PMID: 35991103 PMCID: PMC9380617 DOI: 10.4300/jgme-d-21-01097.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/21/2022] [Accepted: 04/19/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The number of for-profit hospitals has increased in the United States, but their role in and outcomes for graduate medical education (GME) are unclear. OBJECTIVES To describe for-profit involvement in internal medicine (IM), general surgery (GS), and pediatrics GME by quantifying change in for-profit affiliated residency programs and comparing for-profit and nonprofit affiliated program board certifying examination pass rates. METHODS We used Accreditation Council for Graduate Medical Education and Medicare data to quantify for-profit prevalence in IM, GS, and pediatrics GME from 2001 to 2021. We used public pass rate data from the American Board of Surgeons (2017-2019; n=242 programs; 6562 examinees), American Board of Internal Medicine (2018-2020; n=465 programs; 23 922 examinees), and American Board of Pediatrics (2018-2020; n=202 programs; 9819 examinees) to model the relationship between profit status and pass rate within each specialty and across specialties combined using linear regression. RESULTS The proportion of for-profit affiliated residency programs increased 400.0% in IM, 334.4% in GS, and 23.2% in pediatrics from 2001 to 2021. Bivariate linear regression revealed significantly lower pass rate in for-profit affiliated programs in IM β =-7.73, P<.001), pediatrics (β =-14.6, P<.001), and the 3 specialties combined (β =-5.45, P<.001). Upon multiple regression with addition of program characteristic covariates, this relationship remained significant in pediatrics (β =-10.04, P=.006). CONCLUSIONS The proportion of for-profit affiliated residency programs has increased in IM, GS, and pediatrics from 2001 to 2021. After controlling for covariates, for-profit affiliated programs were associated with lower board examination pass rates in pediatrics with no association in IM, GS, or the combined measure.
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Affiliation(s)
- Jared W. Lassner
- Jared W. Lassner, BA, is a Third Year Medical Student, University of Chicago Pritzker School of Medicine
| | - James Ahn
- James Ahn, MD, is Associate Professor of Medicine, Section of Emergency Medicine, and Program Director, Emergency Medicine Residency Program, University of Chicago Medical Center
| | - Shannon Martin
- Shannon Martin, MD, is Associate Professor of Medicine, Section of Hospital Medicine, University of Chicago Medical Center
| | - Alisa McQueen
- Alisa McQueen, MD, is Associate Professor of Pediatrics, and Program Director, Pediatric Residency Program, University of Chicago Medical Center
| | - Paul Kukulski
- Paul Kukulski, MD, is Assistant Professor of Medicine, Section of Emergency Medicine, and Assistant Program Director, Emergency Medicine Residency Program, University of Chicago Medical Center
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Alayon AL, Hagerty V, Hospedales E, Botros J, Levene T, Samuels S, Spader H. Impact of insurance status, hospital ownership type, and children's hospital designation on outcomes for pediatric neurosurgery patients following spasticity procedures in the USA. Childs Nerv Syst 2021; 37:3881-3889. [PMID: 34467419 DOI: 10.1007/s00381-021-05317-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 07/31/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aims to examine the relationship between insurance status, hospital ownership type, and children's hospital designation with outcomes for pediatric patients undergoing neurosurgical treatment for spasticity. METHODS This retrospective cohort study utilized the Healthcare Cost and Utilization Project Kids' Inpatient Database and included 11,916 pediatric patients (≤ 17 years of age) who underwent neurosurgical treatment for spasticity between 2006 and 2012 using ICD-9-CM procedure codes. RESULTS Uninsured patients had a significantly shorter hospital length of stay compared to Medicaid patients (-1.42 days, P = 0.030) as did privately insured patients (-0.74 days; P = 0.035). Discharge disposition and inpatient mortality rate were not associated with insurance status. There were no significant associations with hospital ownership type. Free-standing children's hospitals retained patients significantly longer compared to non-children's hospitals (+1.48 days; P = 0.012) and had a significantly higher likelihood of favorable discharge disposition (P = 0.004). Mortality rate was not associated with children's hospital designation. CONCLUSION Pediatric patients undergoing neurosurgical treatment for spasticity were more likely to stay in the hospital longer if they were insured by Medicaid or treated in a free-standing children's hospital. In addition, patients in free standing children's hospitals were more likely to be discharged with a favorable disposition.
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Affiliation(s)
- Amaris L Alayon
- Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA
| | - Vivian Hagerty
- Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA
| | - Emilio Hospedales
- Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA
| | - James Botros
- Department of Neurosurgery, School of Medicine, University of New Mexico, NM, 87131, Albuquerque, USA
| | - Tamar Levene
- Division of Pediatric Surgery, Joe DiMaggio Children's Hospital, 1150 N 35th Ave, Hollywood, FL, 33021, USA
| | - Shenae Samuels
- Office of Human Research, Memorial Healthcare System, 4411 Sheridan St, Hollywood, FL, 33021, USA
| | - Heather Spader
- Department of Neurosurgery, School of Medicine, University of New Mexico, NM, 87131, Albuquerque, USA. .,Division of Pediatric Neuroscience, Joe DiMaggio Children's Hospital, 1150 N 35th Ave, Hollywood, FL, 33021, USA.
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Cronin CE, Franz B, Choyke K, Rodriguez V, Gran BK. For-profit hospitals have a unique opportunity to serve as anchor institutions in the U.S. Prev Med Rep 2021; 22:101372. [PMID: 33898208 PMCID: PMC8058557 DOI: 10.1016/j.pmedr.2021.101372] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/22/2021] [Accepted: 03/28/2021] [Indexed: 11/22/2022] Open
Abstract
Hospitals serve as anchor institutions in many U.S. communities and make contributions to bolster population health and reduce preventable death. Most studies to date have focused on nonprofit hospitals, but there may be significant opportunity for for-profits to fill this role in both urban and rural communities. Using 2017-2018 data, we calculated descriptive statistics and a multivariate regression model to assess economic and health characteristics for all U.S. counties that contain for-profit as compared to nonprofit or public hospitals (n = 4,622). After controlling for hospital and county characteristics, we found a significant and positive relationship between for-profit hospital presence and higher county unemployment, higher uninsured rates, and the number of residents reporting poor/fair health. For-profit hospitals were also less likely to be located in states that had expanded Medicaid or which had certificate-of-need laws. Our findings suggest that there is substantial opportunity for for-profit hospitals to serve as anchor institutions in many U.S. communities, despite this label more traditionally being applied to nonprofit hospitals. Given that there is not currently a regular reporting mechanism for documenting the community health contributions of for-profit hospitals, policymakers and researchers should evaluate the current state of these contributions and develop incentives to encourage more anchor activities to benefit economically vulnerable communities in the U.S.
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Affiliation(s)
- Cory E. Cronin
- Ohio University, Department of Social and Public Health, Grover W359, Athens, OH 45701, United States
| | - Berkeley Franz
- Ohio University, Heritage College of Osteopathic Medicine, Department of Social Medicine, Grosvenor 311, Athens, OH 45701, United States
| | - Kelly Choyke
- Ohio University, Heritage College of Osteopathic Medicine, Department of Social Medicine, Grosvenor 311, Athens, OH 45701, United States
| | - Vanessa Rodriguez
- Ohio University, Heritage College of Osteopathic Medicine, Department of Social Medicine, Grosvenor 311, Athens, OH 45701, United States
| | - Brian K. Gran
- Case Western Reserve University, Department of Sociology, Mather Memorial Building 224, 10900 Euclid Avenue, Cleveland, OH 44106, United States
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Samuels S, Kimball R, Hagerty V, Levene T, Levene HB, Spader H. Association of hospital characteristics with outcomes for pediatric neurosurgical accidental trauma patients. J Neurosurg Pediatr 2021; 27:637-642. [PMID: 33799296 DOI: 10.3171/2020.10.peds20538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/23/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In the pediatric population, few studies have examined outcomes for neurosurgical accidental trauma care based on hospital characteristics. The purpose of this study was to explore the relationship between hospital ownership type and children's hospital designation with primary outcomes. METHODS This retrospective cohort study utilized data from the Healthcare Cost and Utilization Project 2006, 2009, and 2012 Kids' Inpatient Database. Primary outcomes, including inpatient mortality, length of stay (LOS), and favorable discharge disposition, were assessed for all pediatric neurosurgery patients who underwent a neurosurgical procedure and were discharged with a primary diagnosis of accidental traumatic brain injury. RESULTS Private, not-for-profit hospitals (OR 2.08, p = 0.034) and freestanding children's hospitals (OR 2.88, p = 0.004) were predictors of favorable discharge disposition. Private, not-for-profit hospitals were also associated with reduced inpatient mortality (OR 0.34, p = 0.005). A children's unit in a general hospital was associated with a reduction in hospital LOS by almost 2 days (p = 0.004). CONCLUSIONS Management at freestanding children's hospitals correlated with more favorable discharge dispositions for pediatric patients with accidental trauma who underwent neurosurgical procedures. Management within a children's unit in a general hospital was also associated with reduced LOS. By hospital ownership type, private, not-for-profit hospitals were associated with decreased inpatient mortality and more favorable discharge dispositions.
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Affiliation(s)
- Shenae Samuels
- 1Office of Human Research, Memorial Healthcare System, Hollywood
| | - Rebekah Kimball
- 2Florida Atlantic University, College of Medicine, Boca Raton
| | - Vivian Hagerty
- 2Florida Atlantic University, College of Medicine, Boca Raton
| | | | - Howard B Levene
- 4Department of Neurological Surgery, University of Miami, Florida
| | - Heather Spader
- 5Pediatric Neurosurgery, Joe DiMaggio Children's Hospital, Hollywood; and
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