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Matta S, Chatterjee P, Venkataramani AS. Changes in Health Care Workers' Economic Outcomes Following Medicaid Expansion. JAMA 2024; 331:687-695. [PMID: 38411645 PMCID: PMC10900969 DOI: 10.1001/jama.2023.27014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Importance The extent to which changes in health sector finances impact economic outcomes among health care workers, especially lower-income workers, is not well known. Objective To assess the association between state adoption of the Affordable Care Act's Medicaid expansion-which led to substantial improvements in health care organization finances-and health care workers' annual incomes and benefits, and whether these associations varied across low- and high-wage occupations. Design, Setting, and Participants Difference-in-differences analysis to assess differential changes in health care workers' economic outcomes before and after Medicaid expansion among workers in 30 states that expanded Medicaid relative to workers in 16 states that did not, by examining US individuals aged 18 through 65 years employed in the health care industry surveyed in the 2010-2019 American Community Surveys. Exposure Time-varying state-level adoption of Medicaid expansion. Main Outcomes and Measures Primary outcome was annual earned income; secondary outcomes included receipt of employer-sponsored health insurance, Medicaid, and Supplemental Nutrition Assistance Program benefits. Results The sample included 1 322 263 health care workers from 2010-2019. Health care workers in expansion states were similar to those in nonexpansion states in age, sex, and educational attainment, but those in expansion states were less likely to identify as non-Hispanic Black. Medicaid expansion was associated with a 2.16% increase in annual incomes (95% CI, 0.66%-3.65%; P = .005). This effect was driven by significant increases in annual incomes among the top 2 highest-earning quintiles (β coefficient, 2.91%-3.72%), which includes registered nurses, physicians, and executives. Health care workers in lower-earning quintiles did not experience any significant changes. Medicaid expansion was associated with a 3.15 percentage point increase in the likelihood that a health care worker received Medicaid benefits (95% CI, 2.46 to 3.84; P < .001), with the largest increases among the 2 lowest-earning quintiles, which includes health aides, orderlies, and sanitation workers. There were significant decreases in employer-sponsored health insurance and increases in SNAP following Medicaid expansion. Conclusion and Relevance Medicaid expansion was associated with increases in compensation for health care workers, but only among the highest earners. These findings suggest that improvements in health care sector finances may increase economic inequality among health care workers, with implications for worker health and well-being.
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Affiliation(s)
- Sasmira Matta
- Department of Health Care Management, Wharton School, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Paula Chatterjee
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Atheendar S Venkataramani
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Schpero WL, Brahmbhatt D, Liu MX, Ndumele CD, Chatterjee P. Variation in Procedural Denials of Medicaid Eligibility Across States Before the COVID-19 Pandemic. JAMA Health Forum 2023; 4:e233892. [PMID: 37976050 PMCID: PMC10656645 DOI: 10.1001/jamahealthforum.2023.3892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/12/2023] [Indexed: 11/19/2023] Open
Abstract
This cross-sectional study examines denials of Medicaid and Children’s Health Insurance Program coverage due to procedural reasons.
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Affiliation(s)
- William L. Schpero
- Division of Health Policy and Economics, Department of Population Health Sciences, Joan & Sanford I. Weill Medical College, New York, New York
- Center for Health Equity, Cornell University, New York, New York
| | - Diksha Brahmbhatt
- Division of Health Policy and Economics, Department of Population Health Sciences, Joan & Sanford I. Weill Medical College, New York, New York
| | - Michael X. Liu
- Division of Health Policy and Economics, Department of Population Health Sciences, Joan & Sanford I. Weill Medical College, New York, New York
| | - Chima D. Ndumele
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Paula Chatterjee
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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Sarkar B, Shahid T, Bhattacharya J, Chatterjee P, Biswas LN, Goswami S, Ghosh T, Ghosh SK, Pradhan A. A General Assessment of India's Extremely Low Number of Transgender Cancer Patients. Int J Radiat Oncol Biol Phys 2023; 117:e54. [PMID: 37785667 DOI: 10.1016/j.ijrobp.2023.06.766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Physiological transgender (TJ) is one of the most marginalized and oppressed community in the Indian subcontinent. The observable percentage of physiological transgender (TJ) cancer patients is extremely low. This concise report aims to assess the factors that contribute to the scarcity of transgender cancer patients. MATERIALS/METHODS The hospital database (2012-2021) of 2 centers in New Delhi (population 32 million) & 1 in Kolkata (15 million) were evaluated. In addition, 28 senior oncologists (ONC) and 17 trans women (TWs) completed a six-point questionnaire. ONC was asked how many TJ patients they had seen in their career, as well as histopathology/site. Furthermore, the data was extrapolated to account for all clinicians' cumulative years of experience. The questions for TWs were age and where they go if you have a disease or illness. And, do they know any TJ cancer patients? RESULTS India's last census (2011) revealed a half-million TJ population. TJ density must be at least 1 million to be comparable to the rest of the world. Hospital databases counted 10,486 patients, with no patient identified as TJ. A total of 37 TJ cancer patients were reported by 28 ONC with an average and collective years of their medical service of 23.1±4.1 and 646 years; distributed in 3 metropolis of 67 million (combined) population (Kolkata, New Delhi, and Mumbai). The average lifetime number of TJ cancer patients/oncologist was 1.3±1.1. Total 12 cases were head neck cancers, with 4 caused by human papillomavirus. The remaining 25 patients have 5 lung, 5 gynecological, 4 breast, 3 brain cancers, 2 soft tissue sarcomas, and 6 cases of unknown origin. The density of 5-year prevalent cancer cases in India is 0.2%, with an estimated 0.007% of TJ cancer patients. TW could not identify any cancer patients in their community. CONCLUSION Being transgender is a social taboo in this part of the world. Their legal rights and classification as the third gender are uncommon. TJs are denied access to standard education, mainstream occupations, and social respect. Although the exact number has never been determined, it is estimated that a large proportion (≈90%) of TJ people are forced to choose roadside begging and working as cheap sex workers. There is no clinical reason why TJs should have fewer cancer incidents, they should be more susceptible to cancer due to unhealthy living conditions, unprotected sex, lack of medical care, proper nutrition, and all other factors associated with their very low socioeconomic status. Nonetheless, it's difficult to find single TJ cancer patients in both public and private hospital OPD. They may be unable to access a traditional clinic due to social discrimination, financial constraints, or they may be unwilling to disclose their true sex. Even TJ's do not show up at free public clinics. The disclosure of true sex may be beneficial in obtaining better treatment, but the more prevalent reason is social unacceptability, which can be overcome through proper education and community economic growth.
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Affiliation(s)
- B Sarkar
- Apollo Multispecialty Hospitals, Kolkata, India; GLA University, Mathura, India
| | - T Shahid
- Apollo Multispecialty Hospitals, Kolkata, India
| | | | | | - L N Biswas
- Apollo Multispecialty Hospitals, Kolkata, India
| | - S Goswami
- Apollo Multispecialty Hospitals, Kolkata, India
| | - T Ghosh
- Apollo Multispecialty Hospitals, Kolkata, India
| | - S K Ghosh
- Apollo Multispecialty Hospitals, Kolkata, India
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Affiliation(s)
- Paula Chatterjee
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - William L Schpero
- Division of Health Policy and Economics, Department of Population Health Sciences, Joan & Sanford I. Weill Medical College, Cornell University, New York, New York
- Center for Health Equity, Cornell University, New York, New York
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Lee CR, Taggert E, Coe NB, Chatterjee P. Patient Experience at US Hospitals Following the Caregiver Advise, Record, Enable (CARE) Act. JAMA Netw Open 2023; 6:e2311253. [PMID: 37126344 PMCID: PMC10152302 DOI: 10.1001/jamanetworkopen.2023.11253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/19/2023] [Indexed: 05/02/2023] Open
Abstract
Importance Communication with caregivers is often not established or standardized during hospitalization. The Caregiver Advise, Record, Enable (CARE) Act is a state-level policy designed to facilitate communication among patients, caregivers, and clinical care teams during hospitalization to improve patient experience; 42 states have passed this policy since 2014, but whether it was associated with achieving these goals remains unknown. Objective To determine whether passage of the CARE Act was associated with improvements in patient experience. Design, Setting, and Participants This cohort study used a difference-in-differences analysis of short-term, acute-care US hospitals from 2013 to 2019 to analyze changes in patient experience before vs after CARE Act implementation in hospitals located in states that passed the CARE Act compared with those in states that did not. Analyses were performed between September 1, 2021, and July 31, 2022. Exposure Time-varying indicators for whether a hospital was in a state that passed the CARE Act. Main Outcomes and Measures Patient-reported experience via the Hospital Consumer Assessment of Healthcare Providers and Systems survey. Results A total of 2763 hospitals were included, with 2188 hospitals in CARE Act states and 575 in non-CARE Act states. There were differential improvements in patient experience in the measures of communication with nurses (unadjusted mean [SD] score, 78.40% [0.42%]; difference, 0.18 percentage points; 95% CI, 0.07-0.29 percentage points; P = .002), communication with physicians (mean [SD] score, 80.00% [0.19%]; difference, 0.17 percentage points; 95% CI, 0.06-0.28 percentage points; P = .002), and receipt of discharge information (mean [SD] score, 86.40% [0.22%]; difference, 0.11 percentage points; 95% CI, 0.02-0.21 percentage points; P = .02) among CARE Act states compared with non-CARE Act states after policy passage. In subgroup analyses, improvements were larger among hospitals with lower baseline Hospital Consumer Assessment of Healthcare Providers and Systems performance on measures of communication with nurses, communication with physicians, and overall hospital rating. Conclusions and Relevance These findings suggest that implementation of the CARE Act was associated with improvements in several measures of patient experience. Policies that formally incorporate caregivers into patient care during hospitalization may improve patient outcomes.
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Affiliation(s)
- Courtney R. Lee
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Medicine, Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Elizabeth Taggert
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia
| | - Norma B. Coe
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia
| | - Paula Chatterjee
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Medicine, Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Abstract
Importance Nursing homes play a vital role in providing postacute and long-term care for individuals whose needs cannot be met in the home or community. Whether the supply of nursing home beds and, specifically, the supply of high-quality beds has kept pace with the growth of the older adult population is unknown. Objective To describe changes in the supply of population-adjusted nursing home beds from 2011 to 2019. Design, Setting, and Participants This cross-sectional study examines changes in the population-adjusted supply of nursing home beds across all US counties from 2011 to 2019 and describes county and nursing home characteristics where the supply of nursing home beds has increased vs decreased. Main Outcomes and Measures Number of nursing home beds adjusted per 10 000 adults aged 65 years and older. Results The population-adjusted supply of nursing home beds declined from 2011 to 2019 for 86.4% of US counties, by a mean (SD) of 129.9 (123.8) beds per 10 000 adults aged 65 years or older per county from a baseline mean (SD) of 552.5 (274.4) beds per 10 000 adults aged 65 years or older per county in 2011. The share of beds that were high quality (4- or 5-star ratings) also declined, which was driven by a small number of counties where nursing home bed supply increased due to a proliferation of lower-quality beds. Simultaneously, metropolitan counties with declining numbers of nursing home beds also experienced declining number of senior housing residential beds (-11.3 [54.6] beds per 10 000 adults aged 65 years or older per county from a baseline mean [SD] of 354.8 [222.3]). Conclusions and Relevance The findings of this cross-sectional study suggest that the supply of nursing home beds, specifically high-quality nursing home beds, and senior residential housing beds have not kept pace with the demographics of an aging population. Understanding the supply of high-quality nursing home beds and associated geographic variation can inform targeted policies to best support older adults requiring nursing home care.
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Affiliation(s)
- Katherine E. M. Miller
- Division of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Paula Chatterjee
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- General Internal Medicine, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Rachel M. Werner
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- General Internal Medicine, Perelman School of Medicine, Philadelphia, Pennsylvania
- Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, Pennsylvania
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Chatterjee P, Klebanoff MJ, Huang Q, Navathe AS. Characteristics of Hospitals Eligible for Rural Emergency Hospital Designation. JAMA Health Forum 2022; 3:e224613. [PMID: 36484999 PMCID: PMC9856250 DOI: 10.1001/jamahealthforum.2022.4613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This cross-sectional study compares the characteristics, finances, services, and challenges at hospitals that are eligible vs not eligible to become rural emergency hospitals.
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Affiliation(s)
- Paula Chatterjee
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Matthew J. Klebanoff
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Qian Huang
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Amol S. Navathe
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Chatterjee P, Sinha S, Reszczynski O, Amin A, Schpero WL. Variation And Changes In The Targeting Of Medicaid Disproportionate Share Hospital Payments. Health Aff (Millwood) 2022; 41:1781-1789. [PMID: 36469825 DOI: 10.1377/hlthaff.2022.00153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Little is known about how Medicaid disproportionate share hospital payments, which are intended to support hospitals that serve low-income patients, are allocated or whether allocation patterns have changed over time. We employed alternative definitions of targeting, or the degree to which allocations were made in a manner consistent with the statutory goals and intent of the program, to examine disproportionate share hospital payment allocations in forty-nine participating states. The most recent data indicate that 57.2 percent of acute care hospitals received disproportionate share hospital payments, totaling more than $14.5 billion, in 2015. The majority of payments went to hospitals with Medicaid shares above the state-specific median (89.1 percent), hospitals with uncompensated care shares above the state-specific median (60.6 percent), or hospitals deemed as disproportionate share per statutory definitions (64.6 percent). However, among all hospitals receiving these payments, up to 31.6 percent of payments were allocated to hospitals that did not meet a given definition, and 3.2 percent went to hospitals that met none of them. These findings suggest that although the majority of the payments were targeted to hospitals serving low-income patients, opportunities exist to better align allocation with statutory goals and intent or to revise applicable statute.
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Affiliation(s)
- Paula Chatterjee
- Paula Chatterjee , University of Pennsylvania, Philadelphia, Pennsylvania
| | - Soham Sinha
- Soham Sinha, University of Chicago, Chicago, Illinois
| | - Olivia Reszczynski
- Olivia Reszczynski, Medical University of South Carolina, Charleston, South Carolina
| | - Anita Amin
- Anita Amin, Cornell University, New York, New York
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Sarkar B, Shahid T, Biswal S, Appunu K, Bhattacharya J, Ghosh T, De A, George K, Mandal S, Roy Chowdhury S, Ganesh T, Munshi A, Mukherjee M, Das A, Soren P, Arjunan M, Chatterjee P, Biswas L, Pradhan A. A Comparative Dose-Escalation Analysis for the Head and Neck Reirradiation Patients with and without Appropriate DICOM Based Dose-Volume Information of Primary Radiotherapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schpero WL, Chatterjee P. Structural Racial Disparities in the Allocation of Disproportionate Share Hospital Payments. JAMA Netw Open 2022; 5:e2240328. [PMID: 36331505 PMCID: PMC9636516 DOI: 10.1001/jamanetworkopen.2022.40328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This cross-sectional study examines the allocation of Medicare and Medicaid Disproportionate Share Hospital payments by race.
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Affiliation(s)
- William L. Schpero
- Division of Health Policy and Economics, Department of Population Health Sciences, Joan & Sanford I. Weill Medical College, Cornell University, New York, New York
| | - Paula Chatterjee
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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Chatterjee P. Causes and consequences of rural hospital closures. J Hosp Med 2022; 17:938-939. [PMID: 36190813 PMCID: PMC9633454 DOI: 10.1002/jhm.12973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/15/2022] [Accepted: 09/18/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Paula Chatterjee
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Schpero WL, Wiener T, Carter S, Chatterjee P. Lobbying Expenditures in the US Health Care Sector, 2000-2020. JAMA Health Forum 2022; 3:e223801. [PMID: 36306120 PMCID: PMC9617167 DOI: 10.1001/jamahealthforum.2022.3801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
This cross-sectional study uses publicly available, nonpartisan data to evaluate trends in lobbying expenditures across health care industries.
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Affiliation(s)
- William L. Schpero
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Thomas Wiener
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Samuel Carter
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Paula Chatterjee
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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Chatterjee P, Liao JM, Wang E, Feffer D, Navathe AS. Characteristics, utilization, and concentration of outpatient care for dual-eligible Medicare beneficiaries. Am J Manag Care 2022; 28:e370-e377. [PMID: 36252177 PMCID: PMC10084394 DOI: 10.37765/ajmc.2022.89189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To characterize the (1) distribution of outpatient care for dual-eligible Medicare beneficiaries ("duals") and (2) intensity of outpatient care utilization of duals vs non-dual-eligible beneficiaries ("nonduals"). STUDY DESIGN Using data preceding the introduction of several outpatient alternative payment models, as well as Medicaid expansion, we evaluated the distribution of outpatient care across physician practices using a Lorenz curve and compared utilization of different outpatient services between duals and nonduals. METHODS We defined practices that did (high dual) and did not (low dual and no dual) account for the large majority of visits based on the Lorenz curve and then performed descriptive statistics between these groups of practices. Practice-level outcomes included patient demographics, practice characteristics, and county measures of structural disadvantage and population health. Patient-level outcomes included number of outpatient visits and unique outpatient physicians, primary vs subspecialty care visits, and expenditures. RESULTS Nearly 80% of outpatient visits for duals were provided by 35% of practices. Compared with low-dual and no-dual practices, high-dual practices served more patients (1117.6 patients per high-dual practice vs 683.8 patients per low-dual practice and 447.5 patients per no-dual practice; P < .001) with more comorbidities (3.9 mean total Elixhauser comorbidities among patients served by high-dual practices vs 3.6 among low-dual practices and 3.3 among no-dual practices; P < .001). With regard to utilization, duals had 2 fewer outpatient visits per year compared with nonduals (13.3 vs 15.2; P < .001), with particularly fewer subspecialty care visits (6.5 vs 7.9; P < .001) despite having more comorbidities (3.5 vs 2.7; P < .001). CONCLUSIONS Outpatient care for duals was concentrated among a small number of practices. Despite having more chronic conditions, duals had fewer outpatient visits. Duals and the practices that serve them may benefit from targeted policies to promote access and improve outcomes.
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Affiliation(s)
- Paula Chatterjee
- Perelman School of Medicine, University of Pennsylvania, 423 Guardian Dr, Rm 1318, Philadelphia, PA 19104.
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Chatterjee P, Lin Y, Venkataramani AS. Changes in economic outcomes before and after rural hospital closures in the United States: A difference-in-differences study. Health Serv Res 2022; 57:1020-1028. [PMID: 35426125 PMCID: PMC9441283 DOI: 10.1111/1475-6773.13988] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/04/2022] [Accepted: 03/28/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The objective of this study is to assess changes in local economic outcomes before and after rural hospital closures. DATA SOURCES Rural hospital closures from January 1, 2005, to December 31, 2018, were obtained from the Sheps Center for Health Services Research. Economic outcomes from this same period were obtained from the Bureau of Labor Statistics, Bureau of Economic Analysis, Quarterly Workforce Indicators, U.S. Federal Reserve Economic Data, RAND Corporation state statistics database, U.S. Social Security Administration, and U.S. Census Bureau. DESIGN Difference-in-differences study of 2094 rural counties. DATA COLLECTION/EXTRACTION The primary exposure was county-level rural hospital closures. The primary outcomes were county-level unemployment rates; employment-population ratios; labor force participation-population ratios; per capita income; total jobs; health care sector jobs; disability program participation-population ratios; percent of the population with subprime credit scores; total filings for bankruptcies per 1000 population; and population size. PRINCIPAL FINDINGS A total of 104 rural counties experienced a hospital closure, compared to 1990 rural counties that did not. Rural hospital closures were associated with significant reductions in health care sector employment (-13.8%; 95% CI: -22%, -5.6%; p < 0.001), but not with changes in any other economic measure. For unemployment rates, employment-population ratios, per capita income, disability program participation-population ratios, and total jobs, we found evidence of adverse trends preceding hospital closures. Findings were robust to adjusting for county-specific time trends, specifying exposure at the commuting zone-level, and using alternate definitions of rurality to define sample counties. CONCLUSION With the exception of a decline in jobs within the health care sector, there was no association between rural hospital closures and county-level economic outcomes. Instead, economic conditions were already declining in counties experiencing closures compared to those that did not.
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Affiliation(s)
- Paula Chatterjee
- Department of Medicine, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Yuqing Lin
- Department of Medicine, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Atheendar S. Venkataramani
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Ethics & Health Policy, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Fisher HN, Chatterjee P, Warren SB, Yialamas MA. Witnessed Microaggression Experiences of Internal Medicine Trainees: a Single-Site Survey. J Gen Intern Med 2022; 37:3208-3210. [PMID: 35319080 PMCID: PMC9485325 DOI: 10.1007/s11606-022-07415-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/13/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Herrick Nadine Fisher
- Brigham & Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Paula Chatterjee
- Perelman School of Medicine at the University of Pennsylvania, Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
| | - Sophia Bellin Warren
- Harvard Medical School, Boston, MA, USA
- Dana Farber Cancer Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Maria A Yialamas
- Brigham & Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Takvorian SU, Chatterjee P, Mamtani R, Wu Y, Guerra C, Werner RM, Schpero W. Association between state Medicaid policies and accrual of Black participants to cancer clinical trials. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.1501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1501 Background: Black individuals remain underrepresented in U.S. cancer clinical trials, partly due to financial barriers to participation. While coverage of the routine costs of trial participation has long been mandatory for Medicare and the commercially insured, only 16 states have enacted similar mandates for Medicaid enrollees. Given the disproportionate representation of Black individuals in state Medicaid programs, we hypothesized that such mandates may have led to improved accrual of Black participants to cancer clinical trials. Methods: We conducted a retrospective, quasi-experimental study using de-identified data from the ECOG-ACRIN Cancer Research Group to evaluate changes in the accrual of Black participants to cancer clinical trials associated with state-mandated Medicaid coverage of routine trial costs. The study population included non-elderly adults enrolled in therapeutic clinical trials for breast, colorectal, lung, or prostate cancer from 2000-2019. We employed a difference-in-differences approach with event-study specification to compare outcomes in states that mandated Medicaid coverage of routine trial costs relative to states that did not, before and after mandates were enacted. Outcomes included the proportion of trial participants who had Medicaid insurance (vs. non-Medicaid) and the proportion who were Black (vs. non-Black). Models adjusted for age, sex, cancer type, cancer stage, study phase, and study site (community vs. academic). Results: Among 24,321 trial participants (mean age 52.0 [SD 8.2] years, 82.8% female), 7.2% had Medicaid coverage and 10.5% were Black. Compared to states without Medicaid coverage mandates, states with mandates had a statistically significant increase in the proportion of Black trial participants in the first year following the mandate (+6.4 percentage points [95%CI 1.8% to 11.0%]) but not in subsequent years. There was no association between state mandates and the proportion of trial participants enrolled in Medicaid (effects ranged from -0.7 percentage points [95%CI -4.6% to 3.3%] in the first year after mandates to -3.9% [95%CI -8.6% to 0.8%] in the third year). Conclusions: State-mandated Medicaid coverage of the routine costs of trial participation was associated with a short-term increase in the proportion of Black trial participants. These findings suggest that Medicaid policies have the potential to improve representation of racial minority groups in cancer clinical trials, and support recent federal legislation mandating state Medicaid programs to cover trial participation costs as of January 2022. Our study was limited by use of data from only one large cancer research group, focus on only four common cancers, and limited power to analyze the policy impact for other racial and ethnic minority groups. Additional work is needed to replicate these findings in larger cohorts of trial participants.
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Affiliation(s)
- Samuel U Takvorian
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Paula Chatterjee
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ronac Mamtani
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Yaxin Wu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Carmen Guerra
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rachel M. Werner
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Chatterjee P, Stevens H, Bowles-Welch A, Kippner L, Marmon A, Drissi H, Gibson G, Yeago C, Roy K. Mesenchymal Stem/Stromal Cells: HIGH-DIMENSIONALL MULTI-OMICS COMPARISON OF CELLS IN BONE MARROW REVEALED ALTERATIONS TO IMMUNE CELLS IN OSTEOARTHRITIS. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00163-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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18
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Agarwal S, Kardam S, Chatterjee P, Kumar C, Boruah M, Sharma MC, Tabin M, Ramakrishnan L. CaSR expression in normal parathyroid and PHPT: new insights into pathogenesis from an autopsy-based study. J Endocrinol Invest 2022; 45:337-346. [PMID: 34302683 DOI: 10.1007/s40618-021-01646-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Calcium sensing receptor (CaSR), on the surface of normal parathyroid cells, is essential for maintaining serum calcium levels. The normal pattern of CaSR immunostaining remains undefined and is presumptively circumferential. Given the physiological variation in serum calcium, we postulated that CaSR expression could not be uniformly circumferential. Also, cytoplasmic expression has not been evaluated either in normal or pathological tissues. We studied normal parathyroid tissues derived from forensic autopsies and those rimming parathyroid adenomas for membranous and cytoplasmic CaSR immunoexpression. Results were compared with primary hyperparathyroidism (PHPT) to look for any pathogenetic implications. MATERIALS AND METHODS We evaluated 34 normal parathyroid tissues from 11 autopsies, 30 normal rims, 45 parathyroid adenoma, 10 hyperplasia, and 7 carcinoma cases. Membranous expression was categorized complete/incomplete and weak/moderate/strong; scored using Her2/Neu and Histo-scores; predominant pattern noted. Cytoplasmic expression was categorized negative/weak/moderate/strong; predominant intensity noted. RESULTS Normal autopsy-derived parathyroid tissues were Her2/Neu 3 + , but incomplete membranous staining predominated in 85%. Their immune-scores were significantly more than the cases (p < < 0.05). The mean histo-score of normal rims was intermediate between the two (p < < 0.05). Cytoplasmic expression was strong in all autopsy-derived tissues, weak/negative in hyperplasia (100%), moderate in 16% adenomas, and 43% carcinomas. CONCLUSIONS Normal autopsy-derived parathyroid tissues showed strong but predominantly incomplete membranous expression. Surface CaSR expression decreased in PHPT and is probably an early event in parathyroid adenoma, seen even in normal rims. Whether there is a defect in CaSR trafficking from the cytoplasm to the cell surface in adenoma and carcinoma needs further evaluation.
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Affiliation(s)
- S Agarwal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - S Kardam
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - P Chatterjee
- Department of Pathology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - C Kumar
- Department of Surgical Oncology, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India
| | - M Boruah
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - M C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - M Tabin
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, New Delhi, India
| | - L Ramakrishnan
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India
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Chatterjee P, Werner RM, Joynt Maddox KE. Medicaid Expansion Alone Not Associated With Improved Finances, Staffing, Or Quality At Critical Access Hospitals. Health Aff (Millwood) 2021; 40:1846-1855. [PMID: 34871072 DOI: 10.1377/hlthaff.2021.00643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Critical access hospitals are important providers of care for rural and other underserved communities, but they face staffing and quality challenges while operating with low margins. Medicaid expansion has been found to improve hospital finances broadly and therefore may have permitted sustained investments in staffing and quality improvement at these vulnerable hospitals. In this difference-in-differences analysis, we found that critical access hospitals in Medicaid expansion states did not have statistically significant postexpansion increases in operating margins relative to hospitals in nonexpansion states. Nor did we see evidence of statistically significant differential improvement at critical access hospitals in expansion versus nonexpansion states on either staffing measures (physicians and registered nurses per 1,000 patient days) or quality measures (percentage-point changes in readmissions and mortality within thirty days of admission for pneumonia or heart failure). These findings suggest that critical access hospitals may need to take additional measures to bolster finances to provide continued support for the delivery of high-quality care to rural and other underserved communities.
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Affiliation(s)
- Paula Chatterjee
- Paula Chatterjee is an assistant professor of medicine in the Division of General Internal Medicine, Perelman School of Medicine, and a senior fellow at the Leonard Davis Institute of Health Economics, both at the University of Pennsylvania, in Philadelphia, Pennsylvania
| | - Rachel M Werner
- Rachel M. Werner is the Robert D. Eilers Professor of Health Care Management at the Wharton School, a professor of medicine at the Perelman School of Medicine, and executive director of the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania, and core faculty at the Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, in Philadelphia, Pennsylvania
| | - Karen E Joynt Maddox
- Karen E. Joynt Maddox is an associate professor of medicine in the Department of Medicine and codirector of the Center for Health Economics and Policy, both at the Washington University School of Medicine, in St. Louis, Missouri
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20
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Liao JM, Chatterjee P, Wang E, Connolly J, Zhu J, Cousins DS, Navathe AS. The Effect of Hospital Safety Net Status on the Association Between Bundled Payment Participation and Changes in Medical Episode Outcomes. J Hosp Med 2021; 16:716-723. [PMID: 34798000 PMCID: PMC8626055 DOI: 10.12788/jhm.3722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/13/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Under Medicare's Bundled Payments for Care Improvement (BPCI) program, hospitals have maintained quality and achieved savings for medical conditions. However, safety net hospitals may perform differently owing to financial constraints and organizational challenges. OBJECTIVE To evaluate whether hospital safety net status affected the association between bundled payment participation and medical episode outcomes. DESIGN, SETTING, AND PARTICIPANTS This observational difference-in-differences analysis was conducted in safety net and non-safety net hospitals participating in BPCI for medical episodes (BPCI hospitals) using data from 2011-2016 Medicare fee-for-service beneficiaries hospitalized for acute myocardial infarction, pneumonia, congestive heart failure, and chronic obstructive pulmonary disease. EXPOSURE(S) Hospital BPCI participation and safety net status. MAIN OUTCOME(S) AND MEASURE(S) The primary outcome was postdischarge spending. Secondary outcomes included quality and post-acute care utilization measures. RESULTS Our sample consisted of 803 safety net and 2263 non-safety net hospitals. Safety net hospitals were larger and located in areas with more low-income individuals than non-safety net hospitals. Among BPCI hospitals, safety net status was not associated with differential postdischarge spending (adjusted difference-in-differences [aDID], $40; 95% CI, -$254 to $335; P = .79) or quality (mortality, readmissions). However, BPCI safety net hospitals had differentially greater discharge to institutional post-acute care (aDID, 1.06 percentage points; 95% CI, 0.37-1.76; P = .003) and lower discharge home with home health (aDID, -1.15 percentage points; 95% CI, -1.73 to -0.58; P < .001) than BPCI non-safety net hospitals. CONCLUSIONS Under medical condition bundles, safety net hospitals perform differently from other hospitals in terms of post-acute care utilization, but not spending. Policymakers could support safety net hospitals and consider safety net status when evaluating bundled payment programs.
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Affiliation(s)
- Joshua M Liao
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
- Corresponding Author: Joshua M Liao, MD, MSc; ; Telephone: 206-616-6934. Twitter: @JoshuaLiaoMD
| | - Paula Chatterjee
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erkuan Wang
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John Connolly
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jingsan Zhu
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Deborah S Cousins
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amol S Navathe
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Corporal Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania
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21
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Sarkar B, Munshi A, Shahid T, Sengupta S, Bhaskar R, Ganesh T, Paul A, Bhattacharjee B, Pun R, Imbulgoda N, Biswal S, Rastogi K, Bansal K, Baba A, Yasmin T, Bhattacharya J, Ghosh T, De A, Chatterjee P, Pradhan A. Growth Characteristics of Woman Radiation Oncologists in South Asia: Assessment of Gender Neutrality and Leadership Position. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Fisher HN, Chatterjee P, Shapiro J, Katz JT, Yialamas MA. "Let's Talk About What Just Happened": a Single-Site Survey Study of a Microaggression Response Workshop for Internal Medicine Residents. J Gen Intern Med 2021; 36:3592-3594. [PMID: 33479935 PMCID: PMC7819694 DOI: 10.1007/s11606-020-06576-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/29/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Herrick N Fisher
- Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, USA.
| | - Paula Chatterjee
- Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute for Health Economics, Philadelphia, PA, USA
| | - Jo Shapiro
- Harvard Medical School, Boston, USA
- Department of Anesthesia, Pain and Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Joel T Katz
- Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, USA
| | - Maria A Yialamas
- Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, USA
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23
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Affiliation(s)
- Morgan C Shields
- Center for Mental Health, Department of Psychiatry(Shields, Marcus), Leonard Davis Institute of Health Economics (Shields, Marcus, Chatterjee), School of Social Policy and Practice (Marcus), and Department of Medicine (Chatterjee).,University of Pennsylvania, Philadelphia; Center for Mental Health and Addiction Policy, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (Hollander)
| | - A G Hollander
- Center for Mental Health, Department of Psychiatry(Shields, Marcus), Leonard Davis Institute of Health Economics (Shields, Marcus, Chatterjee), School of Social Policy and Practice (Marcus), and Department of Medicine (Chatterjee).,University of Pennsylvania, Philadelphia; Center for Mental Health and Addiction Policy, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (Hollander)
| | - Steven C Marcus
- Center for Mental Health, Department of Psychiatry(Shields, Marcus), Leonard Davis Institute of Health Economics (Shields, Marcus, Chatterjee), School of Social Policy and Practice (Marcus), and Department of Medicine (Chatterjee).,University of Pennsylvania, Philadelphia; Center for Mental Health and Addiction Policy, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (Hollander)
| | - Paula Chatterjee
- Center for Mental Health, Department of Psychiatry(Shields, Marcus), Leonard Davis Institute of Health Economics (Shields, Marcus, Chatterjee), School of Social Policy and Practice (Marcus), and Department of Medicine (Chatterjee).,University of Pennsylvania, Philadelphia; Center for Mental Health and Addiction Policy, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (Hollander)
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24
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Matta S, Chatterjee P, Venkataramani AS. The Income-Based Mortality Gradient Among US Health Care Workers: Cohort Study. J Gen Intern Med 2021; 36:2870-2872. [PMID: 32607931 PMCID: PMC7325834 DOI: 10.1007/s11606-020-05989-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/12/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Sasmira Matta
- Department of Health Care Management, Wharton School of Business, University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Paula Chatterjee
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Atheendar S Venkataramani
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA. .,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Abstract
IMPORTANCE Women are less likely to be promoted and hold leadership positions in academic medicine. How often academic articles are cited is a key measure of scholarly impact and frequently assessed for professional advancement; however, it is unknown whether peer-reviewed articles written by men and women are cited differently. OBJECTIVE To evaluate whether academic articles from high-impact medical journals written by men and women are cited differently. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study of all original research and commentary articles from 5 high-impact medical journals (Annals of Internal Medicine, British Medical Journal, JAMA, JAMA Internal Medicine, and The New England Journal of Medicine) from 2015 to 2018, the gender of the primary and senior authors of each article were identified using an online database, and the number of times each article has been cited was identified using Web of Science. The number of citations by primary and senior author gender were then compared. Data were analyzed from July 2020 to April 2021. EXPOSURES Primary and senior authors' genders. MAIN OUTCOMES AND MEASURES Number of citations per article. RESULTS Among 5554 articles, women wrote 1975 (35.6%) as primary author and 1273 of 4940 (25.8%) as senior author. Original research articles written by women as primary authors had fewer median (interquartile range) citations than articles written by men as primary authors (36 [17-82] citations vs 54 [22-141] citations; P < .001) and senior authors (37 [17-93] citations vs 51 [20-128] citations; P < .001). Articles written by women as both primary and senior authors had approximately half as many median (interquartile range) citations as those authored by men as both primary and senior authors (33 [15-68] citations vs 59 [23-149] citations; P < .001). Differences in citations remained in each year of the study and were less pronounced among commentary articles. CONCLUSIONS AND RELEVANCE In this study, articles written by women in high-impact medical journals had fewer citations than those written by men, particularly when women wrote together as primary and senior authors. These differences may have important consequences for the professional success of women and achieving gender equity in academic medicine.
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Affiliation(s)
- Paula Chatterjee
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Penn Presbyterian Hospital, Philadelphia, Pennsylvania
| | - Rachel M. Werner
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- The Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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26
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Pradhan P, Chatterjee P, Stevens H, Marmon A, Medrano-Trochez C, Jimenez A, Kippner L, Li Y, Savage E, Gaul D, Fernández F, Gibson G, Kurtzberg J, Kotanchek T, Yeago C, Roy K. Multiomic analysis and computational modeling to identify critical quality attributes for immunomodulatory potency of mesenchymal stromal cells. Cytotherapy 2021. [DOI: 10.1016/s1465324921002826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
IMPORTANCE Safety-net hospitals (SNHs) operate under limited financial resources and have had challenges providing high-quality care. Medicaid expansion under the Affordable Care Act led to improvements in hospital finances, but whether this was associated with better hospital quality, particularly among SNHs given their baseline financial constraints, remains unknown. OBJECTIVE To compare changes in quality from 2012 to 2018 between SNHs in states that expanded Medicaid vs those in states that did not. DESIGN, SETTING, AND PARTICIPANTS Using a difference-in-differences analysis in a cohort study, performance on quality measures was compared between SNHs, defined as those in the highest quartile of uncompensated care in the pre-Medicaid expansion period, in expansion vs nonexpansion states, before and after the implementation of Medicaid expansion. A total of 811 SNHs were included in the analysis, with 316 in nonexpansion states and 495 in expansion states. The study was conducted from January to November 2020. EXPOSURES Time-varying indicators for Medicaid expansion status. MAIN OUTCOMES AND MEASURES The primary outcome was hospital quality measured by patient-reported experience (Hospital Consumer Assessment of Healthcare Providers and Systems Survey), health care-associated infections (central line-associated bloodstream infections, catheter-associated urinary tract infections, and surgical site infections following colon surgery) and patient outcomes (30-day mortality and readmission rates for acute myocardial infarction, heart failure, and pneumonia). Secondary outcomes included hospital financial measures (uncompensated care and operating margins), adoption of electronic health records, provision of safety-net services (enabling, linguistic/translation, and transportation services), or safety-net service lines (trauma, burn, obstetrics, neonatal intensive, and psychiatric care). RESULTS In this difference-in-differences analysis of a cohort of 811 SNHs, no differential changes in patient-reported experience, health care-associated infections, readmissions, or mortality were noted, regardless of Medicaid expansion status after the Affordable Care Act. There were modest differential increases between 2012 and 2016 in the adoption of electronic health records (mean [SD]: nonexpansion states, 99.4 [7.4] vs 99.9 [3.8]; expansion states, 94.6 [22.6] vs 100.0 [2.2]; 1.7 percentage points; P = .02) and between 2012 and 2018 in the number of inpatient psychiatric beds (mean [SD]: nonexpansion states, 24.7 [36.0] vs 23.6 [39.0]; expansion states: 29.3 [42.8] vs 31.4 [44.3]; 1.4 beds; P = .02) among SNHs in expansion states, although they were not statistically significant at a threshold adjusted for multiple comparisons. In subgroup analyses comparing SNHs with higher vs lower baseline operating margins, an isolated differential improvement was noted in heart failure readmissions among SNHs with lower baseline operating margins in expansion states (mean [SD], 22.8 [2.1]; -0.53 percentage points; P = .001). CONCLUSIONS AND RELEVANCE This difference-in-differences cohort study found that despite reductions in uncompensated care and improvements in operating margins, there appears to be little evidence of quality improvement among SNHs in states that expanded Medicaid compared with those in states that did not.
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Affiliation(s)
- Paula Chatterjee
- Perelman School of Medicine, Division of General Internal Medicine, University of Pennsylvania, Philadelphia.,The Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia.,Department of Medicine, Penn Presbyterian Hospital, Philadelphia
| | - Mingyu Qi
- Perelman School of Medicine, Division of General Internal Medicine, University of Pennsylvania, Philadelphia
| | - Rachel M Werner
- Perelman School of Medicine, Division of General Internal Medicine, University of Pennsylvania, Philadelphia.,The Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia.,The Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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Chatterjee P, Qi M, Werner R. Relative contributions of hospital versus skilled nursing facility quality on patient outcomes. BMJ Qual Saf 2021; 30:195-201. [PMID: 32229627 PMCID: PMC7770560 DOI: 10.1136/bmjqs-2019-010660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/04/2020] [Accepted: 03/17/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Hospitals and health systems worldwide have adopted value-based payment to improve quality and reduce costs. In the USA, skilled nursing facilities (SNFs) are now financially penalised for higher-than-expected readmission rates. However, the extent to which SNFs contribute to, and should thus be held accountable for, readmission rates is unknown. To compare the relative contributions of hospital and SNF quality on readmission rates while controlling for unobserved patient characteristics. METHODS Retrospective cohort study of Medicare beneficiaries, 2010-2016. Acute care hospitals and SNFs in the USA. Medicare beneficiaries with two hospitalisations followed by SNF admissions, divided into two groups: (1) patients who went to different hospitals but were discharged to the same SNF after both hospitalisations and (2) patients who went to the same hospital but were discharged to different SNFs. Hospital-level and SNF-level quality, using a lagged measure of 30-day risk-standardised readmission rates (RSRRs). Readmission within 30 days of hospital discharge. RESULTS There were 140 583 patients who changed hospitals but not SNFs, and 183 232 who changed SNFs but not hospitals. Patients who went to the lowest-performing hospitals (highest RSRR) had a 0.9% higher likelihood of readmission (p=0.005) compared with patients who went to the highest-performing hospitals (lowest RSRR). In contrast, patients who went to the lowest-performing SNFs had a 2% higher likelihood of readmission (p<0.001) compared with patients to went to the highest-performing SNFs. CONCLUSIONS The association between SNF quality and patient outcomes was larger than the association between hospital quality and patient outcomes among postacute care patients. Holding postacute care providers accountable for their quality may be an effective strategy to improve SNF quality.
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Affiliation(s)
- Paula Chatterjee
- Department of Medicine, Division of General Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute for Health Economics, Philadelphia, Pennsylvania, USA
- Penn Presbyterian Hospital, Philadelphia, Pennsylvania, USA
| | - Mingyu Qi
- Department of Medicine, Division of General Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachel Werner
- Department of Medicine, Division of General Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute for Health Economics, Philadelphia, Pennsylvania, USA
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29
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Chatterjee P, Warner LN, Basil MC, Christopher M, Manning K, Fisher HN, Rexrode KM, Solomon SR, Kakoza RM, Yialamas MA. "Make the Implicit Explicit": Measuring Perceptions of Gender Bias and Creating a Gender Bias Curriculum for Internal Medicine Residents. Adv Med Educ Pract 2021; 12:49-52. [PMID: 33488136 PMCID: PMC7814655 DOI: 10.2147/amep.s292166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/28/2020] [Indexed: 06/02/2023]
Abstract
BACKGROUND Gender bias in clinical training has been well established; however, little is known about how perceptions differ between men and women. Furthermore, few curricular options have been developed to discuss gender bias. OBJECTIVE To measure the prevalence of gender bias, examine qualitative differences between men and women, and create a gender bias curriculum for internal medicine residents. METHODS We surveyed 114 residents (response rate of 53.5%) to identify the prevalence and types of gender bias experienced in training. We compared estimates between genders and organized qualitative results into shared themes. We then developed a curriculum to promote and normalize discussions of gender bias. RESULTS Among surveyed residents, 61% reported personal experiences of gender bias during training, with 98% of women and 19% of men reporting experiences when stratified by gender. We identified two domains in which gender bias manifested: role misidentification and a difficult working environment. Residents identified action items that led to the development of a gender bias curriculum. The curriculum includes didactic conferences and training sessions, a microaggression response toolkit, dinners for men and women residents, participation in a WhatsApp support group, and participation in academic projects related to gender bias in training. CONCLUSION We confirmed a wide prevalence of gender bias and developed a scalable curriculum for gender bias training. Future work should explore the long-term impacts of these interventions.
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Affiliation(s)
- Paula Chatterjee
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Lindsay N Warner
- Department of Medicine, Virginia Mason Medical Center, Seattle, WA, USA
| | - Maria C Basil
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Michelle Christopher
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Herrick N Fisher
- Department of Medicine, Brigham & Women’s Hospital, Boston, MA, USA
| | | | - Sonja R Solomon
- Department of Medicine, Brigham & Women’s Hospital, Boston, MA, USA
| | - Rose M Kakoza
- Department of Primary Care and Community Medicine, Christiana Care, Wilmington, DE, USA
| | - Maria A Yialamas
- Department of Medicine, Brigham & Women’s Hospital, Boston, MA, USA
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Affiliation(s)
- Paula Chatterjee
- From the Department of Medicine, Perelman School of Medicine, and the Leonard Davis Institute of Health Economics, University of Pennsylvania - both in Philadelphia (P.C.); the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, and the Department of Medicine, Brigham and Women's Hospital - both in Boston (B.D.S.); and the Cardiovascular Division, John T. Milliken Department of Medicine, Washington University School of Medicine in St. Louis, and the Center for Health Economics and Policy, Washington University in St. Louis - both in St. Louis (K.E.J.M.)
| | - Benjamin D Sommers
- From the Department of Medicine, Perelman School of Medicine, and the Leonard Davis Institute of Health Economics, University of Pennsylvania - both in Philadelphia (P.C.); the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, and the Department of Medicine, Brigham and Women's Hospital - both in Boston (B.D.S.); and the Cardiovascular Division, John T. Milliken Department of Medicine, Washington University School of Medicine in St. Louis, and the Center for Health Economics and Policy, Washington University in St. Louis - both in St. Louis (K.E.J.M.)
| | - Karen E Joynt Maddox
- From the Department of Medicine, Perelman School of Medicine, and the Leonard Davis Institute of Health Economics, University of Pennsylvania - both in Philadelphia (P.C.); the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, and the Department of Medicine, Brigham and Women's Hospital - both in Boston (B.D.S.); and the Cardiovascular Division, John T. Milliken Department of Medicine, Washington University School of Medicine in St. Louis, and the Center for Health Economics and Policy, Washington University in St. Louis - both in St. Louis (K.E.J.M.)
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Anastos-Wallen R, Werner RM, Chatterjee P. Prevalence of Informal Caregiving in States Participating in the US Patient Protection and Affordable Care Act Balancing Incentive Program, 2011-2018. JAMA Netw Open 2020; 3:e2025833. [PMID: 33320262 PMCID: PMC7739120 DOI: 10.1001/jamanetworkopen.2020.25833] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/20/2020] [Indexed: 11/14/2022] Open
Abstract
Importance The Balancing Incentives Program (BIP), established under the 2010 Patient Protection and Affordable Care Act provided federal funding for states to shift long-term care out of institutional settings and into the home. However, the association of its implementation with informal caregiving is not known. Objective To evaluate the association between BIP participation and the prevalence and frequency of informal caregiving and socioeconomic disparities among caregivers. Design, Setting, and Participants The cohort study included respondents to the 2011-2018 American Time Use Survey in BIP-adopting states and non-BIP-adopting states. Exposure Living in a state that had implemented the BIP after program implementation had begun (April 2012 to April 2018). Main Outcomes and Measures Prevalence of caregiving among all respondents, frequency of caregiving, and minutes of daily sleep, a marker of well-being. Differences-in-differences (DID) regression analysis was used to compare these outcomes between BIP-adopting states and non-BIP-adopting states. Results The study included 38 343 respondents in BIP-adopting states (median age, 47 years [interquartile range (IQR), 31-61 years]; 51.9% women), of whom 7428 were caregivers (median age, 51 years [IQR, 37-61 years]; 55.6% women), and 26 437 respondents in non-BIP-adopting states (median age, 48 years [IQR, 32-62 years]; 52.7% women), of whom 5527 were caregivers (median age, 52 years [IQR, 38-62 years]; 57.9% women). There was no change in the prevalence of caregiving between BIP-adopting and non-BIP-adopting states after program implementation (DID, 0.00%; 95% CI, -0.01% to 0.01%). Caregivers in BIP-adopting states were more likely to provide daily care after implementation (DID, 3.2%; 95% CI, 0.3%-6.0%; P = .03) and report increased time sleeping (DID, 15.6 minutes; 95% CI, 4.9-26.2 minutes; P = .005) compared with caregivers in non-BIP-adopting states. This association was more pronounced among caregivers with more education (DID, 25.1 minutes; 95% CI, 6.5-43.8 minutes; P = .01) and higher annual family income (DID, 16.9 minutes; 95% CI, 5.9-27.9 minutes; P = .004) compared with caregivers in non-BIP-adopting states who had the same education and income levels, respectively. Conclusions and Relevance In this cohort study, the BIP was associated with increased daily caregiving and improved caregiver well-being. However, it may have disproportionately benefited caregivers of higher socioeconomic status, potentially exacerbating disparities in caregiver stress. Future policies should aim to mitigate this unintended consequence.
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Affiliation(s)
- Rebecca Anastos-Wallen
- Perelman School of Medicine, Department of Medicine, University of Pennsylvania, Philadelphia
- Hospital of the University of Pennsylvania, Philadelphia
| | - Rachel M. Werner
- Perelman School of Medicine, Department of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Paula Chatterjee
- Perelman School of Medicine, Department of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
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Sarkar B, Munshi A, Shahid T, Ganesh T, Mohanti B, Bansal K, Rastogi K, Chaudhari B, Manikandan A, Biswal S, Bhattacharya J, Ghosh T, De A, Roy Chowdhury S, Mandal S, George K, Mukherjee M, Gazi M, Chauhan R, Chatterjee P. Challenges Faced by Woman Radiation Oncologists (WRO) in South Asia. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Affiliation(s)
- Paula Chatterjee
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Penn Presbyterian Hospital, Philadelphia, Pennsylvania
| | - Sheila Kelly
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Mingyu Qi
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Rachel M Werner
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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Nathan AS, Blebea C, Chatterjee P, Thomasson A, Diamond JM, Groeneveld PW, Giri J, Goldberg HJ, Courtwright AM. Mortality trends around the one‐year survival mark after heart, liver, and lung transplantation in the United States. Clin Transplant 2020; 34:e13852. [DOI: 10.1111/ctr.13852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/19/2020] [Accepted: 03/03/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Ashwin S. Nathan
- Cardiovascular Division Hospital of the University of Pennsylvania Philadelphia Pennsylvania USA
- Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia Pennsylvania USA
- Penn Cardiovascular Outcomes Quality, and Evaluative Research Center Cardiovascular Institute University of Pennsylvania Philadelphia Pennsylvania USA
| | - Catherine Blebea
- Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
| | - Paula Chatterjee
- Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia Pennsylvania USA
- Division of General Internal Medicine Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
| | - Arwin Thomasson
- Pulmonary Division Hospital of the University of Pennsylvania Philadelphia Pennsylvania USA
| | - Joshua M. Diamond
- Pulmonary Division Hospital of the University of Pennsylvania Philadelphia Pennsylvania USA
| | - Peter W. Groeneveld
- Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia Pennsylvania USA
- Penn Cardiovascular Outcomes Quality, and Evaluative Research Center Cardiovascular Institute University of Pennsylvania Philadelphia Pennsylvania USA
- Division of General Internal Medicine Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
- Corporal Michael J. Crescenz VA Medical Center Philadelphia Pennsylvania USA
| | - Jay Giri
- Cardiovascular Division Hospital of the University of Pennsylvania Philadelphia Pennsylvania USA
- Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia Pennsylvania USA
- Penn Cardiovascular Outcomes Quality, and Evaluative Research Center Cardiovascular Institute University of Pennsylvania Philadelphia Pennsylvania USA
- Corporal Michael J. Crescenz VA Medical Center Philadelphia Pennsylvania USA
| | - Hilary J. Goldberg
- Pulmonary Division Brigham and Women's Hospital Boston Massachusetts USA
| | - Andrew M. Courtwright
- Pulmonary Division Hospital of the University of Pennsylvania Philadelphia Pennsylvania USA
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35
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Affiliation(s)
- Paula Chatterjee
- Department of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel M Werner
- Department of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
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Abstract
Importance Hospitals in the United States have been subject to mandatory public reporting of mortality rates for acute myocardial infarction (AMI) and heart failure (HF) since 2007 and to value-based payment programs for these conditions since 2011. However, whether hospitals with initially poor baseline performance have improved relative to other hospitals under these programs, and whether patterns of improvement differ by condition, is unknown. Understanding trends within public reporting and value-based payment can inform future efforts in these areas. Objective To examine patterns in 30-day mortality from AMI and HF and determine whether they differ for baseline poor performers (worst quartile in 2009 and 2010 in public reporting, prior to value-based payment) compared with other hospitals. Design, Setting, and Participants Retrospective cross-sectional study at US acute care hospitals from 2009 to 2015 that included 2751 and 3796 hospitals with publicly reported mortality data for AMI and HF, respectively. Exposures Public reporting and value-based purchasing. Main Outcomes and Measures Hospital-level risk-adjusted 30-day mortality rates. Results We identified 422 and 600 baseline poor-performing hospitals for AMI and HF, respectively. Baseline poor performers for AMI were more often public and for-profit and less often teaching hospitals. Baseline poor performers for HF were less often large hospitals. For AMI, 30-day mortality among baseline poor performers was higher at baseline but improved more over time compared with other hospitals (18.6% in 2009 to 14.6% in 2015; -0.74% per year; P < .001 vs 15.7% in 2009 to 14.0% in 2015; -0.26% per year; P < .001; P for interaction <.001). In contrast, for HF, baseline poor performers improved over time (13.5%-13.0%; -0.12% per year; P < .001), but mean mortality among all other HF hospitals increased during the study period (10.9%-12.0%; 0.17% per year; P < .001; P for interaction, <.001). Conclusions and Relevance Despite being subject to identical policy pressures, mortality trends for AMI and HF differed markedly between 2009 and 2015.
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Affiliation(s)
- Paula Chatterjee
- Department of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,The Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
| | - Karen E Joynt Maddox
- The Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri.,The Washington University Brown School of Social Work, St Louis, Missouri
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Chatterjee P, Qi M, Coe NB, Konetzka RT, Werner RM. Association Between High Discharge Rates of Vulnerable Patients and Skilled Nursing Facility Copayments. JAMA Intern Med 2019; 179:1296-1298. [PMID: 31135825 PMCID: PMC6547066 DOI: 10.1001/jamainternmed.2019.1209] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study uses data from the Centers for Medicare and Medicaid Services to investigate the association between Medicare copayment policies and discharge rates of vulnerable patients from skilled nursing facilities.
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Affiliation(s)
- Paula Chatterjee
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
| | - Mingyu Qi
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Norma B Coe
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - R Tamara Konetzka
- Department of Public Health Sciences, University of Chicago, Illinois
| | - Rachel M Werner
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia.,Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
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Abstract
Millions of Americans have purchased health insurance through the Marketplaces, but their access to care is not well understood. Using an audit study, we compared the scope of primary care physicians' participation in Marketplace plans to that in other insurance types in 2016. Across ten diverse states, rates of participation in Marketplace plans were higher than those in Medicaid, but lower than those in employer-sponsored insurance.
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Affiliation(s)
- Daniel Polsky
- Daniel Polsky ( ) is the Robert D. Eilers Professor in Health Care Management and Economics and executive director of the Leonard Davis Institute of Health Economics, both at the University of Pennsylvania, in Philadelphia
| | - Molly K Candon
- Molly K. Candon is a postdoctoral fellow at the Leonard Davis Institute of Health Economics and Center for Mental Health Policy and Services Research, University of Pennsylvania
| | - Paula Chatterjee
- Paula Chatterjee is a postdoctoral fellow in the Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania
| | - Xinwei Chen
- Xinwei Chen is a statistical analyst in the Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania
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Bhattacharya J, Mukherjee M, Kumar K V, Rajan R, Shahid T, Goswami S, Naha Biswas L, Chatterjee P, Saha S. EP-1180 Re-radiation in head and neck malignancies: experience from a tertiary care centre in eastern india. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31600-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Nathan AS, Shah RM, Khatana SA, Dayoub E, Chatterjee P, Desai ND, Waldo SW, Yeh RW, Groeneveld PW, Giri J. Effect of Public Reporting on the Utilization of Coronary Angiography After Out-of-Hospital Cardiac Arrest. Circ Cardiovasc Interv 2019; 12:e007564. [PMID: 30998398 PMCID: PMC9123930 DOI: 10.1161/circinterventions.118.007564] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Public reporting of cardiovascular outcomes has been associated with risk aversion for potentially lifesaving procedures and may have spillover effects on nonreported but related procedures. METHODS AND RESULTS A cross-sectional analysis of the utilization of coronary angiography among patients presenting with out-of-hospital cardiac arrest between 2005 and 2011 in states with public reporting of percutaneous coronary intervention outcomes (New York and Massachusetts) versus neighboring states without public reporting of percutaneous coronary intervention outcomes (Delaware, Connecticut, Maine, Vermont, Maryland, and Rhode Island) was performed using the Nationwide Inpatient Sample. We analyzed 50 125 admission records with out-of-hospital cardiac arrest between 2005 and 2011. The unadjusted rate of coronary angiography for patients presenting with out-of-hospital cardiac arrest in states with public reporting versus without public reporting was not different (20.8% versus 22.8%, P=0.35). We found no statistically significant difference in the adjusted likelihood of coronary angiography in states with public reporting, though the point estimate suggested decreased utilization (odds ratio, 0.84; 95% CI, 0.66-1.06; P=0.14). There was no difference in the adjusted likelihood of in-hospital mortality for patients presenting with out-of-hospital cardiac arrest in states with public reporting compared to states without public reporting (odds ratio, 0.98; 95% CI, 0.78-1.23; P=0.88). CONCLUSIONS Public reporting of percutaneous coronary intervention outcomes was associated with a nonstatistically significant reduction in the utilization of diagnostic coronary angiography, a nonreported but related procedure, for patients with out-of-hospital cardiac arrest.
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Affiliation(s)
- Ashwin S. Nathan
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA
| | | | - Sameed A. Khatana
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA
| | - Elias Dayoub
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA
| | - Paula Chatterjee
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nimesh D. Desai
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA
| | - Stephen W. Waldo
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO
| | - Robert W. Yeh
- Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Peter W. Groeneveld
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Jay Giri
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
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Prakash A, Jaiswal A, Mittal S, Chatterjee P, Kotalwar S, Datta B. Barber′s neck manipulation causing bilateral diaphragmatic paralysis and type-2 respiratory failure. Lung India 2019. [DOI: 10.4103/0970-2113.257713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Affiliation(s)
- Atheendar S Venkataramani
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Paula Chatterjee
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Chatterjee P, Joynt Maddox K. Patterns of performance and improvement in US Medicare's Hospital Star Ratings, 2016-2017. BMJ Qual Saf 2018; 28:486-494. [PMID: 30530807 DOI: 10.1136/bmjqs-2018-008384] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/05/2018] [Accepted: 11/05/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Publicly reported quality data can help consumers make informed choices about where to seek medical care. The Centers for Medicare and Medicaid Services developed a composite Hospital Compare Overall Star Rating for US acute-care hospitals in 2016. However, patterns of performance and improvement have not been previously described. OBJECTIVE To characterise high-quality and low-quality hospitals as assessed by Star Ratings. DESIGN We performed a retrospective cross-sectional study of 3429 US acute-care hospitals assigned Overall Star Ratings in both 2016 and 2017. We used multivariable logistic regression models to identify characteristics associated with receiving 4 or 5 stars. RESULTS Small hospitals were more likely to receive 4 or 5 stars in 2016 (33% of small hospitals, 26% of medium hospitals and 21% of large hospitals, OR for medium 0.78, p=0.02, and for large, 0.61, p=0.003). Non-profit status (OR 1.37, p=0.01), midwest region (OR=2.30, p<0.001), west region (OR 1.30 in 2016, p=0.06) and system membership (OR 1.33, p=0.003) were associated with higher odds of achieving a higher Star Rating. Hospitals with the most Medicaid patients were markedly less likely to receive 4 or 5 stars (OR for highest quartile=0.32, p<0.001), and hospitals with the highest proportion of Medicare patients were somewhat less likely to do so (OR for highest quartile=0.68, p=0.01). These associations remained largely consistent over the first two years of reporting and were also associated with the highest likelihood of improvement. CONCLUSIONS Small hospitals with fewer Medicaid patients had the highest odds of performing well on Star Ratings. Further monitoring of these trends is needed as patients, clinicians and policymakers strive to use this information to promote high-quality care.
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Affiliation(s)
- Paula Chatterjee
- General Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karen Joynt Maddox
- Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
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Goozee K, Chatterjee P, James I, Shen K, Sohrabi HR, Asih PR, Dave P, ManYan C, Taddei K, Ayton SJ, Garg ML, Kwok JB, Bush AI, Chung R, Magnussen JS, Martins RN. Elevated plasma ferritin in elderly individuals with high neocortical amyloid-β load. Mol Psychiatry 2018; 23:1807-1812. [PMID: 28696433 DOI: 10.1038/mp.2017.146] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/14/2017] [Accepted: 05/26/2017] [Indexed: 12/14/2022]
Abstract
Ferritin, an iron storage and regulation protein, has been associated with Alzheimer's disease (AD); however, it has not been investigated in preclinical AD, detected by neocortical amyloid-β load (NAL), before cognitive impairment. Cross-sectional analyses were carried out for plasma and serum ferritin in participants in the Kerr Anglican Retirement Village Initiative in Aging Health cohort. Subjects were aged 65-90 years and were categorized into high and low NAL groups via positron emission tomography using a standard uptake value ratio cutoff=1.35. Ferritin was significantly elevated in participants with high NAL compared with those with low NAL, adjusted for covariates age, sex, apolipoprotein E ɛ4 carriage and levels of C-reactive protein (an inflammation marker). Ferritin was also observed to correlate positively with NAL. A receiver operating characteristic curve based on a logistic regression of the same covariates, the base model, distinguished high from low NAL (area under the curve (AUC)=0.766), but was outperformed when plasma ferritin was added to the base model (AUC=0.810), such that at 75% sensitivity, the specificity increased from 62 to 71% on adding ferritin to the base model, indicating that ferritin is a statistically significant additional predictor of NAL over and above the base model. However, ferritin's contribution alone is relatively minor compared with the base model. The current findings suggest that impaired iron mobilization is an early event in AD pathogenesis. Observations from the present study highlight ferritin's potential to contribute to a blood biomarker panel for preclinical AD.
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Affiliation(s)
- K Goozee
- Department of Biomedical Sciences, Macquarie University, Sydney, NSW, Australia.,Anglicare, Sydney, NSW, Australia.,School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia.,School of Medical Health and Sciences, Edith Cowan University, Perth, WA, Australia.,McCusker Alzheimer Research Foundation, Perth, WA, Australia.,KaRa Institute of Neurological Disease, Sydney, NSW, Australia.,The Cooperative Research Centre for Mental Health, Carlton, VIC, Australia
| | - P Chatterjee
- Department of Biomedical Sciences, Macquarie University, Sydney, NSW, Australia.,School of Medical Health and Sciences, Edith Cowan University, Perth, WA, Australia.,KaRa Institute of Neurological Disease, Sydney, NSW, Australia
| | - I James
- Institute for Immunology and Infectious Diseases, Murdoch University, Perth, WA, Australia
| | - K Shen
- Australian eHealth Research Centre, CSIRO, Floreat, WA, Australia
| | - H R Sohrabi
- Department of Biomedical Sciences, Macquarie University, Sydney, NSW, Australia.,School of Medical Health and Sciences, Edith Cowan University, Perth, WA, Australia.,McCusker Alzheimer Research Foundation, Perth, WA, Australia.,The Cooperative Research Centre for Mental Health, Carlton, VIC, Australia
| | - P R Asih
- KaRa Institute of Neurological Disease, Sydney, NSW, Australia.,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - P Dave
- Department of Biomedical Sciences, Macquarie University, Sydney, NSW, Australia.,Anglicare, Sydney, NSW, Australia
| | - C ManYan
- Anglicare, Sydney, NSW, Australia
| | - K Taddei
- School of Medical Health and Sciences, Edith Cowan University, Perth, WA, Australia.,McCusker Alzheimer Research Foundation, Perth, WA, Australia
| | - S J Ayton
- Florey Department of Neuroscience and Mental Health, University of Melbourne University, Melbourne, VIC, Australia
| | - M L Garg
- Nutraceuticals Research Program, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
| | - J B Kwok
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia.,Neuroscience Research Australia, Sydney, NSW, Australia
| | - A I Bush
- The Cooperative Research Centre for Mental Health, Carlton, VIC, Australia.,Florey Department of Neuroscience and Mental Health, University of Melbourne University, Melbourne, VIC, Australia
| | - R Chung
- Department of Biomedical Sciences, Macquarie University, Sydney, NSW, Australia
| | - J S Magnussen
- Department of Clinical Medicine, Macquarie University, Sydney, NSW, Australia
| | - R N Martins
- Department of Biomedical Sciences, Macquarie University, Sydney, NSW, Australia. .,School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia. .,School of Medical Health and Sciences, Edith Cowan University, Perth, WA, Australia. .,McCusker Alzheimer Research Foundation, Perth, WA, Australia. .,KaRa Institute of Neurological Disease, Sydney, NSW, Australia. .,The Cooperative Research Centre for Mental Health, Carlton, VIC, Australia.
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Prakash AK, Datta B, Tripathy JP, Kumar N, Chatterjee P, Jaiswal A. The clinical utility of cycle of threshold value of GeneXpert MTB/RIF (CBNAAT) and its diagnostic accuracy in pulmonary and extra-pulmonary samples at a tertiary care center in India. Indian J Tuberc 2018; 65:296-302. [PMID: 30522616 DOI: 10.1016/j.ijtb.2018.05.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/23/2018] [Accepted: 05/24/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND There are knowledge gaps in the in-depth analysis of the most promising and robust diagnostic tool, GeneXpert MTB/RIF (CBNAAT). The cycle of threshold (CT) value of the CBNAAT test and its clinical implications has not been explored much. AIMS AND OBJECTIVES The study aimed at (a) estimating the diagnostic accuracy and incremental yield of Xpert MTB/RIF in various specimens (b) establishing the association between CT value category (high, medium, low, very low) and culture time-to-positivity (TTP). METHODS A total of 1000 samples, both pulmonary and extra-pulmonary were collected from presumptive TB cases in a large tertiary care hospital. Sensitivity and specificity of CBNAAT was calculated with culture as the gold standard. The association of CT value with culture TTP was also studied. RESULTS The overall sensitivity of CBNAAT was 88.5%, with bronchial washing specimen being the most sensitive (92.3%) and pleural fluid being the least (66.7%). In smear negative individuals, the sensitivity of CBNAAT was 80.9%. The additional yield of CBNAAT over smear microscopy was 10.9%. It was observed that as we move from high to very low CT category, culture positivity decreases significantly (p<0.001), whereas time taken for culture growth increases (p<0.001). CONCLUSION CBNAAT is a robust test for accurate diagnosis of tuberculosis both pulmonary and extra-pulmonary, smear negative as well, especially in resource-limited settings. The correlation between CT value and culture TTP has potential in predicting bacillary load, though further studies are required.
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Affiliation(s)
- Ashish K Prakash
- Department of Respiratory & Sleep Medicine, Medanta - The Medicity Gurgaon, India.
| | - B Datta
- Department of Respiratory & Sleep Medicine, Medanta - The Medicity Gurgaon, India
| | - J P Tripathy
- International Union Against Tuberculosis and Lung Disease, The Union South East Asia Office, New Delhi, India
| | - N Kumar
- Department of Microbiology, Medanta - The Medicity Gurgaon, India
| | - P Chatterjee
- Department of Respiratory & Sleep Medicine, Medanta - The Medicity Gurgaon, India
| | - A Jaiswal
- Department of Respiratory & Sleep Medicine, Medanta - The Medicity Gurgaon, India
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Navathe AS, Liao JM, Shah Y, Lyon Z, Chatterjee P, Polsky D, Emanuel EJ. Characteristics of Hospitals Earning Savings in the First Year of Mandatory Bundled Payment for Hip and Knee Surgery. JAMA 2018; 319:930-932. [PMID: 29509857 PMCID: PMC5885897 DOI: 10.1001/jama.2018.0678] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study uses Medicare data to compare the characteristics of hospitals that did vs did not realize episodes savings under the Centers for Medicare & Medicaid Services’ Comprehensive Care for Joint Replacement program, which bundled payments for hip and knee surgery and paid bonuses to hospitals that exceeded quality and cost benchmarks.
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Affiliation(s)
- Amol S. Navathe
- Corporal Michael J. Crescenz Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Joshua M. Liao
- Department of Medicine, University of Washington School of Medicine, Seattle
| | - Yash Shah
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Zoe Lyon
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Paula Chatterjee
- Department of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Dan Polsky
- Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia
| | - Ezekiel J. Emanuel
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Akpoveso OO, Olivier G, Chatterjee P, Olajide O, Tumbas Šaponjac V. Investigation of potential anti-diabetic effect of Mucuna pruriens (L) DC (Fabaceae) aqueous leaf extract. Am J Transl Res 2017. [DOI: 10.1055/s-0037-1608397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- OO Akpoveso
- University of Brighton, Brighton, United Kingdom
| | - G Olivier
- University of Brighton, Brighton, United Kingdom
| | - P Chatterjee
- University of Brighton, Brighton, United Kingdom
| | - O Olajide
- University of Huddersfield, Huddersfield, United Kingdom
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Singh H, Chatterjee P, Narang R, Dey A. GERIATRIC SYNDROMES WITH HEART FAILURE, CROSS-SECTIONAL STUDY WITH IMPLICATION IN CLINICAL PRACTICE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H. Singh
- ALL INDIA INSTITUTE OF MEDICAL SCIENCES, NEW DELHI, NEW DELHI, India,
| | - P. Chatterjee
- ALL INDIA INSTITUTE OF MEDICAL SCIENCES, NEW DELHI, NEW DELHI, India,
| | - R. Narang
- CARDIOLOGY, ALL INDIA INSTITUTE OF MEDICAL SCIENCES, NEW DELHI, NEW DELHI, India
| | - A. Dey
- ALL INDIA INSTITUTE OF MEDICAL SCIENCES, NEW DELHI, NEW DELHI, India,
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Prem N, Chatterjee P, Chakrawarty A, Dey A. URINARY INCONTINENCE AMONG OLDER INDIANS: ASSESSMENT AND IMPACT ON QUALITY OF LIFE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N.N. Prem
- Geriatric Medicine, All India Insititute of Medical Sciences, New Delhi, Delhi, India
| | - P. Chatterjee
- Geriatric Medicine, All India Insititute of Medical Sciences, New Delhi, Delhi, India
| | - A. Chakrawarty
- Geriatric Medicine, All India Insititute of Medical Sciences, New Delhi, Delhi, India
| | - A.B. Dey
- Geriatric Medicine, All India Insititute of Medical Sciences, New Delhi, Delhi, India
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Subramanian M, Chatterjee P, Chakrawarty A, Dey A. A STUDY OF GAIT AND FALLS IN OLDER INDIANS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M. Subramanian
- Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi., New Delhi, India
| | - P. Chatterjee
- Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi., New Delhi, India
| | - A. Chakrawarty
- Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi., New Delhi, India
| | - A.B. Dey
- Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, New Delhi., New Delhi, India
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