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DeLong, Elizabeth Ray

Overview:

Developing methods for assessing, comparing, and validating statistical models of short and long term outcomes.
Developing and testing methods for evaluating comparative effectiveness in observational data. 

Positions:

Professor of Biostatistics and Bioinformatics

Biostatistics & Bioinformatics
School of Medicine

Chair, Department of Biostatistics and Bioinformatics

Biostatistics & Bioinformatics
School of Medicine

Member in the Duke Clinical Research Institute

Duke Clinical Research Institute
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.A. 1970

M.A. — University Maine Orono

Ph.D. 1979

Ph.D. — University of North Carolina at Chapel Hill

News:

Duke trustees approve six new graduate programs

December 09, 2013 — Durham Herald-Sun

Grants:

NIH Health Care Systems Research Collaboratory - Coordinating Center

Administered By
Duke Clinical Research Institute
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
September 15, 2017
End Date
August 31, 2022

Bridging the Gap to Enhance Clinical Research Program (BIGGER)

Administered By
Medicine, Infectious Diseases
AwardedBy
National Institutes of Health
Role
Statistician
Start Date
December 15, 2016
End Date
November 30, 2021

Putting Patients at the Center of Kidney Care Transitions

Administered By
Medicine, General Internal Medicine
AwardedBy
Patient-Centered Outcomes Research Institute
Role
Co Investigator
Start Date
January 01, 2016
End Date
December 31, 2020

IPA - Terry Hyslop

Administered By
Biostatistics & Bioinformatics
AwardedBy
Durham Veterans Affairs Medical Center
Role
Principal Investigator
Start Date
October 01, 2017
End Date
July 31, 2019

IPA - Andrzej Kosinski

Administered By
Biostatistics & Bioinformatics
AwardedBy
Durham Veterans Affairs Medical Center
Role
Principal Investigator
Start Date
April 01, 2017
End Date
March 31, 2019

Health Care Systems Research Collaboratory - Coordinating Center

Administered By
Duke Clinical Research Institute
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
September 30, 2012
End Date
August 31, 2018

Integrated Biostatistical Training for CVD Research

Administered By
Biostatistics & Bioinformatics
AwardedBy
North Carolina State University
Role
Principal Investigator
Start Date
May 01, 2017
End Date
April 30, 2018

Duke CTSA (UL1)

Administered By
Institutes and Centers
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
September 26, 2013
End Date
April 30, 2018

Duke CTSA (UL1): Statistical methods for complex data in CV disease research

Administered By
Institutes and Centers
AwardedBy
National Institutes of Health
Role
Mentor
Start Date
September 26, 2013
End Date
April 30, 2018

Duke Research Training Program for Pediatricians

Administered By
Pediatrics, Infectious Diseases
AwardedBy
National Institutes of Health
Role
Training Faculty
Start Date
July 01, 2002
End Date
April 30, 2018

Making better use of randomized trials: assessing applicability & transporting causal effects

Administered By
Biostatistics & Bioinformatics
AwardedBy
Brown University
Role
Principal Investigator
Start Date
March 01, 2016
End Date
February 28, 2018

Engaging, Inspiring, and Preparing the Next Generation of Biostatisticians

Administered By
Biostatistics & Bioinformatics
AwardedBy
North Carolina State University
Role
Principal Investigator
Start Date
September 01, 2016
End Date
July 31, 2017

Supplement to: Evaluating Observational data Analyses:Confounding Control and Treatment Effect Heterogeneity

Administered By
Biostatistics & Bioinformatics
AwardedBy
Brown University
Role
Principal Investigator
Start Date
June 01, 2016
End Date
May 31, 2017

Integrating Causal Inference, Evidence Synthesis, and Research Prioritization Methods

Administered By
Biostatistics & Bioinformatics
AwardedBy
Tufts University
Role
Principal Investigator
Start Date
January 01, 2017
End Date
March 31, 2017

Institutional Training Grant in Pediatric Infectious Disease

Administered By
Pediatrics, Infectious Diseases
AwardedBy
National Institutes of Health
Role
Mentor
Start Date
May 21, 2011
End Date
December 31, 2016

Integrating Causal Inference, Evidence Synthesis, and Research Prioritization Methods

Administered By
Biostatistics & Bioinformatics
AwardedBy
Tufts University
Role
Principal Investigator
Start Date
October 01, 2013
End Date
December 30, 2016

Clinical and Molecular Epidemiology of Multidrug-Resistant Organisms in a Community Hospital

Administered By
Medicine, Infectious Diseases
AwardedBy
National Institutes of Health
Role
Advisor
Start Date
July 15, 2011
End Date
June 30, 2016

Engaging, Inspiring, and Preparing the Next Generation of Biostatisticians

Administered By
Duke Clinical Research Institute
AwardedBy
North Carolina State University
Role
Principal Investigator
Start Date
August 20, 2009
End Date
February 28, 2016

IPA-Yuliya Lokhnygina

Administered By
Duke Clinical Research Institute
AwardedBy
Durham Veterans Affairs Medical Center
Role
Principal Investigator
Start Date
August 14, 2012
End Date
June 30, 2014

Career Development in Outcomes Assessment in Congenital Heart Surgery

Administered By
Duke Clinical Research Institute
AwardedBy
National Institutes of Health
Role
Advisor
Start Date
July 20, 2010
End Date
April 30, 2014

IPA for Robert Woolson

Administered By
Biostatistics & Bioinformatics
AwardedBy
Department of Veterans Affairs
Role
Principal Investigator
Start Date
February 01, 2012
End Date
November 30, 2013

Inter-disciplinary Program for Training and Mentoring in CER Methods and Practice

Administered By
Biostatistics & Bioinformatics
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
September 28, 2010
End Date
September 27, 2013

Duke Cardiovascular CERTs

Administered By
Duke Clinical Research Institute
AwardedBy
Agency for Healthcare Research and Quality
Role
Co Investigator
Start Date
September 01, 2007
End Date
February 29, 2012

IPA for Robert Woolson

Administered By
Biostatistics & Bioinformatics
AwardedBy
Department of Veterans Affairs
Role
Principal Investigator
Start Date
February 01, 2010
End Date
January 31, 2012

Barriers to Optimal Cardiovascular Medication Use in Diabetes and Renal Disease

Administered By
Duke Clinical Research Institute
AwardedBy
National Institutes of Health
Role
Co-Mentor
Start Date
September 25, 2006
End Date
August 31, 2011

Early Diagnosis of Neonatal Candidiasis

Administered By
Duke Clinical Research Institute
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
January 01, 2005
End Date
December 31, 2009

Safer Antithrombotic Therapy for Elderly ACS Patients

Administered By
Duke Clinical Research Institute
AwardedBy
National Institutes of Health
Role
Co-Principal Investigator
Start Date
September 15, 2005
End Date
July 31, 2008

Towards an Understanding of the Pathophysiology and Clinical Outcomes of Patients w/Endocarditis

Administered By
Duke Clinical Research Institute
AwardedBy
National Institutes of Health
Role
Statistician
Start Date
July 10, 2002
End Date
June 30, 2006

Impact of early discharge following bypass surgery

Administered By
Duke Clinical Research Institute
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
September 11, 2000
End Date
August 31, 2004

Coordinating Center for CERTs

Administered By
Duke Clinical Research Institute
AwardedBy
National Institutes of Health
Role
Biostatistician
Start Date
September 30, 2002
End Date
September 29, 2003

Managed Care Features Affecting Quality for CAD Patients

Administered By
Duke Clinical Research Institute
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
July 26, 1999
End Date
June 30, 2003

DCRI CERT for Cardiovascular Therapies

Administered By
Duke Clinical Research Institute
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
September 30, 1999
End Date
September 29, 2002

Validating Risk Prediction Models In Cardiology

Administered By
Community and Family Medicine
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
September 30, 1995
End Date
September 29, 1998

Magnetic Resonance Studies In Venous Thromboembolism

Administered By
Radiology
AwardedBy
National Institutes of Health
Role
Co-Principal Investigator
Start Date
July 01, 1993
End Date
June 30, 1996

Outcome Assessment Program In Ischemic Heart Disease

Administered By
Community and Family Medicine
AwardedBy
National Institutes of Health
Role
Co-Principal Investigator
Start Date
July 01, 1990
End Date
December 31, 1995

Outcome Assessment Program In Ischemic Heart Disease

Administered By
Community and Family Medicine
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
July 01, 1990
End Date
December 31, 1995

Outcome Assessment Program In Ischemic Heart Disease

Administered By
Medicine, Cardiology
AwardedBy
National Institutes of Health
Role
Co-Principal Investigator
Start Date
July 01, 1992
End Date
June 30, 1995
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Publications:

An evaluation of constrained randomization for the design and analysis of group-randomized trials.

In group-randomized trials, a frequent practical limitation to adopting rigorous research designs is that only a small number of groups may be available, and therefore, simple randomization cannot be relied upon to balance key group-level prognostic factors across the comparison arms. Constrained randomization is an allocation technique proposed for ensuring balance and can be used together with a permutation test for randomization-based inference. However, several statistical issues have not been thoroughly studied when constrained randomization is considered. Therefore, we used simulations to evaluate key issues including the following: the impact of the choice of the candidate set size and the balance metric used to guide randomization; the choice of adjusted versus unadjusted analysis; and the use of model-based versus randomization-based tests. We conducted a simulation study to compare the type I error and power of the F-test and the permutation test in the presence of group-level potential confounders. Our results indicate that the adjusted F-test and the permutation test perform similarly and slightly better for constrained randomization relative to simple randomization in terms of power, and the candidate set size does not substantially affect their power. Under constrained randomization, however, the unadjusted F-test is conservative, while the unadjusted permutation test carries the desired type I error rate as long as the candidate set size is not too small; the unadjusted permutation test is consistently more powerful than the unadjusted F-test and gains power as candidate set size changes. Finally, we caution against the inappropriate specification of permutation distribution under constrained randomization. An ongoing group-randomized trial is used as an illustrative example for the constrained randomization design.

Authors
Li, F; Lokhnygina, Y; Murray, DM; Heagerty, PJ; DeLong, ER
MLA Citation
Li, F, Lokhnygina, Y, Murray, DM, Heagerty, PJ, and DeLong, ER. "An evaluation of constrained randomization for the design and analysis of group-randomized trials." Statistics in medicine 35.10 (May 2016): 1565-1579.
PMID
26598212
Source
epmc
Published In
Statistics in Medicine
Volume
35
Issue
10
Publish Date
2016
Start Page
1565
End Page
1579
DOI
10.1002/sim.6813

A Cluster Randomized Controlled Trial to Evaluate The Effect of a Simplified Multifaceted Management Program in High Cardiovascular Disease Risk Patients in Rural China and India: Simcard Study

Authors
Tian, M; Ajay, VS; Dunzhu, D; Hameed, SS; Li, X; Liu, Z; Li, C; Chen, H; Cho, K; Li, R; Zhao, X; Jindal, D; Rawal, I; Ali, MK; Peterson, ED; Delong, ER; Ji, J; Amarchand, R; Krishnan, A; Tandon, N; Xu, L-Q; Wu, Y; Prabhakaran, D; Yan, LL
MLA Citation
Tian, M, Ajay, VS, Dunzhu, D, Hameed, SS, Li, X, Liu, Z, Li, C, Chen, H, Cho, K, Li, R, Zhao, X, Jindal, D, Rawal, I, Ali, MK, Peterson, ED, Delong, ER, Ji, J, Amarchand, R, Krishnan, A, Tandon, N, Xu, L-Q, Wu, Y, Prabhakaran, D, and Yan, LL. "A Cluster Randomized Controlled Trial to Evaluate The Effect of a Simplified Multifaceted Management Program in High Cardiovascular Disease Risk Patients in Rural China and India: Simcard Study." December 2, 2014.
Source
wos-lite
Published In
Circulation
Volume
130
Issue
23
Publish Date
2014
Start Page
2117
End Page
2117

Composite outcomes in coronary bypass surgery versus percutaneous intervention.

Recent observational studies show that patients with multivessel coronary disease have a long-term survival advantage with coronary artery bypass grafting (CABG) compared with percutaneous coronary intervention (PCI). Important nonfatal outcomes may also affect optimal treatment recommendation.CABG was compared with percutaneous catheter intervention by using a composite of death, myocardial infarction (MI), or stroke. Medicare patients undergoing revascularization for stable multivessel coronary disease from 2004 through 2008 were identified in national registries. Short-term clinical information from the registries was linked to Medicare data to obtain long-term follow-up out to 4 years from the time of the procedure. Propensity scoring with inverse probability weighting was used to adjust for baseline risk factors.There were 86,244 CABG and 103,549 PCI patients. The mean age was 74 years, with a median 2.67 years of follow-up. At 4 years, the propensity-adjusted adjusted cumulative incidence of MI was 3.2% in CABG compared with 6.6% in PCI (risk ratio, 0.49; 95% confidence interval, 0.45 to 0.53). At 4 years, the cumulative incidence of stroke was 4.5% in CABG compared with 3.1% in PCI patients (risk ratio, 1.43; 95% confidence interval, 1.31 to 1.54). This difference was primarily due to the higher 30-day stroke rate for CABG (1.55% vs 0.37%). For the composite of death, MI, or stroke, the 4-year adjusted cumulative incidence was 21.6% for CABG and 26.7% for PCI (risk ratio, 0.81; 95% confidence interval, 0.78 to 0.83).The 4-year composite event rate of death, MI, and stroke favored CABG, whereas the risk of stroke alone favored PCI.

Authors
Edwards, FH; Shahian, DM; Grau-Sepulveda, MV; Grover, FL; Mayer, JE; O'Brien, SM; DeLong, E; Peterson, ED; McKay, C; Shaw, RE; Garratt, KN; Dangas, GD; Messenger, J; Klein, LW; Popma, JJ; Weintraub, WS
MLA Citation
Edwards, FH, Shahian, DM, Grau-Sepulveda, MV, Grover, FL, Mayer, JE, O'Brien, SM, DeLong, E, Peterson, ED, McKay, C, Shaw, RE, Garratt, KN, Dangas, GD, Messenger, J, Klein, LW, Popma, JJ, and Weintraub, WS. "Composite outcomes in coronary bypass surgery versus percutaneous intervention." The Annals of thoracic surgery 97.6 (June 2014): 1983-1988.
PMID
24775805
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
97
Issue
6
Publish Date
2014
Start Page
1983
End Page
1988
DOI
10.1016/j.athoracsur.2014.01.087

Population impact of a high cardiovascular risk management program delivered by village doctors in rural China: design and rationale of a large, cluster-randomized controlled trial.

The high-risk strategy has been proven effective in preventing cardiovascular disease; however, the population benefits from these interventions remain unknown. This study aims to assess, at the population level, the effects of an evidence-based high cardiovascular risk management program delivered by village doctors in rural China.The study will employ a cluster-randomized controlled trial in which a total of 120 villages in five northern provinces of China, will be assigned to either intervention (60 villages) or control (60 villages). Village doctors in intervention villages will be trained to implement a simple evidence-based management program designed to identify, treat and follow-up as many as possible individuals at high-risk of cardiovascular disease in the village. The intervention will also include performance feedback as well as a performance-based incentive payment scheme and will last for 2 years. We will draw two different (independent) random samples, before and after the intervention, 20 men aged≥50 years and 20 women aged≥60 years from each village in each sample and a total of 9,600 participants from 2 samples to measure the study outcomes at the population level. The primary outcome will be the pre-post difference in mean systolic blood pressure, analyzed with a generalized estimating equations extension of linear regression model to account for cluster effect. Secondary outcomes will include monthly clinic visits, provision of lifestyle advice, use of antihypertensive medications and use of aspirin. Process and economic evaluations will also be conducted.This trial will be the first implementation trial in the world to evaluate the population impact of the high-risk strategy in prevention and control of cardiovascular disease. The results are expected to provide important information (effectiveness, cost-effectiveness, feasibility and acceptability) to guide policy making for rural China as well as other resource-limited countries.The trial is registered at ClinicalTrials.gov (NCT01259700). Date of initial registration is December 13, 2010.

Authors
Yan, LL; Fang, W; Delong, E; Neal, B; Peterson, ED; Huang, Y; Sun, N; Yao, C; Li, X; MacMahon, S; Wu, Y
MLA Citation
Yan, LL, Fang, W, Delong, E, Neal, B, Peterson, ED, Huang, Y, Sun, N, Yao, C, Li, X, MacMahon, S, and Wu, Y. "Population impact of a high cardiovascular risk management program delivered by village doctors in rural China: design and rationale of a large, cluster-randomized controlled trial." BMC public health 14 (April 11, 2014): 345-.
Website
http://hdl.handle.net/10161/15015
PMID
24721435
Source
epmc
Published In
BMC Public Health
Volume
14
Publish Date
2014
Start Page
345
DOI
10.1186/1471-2458-14-345

Angiographic validation of the American College of Cardiology Foundation-the Society of Thoracic Surgeons Collaboration on the Comparative Effectiveness of Revascularization Strategies study.

The goal of this study was to compare angiographic interpretation of coronary arteriograms by sites in community practice versus those made by a centralized angiographic core laboratory.The study population consisted of 2013 American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR) records with 2- and 3- vessel coronary disease from 54 sites in 2004 to 2007. The primary analysis compared Registry (NCDR)-defined 2- and 3-vessel disease versus those from an angiographic core laboratory analysis. Vessel-level kappa coefficients suggested moderate agreement between NCDR and core laboratory analysis, ranging from kappa=0.39 (95% confidence intervals, 0.32-0.45) for the left anterior descending artery to kappa=0.59 (95% confidence intervals, 0.55-0.64) for the right coronary artery. Overall, 6.3% (n=127 out of 2013) of those patients identified with multivessel disease at NCDR sites had had 0- or 1-vessel disease by core laboratory reading. There was no directional bias with regard to overcall, that is, 12.3% of cases read as 3-vessel disease by the sites were read as <3-vessel disease by the core laboratory, and 13.9% of core laboratory 3-vessel cases were read as <3-vessel by the sites. For a subset of patients with left main coronary disease, registry overcall was not linked to increased rates of mortality or myocardial infarction.There was only modest agreement between angiographic readings in clinical practice and those from an independent core laboratory. Further study will be needed because the implications for patient management are uncertain.

Authors
Chakrabarti, AK; Grau-Sepulveda, MV; O'Brien, S; Abueg, C; Ponirakis, A; Delong, E; Peterson, E; Klein, LW; Garratt, KN; Weintraub, WS; Gibson, CM
MLA Citation
Chakrabarti, AK, Grau-Sepulveda, MV, O'Brien, S, Abueg, C, Ponirakis, A, Delong, E, Peterson, E, Klein, LW, Garratt, KN, Weintraub, WS, and Gibson, CM. "Angiographic validation of the American College of Cardiology Foundation-the Society of Thoracic Surgeons Collaboration on the Comparative Effectiveness of Revascularization Strategies study." Circulation. Cardiovascular interventions 7.1 (February 4, 2014): 11-18.
PMID
24496239
Source
epmc
Published In
Circulation: Cardiovascular Interventions
Volume
7
Issue
1
Publish Date
2014
Start Page
11
End Page
18
DOI
10.1161/circinterventions.113.000679

Composite outcomes in coronary bypass surgery versus percutaneous intervention

Background Recent observational studies show that patients with multivessel coronary disease have a long-term survival advantage with coronary artery bypass grafting (CABG) compared with percutaneous coronary intervention (PCI). Important nonfatal outcomes may also affect optimal treatment recommendation. Methods CABG was compared with percutaneous catheter intervention by using a composite of death, myocardial infarction (MI), or stroke. Medicare patients undergoing revascularization for stable multivessel coronary disease from 2004 through 2008 were identified in national registries. Short-term clinical information from the registries was linked to Medicare data to obtain long-term follow-up out to 4 years from the time of the procedure. Propensity scoring with inverse probability weighting was used to adjust for baseline risk factors. Results There were 86,244 CABG and 103,549 PCI patients. The mean age was 74 years, with a median 2.67 years of follow-up. At 4 years, the propensity-adjusted adjusted cumulative incidence of MI was 3.2% in CABG compared with 6.6% in PCI (risk ratio, 0.49; 95% confidence interval, 0.45 to 0.53). At 4 years, the cumulative incidence of stroke was 4.5% in CABG compared with 3.1% in PCI patients (risk ratio, 1.43; 95% confidence interval, 1.31 to 1.54). This difference was primarily due to the higher 30-day stroke rate for CABG (1.55% vs 0.37%). For the composite of death, MI, or stroke, the 4-year adjusted cumulative incidence was 21.6% for CABG and 26.7% for PCI (risk ratio, 0.81; 95% confidence interval, 0.78 to 0.83). Conclusions The 4-year composite event rate of death, MI, and stroke favored CABG, whereas the risk of stroke alone favored PCI. © 2014 by The Society of Thoracic Surgeons Published by Elsevier Inc.

Authors
Edwards, FH; Shahian, DM; Grau-Sepulveda, MV; Grover, FL; Mayer, JE; O'Brien, SM; Delong, E; Peterson, ED; McKay, C; Shaw, RE; Garratt, KN; Dangas, GD; Messenger, J; Klein, LW; Popma, JJ; Weintraub, WS
MLA Citation
Edwards, FH, Shahian, DM, Grau-Sepulveda, MV, Grover, FL, Mayer, JE, O'Brien, SM, Delong, E, Peterson, ED, McKay, C, Shaw, RE, Garratt, KN, Dangas, GD, Messenger, J, Klein, LW, Popma, JJ, and Weintraub, WS. "Composite outcomes in coronary bypass surgery versus percutaneous intervention." Annals of Thoracic Surgery 97.6 (January 1, 2014): 1983-1990.
Source
scopus
Published In
The Annals of Thoracic Surgery
Volume
97
Issue
6
Publish Date
2014
Start Page
1983
End Page
1990
DOI
10.1016/j.athoracsur.2014.01.087

Predictors of long-term survival after coronary artery bypass grafting surgery: results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database (the ASCERT study).

BACKGROUND: Most survival prediction models for coronary artery bypass grafting surgery are limited to in-hospital or 30-day end points. We estimate a long-term survival model using data from the Society of Thoracic Surgeons Adult Cardiac Surgery Database and Centers for Medicare and Medicaid Services. METHODS AND RESULTS: The final study cohort included 348 341 isolated coronary artery bypass grafting patients aged ≥65 years, discharged between January 1, 2002, and December 31, 2007, from 917 Society of Thoracic Surgeons-participating hospitals, randomly divided into training (n=174 506) and validation (n=173 835) samples. Through linkage with Centers for Medicare and Medicaid Services claims data, we ascertained vital status from date of surgery through December 31, 2008 (1- to 6-year follow-up). Because the proportional hazards assumption was violated, we fit 4 Cox regression models conditional on being alive at the beginning of the following intervals: 0 to 30 days, 31 to 180 days, 181 days to 2 years, and >2 years. Kaplan-Meier-estimated mortality was 3.2% at 30 days, 6.4% at 180 days, 8.1% at 1 year, and 23.3% at 3 years of follow-up. Harrell's C statistic for predicting overall survival time was 0.732. Some risk factors (eg, emergency status, shock, reoperation) were strong predictors of short-term outcome but, for early survivors, became nonsignificant within 2 years. The adverse impact of some other risk factors (eg, dialysis-dependent renal failure, insulin-dependent diabetes mellitus) continued to increase. CONCLUSIONS: Using clinical registry data and longitudinal claims data, we developed a long-term survival prediction model for isolated coronary artery bypass grafting. This provides valuable information for shared decision making, comparative effectiveness research, quality improvement, and provider profiling.

Authors
Shahian, DM; O'Brien, SM; Sheng, S; Grover, FL; Mayer, JE; Jacobs, JP; Weiss, JM; Delong, ER; Peterson, ED; Weintraub, WS; Grau-Sepulveda, MV; Klein, LW; Shaw, RE; Garratt, KN; Moussa, ID; Shewan, CM; Dangas, GD; Edwards, FH
MLA Citation
Shahian, DM, O'Brien, SM, Sheng, S, Grover, FL, Mayer, JE, Jacobs, JP, Weiss, JM, Delong, ER, Peterson, ED, Weintraub, WS, Grau-Sepulveda, MV, Klein, LW, Shaw, RE, Garratt, KN, Moussa, ID, Shewan, CM, Dangas, GD, and Edwards, FH. "Predictors of long-term survival after coronary artery bypass grafting surgery: results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database (the ASCERT study)." Circulation 125.12 (March 27, 2012): 1491-1500.
PMID
22361330
Source
pubmed
Published In
Circulation
Volume
125
Issue
12
Publish Date
2012
Start Page
1491
End Page
1500
DOI
10.1161/CIRCULATIONAHA.111.066902

Prediction of long-term mortality after percutaneous coronary intervention in older adults: results from the National Cardiovascular Data Registry.

BACKGROUND: The purpose of this study was to develop a long-term model to predict mortality after percutaneous coronary intervention in both patients with ST-segment elevation myocardial infarction and those with more stable coronary disease. METHODS AND RESULTS: The American College of Cardiology Foundation CathPCI Registry data were linked to the Centers for Medicare and Medicaid Services 100% denominator file by probabilistic matching. Preprocedure demographic and clinical variables from the CathPCI Registry were used to predict the probability of death over 3 years as recorded in the Centers for Medicare and Medicaid Services database. Between 2004 and 2007, 343 466 patients (66%) of 518 195 patients aged ≥65 years undergoing first percutaneous coronary intervention in the CathPCI Registry were successfully linked to Centers for Medicare and Medicaid Services data. This study population was randomly divided into 60% derivation and 40% validation cohorts. Median follow-up was 15 months, with mortality of 3.0% at 30 days and 8.7%, 13.4%, and 18.7% at 1, 2, and 3 years, respectively. Twenty-four characteristics related to demographics, clinical comorbidity, prior history of disease, and indices of disease severity and acuity were identified as being associated with mortality. The C indices in the validation cohorts for patients with and without ST-segment elevation myocardial infarction were 0.79 and 0.78. The model calibrated well across a wide range of predicted probabilities. CONCLUSIONS: On the basis of the large and nationally representative CathPCI Registry, we have developed a model that has excellent discrimination, calibration, and validation to predict survival up to 3 years after percutaneous coronary intervention.

Authors
Weintraub, WS; Grau-Sepulveda, MV; Weiss, JM; Delong, ER; Peterson, ED; O'Brien, SM; Kolm, P; Klein, LW; Shaw, RE; McKay, C; Ritzenthaler, LL; Popma, JJ; Messenger, JC; Shahian, DM; Grover, FL; Mayer, JE; Garratt, KN; Moussa, ID; Edwards, FH; Dangas, GD
MLA Citation
Weintraub, WS, Grau-Sepulveda, MV, Weiss, JM, Delong, ER, Peterson, ED, O'Brien, SM, Kolm, P, Klein, LW, Shaw, RE, McKay, C, Ritzenthaler, LL, Popma, JJ, Messenger, JC, Shahian, DM, Grover, FL, Mayer, JE, Garratt, KN, Moussa, ID, Edwards, FH, and Dangas, GD. "Prediction of long-term mortality after percutaneous coronary intervention in older adults: results from the National Cardiovascular Data Registry." Circulation 125.12 (March 27, 2012): 1501-1510.
PMID
22361329
Source
pubmed
Published In
Circulation
Volume
125
Issue
12
Publish Date
2012
Start Page
1501
End Page
1510
DOI
10.1161/CIRCULATIONAHA.111.066969

Response to letter regarding article, "predictors of long-term survival after coronary artery bypass grafting surgery: Results from the society of thoracic surgeons adult cardiac surgery database (the ASCERT Study)"

Authors
Shahian, DM; O'Brien, SM; Sheng, S; Delong, ER; Peterson, ED; Grau-Sepulveda, MV; Grover, FL; Mayer, JE; Jacobs, JP; Weiss, JM; Weintraub, WS; Klein, LW; Shaw, RE; Garratt, K; Moussa, I; Shewan, CM; Dangas, GD; Edwards, FH
MLA Citation
Shahian, DM, O'Brien, SM, Sheng, S, Delong, ER, Peterson, ED, Grau-Sepulveda, MV, Grover, FL, Mayer, JE, Jacobs, JP, Weiss, JM, Weintraub, WS, Klein, LW, Shaw, RE, Garratt, K, Moussa, I, Shewan, CM, Dangas, GD, and Edwards, FH. "Response to letter regarding article, "predictors of long-term survival after coronary artery bypass grafting surgery: Results from the society of thoracic surgeons adult cardiac surgery database (the ASCERT Study)"." Circulation 126.16 (2012): e259-.
Source
scival
Published In
Circulation
Volume
126
Issue
16
Publish Date
2012
Start Page
e259
DOI
10.1161/CIRCULATIONAHA.112.130989

ACCF/AHA methodology for the development of quality measures for cardiovascular technology: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures.

Consistent with the growing national focus on healthcare quality, the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) have taken a leadership role over the past decade in developing measures of the quality of cardiovascular care by convening a joint ACCF/AHA Task Force on Performance Measures. The Task Force is charged with identifying the clinical topics appropriate for the development of performance measures and with assembling writing committees composed of clinical and methodological experts in collaboration with appropriate subspecialty societies. The Task Force has also created methodology documents that offer guidance in the development of process, outcome, composite, and efficiency measures. Cardiovascular performance measures using existing ACCF/AHA methodology are based on Class I or Class III guidelines recommendations, usually with Level A evidence. These performance measures, based on evidence-based ACCF/AHA guidelines, remain the most rigorous quality measures for both internal quality improvement and public reporting. However, many of the tools for diagnosis and treatment of cardiovascular disease involve advanced technologies, such as cardiac imaging, for which there are often no underlying guideline documents. Because these technologies affect the quality of cardiovascular care and also have the potential to contribute to cardiovascular health expenditures, there is a need for more critical assessment of the use of technology, including the development of quality and performance measures in areas in which guideline recommendations are absent. The evaluation of quality in the use of cardiovascular technologies requires consideration of multiple parameters that differ from other healthcare processes. The present document describes methodology for development of 2 new classes of quality measures in these situations, appropriate use measures and structure/safety measures. Appropriate use measures are based on specific indications, processes, or parameters of care for which high level of evidence data and Class I or Class III guideline recommendations may be lacking but are addressed in ACCF appropriate use criteria documents. Structure/safety measures represent measures developed to address structural aspects of the use of healthcare technology (e.g., laboratory accreditation, personnel training, and credentialing) or quality issues related to patient safety when there are neither guidelines recommendations nor appropriate use criteria. Although the strength of evidence for appropriate use measures and structure/safety measures may not be as strong as that for formal performance measures, they are quality measures that are otherwise rigorously developed, reviewed, tested, and approved in the same manner as ACCF/AHA performance measures. The ultimate goal of the present document is to provide direction in defining and measuring the appropriate use-avoiding not only underuse but also overuse and misuse-and proper application of cardiovascular technology and to describe how such appropriate use measures and structure/safety measures might be developed for the purposes of quality improvement and public reporting. It is anticipated that this effort will help focus the national dialogue on the use of cardiovascular technology and away from the current concerns about volume and cost alone to a more holistic emphasis on value.

Authors
Bonow, RO; Douglas, PS; Buxton, AE; Cohen, DJ; Curtis, JP; Delong, E; Drozda, JP; Ferguson, TB; Heidenreich, PA; Hendel, RC; Masoudi, FA; Peterson, ED; Taylor, AJ; American College of Cardiology Foundation, ; American Heart Association Task Force on Performance Measures,
MLA Citation
Bonow, RO, Douglas, PS, Buxton, AE, Cohen, DJ, Curtis, JP, Delong, E, Drozda, JP, Ferguson, TB, Heidenreich, PA, Hendel, RC, Masoudi, FA, Peterson, ED, Taylor, AJ, American College of Cardiology Foundation, , and American Heart Association Task Force on Performance Measures, . "ACCF/AHA methodology for the development of quality measures for cardiovascular technology: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures." Circulation 124.13 (September 27, 2011): 1483-1502.
PMID
21875906
Source
pubmed
Published In
Circulation
Volume
124
Issue
13
Publish Date
2011
Start Page
1483
End Page
1502
DOI
10.1161/CIR.0b013e31822935fc

ACCF/AHA methodology for the development of quality measures for cardiovascular technology: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures.

Consistent with the growing national focus on healthcare quality, the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) have taken a leadership role over the past decade in developing measures of the quality of cardiovascular care by convening a joint ACCF/AHA Task Force on Performance Measures. The Task Force is charged with identifying the clinical topics appropriate for the development of performance measures and with assembling writing committees composed of clinical and methodological experts in collaboration with appropriate subspecialty societies. The Task Force has also created methodology documents that offer guidance in the development of process, outcome, composite, and efficiency measures. Cardiovascular performance measures using existing ACCF/AHA methodology are based on Class I or Class III guidelines recommendations, usually with Level A evidence. These performance measures, based on evidence-based ACCF/AHA guidelines, remain the most rigorous quality measures for both internal quality improvement and public reporting. However, many of the tools for diagnosis and treatment of cardiovascular disease involve advanced technologies, such as cardiac imaging, for which there are often no underlying guideline documents. Because these technologies affect the quality of cardiovascular care and also have the potential to contribute to cardiovascular health expenditures, there is a need for more critical assessment of the use of technology, including the development of quality and performance measures in areas in which guideline recommendations are absent. The evaluation of quality in the use of cardiovascular technologies requires consideration of multiple parameters that differ from other healthcare processes. The present document describes methodology for development of 2 new classes of quality measures in these situations, appropriate use measures and structure/safety measures. Appropriate use measures are based on specific indications, processes, or parameters of care for which high level of evidence data and Class I or Class III guideline recommendations may be lacking but are addressed in ACCF appropriate use criteria documents. Structure/safety measures represent measures developed to address structural aspects of the use of healthcare technology (e.g., laboratory accreditation, personnel training, and credentialing) or quality issues related to patient safety when there are neither guidelines recommendations nor appropriate use criteria. Although the strength of evidence for appropriate use measures and structure/safety measures may not be as strong as that for formal performance measures, they are quality measures that are otherwise rigorously developed, reviewed, tested, and approved in the same manner as ACCF/AHA performance measures. The ultimate goal of the present document is to provide direction in defining and measuring the appropriate use-avoiding not only underuse but also overuse and misuse-and proper application of cardiovascular technology and to describe how such appropriate use measures and structure/safety measures might be developed for the purposes of quality improvement and public reporting. It is anticipated that this effort will help focus the national dialogue on the use of cardiovascular technology and away from the current concerns about volume and cost alone to a more holistic emphasis on value.

Authors
Bonow, RO; Douglas, PS; Buxton, AE; Cohen, DJ; Curtis, JP; Delong, E; Drozda, JP; Ferguson, TB; Heidenreich, PA; Hendel, RC; Masoudi, FA; Peterson, ED; Taylor, AJ
MLA Citation
Bonow, RO, Douglas, PS, Buxton, AE, Cohen, DJ, Curtis, JP, Delong, E, Drozda, JP, Ferguson, TB, Heidenreich, PA, Hendel, RC, Masoudi, FA, Peterson, ED, and Taylor, AJ. "ACCF/AHA methodology for the development of quality measures for cardiovascular technology: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures." J Am Coll Cardiol 58.14 (September 27, 2011): 1517-1538.
PMID
21880456
Source
pubmed
Published In
Journal of the American College of Cardiology
Volume
58
Issue
14
Publish Date
2011
Start Page
1517
End Page
1538
DOI
10.1016/j.jacc.2011.07.007

Secondary prevention after coronary artery bypass graft surgery: findings of a national randomized controlled trial and sustained society-led incorporation into practice.

BACKGROUND: Despite evidence supporting the use of aspirin, β-blockers, angiotensin-converting enzyme inhibitors, and lipid-lowering therapies in eligible patients, adoption of these secondary prevention measures after coronary artery bypass grafting has been inconsistent. We sought to rigorously test on a national scale whether low-intensity continuous quality improvement interventions can be used to speed secondary prevention adherence after coronary artery bypass grafting. METHODS AND RESULTS: A total of 458 hospitals participating in the Society of Thoracic Surgeons National Cardiac Database and treating 361 328 patients undergoing isolated coronary artery bypass grafting were randomized to either a control or an intervention group. The intervention group received continuous quality improvement materials designed to influence the prescription of the secondary prevention medications at discharge. The primary outcome measure was discharge prescription rates of the targeted secondary prevention medications at intervention versus control sites, assessed by measuring preintervention and postintervention site differences. Prerandomization treatment patterns and baseline data were similar in the control (n=234) and treatment (n=224) groups. Individual medication use and composite adherence increased over 24 months in both groups, with a markedly more rapid rate of adherence uptake among the intervention hospitals and a statistically significant therapy hazard ratio in the intervention versus control group for all 4 secondary prevention medications. CONCLUSIONS: Provider-led, low-intensity continuous quality improvement efforts can improve the adoption of care processes into national practice within the context of a medical specialty society infrastructure. The findings of the present trial have led to the incorporation of study outcome metrics into a medical society rating system for ongoing quality improvement.

Authors
Williams, JB; Delong, ER; Peterson, ED; Dokholyan, RS; Ou, F-S; Ferguson, TB; Society of Thoracic Surgeons and the National Cardiac Database,
MLA Citation
Williams, JB, Delong, ER, Peterson, ED, Dokholyan, RS, Ou, F-S, Ferguson, TB, and Society of Thoracic Surgeons and the National Cardiac Database, . "Secondary prevention after coronary artery bypass graft surgery: findings of a national randomized controlled trial and sustained society-led incorporation into practice." Circulation 123.1 (January 4, 2011): 39-45.
PMID
21173357
Source
pubmed
Published In
Circulation
Volume
123
Issue
1
Publish Date
2011
Start Page
39
End Page
45
DOI
10.1161/CIRCULATIONAHA.110.981068

ACCF/AHA/ACR/SCAI/SIR/SVM/SVN/SVS 2010 performance measures for adults with peripheral artery disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures, the American College of Radiology, the Society for Cardiac Angiography and Interventions, the Society for Interventional Radiology, the Society for Vascular Medicine, the Socie

Authors
Olin, JW; Allie, DE; Belkin, M; Bonow, RO; Casey, DE; Creager, MA; Gerber, TC; Hirsch, AT; Jaff, MR; Kaufman, JA; Lewis, CA; Martin, ET; Martin, LG; Sheehan, P; Stewart, KJ; Treat-Jacobson, D; White, CJ; Zheng, Z-J; Masoudi, FA; Bonow, RO; DeLong, E; Erwin, JP; Goff, DC; Grady, K; Green, LA; Heidenreich, PA; Jenkins, KJ; Loth, AR; Peterson, ED; Shahian, DM
MLA Citation
Olin, JW, Allie, DE, Belkin, M, Bonow, RO, Casey, DE, Creager, MA, Gerber, TC, Hirsch, AT, Jaff, MR, Kaufman, JA, Lewis, CA, Martin, ET, Martin, LG, Sheehan, P, Stewart, KJ, Treat-Jacobson, D, White, CJ, Zheng, Z-J, Masoudi, FA, Bonow, RO, DeLong, E, Erwin, JP, Goff, DC, Grady, K, Green, LA, Heidenreich, PA, Jenkins, KJ, Loth, AR, Peterson, ED, and Shahian, DM. "ACCF/AHA/ACR/SCAI/SIR/SVM/SVN/SVS 2010 performance measures for adults with peripheral artery disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures, the American College of Radiology, the Society for Cardiac Angiography and Interventions, the Society for Interventional Radiology, the Society for Vascular Medicine, the Socie." Journal of Vascular Nursing 29.1 (2011): 23-60.
Source
scival
Published In
Journal of Vascular Nursing
Volume
29
Issue
1
Publish Date
2011
Start Page
23
End Page
60
DOI
10.1016/j.jvn.2010.11.002

A Prediction Model for Long Term Mortality after PCI: Results from the NCDR

Authors
Weintraub, WS; Grau-Sepulveda, MV; Weiss, JM; DeLong, ER; Peterson, ED; O'Brien, S; Kolm, P; Klein, LW; Shaw, RE; Ritzenthaler, LL; Popma, JJ; Messenger, J; Edwards, FH; Dangas, GD
MLA Citation
Weintraub, WS, Grau-Sepulveda, MV, Weiss, JM, DeLong, ER, Peterson, ED, O'Brien, S, Kolm, P, Klein, LW, Shaw, RE, Ritzenthaler, LL, Popma, JJ, Messenger, J, Edwards, FH, and Dangas, GD. "A Prediction Model for Long Term Mortality after PCI: Results from the NCDR." CIRCULATION 122.21 (November 23, 2010).
Source
wos-lite
Published In
Circulation
Volume
122
Issue
21
Publish Date
2010

ACCF/AHA new insights into the methodology of performance measurement: a report of the American College of Cardiology Foundation/American Heart Association Task Force on performance measures.

Authors
Spertus, JA; Bonow, RO; Chan, P; Diamond, GA; Drozda, JP; Kaul, S; Krumholz, HM; Masoudi, FA; Normand, S-LT; Peterson, ED; Radford, MJ; Rumsfeld, JS; ACCF/AHA Task Force on Performance Measures,
MLA Citation
Spertus, JA, Bonow, RO, Chan, P, Diamond, GA, Drozda, JP, Kaul, S, Krumholz, HM, Masoudi, FA, Normand, S-LT, Peterson, ED, Radford, MJ, Rumsfeld, JS, and ACCF/AHA Task Force on Performance Measures, . "ACCF/AHA new insights into the methodology of performance measurement: a report of the American College of Cardiology Foundation/American Heart Association Task Force on performance measures." Circulation 122.20 (November 16, 2010): 2091-2106.
PMID
21060078
Source
pubmed
Published In
Circulation
Volume
122
Issue
20
Publish Date
2010
Start Page
2091
End Page
2106
DOI
10.1161/CIR.0b013e3181f7d78c

Delay from symptom onset to hospital presentation for patients with non-ST-segment elevation myocardial infarction.

BACKGROUND: Secular trends and factors associated with delay time from symptom onset to hospital presentation are known for patients with ST-segment elevation myocardial infarction (STEMI) but are less well-described for non-STEMI. METHODS: We studied 104 622 patients with non-STEMI enrolled at 568 hospitals participating in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines (CRUSADE) National Quality Improvement Initiative from January 1, 2001, to December 31, 2006. We examined secular trends and factors associated with delay time and the association of delay time with in-hospital mortality. RESULTS: Median delay time from symptom onset to hospital presentation was 2.6 hours (interquartile range, 1.3-6.0) and has been stable from 2001 to 2006 (P value for trend, .16). After multivariable adjustment, factors associated with longer delay time included older age, female sex, nonwhite race, diabetes, and current smoking. In addition, compared with those who presented during weekday daytime (>8 am to 4 pm), patients who presented during weekday and weekend nights (>12 am to 8 am) had a 24.7% and 24.3% shorter delay time, respectively (P < .001). After multivariable adjustment, the odds ratio of in-hospital mortality for patients with delay times of 0 to 1 hour or less, more than 1 to 2 hours, more than 2 to 3 hours, and more than 3 to 6 hours compared with the reference group (delay time >6 hours) were 1.19 (95% confidence interval [CI], 1.08-1.30), 0.91 (95% CI, 0.83-1.00), 0.77 (95% CI, 0.69-0.88), and 0.90 (95% CI, 0.81-1.00), respectively. CONCLUSIONS: Long delay times are common and have not changed over time for patients with non-STEMI. Because patients cannot differentiate whether symptoms are due to STEMI or non-STEMI, early presentation is desirable in both instances.

Authors
Ting, HH; Chen, AY; Roe, MT; Chan, PS; Spertus, JA; Nallamothu, BK; Sullivan, MD; DeLong, ER; Bradley, EH; Krumholz, HM; Peterson, ED
MLA Citation
Ting, HH, Chen, AY, Roe, MT, Chan, PS, Spertus, JA, Nallamothu, BK, Sullivan, MD, DeLong, ER, Bradley, EH, Krumholz, HM, and Peterson, ED. "Delay from symptom onset to hospital presentation for patients with non-ST-segment elevation myocardial infarction." Arch Intern Med 170.20 (November 8, 2010): 1834-1841.
PMID
21059977
Source
pubmed
Published In
Archives of internal medicine
Volume
170
Issue
20
Publish Date
2010
Start Page
1834
End Page
1841
DOI
10.1001/archinternmed.2010.385

Reclassification of cardiovascular risk using integrated clinical and molecular biosignatures: Design of and rationale for the Measurement to Understand the Reclassification of Disease of Cabarrus and Kannapolis (MURDOCK) Horizon 1 Cardiovascular Disease Study.

BACKGROUND: Clinical predictive models leave gaps in our ability to stratify cardiovascular risk. High-throughput molecular profiling promises to improve risk classification. METHODS: Horizon 1 of the Measurement to Understand the Reclassification of Disease of Cabarrus and Kannapolis (MURDOCK) Study was conceived to apply emerging molecular techniques to existing data sets to characterize mechanistic diversity underlying complex human diseases, response to therapy, and prognosis. No previous studies have applied multiple, complementary molecular techniques in combination with well-developed clinical risk models to refine cardiovascular risk prediction. The MURDOCK Cardiovascular Disease Study will assess molecular profiles integrated with clinical data in "clinomic" profiles for cardiovascular risk classification. CONCLUSION: Herein, we describe the design of and rationale for the MURDOCK Cardiovascular Disease Study.

Authors
Shah, SH; Granger, CB; Hauser, ER; Kraus, WE; Sun, J-L; Pieper, K; Nelson, CL; Delong, ER; Califf, RM; Newby, LK; MURDOCK Horizon 1 Cardiovascular Disease Investigators,
MLA Citation
Shah, SH, Granger, CB, Hauser, ER, Kraus, WE, Sun, J-L, Pieper, K, Nelson, CL, Delong, ER, Califf, RM, Newby, LK, and MURDOCK Horizon 1 Cardiovascular Disease Investigators, . "Reclassification of cardiovascular risk using integrated clinical and molecular biosignatures: Design of and rationale for the Measurement to Understand the Reclassification of Disease of Cabarrus and Kannapolis (MURDOCK) Horizon 1 Cardiovascular Disease Study." Am Heart J 160.3 (September 2010): 371-379.e2.
PMID
20826242
Source
pubmed
Published In
American Heart Journal
Volume
160
Issue
3
Publish Date
2010
Start Page
371
End Page
379.e2
DOI
10.1016/j.ahj.2010.06.051

Contemporary mortality risk prediction for percutaneous coronary intervention: results from 588,398 procedures in the National Cardiovascular Data Registry.

OBJECTIVES: We sought to create contemporary models for predicting mortality risk following percutaneous coronary intervention (PCI). BACKGROUND: There is a need to identify PCI risk factors and accurately quantify procedural risks to facilitate comparative effectiveness research, provider comparisons, and informed patient decision making. METHODS: Data from 181,775 procedures performed from January 2004 to March 2006 were used to develop risk models based on pre-procedural and/or angiographic factors using logistic regression. These models were independently evaluated in 2 validation cohorts: contemporary (n = 121,183, January 2004 to March 2006) and prospective (n = 285,440, March 2006 to March 2007). RESULTS: Overall, PCI in-hospital mortality was 1.27%, ranging from 0.65% in elective PCI to 4.81% in ST-segment elevation myocardial infarction patients. Multiple pre-procedural clinical factors were significantly associated with in-hospital mortality. Angiographic variables provided only modest incremental information to pre-procedural risk assessments. The overall National Cardiovascular Data Registry (NCDR) model, as well as a simplified NCDR risk score (based on 8 key pre-procedure factors), had excellent discrimination (c-index: 0.93 and 0.91, respectively). Discrimination and calibration of both risk tools were retained among specific patient subgroups, in the validation samples, and when used to estimate 30-day mortality rates among Medicare patients. CONCLUSIONS: Risks for early mortality following PCI can be accurately predicted in contemporary practice. Incorporation of such risk tools should facilitate research, clinical decisions, and policy applications.

Authors
Peterson, ED; Dai, D; DeLong, ER; Brennan, JM; Singh, M; Rao, SV; Shaw, RE; Roe, MT; Ho, KKL; Klein, LW; Krone, RJ; Weintraub, WS; Brindis, RG; Rumsfeld, JS; Spertus, JA; NCDR Registry Participants,
MLA Citation
Peterson, ED, Dai, D, DeLong, ER, Brennan, JM, Singh, M, Rao, SV, Shaw, RE, Roe, MT, Ho, KKL, Klein, LW, Krone, RJ, Weintraub, WS, Brindis, RG, Rumsfeld, JS, Spertus, JA, and NCDR Registry Participants, . "Contemporary mortality risk prediction for percutaneous coronary intervention: results from 588,398 procedures in the National Cardiovascular Data Registry." J Am Coll Cardiol 55.18 (May 4, 2010): 1923-1932.
PMID
20430263
Source
pubmed
Published In
Journal of the American College of Cardiology
Volume
55
Issue
18
Publish Date
2010
Start Page
1923
End Page
1932
DOI
10.1016/j.jacc.2010.02.005

ACCF/AHA 2010 Position Statement on Composite Measures for Healthcare Performance Assessment: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures (Writing Committee to develop a position statement on composite measures).

Authors
Peterson, ED; Delong, ER; Masoudi, FA; O'Brien, SM; Peterson, PN; Rumsfeld, JS; Shahian, DM; Shaw, RE; ACCF/AHA Task Force on Performance Measures, ; Goff, DC; Grady, K; Green, LA; Jenkins, KJ; Loth, A; Radford, MJ
MLA Citation
Peterson, ED, Delong, ER, Masoudi, FA, O'Brien, SM, Peterson, PN, Rumsfeld, JS, Shahian, DM, Shaw, RE, ACCF/AHA Task Force on Performance Measures, , Goff, DC, Grady, K, Green, LA, Jenkins, KJ, Loth, A, and Radford, MJ. "ACCF/AHA 2010 Position Statement on Composite Measures for Healthcare Performance Assessment: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures (Writing Committee to develop a position statement on composite measures)." Circulation 121.15 (April 20, 2010): 1780-1791.
PMID
20351232
Source
pubmed
Published In
Circulation
Volume
121
Issue
15
Publish Date
2010
Start Page
1780
End Page
1791
DOI
10.1161/CIR.0b013e3181d2ab98

ACCF/AHA 2010 Position Statement on Composite Measures for Healthcare Performance Assessment: a report of American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures (Writing Committee to Develop a Position Statement on Composite Measures).

Authors
Peterson, ED; DeLong, ER; Masoudi, FA; O'Brien, SM; Peterson, PN; Rumsfeld, JS; Shahian, DM; Shaw, RE
MLA Citation
Peterson, ED, DeLong, ER, Masoudi, FA, O'Brien, SM, Peterson, PN, Rumsfeld, JS, Shahian, DM, and Shaw, RE. "ACCF/AHA 2010 Position Statement on Composite Measures for Healthcare Performance Assessment: a report of American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures (Writing Committee to Develop a Position Statement on Composite Measures)." J Am Coll Cardiol 55.16 (April 20, 2010): 1755-1766.
PMID
20394884
Source
pubmed
Published In
Journal of the American College of Cardiology
Volume
55
Issue
16
Publish Date
2010
Start Page
1755
End Page
1766
DOI
10.1016/j.jacc.2010.02.016

Influence of clinical trial participation on subsequent antithrombin use.

BACKGROUND: Results from the Superior Yield of the New Strategy of Enoxaparin, Revascularization, and Glycoprotein IIb/IIIa Inhibitors (SYNERGY) trial showed that the low-molecular-weight heparin (LMWH) enoxaparin was non-inferior compared with unfractionated heparin (UFH) in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) managed invasively. HYPOTHESIS: We explored the influence of SYNERGY trial site participation on subsequent patterns of heparin use for NSTE-ACS patients treated in routine practice. METHODS: We examined temporal patterns of LMWH use compared with UFH use among 122 764 patients with NSTE-ACS enrolled in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) quality improvement initiative between January 1, 2002 and June 30, 2006, to determine whether site participation in SYNERGY influenced the type of heparin used before and after publication of the SYNERGY results in July 2004. RESULTS: A total of 118 out of 388 (30%) U.S. hospitals participating in CRUSADE simultaneously participated in SYNERGY. SYNERGY sites in the CRUSADE registry were more likely to have a teaching affiliation and have more hospital beds than non-SYNERGY centers in the registry. There was no difference in the proportion of patients treated with LMWH at SYNERGY and non-SYNERGY sites prior to July 2004 compared with after July 2004. However, at SYNERGY sites, there was a slight decrease in the proportion of patients treated with both UFH and LMWH within 24 hours of presentation. CONCLUSIONS: The results of the SYNERGY trial did not appear to influence temporal patterns of LMWH use at sites in the CRUSADE registry. Furthermore, site participation in the SYNERGY trial did not alter patterns of LMWH use for NSTE-ACS after publication of the trial results in July 2004.

Authors
Shah, BR; Peterson, ED; Chen, AY; Mahaffey, KW; DeLong, ER; Ohman, EM; Pollack, CV; Gibler, WB; Roe, MT
MLA Citation
Shah, BR, Peterson, ED, Chen, AY, Mahaffey, KW, DeLong, ER, Ohman, EM, Pollack, CV, Gibler, WB, and Roe, MT. "Influence of clinical trial participation on subsequent antithrombin use." Clin Cardiol 33.3 (March 2010): E49-E55.
PMID
20127904
Source
pubmed
Published In
Clinical Cardiology
Volume
33
Issue
3
Publish Date
2010
Start Page
E49
End Page
E55
DOI
10.1002/clc.20581

ASCERT: the American College of Cardiology Foundation--the Society of Thoracic Surgeons Collaboration on the comparative effectiveness of revascularization strategies.

Authors
Klein, LW; Edwards, FH; DeLong, ER; Ritzenthaler, L; Dangas, GD; Weintraub, WS
MLA Citation
Klein, LW, Edwards, FH, DeLong, ER, Ritzenthaler, L, Dangas, GD, and Weintraub, WS. "ASCERT: the American College of Cardiology Foundation--the Society of Thoracic Surgeons Collaboration on the comparative effectiveness of revascularization strategies." JACC Cardiovasc Interv 3.1 (January 2010): 124-126.
PMID
20129582
Source
pubmed
Published In
JACC: Cardiovascular Interventions
Volume
3
Issue
1
Publish Date
2010
Start Page
124
End Page
126
DOI
10.1016/j.jcin.2009.11.005

ACCF/AHA/ACR/SCAI/SIR/SVM/SVN/SVS 2010 performance measures for adults with peripheral artery disease: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures, the American College of Radiology, the Society for Cardiac Angiography and Interventions, the Society for Interventional Radiology, the Society for Vascular Medicine

Authors
Olin, JW; Allie, DE; Belkin, M; Bonow, RO; Casey, DE; Creager, MA; Gerber, TC; Hirsch, AT; Jaff, MR; Kaufman, JA; Lewis, CA; Martin, ET; Martin, LG; Sheehan, P; Stewart, KJ; Treat-Jacobson, D; White, CJ; Zheng, Z-J; Masoudi, FA; Delong, E; Erwin, JP; Goff, DC; Grady, K; Green, LA; Heidenreich, PA; Jenkins, KJ; Loth, AR; Peterson, ED; Shahian, DM
MLA Citation
Olin, JW, Allie, DE, Belkin, M, Bonow, RO, Casey, DE, Creager, MA, Gerber, TC, Hirsch, AT, Jaff, MR, Kaufman, JA, Lewis, CA, Martin, ET, Martin, LG, Sheehan, P, Stewart, KJ, Treat-Jacobson, D, White, CJ, Zheng, Z-J, Masoudi, FA, Delong, E, Erwin, JP, Goff, DC, Grady, K, Green, LA, Heidenreich, PA, Jenkins, KJ, Loth, AR, Peterson, ED, and Shahian, DM. "ACCF/AHA/ACR/SCAI/SIR/SVM/SVN/SVS 2010 performance measures for adults with peripheral artery disease: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures, the American College of Radiology, the Society for Cardiac Angiography and Interventions, the Society for Interventional Radiology, the Society for Vascular Medicine." Circulation 122.24 (2010): 2583-2618.
PMID
21126978
Source
scival
Published In
Circulation
Volume
122
Issue
24
Publish Date
2010
Start Page
2583
End Page
2618
DOI
10.1161/CIR.0b013e3182031a3c

Reprint-AACVPR/ACCF/AHA 2010 update: Performance measures on cardiac rehabilitation for referral to cardiac rehabilitation/secondary prevention services

Endorsed by the American College of Chest Physicians, the American College of Sports Medicine, the American Physical Therapy Association, the Canadian Association of Cardiac Rehabilitation, the European Association for Cardiovascular Prevention and Rehabilitation, the Inter-American Heart Foundation, the National Association of Clinical Nurse Specialists, the Preventive Cardiovascular Nurses Association, and the Society of Thoracic Surgeons. This document was approved by the American College of Cardiology Foundation Executive Committee in April 2010, by the American Heart Association Science Advisory and Coordinating Committee in April 2010, and by the AACVPR Document Oversight Committee and Board of Directors in June 2010. © 2010 American Physical Therapy Association.

Authors
Thomas, RJ; King, M; Lui, K; Oldridge, N; Pina, IL; Spertus, J; Masoudi, FA; DeLong, E; III, JPE; Jr, DCG; Grady, K; Green, LA; Heidenreich, PA; Jenkins, KJ; Loth, AR; Peterson, ED; Shahian, DM
MLA Citation
Thomas, RJ, King, M, Lui, K, Oldridge, N, Pina, IL, Spertus, J, Masoudi, FA, DeLong, E, III, JPE, Jr, DCG, Grady, K, Green, LA, Heidenreich, PA, Jenkins, KJ, Loth, AR, Peterson, ED, and Shahian, DM. "Reprint-AACVPR/ACCF/AHA 2010 update: Performance measures on cardiac rehabilitation for referral to cardiac rehabilitation/secondary prevention services." Physical Therapy 90.10 (2010): 1373-1382.
Source
scival
Published In
Physical Therapy
Volume
90
Issue
10
Publish Date
2010
Start Page
1373
End Page
1382
DOI
10.106/j.jACC.2010.06.006

Contemporary mortality risk prediction for percutaneous coronary intervention: Results from 588, 398 procedures in the national cardiovascular data registry

Objectives: We sought to create contemporary models for predicting mortality risk following percutaneous coronary intervention (PCI). Background: There is a need to identifiy PCI risk factors and accurately quantify procedural risks to facilitate comparative effectiveness research, provider comparisons, and informed patient decision making. Methods: Data from 181,775 procedures performed from January 2004 to March 2006 were used to develop risk models based on pre-procedural and/or angiographic factors usind logistic regression. These models were independently evaluated in 2 validation cohorts: contempoarar7 (n = 121,183, January 2004 to March 2006) and prospective (n= 285,440, March 2006 to March 2007). Results: Overall, PCI in-Hospital mortality was 1.27% ranging from 0.65% in elective PCI to 4.81% in ST-segment elevation myocardial infarction patients. Multiple pre-procedual clinical factors were significantly associated with in-hospital mortality. Angiographic variables provided only modest incremental information to pre-procedural risk assessments. The overall National Cardiovascular Data Registry (NCDR) model, as well as a simplified NCDR risk score (based on 8 key pre-procedure factors), had excellent discrimination (c-index: 0.93 and 0.91, respectively). Discrimination and calibration of both risk tools were retaine among specific patient subgroups, in the validation samples, and when used to estimate 30-day mortality rates among Medicare patients. Conclusions: Risk, for early mortality following PCI can be accurately predicted in contemporary practice. Incorporation of such risk tools schould facilitate research, clinical decisions, and policy applications.

Authors
Petersen, ED; Dai, D; Delong, ER
MLA Citation
Petersen, ED, Dai, D, and Delong, ER. "Contemporary mortality risk prediction for percutaneous coronary intervention: Results from 588, 398 procedures in the national cardiovascular data registry." Revista Portuguesa de Cardiologia 29.11 (2010): 1767-1770.
Source
scival
Published In
Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology
Volume
29
Issue
11
Publish Date
2010
Start Page
1767
End Page
1770

AACVPR/ACCF/AHA 2010 Update: Performance Measures on Cardiac Rehabilitation for Referral to Cardiac Rehabilitation/Secondary Prevention Services: A Report of the American Association of Cardiovascular and Pulmonary Rehabilitation and the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures

Authors
Thomas, RJ; King, M; Lui, K; Oldridge, N; Piña, IL; Spertus, J; Masoudi, FA; Delong, E; Erwin, JP; Goff, DC; Grady, K; Green, LA; Heidenreich, PA; Jenkins, KJ; Loth, AR; Peterson, ED; Shahian, DM
MLA Citation
Thomas, RJ, King, M, Lui, K, Oldridge, N, Piña, IL, Spertus, J, Masoudi, FA, Delong, E, Erwin, JP, Goff, DC, Grady, K, Green, LA, Heidenreich, PA, Jenkins, KJ, Loth, AR, Peterson, ED, and Shahian, DM. "AACVPR/ACCF/AHA 2010 Update: Performance Measures on Cardiac Rehabilitation for Referral to Cardiac Rehabilitation/Secondary Prevention Services: A Report of the American Association of Cardiovascular and Pulmonary Rehabilitation and the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures." Circulation 122.13 (2010): 1342-1350.
PMID
20805435
Source
scival
Published In
Circulation
Volume
122
Issue
13
Publish Date
2010
Start Page
1342
End Page
1350
DOI
10.1161/CIR.0b013e3181f5185b

Hypercholesterolemia paradox in relation to mortality in acute coronary syndrome.

BACKGROUND: Hypercholesterolemia is a risk factor for coronary artery disease, yet is associated with lower risk of adverse outcomes in patients with acute coronary syndromes (ACS). HYPOTHESIS: We explored this paradox in 84,429 patients with non-ST-segment elevation ACS in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines registry. METHODS: We examined the association between a history of hypercholesterolemia and in-hospital mortality after adjusting for clinical covariates. After excluding patients with previously diagnosed hypercholesterolemia, we repeated the analysis, examining the association between newly diagnosed hypercholesterolemia (in-hospital low-density lipoprotein cholesterol [LDL-C] > or = 100 mg/dL) and mortality. RESULTS: A history of hypercholesterolemia was associated with lower in-hospital mortality (unadjusted odds ratio [OR]: 0.58; 95% confidence interval [CI]: 0.55, 0.62). This protective association persisted after adjusting for baseline characteristics (OR: 0.71; 95% CI: 0.66, 0.76) and prior statin use (OR: 0.74; 95% CI: 0.68, 0.80). Among 22,711 patients with no history of hypercholesterolemia, 12,809 had a new in-hospital diagnosis of hypercholesterolemia. Unadjusted mortality in these patients was lower than among those with normal LDL levels (OR: 0.58; 95% CI: 0.50, 0.67); however, this difference was not significant after multivariable adjustment (OR: 0.86; 95% CI: 0.73, 1.01). CONCLUSIONS: The association of hypercholesterolemia with better outcomes highlights a major challenge in observational analyses. Our results suggest this paradox may result from confounding due to other clinical characteristics, impact of statin treatment, and perhaps most importantly, the fact that previously diagnosed hypercholesterolemia is a marker for patients with more prior medical contact.

Authors
Wang, TY; Newby, LK; Chen, AY; Mulgund, J; Roe, MT; Sonel, AF; Bhatt, DL; DeLong, ER; Ohman, EM; Gibler, WB; Peterson, ED
MLA Citation
Wang, TY, Newby, LK, Chen, AY, Mulgund, J, Roe, MT, Sonel, AF, Bhatt, DL, DeLong, ER, Ohman, EM, Gibler, WB, and Peterson, ED. "Hypercholesterolemia paradox in relation to mortality in acute coronary syndrome." Clin Cardiol 32.9 (September 2009): E22-E28.
PMID
19645040
Source
pubmed
Published In
Clinical Cardiology
Volume
32
Issue
9
Publish Date
2009
Start Page
E22
End Page
E28
DOI
10.1002/clc.20518

Assessing the economic attractiveness of coronary artery revascularization in chronic kidney disease patients.

Chronic kidney disease (CKD) is associated with increased morbidity and mortality in coronary artery disease (CAD) patients. We compared the economic attractiveness of CAD revascularization procedures in patients with and without CKD. Our population included 6218 patients with significant CAD undergoing cardiac catheterization at Duke University between 1996 and 2001, with follow-up through 2002. We investigated the influence of CKD (creatinine clearance < 60 mL/min) upon 3-year survival and medical costs in our CAD population. Coronary artery bypass graft (CABG) surgery was an economically attractive alternative vs. percutaneous coronary intervention (PCI) or medical therapy for all patients with left main disease, three-vessel CAD patients without CKD, and two-vessel CAD patients with CKD. Medical therapy was an economically attractive strategy vs. CABG surgery or PCI for three-vessel CAD patients with CKD, two-vessel CAD patients without CKD, and all single-vessel CAD patients.

Authors
Eisenstein, EL; Sun, JL; Anstrom, KJ; DeLong, ER; Szczech, LA; Mark, DB
MLA Citation
Eisenstein, EL, Sun, JL, Anstrom, KJ, DeLong, ER, Szczech, LA, and Mark, DB. "Assessing the economic attractiveness of coronary artery revascularization in chronic kidney disease patients." J Med Syst 33.4 (August 2009): 287-297.
PMID
19697695
Source
pubmed
Published In
Journal of Medical Systems
Volume
33
Issue
4
Publish Date
2009
Start Page
287
End Page
297

The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 1--coronary artery bypass grafting surgery.

BACKGROUND: The first version of The Society of Thoracic Surgeons National Adult Cardiac Surgery Database (STS NCD) was developed nearly 2 decades ago. Since its inception, the number of participants has grown dramatically, patient acuity has increased, and overall outcomes have consistently improved. To adjust for these and other changes, all STS risk models have undergone periodic revisions. This report provides a detailed description of the 2008 STS risk model for coronary artery bypass grafting surgery (CABG). METHODS: The study population consisted of 774,881 isolated CABG procedures performed on adult patients aged 20 to 100 years between January 1, 2002, and December 31, 2006, at 819 STS NCD participating centers. This cohort was randomly divided into a 60% training (development) sample and a 40% test (validation) sample. The development sample was used to identify predictor variables and estimate model coefficients. The validation sample was used to assess model calibration and discrimination. Model outcomes included operative mortality, renal failure, stroke, reoperation for any cause, prolonged ventilation, deep sternal wound infection, composite major morbidity or mortality, prolonged length of stay (> 14 days), and short length of stay (< 6 days and alive). Candidate predictor variables were selected based on their availability in versions 2.35, 2.41, and 2.52.1 of the STS NCD and their presence in (or ability to be mapped to) version 2.61. Potential predictor variables were screened for overall prevalence in the study population, missing data frequency, coding concerns, bivariate relationships with outcomes, and their presence in previous STS or other CABG risk models. Supervised backwards selection was then performed with input from an expert panel of cardiac surgeons and biostatisticians. After successfully validating the fit of the models, the development and validation samples were subsequently combined, and the final regression coefficients were estimated using the overall combined (development plus validation) sample. RESULTS: The c-index for the mortality model was 0.812, and the c-indices for other endpoints ranged from 0.653 for reoperation to 0.793 for renal failure in the validation sample. Plots of observed versus predicted event rates revealed acceptable calibration in the overall population and in numerous subgroups. When patients were grouped into categories of predicted risk, the absolute difference between the observed and expected event rates was less than 1.5% for each endpoint. The final model intercept and coefficients are provided. CONCLUSIONS: New STS risk models have been developed for CABG mortality and eight other endpoints. Detailed descriptions of model development and testing are provided, together with the final algorithm. Overall model performance is excellent.

Authors
Shahian, DM; O'Brien, SM; Filardo, G; Ferraris, VA; Haan, CK; Rich, JB; Normand, S-LT; DeLong, ER; Shewan, CM; Dokholyan, RS; Peterson, ED; Edwards, FH; Anderson, RP; Society of Thoracic Surgeons Quality Measurement Task Force,
MLA Citation
Shahian, DM, O'Brien, SM, Filardo, G, Ferraris, VA, Haan, CK, Rich, JB, Normand, S-LT, DeLong, ER, Shewan, CM, Dokholyan, RS, Peterson, ED, Edwards, FH, Anderson, RP, and Society of Thoracic Surgeons Quality Measurement Task Force, . "The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 1--coronary artery bypass grafting surgery." Ann Thorac Surg 88.1 Suppl (July 2009): S2-22.
PMID
19559822
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
88
Issue
1 Suppl
Publish Date
2009
Start Page
S2
End Page
22
DOI
10.1016/j.athoracsur.2009.05.053

The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 2--isolated valve surgery.

BACKGROUND: Adjustment for case-mix is essential when using observational data to compare surgical techniques or providers. That is most often accomplished through the use of risk models that account for preoperative patient factors that may impact outcomes. The Society of Thoracic Surgeons (STS) uses such risk models to create risk-adjusted performance reports for participants in the STS National Adult Cardiac Surgery Database (NCD). Although risk models were initially developed for coronary artery bypass surgery, similar models have now been developed for use with heart valve surgery, particularly as the proportion of such procedures has increased. The last published STS model for isolated valve surgery was based on data from 1994 to 1997 and did not include patients undergoing mitral valve repair. STS has developed new valve surgery models using contemporary data that include both valve repair as well as replacement. Expanding upon existing valve models, the new STS models include several nonfatal complications in addition to mortality. METHODS: Using STS data from 2002 to 2006, isolated valve surgery risk models were developed for operative mortality, permanent stroke, renal failure, prolonged ventilation (> 24 hours), deep sternal wound infection, reoperation for any reason, a major morbidity or mortality composite endpoint, prolonged postoperative length of stay, and short postoperative length of stay. The study population consisted of adult patients who underwent one of three types of valve surgery: isolated aortic valve replacement (n = 67,292), isolated mitral valve replacement (n = 21,229), or isolated mitral valve repair (n = 21,238). The population was divided into a 60% development sample and a 40% validation sample. After an initial empirical investigation, the three surgery groups were combined into a single logistic regression model with numerous interactions to allow the covariate effects to differ across these groups. Variables were selected based on a combination of automated stepwise selection and expert panel review. RESULTS: Unadjusted operative mortality (in-hospital regardless of timing, and 30-day regardless of venue) for all isolated valve procedures was 3.4%, and unadjusted in-hospital morbidity rates ranged from 0.3% for deep sternal wound infection to 11.8% for prolonged ventilation. The number of predictors in each model ranged from 10 covariates in the sternal infection model to 24 covariates in the composite mortality plus morbidity model. Discrimination as measured by the c-index ranged from 0.639 for reoperation to 0.799 for mortality. When patients in the validation sample were grouped into 10 categories based on deciles of predicted risk, the average absolute difference between observed versus predicted events within these groups ranged from 0.06% for deep sternal wound infection to 1.06% for prolonged postoperative stay. CONCLUSIONS: The new STS risk models for valve surgery include mitral valve repair as well as multiple endpoints other than mortality. Model coefficients are provided and an online risk calculator is publicly available from The Society of Thoracic Surgeons website.

Authors
O'Brien, SM; Shahian, DM; Filardo, G; Ferraris, VA; Haan, CK; Rich, JB; Normand, S-LT; DeLong, ER; Shewan, CM; Dokholyan, RS; Peterson, ED; Edwards, FH; Anderson, RP; Society of Thoracic Surgeons Quality Measurement Task Force,
MLA Citation
O'Brien, SM, Shahian, DM, Filardo, G, Ferraris, VA, Haan, CK, Rich, JB, Normand, S-LT, DeLong, ER, Shewan, CM, Dokholyan, RS, Peterson, ED, Edwards, FH, Anderson, RP, and Society of Thoracic Surgeons Quality Measurement Task Force, . "The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 2--isolated valve surgery." Ann Thorac Surg 88.1 Suppl (July 2009): S23-S42.
PMID
19559823
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
88
Issue
1 Suppl
Publish Date
2009
Start Page
S23
End Page
S42
DOI
10.1016/j.athoracsur.2009.05.056

The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 3--valve plus coronary artery bypass grafting surgery.

BACKGROUND: Since 1999, The Society of Thoracic Surgeons (STS) has published two risk models that can be used to adjust the results of valve surgery combined with coronary artery bypass graft surgery (CABG). The most recent was developed from data for patients who had surgery between 1994 and 1997 using operative mortality as the only endpoint. Furthermore, this model did not specifically consider mitral valve repair plus CABG, an increasingly common procedure. Consistent with STS policy of periodically updating and improving its risk models, new models for valve surgery combined with CABG have been developed. These models specifically address both perioperative morbidity and mitral valve repair, and they are based on contemporary data. METHODS: The final study population consisted of 101,661 procedures, including aortic valve replacement (AVR) plus CABG, mitral valve replacement (MVR) plus CABG, or mitral valve repair (MVRepair) plus CABG between January 1, 2002, and December 31, 2006. Model outcomes included operative mortality, stroke, deep sternal wound infection, reoperation, prolonged ventilation, renal failure, composite major morbidity or mortality, prolonged postoperative length of stay, and short postoperative length of stay. Candidate variables were screened for frequency of missing data, and imputation techniques were used where appropriate. Stepwise variable selection was employed, supplemented by advice from an expert panel of cardiac surgeons and biostatisticians. Several variables were forced into models to insure face validity (eg, atrial fibrillation for the permanent stroke model, sex for all models). Based on preliminary analyses of the data, a single model was employed for valve plus CABG, with indicator variables for the specific type of procedure. Interaction terms were included to allow for differential impact of predictor variables depending on procedure type. After validating the model in the 40% validation sample, the development and validation samples were then combined, and the final model coefficients were estimated using the overall 100% combined sample. The final logistic regression model was estimated using generalized estimating equations to account for clustering of patients within institutions. RESULTS: The c-index for mortality prediction for the overall valve plus CABG population was 0.75. Morbidity model c-indices for specific complications (permanent stroke, renal failure, prolonged ventilation > 24 hours, deep sternal wound infection, reoperation for any reason, major morbidity or mortality composite, and prolonged postoperative length of stay) for the overall group of valve plus CABG procedures ranged from 0.622 to 0.724, and calibration was excellent. CONCLUSIONS: New STS risk models have been developed for heart valve surgery combined with CABG. These are the first valve plus CABG models that also include risk prediction for individual major morbidities, composite major morbidity or mortality, and short and prolonged length of stay.

Authors
Shahian, DM; O'Brien, SM; Filardo, G; Ferraris, VA; Haan, CK; Rich, JB; Normand, S-LT; DeLong, ER; Shewan, CM; Dokholyan, RS; Peterson, ED; Edwards, FH; Anderson, RP; Society of Thoracic Surgeons Quality Measurement Task Force,
MLA Citation
Shahian, DM, O'Brien, SM, Filardo, G, Ferraris, VA, Haan, CK, Rich, JB, Normand, S-LT, DeLong, ER, Shewan, CM, Dokholyan, RS, Peterson, ED, Edwards, FH, Anderson, RP, and Society of Thoracic Surgeons Quality Measurement Task Force, . "The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 3--valve plus coronary artery bypass grafting surgery." Ann Thorac Surg 88.1 Suppl (July 2009): S43-S62.
PMID
19559824
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
88
Issue
1 Suppl
Publish Date
2009
Start Page
S43
End Page
S62
DOI
10.1016/j.athoracsur.2009.05.055

ACCF/AHA 2009 performance measures for primary prevention of cardiovascular disease in adults: A report of the american college of cardiology foundation/american heart association task force on performance measures (writing committee to develop performance measures for primary prevention of cardiovascular disease): Developed in collaboration with the american academy of family physicians

Authors
Redberg, RF; Benjamin, EJ; Bittner, V; Braun, LT; Goff, DC; Havas, S; Labarthe, DR; Limacher, MC; Lloyd-Jones, DM; Mora, S; Pearson, TA; Radford, MJ; Smetana, GW; Spertus, JA; Swegler, EW; Masoudi, FA; Bonow, RO; Delong, E; Grady, K; Green, LA; Jenkins, KJ; Loth, AR; Peterson, ED; Rumsfeld, JS; Shahian, DM
MLA Citation
Redberg, RF, Benjamin, EJ, Bittner, V, Braun, LT, Goff, DC, Havas, S, Labarthe, DR, Limacher, MC, Lloyd-Jones, DM, Mora, S, Pearson, TA, Radford, MJ, Smetana, GW, Spertus, JA, Swegler, EW, Masoudi, FA, Bonow, RO, Delong, E, Grady, K, Green, LA, Jenkins, KJ, Loth, AR, Peterson, ED, Rumsfeld, JS, and Shahian, DM. "ACCF/AHA 2009 performance measures for primary prevention of cardiovascular disease in adults: A report of the american college of cardiology foundation/american heart association task force on performance measures (writing committee to develop performance measures for primary prevention of cardiovascular disease): Developed in collaboration with the american academy of family physicians." Circulation 120.13 (2009): 1296-1336.
PMID
19770388
Source
scival
Published In
Circulation
Volume
120
Issue
13
Publish Date
2009
Start Page
1296
End Page
1336
DOI
10.1161/CIRCULATIONAHA.109.192617

Strategies for analyzing multilevel cluster-randomized studies with binary outcomes collected at varying intervals of time.

Frequently, studies are conducted in a real clinic setting. When the outcome of interest is collected longitudinally over a specified period of time, this design can lead to unequally spaced intervals and varying numbers of assessments. In our study, these features were embedded in a randomized, factorial design in which interventions to improve blood pressure control were delivered to both patients and providers. We examine the effect of the intervention and compare methods of estimation of both fixed effects and variance components in the multilevel generalized linear mixed model. Methods of comparison include penalized quasi-likelihood (PQL), adaptive quadrature, and Bayesian Monte Carlo methods. We also investigate the implications of reducing the data and analysis to baseline and final measurements. In the full analysis, the PQL fixed-effects estimates were closest to zero and confidence intervals were generally narrower than those of the other methods. The adaptive quadrature and Bayesian fixed-effects estimates were similar, but the Bayesian credible intervals were consistently wider. Variance component estimation was markedly different across methods, particularly for the patient-level random effects. In the baseline and final measurement analysis, we found that estimates and corresponding confidence intervals for the adaptive quadrature and Bayesian methods were very similar. However, the time effect was diminished and other factors also failed to reach statistical significance, most likely due to decreased power. When analyzing data from this type of design, we recommend using either adaptive quadrature or Bayesian methods to fit a multilevel generalized linear mixed model including all available measurements.

Authors
Olsen, MK; DeLong, ER; Oddone, EZ; Bosworth, HB
MLA Citation
Olsen, MK, DeLong, ER, Oddone, EZ, and Bosworth, HB. "Strategies for analyzing multilevel cluster-randomized studies with binary outcomes collected at varying intervals of time." Stat Med 27.29 (December 20, 2008): 6055-6071.
PMID
18825655
Source
pubmed
Published In
Statistics in Medicine
Volume
27
Issue
29
Publish Date
2008
Start Page
6055
End Page
6071
DOI
10.1002/sim.3446

ACC/AHA classification of care metrics: performance measures and quality metrics: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures.

The American College of Cardiology (ACC) and the American Heart Association (AHA) have provided leadership in enhancing the quality of cardiovascular care, including the development of clinical performance measures and clinical registries that permit the evaluation of quality of care and stimulate quality improvement. Compliance with ACC/AHA performance measures and metrics encourages the provision of the strongest evidence-based quality of care, including therapies that are life-extending or life-enhancing. Among quality metrics, only a subset should be considered performance measures-that is, those measures specifically suitable for public reporting, external comparisons, and possibly pay-for-performance programs, in addition to quality improvement. These performance measures have been developed using ACC/AHA methodology, often in collaboration with other organizations, and include the process of public comment and peer review. Quality metrics are those measures that have been developed to support self assessment and quality improvement at the provider, hospital, and/or health care system level. These metrics represent valuable tools to aid clinicians and hospitals in improving quality of care and enhancing patient outcomes, but may not meet all specifications of formal performance measures. These quality metrics may also be considered "candidate" measures that with further research of field testing would meet the criteria for formal performance measures in the future. This measure classification is intended to aid providers, hospitals, health systems, and payers in identifying those measures that the ACC and AHA formally endorse as performance measures, while at the same time promoting the broader range of clinical metrics that are useful for quality improvement efforts.

Authors
Bonow, RO; Masoudi, FA; Rumsfeld, JS; Delong, E; Estes, NAM; Goff, DC; Grady, K; Green, LA; Loth, AR; Peterson, ED; Piña, IL; Radford, MJ; Shahian, DM; American College of Cardiology, ; American Heart Association Task Force on Performance Measures,
MLA Citation
Bonow, RO, Masoudi, FA, Rumsfeld, JS, Delong, E, Estes, NAM, Goff, DC, Grady, K, Green, LA, Loth, AR, Peterson, ED, Piña, IL, Radford, MJ, Shahian, DM, American College of Cardiology, , and American Heart Association Task Force on Performance Measures, . "ACC/AHA classification of care metrics: performance measures and quality metrics: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures." J Am Coll Cardiol 52.24 (December 9, 2008): 2113-2117.
PMID
19056002
Source
pubmed
Published In
Journal of the American College of Cardiology
Volume
52
Issue
24
Publish Date
2008
Start Page
2113
End Page
2117
DOI
10.1016/j.jacc.2008.10.014

ACC/AHA classification of care metrics: performance measures and quality metrics: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures.

The American College of Cardiology (ACC) and the American Heart Association (AHA) have provided leadership in enhancing the quality of cardiovascular care, including the development of clinical performance measures and clinical registries that permit the evaluation of quality of care and stimulate quality improvement. Compliance with ACC/AHA performance measures and metrics encourages the provision of the strongest evidence-based quality of care, including therapies that are life-extending or life-enhancing. Among quality metrics, only a subset should be considered performance measures-that is, those measures specifically suitable for public reporting, external comparisons, and possibly pay-for-performance programs, in addition to quality improvement. These performance measures have been developed using ACC/AHA methodology, often in collaboration with other organizations, and include the process of public comment and peer review. Quality metrics are those measures that have been developed to support self assessment and quality improvement at the provider, hospital, and/or health care system level. These metrics represent valuable tools to aid clinicians and hospitals in improving quality of care and enhancing patient outcomes, but may not meet all specifications of formal performance measures. These quality metrics may also be considered "candidate" measures that with further research or field testing would meet the criteria for formal performance measures in the future. This measure classification is intended to aid providers, hospitals, health systems, and payers in identifying those measures that the ACC and AHA formally endorse as performance measures, while at the same time promoting the broader range of clinical metrics that are useful for quality improvement efforts.

Authors
American College of Cardiology/American Heart Association Task Force on Performance Measures, ; Bonow, RO; Masoudi, FA; Rumsfeld, JS; Delong, E; Estes, NAM; Goff, DC; Grady, K; Green, LA; Loth, AR; Peterson, ED; Piña, IL; Radford, MJ; Shahian, DM
MLA Citation
American College of Cardiology/American Heart Association Task Force on Performance Measures, , Bonow, RO, Masoudi, FA, Rumsfeld, JS, Delong, E, Estes, NAM, Goff, DC, Grady, K, Green, LA, Loth, AR, Peterson, ED, Piña, IL, Radford, MJ, and Shahian, DM. "ACC/AHA classification of care metrics: performance measures and quality metrics: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures." Circulation 118.24 (December 9, 2008): 2662-2666.
PMID
19005092
Source
pubmed
Published In
Circulation
Volume
118
Issue
24
Publish Date
2008
Start Page
2662
End Page
2666
DOI
10.1161/CIRCULATIONAHA.108.191107

ACC/AHA 2008 statement on performance measurement and reperfusion therapy: a report of the ACC/AHA Task Force on Performance Measures (Work Group to address the challenges of performance measurement and reperfusion therapy).

Authors
Masoudi, FA; Bonow, RO; Brindis, RG; Cannon, CP; Debuhr, J; Fitzgerald, S; Heidenreich, PA; Ho, KKL; Krumholz, HM; Leber, C; Magid, DJ; Nilasena, DS; Rumsfeld, JS; Smith, SC; Wharton, TP; DeLong, E; Estes, NAM; Goff, DC; Grady, K; Green, LA; Loth, AR; Peterson, ED; Radford, MJ; Rumsfeld, JS; Shahian, DM; ACC/AHA Task Force on Performance Measures,
MLA Citation
Masoudi, FA, Bonow, RO, Brindis, RG, Cannon, CP, Debuhr, J, Fitzgerald, S, Heidenreich, PA, Ho, KKL, Krumholz, HM, Leber, C, Magid, DJ, Nilasena, DS, Rumsfeld, JS, Smith, SC, Wharton, TP, DeLong, E, Estes, NAM, Goff, DC, Grady, K, Green, LA, Loth, AR, Peterson, ED, Radford, MJ, Rumsfeld, JS, Shahian, DM, and ACC/AHA Task Force on Performance Measures, . "ACC/AHA 2008 statement on performance measurement and reperfusion therapy: a report of the ACC/AHA Task Force on Performance Measures (Work Group to address the challenges of performance measurement and reperfusion therapy)." Circulation 118.24 (December 9, 2008): 2649-2661.
PMID
19001026
Source
pubmed
Published In
Circulation
Volume
118
Issue
24
Publish Date
2008
Start Page
2649
End Page
2661
DOI
10.1161/CIRCULATIONAHA.108.191100

Factors Associated with Longer Delays to Hospital Presentation for Patients with Non-ST-Elevation Myocardial Infarction

Authors
Ting, HH; Chen, AY; Roe, MT; Chan, PS; Spertus, JA; Nallamothu, BK; Sullivan, MD; DeLong, ER; Krumholz, HM; Peterson, ED
MLA Citation
Ting, HH, Chen, AY, Roe, MT, Chan, PS, Spertus, JA, Nallamothu, BK, Sullivan, MD, DeLong, ER, Krumholz, HM, and Peterson, ED. "Factors Associated with Longer Delays to Hospital Presentation for Patients with Non-ST-Elevation Myocardial Infarction." CIRCULATION 118.18 (October 28, 2008): S1164-S1164.
Source
wos-lite
Published In
Circulation
Volume
118
Issue
18
Publish Date
2008
Start Page
S1164
End Page
S1164

Patterns of transfer for patients with non-ST-segment elevation acute coronary syndrome from community to tertiary care hospitals.

BACKGROUND: Practice guidelines for non-ST-segment elevation acute coronary syndromes (NSTE ACS) recommend early invasive management (cardiac catheterization and revascularization within 48 hours of hospital presentation) for high-risk patients, but interhospital transfer is necessary to provide rapid access to revascularization procedures for patients who present to community hospitals without revascularization capabilities. METHODS: We analyzed patterns and factors associated with interhospital transfer among 19,238 patients with NSTE ACS (positive cardiac markers and/or ischemic ST-segment changes) from 124 community hospitals without revascularization capabilities in the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines quality improvement initiative from January 2001 through June 2004. RESULTS: Less than half of the patients (46.3%) admitted to community hospitals were transferred to tertiary hospitals, and fewer (20%) were transferred early (within 48 hours of presentation). Early transfer rates increased by 16% over 10 quarters in patients with a predicted low or moderate risk of inhospital mortality, compared with 5% in high-risk patients. By the last quarter of the analysis, 41.4% of low-risk patients were transferred early versus 12.5% of high-risk patients. Factors significantly associated with early transfer included younger age, lack of prior heart failure, cardiology inpatient care, and ischemic ST-segment electrocardiographic changes. Among patients who were not transferred, 29% had no further risk stratification performed with stress testing, ejection fraction measurement, or diagnostic cardiac catheterization (at hospitals with catheterization laboratories). CONCLUSIONS: Most patients with NSTE ACS presenting to community hospitals without revascularization capabilities are not rapidly transferred to tertiary hospitals, and lower-risk patients appear to be preferentially transferred early. Further investigation is needed to determine if improved risk-based triage at community hospitals can optimize transfer decision making for high-risk patients with NSTE ACS.

Authors
Roe, MT; Chen, AY; Delong, ER; Boden, WE; Calvin, JE; Cairns, CB; Smith, SC; Pollack, CV; Brindis, RG; Califf, RM; Gibler, WB; Ohman, EM; Peterson, ED
MLA Citation
Roe, MT, Chen, AY, Delong, ER, Boden, WE, Calvin, JE, Cairns, CB, Smith, SC, Pollack, CV, Brindis, RG, Califf, RM, Gibler, WB, Ohman, EM, and Peterson, ED. "Patterns of transfer for patients with non-ST-segment elevation acute coronary syndrome from community to tertiary care hospitals." Am Heart J 156.1 (July 2008): 185-192.
PMID
18585515
Source
pubmed
Published In
American Heart Journal
Volume
156
Issue
1
Publish Date
2008
Start Page
185
End Page
192
DOI
10.1016/j.ahj.2008.01.033

Impact of case volume on hospital performance assessment.

BACKGROUND: Process performance measures are increasingly used to assess and reward hospital quality. The impact of small hospital case volumes on such measures is not clear. METHODS: Using data from the Hospital Quality Alliance, we examined hospital performance for 8 publicly reported process measures for acute myocardial infarction (AMI) from 3761 US hospitals during the reporting period of January to December 2005. For each performance measure, we examined the association between hospital case volume, process performance, and designation as a "top hospital" (performance at or above the 90% percentile score). RESULTS: Sample sizes available for process performance assessment varied considerably, ranging from a median of 3 patients per hospital for timely administration of thrombolytics therapy to 62 patients for aspirin given on arrival at the hospital. In aggregate, hospitals with larger AMI case volumes had better process performance; for example, use of beta-blockers at arrival rose from 72% of patients at hospitals with less than 10 AMI cases to 80% of patients at hospitals with more than 100 cases (P < .001 for volume trend). In contrast, owing to an artifact of wide sampling variation in sites with small denominators, classification of a center as a top hospital actually declined rapidly with increasing case volume using current analytic methods (P < .001). This unexpected association persisted after excluding very low volume centers (<25 cases) and when using Achievable Benchmarks of Care. Using hierarchical models removed the paradoxical association but may have introduced a bias in the opposite direction. CONCLUSIONS: Large-volume hospitals had better aggregate performance but were less likely to be identified as top hospitals. Methods that account for small and unequal denominators are needed when assessing hospital process measure performance.

Authors
O'Brien, SM; Delong, ER; Peterson, ED
MLA Citation
O'Brien, SM, Delong, ER, and Peterson, ED. "Impact of case volume on hospital performance assessment." Arch Intern Med 168.12 (June 23, 2008): 1277-1284.
PMID
18574084
Source
pubmed
Published In
Archives of internal medicine
Volume
168
Issue
12
Publish Date
2008
Start Page
1277
End Page
1284
DOI
10.1001/archinte.168.12.1277

Contemporary predictors of procedural mortality among patients undergoing percutaneous coronary intervention (PCI): Results from the ACC-NCDR

Authors
Peterson, ED; Dai, D; DeLong, ER; Rao, SV; Roe, MT; Ho, KL; Singh, M; Rumsfeld, JS; Shaw, RE; Weintraub, WS; Brindis, RG; Spertus, JA
MLA Citation
Peterson, ED, Dai, D, DeLong, ER, Rao, SV, Roe, MT, Ho, KL, Singh, M, Rumsfeld, JS, Shaw, RE, Weintraub, WS, Brindis, RG, and Spertus, JA. "Contemporary predictors of procedural mortality among patients undergoing percutaneous coronary intervention (PCI): Results from the ACC-NCDR." March 11, 2008.
Source
wos-lite
Published In
JACC - Journal of the American College of Cardiology
Volume
51
Issue
10
Publish Date
2008
Start Page
A270
End Page
A270

ACC/AHA 2008 performance measures for adults with ST-elevation and non-ST-elevation myocardial infarction: A report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing committee to develop performance measures for ST-elevation and non-ST-elevation myocardial infarction)

Authors
Krumholz, HM; Anderson, JL; Bachelder, BL; Fesmire, FM; Fihn, SD; Foody, JM; Ho, PM; Kosiborod, MN; Masoudi, FA; Nallamothu, BK; Bonow, RO; DeLong, E; III, NAME; Jr, DCG; Grady, K; Green, LA; Loth, A; Peterson, ED; Radford, MJ; Rumsfeld, JS; Shahian, DM
MLA Citation
Krumholz, HM, Anderson, JL, Bachelder, BL, Fesmire, FM, Fihn, SD, Foody, JM, Ho, PM, Kosiborod, MN, Masoudi, FA, Nallamothu, BK, Bonow, RO, DeLong, E, III, NAME, Jr, DCG, Grady, K, Green, LA, Loth, A, Peterson, ED, Radford, MJ, Rumsfeld, JS, and Shahian, DM. "ACC/AHA 2008 performance measures for adults with ST-elevation and non-ST-elevation myocardial infarction: A report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing committee to develop performance measures for ST-elevation and non-ST-elevation myocardial infarction)." Circulation 118.24 (2008): 2596-2648.
PMID
19001027
Source
scival
Published In
Circulation
Volume
118
Issue
24
Publish Date
2008
Start Page
2596
End Page
2648
DOI
10.1161/CIRCULATIONAHA.108.191099

ACC/AHA/Physician consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter: A report of the American college of cardiology/American heart association task force on performance measures and the physician consortium for performance improvement (writing committee to develop clinical performance measures for atrial fibrillation)

Authors
III, NAME; Halperin, JL; Calkins, H; Ezekowitz, MD; Gitman, P; Go, AS; McNamara, RL; Messer, JV; Ritchie, JL; Romeo, SJW; Waldo, AL; Wyse, DG; Bonow, RO; III, NAME; DeLong, E; Jr, DCG; Grady, K; Green, LA; Hiniker, A; Linderbaum, JA; Masoudi, FA; Piña, IL; Pressler, S; Radford, MJ; Rumsfeld, JS
MLA Citation
III, NAME, Halperin, JL, Calkins, H, Ezekowitz, MD, Gitman, P, Go, AS, McNamara, RL, Messer, JV, Ritchie, JL, Romeo, SJW, Waldo, AL, Wyse, DG, Bonow, RO, III, NAME, DeLong, E, Jr, DCG, Grady, K, Green, LA, Hiniker, A, Linderbaum, JA, Masoudi, FA, Piña, IL, Pressler, S, Radford, MJ, and Rumsfeld, JS. "ACC/AHA/Physician consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter: A report of the American college of cardiology/American heart association task force on performance measures and the physician consortium for performance improvement (writing committee to develop clinical performance measures for atrial fibrillation)." Circulation 117.8 (2008): 1101-1120.
PMID
18283199
Source
scival
Published In
Circulation
Volume
117
Issue
8
Publish Date
2008
Start Page
1101
End Page
1120
DOI
10.1161/CIRCULATIONAHA.107.187192

ACC/AHA/Physician Consortium 2008 Clinical Performance Measures for Adults With Nonvalvular Atrial Fibrillation or Atrial Flutter. A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation)

Authors
III, NAME; Halperin, JL; Calkins, H; Ezekowitz, MD; Gitman, P; Go, AS; McNamara, RL; Messer, JV; Ritchie, JL; Romeo, SJW; Waldo, AL; Wyse, DG; Bonow, RO; III, NAME; DeLong, E; Jr, DCG; Grady, K; Green, LA; Hiniker, A; Linderbaum, JA; Masoudi, FA; Piña, IL; Pressler, S; Radford, MJ; Rumsfeld, JS
MLA Citation
III, NAME, Halperin, JL, Calkins, H, Ezekowitz, MD, Gitman, P, Go, AS, McNamara, RL, Messer, JV, Ritchie, JL, Romeo, SJW, Waldo, AL, Wyse, DG, Bonow, RO, III, NAME, DeLong, E, Jr, DCG, Grady, K, Green, LA, Hiniker, A, Linderbaum, JA, Masoudi, FA, Piña, IL, Pressler, S, Radford, MJ, and Rumsfeld, JS. "ACC/AHA/Physician Consortium 2008 Clinical Performance Measures for Adults With Nonvalvular Atrial Fibrillation or Atrial Flutter. A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation)." Journal of the American College of Cardiology 51.8 (2008): 865-884.
PMID
18294574
Source
scival
Published In
JACC - Journal of the American College of Cardiology
Volume
51
Issue
8
Publish Date
2008
Start Page
865
End Page
884
DOI
10.1016/j.jacc.2008.01.006

Exploring the behavior of hospital composite performance measures: an example from coronary artery bypass surgery.

BACKGROUND: Composite scores that combine several performance measures into a single ranking are becoming the accepted metric for assessing hospital performance. In particular, the Centers for Medicare & Medicaid Services Hospital Quality Incentive Demonstration (HQID) project bases financial rewards and penalties on these scores. Although the HQID composite calculation is straightforward and easily understood, its method of combining process and outcome measures has not been validated. METHODS AND RESULTS: Using data on 530 hospitals from the Society of Thoracic Surgeons National Cardiac Database, we replicated the HQID methodology with 6 nationally endorsed performance measures (5 process measures plus survival) for coronary artery bypass surgery. Composite scores were essentially determined by process measure performance alone; the survival component explained only 4% of the composite score's total variance. This result persisted even when the survival component was allowed a 5-fold greater weighting in the composite summary. The popular "all-or-none" measurement approach was also dominated by the process component. Substantial disagreement was found among hospital rankings when several alternative methods were used; up to 60% of hospitals eligible for the top financial reward under HQID would change designation depending on the composite methodology used. The application of a simple statistical adjustment (standardization) to each method would provide more consistent results and a more balanced assessment of performance based on both process and outcomes. CONCLUSIONS: Existing methods used to create composite performance measures have remarkably different weighting of process versus outcomes metrics and lead to highly divergent provider rankings. Simple alternative methods can create more balanced process-outcome performance assessments.

Authors
O'Brien, SM; DeLong, ER; Dokholyan, RS; Edwards, FH; Peterson, ED
MLA Citation
O'Brien, SM, DeLong, ER, Dokholyan, RS, Edwards, FH, and Peterson, ED. "Exploring the behavior of hospital composite performance measures: an example from coronary artery bypass surgery." Circulation 116.25 (December 18, 2007): 2969-2975.
PMID
18056529
Source
pubmed
Published In
Circulation
Volume
116
Issue
25
Publish Date
2007
Start Page
2969
End Page
2975
DOI
10.1161/CIRCULATIONAHA.107.703553

Pay for performance, quality of care, and outcomes in acute myocardial infarction.

CONTEXT: Pay for performance has been promoted as a tool for improving quality of care. In 2003, the Centers for Medicare & Medicaid Services (CMS) launched the largest pay-for-performance pilot project to date in the United States, including indicators for acute myocardial infarction. OBJECTIVE: To determine if pay for performance was associated with either improved processes of care and outcomes or unintended consequences for acute myocardial infarction at hospitals participating in the CMS pilot project. DESIGN, SETTING, AND PARTICIPANTS: An observational, patient-level analysis of 105,383 patients with acute non-ST-segment elevation myocardial infarction enrolled in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association (ACC/AHA) Guidelines (CRUSADE) national quality-improvement initiative. Patients were treated between July 1, 2003, and June 30, 2006, at 54 hospitals in the CMS program and 446 control hospitals. MAIN OUTCOME MEASURES: The differences in the use of ACC/AHA class I guideline recommended therapies and in-hospital mortality between pay for performance and control hospitals. RESULTS: Among treatments subject to financial incentives, there was a slightly higher rate of improvement for 2 of 6 targeted therapies at pay-for-performance vs control hospitals (odds ratio [OR] comparing adherence scores from 2003 through 2006 at half-year intervals for aspirin at discharge, 1.31; 95% confidence interval [CI], 1.18-1.46 vs OR, 1.17; 95% CI, 1.12-1.21; P = .04) and for smoking cessation counseling (OR, 1.50; 95% CI, 1.29-1.73 vs OR, 1.28; 95% CI, 1.22-1.35; P = .05). There was no significant difference in a composite measure of the 6 CMS rewarded therapies between the 2 hospital groups (change in odds per half-year period of receiving CMS therapies: OR, 1.23; 95% CI, 1.15-1.30 vs OR, 1.17; 95% CI, 1.14-1.20; P = .16). For composite measures of acute myocardial infarction treatments not subject to incentives, rates of improvement were not significantly different (OR, 1.09; 95% CI, 1.05-1.14 vs OR, 1.08; 95% CI, 1.06-1.09; P = .49). Overall, there was no evidence that improvements in in-hospital mortality were incrementally greater at pay-for-performance sites (change in odds of in-hospital death per half-year period, 0.91; 95% CI, 0.84-0.99 vs 0.97; 95% CI, 0.94-0.99; P = .21). CONCLUSIONS: Among hospitals participating in a voluntary quality-improvement initiative, the pay-for-performance program was not associated with a significant incremental improvement in quality of care or outcomes for acute myocardial infarction. Conversely, we did not find evidence that pay for performance had an adverse association with improvement in processes of care that were not subject to financial incentives. Additional studies of pay for performance are needed to determine its optimal role in quality-improvement initiatives.

Authors
Glickman, SW; Ou, F-S; DeLong, ER; Roe, MT; Lytle, BL; Mulgund, J; Rumsfeld, JS; Gibler, WB; Ohman, EM; Schulman, KA; Peterson, ED
MLA Citation
Glickman, SW, Ou, F-S, DeLong, ER, Roe, MT, Lytle, BL, Mulgund, J, Rumsfeld, JS, Gibler, WB, Ohman, EM, Schulman, KA, and Peterson, ED. "Pay for performance, quality of care, and outcomes in acute myocardial infarction." JAMA 297.21 (June 6, 2007): 2373-2380.
PMID
17551130
Source
pubmed
Published In
JAMA : the journal of the American Medical Association
Volume
297
Issue
21
Publish Date
2007
Start Page
2373
End Page
2380
DOI
10.1001/jama.297.21.2373

Influence of clinical trial participation on anti-thrombin use for patients with non-ST-segment elevation acute coronary syndromes: Patterns of enoxaparin vs. unfractionated heparin use in the CRUSADE initiative

Authors
Shah, BR; Chen, AY; Peterson, ED; Mahaffey, KW; DeLong, ER; Ohman, EM; Jr, PCV; Gibler, WB; Roe, MT
MLA Citation
Shah, BR, Chen, AY, Peterson, ED, Mahaffey, KW, DeLong, ER, Ohman, EM, Jr, PCV, Gibler, WB, and Roe, MT. "Influence of clinical trial participation on anti-thrombin use for patients with non-ST-segment elevation acute coronary syndromes: Patterns of enoxaparin vs. unfractionated heparin use in the CRUSADE initiative." CIRCULATION 115.21 (May 29, 2007): E583-E583.
Source
wos-lite
Published In
Circulation
Volume
115
Issue
21
Publish Date
2007
Start Page
E583
End Page
E583

Quality measurement in adult cardiac surgery: part 1--Conceptual framework and measure selection.

Authors
Shahian, DM; Edwards, FH; Ferraris, VA; Haan, CK; Rich, JB; Normand, S-LT; DeLong, ER; O'Brien, SM; Shewan, CM; Dokholyan, RS; Peterson, ED; Society of Thoracic Surgeons Quality Measurement Task Force,
MLA Citation
Shahian, DM, Edwards, FH, Ferraris, VA, Haan, CK, Rich, JB, Normand, S-LT, DeLong, ER, O'Brien, SM, Shewan, CM, Dokholyan, RS, Peterson, ED, and Society of Thoracic Surgeons Quality Measurement Task Force, . "Quality measurement in adult cardiac surgery: part 1--Conceptual framework and measure selection." Ann Thorac Surg 83.4 Suppl (April 2007): S3-12.
PMID
17383407
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
83
Issue
4 Suppl
Publish Date
2007
Start Page
S3
End Page
12
DOI
10.1016/j.athoracsur.2007.01.053

Quality measurement in adult cardiac surgery: part 2--Statistical considerations in composite measure scoring and provider rating.

Authors
O'Brien, SM; Shahian, DM; DeLong, ER; Normand, S-LT; Edwards, FH; Ferraris, VA; Haan, CK; Rich, JB; Shewan, CM; Dokholyan, RS; Anderson, RP; Peterson, ED
MLA Citation
O'Brien, SM, Shahian, DM, DeLong, ER, Normand, S-LT, Edwards, FH, Ferraris, VA, Haan, CK, Rich, JB, Shewan, CM, Dokholyan, RS, Anderson, RP, and Peterson, ED. "Quality measurement in adult cardiac surgery: part 2--Statistical considerations in composite measure scoring and provider rating." Ann Thorac Surg 83.4 Suppl (April 2007): S13-S26.
PMID
17383406
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
83
Issue
4 Suppl
Publish Date
2007
Start Page
S13
End Page
S26
DOI
10.1016/j.athoracsur.2007.01.055

Is early too early? Effect of shorter stays after bypass surgery.

BACKGROUND: Postoperative stays after coronary artery bypass graft surgery (CABG) decreased substantially in the 1990s. Although shorter stays offer clinical benefits, premature discharge could increase adverse events and offset initial savings. This study examined the effect of early discharge after CABG on readmission/death and cost within 60 days of discharge home. Variability in hospitals' tendencies for early discharge and adverse outcomes was also explored. METHODS: Analyses were based on clinical and claims data for 55,889 New York CABG patients discharged home 1995 to 1998. Early discharge was defined as a postoperative stay below the 15th percentile for patients with similar risk. The likelihood of early discharge and its effect on readmission/death were examined using hierarchical logistic regression, accounting for patient risk and within-hospital correlation. The correlation between early discharge and adverse outcomes at the hospital level was assessed. The effect of early discharge on subsequent inpatient, outpatient, skilled nursing, and home health costs was examined in the Medicare subset. RESULTS: Overall, 17% of patients were discharged early, with increasing prevalence over time. The tendency to discharge early varied widely among hospitals (2% to 42% of patients). We found no association between hospitals' tendencies for early discharge and adverse outcomes. Lower postdischarge costs among patients discharged early (mean = 3,491 dollars versus 5,246 dollars for typical stays) resulted in average cumulative savings of 6,309 dollars. CONCLUSIONS: Patients selected for earlier discharge after CABG did not have increased adverse event rates or higher costs. Variation among hospitals in early discharge suggests that more efficient patient management could be achieved at some hospitals.

Authors
Cowper, PA; DeLong, ER; Hannan, EL; Muhlbaier, LH; Lytle, BL; Jones, RH; Holman, WL; Pokorny, JJ; Stafford, JA; Mark, DB; Peterson, ED
MLA Citation
Cowper, PA, DeLong, ER, Hannan, EL, Muhlbaier, LH, Lytle, BL, Jones, RH, Holman, WL, Pokorny, JJ, Stafford, JA, Mark, DB, and Peterson, ED. "Is early too early? Effect of shorter stays after bypass surgery." Ann Thorac Surg 83.1 (January 2007): 100-107.
PMID
17184638
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
83
Issue
1
Publish Date
2007
Start Page
100
End Page
107
DOI
10.1016/j.athoracsur.2006.08.001

Trends in postoperative length of stay after bypass surgery.

BACKGROUND: Although single-site studies have reported reductions in coronary artery bypass graft (CABG) surgery length of stay (LOS) over the last 15 years, less information is available regarding overall temporal trends and interhospital variability. This study examined trends in postoperative LOS, associated rates of transfer at discharge and variation among hospitals in LOS at CABG hospitals in New York State. METHODS: Trends in postoperative LOS and transfers at discharge for 105,842 CABG patients treated in 30 hospitals in New York between 1992 and 1998 were first described graphically. Mixed models were then used to assess temporal trends and interhospital variability in LOS, accounting for differences in patient risk and within-hospital correlation in outcomes. Clinical and LOS data were obtained from the Cardiac Surgery Reporting System. Additional information was extracted from the New York Statewide Planning and Research Cooperative System. RESULTS: Postoperative LOS decreased 30% between 1992 and 1998 after adjusting for patient risk. A concurrent increase in the probability of nonacute patient transfers occurred over time, with the most pronounced increase in patients with stays exceeding 5 days. Underlying the downward trend in LOS was substantial interhospital variability that peaked in 1994 and remained significant in 1998. Stays were longer at hospitals located in New York City. CONCLUSIONS: The downward shift in LOS observed in the 1990s was achieved in part by an increase in nonacute care transfers, reflecting a shift in care setting. After decreasing trends in postoperative stays tapered off, significant variability among hospitals remained.

Authors
Cowper, PA; DeLong, ER; Hannan, EL; Muhlbaier, LH; Lytle, BL; Jones, RH; Holman, WL; Pokorny, JJ; Stafford, JA; Mark, DB; Peterson, ED
MLA Citation
Cowper, PA, DeLong, ER, Hannan, EL, Muhlbaier, LH, Lytle, BL, Jones, RH, Holman, WL, Pokorny, JJ, Stafford, JA, Mark, DB, and Peterson, ED. "Trends in postoperative length of stay after bypass surgery." Am Heart J 152.6 (December 2006): 1194-1200.
PMID
17161075
Source
pubmed
Published In
American Heart Journal
Volume
152
Issue
6
Publish Date
2006
Start Page
1194
End Page
1200
DOI
10.1016/j.ahj.2006.07.017

Insurance coverage and care of patients with non-ST-segment elevation acute coronary syndromes.

BACKGROUND: The impact of insurance coverage on the care of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) is unclear. OBJECTIVE: To compare NSTE ACS care patterns by insurance type. DESIGN: Comparison of Medicaid patients younger than 65 years of age and Medicare patients 65 years of age or older with patients of similar age who have health maintenance organization (HMO) or private insurance coverage. SETTING: 521 U.S. hospitals participating in the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse Outcomes with Early Implementation of the ACC [American College of Cardiology]/AHA [American Heart Association] Guidelines) quality improvement initiative from January 2001 through March 2005. PATIENTS: 37,345 NSTE ACS patients younger than 65 years of age and 59,550 patients 65 years of age or older. MEASUREMENTS: Guideline-recommended treatments, and in-hospital outcomes. RESULTS: Medicaid was the primary payer for 18.7% (6999 of 37,345) of patients younger than age 65 years, whereas Medicare was the primary payer for 67.5% (40,199 of 59,550) of patients age 65 years or older. Medicaid patients were statistically significantly less likely to receive short-term (less than 24 hours) medications and to undergo invasive cardiac procedures than patients covered by HMO and private insurance. They also had higher mortality rates (2.9% vs. 1.2%; adjusted odds ratio, 1.33; 95% CI, 1.08 to 1.63). Medications and invasive procedures were used to a similar extent in patients with Medicare and HMO or private insurance, and respective mortality rates were not significantly different (6.2% vs. 5.6%; adjusted odds ratio, 1.08; 95% CI, 0.99 to 1.18). LIMITATIONS: Self-pay patients and patients without insurance were not assessed. CONCLUSIONS: NSTE ACS patients with Medicaid (but not Medicare) as the primary payer were less likely to receive evidence-based therapies and had worse outcomes than patients with HMO or private insurance as the primary payer. The causes of these treatment differences and solutions for narrowing the gaps in quality require further investigation.

Authors
Calvin, JE; Roe, MT; Chen, AY; Mehta, RH; Brogan, GX; Delong, ER; Fintel, DJ; Gibler, WB; Ohman, EM; Smith, SC; Peterson, ED
MLA Citation
Calvin, JE, Roe, MT, Chen, AY, Mehta, RH, Brogan, GX, Delong, ER, Fintel, DJ, Gibler, WB, Ohman, EM, Smith, SC, and Peterson, ED. "Insurance coverage and care of patients with non-ST-segment elevation acute coronary syndromes." Ann Intern Med 145.10 (November 21, 2006): 739-748.
PMID
17116918
Source
pubmed
Published In
Annals of internal medicine
Volume
145
Issue
10
Publish Date
2006
Start Page
739
End Page
748

Selection of surgical or percutaneous coronary intervention provides differential longevity benefit.

BACKGROUND: Treatment of coronary artery disease (CAD) is evolving with better medications, improvements in percutaneous coronary intervention (PCI), and enhanced techniques for coronary artery bypass grafting (CABG). METHODS: In this study, 18,481 patients with significant (>75% stenosis) CAD treated at a single center between 1986 and 2000 were assigned to one of three groups based on initial treatment strategy: medical therapy (MED) (n = 6862), PCI (n = 6292), or CABG (n = 5327). Each group was categorized into 3 groups according to baseline severity of CAD: low-severity (predominantly 1-vessel), intermediate-severity (predominantly 2-vessel), and high-severity (all 3-vessel), and prospectively evaluated in Cox models for all-cause mortality adjusted for cardiac risk, comorbidity, and propensity for selection of a specific treatment. Treatments were compared for the entire period and three eras (1: 1986 to 1990; 2: 1991 to 1995; 3: 1996 to 2000), the last encompassing widespread availability of PCI with stenting. RESULTS: Survival significantly improved in all groups for all degrees of CAD, despite increasing severity of illness. Revascularization strategies provided significant survival over MED with 8.1, 10.6, and 23.6 additional months per 15 years of follow-up for low-severity, intermediate-severity, and high-severity CAD, respectively. Therapeutic improvements led to increased survival of 5.3 additional months per 7 years of follow-up (95% confidence interval, 0.2 to 10.2; p = 0.039) in era 3 for CABG compared with PCI for high-severity CAD. CONCLUSIONS: Initial revascularization strategies result in significant survival advantage over MED for all CAD levels. Patients with high-severity CAD have reduced survival with PCI compared with those initially treated with CABG.

Authors
Smith, PK; Califf, RM; Tuttle, RH; Shaw, LK; Lee, KL; Delong, ER; Lilly, RE; Sketch, MH; Peterson, ED; Jones, RH
MLA Citation
Smith, PK, Califf, RM, Tuttle, RH, Shaw, LK, Lee, KL, Delong, ER, Lilly, RE, Sketch, MH, Peterson, ED, and Jones, RH. "Selection of surgical or percutaneous coronary intervention provides differential longevity benefit." Ann Thorac Surg 82.4 (October 2006): 1420-1428.
PMID
16996946
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
82
Issue
4
Publish Date
2006
Start Page
1420
End Page
1428
DOI
10.1016/j.athoracsur.2006.04.044

Influence of provider volume and case-mix on risk-adjusted performance rankings

Authors
O'Brien, SM; DeLong, ER; Edwards, FH; Peterson, ED
MLA Citation
O'Brien, SM, DeLong, ER, Edwards, FH, and Peterson, ED. "Influence of provider volume and case-mix on risk-adjusted performance rankings." May 30, 2006.
Source
wos-lite
Published In
Circulation
Volume
113
Issue
21
Publish Date
2006
Start Page
E792
End Page
E792

The "July Phenomenon" revisited: Is the quality of care for patients presenting with acute coronary syndromes affected by house officer inexperience? Insights from CRUSADE

Authors
Leder, DM; D Peterson, E; Roe, MT; DeLong, ER; Chen, AY; Ohman, EM; Gibler, WB; Lytle, BL; Cohen, DJ
MLA Citation
Leder, DM, D Peterson, E, Roe, MT, DeLong, ER, Chen, AY, Ohman, EM, Gibler, WB, Lytle, BL, and Cohen, DJ. "The "July Phenomenon" revisited: Is the quality of care for patients presenting with acute coronary syndromes affected by house officer inexperience? Insights from CRUSADE." May 30, 2006.
Source
wos-lite
Published In
Circulation
Volume
113
Issue
21
Publish Date
2006
Start Page
E818
End Page
E819

Multifaceted intervention to promote beta-blocker use in heart failure.

BACKGROUND: Despite a survival benefit and guideline recommendation for beta-blockers in left ventricular systolic dysfunction, beta-blockers are underused in clinical practice. METHODS: Medical practices with > or = 15 patients with heart failure (HF) in the Duke Databank for Cardiovascular Disease (DDCD) were identified for a prospective, randomized study using a multifaceted intervention to improve beta-blocker use. Intervention practices received provider education, patient education materials, feedback on beta-blocker use of their patients with HF, and access to telephone consultation with an HF expert. The primary outcome was a comparison between intervention and control practices of the proportion of patients with HF self-reporting beta-blocker use on their first routine DDCD follow-up in the postintervention year. A random effects model was used for the analysis. RESULTS: Post intervention, 2631 patients (1701 in 23 intervention practices and 930 in 22 control practices) completed DDCD follow-up. No significant difference in the proportion of patients with HF reporting beta-blocker use was found in the intervention versus control groups (OR 1.16, 95% CI 0.94-1.43, P = .2), although more patients in the intervention group started a beta-blocker than stopped a beta-blocker during the study period (P = .02). CONCLUSIONS: This multifaceted intervention did not significantly increase the mean proportion of patients taking beta-blockers within practices exposed to the intervention, although favorable trends were observed. Further studies are needed to identify and evaluate strategies for translating evidence into clinical practice to reduce the global health burden associated with HF.

Authors
LaPointe, NMA; DeLong, ER; Chen, A; Hammill, BG; Muhlbaier, LH; Califf, RM; Kramer, JM
MLA Citation
LaPointe, NMA, DeLong, ER, Chen, A, Hammill, BG, Muhlbaier, LH, Califf, RM, and Kramer, JM. "Multifaceted intervention to promote beta-blocker use in heart failure." Am Heart J 151.5 (May 2006): 992-998.
PMID
16644320
Source
pubmed
Published In
American Heart Journal
Volume
151
Issue
5
Publish Date
2006
Start Page
992
End Page
998
DOI
10.1016/j.ahj.2005.06.038

Association between hospital process performance and outcomes among patients with acute coronary syndromes.

CONTEXT: Selected care processes are increasingly being used to measure hospital quality; however, data regarding the association between hospital process performance and outcomes are limited. OBJECTIVES: To evaluate contemporary care practices consistent with the American College of Cardiology/American Heart Association (ACC/AHA) guideline recommendations, to examine how hospital performance varied among centers, to identify characteristics predictive of higher guideline adherence, and to assess whether hospitals' overall composite guideline adherence was associated with observed and risk-adjusted in-hospital mortality rates. DESIGN, SETTING, AND PARTICIPANTS: An observational analysis of hospital care in 350 academic and nonacademic US centers of 64,775 patients enrolled in the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines) National Quality Improvement Initiative between January 1, 2001, and September 30, 2003, presenting with chest pain and positive electrocardiographic changes or cardiac biomarkers consistent with non-ST-segment elevation acute coronary syndrome (ACS). MAIN OUTCOME MEASURES: Use of 9 ACC/AHA class I guideline-recommended treatments and the correlation among hospitals' use of individual care processes as well as overall composite adherence rates. RESULTS: Overall, the 9 ACC/AHA guideline-recommended treatments were adhered to in 74% of eligible instances. There was modest correlation in hospital performance among the individual ACS process metrics. However, composite adherence performance varied widely (median [interquartile range] composite adherence scores from lowest to highest hospital quartiles, 63% [59%-66%] vs 82% [80%-84%]). Composite guideline adherence rate was significantly associated with in-hospital mortality, with observed mortality rates decreasing from 6.31% for the lowest adherence quartile to 4.15% for the highest adherence quartile (P<.001). After risk adjustment, every 10% increase in composite adherence at a hospital was associated with an analogous 10% decrease in its patients' likelihood of in-hospital mortality (adjusted odds ratio, 0.90; 95% confidence interval, 0.84-0.97; P<.001). CONCLUSION: A significant association between care process and outcomes was found, supporting the use of broad, guideline-based performance metrics as a means of assessing and helping improve hospital quality.

Authors
Peterson, ED; Roe, MT; Mulgund, J; DeLong, ER; Lytle, BL; Brindis, RG; Smith, SC; Pollack, CV; Newby, LK; Harrington, RA; Gibler, WB; Ohman, EM
MLA Citation
Peterson, ED, Roe, MT, Mulgund, J, DeLong, ER, Lytle, BL, Brindis, RG, Smith, SC, Pollack, CV, Newby, LK, Harrington, RA, Gibler, WB, and Ohman, EM. "Association between hospital process performance and outcomes among patients with acute coronary syndromes." JAMA 295.16 (April 26, 2006): 1912-1920.
PMID
16639050
Source
pubmed
Published In
JAMA : the journal of the American Medical Association
Volume
295
Issue
16
Publish Date
2006
Start Page
1912
End Page
1920
DOI
10.1001/jama.295.16.1912

Determinants of operative mortality in valvular heart surgery.

OBJECTIVE: In some respects, outcome reporting in valvular surgery has been hampered by focusing on specific populations, reluctance to publish high-risk subgroups, and possibly skewed or inadequate samples. The goal of this study was to evaluate risk factors for operative mortality comprehensively across the entire spectrum of cardiac valvular procedures over the past decade. METHODS: All 409,904 valve procedures in the Society of Thoracic Surgeons database performed between 1994 and 2003 were assessed, and Society of Thoracic Surgeons preoperative and operative variables were related to operative mortality by using a multivariable logistic regression model. Data were greater than 95% complete, and the relative importance of relevant risk factors was determined by ranking odds ratios. The analysis had a high predictive power, with a C statistic of 0.735. RESULTS: In the model, 19 variables independently influenced operative mortality (all P < .01). The most significant was nonelective (acute) presentation (odds ratios, 2.11), followed by advanced age (odds ratios, 1.88), reoperation (odds ratios, 1.61), endocarditis (odds ratios, 1.59), and coronary disease (odds ratios, 1.58). Generally, valve replacement was associated with higher mortality than repair (odds ratios, 1.52). Overall, female gender was very important (odds ratios, 1.37), and earlier year of operation increased risk (odds ratios, 1.34), implying improving outcomes over time. Although any single comorbidity, on average, was only moderately contributory (odds ratios, 1.19), specific comorbidities, such as renal failure, or multiple comorbidities in a given patient could be very significant. Aortic root reconstruction carried the highest risk (odds ratios, 2.78), followed by tricuspid valve surgery (odds ratios, 2.26), multiple valve procedures (odds ratios, 2.06), and then isolated mitral (odds ratios, 1.47), pulmonic (odds ratios, 1.29), and aortic (reference procedure) operations. Reduced ejection fraction and severity of valve lesion were relatively less important (odds ratios, 1.34 and 0.83, respectively). CONCLUSIONS: These data illustrate the significance of acute presentation in determining operative risk, and earlier surgical intervention under elective conditions might be emphasized for all types of significant valve lesions. Because aortic root reconstruction doubles mortality compared with simple aortic valve procedures, root replacement should be reserved for specific root pathology. Finally, issues related to reoperation, endocarditis, valve repair, gender, and the various procedures deserve more detailed examination.

Authors
Rankin, JS; Hammill, BG; Ferguson, TB; Glower, DD; O'Brien, SM; DeLong, ER; Peterson, ED; Edwards, FH
MLA Citation
Rankin, JS, Hammill, BG, Ferguson, TB, Glower, DD, O'Brien, SM, DeLong, ER, Peterson, ED, and Edwards, FH. "Determinants of operative mortality in valvular heart surgery." J Thorac Cardiovasc Surg 131.3 (March 2006): 547-557.
PMID
16515904
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
131
Issue
3
Publish Date
2006
Start Page
547
End Page
557
DOI
10.1016/j.jtcvs.2005.10.041

Long-term adherence to evidence-based secondary prevention therapies in coronary artery disease.

BACKGROUND: Studies have examined the use of evidence-based therapies for coronary artery disease (CAD) in the short term and at hospital discharge, but few have evaluated long-term use. METHODS AND RESULTS: Using the Duke Databank for Cardiovascular Disease for the years 1995 to 2002, we determined the annual prevalence and consistency of self-reported use of aspirin, beta-blockers, lipid-lowering agents, and their combinations in all CAD patients and of angiotensin-converting enzyme inhibitors (ACEIs) in those with and without heart failure. Logistic-regression models identified characteristics associated with consistent use (reported on > or =2 consecutive follow-up surveys and then through death, withdrawal, or study end), and Cox proportional-hazards models explored the association of consistent use with mortality. Use of all agents and combinations thereof increased yearly. In 2002, 83% reported aspirin use; 61%, beta-blocker use; 63%, lipid-lowering therapy use; 54%, aspirin and beta-blocker use; and 39%, use of all 3. Consistent use was as follows: For aspirin, 71%; beta-blockers, 46%; lipid-lowering therapy, 44%; aspirin and beta-blockers, 36%; and all 3, 21%. Among patients without heart failure, 39% reported ACEI use in 2002; consistent use was 20%. Among heart failure patients, ACEI use was 51% in 2002 and consistent use, 39%. Except for ACEIs among patients without heart failure, consistent use was associated with lower adjusted mortality: Aspirin hazard ratio (HR), 0.58 and 95% confidence interval (CI), 0.54 to 0.62; beta-blockers, HR, 0.63 and 95% CI, 0.59 to 0.67; lipid-lowering therapy, HR, 0.52 and 95% CI, 0.42 to 0.65; all 3, HR, 0.67 and 95% CI, 0.59 to 0.77; aspirin and beta-blockers, HR, 0.61 and 95% CI, 0.57 to 0.65; and ACEIs among heart failure patients, HR, 0.75 and 95% CI, 0.67 to 0.84. CONCLUSIONS: Use of evidence-based therapies for CAD has improved but remains suboptimal. Although improved discharge prescription of these agents is needed, considerable attention must also be focused on understanding and improving long-term adherence.

Authors
Newby, LK; LaPointe, NMA; Chen, AY; Kramer, JM; Hammill, BG; DeLong, ER; Muhlbaier, LH; Califf, RM
MLA Citation
Newby, LK, LaPointe, NMA, Chen, AY, Kramer, JM, Hammill, BG, DeLong, ER, Muhlbaier, LH, and Califf, RM. "Long-term adherence to evidence-based secondary prevention therapies in coronary artery disease." Circulation 113.2 (January 17, 2006): 203-212.
PMID
16401776
Source
pubmed
Published In
Circulation
Volume
113
Issue
2
Publish Date
2006
Start Page
203
End Page
212
DOI
10.1161/CIRCULATIONAHA.105.505636

Detecting pheochromocytoma: defining the most sensitive test.

OBJECTIVE: To define the most sensitive biochemical test to establish the diagnosis of pheochromocytoma and also to assess the potential role of iodine 131-labeled metaiodobenzylguanidine scintigraphy (I-MIBG) in the diagnosis of this tumor. SUMMARY BACKGROUND DATA: Pheochromocytoma is a rare, catecholamine-producing tumor with preferential localization in the adrenal gland. Despite its importance, the most sensitive test to establish the diagnosis remains to be defined. METHODS: Prospective data collection was done on patients with pheochromocytoma treated at the Duke University Medical Center and the Durham Veterans Affairs Medical Center, Durham, NC. All urinary, plasma, and platelet analyses were highly standardized and supervised by one investigator (J.M.F.). I-MIBG scans were independently reviewed by 2 nuclear medicine physicians. RESULTS: A total of 152 patients (55.3% female) were enrolled in the present analysis. Patients were predominantly white (73.7%). Spells (defined as profuse sweating, tachycardia, and headache) and hypertension at diagnosis were present in 51.4% and 66.6%, respectively. Bilateral disease was found in 12.5%, malignant pheochromocytoma in 29.6%, and hereditary forms in 23.0%. The most sensitive tests were total urinary normetanephrine (96.9%), platelet norepinephrine (93.8%), and I-MIBG scintigraphy (83.7%). In combination with I-MIBG scintigraphy, platelet norepinephrine had a sensitivity of 100%, plasma norepinephrine/MIBG of 97.1%, total urine normetanephrine/MIBG of 96.6%, and urine norepinephrine/MIBG of 95.3%. CONCLUSIONS: The tests of choice to establish the diagnosis of pheochromocytoma are urinary normetanephrine and platelet norepinephrine. A combination of I-MIBG scintigraphy and diagnostic tests in urine, blood, or platelets does further improve the sensitivity. We thus advocate performing an MIBG scan if the diagnosis of pheochromocytoma is clinically suspected and catecholamine measurements are within the normal range.

Authors
Guller, U; Turek, J; Eubanks, S; Delong, ER; Oertli, D; Feldman, JM
MLA Citation
Guller, U, Turek, J, Eubanks, S, Delong, ER, Oertli, D, and Feldman, JM. "Detecting pheochromocytoma: defining the most sensitive test." Ann Surg 243.1 (January 2006): 102-107.
PMID
16371743
Source
pubmed
Published In
Annals of Surgery
Volume
243
Issue
1
Publish Date
2006
Start Page
102
End Page
107

Response to letter regarding article, "Long-term adherence to evidence-based secondary prevention therapies in coronary artery disease" [2]

Authors
Newby, LK; Allen-LaPointe, NM; Chen, AY; Kramer, JM; Hammill, BG; DeLong, ER; Muhlbaier, LH; Califf, RM
MLA Citation
Newby, LK, Allen-LaPointe, NM, Chen, AY, Kramer, JM, Hammill, BG, DeLong, ER, Muhlbaier, LH, and Califf, RM. "Response to letter regarding article, "Long-term adherence to evidence-based secondary prevention therapies in coronary artery disease" [2]." Circulation 114.6 (2006): e241-.
Source
scival
Published In
Circulation
Volume
114
Issue
6
Publish Date
2006
Start Page
e241
DOI
10.1161/CIRCULATIONAHA.106.627521

Multifaceted intervention to promote β-blocker use in heart failure

Background: Despite a survival benefit and guideline recommendation for β-blockers in left ventricular systolic dysfunction, β-blockers are underused in clinical practice. Methods: Medical practices with ≥15 patients with heart failure (HF) in the Duke Databank for Cardiovascular Disease (DDCD) were identified for a prospective, randomized study using a multifaceted intervention to improve β-blocker use. Intervention practices received provider education, patient education materials, feedback on β-blocker use of their patients with HF, and access to telephone consultation with an HF expert. The primary outcome was a comparison between intervention and control practices of the proportion of patients with HF self-reporting β-blocker use on their first routine DDCD follow-up in the postintervention year. A random effects model was used for the analysis. Results: Post intervention, 2631 patients (1701 in 23 intervention practices and 930 in 22 control practices) completed DDCD follow-up. No significant difference in the proportion of patients with HF reporting β-blocker use was found in the intervention versus control groups (OR 1.16, 95% CI 0.94-1.43, P = .2), although more patients in the intervention group started a β-blocker than stopped a β-blocker during the study period (P = .02). Conclusions: This multifaceted intervention did not significantly increase the mean proportion of patients taking β-blockers within practices exposed to the intervention, although favorable trends were observed. Further studies are needed to identify and evaluate strategies for translating evidence into clinical practice to reduce the global health burden associated with HF. © 2006 Mosby, Inc. All rights reserved.

Authors
LaPointe, NMA; DeLong, ER; Chen, A; Hammill, BG; Muhlbaier, LH; Califf, RM; Kramer, JM
MLA Citation
LaPointe, NMA, DeLong, ER, Chen, A, Hammill, BG, Muhlbaier, LH, Califf, RM, and Kramer, JM. "Multifaceted intervention to promote β-blocker use in heart failure." American Heart Journal 151.5 (2006): 999-1005.
Source
scival
Published In
American Heart Journal
Volume
151
Issue
5
Publish Date
2006
Start Page
999
End Page
1005
DOI
10.1016/j.ahj.2005.10.011

The evaluation of treatment when center-specific selection criteria vary with respect to patient risk.

Many standards of medical care are based on the demonstrated effects of various treatment strategies or processes. Unlike pharmacological treatments, these strategies or processes are not necessarily subjected to rigorous clinical trials and their benefit is frequently assessed from observational data. For evaluating the influence of such medical processes on patient outcomes, not only is risk adjustment an issue, but also the "center effect" represents an important, often overlooked consideration. Both the quality of care and the tendency to use certain treatments or processes vary from one center to another. The induced similarity in outcomes within center, as well as the potential for confounding by center, needs to be addressed within the context of risk adjustment. In addition, center-specific selection criteria for a treatment strategy can vary with respect to patient risk. Because of these considerations, it is important to adequately separate the within-center effects of the treatment or strategy from the across-center effects, which relate more to center performance. The primary objective of this article is to explore and extend current methods of dealing with center confounding for dichotomous outcomes, primarily for the situation where selection on the basis of patient risk can vary from center to center. A simulation study compares results from several different analytic methods and provides evidence for the importance of considering confounding due to both risk and center when evaluating the effectiveness of a process. An example that examines the effect of early extubation after bypass surgery is also presented.

Authors
DeLong, ER; Coombs, LP; Ferguson, TB; Peterson, ED
MLA Citation
DeLong, ER, Coombs, LP, Ferguson, TB, and Peterson, ED. "The evaluation of treatment when center-specific selection criteria vary with respect to patient risk." Biometrics 61.4 (December 2005): 942-949.
PMID
16401267
Source
pubmed
Published In
Biometrics
Volume
61
Issue
4
Publish Date
2005
Start Page
942
End Page
949
DOI
10.1111/j.1541-0420.2005.00358.x

Optimal timing of intervention in non-ST-segment elevation acute coronary syndromes: insights from the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines) Registry.

BACKGROUND: Recent studies indicate that a routine invasive approach for patients with unstable angina (UA) and non-ST-segment elevation myocardial infarction (NSTEMI) yields improved outcomes compared with a conservative approach, but the optimal timing of this approach remains open to debate. METHODS AND RESULTS: We used day of hospital presentation as an instrumental variable to study the impact of timing of cardiac catheterization and revascularization therapy on acute outcomes (death, reinfarction, stroke, cardiogenic shock, or congestive heart failure) among patients with UA and NSTEMI. Between January 2001 and September 2003, 56,352 patients with UA or NSTEMI were treated at 310 US hospitals participating in the CRUSADE national quality improvement initiative. Weekend patients were defined as those who presented to the hospital between 5 PM on Friday and 7 AM on Sunday. All other patients were classified as weekday. Weekday patients were similar to weekend patients in terms of demographics, clinical characteristics, and the use of medical therapies in the first 24 hours. Although overall rates of cardiac catheterization and revascularization were similar for the 2 groups, median time to catheterization was significantly longer for weekend than for weekday patients (46.3 versus 23.4 hours, P<0.0001). This delay was not associated with increased in-hospital adverse events, including death (weekend 4.4% versus weekday 4.1%, P=0.23), recurrent MI (2.9% versus 3.0%, P=0.36), or their combination (6.6% versus 6.6%, P=0.86). These findings were not affected by risk adjustment or use of alternative definitions of weekend versus weekday presentation. When weekend presentation was used as the basis for an instrumental variable analysis, we found that catheterization within the first 12 hours of presentation was associated with a nonsignificant trend toward reduced in-hospital mortality (absolute risk reduction 1.9%; 95% CI 6.7% lower to 2.9% higher; P=0.43) that decreased with longer treatment delays. CONCLUSIONS: Although weekend presentation is associated with a delay in invasive management among patients with UA and NSTEMI, in the context of contemporary medical therapy, this does not increase adverse events. Weekend presentation appears to fulfill accepted criteria as an instrumental variable for studying the optimal timing of invasive management for acute coronary syndrome patients. Using weekend status as an instrumental variable, we found no significant benefit to early catheterization, although we could not exclude an important risk reduction, particularly for catheterization within 12 hours of presentation.

Authors
Ryan, JW; Peterson, ED; Chen, AY; Roe, MT; Ohman, EM; Cannon, CP; Berger, PB; Saucedo, JF; DeLong, ER; Normand, S-L; Pollack, CV; Cohen, DJ; CRUSADE Investigators,
MLA Citation
Ryan, JW, Peterson, ED, Chen, AY, Roe, MT, Ohman, EM, Cannon, CP, Berger, PB, Saucedo, JF, DeLong, ER, Normand, S-L, Pollack, CV, Cohen, DJ, and CRUSADE Investigators, . "Optimal timing of intervention in non-ST-segment elevation acute coronary syndromes: insights from the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines) Registry." Circulation 112.20 (November 15, 2005): 3049-3057.
PMID
16275863
Source
pubmed
Published In
Circulation
Volume
112
Issue
20
Publish Date
2005
Start Page
3049
End Page
3057
DOI
10.1161/CIRCULATIONAHA.105.582346

Prognostic/Clinical Prediction Models: Using Observational Data to Estimate Prognosis: An Example Using a Coronary Artery Disease Registry

© 2004 John Wiley & Sons Ltd. All Rights Reserved. With the proliferation of clinical data registries and the rising expense of clinical trials, observational data sources are increasingly providing evidence for clinical decision making. These data are viewed as complementary to randomized clinical trials (RCT). While not as rigorous a methodological design, observational studies yield important information about effectiveness of treatment, as compared with the efficacy results of RCTs. In addition, these studies often have the advantage of providing longer-term follow-up, beyond that of clinical trials. Hence, they are useful for assessing and comparing patients' long-term prognosis under different treatment strategies. For patients with coronary artery disease, many observational comparisons have focused on medical therapy versus interventional procedures. In addition to the well-studied problem of treatment selection bias (which is not the focus of the present study), three significant methodological problems must be addressed in the analysis of these data: (i) designation of the therapeutic arms in the presence of early deaths, withdrawals, and treatment cross-overs; (ii) identification of an equitable starting point for attributing survival time; (iii) site to site variability in short-term mortality. This paper discusses these issues and suggests strategies to deal with them. A proposed methodology is developed, applied and evaluated on a large observational database that has long-term follow-up on nearly 10 000 patients.

Authors
Delong, ER; Nelson, CL; Wong, JB; Pryor, DB; Peterson, ED; Lee, KL; Mark, DB; Califf, RM; Pauker, SG
MLA Citation
Delong, ER, Nelson, CL, Wong, JB, Pryor, DB, Peterson, ED, Lee, KL, Mark, DB, Califf, RM, and Pauker, SG. "Prognostic/Clinical Prediction Models: Using Observational Data to Estimate Prognosis: An Example Using a Coronary Artery Disease Registry." Tutorials in Biostatistics, Statistical Methods in Clinical Studies. August 24, 2005. 287-314.
Source
scopus
Volume
1
Publish Date
2005
Start Page
287
End Page
314
DOI
10.1002/0470023678.ch2b(iii)

Predicting risk-adjusted mortality for CABG surgery: logistic versus hierarchical logistic models.

BACKGROUND: In recent years, several studies in the medical and health service research literature have advocated the use of hierarchical statistical models (multilevel models or random-effects models) to analyze data that are nested (eg, patients nested within hospitals). However, these models are computer-intensive and complicated to perform. There is virtually nothing in the literature that compares the results of standard logistic regression to those of hierarchical logistic models in predicting future provider performance. OBJECTIVE: We sought to compare the ability of standard logistic regression relative to hierarchical modeling in predicting risk-adjusted hospital mortality rates for coronary artery bypass graft (CABG) surgery in New York State. DESIGN, SETTING AND PATIENTS: New York State CABG Registry data from 1994 to 1999 were used to relate statistical predictions from a given year to hospital performance 2 years hence. MAIN OUTCOME MEASURES: Predicted and observed hospital mortality rates 2 years hence were compared using root mean square errors, the mean absolute difference, and the number of hospitals whose predicted mortality rate data was within a 95% confidence interval around the observed mortality rate. RESULTS: In these data, standard logistic regression performed similarly to hierarchical models, both with and without a second level covariate. Differences in the criteria used for comparison were minimal, and when the differences could be statistically tested no significant differences were identified. CONCLUSIONS: It is instructive to compare the predictive abilities of alternative statistical models in the process of assessing their relative performance on a specific database and application.

Authors
Hannan, EL; Wu, C; DeLong, ER; Raudenbush, SW
MLA Citation
Hannan, EL, Wu, C, DeLong, ER, and Raudenbush, SW. "Predicting risk-adjusted mortality for CABG surgery: logistic versus hierarchical logistic models." Med Care 43.7 (July 2005): 726-735.
PMID
15970789
Source
pubmed
Published In
Medical Care
Volume
43
Issue
7
Publish Date
2005
Start Page
726
End Page
735

Influence of racial disparities in procedure use on functional status outcomes among patients with coronary artery disease.

BACKGROUND: Although black cardiac patients receive fewer revascularization procedures than whites, it is unclear whether this has a detrimental impact on outcomes. The objective of our study was to compare 6-month functional status and angina outcomes among blacks and whites with documented coronary disease and to assess whether differential use of revascularization procedures affects these outcomes. METHODS AND RESULTS: We identified a prospective cohort of 1534 white and 337 black patients undergoing cardiac catheterization between August 1998 and April 2001. Health status was assessed at baseline and 6 months with the Short-Form 36 (SF-36) Health Survey and the Seattle Angina Questionnaire (SAQ) Angina Frequency Scale. Compared with whites, blacks received fewer coronary revascularization procedures (52.5% versus 66.0%; P<0.01). By 6 months, blacks had similar mortality (odds ratio, 1.03; 95% CI, 0.57 to 1.9) but worse scores in 5 SF-36 domains (physical, social, role physical, role emotional, and mental health function). Blacks also reported higher rates of angina at 6 months than whites (34.2% versus 24.6%; P<0.01). After adjustment for baseline functional status and clinical and demographic variables, blacks had significantly worse summary physical component scores, summary mental component scores, and SAQ Angina Frequency Scale scores. However, differences in physical component summary scores and SAQ scores between blacks and whites were no longer significant after adjustment for revascularization status. CONCLUSIONS: Our study is among the first to document greater symptoms and functional impairment among black cardiac patients relative to whites. Differential use of coronary revascularization may contribute to the poorer functional outcomes observed among black patients with documented coronary disease.

Authors
Kaul, P; Lytle, BL; Spertus, JA; DeLong, ER; Peterson, ED
MLA Citation
Kaul, P, Lytle, BL, Spertus, JA, DeLong, ER, and Peterson, ED. "Influence of racial disparities in procedure use on functional status outcomes among patients with coronary artery disease." Circulation 111.10 (March 15, 2005): 1284-1290.
PMID
15769770
Source
pubmed
Published In
Circulation
Volume
111
Issue
10
Publish Date
2005
Start Page
1284
End Page
1290
DOI
10.1161/01.CIR.0000157731.66268.E1

The relation between angina, treatment and quality of life in cardiac patients

Authors
Cowper, PA; DeLong, ER; Lytle, BA; Mayhan, S; Peterson, ED
MLA Citation
Cowper, PA, DeLong, ER, Lytle, BA, Mayhan, S, and Peterson, ED. "The relation between angina, treatment and quality of life in cardiac patients." February 1, 2005.
Source
wos-lite
Published In
JACC - Journal of the American College of Cardiology
Volume
45
Issue
3
Publish Date
2005
Start Page
349A
End Page
349A

Research, managed care, and patient privacy: Challenges to successful collaboration

• Objective: To illustrate the impact of increased patient privacy concerns on the conduct of research on managed care patients and to suggest mechanisms for successful collaboration between managed care organizations and academic research organizations. • Patients and setting: Government-funded collaborative research project involving an academic research organization and several managed care organizations. The context is a large coronary artery disease study in which patients were identified using managed care electronic files and then surveyed at 2 different times about their posthospital care. • Data collection/extraction methods: Data for the study included patient surveys as well as electronic claims files. The data relevant to this report are summaries of tracking files that were created for administrative purposes. • Results: The principal observations from this evaluation are: (1) fear of negative publicity for managed care organizations and, more importantly, increased patient privacy concerns create barriers to patient contact; (2) these challenges can have a dramatic effect on duration of a study and the ultimate response rate; (3) response rate can also depend on the mechanism by which the study is introduced to patients. • Conclusions: Managed care research is critical, but managed care organizations perceive significant risks to participation. The process of obtaining funding and executing a successful study would benefit from specific safeguards and sufficient incentives to offset the risks to managed care organizations.

Authors
DeLong, ER; Lytle, BL; Cowper, PA; Alexander, KP; Peterson, ED; Mark, DB
MLA Citation
DeLong, ER, Lytle, BL, Cowper, PA, Alexander, KP, Peterson, ED, and Mark, DB. "Research, managed care, and patient privacy: Challenges to successful collaboration." Journal of Clinical Outcomes Management 12.3 (2005): 151-156.
Source
scival
Published In
Journal of Clinical Outcomes Management
Volume
12
Issue
3
Publish Date
2005
Start Page
151
End Page
156

Long-term adherence to evidence-based secondary prevention in coronary artery disease

Authors
Newby, LK; LaPointe, NMA; Kramer, JM; Chen, A; Hammil, BG; Muhlbaier, LH; DeLong, ER; Califf, RM
MLA Citation
Newby, LK, LaPointe, NMA, Kramer, JM, Chen, A, Hammil, BG, Muhlbaier, LH, DeLong, ER, and Califf, RM. "Long-term adherence to evidence-based secondary prevention in coronary artery disease." May 25, 2004.
Source
wos-lite
Published In
Circulation
Volume
109
Issue
20
Publish Date
2004
Start Page
E231
End Page
E231

Time trends and factors associated with outpatient beta-blocker use in patients with heart failure or left ventricular dysfunction

Authors
Kramer, JM; Chen, AY; Hammill, BG; DeLong, ER; LaPointe, NA; Muhlbaier, LH; McCants, CB; Califf, RM
MLA Citation
Kramer, JM, Chen, AY, Hammill, BG, DeLong, ER, LaPointe, NA, Muhlbaier, LH, McCants, CB, and Califf, RM. "Time trends and factors associated with outpatient beta-blocker use in patients with heart failure or left ventricular dysfunction." May 25, 2004.
Source
wos-lite
Published In
Circulation
Volume
109
Issue
20
Publish Date
2004
Start Page
E265
End Page
E265

A randomized controlled trial of Internet-based academic detailing in heart failure: Failure to engage or change

Authors
LaPointe, NMA; Kramer, JM; DeLong, ER; Muhlbaier, LH; Chen, A; Hammill, BG; McCants, CB; Califf, RM
MLA Citation
LaPointe, NMA, Kramer, JM, DeLong, ER, Muhlbaier, LH, Chen, A, Hammill, BG, McCants, CB, and Califf, RM. "A randomized controlled trial of Internet-based academic detailing in heart failure: Failure to engage or change." March 3, 2004.
Source
wos-lite
Published In
JACC - Journal of the American College of Cardiology
Volume
43
Issue
5
Publish Date
2004
Start Page
424A
End Page
424A

Early versus delayed intervention in non-ST-elevation acute coronary syndromes: A natural experiment from the CRUSADE initiative

Authors
Ryan, JW; Peterson, ED; Chen, A; Roe, MT; Ohman, EM; Cannon, CP; Berger, PB; Saucedo, JF; DeLong, ER; Pollack, CV; Cohen, DJ
MLA Citation
Ryan, JW, Peterson, ED, Chen, A, Roe, MT, Ohman, EM, Cannon, CP, Berger, PB, Saucedo, JF, DeLong, ER, Pollack, CV, and Cohen, DJ. "Early versus delayed intervention in non-ST-elevation acute coronary syndromes: A natural experiment from the CRUSADE initiative." March 3, 2004.
Source
wos-lite
Published In
JACC - Journal of the American College of Cardiology
Volume
43
Issue
5
Publish Date
2004
Start Page
276A
End Page
276A
DOI
10.1016/S0735-1097(04)91173-4

Higher mortality and less evidence-based therapies among medicaid-insured patients with high-risk acute coronary syndromes: Results from CRUSADE

Authors
Calvin, JE; Roe, MT; Chen, A; Brogan, GX; DeLong, ER; Gibler, WB; Ohman, EM; Fintel, D; Smith, SC; Peterson, ED
MLA Citation
Calvin, JE, Roe, MT, Chen, A, Brogan, GX, DeLong, ER, Gibler, WB, Ohman, EM, Fintel, D, Smith, SC, and Peterson, ED. "Higher mortality and less evidence-based therapies among medicaid-insured patients with high-risk acute coronary syndromes: Results from CRUSADE." March 3, 2004.
Source
wos-lite
Published In
JACC - Journal of the American College of Cardiology
Volume
43
Issue
5
Publish Date
2004
Start Page
413A
End Page
413A
DOI
10.1016/S0735-1097(04)91745-7

Physician Counseling can influence health-related quality of life

Authors
Lytle, BL; Shook, GJ; Alexander, KP; Cowper, PA; Mark, DB; DeLong, ER
MLA Citation
Lytle, BL, Shook, GJ, Alexander, KP, Cowper, PA, Mark, DB, and DeLong, ER. "Physician Counseling can influence health-related quality of life." March 3, 2004.
Source
wos-lite
Published In
JACC - Journal of the American College of Cardiology
Volume
43
Issue
5
Publish Date
2004
Start Page
418A
End Page
418A
DOI
10.1016/S0735-1097(04)91763-9

Mortality following blood culture in premature infants: increased with Gram-negative bacteremia and candidemia, but not Gram-positive bacteremia.

OBJECTIVE: To describe survival following nosocomial bloodstream infections and quantify excess mortality associated with positive blood culture. STUDY DESIGN: Multicenter cohort study of premature infants. RESULTS: First blood culture was negative for 4648/5497 (78%) of the neonates--390/4648 (8%) died prior to discharge. Mortality prior to discharge was 19% in the 161 infants with Gram-negative rod (GNR) bacteremia, 8% in the 854 neonates with coagulase negative staphylococcus (CONS), 6% in the 169 infants infected with other Gram-positive bacteria (GP-o), and 26% in the 115 neonates with candidemia. The excess 7-day mortality was 0% for Gram-positive organisms and 83% for GNR bacteremia and candidemia. Using negative blood culture as referent, GNR [hazard ratio (HR)=2.61] and candidemia (HR=2.27) were associated with increased mortality; CONS (HR=1.08) and GP-o (HR=0.97) were not. CONCLUSIONS: Nosocomial GNR bacteremia and candidemia were associated with increased mortality but Gram-positive bacteremia was not.

Authors
Benjamin, DK; DeLong, E; Cotten, CM; Garges, HP; Steinbach, WJ; Clark, RH
MLA Citation
Benjamin, DK, DeLong, E, Cotten, CM, Garges, HP, Steinbach, WJ, and Clark, RH. "Mortality following blood culture in premature infants: increased with Gram-negative bacteremia and candidemia, but not Gram-positive bacteremia." J Perinatol 24.3 (March 2004): 175-180.
PMID
14985775
Source
pubmed
Published In
Journal of Perinatology
Volume
24
Issue
3
Publish Date
2004
Start Page
175
End Page
180
DOI
10.1038/sj.jp.7211068

Interpreting statistics in medical literature: a vade mecum for surgeons.

Authors
Guller, U; DeLong, ER
MLA Citation
Guller, U, and DeLong, ER. "Interpreting statistics in medical literature: a vade mecum for surgeons." J Am Coll Surg 198.3 (March 2004): 441-458. (Review)
PMID
14992748
Source
pubmed
Published In
Journal of The American College of Surgeons
Volume
198
Issue
3
Publish Date
2004
Start Page
441
End Page
458
DOI
10.1016/j.jamcollsurg.2003.09.017

Postconception age and other risk factors associated with mortality following Gram-negative rod bacteremia.

BACKGROUND: Neonatal nosocomial Gram-negative rod bacteremia (GNR-b) is considered ominous. DESIGN: Multi-center cohort study of premature infants (N=6172) who had a blood culture after day of life 3 and whose birthweight was < or =1250 g. RESULTS: A total of 437 neonates developed GNR-b; most commonly with Klebsiella (122/437; 28%), Enterobacter (97/437; 22%), Escherichia coli (90/437; 21%), Pseudomonas (63/437; 14%), and Serratia (49/437; 11%). Neonates infected with Pseudomonas were more likely to die (21/63; 33%) than infants infected with other GNR (50/374; 13%). In multivariable logistic regression, infection with Pseudomonas, mechanical ventilation, and race were associated with subsequent mortality. Postconception age (PCA) was most strongly associated with mortality. Using neonates with >34 weeks PCA at the time of the first blood culture as the reference category, mortality was higher in neonates <26 weeks PCA (odds ratio (OR)=9.21; 95% confidence interval (CI)=2.79, 30.44), and in neonates 26 to 28 weeks PCA (OR=3.94; 95% CI=1.29, 12.03). CONCLUSIONS: Among premature infants, much of the mortality experienced in GNR-b is due to infection with Pseudomonas rather than enteric GNR. Race, the need for mechanical ventilation, and younger PCA when the blood culture was obtained were also strongly associated with mortality.

Authors
Benjamin, DK; DeLong, ER; Cotten, CM; Garges, HP; Clark, RH
MLA Citation
Benjamin, DK, DeLong, ER, Cotten, CM, Garges, HP, and Clark, RH. "Postconception age and other risk factors associated with mortality following Gram-negative rod bacteremia." J Perinatol 24.3 (March 2004): 169-174.
PMID
14985773
Source
pubmed
Published In
Journal of Perinatology
Volume
24
Issue
3
Publish Date
2004
Start Page
169
End Page
174
DOI
10.1038/sj.jp.7211047

Economic effects of beta-blocker therapy in patients with heart failure.

PURPOSE: Studies suggest that beta-blockers improve outcomes in heart failure patients and may be cost saving to society. However, many heart failure patients are not treated with beta-blockers. Economic incentives facing hospitals, physicians, payers, and patients may not encourage treatment adoption. We assessed the economic effects of beta-blocker therapy from various perspectives: societal, Medicare, hospital, physician, and patient. METHODS: A Markov model of heart failure progression over 5 years was developed. Transition probabilities and the effect of beta-blockers on mortality and hospitalization were based on clinical trial data. Estimates of hospital costs and reimbursement were obtained from the Duke University Medical Center. Physician fees were based on the Medicare fee schedule. RESULTS: Beta-blocker therapy increased survival by 0.3 years per patient and reduced societal costs by US dollars 3959 per patient over 5 years. Medicare costs declined by US dollars 6064 per patient, due primarily to lower hospitalization rates. Unless heart failure admissions could be replaced with other hospitalizations that generated an equal or greater revenue above variable cost, hospital revenue would be negatively affected. Physician revenue from treating heart failure patients would also decline. Patient costs increased with beta-blocker use (US dollars 2113 over 5 years). CONCLUSION: Beta-blocker therapy improves the clinical outcomes of heart failure patients and is cost saving to society and Medicare. However, hospitals and physicians have no clear financial incentives to support increased beta-blocker use. Changes in practice patterns could be encouraged by linking reimbursement with evidence-based care and covering patients' medication costs.

Authors
Cowper, PA; DeLong, ER; Whellan, DJ; Allen LaPointe, NM; Califf, RM
MLA Citation
Cowper, PA, DeLong, ER, Whellan, DJ, Allen LaPointe, NM, and Califf, RM. "Economic effects of beta-blocker therapy in patients with heart failure." Am J Med 116.2 (January 15, 2004): 104-111.
PMID
14715324
Source
pubmed
Published In
The American Journal of Medicine
Volume
116
Issue
2
Publish Date
2004
Start Page
104
End Page
111

Procedural volume as a marker of quality for CABG surgery.

CONTEXT: There have been recent calls for using hospital procedural volume as a quality indicator for coronary artery bypass graft (CABG) surgery, but further research into analysis and policy implication is needed before hospital procedural volume is accepted as a standard quality metric. OBJECTIVE: To examine the contemporary association between hospital CABG procedure volume and outcome in a large national clinical database. DESIGN, SETTING, AND PARTICIPANTS: Observational analysis of 267 089 isolated CABG procedures performed at 439 US hospitals participating in the Society of Thoracic Surgeons National Cardiac Database between January 1, 2000, and December 31, 2001. MAIN OUTCOME MEASURE: Association between hospital CABG procedural volume and all-cause operative mortality (in-hospital or 30-day, whichever was longer). RESULTS: The median (interquartile range) annual hospital-isolated CABG volume was 253 (165-417) procedures, with 82% of centers performing fewer than 500 procedures per year. The overall operative mortality was 2.66%. After adjusting for patient risk and clustering effects, rates of operative mortality decreased with increasing hospital CABG volume (0.07% for every 100 additional CABG procedures; adjusted odds ratio [OR], 0.98; 95% confidence interval [CI], 0.96-0.99; P =.004). While the association between volume and outcome was statistically significant overall, this association was not observed in patients younger than 65 years or in those at low operative risk and was confounded by surgeon volume. The ability of hospital volume to discriminate those centers with significantly better or worse mortality was limited due to the wide variability in risk-adjusted mortality among hospitals with similar volume. Closure of up to 100 of the lowest-volume centers (ie, those performing < or =150 CABG procedures/year) was estimated to avert fewer than 50 of 7110 (<1% of total) CABG-related deaths. CONCLUSION: In contemporary practice, hospital procedural volume is only modestly associated with CABG outcomes and therefore may not be an adequate quality metric for CABG surgery.

Authors
Peterson, ED; Coombs, LP; DeLong, ER; Haan, CK; Ferguson, TB
MLA Citation
Peterson, ED, Coombs, LP, DeLong, ER, Haan, CK, and Ferguson, TB. "Procedural volume as a marker of quality for CABG surgery." JAMA 291.2 (January 14, 2004): 195-201.
PMID
14722145
Source
pubmed
Published In
JAMA : the journal of the American Medical Association
Volume
291
Issue
2
Publish Date
2004
Start Page
195
End Page
201
DOI
10.1001/jama.291.2.195

Latent class analysis: an illustrative application for education in the assessment of resident otoscopic skills.

BACKGROUND: There is no gold standard readily available in several components of the routine physical exam: one example is the otoscopic exam, where the gold standard is confirmation by tympanocentesis. Resident education does not typically include routine assessment by the gold standard, making estimates of trainee performance extremely difficult. This is one reason why the otoscopic examination is difficult to teach. Available techniques can assess diagnostic exams when there is no gold standard-one of these is latent class analysis. METHODS: We use latent class analysis, a form of regression analysis, to compare the ability of pediatric residents to diagnose effusion with pediatric otolaryngologists and tympanometry. We briefly outline the technique of how to complete latent class analysis and provide an operational plan to use the method to assess resident performance. RESULTS: The sensitivity and specificity of pediatric resident otoscopic examination to diagnose the presence of effusion was 72% and 84%, respectively. Pediatric otolaryngologist sensitivity and specificity was 91% and 82%; tympanometry had a sensitivity of 70% and specificity 76%. Our estimates of the performance of otolaryngologists and tympanometry to diagnose effusion were the same as previously reported when these diagnosticians have been compared with the gold standard of tympanocentesis. CONCLUSIONS: Latent class analysis can help estimate otoscopic examination performance of residents. This technique can be incorporated into assessment in medical education.

Authors
Benjamin, DK; DeLong, E; Steinbach, WJ
MLA Citation
Benjamin, DK, DeLong, E, and Steinbach, WJ. "Latent class analysis: an illustrative application for education in the assessment of resident otoscopic skills." Ambul Pediatr 4.1 (January 2004): 13-17.
PMID
14731098
Source
pubmed
Published In
Ambulatory Pediatrics
Volume
4
Issue
1
Publish Date
2004
Start Page
13
End Page
17

ROC methodology within a monitoring framework.

Receiver operating characteristic (ROC) methodology is widely used to evaluate and compare diagnostic tests. Generally, each diagnostic test is applied once to each subject in a population and the results, reported on a continuous scale, are used to construct the ROC curve. We extend the standard method to accommodate a framework in which the diagnostic test is repeated over time to monitor for occurrence of an event. Unlike the usual situation in which event status is static, the problem we address involves event status that is not constant over the monitoring period. Subjects generally are classified as non-events, or controls, until they experience events that convert them to cases. Viewing the data as incomplete discrete failure time data with time-varying covariates, potentially useful diagnostic markers can be related appropriately in time with the true condition and varying amounts of information per individual can be taken into account. The ROC curve provides an assessment of the performance of the test in combination with the schedule of testing. Within this framework, a computational simplification is introduced to calculate variances and covariances for the areas under the ROC curves. Periodic monitoring for reperfusion following thrombolytic treatment for acute myocardial infarction provides a detailed example, whereby the lengths of the testing interval combined with different diagnostic markers are compared.

Authors
Parker, CB; DeLong, ER
MLA Citation
Parker, CB, and DeLong, ER. "ROC methodology within a monitoring framework." Stat Med 22.22 (November 30, 2003): 3473-3488.
PMID
14601014
Source
pubmed
Published In
Statistics in Medicine
Volume
22
Issue
22
Publish Date
2003
Start Page
3473
End Page
3488
DOI
10.1002/sim.1580

Evaluation of the dofetilide risk-management program.

BACKGROUND: Dose-dependent torsades de pointes has been shown to occur with dofetilide (Tikosyn) and sotalol HCl (Betapace AF); thus, detailed dosing and monitoring recommendations to minimize this risk are included in the product labeling for both drugs. Only dofetilide, however, has a mandated risk-management program that restricts distribution of the drug and requires prescriber education on the drug. We investigated whether this program improved adherence to dosing and monitoring recommendations for dofetilide as compared with sotalol. METHODS: Charts for 47 patients taking dofetilide and 117 patients taking sotalol were reviewed. RESULTS: The recommended starting dose was prescribed more frequently in the dofetilide group than in the sotalol group (79% vs 35%, P <.001). A higher number of patients in the dofetilide group compared with the sotalol group received the recommended baseline tests for potassium (100% vs 82%, P <.001), magnesium (89% vs 38%, P <.001), serum creatinine (100% vs 82%, P <.001), and electrocardiography (94% vs 67%, P <.001). A significantly greater proportion of patients in the dofetilide group received recommended electrocardiograms obtained after the first dose (94% for dofetilide vs 43% for sotalol, P <.001) and subsequent doses (80% for dofetilide vs 3.5% for sotalol, P <.001). CONCLUSION: Better adherence to several dosing and monitoring recommendations in the dofetilide group may be caused by the presence of the risk-management program. However, low usage of dofetilide during the study period may signify an unintended, negative consequence of the risk-management program.

Authors
Allen LaPointe, NM; Chen, A; Hammill, B; DeLong, E; Kramer, JM; Califf, RM
MLA Citation
Allen LaPointe, NM, Chen, A, Hammill, B, DeLong, E, Kramer, JM, and Califf, RM. "Evaluation of the dofetilide risk-management program." Am Heart J 146.5 (November 2003): 894-901.
PMID
14597941
Source
pubmed
Published In
American Heart Journal
Volume
146
Issue
5
Publish Date
2003
Start Page
894
End Page
901
DOI
10.1016/S0002-8703(03)00409-5

Is coronary artery revascularization associated with, increased life expectancy in chronic kidney disease patients?

Authors
Eisenstein, EL; Sun, JL; Delong, ER; Mark, DB; Reddan, DN; Svetkey, LP; Szczech, LA; Tsiatis, AA; Owen, WF
MLA Citation
Eisenstein, EL, Sun, JL, Delong, ER, Mark, DB, Reddan, DN, Svetkey, LP, Szczech, LA, Tsiatis, AA, and Owen, WF. "Is coronary artery revascularization associated with, increased life expectancy in chronic kidney disease patients?." November 2003.
Source
wos-lite
Published In
Journal of the American Society of Nephrology : JASN
Volume
14
Publish Date
2003
Start Page
675A
End Page
675A

Is early too early? Impact of shorter stays following bypass surgery on outcomes

Authors
Cowper, PA; DeLong, ER; Hannan, EL; Muhlbaier, LH; Lytle, BA; Jones, RH; Holman, WL; Mark, DB; Peterson, ED
MLA Citation
Cowper, PA, DeLong, ER, Hannan, EL, Muhlbaier, LH, Lytle, BA, Jones, RH, Holman, WL, Mark, DB, and Peterson, ED. "Is early too early? Impact of shorter stays following bypass surgery on outcomes." October 28, 2003.
Source
wos-lite
Published In
Circulation
Volume
108
Issue
17
Publish Date
2003
Start Page
769
End Page
769

Risk-adjusted mortality, revascularization completeness and the learning curve effect in off-pump CABG

Authors
Ferguson, TB; Shroyer, LA; Coombs, LP; DeLong, ER; Grover, FL; Peterson, ED
MLA Citation
Ferguson, TB, Shroyer, LA, Coombs, LP, DeLong, ER, Grover, FL, and Peterson, ED. "Risk-adjusted mortality, revascularization completeness and the learning curve effect in off-pump CABG." October 28, 2003.
Source
wos-lite
Published In
Circulation
Volume
108
Issue
17
Publish Date
2003
Start Page
391
End Page
391

Can we predict future hospital bypass surgery outcomes?

Authors
Peterson, ED; Coombs, LP; DeLong, ER; Ferguson, TB
MLA Citation
Peterson, ED, Coombs, LP, DeLong, ER, and Ferguson, TB. "Can we predict future hospital bypass surgery outcomes?." October 28, 2003.
Source
wos-lite
Published In
Circulation
Volume
108
Issue
17
Publish Date
2003
Start Page
769
End Page
769

Empirical therapy for neonatal candidemia in very low birth weight infants.

OBJECTIVE: Neonatal candidemia is often fatal. Empirical antifungal therapy is associated with improved survival in neonates and patients with fever and neutropenia. Although guidelines for empirical therapy exist for patients with fever and neutropenia, these do not exist for neonates. METHODS: A multicenter, retrospective, cohort study was conducted of neonatal intensive care unit patients (N = 6172) who had a blood culture (N = 21,233) after day of life 3 and whose birth weight was or=28 weeks. We developed a candidemia score on the basis of the ORs from the multivariable model. Children with a candidemia score >or=2 points were classified as having a "positive" score, and a score of >or=2 points had a sensitivity of 85% and a specificity of 47%. CONCLUSIONS: We developed a clinical predictive model for neonatal candidemia with high sensitivity and moderate specificity for candidemia. On the basis of our model, when a physician obtains a blood culture, the physician should consider providing antifungal therapy to neonates who are <25 weeks' estimated gestational age and to neonates who have thrombocytopenia at the time of blood culture. In addition, if a physician obtains a blood culture from a child who is 25 to 27 weeks' estimated gestational age and is not thrombocytopenic but has a history of third-generation cephalosporin or carbapenem exposure in the 7 days before the blood culture, then the physician should consider administration of empirical antifungal therapy.

Authors
Benjamin, DK; DeLong, ER; Steinbach, WJ; Cotton, CM; Walsh, TJ; Clark, RH
MLA Citation
Benjamin, DK, DeLong, ER, Steinbach, WJ, Cotton, CM, Walsh, TJ, and Clark, RH. "Empirical therapy for neonatal candidemia in very low birth weight infants." Pediatrics 112.3 Pt 1 (September 2003): 543-547.
PMID
12949281
Source
pubmed
Published In
Pediatrics
Volume
112
Issue
3 Pt 1
Publish Date
2003
Start Page
543
End Page
547

Use of continuous quality improvement to increase use of process measures in patients undergoing coronary artery bypass graft surgery: a randomized controlled trial.

CONTEXT: A rigorous evaluation of continuous quality improvement (CQI) in medical practice has not been carried out on a national scale. OBJECTIVE: To test whether low-intensity CQI interventions can be used to speed the national adoption of 2 coronary artery bypass graft (CABG) surgery process-of-care measures: preoperative beta-blockade therapy and internal mammary artery (IMA) grafting in patients 75 years or older. DESIGN, SETTING, AND PARTICIPANTS: Three hundred fifty-nine academic and nonacademic hospitals (treating 267 917 patients using CABG surgery) participating in the Society of Thoracic Surgeons National Cardiac Database between January 2000 and July 2002 were randomized to a control arm or to 1 of 2 groups that used CQI interventions designed to increase use of the process-of-care measures. INTERVENTION: Each intervention group received measure-specific information, including a call to action to a physician leader; educational products; and periodic longitudinal, nationally benchmarked, site-specific feedback. MAIN OUTCOME MEASURE: Differential incorporation of the targeted care processes into practice at the intervention sites vs the control sites, assessed by measuring preintervention (January-December 2000)/postintervention (January 2001-July 2002) site differences and by using a hierarchical patient-level analysis. RESULTS: From January 2000 to July 2002, use of both process measures increased nationally (beta-blockade, 60.0%-65.6%; IMA grafting, 76.2%-82.8%). Use of beta-blockade increased significantly more at beta-blockade intervention sites (7.3% [SD, 12.8%]) vs control sites (3.6% [SD, 11.5%]) in the preintervention/postintervention (P =.04) and hierarchical analyses (P<.001). Use of IMA grafting also tended to increase at IMA intervention sites (8.7% [SD, 17.5%]) vs control sites (5.4% [SD,15.8%]) (P =.20 and P =.11 for preintervention/postintervention and hierarchical analyses, respectively). Both interventions tended to have more impact at lower-volume CABG sites (for interaction: P =.04 for beta-blockade; P =.02 for IMA grafting). CONCLUSIONS: A multifaceted, physician-led, low-intensity CQI effort can improve the adoption of care processes into national practice within the context of a medical specialty society infrastructure.

Authors
Ferguson, TB; Peterson, ED; Coombs, LP; Eiken, MC; Carey, ML; Grover, FL; DeLong, ER; Society of Thoracic Surgeons and the National Cardiac Database,
MLA Citation
Ferguson, TB, Peterson, ED, Coombs, LP, Eiken, MC, Carey, ML, Grover, FL, DeLong, ER, and Society of Thoracic Surgeons and the National Cardiac Database, . "Use of continuous quality improvement to increase use of process measures in patients undergoing coronary artery bypass graft surgery: a randomized controlled trial." JAMA 290.1 (July 2, 2003): 49-56.
PMID
12837711
Source
pubmed
Published In
JAMA : the journal of the American Medical Association
Volume
290
Issue
1
Publish Date
2003
Start Page
49
End Page
56
DOI
10.1001/jama.290.1.49

The Society of Thoracic Surgeons: 30-day operative mortality and morbidity risk models.

BACKGROUND: Although 30 day risk-adjusted operative mortality (ROM) has been used for quality assessment, it is not sufficient to describe the outcomes after coronary artery bypass grafting (CABG) surgery. Risk-adjusted major morbidity may differentially impact quality of care (as complications occur more frequently than death) and enhance a surgical team's ability to assess their quality. This study identified the preoperative risk factors associated with several complications and a composite outcome (the presence of any major morbidity or 30-day operative mortality or both). METHODS: For CABG procedures, the 1997 to 1999 Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database was used to develop ROM and risk-adjusted morbidity (ROMB) models. Risk factors were selected using standard STS univariate screening and multivariate logistic regression approaches. Risk model performance was assessed. Across STS participating sites, the association of observed-to-expected (O/E) ratios for ROM and ROMB was evaluated. RESULTS: The 30-day operative death and major complication rates for STS CABG procedures were 3.05% and 13.40%, respectively (503,478 CABG procedures), including stroke (1.63%), renal failure (3.53%), reoperation (5.17%), prolonged ventilation (5.96%), and sternal infection (0.63%). Risk models were developed (c-indexes for stroke [0.72], renal failure [0.76], reoperation [0.64], prolonged ventilation [0.75], sternal infection [0.66], and the composite endpoint [0.71]). Only a slight correlation was found, however, between ROMB and ROM indicators. CONCLUSIONS: Used in combination, ROMB and ROM may provide the surgical team with additional information to evaluate the quality of their care as well as valuable insights to allow them to focus on areas for improvement.

Authors
Shroyer, ALW; Coombs, LP; Peterson, ED; Eiken, MC; DeLong, ER; Chen, A; Ferguson, TB; Grover, FL; Edwards, FH; Society of Thoracic Surgeons,
MLA Citation
Shroyer, ALW, Coombs, LP, Peterson, ED, Eiken, MC, DeLong, ER, Chen, A, Ferguson, TB, Grover, FL, Edwards, FH, and Society of Thoracic Surgeons, . "The Society of Thoracic Surgeons: 30-day operative mortality and morbidity risk models." Ann Thorac Surg 75.6 (June 2003): 1856-1864.
PMID
12822628
Source
pubmed
Published In
The Annals of Thoracic Surgery
Volume
75
Issue
6
Publish Date
2003
Start Page
1856
End Page
1864

Empirical therapy for neonatal candidemia: Evaluation of 21,233 blood cultures

Authors
Benjamin, DK; Delong, ER; Steinbach, WJ; Cotten, CM; Walsh, TJ; Clark, RH
MLA Citation
Benjamin, DK, Delong, ER, Steinbach, WJ, Cotten, CM, Walsh, TJ, and Clark, RH. "Empirical therapy for neonatal candidemia: Evaluation of 21,233 blood cultures." April 2003.
Source
wos-lite
Published In
Pediatric Research
Volume
53
Issue
4
Publish Date
2003
Start Page
396A
End Page
396A

Long-term adherence to evidence-based therapies for coronary artery disease and heart failure in the outpatient setting

Authors
LaPointe, NMA; Kramer, JM; Hammill, BG; Chen, A; DeLong, ER; Ricketts, RK; Muhlbaier, LH; McCants, CB; Califf, RM
MLA Citation
LaPointe, NMA, Kramer, JM, Hammill, BG, Chen, A, DeLong, ER, Ricketts, RK, Muhlbaier, LH, McCants, CB, and Califf, RM. "Long-term adherence to evidence-based therapies for coronary artery disease and heart failure in the outpatient setting." March 19, 2003.
Source
wos-lite
Published In
JACC - Journal of the American College of Cardiology
Volume
41
Issue
6
Publish Date
2003
Start Page
517A
End Page
517A

Home health care for coronary artery disease patients impacts quality of life

Authors
Lytle, BL; Coombs, LP; Shook, GJ; Cowper, PA; Alexander, KP; Peterson, ED; Mark, DB; DeLong, ER
MLA Citation
Lytle, BL, Coombs, LP, Shook, GJ, Cowper, PA, Alexander, KP, Peterson, ED, Mark, DB, and DeLong, ER. "Home health care for coronary artery disease patients impacts quality of life." March 19, 2003.
Source
wos-lite
Published In
JACC - Journal of the American College of Cardiology
Volume
41
Issue
6
Publish Date
2003
Start Page
521A
End Page
521A

Empirical therapy for neonatal candidemia in very low birth weight infants

Objective. Neonatal candidemia is often fatal. Empirical antifungal therapy is associated with improved survival in neonates and patients with fever and neutropenia. Although guidelines for empirical therapy exist for patients with fever and neutropenia, these do not exist for neonates. Methods. A multicenter, retrospective, cohort study was conducted of neonatal intensive care unit patients (N = 6172) who had a blood culture (N = 21 233) after day of life 3 and whose birth weight was ≤1250 g. We performed multivariable conditional logistic regression of risk factors for candidemia. From the regression modeling coefficients, we developed a candidemia score. Results. In multivariable modeling, thrombocytopenia (odds ratio [OR]: 3.56; 95% confidence interval [CI]: 2.68-4.74) and cephalosporin or carbapenem use in the 7 days before obtaining the blood culture (OR: 1.77; 95% CI: 1.33-2.29) were risk factors for subsequent candidemia. Children who were 25 to 27 weeks' estimated gestational age (OR: 2.02; 95% CI: 1.52-3.05) and children who were born at <25 weeks (OR: 4.15; 95% CI: 3.12-6.29) were at higher risk of developing candidemia than were children who were born at ≥8 weeks. We developed a candidemia score on the basis of the ORs from the multivariable model. Children with a candidemia score ≥2 points were classified as having a "positive" score, and a score of ≥2 points had a sensitivity of 85% and a specificity of 47%. Conclusions. We developed a clinical predictive model for neonatal candidemia with high sensitivity and moderate specificity for candidemia. On the basis of our model, when a physician obtains a blood culture, the physician should consider providing antifungal therapy to neonates who are <25 weeks' estimated gestational age and to neonates who have thrombocytopenia at the time of blood culture. In addition, if a physician obtains a blood culture from a child who is 25 to 27 weeks' estimated gestational age and is not thrombocytopenic but has a history of third-generation cephalosporin or carbapenem exposure in the 7 days before the blood culture, then the physician should consider administration of empirical antifungal therapy.

Authors
Jr, DKB; DeLong, ER; Steinbach, WJ; Cotton, CM; Walsh, TJ; Clark, RH
MLA Citation
Jr, DKB, DeLong, ER, Steinbach, WJ, Cotton, CM, Walsh, TJ, and Clark, RH. "Empirical therapy for neonatal candidemia in very low birth weight infants." Pediatrics 112.3 I (2003): 543-547.
Source
scival
Published In
Pediatrics
Volume
112
Issue
3 I
Publish Date
2003
Start Page
543
End Page
547
DOI
10.1542/peds.112.3.543

Hierarchical modeling: Its time has come

Authors
DeLong, E
MLA Citation
DeLong, E. "Hierarchical modeling: Its time has come." American Heart Journal 145.1 (2003): 16-18.
PMID
12514649
Source
scival
Published In
American Heart Journal
Volume
145
Issue
1
Publish Date
2003
Start Page
16
End Page
18
DOI
10.1067/mhj.2003.27

Impact of the dofetilide risk management program: A comparison with sotalol

Authors
LaPointe, NMA; Chen, A; Hammill, BG; DeLong, ER; Kramer, JM; Califf, RM
MLA Citation
LaPointe, NMA, Chen, A, Hammill, BG, DeLong, ER, Kramer, JM, and Califf, RM. "Impact of the dofetilide risk management program: A comparison with sotalol." November 5, 2002.
Source
wos-lite
Published In
Circulation
Volume
106
Issue
19
Publish Date
2002
Start Page
547
End Page
547

Use of procedural volume as a marker of bypass surgery quality: Results from the Society of Thoracic Surgery (STS) National Cardiac Database

Authors
Peterson, ED; Coombs, LP; Haan, CK; DeLong, ER; Ferguson, TB
MLA Citation
Peterson, ED, Coombs, LP, Haan, CK, DeLong, ER, and Ferguson, TB. "Use of procedural volume as a marker of bypass surgery quality: Results from the Society of Thoracic Surgery (STS) National Cardiac Database." November 5, 2002.
Source
wos-lite
Published In
Circulation
Volume
106
Issue
19
Publish Date
2002
Start Page
553
End Page
553

Economic impact of beta-blocker therapy in patients with congestive heart failure

Authors
Cowper, PA; Delong, ER; Whellan, DJ; Lapointe, NA; Califf, RM
MLA Citation
Cowper, PA, Delong, ER, Whellan, DJ, Lapointe, NA, and Califf, RM. "Economic impact of beta-blocker therapy in patients with congestive heart failure." October 15, 2002.
Source
wos-lite
Published In
Circulation
Volume
106
Issue
16
Publish Date
2002
Start Page
E106
End Page
E106

Percutaneous transluminal septal reduction for hypertrophic obstructive cardiomyopathy: report from an international pilot study.

Assessing the effectiveness of newer treatments for rare diseases can be challenging because of the small number of patients treated at individual centers. We enrolled patients undergoing percutaneous transluminal septal myocardial ablation (PTSMA) for hypertrophic obstructive cardiomyopathy (HOCM) at five international centers (1 Japan, 2 United Kingdom, and 2 United States). Our study group developed standard data definitions regarding clinical symptom severity, previous HOCM treatment, procedure status, and outcome, and entered patient data directly into a shared, web-based registry system. In the first 10 months of 1998, 51 patients were enrolled in our registry, with 47 ultimately receiving the PTSMA procedure. Although HOCM is consider a single disease, there were significant differences among centers in patient characteristics (age, gender, and family history of HOCM), symptom severity, diagnostic techniques (measurements taken after provocation), and treatment (amount of alcohol used, timing of injection, and number of branches attempted).

Authors
Buell, HE; Stables, RH; DeLong, ER; Shuping, KB; Killip, DM; Lever, HM; McKenna, WJ; Rubin, D; Sigwart, U; Takayama, M; Wagner, GS; Eisenstein, EL; Spencer, WH
MLA Citation
Buell, HE, Stables, RH, DeLong, ER, Shuping, KB, Killip, DM, Lever, HM, McKenna, WJ, Rubin, D, Sigwart, U, Takayama, M, Wagner, GS, Eisenstein, EL, and Spencer, WH. "Percutaneous transluminal septal reduction for hypertrophic obstructive cardiomyopathy: report from an international pilot study." J Med Syst 26.4 (August 2002): 293-300.
PMID
12118813
Source
pubmed
Published In
Journal of Medical Systems
Volume
26
Issue
4
Publish Date
2002
Start Page
293
End Page
300

Hospital variability in length of stay after coronary artery bypass surgery: results from the Society of Thoracic Surgeon's National Cardiac Database.

BACKGROUND: There is growing interest in comparing resource, as well as patient outcome metrics among coronary artery bypass graft surgery (CABG) providers, yet few tools exist for adjusting these provider comparisons for patient case-mix. In this study, we aimed to define the magnitude of hospital variability in postoperative length of stay (PLOS) in contemporary practice and to determine the degree to which this variability was accounted for by differences in patient case-mix. We also sought to determine the relationship between hospitals' risk-adjusted PLOS and mortality outcomes. METHODS: We analyzed 496,797 isolated CABG procedures performed between January 1997 to January 2001 at 587 US hospitals participating in the Society of Thoracic Surgeon's National Cardiac Database. Logistic and linear regression were used to identify independent preoperative factors affecting a patient's likelihood for early discharge (PLOS < or = 5 day), prolonged stay (> 14 days), and overall PLOS. Hierarchical models were used to determine the degree to which hospital factors influenced PLOS beyond patient factors. RESULTS: Overall, 53% of CABG patients were discharged within 5 days of CABG, whereas 5% required prolonged (> 14 days) stays. More than 25 preoperative patient factors were independently associated with a patients' likelihood for early discharge and prolonged stay (model C index 0.70 and 0.75, respectively). After adjusting for patient factors, however, there remained wide unexplained variability among hospitals in PLOS and limited correlation between these PLOS metrics and hospitals' risk-adjusted mortality results (Spearman correlation coefficient -0.15 and 0.35). CONCLUSIONS: Our study provides a method for institutions to receive meaningful risk-adjusted bypass PLOS information. Given the marked variability among hospitals in CABG PLOS, institutions should consider benchmarking metrics of efficiency, as well as patient outcomes.

Authors
Peterson, ED; Coombs, LP; Ferguson, TB; Shroyer, AL; DeLong, ER; Grover, FL; Edwards, FH
MLA Citation
Peterson, ED, Coombs, LP, Ferguson, TB, Shroyer, AL, DeLong, ER, Grover, FL, and Edwards, FH. "Hospital variability in length of stay after coronary artery bypass surgery: results from the Society of Thoracic Surgeon's National Cardiac Database." Ann Thorac Surg 74.2 (August 2002): 464-473.
PMID
12173830
Source
pubmed
Published In
The Annals of Thoracic Surgery
Volume
74
Issue
2
Publish Date
2002
Start Page
464
End Page
473

Patient-reported frequency of taking aspirin in a population with coronary artery disease.

Despite the established benefits of antiplatelet agents in coronary artery disease (CAD), many appropriate patients are not receiving them. We investigated the prevalence of and factors associated with aspirin use and nonuse within a large referral population with CAD. The goal was to identify an approach to increase the use of antiplatelet agents by such patients. We surveyed a subset (n = 2,694) of a large CAD referral population (n = 16,174) to determine the use of aspirin and factors associated with its use or nonuse. The subset was made up of all of the CAD referral population who were considered nonusers of aspirin and a 5% sample of those considered aspirin users. We then extrapolated survey data to the overall population to estimate how many eligible patients were not taking antiplatelet agents. In all, 1,626 (63%) of the surviving patients responded to the survey. Of these, 948 (58%) reported taking aspirin, and 678 (42%) reported no aspirin use. The extrapolated rate of aspirin use in the overall population was 85%. Of 2,367 nonusers, 998 (42%, or 6% of the overall cohort) were eligible for antiplatelet agents but were not taking such therapy. Although the rate of aspirin use in this population was higher than previously reported, an estimated 6% of eligible patients were not receiving antiplatelet therapy.

Authors
Allen LaPointe, NM; Kramer, JM; DeLong, ER; Ostbye, T; Hammill, BG; Muhlbaier, LH; McCants, CB; Chen, A; Califf, RM
MLA Citation
Allen LaPointe, NM, Kramer, JM, DeLong, ER, Ostbye, T, Hammill, BG, Muhlbaier, LH, McCants, CB, Chen, A, and Califf, RM. "Patient-reported frequency of taking aspirin in a population with coronary artery disease." Am J Cardiol 89.9 (May 1, 2002): 1042-1046.
PMID
11988192
Source
pubmed
Published In
The American Journal of Cardiology
Volume
89
Issue
9
Publish Date
2002
Start Page
1042
End Page
1046

Association between pulse pressure and mortality in patients undergoing maintenance hemodialysis.

CONTEXT: Although increased blood pressure is associated with adverse outcomes in the general population, elevated blood pressure is associated with decreased mortality in patients with end-stage renal disease undergoing maintenance hemodialysis. Recent investigations in the general population have demonstrated the predictive utility of pulse pressure (systolic minus diastolic blood pressure), a measure reflecting the pulsatile nature of the cardiac cycle. OBJECTIVES: To estimate the relationship between pulse pressure and mortality in patients undergoing maintenance hemodialysis and to test our hypothesis that an increasing pulse pressure would be associated with increased risk of death up to 1 year despite the inverse relationship between conventional blood pressure measures and mortality in patients with end-stage renal disease. DESIGN, SETTING, AND PATIENTS: Retrospective cohort investigation of patients with end-stage renal disease undergoing maintenance hemodialysis at 782 hemodialysis facilities throughout the United States. Of 44 069 eligible patients as of January 1, 1998, 37 069 with complete demographic data were included in the analyses of clinical and laboratory data collected from October 1 through December 31, 1997. Patients were followed up through December 31, 1998. MAIN OUTCOME MEASURES: The primary study outcome was death at 1 year. A secondary outcome was the magnitude of the pulse pressure. RESULTS: The final patient cohort was similar to national averages with respect to age, sex, race, and diabetic status. Mean (SD) pulse pressures before dialysis were 75.0 (15.0) mm Hg and 66.9 (13.9) mm Hg after dialysis. By the end of the 1-year follow-up, 5731 patients (18.4%) died. After adjusting for level of systolic blood pressure, multivariable Cox proportional hazards modeling showed a direct and consistent relationship between increasing pulse pressure and increasing death risk. Each incremental elevation of 10 mm Hg in postdialysis pulse pressure was associated with a 12% increase in the hazard for death (hazard ratio, 1.12; 95% confidence interval, 1.06-1.18). Postdialysis systolic blood pressure was inversely related to mortality with a 13% decreased hazard for death for each incremental elevation of 10 mm Hg (hazard ratio, 0.87; 95% confidence interval, 0.84-0.90). In a multivariable linear regression model, important variables directly associated with elevated pulse pressure included age, diabetes, white race, female sex, and number of years receiving dialysis (all P<.001). CONCLUSIONS: Pulse pressure is associated with risk of death in a large, nationally representative sample of patients undergoing maintenance hemodialysis. The recognition of pulse pressure as an important correlate of mortality in patients receiving dialysis highlights the need to investigate the relationship between potential therapeutic implications of conduit vessel function and clinical outcomes in patients with end-stage renal disease.

Authors
Klassen, PS; Lowrie, EG; Reddan, DN; DeLong, ER; Coladonato, JA; Szczech, LA; Lazarus, JM; Owen, WF
MLA Citation
Klassen, PS, Lowrie, EG, Reddan, DN, DeLong, ER, Coladonato, JA, Szczech, LA, Lazarus, JM, and Owen, WF. "Association between pulse pressure and mortality in patients undergoing maintenance hemodialysis." JAMA 287.12 (March 27, 2002): 1548-1555.
PMID
11911757
Source
pubmed
Published In
JAMA : the journal of the American Medical Association
Volume
287
Issue
12
Publish Date
2002
Start Page
1548
End Page
1555

Underuse of aspirin in a referral population with documented coronary artery disease.

Despite substantial evidence that antiplatelet therapy saves lives and reduces adverse events in patients with coronary artery disease (CAD), use of the most widely available and lowest cost antiplatelet agent, aspirin, continues to be disappointingly low. In a large database of patients with known CAD, we (1) explored trends in the use of aspirin over time, (2) characterized patients most likely to take aspirin regularly, and (3) estimated the effectiveness of aspirin use by examining long-term outcomes. Using patients entered in the Duke Databank for Cardiovascular Diseases, we explored the use of aspirin from 1969 to 1999. More than 25,000 patients were sent a questionnaire that included several questions about medication use, including 1 question specifically about aspirin. Patients who failed to respond to the questionnaire received a follow-up telephone call. Aspirin use increased substantially over the most recent 4 years in the study, from 59% in 1995 to 81% in 1999. Predictors of aspirin use included younger age, male sex, being a nonsmoker, and having had a myocardial infarction or revascularization procedure. Patients who never took aspirin had a risk ratio for death of 1.85 compared with patients who regularly took aspirin. Despite the well-known beneficial effects of aspirin, too many patients without contraindications to aspirin fail to take it regularly. The health care system currently lacks effective methods to ensure that patients who have CAD have adequate follow-up concerning aspirin use.

Authors
Califf, RM; DeLong, ER; Ostbye, T; Muhlbaier, LH; Chen, A; LaPointe, NA; Hammill, BG; McCants, CB; Kramer, JM
MLA Citation
Califf, RM, DeLong, ER, Ostbye, T, Muhlbaier, LH, Chen, A, LaPointe, NA, Hammill, BG, McCants, CB, and Kramer, JM. "Underuse of aspirin in a referral population with documented coronary artery disease." Am J Cardiol 89.6 (March 15, 2002): 653-661.
PMID
11897205
Source
pubmed
Published In
The American Journal of Cardiology
Volume
89
Issue
6
Publish Date
2002
Start Page
653
End Page
661

A decade of change--risk profiles and outcomes for isolated coronary artery bypass grafting procedures, 1990-1999: a report from the STS National Database Committee and the Duke Clinical Research Institute. Society of Thoracic Surgeons.

BACKGROUND: The Society of Thoracic Surgeons National Adult Cardiac Database is the largest voluntary clinical database in medicine. Using this database we examined changes in the risk profile of patients undergoing isolated coronary artery bypass grafting (CABG) and their outcomes during the decade 1990 to 1999. METHODS: Trends in 23 preoperative risk factors were tracked for CABG cases during this decade. Using a multivariate logistic risk model, we also determined the degree to which operative risk and risk-adjusted operative mortality changed during this 10-year interval. RESULTS: Between 1990 and 1999, 1,154,486 patient records were harvested by the Society of Thoracic Surgeons National Adult Cardiac Database for isolated CABG procedures performed at 522 Society of Thoracic Surgeons participant sites in the United States and Canada. Over time, CABG patients were more likely to be older (mean age 63.7 in 1990, 65.1 in 1999), of female gender (25.7% women in 1990, 28.7% in 1999), and have a history of smoking, diabetes mellitus, renal failure, hypertension, stroke, chronic lung disease, New York Heart Association functional class IV, and three-vessel disease (p < 0.0001). Patients' predicted operative risk increased by 30.1%, from 2.6% in 1990 to 3.4% in 1999. Despite higher risk, observed operative mortality decreased by 23.1%, from 3.9% in 1990 to 3.0% in 1999 (p < 0.0001). During the decade, a Medicare-aged subset (n = 629,174) experienced similar increases in risk and declines in mortality. CONCLUSIONS: Patients referred for isolated CABG are significantly older, sicker, and have a higher risk than a decade ago. Despite this, CABG mortality rates have declined substantially. These results highlight the excellent progress in the care of CABG patients achieved during the past decade.

Authors
Ferguson, TB; Hammill, BG; Peterson, ED; DeLong, ER; Grover, FL; STS National Database Committee,
MLA Citation
Ferguson, TB, Hammill, BG, Peterson, ED, DeLong, ER, Grover, FL, and STS National Database Committee, . "A decade of change--risk profiles and outcomes for isolated coronary artery bypass grafting procedures, 1990-1999: a report from the STS National Database Committee and the Duke Clinical Research Institute. Society of Thoracic Surgeons." Ann Thorac Surg 73.2 (February 2002): 480-489.
PMID
11845863
Source
pubmed
Published In
The Annals of Thoracic Surgery
Volume
73
Issue
2
Publish Date
2002
Start Page
480
End Page
489

Variability in cost of coronary bypass surgery in New York State: potential for cost savings.

OBJECTIVE: Previous analyses of variability in bypass resource use have not focused on hospital-level variation or adequately explored the influence of patient risk. We combined a clinical database with claims data to fully characterize patient level and hospital level variability in bypass surgery cost and length of stay in New York State and explored the extent to which lower cost is associated with worse quality of care. METHODS: By use of 1992 clinical and claims data, we identified by multivariable regression which patient characteristics influence bypass cost and length of stay. Hospital was then incorporated as a random variable in mixed linear models to determine its impact on resource use. The relationship between risk-adjusted in-hospital mortality and cost was then explored. RESULTS: In the 21 hospitals for which cost data were available, mean leveled cost (exclusive of professional fees and noncomparable costs) was $15,713, with a mean length of stay of 14 days (n = 12,087). One fifth of the variation in resource use was explained by baseline patient risk. After adjustment for patient risk, hospital explained an additional 42% of variation in cost and an additional 8% of variation in length of stay. Among hospitals, risk-adjusted cost varied almost 3-fold and risk-adjusted length of stay varied 50%. There was no association between cost and in-hospital mortality. CONCLUSIONS: As of 1992, there was considerable interhospital variability in bypass surgery cost after patient baseline risk was accounted for. This suggests that reductions in bypass cost could be achieved by normalizing clinical practice.

Authors
Cowper, PA; DeLong, ER; Peterson, ED; Hannan, EL; Ray, KT; Racz, M; Mark, DB
MLA Citation
Cowper, PA, DeLong, ER, Peterson, ED, Hannan, EL, Ray, KT, Racz, M, and Mark, DB. "Variability in cost of coronary bypass surgery in New York State: potential for cost savings." Am Heart J 143.1 (January 2002): 130-139.
PMID
11773923
Source
pubmed
Published In
American Heart Journal
Volume
143
Issue
1
Publish Date
2002
Start Page
130
End Page
139

The impact of statistical adjustment on economic profiles of interventional cardiologists.

OBJECTIVES: The objective of this study was to identify preprocedure patient factors associated with percutaneous intervention costs and to examine the impact of these patient factors on economic profiles of interventional cardiologists. BACKGROUND: There is increasing demand for information about comparative resource use patterns of interventional cardiologists. Economic provider profiles, however, often fail to account for patient characteristics. METHODS: Data were obtained from Duke Medical Center cost and clinical information systems for 1,949 procedures performed by 13 providers between July 1, 1997, and December 31, 1998. Patient factors that influenced cost were identified using multiple regression analysis. After assessing interprovider variation in unadjusted cost, mixed linear models were used to examine how much cost variability was associated with the provider when patient characteristics were taken into account. RESULTS: Total hospital costs averaged $15,643 (median, $13,809), $6,515 of which represented catheterization laboratory costs. Disease severity, acuity, comorbid illness and lesion type influenced total costs (R(2) = 38%), whereas catheterization costs were affected by lesion type and acuity (R(2) = 32%). Patient characteristics varied significantly among providers. Unadjusted total costs were weakly associated with provider, and this association disappeared after accounting for patient factors. The provider influence on catheterization costs persisted after adjusting for patient characteristics. Furthermore, the pattern of variation changed: the adjusted analysis identified three new outliers, and two providers lost their outlier status. Only one provider was consistently identified as an outlier in the unadjusted and adjusted analyses. CONCLUSIONS: Economic profiles of interventional cardiologists may be misleading if they do not adequately adjust for patient characteristics before procedure.

Authors
Cowper, PA; Peterson, ED; DeLong, ER; Wightman, MB; Wawrzynski, RP; Muhlbaier, LH; Sketch, MH
MLA Citation
Cowper, PA, Peterson, ED, DeLong, ER, Wightman, MB, Wawrzynski, RP, Muhlbaier, LH, and Sketch, MH. "The impact of statistical adjustment on economic profiles of interventional cardiologists." J Am Coll Cardiol 38.5 (November 1, 2001): 1416-1423.
PMID
11691517
Source
pubmed
Published In
JACC - Journal of the American College of Cardiology
Volume
38
Issue
5
Publish Date
2001
Start Page
1416
End Page
1423

Patient factors that influence early discharge or prolonged length of stay after bypass surgery

Authors
Peterson, ED; Coombs, LP; Ferguson, TBB; Shroyer, L; Delong, ER; Edwards, FH
MLA Citation
Peterson, ED, Coombs, LP, Ferguson, TBB, Shroyer, L, Delong, ER, and Edwards, FH. "Patient factors that influence early discharge or prolonged length of stay after bypass surgery." CIRCULATION 104.17 (October 23, 2001): 596-596.
Source
wos-lite
Published In
Circulation
Volume
104
Issue
17
Publish Date
2001
Start Page
596
End Page
596

A decade of change: Risk profiles and outcomes for isolated CABG procedures, 1990-1999

Authors
Ferguson, TB; Hammill, B; Peterson, ED; Delong, ER; Grover, FL; Committee, ND
MLA Citation
Ferguson, TB, Hammill, B, Peterson, ED, Delong, ER, Grover, FL, and Committee, ND. "A decade of change: Risk profiles and outcomes for isolated CABG procedures, 1990-1999." CIRCULATION 104.17 (October 23, 2001): 596-596.
Source
wos-lite
Published In
Circulation
Volume
104
Issue
17
Publish Date
2001
Start Page
596
End Page
596

Using observational data to estimate prognosis: an example using a coronary artery disease registry.

With the proliferation of clinical data registries and the rising expense of clinical trials, observational data sources are increasingly providing evidence for clinical decision making. These data are viewed as complementary to randomized clinical trials (RCT). While not as rigorous a methodological design, observational studies yield important information about effectiveness of treatment, as compared with the efficacy results of RCTs. In addition, these studies often have the advantage of providing longer-term follow-up, beyond that of clinical trials. Hence, they are useful for assessing and comparing patients' long-term prognosis under different treatment strategies. For patients with coronary artery disease, many observational comparisons have focused on medical therapy versus interventional procedures. In addition to the well-studied problem of treatment selection bias (which is not the focus of the present study), three significant methodological problems must be addressed in the analysis of these data: (i) designation of the therapeutic arms in the presence of early deaths, withdrawals, and treatment cross-overs; (ii) identification of an equitable starting point for attributing survival time; (iii) site to site variability in short-term mortality. This paper discusses these issues and suggests strategies to deal with them. A proposed methodology is developed, applied and evaluated on a large observational database that has long-term follow-up on nearly 10 000 patients.

Authors
DeLong, ER; Nelson, CL; Wong, JB; Pryor, DB; Peterson, ED; Lee, KL; Mark, DB; Califf, RM; Pauker, SG
MLA Citation
DeLong, ER, Nelson, CL, Wong, JB, Pryor, DB, Peterson, ED, Lee, KL, Mark, DB, Califf, RM, and Pauker, SG. "Using observational data to estimate prognosis: an example using a coronary artery disease registry." Stat Med 20.16 (August 30, 2001): 2505-2532.
PMID
11512139
Source
pubmed
Published In
Statistics in Medicine
Volume
20
Issue
16
Publish Date
2001
Start Page
2505
End Page
2532

Sex differences in neurological outcomes and mortality after cardiac surgery: a society of thoracic surgery national database report.

BACKGROUND: The purpose of this study was to evaluate whether women undergoing cardiac surgery are more likely to suffer neurological complications than men and whether these complications could explain, at least in part, their higher perioperative mortality. METHODS AND RESULTS: The Society of Thoracic Surgery National Cardiac Surgery Database was examined for the years 1996 and 1997 to determine the frequency of new neurological events (stroke, transient ischemic attack, or coma) occurring after cardiac surgery. We reviewed clinical information on 416 347 patients (32% women) for whom complete neurological outcome data were available. New neurological events after surgery were higher for women than for men (3.8% versus 2.4%, P=0.001). For the whole group, the 30-day mortality was higher for women than for men (5.7% versus 3.5%, P=0.001), and among those patients who suffered a perioperative neurological event, mortality was also significantly higher for women than men (32% versus 28%, P=0.001). After adjustment for other risk factors (eg, age, history of hypertension and/or diabetes, duration of cardiopulmonary bypass, and other comorbid conditions) by multivariable logistic regression, female sex was independently associated with significantly higher risk of suffering new neurological events after cardiac surgery (OR 1.21, 95% CI 1.14 to 1.28, P=0.001). CONCLUSIONS: Women undergoing cardiac surgery are more likely than men to suffer new perioperative neurological events, and they have higher 30-day mortality when these complications occur. The higher incidence of perioperative neurological complications in women cannot be explained by currently known risk factors.

Authors
Hogue, CW; Barzilai, B; Pieper, KS; Coombs, LP; DeLong, ER; Kouchoukos, NT; Dávila-Román, VG
MLA Citation
Hogue, CW, Barzilai, B, Pieper, KS, Coombs, LP, DeLong, ER, Kouchoukos, NT, and Dávila-Román, VG. "Sex differences in neurological outcomes and mortality after cardiac surgery: a society of thoracic surgery national database report." Circulation 103.17 (May 1, 2001): 2133-2137. (Review)
PMID
11331252
Source
pubmed
Published In
Circulation
Volume
103
Issue
17
Publish Date
2001
Start Page
2133
End Page
2137

Prediction of operative mortality after valve replacement surgery.

OBJECTIVES: We sought to develop national benchmarks for valve replacement surgery by developing statistical risk models of operative mortality. BACKGROUND: National risk models for coronary artery bypass graft surgery (CABG) have gained widespread acceptance, but there are no similar models for valve replacement surgery. METHODS: The Society of Thoracic Surgeons National Cardiac Surgery Database was used to identify risk factors associated with valve surgery from 1994 through 1997. The population was drawn from 49,073 patients undergoing isolated aortic valve replacement (AVR) or mitral valve replacement (MVR) and from 43,463 patients undergoing CABG combined with AVR or MVR. Two multivariable risk models were developed: one for isolated AVR or MVR and one for CABG plus AVR or CABG plus MVR. RESULTS: Operative mortality rates for AVR, MVR, combined CABG/AVR and combined CABG/ MVR were 4.00%, 6.04%, 6.80% and 13.29%, respectively. The strongest independent risk factors were emergency/salvage procedures, recent infarction, reoperations and renal failure. The c-indexes were 0.77 and 0.74 for the isolated valve replacement and combined CABG/valve replacement models, respectively. These models retained their predictive accuracy when applied to a prospective patient population undergoing operation from 1998 to 1999. The Hosmer-Lemeshow goodness-of-fit statistic was 10.6 (p = 0.225) for the isolated valve replacement model and 12.2 (p = 0.141) for the CABG/valve replacement model. CONCLUSIONS: Statistical models have been developed to accurately predict operative mortality after valve replacement surgery. These models can be used to enhance quality by providing a national benchmark for valve replacement surgery.

Authors
Edwards, FH; Peterson, ED; Coombs, LP; DeLong, ER; Jamieson, WR; Shroyer ALW, ; Grover, FL
MLA Citation
Edwards, FH, Peterson, ED, Coombs, LP, DeLong, ER, Jamieson, WR, Shroyer ALW, , and Grover, FL. "Prediction of operative mortality after valve replacement surgery." J Am Coll Cardiol 37.3 (March 1, 2001): 885-892.
PMID
11693766
Source
pubmed
Published In
JACC - Journal of the American College of Cardiology
Volume
37
Issue
3
Publish Date
2001
Start Page
885
End Page
892

A diagnostic for Cox regression with discrete failure-time models.

Changes in maximum likelihood parameter estimates due to deletion of individual observations are useful statistics, both for regression diagnostics and for computing robust estimates of covariance. For many likelihoods, including those in the exponential family, these delete-one statistics can be approximated analytically from a one-step Newton-Raphson iteration on the full maximum likelihood solution. But for general conditional likelihoods and the related Cox partial likelihood, the one-step method does not reduce to an analytic solution. For these likelihoods, an alternative analytic approximation that relies on an appropriately augmented design matrix has been proposed. In this paper, we extend the augmentation approach to explicitly deal with discrete failure-time models. In these models, an individual subject may contribute information at several time points, thereby appearing in multiple risk sets before eventually experiencing a failure or being censored. Our extension also allows the covariates to be time dependent. The new augmentation requires no additional computational resources while improving results.

Authors
Parker, CB; Delong, ER
MLA Citation
Parker, CB, and Delong, ER. "A diagnostic for Cox regression with discrete failure-time models." Biometrics 56.4 (December 2000): 996-1001.
PMID
11213761
Source
pubmed
Published In
Biometrics
Volume
56
Issue
4
Publish Date
2000
Start Page
996
End Page
1001

Challenges in comparing risk-adjusted bypass surgery mortality results: results from the Cooperative Cardiovascular Project.

OBJECTIVES: We sought to evaluate the predictive accuracy of four bypass surgery mortality clinical risk models and to examine the extent to which hospitals' risk-adjusted surgical outcomes vary depending on which risk-adjustment method is applied. BACKGROUND: Cardiovascular "report cards" often compare risk-adjusted surgical outcomes; however, it is unclear to what extent the risk-adjustment process itself may affect these metrics. METHODS: As part of the Cooperative Cardiovascular Project's Pilot Revascularization Study, we compared the predictive accuracy of four bypass clinical risk models among 3,654 Medicare patients undergoing surgery at 28 hospitals in Alabama and Iowa. We also compared the agreement in hospital-level risk-adjusted bypass outcome performance ratings depending on which of the four risk models was applied. RESULTS: Although the four risk models had similar discriminatory abilities (C-index, 0.71 to 0.74), certain models tended to overpredict mortality in higher-risk patients. There was high correlation between a hospital's risk-adjusted mortality rates regardless of which of the four models was used (correlation between risk-adjusted rating, 0.93 to 0.97). In contrast, there was limited agreement in which hospitals were identified as "performance outliers" depending on which risk-adjustment model was used and how outlier status was defined. CONCLUSIONS: A hospital's risk-adjusted bypass surgery mortality rating, relative to its peers, was consistent regardless of the risk-adjustment model applied, supporting their use as a means of provider performance feedback. Designation of performance outliers, however, can vary significantly depending on the benchmark and methods used for this determination.

Authors
Peterson, ED; DeLong, ER; Muhlbaier, LH; Rosen, AB; Buell, HE; Kiefe, CI; Kresowik, TF
MLA Citation
Peterson, ED, DeLong, ER, Muhlbaier, LH, Rosen, AB, Buell, HE, Kiefe, CI, and Kresowik, TF. "Challenges in comparing risk-adjusted bypass surgery mortality results: results from the Cooperative Cardiovascular Project." J Am Coll Cardiol 36.7 (December 2000): 2174-2184.
PMID
11127458
Source
pubmed
Published In
JACC - Journal of the American College of Cardiology
Volume
36
Issue
7
Publish Date
2000
Start Page
2174
End Page
2184

The impact of risk adjustment on economic profiles of interventional cardiologists

Authors
Cowper, PA; Peterson, ED; Delong, ER; Wightman, MB; Stafford, J; Muhlbaier, LH; Wawrzynski, RP; Sketch, MH; Ryan, T
MLA Citation
Cowper, PA, Peterson, ED, Delong, ER, Wightman, MB, Stafford, J, Muhlbaier, LH, Wawrzynski, RP, Sketch, MH, and Ryan, T. "The impact of risk adjustment on economic profiles of interventional cardiologists." CIRCULATION 102.18 (October 31, 2000): 840-840.
Source
wos-lite
Published In
Circulation
Volume
102
Issue
18
Publish Date
2000
Start Page
840
End Page
840

Prediction of operative mortality following valve replacement surgery

Authors
Edwards, FH; DeLong, ER; Shroyer, AL; Anstrom, KJ; Grover, FL; Peterson, ED; STS, STS
MLA Citation
Edwards, FH, DeLong, ER, Shroyer, AL, Anstrom, KJ, Grover, FL, Peterson, ED, and STS, STS. "Prediction of operative mortality following valve replacement surgery." JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 35.2 (February 2000): 529A-530A.
Source
wos-lite
Published In
JACC - Journal of the American College of Cardiology
Volume
35
Issue
2
Publish Date
2000
Start Page
529A
End Page
530A

Measuring and improving quality of care: A report from the American Heart Association/American College of Cardiology First Scientific Forum on Assessment of Healthcare Quality in Cardiovascular Disease and Stroke

Authors
Krumholz, HM; Brass, LM; Every, NR; Spertus, JA; Bazzarre, T; Cohen, DJ; Hlatky, MA; Peterson, ED; Radford, MJ; Weintraub, WS; Cannon, CP; Ellerbeck, EF; McNeil, BJ; Ryan, TJ; Jr, SSC; Baker, DW; Ashton, CM; Dunbar, SB; Friesinger, GC; Havranek, EP; Konstam, M; Ordin, DL; Pina, IL; Pitt, B; DeLong, ER; Eagle, KA; Normand, S-L; Mark, DB; McAllister, BD; Thomas, JW; Duncan, PW; Goldstein, LB; Gorelick, PB; Hinchey, JA; Matchar, DB; Nilasena, D; Wennberg, D; Williams, LS; Wolf, PA
MLA Citation
Krumholz, HM, Brass, LM, Every, NR, Spertus, JA, Bazzarre, T, Cohen, DJ, Hlatky, MA, Peterson, ED, Radford, MJ, Weintraub, WS, Cannon, CP, Ellerbeck, EF, McNeil, BJ, Ryan, TJ, Jr, SSC, Baker, DW, Ashton, CM, Dunbar, SB, Friesinger, GC, Havranek, EP, Konstam, M, Ordin, DL, Pina, IL, Pitt, B, DeLong, ER, Eagle, KA, Normand, S-L, Mark, DB, McAllister, BD, Thomas, JW, Duncan, PW, Goldstein, LB, Gorelick, PB, Hinchey, JA, Matchar, DB, Nilasena, D, Wennberg, D, Williams, LS, and Wolf, PA. "Measuring and improving quality of care: A report from the American Heart Association/American College of Cardiology First Scientific Forum on Assessment of Healthcare Quality in Cardiovascular Disease and Stroke." Stroke 31.4 (2000): 1002-1012.
Source
scival
Published In
Stroke
Volume
31
Issue
4
Publish Date
2000
Start Page
1002
End Page
1012

Measuring and improving quality of care: A report from the American Heart Association/American College of Cardiology First Scientific Forum on Assessment of Healthcare Quality in Cardiovascular Disease and Stroke

Authors
Krumholz, HM; Brass, LM; Every, NR; Spertus, JA; Bazzarre, T; Cohen, DJ; Hlatky, MA; Peterson, ED; Radford, MJ; Weintraub, WS; Cannon, CP; Ellerbeck, EF; McNeil, BJ; Ryan, TJ; Jr, SSC; Baker, DW; Ashton, CM; Dunbar, SB; Friesinger, GC; Havranek, EP; Konstam, M; Ordin, DL; Pina, IL; Pitt, B; DeLong, ER; Eagle, KA; Normand, S-L; Mark, DB; McAllister, BD; Thomas, JW; Duncan, PW; Goldstein, LB; Gorelick, PB; Hinchey, JA; Matchar, DB; Nilasena, D; Wennberg, D; Williams, LS; Wolf, PA
MLA Citation
Krumholz, HM, Brass, LM, Every, NR, Spertus, JA, Bazzarre, T, Cohen, DJ, Hlatky, MA, Peterson, ED, Radford, MJ, Weintraub, WS, Cannon, CP, Ellerbeck, EF, McNeil, BJ, Ryan, TJ, Jr, SSC, Baker, DW, Ashton, CM, Dunbar, SB, Friesinger, GC, Havranek, EP, Konstam, M, Ordin, DL, Pina, IL, Pitt, B, DeLong, ER, Eagle, KA, Normand, S-L, Mark, DB, McAllister, BD, Thomas, JW, Duncan, PW, Goldstein, LB, Gorelick, PB, Hinchey, JA, Matchar, DB, Nilasena, D, Wennberg, D, Williams, LS, and Wolf, PA. "Measuring and improving quality of care: A report from the American Heart Association/American College of Cardiology First Scientific Forum on Assessment of Healthcare Quality in Cardiovascular Disease and Stroke." Circulation 101.12 (2000): 1483-1493.
PMID
10736296
Source
scival
Published In
Circulation
Volume
101
Issue
12
Publish Date
2000
Start Page
1483
End Page
1493

31 Statistical applications in cardiovascular disease

Authors
DeLong, ER; DeLong, DM
MLA Citation
DeLong, ER, and DeLong, DM. "31 Statistical applications in cardiovascular disease." Handbook of Statistics 18 (2000): 915-939.
Source
scival
Published In
Handbook of Statistics
Volume
18
Publish Date
2000
Start Page
915
End Page
939
DOI
10.1016/S0169-7161(00)18033-2

The safety of early extubation following CABG in the elderly: Results in 4,538 pts aged 65 yrs or older

Authors
Peterson, ED; Anstrom, KJ; Holman, WL; DeLong, ER; Klefe, CI; Allman, RM
MLA Citation
Peterson, ED, Anstrom, KJ, Holman, WL, DeLong, ER, Klefe, CI, and Allman, RM. "The safety of early extubation following CABG in the elderly: Results in 4,538 pts aged 65 yrs or older." CIRCULATION 100.18 (November 2, 1999): 592-592.
Source
wos-lite
Published In
Circulation
Volume
100
Issue
18
Publish Date
1999
Start Page
592
End Page
592

Highly accurate risk prediction models may not predict outcomes

Authors
DeLong, ER; Muhlbaler, LH; Cowper, PA; Peterson, ED
MLA Citation
DeLong, ER, Muhlbaler, LH, Cowper, PA, and Peterson, ED. "Highly accurate risk prediction models may not predict outcomes." CIRCULATION 100.18 (November 2, 1999): 318-318.
Source
wos-lite
Published In
Circulation
Volume
100
Issue
18
Publish Date
1999
Start Page
318
End Page
318

Do the very aged benefit from revascularization? Results from 2,613 pts aged >= 75 yrs in the Duke database

Authors
Peterson, ED; Burell, H; DeLong, ER; Jones, RH; Mark, DB
MLA Citation
Peterson, ED, Burell, H, DeLong, ER, Jones, RH, and Mark, DB. "Do the very aged benefit from revascularization? Results from 2,613 pts aged >= 75 yrs in the Duke database." CIRCULATION 100.18 (November 2, 1999): 84-85.
Source
wos-lite
Published In
Circulation
Volume
100
Issue
18
Publish Date
1999
Start Page
84
End Page
85

Economics and cost-effectiveness in evaluating the value of cardiovascular therapies. Statistical issues in cost-effectiveness analysis.

Authors
DeLong, ER; Simons, T
MLA Citation
DeLong, ER, and Simons, T. "Economics and cost-effectiveness in evaluating the value of cardiovascular therapies. Statistical issues in cost-effectiveness analysis." Am Heart J 137.5 (May 1999): S47-S50.
PMID
10220596
Source
pubmed
Published In
American Heart Journal
Volume
137
Issue
5
Publish Date
1999
Start Page
S47
End Page
S50

Acute and long-term cost implications of coronary stenting.

OBJECTIVES: We compared the acute and one year medical costs and outcomes of coronary stenting with those for balloon angioplasty (percutaneous transluminal coronary angioplasty) in contemporary clinical practice. BACKGROUND: While coronary stent implantation reduces the need for repeat revascularization, it has been associated with significantly higher acute costs compared with coronary angioplasty. METHODS: We studied patients treated at Duke University between September 1995 and June 1996 who received either coronary stent (n = 384) or coronary angioplasty (n = 159) and met eligibility criteria. Detailed cost data were collected initially and up to one year following the procedure. Our primary analyses compared six and 12 month cumulative costs for coronary angioplasty- and stent-treated cohorts. We also compared treatment costs after excluding nontarget vessel interventions; after limiting analysis to those without prior revascularization; and after risk-adjusting cumulative cost estimates. RESULTS: Baseline clinical characteristics were generally similar between the two treatment groups. The mean in-hospital cost for stent patients was $3,268 higher than for those receiving coronary angioplasty ($14,802 vs. $11,534, p < 0.001). However, stent patients were less likely to be rehospitalized (22% vs. 34%, p = 0.002) or to undergo repeat revascularization (9% vs. 26%, p = 0.001) than coronary angioplasty patients within six months of the procedure. As such, mean cumulative costs at 6 months ($19,598 vs. $19,820, p = 0.18) and one year ($22,140 vs. $22,571, p = 0.26) were similar for the two treatments. Adjusting for baseline predictors of cost and selectively examining target vessel revascularization, or those without prior coronary intervention yielded similar conclusions. CONCLUSIONS: In contemporary practice, coronary stenting provides equivalent or better one-year patient outcomes without increasing cumulative health care costs.

Authors
Peterson, ED; Cowper, PA; DeLong, ER; Zidar, JP; Stack, RS; Mark, DB
MLA Citation
Peterson, ED, Cowper, PA, DeLong, ER, Zidar, JP, Stack, RS, and Mark, DB. "Acute and long-term cost implications of coronary stenting." J Am Coll Cardiol 33.6 (May 1999): 1610-1618.
PMID
10334432
Source
pubmed
Published In
JACC - Journal of the American College of Cardiology
Volume
33
Issue
6
Publish Date
1999
Start Page
1610
End Page
1618

Hyperbaric oxygen for carbon monoxide poisoning.

Authors
Moon, RE; DeLong, E
MLA Citation
Moon, RE, and DeLong, E. "Hyperbaric oxygen for carbon monoxide poisoning." Med J Aust 170.5 (March 1, 1999): 197-199.
PMID
10092913
Source
pubmed
Published In
The Medical journal of Australia
Volume
170
Issue
5
Publish Date
1999
Start Page
197
End Page
199

Erratum: Value of exercise treadmill testing in women. Low dose dobutamine echocardiography predicts improvement in functional capacity after exercise training in patients with ischemic cardiomyopathy (Journal of the American College of Cardiology (1998) 32 (1657-1664))

Authors
Alexander, K; Shaw, LJ; Shaw, LK; DeLong, E; Mark, D; Peterson, E
MLA Citation
Alexander, K, Shaw, LJ, Shaw, LK, DeLong, E, Mark, D, and Peterson, E. "Erratum: Value of exercise treadmill testing in women. Low dose dobutamine echocardiography predicts improvement in functional capacity after exercise training in patients with ischemic cardiomyopathy (Journal of the American College of Cardiology (1998) 32 (1657-1664))." Journal of the American College of Cardiology 33.1 (1999): 289--.
Source
scival
Published In
JACC - Journal of the American College of Cardiology
Volume
33
Issue
1
Publish Date
1999
Start Page
289-
DOI
10.1016/S0735-1097(98)00655-X

Determination of the potency of remifentanil compared with alfentanil using ventilatory depression as the measure of opioid effect

Background: Remifentanil is a new opioid with properties similar to other mu-specific agonists. To establish its pharmacologic profile relative to other known opioids, it is important to determine its potency. This study investigated the relative potency of remifentanil compared with alfentanil. Methods: Thirty young healthy males were administered double-blind remifentanil or alfentanil intravenously for 180 min using a computer- assisted continuous infusion device. Depression of ventilation was assessed by the minute ventilatory response to 7.5% CO2 administered via a 'bag in the box' system. The target concentration of the study drug was adjusted to obtain 40-70% depression of baseline minute ventilation. Multiple blood samples were obtained during and following the infusion. The concentration- effect relationship of each drug was modeled, and the concentration needed to provide a 50% depression of ventilation (EC50) was determined. Results: Only 11 subjects in each drug group completed the study; however, there were sufficient data in 28 volunteers to model their EC50 values. The EC50 (mean and 95% confidence interval) for depression of minute ventilation with remifentanil was 1.17 (0.85-1.49) ng/ml and the EC50 for alfentanil was 49.4 (32.4-66.5) ng/ml. Conclusion: Based on depression of the minute ventilatory response to 7.5% CO2, remifentanil is approximately 40 (26- 65) times more potent than alfentanil when remifentanil and alfentanil whole- blood concentrations are compared. As alfentanil is usually measured as a plasma concentration, remifentanil is approximately 70 (41-104) times more potent than alfentanil when remifentanil whole-blood concentration is compared with alfentanil plasma concentration. This information should be used when performing comparative studies between remifentanil and other opioids.

Authors
Glass, PSA; Iselin-Chaves, IA; Goodman, D; Delong, E; Hermann, DJ
MLA Citation
Glass, PSA, Iselin-Chaves, IA, Goodman, D, Delong, E, and Hermann, DJ. "Determination of the potency of remifentanil compared with alfentanil using ventilatory depression as the measure of opioid effect." Anesthesiology 90.6 (1999): 1556-1563.
PMID
10360852
Source
scival
Published In
Anesthesiology
Volume
90
Issue
6
Publish Date
1999
Start Page
1556
End Page
1563
DOI
10.1097/00000542-199906000-00010

Statistical issues in cost-effectiveness analysis

Authors
DeLong, ER; Simons, T
MLA Citation
DeLong, ER, and Simons, T. "Statistical issues in cost-effectiveness analysis." American Heart Journal 137.5 (1999): S47-S50.
Source
scival
Published In
American Heart Journal
Volume
137
Issue
5
Publish Date
1999
Start Page
S47
End Page
S50
DOI
10.1016/S0002-8703(99)70428-X

A comparison of 0.5% bupivacaine, 0.5% ropivacaine, and 0.75% ropivacaine for interscalene brachial plexus block.

UNLABELLED: The onset time and duration of action of ropivacaine during an interscalene block are not known. The potentially improved safety profile of ropivacaine may allow the use of higher concentrations to try and speed onset time. We compared bupivacaine and ropivacaine to determine the optimal long-acting local anesthetic and concentration for interscalene brachial plexus block. Seventy-five adult patients scheduled for outpatient shoulder surgery under interscalene block were entered into this double-blind, randomized study. Patients were assigned (n = 25 per group) to receive an interscalene block using 30 mL of 0.5% bupivacaine, 0.5% ropivacaine, or 0.75% ropivacaine. All solutions contained fresh epinephrine in a 1:400,000 concentration. At 1-min intervals after local anesthetic injection, patients were assessed to determine loss of shoulder abduction and loss of pinprick in the C5-6 dermatomes. Before discharge, patients were asked to document the time of first oral narcotic use, when incisional discomfort began, and when full sensation returned to the shoulder. The mean onset time of both motor and sensory blockade was <6 min in all groups. Duration of sensory blockade was similar in all groups as defined by the three recovery measures. We conclude that there is no clinically important difference in times to onset and recovery of interscalene block for bupivacaine 0.5%, ropivacaine 0.5%, and ropivacaine 0.75% when injected in equal volumes. IMPLICATIONS: In this study, we demonstrated a similar efficacy between equal concentrations of ropivacaine and bupivacaine. In addition, increasing the concentration of ropivacaine from 0.5% to 0.75% fails to improve the onset or duration of interscalene brachial plexus block.

Authors
Klein, SM; Greengrass, RA; Steele, SM; D'Ercole, FJ; Speer, KP; Gleason, DH; DeLong, ER; Warner, DS
MLA Citation
Klein, SM, Greengrass, RA, Steele, SM, D'Ercole, FJ, Speer, KP, Gleason, DH, DeLong, ER, and Warner, DS. "A comparison of 0.5% bupivacaine, 0.5% ropivacaine, and 0.75% ropivacaine for interscalene brachial plexus block." Anesth Analg 87.6 (December 1998): 1316-1319.
PMID
9842819
Source
pubmed
Published In
Anesthesia and Analgesia
Volume
87
Issue
6
Publish Date
1998
Start Page
1316
End Page
1319

Value of exercise treadmill testing in women.

OBJECTIVES: We sought to determine the ability of a treadmill score to provide accurate diagnostic and prognostic risk estimates in women. BACKGROUND: Treadmill testing has been reported to have a lower accuracy for diagnosis of chest pain in women. The diagnostic and prognostic value of the Duke Treadmill Score (DTS) in women is unknown. METHODS: We determined the diagnostic and prognostic value of the DTS in 976 women and 2,249 men who underwent both treadmill testing and cardiac catheterization in a single institution from 1984 to 1994. RESULTS: Women and men differed significantly in DTS (1.6 vs. -0.3, p < 0.0001), disease prevalence (32% vs. 72% significant coronary artery disease [CAD], p < 0.001), and 2-year mortality (1.9% vs. 4.9%, p < 0.0001). The DTS provided information beyond clinical predictors of both coronary disease and survival in women and men. Although overall women had better survival, the DTS performed equally well in stratifying both genders into prognostic categories. The DTS actually performed better in women than in men for excluding disease, with fewer low risk women having any significant coronary disease (> or = 1 vessel with > or =75% stenosis) (20% vs. 47%, p < 0.001), or severe disease (3-vessel disease or > or =75% left main stenosis) (3.5% vs. 11.4%, p < 0.001). CONCLUSIONS: By combining several aspects of treadmill testing, the DTS effectively stratifies women into diagnostic and prognostic risk categories.

Authors
Alexander, KP; Shaw, LJ; Shaw, LK; Delong, ER; Mark, DB; Peterson, ED
MLA Citation
Alexander, KP, Shaw, LJ, Shaw, LK, Delong, ER, Mark, DB, and Peterson, ED. "Value of exercise treadmill testing in women." J Am Coll Cardiol 32.6 (November 15, 1998): 1657-1664.
PMID
9822093
Source
pubmed
Published In
JACC - Journal of the American College of Cardiology
Volume
32
Issue
6
Publish Date
1998
Start Page
1657
End Page
1664

Use of a prognostic treadmill score in identifying diagnostic coronary disease subgroups.

BACKGROUND: Exercise testing is useful in the assessment of symptomatic patients for diagnosis of significant or extensive coronary disease and to predict their future risk of cardiac events. The Duke treadmill score (DTS) is a composite index that was designed to provide survival estimates based on results from the exercise test, including ST-segment depression, chest pain, and exercise duration. However, its usefulness for providing diagnostic estimates has yet to be determined. METHODS AND RESULTS: A logistic regression model was used to predict significant (>/=75% stenosis) and severe (3-vessel or left main) coronary artery disease, and a Cox regression analysis was used to predict cardiac survival. After adjustment for baseline clinical risk, the DTS was effectively diagnostic for significant (P<0.0001) and severe (P<0.0001) coronary artery disease. For low-risk patients (score >/=+5), 60% had no coronary stenosis >/=75% and 16% had single-vessel >/=75% stenosis. By comparison, 74% of high-risk patients (score <-11) had 3-vessel or left main coronary disease. Five-year mortality was 3%, 10%, and 35% for low-, moderate-, and high-risk DTS groups (P<0.0001). CONCLUSIONS: The composite DTS provides accurate diagnostic and prognostic information for the evaluation of symptomatic patients evaluated for clinically suspected ischemic heart disease.

Authors
Shaw, LJ; Peterson, ED; Shaw, LK; Kesler, KL; DeLong, ER; Harrell, FE; Muhlbaier, LH; Mark, DB
MLA Citation
Shaw, LJ, Peterson, ED, Shaw, LK, Kesler, KL, DeLong, ER, Harrell, FE, Muhlbaier, LH, and Mark, DB. "Use of a prognostic treadmill score in identifying diagnostic coronary disease subgroups." Circulation 98.16 (October 20, 1998): 1622-1630.
PMID
9778327
Source
pubmed
Published In
Circulation
Volume
98
Issue
16
Publish Date
1998
Start Page
1622
End Page
1630

The effects of New York's bypass surgery provider profiling on access to care and patient outcomes in the elderly.

OBJECTIVE: The aim of this study was to examine the effects of provider profiling on bypass surgery access and outcomes in elderly patients in New York. BACKGROUND: Since 1989, New York (NY) has compiled provider-specific bypass surgery mortality reports. While some have proposed that "provider profiling" has led to lower surgical mortality rates, critics have suggested that such programs lower in-state procedural access (increasing out-of-state transfers) without improving patient outcomes. METHODS: Using national Medicare data, we examined trends in the percentages of NY residents aged 65 years or older receiving out-of-state bypass surgery between 1987 and 1992 (before and after program initiation). We also examined in-state procedure use among elderly myocardial infarction patients during this period. Finally, we compared trends in surgical outcomes in NY Medicare patients with those for the rest of the nation. RESULTS: Between 1987 and 1992, the percentage of NY residents receiving bypass out-of-state actually declined (from 12.5% to 11.3%, p < 0.01 for trend). An elderly patient's likelihood for bypass following myocardial infarction in NY increased significantly since the program's initiation. Between 1987 and 1992, unadjusted 30-day mortality rates following bypass declined by 33% in NY Medicare patients compared with a 19% decline nationwide (p < 0.001). As a result of this improvement, NY had the lowest risk-adjusted bypass mortality rate of any state in 1992. CONCLUSIONS: We found no evidence that NY's provider profiling limited procedure access in NY's elderly or increased out-of-state transfers. Despite an increasing preoperative risk profile, procedural outcomes in NY improved significantly faster than the national average.

Authors
Peterson, ED; DeLong, ER; Jollis, JG; Muhlbaier, LH; Mark, DB
MLA Citation
Peterson, ED, DeLong, ER, Jollis, JG, Muhlbaier, LH, and Mark, DB. "The effects of New York's bypass surgery provider profiling on access to care and patient outcomes in the elderly." J Am Coll Cardiol 32.4 (October 1998): 993-999.
PMID
9768723
Source
pubmed
Published In
JACC - Journal of the American College of Cardiology
Volume
32
Issue
4
Publish Date
1998
Start Page
993
End Page
999

A large population study reveals reduced anesthetic requirements in females

Authors
DeLong, ER; Kwatra, MM; Gan, TJ; Glass, PSA; Sanderson, IC; Gilbert, WC; Coleman, RL; Lubarsky, DA; Reves, JG
MLA Citation
DeLong, ER, Kwatra, MM, Gan, TJ, Glass, PSA, Sanderson, IC, Gilbert, WC, Coleman, RL, Lubarsky, DA, and Reves, JG. "A large population study reveals reduced anesthetic requirements in females." ANESTHESIOLOGY 89.3A (September 1998): U191-U191.
Source
wos-lite
Published In
Anesthesiology
Volume
89
Issue
3A
Publish Date
1998
Start Page
U191
End Page
U191

Aging profoundly decreases anesthetic requirement

Authors
DeLong, ER; Kawatra, MM; Gan, TJ; Glass, PSA; Sanderson, IC; Gilbert, WC; Coleman, RL; Lubarsky, DA; Reves, JG
MLA Citation
DeLong, ER, Kawatra, MM, Gan, TJ, Glass, PSA, Sanderson, IC, Gilbert, WC, Coleman, RL, Lubarsky, DA, and Reves, JG. "Aging profoundly decreases anesthetic requirement." ANESTHESIOLOGY 89.3A (September 1998): U766-U766.
Source
wos-lite
Published In
Anesthesiology
Volume
89
Issue
3A
Publish Date
1998
Start Page
U766
End Page
U766

The impact of choice of muscle relaxant on postoperative recovery time.

Authors
Lubarsky, DA; DeLong, ER
MLA Citation
Lubarsky, DA, and DeLong, ER. "The impact of choice of muscle relaxant on postoperative recovery time." Anesth Analg 87.2 (August 1998): 499-500. (Letter)
PMID
9706968
Source
pubmed
Published In
Anesthesia and Analgesia
Volume
87
Issue
2
Publish Date
1998
Start Page
499
End Page
500

Writing successful research proposals for medical science.

Authors
Schwinn, DA; DeLong, ER; Shafer, SL
MLA Citation
Schwinn, DA, DeLong, ER, and Shafer, SL. "Writing successful research proposals for medical science." Anesthesiology 88.6 (June 1998): 1660-1666.
PMID
9637661
Source
pubmed
Published In
Anesthesiology
Volume
88
Issue
6
Publish Date
1998
Start Page
1660
End Page
1666

Economic assessment of low-molecular-weight heparin (enoxaparin) versus unfractionated heparin in acute coronary syndrome patients: results from the ESSENCE randomized trial. Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q wave Coronary Events [unstable angina or non-Q-wave myocardial infarction].

BACKGROUND: In the ESSENCE trial, subcutaneous low-molecular-weight heparin (enoxaparin) reduced the 30-day incidence of death, myocardial infarction, and recurrent angina relative to intravenous unfractionated heparin in 3171 patients with acute coronary syndrome (unstable angina or non-Q-wave myocardial infarction). No increase in major bleeding was seen. METHODS AND RESULTS: Of the 936 ESSENCE patients randomized in the United States, 655 had hospital billing data collected. For the remainder, hospital costs were imputed with a multivariable linear regression model (R2=.86). Physician fees were estimated from the Medicare Fee Schedule. During the initial hospitalization, major resource use was reduced for enoxaparin patients, with the largest effect seen with coronary angioplasty (15% versus 20% for heparin, P=.04). At 30 days, these effects persisted, with the largest reductions seen in diagnostic catheterization (57% versus 63% for heparin, P=.04) and coronary angioplasty (18% versus 22%, P=.08). All resource use trends seen in the US cohort were also evident in the overall ESSENCE study population. In the United States, the mean cost of a course of enoxaparin therapy was $155, whereas that for heparin was $80. The total medical costs (hospital, physician, drug) for the initial hospitalization were $11 857 for enoxaparin and $12620 for heparin, a cost advantage for the enoxaparin arm of $763 (P=.18). At the end of 30 days, the cumulative cost savings associated with enoxaparin was $1172 (P=.04). In 200 bootstrap samples of the 30-day data, 94% of the samples showed a cost advantage for enoxaparin. CONCLUSIONS: In patients with acute coronary syndrome, low-molecular-weight heparin (enoxaparin) both improves important clinical outcomes and saves money relative to therapy with standard unfractionated heparin.

Authors
Mark, DB; Cowper, PA; Berkowitz, SD; Davidson-Ray, L; DeLong, ER; Turpie, AG; Califf, RM; Weatherley, B; Cohen, M
MLA Citation
Mark, DB, Cowper, PA, Berkowitz, SD, Davidson-Ray, L, DeLong, ER, Turpie, AG, Califf, RM, Weatherley, B, and Cohen, M. "Economic assessment of low-molecular-weight heparin (enoxaparin) versus unfractionated heparin in acute coronary syndrome patients: results from the ESSENCE randomized trial. Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q wave Coronary Events [unstable angina or non-Q-wave myocardial infarction]." Circulation 97.17 (May 5, 1998): 1702-1707.
PMID
9591764
Source
pubmed
Published In
Circulation
Volume
97
Issue
17
Publish Date
1998
Start Page
1702
End Page
1707

Do PTCA mortality outcomes need to be risk-adjusted? Results from the national cardiovascular network (NCN)

Authors
Peterson, ED; Moore, D; Muhlbaier, LH; DeLong, ER
MLA Citation
Peterson, ED, Moore, D, Muhlbaier, LH, and DeLong, ER. "Do PTCA mortality outcomes need to be risk-adjusted? Results from the national cardiovascular network (NCN)." JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 31.2 (February 1998): 173A-173A.
Source
wos-lite
Published In
JACC - Journal of the American College of Cardiology
Volume
31
Issue
2
Publish Date
1998
Start Page
173A
End Page
173A
DOI
10.1016/S0735-1097(97)84462-2

Predicting mortality following PTCA: Results from NCN

Authors
Peterson, ED; Moore, D; Muhlbaier, LH; DeLong, ER; Grosswald, R
MLA Citation
Peterson, ED, Moore, D, Muhlbaier, LH, DeLong, ER, and Grosswald, R. "Predicting mortality following PTCA: Results from NCN." JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 31.2 (February 1998): 179A-179A.
Source
wos-lite
Published In
JACC - Journal of the American College of Cardiology
Volume
31
Issue
2
Publish Date
1998
Start Page
179A
End Page
179A
DOI
10.1016/S0735-1097(97)84485-3

Economic assessment of low-molecular-weight heparin (enoxaparin) versus unfractionated heparin in acute coronary syndrome patients: Results from the ESSENCE randomized trial

Background - In the ESSENCE trial, subcutaneous low-molecular-weight heparin (enoxaparin) reduced the 30-day incidence of death, myocardial infarction, and recurrent angina relative to intravenous unfractionated heparin in 3171 patients with acute coronary syndrome (unstable angina or non-Q-wave myocardial infarction). No increase in major bleeding was seen. Methods and Results - Of the 936 ESSENCE patients randomized in the United States, 655 had hospital billing data collected. For the remainder, hospital costs were imputed with a multivariable linear regression model (R2=.86). Physician fees were estimated from the Medicare Fee Schedule. During the initial hospitalization, major resource use was reduced for enoxaparin patients, with the largest effect seen with coronary angioplasty (15% versus 20% for heparin, P=.04). At 30 days, these effects persisted, with the largest reductions seen in diagnostic catheterization (57% versus 63% for heparin, P=.04) and coronary angioplasty (18% versus 22%, P=.08). All resource use trends seen in the US cohort were also evident in the overall ESSENCE study population. In the United States, the mean cost of a course of enoxaparin therapy was $155, whereas that for heparin was $80. The total medical costs (hospital, physician, drug) for the initial hospitalization were $11 857 for enoxaparin and $12 620 for heparin, a cost advantage for the enoxaparin arm of $763 (P=.18). At the end of 30 days, the cumulative cost savings associated with enoxaparin was $1172 (P=.04). In 200 bootstrap samples of the 30-day data, 94% of the samples showed a cost advantage for enoxaparin. Conclusions - In patients with acute coronary syndrome, low- molecular-weight heparin (enoxaparin) both improves important clinical outcomes and saves money relative to therapy with standard unfractionated heparin.

Authors
Mark, DB; Cowper, PA; Berkowitz, SD; Davidson-Ray, L; Delong, ER; Turpie, AGG; Califf, RM; Weatherley, B; Cohen, M
MLA Citation
Mark, DB, Cowper, PA, Berkowitz, SD, Davidson-Ray, L, Delong, ER, Turpie, AGG, Califf, RM, Weatherley, B, and Cohen, M. "Economic assessment of low-molecular-weight heparin (enoxaparin) versus unfractionated heparin in acute coronary syndrome patients: Results from the ESSENCE randomized trial." Circulation 97.17 (1998): 1702-1707.
Source
scival
Published In
Circulation
Volume
97
Issue
17
Publish Date
1998
Start Page
1702
End Page
1707

Use of an automated anesthesia information system to determine reference limits for vital signs during cesarean section

Introduction. We evaluated whether automated anesthesia information systems can be used to calculate reference limits (popular-ion-based 'normal values') for vital signs. We considered four populations of women undergoing cesarean section: healthy under spinal anesthesia. healthy under general anesthesia, pre-eclamptic/eclamptic under spinal anesthesia, and pre-eclamytic/eclamptic under general anesthesia. Methods. Reference limits were calculated for each of the study populations by determination of percentiles for. minimum heart rate, maximum heart rate, minimum arterial oxyhemoglobin saturation (SaO 2), minimum mean arterial pressure (MAP), maximum MAP, decrease in MAP, and increase in MAP. Results. There was one adverse anesthetic outcome among the 1300 women in the study, the woman sustained a post-dural puncture headache. The 5th percentiles of SaO 2 were at least 95% saturation under spinal versus 90% under general. Under spinal anesthesia, 95th percentiles for decreases in MAP from baseline were 63 mmHg for healthy and 75 mmHg for pre-eclamptic/eclamptic women. Under general anesthesia, the 95th percentiles for maximum MAP were 161 and 177 mmHg, respectively. Two women of the 1300 patients experienced simultaneously a minimum SaO 2 < 92% and minimum MAP < 50 mmHg. Discussion. Automated anesthesia information systems can be used to determine reference limits for vital signs during anesthesia. Reference limits may play a role in malpractice cases when an expert claims that care by an anesthesiologist was sub-standard as shown by vital signs that were not maintained within the normal range during the critical portions of an anesthetic. Automated anesthesia information systems may enhance expert witnesses' clinical judgment.

Authors
Dexter, F; Penning, DH; Lubarsky, DA; DeLong, E; Sanderson, I; Gilbert, BC; Bell, E; Reves, JG
MLA Citation
Dexter, F, Penning, DH, Lubarsky, DA, DeLong, E, Sanderson, I, Gilbert, BC, Bell, E, and Reves, JG. "Use of an automated anesthesia information system to determine reference limits for vital signs during cesarean section." Journal of Clinical Monitoring and Computing 14.7-8 (1998): 491-498.
PMID
10385858
Source
scival
Published In
Journal of Clinical Monitoring and Computing
Volume
14
Issue
7-8
Publish Date
1998
Start Page
491
End Page
498
DOI
10.1023/A:1009900810721

The impact of choice of muscle relaxant on postoperative recovery time [11] (multiple letters)

Authors
Lubarsky, DA; DeLong, ER; Ballantyne, JC; Chang, Y
MLA Citation
Lubarsky, DA, DeLong, ER, Ballantyne, JC, and Chang, Y. "The impact of choice of muscle relaxant on postoperative recovery time [11] (multiple letters)." Anesthesia and Analgesia 87.2 (1998): 499-500.
Source
scival
Published In
Anesthesia and Analgesia
Volume
87
Issue
2
Publish Date
1998
Start Page
499
End Page
500

Comparing risk-adjustment methods for provider profiling.

Risk-adjustment and provider profiling have become common terms as the medical profession attempts to measure quality and assess value in health care. One of the areas of care most thoroughly developed in this regard is quality assessment for coronary artery bypass grafting (CABG). Because in-hospital mortality following CABG has been studied extensively, risk-adjustment mechanisms are already being used in this area for provider profiling. This study compares eight different risk-adjustment methods as applied to a CABG surgery population of 28 providers. Five of the methods use an external risk-adjustment algorithm developed in an independent population, while the other three rely on an internally developed logistic model. The purposes of this study are to: (i) create a common metric by which to display the results of these various risk-adjustment methodologies with regard to dichotomous outcomes such as in-hospital mortality, and (ii) to compare how these risk-adjustment methods quantify the 'outlier' standing of providers. Section 2 describes the data, the external and internal risk-adjustment algorithms, and eight approaches to provider profiling. Section 3 then demonstrates the results of applying these methods on a data set specifically collected for quality improvement.

Authors
DeLong, ER; Peterson, ED; DeLong, DM; Muhlbaier, LH; Hackett, S; Mark, DB
MLA Citation
DeLong, ER, Peterson, ED, DeLong, DM, Muhlbaier, LH, Hackett, S, and Mark, DB. "Comparing risk-adjustment methods for provider profiling." Stat Med 16.23 (December 15, 1997): 2645-2664. (Review)
PMID
9421867
Source
pubmed
Published In
Statistics in Medicine
Volume
16
Issue
23
Publish Date
1997
Start Page
2645
End Page
2664

Comparison of synovial fluid cartilage marker concentrations and chondral damage assessed arthroscopically in acute knee injury.

OBJECTIVE: To examine the correlation between synovial fluid cartilage markers and degree of cartilage damage determined by arthroscopic evaluation in subjects with acute knee injury. DESIGN: Chondral damage was quantified using a validated arthroscopic scoring system in 20 subjects with effusive acute knee injuries of less then 4 months duration and no history or radiographic evidence of joint pathology. Levels of synovial fluid 3B3(-) neoepitope, 3B3(+) chondroitinase generated epitope of proteoglycan, keratan sulfate (KS) and hyaluronic acid (HA) were measured by competitive enzyme-linked immunosorbent assays using monoclonal antibodies 3B3 and 5D4. Total sulfated glycosaminoglycan (GAG) was measured by 1,9-dimethylmethylene blue colorimetric dye-binding assay. RESULTS: We found a dramatic decrease in levels of 3B3(-) (rs = -0.62, P = 0.004), and GAG (rs = -0.49, P = 0.03) with increasing chondral damage score; but no correlation of damage score with 3B3(+), KS or HA levels. CONCLUSION: These data reveal a change in cartilage metabolism within the first 4 months of symptomatic knee injury evinced by a significant inverse correlation of 3B3(-) and GAG levels to chondral lesion severity. These results suggest that serial measurement of these synovial fluid markers in the setting of acute knee injury could predict chondral lesion severity and aid in the decision to intervene surgically.

Authors
Bello, AE; Garrett, WE; Wang, H; Lohnes, J; DeLong, E; Caterson, B; Kraus, VB
MLA Citation
Bello, AE, Garrett, WE, Wang, H, Lohnes, J, DeLong, E, Caterson, B, and Kraus, VB. "Comparison of synovial fluid cartilage marker concentrations and chondral damage assessed arthroscopically in acute knee injury." Osteoarthritis Cartilage 5.6 (November 1997): 419-426.
PMID
9536290
Source
pubmed
Published In
Osteoarthritis and Cartilage
Volume
5
Issue
6
Publish Date
1997
Start Page
419
End Page
426

Relationship between diabetes mellitus and long-term survival after coronary bypass and angioplasty.

BACKGROUND: Recent subgroup analyses of randomized trials have suggested that percutaneous intervention in diabetic patients with multivessel disease results in higher mortality than coronary artery bypass graft surgery (CABG). We studied the relationship between diabetes and survival after revascularization in a large prospective cohort of patients with multivessel coronary artery disease. METHODS AND RESULTS: By analyzing data for 3220 patients (24% diabetic) with symptomatic two- or three-vessel coronary disease who were undergoing percutaneous transluminal coronary angioplasty (PTCA) or CABG at Duke University Medical Center between 1984 and 1990, we found that at 5 years, unadjusted survival in the group of patients undergoing CABG was 74% in diabetics and 86% in nondiabetics. Similarly, 5-year survival among PTCA patients was 76% in diabetics and 88% in patients without diabetes. After adjustment for baseline characteristics, diabetic patients receiving either PTCA or CABG had significantly poorer survival than nondiabetics (chi2=43.56, P<.0001). Unlike previous studies, however, there was no significant differential effect of diabetes on outcome between patients treated with PTCA and those treated with CABG (chi2=0.01, P=.91). CONCLUSIONS: Although diabetes was associated with a worse long-term outcome after both PTCA and CABG in patients with multivessel coronary artery disease, the effect of diabetes on prognosis was similar in both treatment groups. Thus, our findings support the concept that the choice of initial revascularization strategy should not be based exclusively on a history of diabetes but rather should rely on other factors, such as angiographic suitability and clinical status.

Authors
Barsness, GW; Peterson, ED; Ohman, EM; Nelson, CL; DeLong, ER; Reves, JG; Smith, PK; Anderson, RD; Jones, RH; Mark, DB; Califf, RM
MLA Citation
Barsness, GW, Peterson, ED, Ohman, EM, Nelson, CL, DeLong, ER, Reves, JG, Smith, PK, Anderson, RD, Jones, RH, Mark, DB, and Califf, RM. "Relationship between diabetes mellitus and long-term survival after coronary bypass and angioplasty." Circulation 96.8 (October 21, 1997): 2551-2556.
PMID
9355893
Source
pubmed
Published In
Circulation
Volume
96
Issue
8
Publish Date
1997
Start Page
2551
End Page
2556

Coronary stent costs completely recouped in six months

Authors
Cowper, PA; Peterson, ED; Zidar, JP; Delong, ER; McCants, CB; Mark, DB
MLA Citation
Cowper, PA, Peterson, ED, Zidar, JP, Delong, ER, McCants, CB, and Mark, DB. "Coronary stent costs completely recouped in six months." CIRCULATION 96.8 (October 21, 1997): 2551-2551.
Source
wos-lite
Published In
Circulation
Volume
96
Issue
8
Publish Date
1997
Start Page
2551
End Page
2551

Transportability of CABG mortality models

Authors
Delong, ER; Buell, HE; Nelson, CL; Hannan, EL; Peterson, ED; OConnor, GT
MLA Citation
Delong, ER, Buell, HE, Nelson, CL, Hannan, EL, Peterson, ED, and OConnor, GT. "Transportability of CABG mortality models." CIRCULATION 96.8 (October 21, 1997): 3789-3789.
Source
wos-lite
Published In
Circulation
Volume
96
Issue
8
Publish Date
1997
Start Page
3789
End Page
3789

Impact of early discharge after coronary artery bypass graft surgery on rates of hospital readmission and death. The Ischemic Heart Disease (IHD) Patient Outcomes Research Team (PORT) Investigators.

OBJECTIVES: This study examined the impact of early hospital discharge on short-term clinical outcomes of elderly patients treated with coronary artery bypass graft surgery (CABG) in the United States in 1992. BACKGROUND: Protocols that encourage earlier discharge of patients who have had CABG have been implemented across the country. Although delivery of efficient care benefits both patients and providers, premature discharge can adversely affect clinical outcomes, resulting in increased hospital readmissions and higher long-term costs. METHODS: We examined the prevalence of early discharge (postoperative length of stay < or = 5 days) among 83,347 non-health maintenance organization (HMO) Medicare patients who underwent CABG in the United States in 1992. Using logistic regression models, we identified patient characteristics associated with early discharge and obtained risk-adjusted rates of death and readmission or death for postoperative lengths of stay between 4 and 14 days. RESULTS: In 1992, 6% of Medicare patients undergoing CABG were discharged within 5 days of the operation. The prevalence of early discharge varied considerably among states, ranging from 1% to 21%. Patients discharged early tended to be younger and male and have fewer comorbid illnesses. Risk-adjusted rates of death and death or cardiovascular readmission were lowest among patients discharged early. CONCLUSIONS: As of 1992, early discharge of elderly patients treated with CABG in non-HMO settings was not associated with higher 60-day rates of death or readmission. This suggests that physicians were able to identify low risk candidates for early discharge. Variation across the nation in early discharge rates, along with the percentage of patients without major risk factors for adverse outcomes, suggests that higher rates of early discharge might be safely achieved.

Authors
Cowper, PA; Peterson, ED; DeLong, ER; Jollis, JG; Muhlbaier, LH; Mark, DB
MLA Citation
Cowper, PA, Peterson, ED, DeLong, ER, Jollis, JG, Muhlbaier, LH, and Mark, DB. "Impact of early discharge after coronary artery bypass graft surgery on rates of hospital readmission and death. The Ischemic Heart Disease (IHD) Patient Outcomes Research Team (PORT) Investigators." J Am Coll Cardiol 30.4 (October 1997): 908-913.
PMID
9316517
Source
pubmed
Published In
JACC - Journal of the American College of Cardiology
Volume
30
Issue
4
Publish Date
1997
Start Page
908
End Page
913

Racial variation in the use of coronary-revascularization procedures - Reply

Authors
Peterson, ED; Shaw, LK; DeLong, ER
MLA Citation
Peterson, ED, Shaw, LK, and DeLong, ER. "Racial variation in the use of coronary-revascularization procedures - Reply." NEW ENGLAND JOURNAL OF MEDICINE 337.2 (July 10, 1997): 132-132.
Source
wos-lite
Published In
The New England journal of medicine
Volume
337
Issue
2
Publish Date
1997
Start Page
132
End Page
132

Relationship between physician and hospital coronary angioplasty volume and outcome in elderly patients.

BACKGROUND: With the expectation that physicians who perform larger numbers of coronary angioplasty procedures will have better outcomes, the American College of Cardiology/ American Heart Association guidelines recommend minimum physician volumes of 75 procedures per year. However, there is little empirical data to support this recommendation. METHODS AND RESULTS: We examined in-hospital bypass surgery and death after angioplasty according to 1992 physician and hospital Medicare procedure volume. In 1992, 6115 physicians performed angioplasty on 97,478 Medicare patients at 984 hospitals. The median numbers of procedures performed per physician and per hospital were 13 (interquartile range, 5 to 25) and 98 (interquartile range, 40 to 181), respectively. With the assumption that Medicare patients composed one half to one third of all patients undergoing angioplasty, these median values are consistent with an overall physician volume of 26 to 39 cases per year and an overall hospital volume of 196 to 294 cases per year. After adjusting for age, sex, race, acute myocardial infarction, and comorbidity, low-volume physicians were associated with higher rates of bypass surgery (P < .001) and low-volume hospitals were associated with higher rates of bypass surgery and death (P < .001). Improving outcomes were seen up to threshold values of 75 Medicare cases per physician and 200 Medicare cases per hospital. CONCLUSIONS: More than 50% of physicians and 25% of hospitals performing coronary angioplasty in 1992 were unlikely to have met the minimum volume guidelines first published in 1988, and these patients had worse outcomes. While more recent data are required to determine whether the same relationships persist after the introduction of newer technologies, this study suggests that adherence to minimum volume standards by physicians and hospitals will lead to better outcomes for elderly patients undergoing coronary angioplasty.

Authors
Jollis, JG; Peterson, ED; Nelson, CL; Stafford, JA; DeLong, ER; Muhlbaier, LH; Mark, DB
MLA Citation
Jollis, JG, Peterson, ED, Nelson, CL, Stafford, JA, DeLong, ER, Muhlbaier, LH, and Mark, DB. "Relationship between physician and hospital coronary angioplasty volume and outcome in elderly patients." Circulation 95.11 (June 3, 1997): 2485-2491.
PMID
9184578
Source
pubmed
Published In
Circulation
Volume
95
Issue
11
Publish Date
1997
Start Page
2485
End Page
2491

Outcome of acute myocardial infarction according to the specialty of the admitting physician - Reply

Authors
Jollis, JG; DeLong, ER; Mark, DB
MLA Citation
Jollis, JG, DeLong, ER, and Mark, DB. "Outcome of acute myocardial infarction according to the specialty of the admitting physician - Reply." NEW ENGLAND JOURNAL OF MEDICINE 336.22 (May 29, 1997): 1608-1609.
Source
wos-lite
Published In
The New England journal of medicine
Volume
336
Issue
22
Publish Date
1997
Start Page
1608
End Page
1609

Geographic variation in resource use for coronary artery bypass surgery. IHD Port Investigators.

OBJECTIVES: The purpose of this study was to examine the national variability in patient-level cost and length of stay for coronary artery bypass grafting (CABG) in Medicare patients. METHODS: Retrospective multivariate regression analysis was done using Medicare administrative files and American Hospital Association files. Patients in the study had an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure code for CABG, with accompanying 1990 procedure data, in the Medicare Provider Analysis and Review File (n = 92,449). RESULTS: Outcome measures used were inpatient cost (exclusive of professional fees) and inpatient length of stay associated with bypass admission. The national average cost of bypass surgery was $22,847 (median $18,783), with an accompanying average length of stay of 16 days (median 13 days). Multivariate regression analysis revealed that patient-level cost and length of stay were related to clinical, demographic, hospital, and regional characteristics (R2 = 25% and 16%, respectively). After accounting for these characteristics at the patient level, considerable variation among states persisted in both cost and length of stay. In addition, states with similar adjusted lengths of stay varied widely with respect to adjusted cost. No relation was found at the state level between level of resource use and either procedural mortality or 60-day mortality/readmission rates. CONCLUSIONS: Considerable variability exists among states in patient-level cost and length of stay for CABG surgery, after adjusting to the extent possible for clinical, demographic, hospital, and regional characteristics. The lack of association at the state level between resource use and rates of mortality and hospital readmission suggests that costs could be reduced in many areas of the United States without compromising quality of care.

Authors
Cowper, PA; DeLong, ER; Peterson, ED; Lipscomb, J; Muhlbaier, LH; Jollis, JG; Pryor, DB; Mark, DB
MLA Citation
Cowper, PA, DeLong, ER, Peterson, ED, Lipscomb, J, Muhlbaier, LH, Jollis, JG, Pryor, DB, and Mark, DB. "Geographic variation in resource use for coronary artery bypass surgery. IHD Port Investigators." Med Care 35.4 (April 1997): 320-333.
PMID
9107202
Source
pubmed
Published In
Medical Care
Volume
35
Issue
4
Publish Date
1997
Start Page
320
End Page
333

Racial variation in the use of coronary-revascularization procedures. Are the differences real? Do they matter?

BACKGROUND: Studies have reported that blacks undergo fewer coronary-revascularization procedures than whites, but it is not clear whether the clinical characteristics of the patients account for these differences or whether they indicate underuse of the procedures in blacks or overuse in whites. METHODS: In a study at Duke University of 12,402 patients (10.3 percent of whom were black) with coronary disease, we calculated unadjusted and adjusted rates of angioplasty and bypass surgery in blacks and whites after cardiac catheterization. We also examined patterns of treatment after stratifying the patients according to the severity of disease, angina status, and estimated survival benefit due to revascularization. Finally, we compared five-year survival rates in blacks and whites. RESULTS: After adjustment for the severity of disease and other characteristics, blacks were 13 percent less likely than whites to undergo angioplasty and 32 percent less likely to undergo bypass surgery. The adjusted black:white odds ratios for receiving these procedures were 0.87 (95 percent confidence interval, 0.73 to 1.03) and 0.68 (95 percent confidence interval, 0.56 to 0.82), respectively. The racial differences in rates of bypass surgery persisted among those with severe anginal symptoms (31 percent of blacks underwent surgery, vs. 45 percent of whites, P<0.001) and among those predicted to have the greatest survival benefit from revascularization (42 percent vs. 61 percent, P<0.001). Finally, unadjusted and adjusted rates of survival for five years were significantly lower in blacks than in whites. CONCLUSIONS: Blacks with coronary disease were significantly less likely than whites to undergo coronary revascularization, particularly bypass surgery - a difference that could not be explained by the clinical features of their disease. The differences in treatment were most pronounced among those predicted to benefit the most from revascularization. Since these differences also correlated with a lower survival rate in blacks, we conclude that coronary revascularization appears to be underused in blacks.

Authors
Peterson, ED; Shaw, LK; DeLong, ER; Pryor, DB; Califf, RM; Mark, DB
MLA Citation
Peterson, ED, Shaw, LK, DeLong, ER, Pryor, DB, Califf, RM, and Mark, DB. "Racial variation in the use of coronary-revascularization procedures. Are the differences real? Do they matter?." N Engl J Med 336.7 (February 13, 1997): 480-486.
PMID
9017942
Source
pubmed
Published In
The New England journal of medicine
Volume
336
Issue
7
Publish Date
1997
Start Page
480
End Page
486
DOI
10.1056/NEJM199702133360706

Regional variation in post-MI testing: Results in 190,237 pts

Authors
Peterson, ED; Jollis, JG; Shaw, LJ; Stafford, JA; DeLong, ER; Muhlbaier, LH; Mark, DB
MLA Citation
Peterson, ED, Jollis, JG, Shaw, LJ, Stafford, JA, DeLong, ER, Muhlbaier, LH, and Mark, DB. "Regional variation in post-MI testing: Results in 190,237 pts." JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 29.2 (February 1997): 7995-7995.
Source
wos-lite
Published In
JACC - Journal of the American College of Cardiology
Volume
29
Issue
2
Publish Date
1997
Start Page
7995
End Page
7995

Comparison of three coronary bypass mortality prediction models: Results from the national cardiovascular network

Authors
Peterson, ED; Mauldin, PD; Muhlbaier, LH; DeLong, ER; Lanzilotta, MJ
MLA Citation
Peterson, ED, Mauldin, PD, Muhlbaier, LH, DeLong, ER, and Lanzilotta, MJ. "Comparison of three coronary bypass mortality prediction models: Results from the national cardiovascular network." JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 29.2 (February 1997): 64170-64170.
Source
wos-lite
Published In
JACC - Journal of the American College of Cardiology
Volume
29
Issue
2
Publish Date
1997
Start Page
64170
End Page
64170

Outcome of acute myocardial infarction by physician specialty

Authors
Jollis, JG; Peterson, ED; DeLong, ER; Muhlbaier, LH; Mark, DB
MLA Citation
Jollis, JG, Peterson, ED, DeLong, ER, Muhlbaier, LH, and Mark, DB. "Outcome of acute myocardial infarction by physician specialty." JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 29.2 (February 1997): 7993-7993.
Source
wos-lite
Published In
JACC - Journal of the American College of Cardiology
Volume
29
Issue
2
Publish Date
1997
Start Page
7993
End Page
7993

Post-MI testing in the elderly: Results in 190,135 patients

Authors
Peterson, ED; Jollis, JG; Stafford, JA; DeLong, ER; Muhlbaier, LH; Shaw, LJ; Mark, DB
MLA Citation
Peterson, ED, Jollis, JG, Stafford, JA, DeLong, ER, Muhlbaier, LH, Shaw, LJ, and Mark, DB. "Post-MI testing in the elderly: Results in 190,135 patients." JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 29.2 (February 1997): 7775-7775.
Source
wos-lite
Published In
JACC - Journal of the American College of Cardiology
Volume
29
Issue
2
Publish Date
1997
Start Page
7775
End Page
7775

Impact of early discharge after coronary artery bypass graft surgery on rates of hospital readmission and death

Objectives: This study examined the impact of early hospital discharge on short-term clinical outcomes of elderly patients treated with coronary artery bypass graft surgery (CABG) in the United States in 1992. Background: Protocols that encourage earlier discharge of patients who have had CABG have been implemented across the country. Although delivery of efficient care benefits both patients and providers, premature discharge can adversely affect clinical outcomes, resulting in increased hospital readmissions and higher long-term costs. Methods: We examined the prevalence of early discharge (postoperative length of stay ≤5 days) among 83,347 non-health maintenance organization (HMO) Medicare patients who underwent CABG in the United States in 1992. Using logistic regression models, we identified patient characteristics associated with early discharge and obtained risk- adjusted rates of death and readmission or death for postoperative lengths of stay between 4 and 14 days. Results: In 1992, 6% of Medicare patients undergoing CABG were discharged within 5 days of the operation. The prevalence of early discharge varied considerably among states, ranging from 1% to 21%. Patients discharged early tended to be younger and male and have fewer comorbid illnesses. Risk-adjusted rates of death and death or cardiovascular readmission were lowest among patients discharged early. Conclusions: As of 1992, early discharge of elderly patients treated with CABG in non-HMO settings was not associated with higher 60-day rates of death or readmission. This suggests that physicians were able to identify low risk candidates for early discharge. Variation across the nation in early discharge rates, along with the percentage of patients without major risk factors for adverse outcomes, suggests that higher rates of early discharge might be safely achieved.

Authors
Cowper, PA; Peterson, ED; DeLong, ER; Jollis, JG; Muhlbaier, LH; Mark, DB
MLA Citation
Cowper, PA, Peterson, ED, DeLong, ER, Jollis, JG, Muhlbaier, LH, and Mark, DB. "Impact of early discharge after coronary artery bypass graft surgery on rates of hospital readmission and death." Journal of the American College of Cardiology 30.4 (1997): 908-913.
Source
scival
Published In
JACC - Journal of the American College of Cardiology
Volume
30
Issue
4
Publish Date
1997
Start Page
908
End Page
913
DOI
10.1016/S0735-1097(97)00243-X

Geographic Variation in Resource Use for Coronary Artery Bypass Surgery

OBJECTIVES. The purpose of this study was to examine the national variability in patient-level cost and length of stay for coronary artery bypass grafting (CABG) in Medicare patients. METHODS. Retrospective multivariate regression analysis was done using Medicare administrative files and American Hospital Association files. Patients in the study had an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure code for CABG, with accompanying 1990 procedure date, in the Medicare Provider Analysis and Review File (n = 92,449). RESULTS. Outcome measures used were inpatient cost (exclusive of professional fees) and inpatient length of stay associated with bypass admission. The national average cost of bypass surgery was $22,847 (median $18,783), with an accompanying average length of stay of 16 days (median 13 days). Multivariate regression analysis revealed that patient-level cost and length of stay were related to clinical, demographic, hospital, and regional characteristics (R2 = 25% and 16%, respectively). After accounting for these characteristics at the patient level, considerable variation among states persisted in both cost and length of stay. In addition, states with similar adjusted lengths of stay varied widely with respect to adjusted cost. No relation was found at the state level between level of resource use and either procedural mortality or 60-day mortality/readmission rates. CONCLUSIONS. Considerable variability exists among states in patient-level cost and length of stay for CABG surgery, after adjusting to the extent possible for clinical, demographic, hospital, and regional characteristics. The lack of association at the state level between resource use and rates of mortality and hospital readmission suggests that costs could be reduced in many areas of the United States without compromising quality of care.

Authors
Cowper, PA; DeLong, ER; Peterson, ED; Lipscomb, J; Muhlbaier, LH; Jollis, JG; Pryor, DB; Mark, DB
MLA Citation
Cowper, PA, DeLong, ER, Peterson, ED, Lipscomb, J, Muhlbaier, LH, Jollis, JG, Pryor, DB, and Mark, DB. "Geographic Variation in Resource Use for Coronary Artery Bypass Surgery." Medical Care 35.4 (1997): 320-333.
Source
scival
Published In
Medical Care
Volume
35
Issue
4
Publish Date
1997
Start Page
320
End Page
333

Outcome of acute myocardial infarction according to the specialty of the admitting physician [2] (multiple letters)

Authors
Starfield, B; Marciniak, TA; Eaton, CB; Murphy, JB; Hunt, VR; Belin, DC; Jollis, JG; DeLong, ER; Mark, DB
MLA Citation
Starfield, B, Marciniak, TA, Eaton, CB, Murphy, JB, Hunt, VR, Belin, DC, Jollis, JG, DeLong, ER, and Mark, DB. "Outcome of acute myocardial infarction according to the specialty of the admitting physician [2] (multiple letters)." New England Journal of Medicine 336.22 (1997): 1607-1610.
PMID
9173258
Source
scival
Published In
New England Journal of Medicine
Volume
336
Issue
22
Publish Date
1997
Start Page
1607
End Page
1610
DOI
10.1056/NEJM199705293362214

Racial variation in the use of coronary-revascularization procedures [3] (multiple letters)

Authors
Barnhart, JM; Wassertheil-Smoller, S; Fowler, C; Peterson, ED; Shaw, LK; Delong, ER
MLA Citation
Barnhart, JM, Wassertheil-Smoller, S, Fowler, C, Peterson, ED, Shaw, LK, and Delong, ER. "Racial variation in the use of coronary-revascularization procedures [3] (multiple letters)." New England Journal of Medicine 337.2 (1997): 131-132.
PMID
9221341
Source
scival
Published In
The New England journal of medicine
Volume
337
Issue
2
Publish Date
1997
Start Page
131
End Page
132
DOI
10.1056/NEJM199707103370213

Outcome of acute myocardial infarction according to the specialty of the admitting physician.

BACKGROUND: In order to limit costs, health care organizations in the United States are shifting medical care from specialists to primary care physicians. Although primary care physicians provide less resource-intensive care, there is little information concerning the effects of this strategy on outcomes. METHODS: We examined mortality according to the specialty of the admitting physician among 8241 Medicare patients who were hospitalized for acute myocardial infarction in four states during a seven-month period in 1992. Proportional-hazards regression models were used to examine survival up to one year after the myocardial infarction. To determine the generalizability of our findings, we also examined insurance claims and survival data for all 220,535 patients for whom there were Medicare claims for hospital care for acute myocardial infarction in 1992. RESULTS: After adjustment for characteristics of the patients and hospitals, patients who were admitted to the hospital by a cardiologist were 12 percent less likely to die within one year than those admitted by a primary care physician (P<0.001). Cardiologists also had the highest rate of use of cardiac procedures and medications, including medications (such as thrombolytic agents and beta-blockers) that are associated with improved survival. CONCLUSIONS: Health care strategies that shift the care of elderly patients with myocardial infarction from cardiologists to primary care physicians lower rates of use of resources (and potentially lower costs), but they may also cause decreased survival. Additional information is needed to elucidate how primary care physicians and specialists should interact in the care of severely ill patients.

Authors
Jollis, JG; DeLong, ER; Peterson, ED; Muhlbaier, LH; Fortin, DF; Califf, RM; Mark, DB
MLA Citation
Jollis, JG, DeLong, ER, Peterson, ED, Muhlbaier, LH, Fortin, DF, Califf, RM, and Mark, DB. "Outcome of acute myocardial infarction according to the specialty of the admitting physician." N Engl J Med 335.25 (December 19, 1996): 1880-1887.
PMID
8948564
Source
pubmed
Published In
The New England journal of medicine
Volume
335
Issue
25
Publish Date
1996
Start Page
1880
End Page
1887
DOI
10.1056/NEJM199612193352505

Identification of preoperative variables needed for risk adjustment of short-term mortality after coronary artery bypass graft surgery. The Working Group Panel on the Cooperative CABG Database Project.

OBJECTIVES: The purpose of this consensus effort was to define and prioritize the importance of a set of clinical variables useful for monitoring and improving the short-term mortality of patients undergoing coronary artery bypass graft surgery (CABG). BACKGROUND: Despite widespread use of data bases to monitor the outcome of patients undergoing CABG, no consistent set of clinical variables has been defined for risk adjustment of observed outcomes for baseline differences in disease severity among patients. METHODS: Experts with a background in epidemiology, biostatistics and clinical care with an interest in assessing outcomes of CABG derived from previous work with professional societies, government or academic institutions volunteered to participate in this unsponsored consensus process. Two meetings of this ad hoc working group were required to define and prioritize clinical variables into core, level 1 or level 2 groupings to reflect their importance for relating to short-term mortality after CABG. Definitions of these 44 variables were simple and specific to enhance objectivity of the 7 core, 13 level 1 and 24 level 2 variables. Core and level 1 variables were evaluated using data from five existing data bases, and core variables only were examined in an additional two data bases to confirm the consensus opinion of the relative prognostic power of each variable. RESULTS: Multivariable logistic regression models of the seven core variables showed all to be predictive of bypass surgery mortality in some of the seven existing data sets. Variables relating to acuteness, age and previous operation proved to be the most important in all data sets tested. Variables describing coronary anatomy appeared to be least significant. Models including both the 7 core and 13 level 1 variables in five of the seven data sets showed the core variables to reflect 45% to 83% of the predictive information. However, some level 1 variables were stronger than some core variables in some data sets. CONCLUSIONS: A relatively small number of clinical variables provide a large amount of prognostic information in patients undergoing CABG.

Authors
Jones, RH; Hannan, EL; Hammermeister, KE; Delong, ER; O'Connor, GT; Luepker, RV; Parsonnet, V; Pryor, DB
MLA Citation
Jones, RH, Hannan, EL, Hammermeister, KE, Delong, ER, O'Connor, GT, Luepker, RV, Parsonnet, V, and Pryor, DB. "Identification of preoperative variables needed for risk adjustment of short-term mortality after coronary artery bypass graft surgery. The Working Group Panel on the Cooperative CABG Database Project." J Am Coll Cardiol 28.6 (November 15, 1996): 1478-1487. (Review)
PMID
8917261
Source
pubmed
Published In
JACC - Journal of the American College of Cardiology
Volume
28
Issue
6
Publish Date
1996
Start Page
1478
End Page
1487

National patterns of post-MI non-invasive testing in the elderly: Results in 190,237 patients.

Authors
Peterson, ED; Jollis, JG; DeLong, ER; Stafford, JA; Muhlbaier, LH; Shaw, LJ; Eisenstein, EL; Mark, DB
MLA Citation
Peterson, ED, Jollis, JG, DeLong, ER, Stafford, JA, Muhlbaier, LH, Shaw, LJ, Eisenstein, EL, and Mark, DB. "National patterns of post-MI non-invasive testing in the elderly: Results in 190,237 patients." CIRCULATION 94.8 (October 15, 1996): 2972-2972.
Source
wos-lite
Published In
Circulation
Volume
94
Issue
8
Publish Date
1996
Start Page
2972
End Page
2972

Examining the prognostic accuracy of exercise treadmill testing in 1,617 symptomatic women

Authors
Kesler, KL; OBrien, JE; Peterson, ED; Shaw, LJ; DeLong, ER; Mark, DB
MLA Citation
Kesler, KL, OBrien, JE, Peterson, ED, Shaw, LJ, DeLong, ER, and Mark, DB. "Examining the prognostic accuracy of exercise treadmill testing in 1,617 symptomatic women." CIRCULATION 94.8 (October 15, 1996): 3307-3307.
Source
wos-lite
Published In
Circulation
Volume
94
Issue
8
Publish Date
1996
Start Page
3307
End Page
3307

Is the prognostic value of ST depression improved with heart rate adjustment?

Authors
Shaw, LJ; Kesler, KL; Peterson, ED; DeLong, ER; Morise, AP; Okin, PM
MLA Citation
Shaw, LJ, Kesler, KL, Peterson, ED, DeLong, ER, Morise, AP, and Okin, PM. "Is the prognostic value of ST depression improved with heart rate adjustment?." CIRCULATION 94.8 (October 15, 1996): 3314-3314.
Source
wos-lite
Published In
Circulation
Volume
94
Issue
8
Publish Date
1996
Start Page
3314
End Page
3314

Development of a stress myocardial perfusion imaging model to predict cardiac death

Authors
Shaw, LJ; Keeler, KL; Marwick, TH; Lauer, MS; Travin, MI; Hachamovitch, R; BorgesNeto, S; DeLong, ER; Miller, D
MLA Citation
Shaw, LJ, Keeler, KL, Marwick, TH, Lauer, MS, Travin, MI, Hachamovitch, R, BorgesNeto, S, DeLong, ER, and Miller, D. "Development of a stress myocardial perfusion imaging model to predict cardiac death." CIRCULATION 94.8 (October 15, 1996): 111-111.
Source
wos-lite
Published In
Circulation
Volume
94
Issue
8
Publish Date
1996
Start Page
111
End Page
111

Can you believe your risk-adjusted outcomes

Authors
DeLong, ER; Peterson, ED; Lawrence, MH
MLA Citation
DeLong, ER, Peterson, ED, and Lawrence, MH. "Can you believe your risk-adjusted outcomes." CIRCULATION 94.8 (October 15, 1996): 59-59.
Source
wos-lite
Published In
Circulation
Volume
94
Issue
8
Publish Date
1996
Start Page
59
End Page
59

Prognostic value of transthoracic echo in the Duke cardiovascular disease database

Authors
Hsieh, A; Jollis, JG; Kesler, KL; Delong, ER; Collins, M; Donovan, CL; Waugh, RA; Ryan, T; Kisslo, J
MLA Citation
Hsieh, A, Jollis, JG, Kesler, KL, Delong, ER, Collins, M, Donovan, CL, Waugh, RA, Ryan, T, and Kisslo, J. "Prognostic value of transthoracic echo in the Duke cardiovascular disease database." CIRCULATION 94.8 (October 15, 1996): 151-151.
Source
wos-lite
Published In
Circulation
Volume
94
Issue
8
Publish Date
1996
Start Page
151
End Page
151

Relationship between physician angioplasty volume and outcome in 97,000 elderly Americans

Authors
Jollis, JG; Peterson, ED; DeLong, ER; Stafford, JA; Muhlbaier, LH; Mark, DB
MLA Citation
Jollis, JG, Peterson, ED, DeLong, ER, Stafford, JA, Muhlbaier, LH, and Mark, DB. "Relationship between physician angioplasty volume and outcome in 97,000 elderly Americans." CIRCULATION 94.8 (October 15, 1996): 3115-3115.
Source
wos-lite
Published In
Circulation
Volume
94
Issue
8
Publish Date
1996
Start Page
3115
End Page
3115

Impact of an interactive video on decision making of patients with ischemic heart disease.

An experimental pilot study using repeated measures to examine the impact of an interactive video program on the decision making of patients with ischemic heart disease was carried on at a tertiary care center and a Veterans Affairs hospital. The patients (n = 80, mean age 61.1 years, 77% male, 75% white, 26.7% with acute myocardial infarction), who had undergone diagnostic cardiac catheterization and were found to have significant coronary artery disease (> or = 75% stenosis in at least one vessel), watched the Shared Decision-Making Program (SDP) for Ischemic Heart Disease (IHD), a novel interactive video system designed to provide information necessary for patients to participate actively in decision making. This program compares medical therapy, angioplasty, and bypass surgery through a physician narrator, patient testimonials, and empirically-based, patient-specific outcome estimates of short-time complications and long-term survival. Before and after viewing the SDP, patients completed surveys containing multiple choice questions and Likert scales. They rated the program as more helpful than all other decision aids except the physician, and after viewing the SDP they expressed increased confidence in their treatment choice and decreased confidence in alternative options (p = .0001). The greatest effects appeared to be concentrated in those patients with less education (p = .04), and the program appeared to increase anxiety in nonwhite patients compared with white patients (p = 0.07).

Authors
Liao, L; Jollis, JG; DeLong, ER; Peterson, ED; Morris, KG; Mark, DB
MLA Citation
Liao, L, Jollis, JG, DeLong, ER, Peterson, ED, Morris, KG, and Mark, DB. "Impact of an interactive video on decision making of patients with ischemic heart disease." J Gen Intern Med 11.6 (June 1996): 373-376.
PMID
8803746
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
11
Issue
6
Publish Date
1996
Start Page
373
End Page
376

Predicting the presence of choledocholithiasis in patients with symptomatic cholelithiasis.

OBJECTIVES: Accurate preoperative prediction of choledocholithiasis is essential in order to minimize patient risk and curtail health care expenditures. This study was designed to identify independent risk factors for choledocholithiasis in patients who had undergone cholecystectomy for symptomatic cholelithiasis and to develop a predictive model based on those factors. METHODS: The charts of 1264 consecutive patients who had undergone cholecystectomy at one of three North Carolina hospitals between January 1, 1989 and December 31, 1991 were reviewed; 465 of these patients had confirmed presence or absence of choledocholithiasis by cholangiography and/or common bile duct exploration and were eligible for analysis. Candidate predictor variables included age and maximum preoperative values for each of the following: temperature, alkaline phosphatase, bilirubin, AST, amylase, white blood cell count, and common bile duct diameter. Model development and validation were conducted using standard data-splitting (60% "training," 40% "test") and logistic regression techniques. RESULTS: Choledocholithiasis was confirmed in 115 (25%) of the 465 eligible patients. Univariate analysis identified bilirubin, common bile duct diameter, AST, temperature, alkaline phosphatase, and age as predictors. Multivariable analysis subsequently identified bilirubin, common bile duct diameter, AST, alkaline phosphatase, and age as independent predictors of choledocholithiasis. A final model containing these variables (except age, whose contribution to the model was small) accurately predicted choledocholithiasis (c-index = 0.76). CONCLUSIONS: Accurate estimates of choledocholithiasis risk can be made using maximum preoperative bilirubin, common bile duct diameter, AST, and alkaline phosphatase values. Use of the model may help physicians select those patients with symptomatic cholelithiasis who would most likely benefit from further investigation to exclude choledocholithiasis.

Authors
Onken, JE; Brazer, SR; Eisen, GM; Williams, DM; Bouras, EP; DeLong, ER; Long, TT; Pancotto, FS; Rhodes, DL; Cotton, PB
MLA Citation
Onken, JE, Brazer, SR, Eisen, GM, Williams, DM, Bouras, EP, DeLong, ER, Long, TT, Pancotto, FS, Rhodes, DL, and Cotton, PB. "Predicting the presence of choledocholithiasis in patients with symptomatic cholelithiasis." Am J Gastroenterol 91.4 (April 1996): 762-767.
PMID
8677945
Source
pubmed
Published In
The American Journal of Gastroenterology (Elsevier)
Volume
91
Issue
4
Publish Date
1996
Start Page
762
End Page
767

Identification of preoperative variables needed for risk adjustment of short-term mortality after coronary artery bypass graft surgery

Objectives. The purpose of this consensus effort was to define and prioritize the importance of a set of clinical variables useful for monitoring and improving the short-term mortality of patients undergoing coronary artery bypass graft surgery (CABG). Background. Despite widespread use of data bases to monitor the outcome of patients undergoing CABG, no consistent set of clinical variables has been defined for risk adjustment of observed outcomes for baseline differences in disease severit among patients. Methods. Experts with a background in epidemiology, biostatistics and clinical care with an interest in assessing outcomes of CABG derived from previous work with professional societies, government or academic institutions volunteered to participate in this unsponsored consensus process. Two meetings of this ad hoc working group were required to define and prioritize clinical variables into core, level 1 or level 2 groupings to reflect their importance for relating to short-term mortality after CABG. Definitions of these 44 variables were simple and specific to enhance objectivity of the 7 core, 13 level 1 and 24 level 2 variables. Core and level 1 variables were evaluated using data from five existing data bases, and core variables only were examined in an additional two data bases to confirm the consensus opinion of the relative prognostic power of each variahle. Results. Multivariable logistic regression models of the seven core variables showed all to be predictive of bypass surgery mortality in some of the severe existing data sets. Variables relating to acuteness, age and previous operation proved to be the most important in all data sets tested. Variables describing coronary anatomy appeared to be least significant. Models including both the 7 core and 13 level 1 variables in five of the seven data sets showed the core variables to reflect 45% to 83% of the predictive information. However, some level 1 variables were stronger than some core variables in some data sets. Conclusions. A relatively small number of clinical variables provide a large amount of prognostic information in patients undergoing CABG.

Authors
Jones, RH; Hannan, EL; Hammermeister, KE; DeLong, ER; O'Connor, GT; Luepker, RV; Parsonnet, V; Pryor, DB
MLA Citation
Jones, RH, Hannan, EL, Hammermeister, KE, DeLong, ER, O'Connor, GT, Luepker, RV, Parsonnet, V, and Pryor, DB. "Identification of preoperative variables needed for risk adjustment of short-term mortality after coronary artery bypass graft surgery." Journal of the American College of Cardiology 28.6 (1996): 1478-1487.
Source
scival
Published In
JACC - Journal of the American College of Cardiology
Volume
28
Issue
6
Publish Date
1996
Start Page
1478
End Page
1487
DOI
10.1016/S0735-1097(96)00359-2

The ischemic heart disease port as related to guideline development

Authors
DeLong, ER; Nelson, CL; Wong, JB; Pauker, SG; Pryor, DB; ASSOC, AS
MLA Citation
DeLong, ER, Nelson, CL, Wong, JB, Pauker, SG, Pryor, DB, and ASSOC, AS. "The ischemic heart disease port as related to guideline development." 1996.
Source
wos-lite
Published In
AMERICAN STATISTICAL ASSOCIATION - 1996 PROCEEDINGS OF THE SECTION ON BAYESIAN STATISTICAL SCIENCE
Publish Date
1996
Start Page
61
End Page
63

Outcomes of coronary artery bypass graft surgery in 24,461 patients aged 80 years or older.

BACKGROUND: Coronary artery bypass graft surgery is increasingly common in patients of age > or = 80 years. Single-institution reviews have cited a wide range of mortality results after bypass surgery in this age group, in part because of limited sample sizes. Using claims data, we examined recent national trends in the use and outcomes of bypass surgery in the very elderly. METHODS AND RESULTS: From an examination of Medicare data from 1987 through 1990, we identified 24,461 patients of age > or = 80 years who underwent bypass surgery. We compared surgical outcomes in these patients with those in Medicare patients of age 65 to 70 years. We found that the national use of bypass surgery in patients of age > or = 80 years increased 67% between 1987 and 1990. Compared with patients of age 65 to 70 years, the very elderly had significantly longer postoperative hospital stays (mean, 14.3 versus 10.4 days), higher charges (mean, $48,200 versus $38,000), and greater costs (mean, $27,200 versus $21,700). In-hospital (11.5% versus 4.4%), 1-year (19.3% versus 7.9%), and 3-year mortality rates (28.8% versus 13.1%) after bypass surgery were also significantly higher in patients of age > or = 80 years compared with younger patients. Although their initial surgical risk was high, octogenarians who underwent bypass surgery had a long-term survival rate similar to that of the general US octogenarian population. CONCLUSIONS: The use of bypass surgery in patients of age > or = 80 years in increasing. These very elderly patients face high surgical risks and accumulate significant hospital expenses. Further research is indicated to determine whether the long-term benefits from bypass surgery in the very elderly outweigh the increased procedural risks.

Authors
Peterson, ED; Cowper, PA; Jollis, JG; Bebchuk, JD; DeLong, ER; Muhlbaier, LH; Mark, DB; Pryor, DB
MLA Citation
Peterson, ED, Cowper, PA, Jollis, JG, Bebchuk, JD, DeLong, ER, Muhlbaier, LH, Mark, DB, and Pryor, DB. "Outcomes of coronary artery bypass graft surgery in 24,461 patients aged 80 years or older." Circulation 92.9 Suppl (November 1, 1995): II85-II91.
PMID
7586468
Source
pubmed
Published In
Circulation
Volume
92
Issue
9 Suppl
Publish Date
1995
Start Page
II85
End Page
II91

OUTCOMES OF CORONARY-ARTERY BYPASS GRAFT-SURGERY IN 24461 PATIENTS AGED 80 YEARS OR OLDER

Authors
PETERSEN, ED; COWPER, PA; JOLLIS, JG; BEBCHUK, JD; DELONG, ER; MUHLBAIER, LH; MARK, DB; PRYOR, DB
MLA Citation
PETERSEN, ED, COWPER, PA, JOLLIS, JG, BEBCHUK, JD, DELONG, ER, MUHLBAIER, LH, MARK, DB, and PRYOR, DB. "OUTCOMES OF CORONARY-ARTERY BYPASS GRAFT-SURGERY IN 24461 PATIENTS AGED 80 YEARS OR OLDER." CIRCULATION 92.9 (November 1, 1995): 85-91.
Source
wos-lite
Published In
Circulation
Volume
92
Issue
9
Publish Date
1995
Start Page
85
End Page
91

THE DUKE TREADMILL SCORE IS AN ACCURATE PREDICTOR OF THE EXTENT OF CORONARY-ARTERY DISEASE AND 5-YEAR SURVIVAL

Authors
SHAW, LJ; KESLER, K; PETERSON, ED; HARRELL, FE; SHAW, LK; DELONG, ER; MUHLBAIER, LH; MARK, DB
MLA Citation
SHAW, LJ, KESLER, K, PETERSON, ED, HARRELL, FE, SHAW, LK, DELONG, ER, MUHLBAIER, LH, and MARK, DB. "THE DUKE TREADMILL SCORE IS AN ACCURATE PREDICTOR OF THE EXTENT OF CORONARY-ARTERY DISEASE AND 5-YEAR SURVIVAL." CIRCULATION 92.8 (October 15, 1995): 1287-1287.
Source
wos-lite
Published In
Circulation
Volume
92
Issue
8
Publish Date
1995
Start Page
1287
End Page
1287

SURVIVAL FOLLOWING ACUTE MYOCARDIAL-INFARCTION ACCORDING TO PHYSICIAN SPECIALTY

Authors
JOLLIS, JG; DELONG, ER; COLLINS, SR; MUHLBAIER, LH; LIAO, L; MARK, DB
MLA Citation
JOLLIS, JG, DELONG, ER, COLLINS, SR, MUHLBAIER, LH, LIAO, L, and MARK, DB. "SURVIVAL FOLLOWING ACUTE MYOCARDIAL-INFARCTION ACCORDING TO PHYSICIAN SPECIALTY." CIRCULATION 92.8 (October 15, 1995): 564-564.
Source
wos-lite
Published In
Circulation
Volume
92
Issue
8
Publish Date
1995
Start Page
564
End Page
564

PREDICTING MORTALITY FOLLOWING CORONARY ANGIOPLASTY - RESULTS FROM THE COOPERATIVE CARDIOVASCULAR PROJECT

Authors
PETERSON, ED; DELONG, ER; FORTIN, DF; MUHLBAIER, CH; ROSEN, AB; PRYOR, DB; MARK, DB; KIEFE, CI; KRESOWIK, TF; ELLERBECK, EF; JENCKS, SF
MLA Citation
PETERSON, ED, DELONG, ER, FORTIN, DF, MUHLBAIER, CH, ROSEN, AB, PRYOR, DB, MARK, DB, KIEFE, CI, KRESOWIK, TF, ELLERBECK, EF, and JENCKS, SF. "PREDICTING MORTALITY FOLLOWING CORONARY ANGIOPLASTY - RESULTS FROM THE COOPERATIVE CARDIOVASCULAR PROJECT." CIRCULATION 92.8 (October 15, 1995): 2274-2274.
Source
wos-lite
Published In
Circulation
Volume
92
Issue
8
Publish Date
1995
Start Page
2274
End Page
2274

PREDICTING MORTALITY FOLLOWING CORONARY-BYPASS SURGERY IN THE ELDERLY - RESULTS FROM THE COOPERATIVE CARDIOVASCULAR PROJECT

Authors
PETERSON, ED; DELONG, ER; MUHLBAIER, LH; ROSEN, AB; FORTIN, DF; PRYOR, DB; MARK, DB; KRESOWIK, TF; KIEFE, CI; ELLERBECK, EF; JENCKS, SF
MLA Citation
PETERSON, ED, DELONG, ER, MUHLBAIER, LH, ROSEN, AB, FORTIN, DF, PRYOR, DB, MARK, DB, KRESOWIK, TF, KIEFE, CI, ELLERBECK, EF, and JENCKS, SF. "PREDICTING MORTALITY FOLLOWING CORONARY-BYPASS SURGERY IN THE ELDERLY - RESULTS FROM THE COOPERATIVE CARDIOVASCULAR PROJECT." CIRCULATION 92.8 (October 15, 1995): 3088-3088.
Source
wos-lite
Published In
Circulation
Volume
92
Issue
8
Publish Date
1995
Start Page
3088
End Page
3088

CAN CLINICAL FACTORS EXPLAIN VARIATIONS IN LENGTH OF STAY FOLLOWING CORONARY-ARTERY BYPASS-SURGERY - RESULTS OF THE COOPERATIVE CARDIOVASCULAR PROJECT

Authors
ROSEN, AB; HUMPHRIES, JO; PETERSON, ED; DELONG, ER; MUHLBAIER, LH; FORTIN, DF; MARK, DB; PRYOR, DB; ELLERBECK, EF; JENCKS, SF
MLA Citation
ROSEN, AB, HUMPHRIES, JO, PETERSON, ED, DELONG, ER, MUHLBAIER, LH, FORTIN, DF, MARK, DB, PRYOR, DB, ELLERBECK, EF, and JENCKS, SF. "CAN CLINICAL FACTORS EXPLAIN VARIATIONS IN LENGTH OF STAY FOLLOWING CORONARY-ARTERY BYPASS-SURGERY - RESULTS OF THE COOPERATIVE CARDIOVASCULAR PROJECT." CIRCULATION 92.8 (October 15, 1995): 2084-2084.
Source
wos-lite
Published In
Circulation
Volume
92
Issue
8
Publish Date
1995
Start Page
2084
End Page
2084

VOLUME OF CORONARY ANGIOPLASTY PROCEDURES AND MORTALITY-RATES - REPLY

Authors
JOLLIS, JG; PETERSON, ED; DELONG, ER; MARK, DB
MLA Citation
JOLLIS, JG, PETERSON, ED, DELONG, ER, and MARK, DB. "VOLUME OF CORONARY ANGIOPLASTY PROCEDURES AND MORTALITY-RATES - REPLY." NEW ENGLAND JOURNAL OF MEDICINE 332.19 (May 11, 1995): 1305-1305.
Source
wos-lite
Published In
The New England journal of medicine
Volume
332
Issue
19
Publish Date
1995
Start Page
1305
End Page
1305

Measuring hospital mortality rates: are 30-day data enough? Ischemic Heart Disease Patient Outcomes Research Team.

OBJECTIVE: We compare 30-day and 180-day postadmission hospital mortality rates for all Medicare patients and those in three categories of cardiac care: coronary artery bypass graft surgery, acute myocardial infarction, and congestive heart failure. DATA SOURCES/COLLECTION: Health Care Financing Administration (HCFA) hospital mortality data for FY 1989. STUDY DESIGN: Using hospital level public use files of actual and predicted mortality at 30 and 180 days, we constructed residual mortality measures for each hospital. We ranked hospitals and used receiver operating characteristic (ROC) curves to compare 0-30, 31-180, and 0-180-day postadmission mortality. PRINCIPAL FINDINGS: For the admissions we studied, we found a broad range of hospital performance when we ranked hospitals using the 30-day data; some hospitals had much lower than predicted 30-day mortality rates, while others had much higher than predicted mortality rates. Data from the time period 31-180 days postadmission yield results that corroborate the 0-30 day postadmission data. Moreover, we found evidence that hospital performance on one condition is related to performance on the other conditions, but that the correlation is much weaker in the 31-180-day interval than in the 0-30-day period. Using ROC curves, we found that the 30-day data discriminated the top and bottom fifths of the 180-day data extremely well, especially for AMI outcomes. CONCLUSIONS: Using data on cumulative hospital mortality from 180 days postadmission does not yield a different perspective from using data from 30 days postadmission for the conditions we studied.

Authors
Garnick, DW; DeLong, ER; Luft, HS
MLA Citation
Garnick, DW, DeLong, ER, and Luft, HS. "Measuring hospital mortality rates: are 30-day data enough? Ischemic Heart Disease Patient Outcomes Research Team." Health Serv Res 29.6 (February 1995): 679-695.
PMID
7860319
Source
pubmed
Published In
Health Services Research
Volume
29
Issue
6
Publish Date
1995
Start Page
679
End Page
695

Volume of coronary angioplasty procedures and mortality rates [3]

Authors
Huff, ED; Schabelman, SE; Jollis, JG; Peterson, ED; DeLong, ER; Mark, DB
MLA Citation
Huff, ED, Schabelman, SE, Jollis, JG, Peterson, ED, DeLong, ER, and Mark, DB. "Volume of coronary angioplasty procedures and mortality rates [3]." New England Journal of Medicine 332.19 (1995): 1304-1305.
PMID
7708083
Source
scival
Published In
New England Journal of Medicine
Volume
332
Issue
19
Publish Date
1995
Start Page
1304
End Page
1305
DOI
10.1056/NEJM199505113321914

Measuring hospital mortality rates: Are 30-day data enough?

Objective. We compare 30-day and 180-day postadmission hospital mortality rates for all Medicare patients and those in three categories of cardiac care: coronary artery bypass graft surgery, acute myocardial infarction, and congestive heart failure. Data Sources/Collection. Health Care Financing Administration (HCFA) hospital mortality data for FY 1989. Study Design. Using hospital level public use files of actual and predicted mortality at 30 and 180 days, we constructed residual mortality measures for each hospital. We ranked hospitals and used receiver operating characteristic (ROC) curves to compare 0-30, 31-180, and 0-180-day postadmission mortality. Principal Findings. For the admissions we studied, we found a broad range of hospital performance when we ranked hospitals using the 30-day data; some hospitals had much lower than predicted 30-day mortality rates, while others had much higher than predicted mortality rates. Data from the time period 31-180 days postadmission yield results that corroborate the 0-30 day postadmission data. Moreover, we found evidence that hospital performance on one condition is related to performance on the other conditions, but that the correlation is much weaker in the 31-180-day interval than in the 0-30-day period. Using ROC curves, we found that the 30-day data discriminated the top and bottom fifths of the 180-day data extremely well, especially for AMI outcomes. Conclusions. Using data on cumulative hospital mortality from 180 days postadmission does not yield a different perspective from using data from 30 days post admission for the conditions we studied.

Authors
Garnick, DW; DeLong, ER; Luft, HS
MLA Citation
Garnick, DW, DeLong, ER, and Luft, HS. "Measuring hospital mortality rates: Are 30-day data enough?." Health Services Research 29.6 (1995): 679-695.
Source
scival
Published In
Health Services Research
Volume
29
Issue
6
Publish Date
1995
Start Page
679
End Page
695

Outcomes of coronary artery bypass graft surgery in 24 461 patients aged 80 years or older

Background: Coronary artery bypass graft surgery is increasingly common in patients of age ≥80 years. Single-institution reviews have cited a wide range of mortality results after bypass surgery in this age group, in part because of limited sample sizes. Using claims data, we examined recent national trends in the use and outcomes of bypass surgery in the very elderly. Methods and Results: From an examination of Medicare data from 1987 through 1990, we identified 24 461 patients of age ≥80 years who underwent bypass surgery. We compared surgical outcomes in these patients with those in Medicare patients of age 65 to 70 years. We found that the national use of bypass surgery in patients of age ≥80 years increased 67% between 1987 and 1990. Compared with patients of age 65 to 70 years, the very elderly had significantly longer postoperative hospital stays (mean, 14.3 versus 10.4 days), higher charges (mean, $48 200 versus $38 000), and greater costs (mean, $27200 versus $21 700). In-hospital (11.5% versus 4.4%), 1-year (19.3% versus 7.9%), and 3-year mortality rates (28.8% versus 13.1%) after bypass surgery were also significantly higher in patients of age ≥80 years compared with younger patients. Although their initial surgical rink was high, octogenarians who underwent bypass surgery had it long-term survival rate similar to that of the general US octogenarian population. Conclusions: The rise of bypass surgery in patients of age ≥80 years is increasing. These very elderly patients face high surgical risks and accumulate significant hospital expenses. Further research is indicated to determine whether the long-term benefits from bypass surgery in the very elderly outweigh the increased procedural risks.

Authors
Peterson, ED; Cowper, PA; Jollis, JG; Bebchuk, JD; DeLong, ER; Muhlbaier, LH; Mark, DB; Pryor, DB
MLA Citation
Peterson, ED, Cowper, PA, Jollis, JG, Bebchuk, JD, DeLong, ER, Muhlbaier, LH, Mark, DB, and Pryor, DB. "Outcomes of coronary artery bypass graft surgery in 24 461 patients aged 80 years or older." Circulation 92.9 SUPPL. (1995): II85-II91.
Source
scival
Published In
Circulation
Volume
92
Issue
9 SUPPL.
Publish Date
1995
Start Page
II85
End Page
II91

The relation between the volume of coronary angioplasty procedures at hospitals treating Medicare beneficiaries and short-term mortality.

BACKGROUND: Previous studies have found that hospitals at which more procedures, such as coronary-artery bypass grafting (CABG) and other vascular surgery, are performed have lower rates of mortality related to these procedures than hospitals where fewer such procedures are performed. METHODS: We examined the relation between the number of percutaneous transluminal coronary angioplasty (PTCA) procedures performed at hospitals (volume) and short-term mortality in a population of 217,836 Medicare beneficiaries 65 years of age or older who underwent angioplasty in the United States from 1987 through 1990. RESULTS: The unadjusted in-hospital mortality among patients who underwent PTCA increased from 2.5 percent among the 10 percent of patients treated in hospitals with the highest volume of such procedures to 3.9 percent among the 10 percent of patients treated in hospitals with the lowest volume. The rate of bypass surgery after PTCA also increased, from 2.8 percent among patients in the highest-volume hospitals to 5.3 percent among those in the lowest-volume hospitals. Higher rates of mortality and CABG persisted in all the groups of patients treated in hospitals that performed fewer than 100 angioplasty procedures per year in Medicare beneficiaries; this volume in Medicare beneficiaries can be extrapolated to an overall annual volume of 200 to 400 angioplasty procedures. In a logistic-regression model, the volume of PTCA procedures at a hospital was found to be a highly significant predictor of in-hospital mortality (P < 0.001). These results suggest that if the hospitals with the lowest volume had achieved the experience and technical results of the highest-volume hospitals, 381 fewer patients would have undergone CABG and there would have been 300 fewer in-hospital deaths in the population we studied. CONCLUSIONS: Hospitals that perform more PTCA procedures have lower short-term mortality rates after the procedure. These data provide evidence in support of the regionalization of angioplasty services.

Authors
Jollis, JG; Peterson, ED; DeLong, ER; Mark, DB; Collins, SR; Muhlbaier, LH; Pryor, DB
MLA Citation
Jollis, JG, Peterson, ED, DeLong, ER, Mark, DB, Collins, SR, Muhlbaier, LH, and Pryor, DB. "The relation between the volume of coronary angioplasty procedures at hospitals treating Medicare beneficiaries and short-term mortality." N Engl J Med 331.24 (December 15, 1994): 1625-1629.
PMID
7969344
Source
pubmed
Published In
The New England journal of medicine
Volume
331
Issue
24
Publish Date
1994
Start Page
1625
End Page
1629
DOI
10.1056/NEJM199412153312406

Changes in mortality after myocardial revascularization in the elderly. The national Medicare experience.

OBJECTIVE: To examine secular changes in the use and outcome of percutaneous transluminal coronary angioplasty and cardiac bypass graft surgery in the elderly. DESIGN: A retrospective cohort study based on a longitudinal database created from the administrative files of Medicare. SETTING: U.S. hospitals that perform myocardial revascularization procedures covered by Medicare. PATIENTS: 225,915 consecutive patients who had angioplasty and 357,885 consecutive patients who had bypass surgery from 1987 to 1990. MEASUREMENTS: The rates of angioplasty and bypass surgery use; unadjusted 30-day and 1-year mortality rates after revascularization; and adjusted odds ratios for mortality by year of procedure for 1987 to 1990. RESULTS: From 1987 to 1990, the rates of angioplasty and bypass surgery done in the elderly increased by 55% and 18%, respectively. During this period, 30-day unadjusted mortality rates after angioplasty and bypass surgery decreased by 25% (95% CI, 22% to 28%) and 12% (CI, 10% to 14%), and 1-year mortality rates decreased by 10% (CI, 8% to 11%) and 8% (CI, 7% to 10%), respectively. After adjustment for changes in patient characteristics, 30-day mortality rates after these procedures decreased by 37% (CI, 32% to 41%) and 18% (CI, 14% to 21%), and 1-year mortality rates decreased by 22% (CI, 18% to 25%) and 19% (CI, 16% to 21%), respectively. CONCLUSIONS: The use of cardiac revascularization procedures in the elderly has steadily increased. Patients who had revascularization are progressively older, have more coded comorbid conditions, and present with more acute diseases. Although elderly patients have apparently higher risk profiles, mortality rates after angioplasty and bypass surgery in the elderly have decreased, suggesting a national improvement in the outcomes of these interventions. Health policy decisions concerning revascularization procedures in the elderly must consider these trends in improved outcome.

Authors
Peterson, ED; Jollis, JG; Bebchuk, JD; DeLong, ER; Muhlbaier, LH; Mark, DB; Pryor, DB
MLA Citation
Peterson, ED, Jollis, JG, Bebchuk, JD, DeLong, ER, Muhlbaier, LH, Mark, DB, and Pryor, DB. "Changes in mortality after myocardial revascularization in the elderly. The national Medicare experience." Ann Intern Med 121.12 (December 15, 1994): 919-927.
PMID
7978717
Source
pubmed
Published In
Annals of internal medicine
Volume
121
Issue
12
Publish Date
1994
Start Page
919
End Page
927

UNEXPLAINED VARIATION IN RESOURCE USE FOR CORONARY-BYPASS GRAFT-SURGERY

Authors
COWPER, PA; DELONG, ER; LIPSCOMB, J; MUHLBAIER, LH; PETERSON, ED; JOLLIS, JG; PRYOR, DB
MLA Citation
COWPER, PA, DELONG, ER, LIPSCOMB, J, MUHLBAIER, LH, PETERSON, ED, JOLLIS, JG, and PRYOR, DB. "UNEXPLAINED VARIATION IN RESOURCE USE FOR CORONARY-BYPASS GRAFT-SURGERY." CIRCULATION 90.4 (October 1994): 92-92.
Source
wos-lite
Published In
Circulation
Volume
90
Issue
4
Publish Date
1994
Start Page
92
End Page
92

OUTCOMES OF CORONARY-BYPASS SURGERY IN US OCTOGENARIANS

Authors
PETERSON, ED; COWPER, PA; JOLLIS, JG; BEBCHUK, JD; DELONG, ER; MUHLBAIER, LH; LIPSCOMB, J; PRYOR, DB
MLA Citation
PETERSON, ED, COWPER, PA, JOLLIS, JG, BEBCHUK, JD, DELONG, ER, MUHLBAIER, LH, LIPSCOMB, J, and PRYOR, DB. "OUTCOMES OF CORONARY-BYPASS SURGERY IN US OCTOGENARIANS." CIRCULATION 90.4 (October 1994): 530-530.
Source
wos-lite
Published In
Circulation
Volume
90
Issue
4
Publish Date
1994
Start Page
530
End Page
530

CAN DISEASE SEVERITY EXPLAIN RACIAL VARIATION IN REVASCULARIZATION USE

Authors
PETERSON, ED; SHAW, LK; DELONG, ER; MARK, DB; PRYOR, DB
MLA Citation
PETERSON, ED, SHAW, LK, DELONG, ER, MARK, DB, and PRYOR, DB. "CAN DISEASE SEVERITY EXPLAIN RACIAL VARIATION IN REVASCULARIZATION USE." CIRCULATION 90.4 (October 1994): 45-45.
Source
wos-lite
Published In
Circulation
Volume
90
Issue
4
Publish Date
1994
Start Page
45
End Page
45

Continuing evolution of therapy for coronary artery disease. Initial results from the era of coronary angioplasty.

BACKGROUND: Survival after coronary artery bypass graft surgery (CABG) and medical therapy in patients with coronary artery disease (CAD) has been studied in both randomized trials and observational treatment comparisons. Over the past decade, the use of coronary angioplasty (PTCA) has increased dramatically, without guidance from either randomized trials or prospective observational comparisons. The purpose of this study was to describe the survival experience of a large prospective cohort of CAD patients treated with medicine, PTCA, or CABG. METHODS AND RESULTS: The study was designed as a prospective nonrandomized treatment comparison in the setting of an academic medical center (tertiary care). Subjects were 9263 patients with symptomatic CAD referred for cardiac catheterization (1984 through 1990). Patients with prior PTCA or CABG, valvular or congenital disease, nonischemic cardiomyopathy, or significant (> or = 75%) left main disease were excluded. Baseline clinical, laboratory, and catheterization data were collected prospectively in the Duke Cardiovascular Disease Databank. All patients were contacted at 6 months, 1 year, and annually thereafter (follow-up 97% complete). Cardiovascular death was the primary end point. Of this cohort, 2788 patients were treated with PTCA (2626 within 60 days) and 3422 with CABG (3080 within 60 days). Repeat or crossover revascularization procedures were counted as part of the initial treatment strategy. Kaplan-Meier survival curves (both unadjusted and adjusted for all known imbalances in baseline prognostic factors) were used to examine absolute survival differences, and treatment pair hazard ratios from the Cox model were used to summarize average relative survival benefits. For the latter, a 13-level CAD prognostic index was used to examine the relation between survival and revascularization as a function of CAD severity. The effects of revascularization on survival depended on the extent of CAD. For the least severe forms of CAD (ie, one-vessel disease), there were no survival advantages out to 5 years for revascularization over medical therapy. For intermediate levels of CAD (ie, two-vessel disease), revascularization was associated with higher survival rates than medical therapy. For less severe forms of two-vessel disease, PTCA had a small advantage over CABG, whereas for the most severe form of two-vessel disease (with a critical lesion of the proximal left anterior descending artery), CABG was superior. For the most severe forms of CAD (ie, three-vessel disease), CABG provided a consistent survival advantage over medicine. PTCA appeared prognostically equivalent to medicine in these patients, but the number of PTCA patients in this subgroup was low. CONCLUSIONS: In this first large-scale, prospective observational treatment comparison of PTCA, CABG, and medicine, we confirmed the previously reported survival advantages for CABG over medical therapy for three-vessel disease and severe two-vessel disease. For less severe CAD, the primary treatment choices are between medicine and PTCA. In these patients, there is a trend for a relative survival advantage with PTCA, although absolute survival differences were modest. In this setting, treatment decisions should be based not only on survival differences but also on symptom relief, quality of life outcomes, and patient preferences.

Authors
Mark, DB; Nelson, CL; Califf, RM; Harrell, FE; Lee, KL; Jones, RH; Fortin, DF; Stack, RS; Glower, DD; Smith, LR
MLA Citation
Mark, DB, Nelson, CL, Califf, RM, Harrell, FE, Lee, KL, Jones, RH, Fortin, DF, Stack, RS, Glower, DD, and Smith, LR. "Continuing evolution of therapy for coronary artery disease. Initial results from the era of coronary angioplasty." Circulation 89.5 (May 1994): 2015-2025.
PMID
8181125
Source
pubmed
Published In
Circulation
Volume
89
Issue
5
Publish Date
1994
Start Page
2015
End Page
2025

Absence of sex bias in the referral of patients for cardiac catheterization.

BACKGROUND: It has been suggested that women with clinical evidence of coronary artery disease are less often referred for cardiac catheterization than are men. To determine whether there is sex-related bias in referral for cardiac catheterization, we prospectively studied a cohort of 410 symptomatic outpatients (280 men and 130 women) who were being evaluated with exercise testing for possible-coronary artery disease. METHODS: Before the patients underwent exercise testing, 15 cardiologists from an academic medical center were asked to predict the probability that the patients they saw in the cardiology clinic would have angiographic evidence of any obstructive coronary disease (stenosis of 75 percent or more); the probability of severe coronary disease (three-vessel or left main coronary artery disease); the probability of left main coronary artery disease; and the probability of survival one, three, and five years after the evaluation. Similar predictions were generated by previously validated statistical models with use of data collected before exercise testing from the history, physical examination, and 12-lead electrocardiography with the patient at rest. RESULTS: Overall, women were referred for cardiac catheterization significantly less often than men (18 percent vs. 27 percent, P = 0.03). As compared with men, women had a significantly lower pretest probability of coronary disease (as estimated by their physicians) and a lower rate of positive exercise-test results. After accounting for differences in these two factors, sex was not an independent predictor of referral for catheterization. Comparing physicians' estimates of outcome with those generated by the statistical models revealed no evidence that the physicians were underestimating the risk of coronary disease in women. Furthermore, physicians' predictions did not underestimate the probability of any obstructive coronary disease in men and women who subsequently underwent catheterization. CONCLUSIONS: Academic cardiologists made appropriately lower pretest predictions of categories of disease in women with possible coronary artery disease than in men, and these assessments, along with women's lower rate of positive exercise tests, rather than bias based on sex, accounted for the lower rate of catheterization among women.

Authors
Mark, DB; Shaw, LK; DeLong, ER; Califf, RM; Pryor, DB
MLA Citation
Mark, DB, Shaw, LK, DeLong, ER, Califf, RM, and Pryor, DB. "Absence of sex bias in the referral of patients for cardiac catheterization." N Engl J Med 330.16 (April 21, 1994): 1101-1106.
PMID
8133852
Source
pubmed
Published In
The New England journal of medicine
Volume
330
Issue
16
Publish Date
1994
Start Page
1101
End Page
1106
DOI
10.1056/NEJM199404213301601

Programmed Outcome Research Teams (PORTs) and implications for clinical practice.

The spiraling cost of health care has created a health care crisis. Concerns about the appropriate use of expensive medical technologies have been heightened by health services research studies that demonstrate widespread and dramatic geographic variability in the use of tests and procedures. The Agency for Health Care Policy and Research has funded 14 Programmed Outcome Research Teams (PORTs) targeted at specific disease entities. The PORT in ischemic heart disease is examining 2 principal decisions--which patients should undergo cardiac catheterization and, following catheterization, how patients should be treated. The PORT in ischemic heart disease combines information from the literature, 18 databases, and patient preference studies in models examining these 2 decisions. The databases have also been used to develop statistical models that estimate outcomes with different therapies. The benefit of a therapy in a population can be illustrated using an empirically derived, marginal value curve that describes the expected improvement in outcome (e.g., survival) that accrues with additional procedures performed in patients who are most likely to benefit.

Authors
Pryor, DB; DeLong, ER
MLA Citation
Pryor, DB, and DeLong, ER. "Programmed Outcome Research Teams (PORTs) and implications for clinical practice." Am J Cardiol 73.6 (March 10, 1994): 34B-38B.
PMID
8141078
Source
pubmed
Published In
The American Journal of Cardiology
Volume
73
Issue
6
Publish Date
1994
Start Page
34B
End Page
38B

DO WOMEN WITH CORONARY-DISEASE TRULY GET TREATED DIFFERENTLY THAN MEN

Authors
PETERSON, ED; SHAW, LK; DELONG, ER; FETTERS, JK; MARK, DB; PRYOR, DB
MLA Citation
PETERSON, ED, SHAW, LK, DELONG, ER, FETTERS, JK, MARK, DB, and PRYOR, DB. "DO WOMEN WITH CORONARY-DISEASE TRULY GET TREATED DIFFERENTLY THAN MEN." JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY (February 1994): A298-A298.
Source
wos-lite
Published In
JACC - Journal of the American College of Cardiology
Publish Date
1994
Start Page
A298
End Page
A298

THE NATIONAL MEDICARE EXPERIENCE - CHANGING PATTERNS OF MYOCARDIAL REVASCULARIZATION UTILIZATION AND OUTCOME

Authors
PETERSON, ED; JOLLIS, JG; COLLINS, SR; BEBCHUCK, JD; DELONG, ER; MUHLBAIER, LHY; MARK, DB; PRYOR, DB
MLA Citation
PETERSON, ED, JOLLIS, JG, COLLINS, SR, BEBCHUCK, JD, DELONG, ER, MUHLBAIER, LHY, MARK, DB, and PRYOR, DB. "THE NATIONAL MEDICARE EXPERIENCE - CHANGING PATTERNS OF MYOCARDIAL REVASCULARIZATION UTILIZATION AND OUTCOME." JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY (February 1994): A438-A438.
Source
wos-lite
Published In
JACC - Journal of the American College of Cardiology
Publish Date
1994
Start Page
A438
End Page
A438

Discordance of databases designed for claims payment versus clinical information systems. Implications for outcomes research.

OBJECTIVE: To determine the suitability of insurance claims information for use in clinical outcomes research in ischemic heart disease. DESIGN: Concordance study of two databases. SETTING: Tertiary care referral center. PATIENTS: A total of 12,937 consecutive patients hospitalized for cardiac catheterization for suspected ischemic heart disease between July 1985 and May 1990. INTERVENTIONS: Two-by-two tables were used to compute overall and kappa measures of agreement comparing clinical versus claims data for 12 important predictors of prognosis in patients with ischemic heart disease. MEASUREMENTS: Kappa statistics (agreement adjusted for chance agreement) were used to quantify agreement rates. RESULTS: Agreement rates between the clinical and claims databases ranged from 0.83 for the diagnosis of diabetes to 0.09 for the diagnosis of unstable angina (kappa values). Claims data failed to identify more than one half of the patients with prognostically important conditions, including mitral insufficiency, congestive heart failure, peripheral vascular disease, old myocardial infarction, hyperlipidemia, cerebrovascular disease, tobacco use, angina, and unstable angina, when compared with the clinical information system. CONCLUSIONS: Our results suggest that insurance claims data lack important diagnostic and prognostic information when compared with concurrently collected clinical data in the study of ischemic heart disease. Thus, insurance claims data are not as useful as clinical data for identifying clinically relevant patient groups and for adjusting for risk in outcome studies, such as analyses of hospital mortality.

Authors
Jollis, JG; Ancukiewicz, M; DeLong, ER; Pryor, DB; Muhlbaier, LH; Mark, DB
MLA Citation
Jollis, JG, Ancukiewicz, M, DeLong, ER, Pryor, DB, Muhlbaier, LH, and Mark, DB. "Discordance of databases designed for claims payment versus clinical information systems. Implications for outcomes research." Ann Intern Med 119.8 (October 15, 1993): 844-850.
PMID
8018127
Source
pubmed
Published In
Annals of internal medicine
Volume
119
Issue
8
Publish Date
1993
Start Page
844
End Page
850

INCOMPLETE REVASCULARIZATION AT ANGIOPLASTY LIMITS THE USEFULNESS OF FOLLOW-UP EXERCISE TESTING IN PREDICTING RESTENOSIS

Authors
HILLEGASS, WB; TIMMIS, GC; MCGREW, FA; BENGTSON, JR; ANCUKIEWICZ, M; DELONG, ER; PRYOR, DB
MLA Citation
HILLEGASS, WB, TIMMIS, GC, MCGREW, FA, BENGTSON, JR, ANCUKIEWICZ, M, DELONG, ER, and PRYOR, DB. "INCOMPLETE REVASCULARIZATION AT ANGIOPLASTY LIMITS THE USEFULNESS OF FOLLOW-UP EXERCISE TESTING IN PREDICTING RESTENOSIS." CIRCULATION 88.4 (October 1993): 64-64.
Source
wos-lite
Published In
Circulation
Volume
88
Issue
4
Publish Date
1993
Start Page
64
End Page
64

THE RELATIONSHIP BETWEEN ANGIOPLASTY VOLUME AND OUTCOME IN THE ELDERLY IN THE MEDICARE DATABASE

Authors
JOLLIS, JG; DELONG, ER; COLLINS, SR; BEBCHUK, JD; ANCUKIEWICZ, M; MUHLBAIER, LH; MARK, DB; PRYOR, DB
MLA Citation
JOLLIS, JG, DELONG, ER, COLLINS, SR, BEBCHUK, JD, ANCUKIEWICZ, M, MUHLBAIER, LH, MARK, DB, and PRYOR, DB. "THE RELATIONSHIP BETWEEN ANGIOPLASTY VOLUME AND OUTCOME IN THE ELDERLY IN THE MEDICARE DATABASE." CIRCULATION 88.4 (October 1993): 480-480.
Source
wos-lite
Published In
Circulation
Volume
88
Issue
4
Publish Date
1993
Start Page
480
End Page
480

ISCHEMIC HEART DISEASE PROGRAM OUTCOME RESEARCH TEAM (PORT)

Authors
DELONG, ER; PRYOR, DB
MLA Citation
DELONG, ER, and PRYOR, DB. "ISCHEMIC HEART DISEASE PROGRAM OUTCOME RESEARCH TEAM (PORT)." 1993.
Source
wos-lite
Published In
CANADIAN JOURNAL OF CARDIOLOGY, VOL 9, SUPPLEMENT D, MAY 1993
Publish Date
1993
Start Page
D183
End Page
D184

PREDISCHARGE EXERCISE TESTING DOES NOT PREDICT CLINICAL EVENTS OR RESTENOSIS AFTER SUCCESSFUL ANGIOPLASTY

Authors
HILLEGASS, WB; BENGTSON, JR; ANCUKIEWICZ, M; DELONG, ER; TIMMIS, GB; MCGREW, FA; PRYOR, DB
MLA Citation
HILLEGASS, WB, BENGTSON, JR, ANCUKIEWICZ, M, DELONG, ER, TIMMIS, GB, MCGREW, FA, and PRYOR, DB. "PREDISCHARGE EXERCISE TESTING DOES NOT PREDICT CLINICAL EVENTS OR RESTENOSIS AFTER SUCCESSFUL ANGIOPLASTY." CIRCULATION 86.4 (October 1992): 137-137.
Source
wos-lite
Published In
Circulation
Volume
86
Issue
4
Publish Date
1992
Start Page
137
End Page
137

INFLUENCE OF GENDER ON REFERRAL TO CARDIAC-CATHETERIZATION - PHYSICIAN BIAS OR APPROPRIATE MANAGEMENT

Authors
MARK, DB; SHAW, L; DELONG, ER; PRYOR, DB
MLA Citation
MARK, DB, SHAW, L, DELONG, ER, and PRYOR, DB. "INFLUENCE OF GENDER ON REFERRAL TO CARDIAC-CATHETERIZATION - PHYSICIAN BIAS OR APPROPRIATE MANAGEMENT." CIRCULATION 86.4 (October 1992): 38-38.
Source
wos-lite
Published In
Circulation
Volume
86
Issue
4
Publish Date
1992
Start Page
38
End Page
38

DOES FOLLOW-UP EXERCISE TESTING PREDICT RESTENOSIS AFTER SUCCESSFUL ANGIOPLASTY

Authors
HILLEGASS, WB; ANCUKIEWICZ, M; BENGTSON, JR; DELONG, ER; TIMMIS, GB; MCGREW, FA; PRYOR, DB
MLA Citation
HILLEGASS, WB, ANCUKIEWICZ, M, BENGTSON, JR, DELONG, ER, TIMMIS, GB, MCGREW, FA, and PRYOR, DB. "DOES FOLLOW-UP EXERCISE TESTING PREDICT RESTENOSIS AFTER SUCCESSFUL ANGIOPLASTY." CIRCULATION 86.4 (October 1992): 137-137.
Source
wos-lite
Published In
Circulation
Volume
86
Issue
4
Publish Date
1992
Start Page
137
End Page
137

Impact of glucose self-monitoring on non-insulin-treated patients with type II diabetes mellitus. Randomized controlled trial comparing blood and urine testing

Authors
Allen, BT; DeLong, ER; Feussner, JR
MLA Citation
Allen, BT, DeLong, ER, and Feussner, JR. "Impact of glucose self-monitoring on non-insulin-treated patients with type II diabetes mellitus. Randomized controlled trial comparing blood and urine testing." Annals of Internal Medicine 114.SUPPL. 1 (1991): 30--.
Source
scival
Published In
Annals of Internal Medicine
Volume
114
Issue
SUPPL. 1
Publish Date
1991
Start Page
30-

Impact of glucose self-monitoring on non-insulin-treated patients with type II diabetes mellitus. Randomized controlled trial comparing blood and urine testing.

The goal of this study was to compare the relative efficacy and cost of self-monitoring of blood glucose (SMBG) with routine urine testing in the management of patients with type II (non-insulin-dependent) diabetes mellitus not treated with insulin. Fifty-four patients with type II diabetes mellitus, not treated with insulin, who had inadequate glucose control on diet alone or diet and oral hypoglycemic agents were studied. Patients performed SMBG or urine glucose testing as part of a standardized treatment program that also included diet and exercise counseling. During the 6-mo study, both the urine-testing and SMBG groups showed similar improvement in glycemic control; within each group, there were significant improvements in fasting plasma glucose (reduction of 1.4 +/- 3.2 mM, P less than 0.03) and glycosylated hemoglobin (reduction of 2.0 +/- 3.4%, P less than 0.01) levels. Seventeen (31%) of 54 patients actually normalized their glycosylated hemoglobin values, 9 in the urine-testing group and 8 in the SMBG group. Comparisons between the urine-testing and SMBG groups showed no significant differences in mean fasting plasma glucose (P greater than 0.86), glycosylated hemoglobin (P greater than 0.95), or weight (P greater than 0.19). In patients with type II diabetes mellitus not treated with insulin, SMBG is no more effective, but is 8-12 times more expensive, than urine testing in facilitating improved glycemic control. Our results do not support widespread use of SMBG in diabetic patients not treated with insulin.

Authors
Allen, BT; DeLong, ER; Feussner, JR
MLA Citation
Allen, BT, DeLong, ER, and Feussner, JR. "Impact of glucose self-monitoring on non-insulin-treated patients with type II diabetes mellitus. Randomized controlled trial comparing blood and urine testing." Diabetes Care 13.10 (October 1990): 1044-1050.
PMID
2170088
Source
pubmed
Published In
Diabetes Care
Volume
13
Issue
10
Publish Date
1990
Start Page
1044
End Page
1050

Randomized, double-blind, placebo-controlled, patient-initiated study of topical high- and low-dose interferon-alpha with nonoxynol-9 in the treatment of recurrent genital herpes.

To explore further topical antiviral therapy for recurrent genital herpes, 188 culture-proven patients were randomized to receive treatment with topical interferon-alpha in high-dose (10(6) IU/g with 1% nonoxynol-9 in 3.5% methylcellulose) or low-dose (10(3) IU/g with 0.1% nonoxynol-9 in 3.5% methylcellulose) treatments or placebo (3.5% methylcellulose, alone), applied three times daily for 5 days. Of these, 105 experienced prodromal symptoms within the study period and applied the medication, of whom 99 could be evaluated for efficacy. Patients were followed with daily clinical assessments and cultures until reepithelialization. The median time to negative virus culture in high-dose recipients was 2.5 days compared with 3.9 days for placebo recipients (P = .023), and a significant dose response was observed (P = .016). Antiviral effects were more prominent in men than women. High-dose recipients also had reduced median duration of symptoms to 2.7 days from 3.7 days for placebo recipients (P = .03), with a significant dose-response relationship (P = .047). Effects on duration of symptoms were more prominent in women. Times to complete reepithelialization in those who applied the drug during the prodromal phase were 5.8 days for high-dose recipients compared with 6.5 days for placebo recipients (P = .053). A multivariate ranked linear model analysis of four efficacy variables (crusting, healing, virus shedding, symptom duration) also favored the high-dose gel (P = .015). High-dose topical interferon-alpha preparation is effective for patients with recurrent genital herpes. Applied early in the course of a recurrent episode, this treatment is safe and may provide a topical alternative to other types of therapy in the future.

Authors
Sacks, SL; Varner, TL; Davies, KS; Rekart, ML; Stiver, HG; DeLong, ER; Sellers, PW
MLA Citation
Sacks, SL, Varner, TL, Davies, KS, Rekart, ML, Stiver, HG, DeLong, ER, and Sellers, PW. "Randomized, double-blind, placebo-controlled, patient-initiated study of topical high- and low-dose interferon-alpha with nonoxynol-9 in the treatment of recurrent genital herpes." J Infect Dis 161.4 (April 1990): 692-698.
PMID
2156945
Source
pubmed
Published In
Journal of Infectious Diseases
Volume
161
Issue
4
Publish Date
1990
Start Page
692
End Page
698

Five-year follow-up of men with androgenetic alopecia treated with topical minoxidil.

Thirty-one men with androgenetic alopecia completed 4 1/2 to 5 years of therapy with 2% and 3% topical minoxidil. Hair regrowth with topical minoxidil tended to peak at 1 year with a slow decline in regrowth over subsequent years. However, at 4 1/2 to 5 years, maintenance of nonvellus hairs beyond that seen at baseline was still evident. Topical minoxidil appears to be effective in helping to maintain nonvellus hair growth in men with androgenetic alopecia.

Authors
Olsen, EA; Weiner, MS; Amara, IA; DeLong, ER
MLA Citation
Olsen, EA, Weiner, MS, Amara, IA, and DeLong, ER. "Five-year follow-up of men with androgenetic alopecia treated with topical minoxidil." J Am Acad Dermatol 22.4 (April 1990): 643-646.
PMID
2180995
Source
pubmed
Published In
Journal of The American Academy of Dermatology
Volume
22
Issue
4
Publish Date
1990
Start Page
643
End Page
646

5-YEAR FOLLOW-UP OF MEN WITH ANDROGENETIC ALOPECIA TREATED WITH TOPICAL MINOXIDIL

Authors
OLSEN, EA; WEINER, MS; AMARA, IA; DELONG, ER
MLA Citation
OLSEN, EA, WEINER, MS, AMARA, IA, and DELONG, ER. "5-YEAR FOLLOW-UP OF MEN WITH ANDROGENETIC ALOPECIA TREATED WITH TOPICAL MINOXIDIL." JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY 22.4 (April 1990): 643-646.
Source
wos-lite
Published In
Journal of The American Academy of Dermatology
Volume
22
Issue
4
Publish Date
1990
Start Page
643
End Page
646
DOI
10.1016/0190-9622(90)70089-Z

Natural history of androgenetic alopecia.

Twenty-two men with patterns III-Va androgenetic alopecia were entered into a 10-month study aimed at establishing information on the natural progression of hair loss over a period of time typical of studies of hair growth promoters. The methodology employed was the same as that in published clinical trials of topical minoxidil, but the men refrained from application of either active drug or vehicle to their scalps. As one of the potential explanations for the observed 'placebo-effect' seen in non-vellus hair counts in the topical minoxidil trials was a learning curve of novice hair counters, we were particularly interested in evaluating this in our 'no-treatment' trial. To that end, both a novice (Observer I) and an experienced (Observer II) hair counter independently performed the hair counts. There was a mean decline in the number of vertex target area non-vellus hairs (-17.2 +/- 80.3 for Observer I and -26.6 +/- 63.5 for Observer II) at the end of 10 months; this was not significant. The novice's hair counts were lower than the experienced observer's counts at baseline, and the difference remained relatively constant during the study. Without the application of a placebo, there was no increase in hair growth, making it unlikely that the methods of hair counting led to the 'placebo-effect' seen in prior topical minoxidil studies.

Authors
Olsen, EA; Buller, TA; Weiner, S; Delong, ER
MLA Citation
Olsen, EA, Buller, TA, Weiner, S, and Delong, ER. "Natural history of androgenetic alopecia." Clin Exp Dermatol 15.1 (January 1990): 34-36.
PMID
2311277
Source
pubmed
Published In
Clinical & Experimental Dermatology
Volume
15
Issue
1
Publish Date
1990
Start Page
34
End Page
36

A controlled trial of two low-dose heparin regimens for the prevention of postoperative deep vein thrombosis

Venous thromboembolism is a serious complication following gynecologic surgery and is particularly common in patients with malignancy. A previous study of subcutaneous low-dose heparin given as one dose preoperatively and every 12 hours postoperatively failed to show a benefit in gynecologic oncology patients. In the present study, two more intense regimens of low-dose heparin were evaluated. Three hundred four patients were assigned randomly to receive no prophylaxis (controls), subcutaneous heparin 5000 units 2 hours before surgery and every 8 hours postoperatively (low-dose heparin)(regimen I), or 5000 units heparin subcutaneously every 8 hours preoperatively (between two and nine doses) and every 8 hours postoperatively (regimen II). All patients had thromboembolism surveillance with the fibrinogen uptake test and clinical evaluation. Eighty-four percent had a malignancy. Thromboemboli were diagnosed in 19 of 103 control patients, ten of 104 regimen I patients, and six of 97 regimen II patients, a statistically significant difference (P < .008). When compared with the control group, the study groups had no evidence of increased bleeding complications or alteration of laboratory coagulation indicators.

Authors
Clarke-Pearson, DL; DeLong, E; Synan, IS; Soper, JT; Creasman, WT; Coleman, RE
MLA Citation
Clarke-Pearson, DL, DeLong, E, Synan, IS, Soper, JT, Creasman, WT, and Coleman, RE. "A controlled trial of two low-dose heparin regimens for the prevention of postoperative deep vein thrombosis." Obstetrics and Gynecology 75.4 (1990): 684-689.
PMID
2179782
Source
scival
Published In
Obstetrics and Gynecology
Volume
75
Issue
4
Publish Date
1990
Start Page
684
End Page
689

Transdermal viprostol in the treatment of male pattern baldness

Fifty-seven men were randomly assigned for treatment of androgenetic alopecia with viprostol, vehicle, or placebo twice daily for 24 weeks. Nonvellus hair growth was assessed subjectively by both patient and investigator and objectively through hair counts from macrophotography of the target area. Nonvellus target area hair counts declined in all three treatment groups at the end of the 6-month study. Viprostol is not an effective hair growth promoter in androgenetic alopecia.

Authors
Olsen, EA; DeLong, E
MLA Citation
Olsen, EA, and DeLong, E. "Transdermal viprostol in the treatment of male pattern baldness." Journal of the American Academy of Dermatology 23.3 I (1990): 470-472.
PMID
2212146
Source
scival
Published In
Journal of the American Academy of Dermatology
Volume
23
Issue
3 I
Publish Date
1990
Start Page
470
End Page
472

Phase II treatment of medulloblastoma and pineoblastoma with melphalan: clinical therapy based on experimental models of human medulloblastoma.

We conducted a phase II study of intravenous (IV) melphalan in the treatment of children with recurrent medulloblastoma and in the initial treatment of children with poor-prognosis medulloblastoma and pineoblastoma. There was one complete response (CR) and two partial responses (PRs) among the 12 children with recurrent medulloblastoma. There were three PRs in the four patients initially treated with melphalan for poor-prognosis medulloblastoma or pineoblastoma. Toxicity was limited to severe myelosuppression with marked neutropenia and thrombocytopenia. These results support our laboratory studies demonstrating melphalan activity in human medulloblastoma, suggest that similar activity may be demonstrated against pineoblastoma, and support further trials with this agent (administered prior to radiotherapy) in the treatment of patients with newly diagnosed poor-prognosis medulloblastoma.

Authors
Friedman, HS; Schold, SC; Mahaley, MS; Colvin, OM; Oakes, WJ; Vick, NA; Burger, PC; Bigner, SH; Borowitz, M; Halperin, EC
MLA Citation
Friedman, HS, Schold, SC, Mahaley, MS, Colvin, OM, Oakes, WJ, Vick, NA, Burger, PC, Bigner, SH, Borowitz, M, and Halperin, EC. "Phase II treatment of medulloblastoma and pineoblastoma with melphalan: clinical therapy based on experimental models of human medulloblastoma." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 7.7 (July 1989): 904-911. (Academic Article)
PMID
2738624
Source
manual
Published In
Journal of Clinical Oncology
Volume
7
Issue
7
Publish Date
1989
Start Page
904
End Page
911

Effect of Daily Charge Feedback on Inpatient Charges and Physician Knowledge and Behavior

Concurrent charge feedback has gained widespread acceptance as a method of minimizing hospitals’ losses under the Medicare prospective payment system despite the fact that its effect on patient outcomes, physician behavior, or charges has not been studied in depth. In a controlled trial on two medical wards in an academic medical center, the effect of daily charge feedback on charges was studied. Sixty-eight house staff and 16 teaching attending physicians participated during a 35-week period, taking care of 1057 eligible patients. No significant differences in charges were seen when all patients were included. Since 45% of patients had planned protocol admissions (diagnostic workups or protocol treatment) on which the house staff had little chance to impact, a subgroup analysis was performed, excluding these patients. In the remaining patients, a highly significant reduction in mean total charges (17%), length of stay (18%), room charges (18%), and diagnostic testing (20%) was found. In-hospital mortality and preventable readmission within 30 days were similar on the two wards. It was concluded that charge feedback alone is effective in a teaching hospital for decreasing charges. © 1989, American Medical Association. All rights reserved.

Authors
Pugh, JA; Frazier, LM; Delong, E; Wallace, AG; Ellenbogen, P; Linfors, E
MLA Citation
Pugh, JA, Frazier, LM, Delong, E, Wallace, AG, Ellenbogen, P, and Linfors, E. "Effect of Daily Charge Feedback on Inpatient Charges and Physician Knowledge and Behavior." Archives of Internal Medicine 149.2 (January 1, 1989): 426-429.
Source
scopus
Published In
Archives of internal medicine
Volume
149
Issue
2
Publish Date
1989
Start Page
426
End Page
429
DOI
10.1001/archinte.1989.00390020122026

Effect of daily charge feedback on inpatient charges and physician knowledge and behavior

Concurrent charge feedback has gained widespread acceptance as a method of minimizing hospitals' losses under the Medicare prospective payment system despite the fact that its effect on patient outcomes, physician behavior, or charges has not been studied in depth. In a controlled trial on two medical wards in an academic medical center, the effect of daily charge feedback on charges was studied. Sixty-eight house staff and 16 teaching attending physicians participated during a 35-week period, taking care of 1057 eligible patients. No significant differences in charges we seen when all patients were included. Since 45% of patients had planned protocol admissions (diagnostic workups or protocol treatment) on which the house staff had little chance to impact, a subgroup analysis was performed, excluding these patients. In the remaining patients, a highly significant reduction in mean total charges (17%), length of stay (18%), room charges (18%), and diagnostic testing (20%) was found. In-hospital mortality and preventable readmission within 30 days were similar on the two wards. It was concluded that charge feedback alone is effective in a teaching hospital for decreasing charges.

Authors
Pugh, JA; Frazier, LM; DeLong, E; Wallace, AG; Ellenbogen, P; Linfors, E
MLA Citation
Pugh, JA, Frazier, LM, DeLong, E, Wallace, AG, Ellenbogen, P, and Linfors, E. "Effect of daily charge feedback on inpatient charges and physician knowledge and behavior." Archives of Internal Medicine 149.2 (1989): 426-429.
PMID
2916887
Source
scival
Published In
Archives of Internal Medicine
Volume
149
Issue
2
Publish Date
1989
Start Page
426
End Page
429

Impact of a medical journal club on house-staff reading habits, knowledge, and critical appraisal skills. A randomized control trial.

The journal club is an established teaching modality in many house-staff training programs. To determine if a journal club improves house-staff reading habits, knowledge of epidemiology and biostatistics, and critical appraisal skills, we randomized 44 medical interns to receive either a journal club or a control seminar series. A test instrument developed by the Delphi method was administered before and after the interventions (mean, five journal club sessions). By self-report, 86% of the house staff in the journal club group improved their reading habits vs 0% in the control group. Knowledge scores increased more in the journal club group than in the control group, and a trend was found toward more knowledge gained as more sessions were attended. Ability to appraise critically a test article increased slightly in each group, but there was no significant difference between the groups. We conclude that a journal club is a powerful motivator of critical house-staff reading behavior and can help teach epidemiology and biostatistics to physicians-in-training.

Authors
Linzer, M; Brown, JT; Frazier, LM; DeLong, ER; Siegel, WC
MLA Citation
Linzer, M, Brown, JT, Frazier, LM, DeLong, ER, and Siegel, WC. "Impact of a medical journal club on house-staff reading habits, knowledge, and critical appraisal skills. A randomized control trial." JAMA 260.17 (November 4, 1988): 2537-2541.
PMID
3050179
Source
pubmed
Published In
JAMA : the journal of the American Medical Association
Volume
260
Issue
17
Publish Date
1988
Start Page
2537
End Page
2541

Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach.

Methods of evaluating and comparing the performance of diagnostic tests are of increasing importance as new tests are developed and marketed. When a test is based on an observed variable that lies on a continuous or graded scale, an assessment of the overall value of the test can be made through the use of a receiver operating characteristic (ROC) curve. The curve is constructed by varying the cutpoint used to determine which values of the observed variable will be considered abnormal and then plotting the resulting sensitivities against the corresponding false positive rates. When two or more empirical curves are constructed based on tests performed on the same individuals, statistical analysis on differences between curves must take into account the correlated nature of the data. This paper presents a nonparametric approach to the analysis of areas under correlated ROC curves, by using the theory on generalized U-statistics to generate an estimated covariance matrix.

Authors
DeLong, ER; DeLong, DM; Clarke-Pearson, DL
MLA Citation
DeLong, ER, DeLong, DM, and Clarke-Pearson, DL. "Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach." Biometrics 44.3 (September 1988): 837-845.
PMID
3203132
Source
pubmed
Published In
Biometrics
Volume
44
Issue
3
Publish Date
1988
Start Page
837
End Page
845

Prognosis of patients with cirrhosis and chronic liver disease admitted to the medical intensive care unit.

Patients with hepatic failure admitted to the medical ICU (MICU) generally have a poor prognosis. To determine if there were readily identifiable clinical factors associated with a high predictive value for outcome, we reviewed retrospectively the charts of 100 patients with serious liver disease admitted to the MICU. The overall mortality of the group was 64%. We found that Child's class, a need for mechanical ventilation, and an elevated serum creatinine had the greatest prognostic significance. Ninety-one percent of the patients receiving assisted ventilation, 89% of the patients in Child's class C, and 93% of the patients with creatinine values greater than 1.3 mg/dl died during their MICU admission. Furthermore, a multivariant regression analysis indicated that patients in Child's class C receiving mechanical ventilation who had an abnormal serum creatinine (greater than 1.3 mg/dl) during the first 72 h in the MICU had only a 2% survival rate.

Authors
Shellman, RG; Fulkerson, WJ; DeLong, E; Piantadosi, CA
MLA Citation
Shellman, RG, Fulkerson, WJ, DeLong, E, and Piantadosi, CA. "Prognosis of patients with cirrhosis and chronic liver disease admitted to the medical intensive care unit." Crit Care Med 16.7 (July 1988): 671-678.
PMID
3371043
Source
pubmed
Published In
Critical Care Medicine
Volume
16
Issue
7
Publish Date
1988
Start Page
671
End Page
678

Erythrocyte anisocytosis. Visual inspection of blood films vs automated analysis of red blood cell distribution width.

An improved anemia classification may be available by combining measures of red blood cell size variability with mean corpuscular volume. Visual inspection of the peripheral blood film allows semiquantitative description of anisocytosis while quantitative measures are determined from electronic cell counter analyzers' red blood cell distribution width. We evaluated correlations between semiquantitative and quantitative measures of anisocytosis for different groups of observers. Hematologists', medical students', and medical residents' semiquantitative assessment of anisocytosis correlated with the quantitative red blood cell distribution width. The interobserver variability demonstrated that all observers correlated with each other, while the intraobserver variability of semiquantitative anisocytosis demonstrated that observers were more precise than could be predicted by chance. However, the extreme precision of the red blood cell distribution width strongly suggests that it should be the "gold standard" for measuring red blood cell size variability.

Authors
Simel, DL; DeLong, ER; Feussner, JR; Weinberg, JB; Crawford, J
MLA Citation
Simel, DL, DeLong, ER, Feussner, JR, Weinberg, JB, and Crawford, J. "Erythrocyte anisocytosis. Visual inspection of blood films vs automated analysis of red blood cell distribution width." Arch Intern Med 148.4 (April 1988): 822-824.
PMID
3355302
Source
pubmed
Published In
Archives of internal medicine
Volume
148
Issue
4
Publish Date
1988
Start Page
822
End Page
824

A RANDOMIZED CONTROL TRIAL OF THE IMPACT OF A MEDICAL JOURNAL CLUB ON HOUSESTAFF READING HABITS, KNOWLEDGE AND CRITICAL-APPRAISAL SKILLS

Authors
LINZER, M; BROWN, JT; FRAZIER, LM; DELONG, ER; SIEGEL, WC
MLA Citation
LINZER, M, BROWN, JT, FRAZIER, LM, DELONG, ER, and SIEGEL, WC. "A RANDOMIZED CONTROL TRIAL OF THE IMPACT OF A MEDICAL JOURNAL CLUB ON HOUSESTAFF READING HABITS, KNOWLEDGE AND CRITICAL-APPRAISAL SKILLS." CLINICAL RESEARCH 36.3 (April 1988): A733-A733.
Source
wos-lite
Published In
Clinical Research
Volume
36
Issue
3
Publish Date
1988
Start Page
A733
End Page
A733

IMPACT OF LIVER BIOPSIES ON THE MANAGEMENT OF PATIENTS WITH SUSPECTED LIVER-DISEASE - A PROSPECTIVE-STUDY

Authors
HLA, KM; DELONG, ER; BRAZER, SR
MLA Citation
HLA, KM, DELONG, ER, and BRAZER, SR. "IMPACT OF LIVER BIOPSIES ON THE MANAGEMENT OF PATIENTS WITH SUSPECTED LIVER-DISEASE - A PROSPECTIVE-STUDY." CLINICAL RESEARCH 36.3 (April 1988): A743-A743.
Source
wos-lite
Published In
Clinical Research
Volume
36
Issue
3
Publish Date
1988
Start Page
A743
End Page
A743

Intestinal obstruction in patients with ovarian cancer. Variables associated with surgical complications and survival.

Intestinal obstruction is frequently encountered in patients with ovarian cancer. Surgical correction of intestinal obstruction may allow the prolonged survival of some patients. We identified prognostic factors associated with operative complications and postoperative survival. Multiple preoperative, intraoperative, and postoperative variables were considered. In addition, a previously published prognostic index was evaluated. Statistical assessment developed a model that demonstrated that the clinical assessment of tumor status, the serum albumin level, and the nutrition score were variables significantly associated with postoperative survival. The amount of residual ovarian cancer at the completion of bowel obstruction surgery was also significantly associated with postoperative survival. This information may aid in the preoperative selection of patients who might benefit from surgical correction of intestinal obstruction.

Authors
Clarke-Pearson, DL; DeLong, ER; Chin, N; Rice, R; Creasman, WT
MLA Citation
Clarke-Pearson, DL, DeLong, ER, Chin, N, Rice, R, and Creasman, WT. "Intestinal obstruction in patients with ovarian cancer. Variables associated with surgical complications and survival." Arch Surg 123.1 (January 1988): 42-45.
PMID
3337655
Source
pubmed
Published In
Archives of Surgery
Volume
123
Issue
1
Publish Date
1988
Start Page
42
End Page
45

Inter-examiner reproducibility of probing pocket depths in molar furcation sites.

This investigation was designed to determine the reproducibility of probing pocket depths in maxillary facial and mandibular facial and lingual grade II and III molar furcation sites. 80 untreated molar teeth with 102 furcation invasions due to periodontitis were probed with a pressure-sensitive periodontal probe by 3 examiners. 8 sites per furcation were measured by each examiner at a single examination. The sequence of examiner probing was rotated in order to evaluate the effect of sequential probing. Tracings were made from radiographs of the inter-root separations in order to classify the interradicular space and to determine the effect of root separation on reproducibility. Data was analyzed by regression analysis. Pearson correlations, intraclass correlations, and the Student-Newman-Keuls test. Analysis indicated a high reproducibility of the maxillary facial and mandibular facial and lingual furcation sites in this untreated adult sample. No effect was due to probing sequence. The mid-root prominences, the line angles, and the internal surface sites of the furcation roots were recordable and reproducible, while the horizontal measurements were not consistently recordable. The reproducibility of the facial and lingual furcation sites that were probed decreased with an increase in probing pocket depth and an increased degree of root separation.

Authors
Moriarty, JD; Scheitler, LE; Hutchens, LH; Delong, ER
MLA Citation
Moriarty, JD, Scheitler, LE, Hutchens, LH, and Delong, ER. "Inter-examiner reproducibility of probing pocket depths in molar furcation sites." J Clin Periodontol 15.1 (January 1988): 68-72.
PMID
3422247
Source
pubmed
Published In
Journal of Clinical Periodontology
Volume
15
Issue
1
Publish Date
1988
Start Page
68
End Page
72

A RANDOMIZED CONTROLLED TRIAL OF THE IMPACT OF A MEDICAL JOURNAL CLUB ON HOUSESTAFF READING HABITS, OBJECTIVE KNOWLEDGE AND CRITICAL-APPRAISAL SKILLS

Authors
LINZER, M; BROWN, JT; FRAZIER, LM; DELONG, ER; SIEGEL, WC
MLA Citation
LINZER, M, BROWN, JT, FRAZIER, LM, DELONG, ER, and SIEGEL, WC. "A RANDOMIZED CONTROLLED TRIAL OF THE IMPACT OF A MEDICAL JOURNAL CLUB ON HOUSESTAFF READING HABITS, OBJECTIVE KNOWLEDGE AND CRITICAL-APPRAISAL SKILLS." CLINICAL RESEARCH 36.1 (January 1988): A90-A90.
Source
wos-lite
Published In
Clinical Research
Volume
36
Issue
1
Publish Date
1988
Start Page
A90
End Page
A90

A comparison of two formats for teaching critical reading skills in a medical journal club.

Authors
Linzer, M; DeLong, ER; Hupart, KH
MLA Citation
Linzer, M, DeLong, ER, and Hupart, KH. "A comparison of two formats for teaching critical reading skills in a medical journal club." J Med Educ 62.8 (August 1987): 690-692.
PMID
3612735
Source
pubmed
Published In
Journal of Medical Education
Volume
62
Issue
8
Publish Date
1987
Start Page
690
End Page
692

Effect of ultraviolet light on topical minoxidil-induced hair growth in advanced male pattern baldness.

Nine healthy men with type IVa or Va male pattern baldness completed a 4-month single-blinded controlled pilot study designed to assess the effect of ultraviolet light (UVL) on topical minoxidil-induced hair growth. Subjects applied 2% topical minoxidil solution twice daily to their balding scalps and to one target area on the upper arm. These men, all of whom had either skin type II or III, were randomized to also receive either incremental doses of UVB or PUVA (topical psoralen) twice weekly to one side of their scalp and to a 2.5 cm target area on the nonminoxidil-treated upper ipsilateral arm. Vellus, nonvellus, and total hair counts were done in two 1-inch in diameter circular target areas in symmetric regions of the scalp and on each upper arm at regular intervals. All nine subjects had an increase in target nonvellus hair and a net loss of vellus hair in scalp target area treated with topical minoxidil. Concomitant UVL did not have a significant synergistic nor adverse effect on topical minoxidil-induced hair growth.

Authors
Pestana, A; Olsen, EA; Delong, ER; Murray, JC
MLA Citation
Pestana, A, Olsen, EA, Delong, ER, and Murray, JC. "Effect of ultraviolet light on topical minoxidil-induced hair growth in advanced male pattern baldness." J Am Acad Dermatol 16.5 Pt 1 (May 1987): 971-976.
PMID
3294945
Source
pubmed
Published In
Journal of The American Academy of Dermatology
Volume
16
Issue
5 Pt 1
Publish Date
1987
Start Page
971
End Page
976

Double-blind, placebo-controlled trial of potassium chloride in the treatment of mild hypertension.

Epidemiological and experimental data suggest blood pressure-lowering effects of dietary potassium. A randomized, double-blind clinical trial was used to assess blood pressure response to orally administered potassium, 120 mEq/day, and to placebo in 101 adults with mild hypertension. Blood pressure was measured with a random-zero sphygmomanometer every 2 weeks of this 8-week trial. Systolic blood pressure in the potassium-treated group decreased by 6.4 +/- 13.7 (SD) mm Hg (p less than or equal to 0.025) compared with 0.11 +/- 13.0 mm Hg in the placebo-treated group (p = 0.96). Diastolic blood pressure in the potassium-treated group decreased by 4.1 +/- 8.3 mm Hg (p less than or equal to 0.05) compared with a 1.6 +/- 6.5 mm Hg decrease in placebo-treated subjects (p = 0.09). Baseline blood pressure of potassium-treated subjects was unexpectedly higher than that of controls. After correcting for baseline variation, blood pressure still decreased 3.4/1.8 mm Hg more in potassium recipients than in placebo recipients (p = 0.14 and 0.24, respectively). Blood pressure decreased by 19/13 mm Hg in five blacks taking potassium versus a 1/0 mm Hg increase in seven blacks taking placebo. Compliance with the potassium regimen was 91.5% by pill count; only one subject discontinued treatment because of side effects. In conclusion, 120 mEq/day of microencapsulated potassium chloride was well tolerated in adults with mild hypertension. An antihypertensive effect of potassium cannot be ruled out despite the fact that there was no statistically significant difference between potassium-treated and placebo-treated subjects after adjustment for differences in baseline blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Authors
Svetkey, LP; Yarger, WE; Feussner, JR; DeLong, E; Klotman, PE
MLA Citation
Svetkey, LP, Yarger, WE, Feussner, JR, DeLong, E, and Klotman, PE. "Double-blind, placebo-controlled trial of potassium chloride in the treatment of mild hypertension." Hypertension 9.5 (May 1987): 444-450.
PMID
3570421
Source
pubmed
Published In
Hypertension
Volume
9
Issue
5
Publish Date
1987
Start Page
444
End Page
450

EFFECT OF ULTRAVIOLET-LIGHT ON TOPICAL MINOXIDIL-INDUCED HAIR-GROWTH IN ADVANCED MALE PATTERN BALDNESS

Authors
PESTANA, A; OLSEN, EA; DELONG, ER; MURRAY, JC
MLA Citation
PESTANA, A, OLSEN, EA, DELONG, ER, and MURRAY, JC. "EFFECT OF ULTRAVIOLET-LIGHT ON TOPICAL MINOXIDIL-INDUCED HAIR-GROWTH IN ADVANCED MALE PATTERN BALDNESS." JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY 16.5 (May 1987): 971-976.
Source
wos-lite
Published In
Journal of The American Academy of Dermatology
Volume
16
Issue
5
Publish Date
1987
Start Page
971
End Page
976
DOI
10.1016/S0190-9622(87)70123-6

Intermediate, indeterminate, and uninterpretable diagnostic test results.

Diagnostic tests do not always yield positive or negative results; sometimes the results are intermediate, indeterminate, or uninterpretable. No consensus exists for the incorporation of such results into data assessment. Conventional Bayesian analysis leads investigators to either exclude patients with non-positive, non-negative results from their studies or categorize such results into inappropriate cells of the standard four-cell decision matrix. The authors propose a standardized method for reporting results in studies dealing with diagnostic test use and discuss how researchers should expand the four-cell matrix to six cells when non-positive, non-negative results occur. They suggest that the six-cell matrix with new operational definitions of sensitivity, specificity, likelihood ratios, and test yield should be adopted routinely. In addition, they define the different types of non-positive, non-negative results and demonstrate how clinicians can use tree-structured decision analysis from the six-cell matrix. While their method does not solve all problems posed by non-positive, non-negative results, it does suggest a standard method for reporting these results and utilizing all the data in decision making.

Authors
Simel, DL; Feussner, JR; DeLong, ER; Matchar, DB
MLA Citation
Simel, DL, Feussner, JR, DeLong, ER, and Matchar, DB. "Intermediate, indeterminate, and uninterpretable diagnostic test results." Med Decis Making 7.2 (April 1987): 107-114.
PMID
3574020
Source
pubmed
Published In
Medical Decision Making
Volume
7
Issue
2
Publish Date
1987
Start Page
107
End Page
114
DOI
10.1177/0272989X8700700208

IMPACT OF GLUCOSE SELF-MONITORING ON TYPE-II DIABETES-MELLITUS - A RANDOMIZED CONTROLLED TRIAL COMPARING BLOOD VS URINE TESTING

Authors
ALLEN, BT; FEUSSNER, JR; DELONG, ER
MLA Citation
ALLEN, BT, FEUSSNER, JR, and DELONG, ER. "IMPACT OF GLUCOSE SELF-MONITORING ON TYPE-II DIABETES-MELLITUS - A RANDOMIZED CONTROLLED TRIAL COMPARING BLOOD VS URINE TESTING." CLINICAL RESEARCH 35.3 (April 1987): A729-A729.
Source
wos-lite
Published In
Clinical Research
Volume
35
Issue
3
Publish Date
1987
Start Page
A729
End Page
A729

ERRORS IN BLOOD-PRESSURE MEASUREMENT - IS IT TIME TO REVISE THE STANDARD TECHNIQUE

Authors
HLA, KM; FEUSSNER, JR; DELONG, ER
MLA Citation
HLA, KM, FEUSSNER, JR, and DELONG, ER. "ERRORS IN BLOOD-PRESSURE MEASUREMENT - IS IT TIME TO REVISE THE STANDARD TECHNIQUE." CLINICAL RESEARCH 35.3 (April 1987): A744-A744.
Source
wos-lite
Published In
Clinical Research
Volume
35
Issue
3
Publish Date
1987
Start Page
A744
End Page
A744

USING DIRECT OPHTHALMOSCOPY TO DETECT GLAUCOMA - PHYSICIAN VARIABILITY AND ACCURACY

Authors
DEMARIA, LC; FEUSSNER, JR; DELONG, ER; MARTONE, J; CROWLEY, G
MLA Citation
DEMARIA, LC, FEUSSNER, JR, DELONG, ER, MARTONE, J, and CROWLEY, G. "USING DIRECT OPHTHALMOSCOPY TO DETECT GLAUCOMA - PHYSICIAN VARIABILITY AND ACCURACY." CLINICAL RESEARCH 35.3 (April 1987): A737-A737.
Source
wos-lite
Published In
Clinical Research
Volume
35
Issue
3
Publish Date
1987
Start Page
A737
End Page
A737

Phase II diaziquone-based chemotherapy trials in patients with anaplastic supratentorial astrocytic neoplasms.

We treated 103 patients with histologically confirmed anaplastic supratentorial astrocytic neoplasms with either diaziquone (AZQ) and carmustine (BCNU) or AZQ and procarbazine. There were 74 patients with glioblastoma multiforme (GBM) and 29 patients with anaplastic astrocytoma (AA). AZQ plus BCNU produced partial (PR) or unequivocal responses in seven of 32 (21.9%) patients with GBMs and three of ten (30%) patients with AAs. Two patients with GBMs (6.3%) and five patients with AAs (50%) showed stable disease (SD). AZQ plus procarbazine produced PRs or unequivocal responses in five of 42 (11.9%) patients with GBMs and nine of 19 (47.4%) patients with AAs. Eight patients with GBMs (19%) and one patient with an AA (5.2%) showed SD. In addition to histologic diagnosis, only the Karnofsky performance-status (KPS) rating independently influenced response and survival. Differences in response rates between the two regimens were not significant, although estimated median survival after adjusting for performance status was slightly better with AZQ plus BCNU than with AZQ plus procarbazine (P = .031). Neither age nor prior chemotherapy were significant independent risk factors. Toxicity was mild and primarily hematologic. We conclude that these AZQ-based regimens have activity in patients with recurrent anaplastic gliomas, but that they are not clearly superior to other agents in current use. The histologic diagnosis of GBM is associated with a significantly worse prognosis than AA, and we believe that this important distinction must be recognized in phase II as well as phase III trials.

Authors
Schold, SC; Mahaley, MS; Vick, NA; Friedman, HS; Burger, PC; DeLong, ER; Albright, RE; Bullard, DE; Khandekar, JD; Cairncross, JG
MLA Citation
Schold, SC, Mahaley, MS, Vick, NA, Friedman, HS, Burger, PC, DeLong, ER, Albright, RE, Bullard, DE, Khandekar, JD, and Cairncross, JG. "Phase II diaziquone-based chemotherapy trials in patients with anaplastic supratentorial astrocytic neoplasms." J Clin Oncol 5.3 (March 1987): 464-471.
PMID
3029339
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
5
Issue
3
Publish Date
1987
Start Page
464
End Page
471
DOI
10.1200/JCO.1987.5.3.464

Long-term follow-up of men with male pattern baldness treated with topical minoxidil.

Forty-one men with male pattern baldness completed 132 study weeks (2 years 9 months) with topical minoxidil and had follow-up 1-inch target-area vertex scalp hair counts. Initially these men were treated with either twice-daily 2% topical minoxidil for 12 months or 3% topical minoxidil for 8 to 12 months (one third of the subjects received placebo for the first 4 months). After 12 months all subjects continued to apply 3% topical minoxidil twice daily for 1 more year, after which they were randomized to once- versus twice-daily topical minoxidil for an additional 9 months. Those subjects who changed to once-daily application of topical minoxidil at 2 years had a mean change from baseline nonvellus hair count at 1 year of 291.2 (range of hairs four to 553) and at 2 years 9 months of 235 (two to 592 hairs). Those subjects who continued with twice-daily application of topical minoxidil throughout the study had a mean change from baseline nonvellus hair count at 1 year of 323 (15 to 589 hairs) and 335 (13 to 808 hairs) at 2 years 9 months with maintenance topical minoxidil. There were subjects on both maintenance schedules of topical minoxidil who lost some of the nonvellus hair they had initially gained with topical minoxidil; however, there was a greater mean loss in those patients following the once-daily versus twice-daily topical minoxidil regimen (p = 0.05). No subject lost nonvellus target hair as compared with baseline.(ABSTRACT TRUNCATED AT 250 WORDS)

Authors
Olsen, EA; DeLong, ER; Weiner, MS
MLA Citation
Olsen, EA, DeLong, ER, and Weiner, MS. "Long-term follow-up of men with male pattern baldness treated with topical minoxidil." J Am Acad Dermatol 16.3 Pt 2 (March 1987): 688-695.
PMID
3549803
Source
pubmed
Published In
Journal of The American Academy of Dermatology
Volume
16
Issue
3 Pt 2
Publish Date
1987
Start Page
688
End Page
695

LONG-TERM FOLLOW-UP OF MEN WITH MALE PATTERN BALDNESS TREATED WITH TOPICAL MINOXIDIL

Authors
OLSEN, EA; DELONG, ER; WEINER, MS
MLA Citation
OLSEN, EA, DELONG, ER, and WEINER, MS. "LONG-TERM FOLLOW-UP OF MEN WITH MALE PATTERN BALDNESS TREATED WITH TOPICAL MINOXIDIL." JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY 16.3 (March 1987): 688-695.
Source
wos-lite
Published In
Journal of The American Academy of Dermatology
Volume
16
Issue
3
Publish Date
1987
Start Page
688
End Page
695
DOI
10.1016/S0190-9622(87)70089-9

Reply

Authors
Olsen, EA; DeLong, E; Weiner, MS
MLA Citation
Olsen, EA, DeLong, E, and Weiner, MS. "Reply." Journal of the American Academy of Dermatology 16.2 (February 1987): 393-394.
Source
crossref
Published In
Journal of The American Academy of Dermatology
Volume
16
Issue
2
Publish Date
1987
Start Page
393
End Page
394
DOI
10.1016/S0190-9622(87)80142-1

A quantitative analysis of palliative care decisions in acute nonlymphocytic leukemia.

With the increasing incidence of cancer in elderly patients, decisions to adopt palliative care become particularly relevant to this patient population. In order to define characteristics of decisions to adopt palliative care, including those factors influencing whether a particular patient received palliation, the frequency of this therapeutic posture, and the duration of this treatment period, we performed a retrospective analytical survey of all patients with acute nonlymphocytic leukemia (ANLL) treated at Duke University Medical Center over the past ten years. Logistic regression analysis identified several potentially significant variables influencing the decision to adopt palliative care. Using a stepwise logistic model, the only independent variable associated with adoption of palliative therapy was initial treatment off a research protocol (P = 0.0001). Initial treatment off a research protocol was itself associated with older age (P = 0.0002), nonspontaneous onset of leukemia (P = 0.005), female sex (P = 0.003), and the absence of dependent children (P = 0.01) when examined by multivariate logistic regression. The palliative treatment interval was defined as the time between the discontinuation of aggressive treatment and the patient's death. Fifty-one percent, 119 of 235 patients, received palliative care; of these, 47% were palliated from the time of diagnosis and 53% were palliated only after receiving remission induction therapy. The median duration for the palliative care period was 46 days (50 days for the initially palliated group, 24 days for the group receiving aggressive therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Authors
Neuss, MN; Feussner, JR; DeLong, ER; Cohen, HJ
MLA Citation
Neuss, MN, Feussner, JR, DeLong, ER, and Cohen, HJ. "A quantitative analysis of palliative care decisions in acute nonlymphocytic leukemia." J Am Geriatr Soc 35.2 (February 1987): 125-131.
PMID
2433324
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
35
Issue
2
Publish Date
1987
Start Page
125
End Page
131

Variables associated with postoperative deep venous thrombosis: a prospective study of 411 gynecology patients and creation of a prognostic model.

Deep venous thrombosis is a major complication following gynecologic surgery. Assessing a patient's risk of developing deep venous thrombosis is important for patient selection and in choosing appropriate prophylactic methods. Four hundred eleven patients undergoing major gynecologic surgery were evaluated prospectively. All known variables associated with deep venous thrombosis were recorded. Deep venous thrombosis was diagnosed by 125I fibrinogen leg counting of all patients. Univariate analysis of all variables identified the following to be significantly related (P less than .05) to postoperative deep venous thrombosis: a prior history of deep venous thrombosis, leg edema or venous stasis changes, venous varicosities, degree of preoperative ambulation, type of surgery, nonwhite race, recurrent malignancy, prior pelvic radiation therapy, age above 45 years, excessive body weight, intraoperative blood loss, and duration of anesthesia. A stepwise logistic regression analysis of these variables was performed. The following preoperative prognostic factors remained significant: type of surgery, age, leg edema, nonwhite patients, severity of venous varicosities, prior radiation therapy, and prior history of deep venous thrombosis. Duration of anesthesia was also important when intraoperative factors were considered in the analysis. Using these factors, a prognostic model was created and tested. The model resulted in a degree of concordance of 0.82 and allows one to evaluate the risks of postoperative deep venous thrombosis for an individual patient.

Authors
Clarke-Pearson, DL; DeLong, ER; Synan, IS; Coleman, RE; Creasman, WT
MLA Citation
Clarke-Pearson, DL, DeLong, ER, Synan, IS, Coleman, RE, and Creasman, WT. "Variables associated with postoperative deep venous thrombosis: a prospective study of 411 gynecology patients and creation of a prognostic model." Obstet Gynecol 69.2 (February 1987): 146-150.
PMID
3808500
Source
pubmed
Published In
Obstetrics & Gynecology (Elsevier)
Volume
69
Issue
2
Publish Date
1987
Start Page
146
End Page
150

Surgical management of intestinal obstruction in ovarian cancer. I. Clinical features, postoperative complications, and survival.

The results of surgery to relieve intestinal obstruction in 49 patients who were known to have ovarian cancer were studied. All patients had received adjunctive chemotherapy and/or radiation therapy prior to bowel obstruction. Thirty patients had small bowel obstruction, 16 patients had colonic obstruction, and 3 patients had concurrent small and large bowel obstruction. Clinical status, nutritional parameters, and radiographic findings were analyzed. Progressive ovarian cancer was ultimately found to be the cause of obstruction in 86% of patients. Major postoperative complications occurred in 49% of patients and were encountered significantly more frequently in those patients with small bowel obstruction (P less than 0.04). Complications most frequently encountered included wound infection, enterocutaneous fistulae, and other septic sequelae. Median postoperative survival was 140 days, with 73% surviving at 60 days postoperatively. A total of 14.3% of patients were alive 12 months postoperatively. These results are similar to prior reports and emphasize the need for clearer preoperative selection criteria.

Authors
Clarke-Pearson, DL; Chin, NO; DeLong, ER; Rice, R; Creasman, WT
MLA Citation
Clarke-Pearson, DL, Chin, NO, DeLong, ER, Rice, R, and Creasman, WT. "Surgical management of intestinal obstruction in ovarian cancer. I. Clinical features, postoperative complications, and survival." Gynecol Oncol 26.1 (January 1987): 11-18.
PMID
2431962
Source
pubmed
Published In
Gynecologic Oncology
Volume
26
Issue
1
Publish Date
1987
Start Page
11
End Page
18

COMPARATIVE ACCURACY OF CHEST-X-RAY INTERPRETATION AT VARIOUS LEVELS OF PHYSICIAN TRAINING

Authors
TAPSON, VF; COREY, GR; FEUSSNER, JR; DELONG, ER; MACGREGOR, JH; RAVIN, CE
MLA Citation
TAPSON, VF, COREY, GR, FEUSSNER, JR, DELONG, ER, MACGREGOR, JH, and RAVIN, CE. "COMPARATIVE ACCURACY OF CHEST-X-RAY INTERPRETATION AT VARIOUS LEVELS OF PHYSICIAN TRAINING." CLINICAL RESEARCH 35.1 (January 1987): A92-A92.
Source
wos-lite
Published In
Clinical Research
Volume
35
Issue
1
Publish Date
1987
Start Page
A92
End Page
A92

PERIPHERAL-BLOOD FILM INTERPRETATION OF ANISOCYTOSIS VERSUS QUANTITATIVE ASSESSMENT BY RDW

Authors
SIMEL, DL; DELONG, ER; FEUSSNER, JR; CRAWFORD, J; WEINBERG, JB
MLA Citation
SIMEL, DL, DELONG, ER, FEUSSNER, JR, CRAWFORD, J, and WEINBERG, JB. "PERIPHERAL-BLOOD FILM INTERPRETATION OF ANISOCYTOSIS VERSUS QUANTITATIVE ASSESSMENT BY RDW." CLINICAL RESEARCH 35.1 (January 1987): A92-A92.
Source
wos-lite
Published In
Clinical Research
Volume
35
Issue
1
Publish Date
1987
Start Page
A92
End Page
A92

ERRORS IN BLOOD-PRESSURE MEASUREMENT - IS IT TIME TO REVISE THE STANDARD TECHNIQUE

Authors
HLA, KM; FEUSSNER, JR; DELONG, ER
MLA Citation
HLA, KM, FEUSSNER, JR, and DELONG, ER. "ERRORS IN BLOOD-PRESSURE MEASUREMENT - IS IT TIME TO REVISE THE STANDARD TECHNIQUE." CLINICAL RESEARCH 35.1 (January 1987): A89-A89.
Source
wos-lite
Published In
Clinical Research
Volume
35
Issue
1
Publish Date
1987
Start Page
A89
End Page
A89

IMPACT OF LIVER BIOPSIES IN THE MANAGEMENT OF PATIENTS WITH SUSPECTED LIVER-DISEASES

Authors
HLA, KM; JOHNSON, AO; DELONG, ER; GILLIAM, GL
MLA Citation
HLA, KM, JOHNSON, AO, DELONG, ER, and GILLIAM, GL. "IMPACT OF LIVER BIOPSIES IN THE MANAGEMENT OF PATIENTS WITH SUSPECTED LIVER-DISEASES." CLINICAL RESEARCH 35.1 (January 1987): A90-A90.
Source
wos-lite
Published In
Clinical Research
Volume
35
Issue
1
Publish Date
1987
Start Page
A90
End Page
A90

Effect of ultraviolet light on topical minoxidil-induced hair growth in advanced male pattern baldness

Nine healthy men with type IVa or Va male pattern baldness completed a 4-month single-blinded controlled pilot study designed to assess the effect of ultraviolet light (UVL) on topical minoxidil-induced hair growth. Subjects applied 2% topical minoxidil solution twice daily to their balding scalps and to one target area on the upper arm. These men, all of whom had either skin type II or III, were randomized to also receive either incremental doses of UVB or PUVA (topical psoralen) twice weekly to one side of their scalp and to a 2.5 cm target area on the nonminoxidil-treated upper ipsilateral arm. Vellus, nonvellus, and total hair counts were done in two 1-inch in diameter circular target areas in symmetric regions of the scalp and on each upper arm at regular intervals. All nine subjects had an increase in target nonvellus hair and a net loss of vellus hair in scalp target areas treated with topical minoxidil. Concomitant UVL did not have a significant synergistic nor adverse effect on topical minoxidil-induced hair growth.

Authors
Pestana, A; Olsen, EA; Delong, ER; Murray, JC
MLA Citation
Pestana, A, Olsen, EA, Delong, ER, and Murray, JC. "Effect of ultraviolet light on topical minoxidil-induced hair growth in advanced male pattern baldness." Journal of the American Academy of Dermatology 16.5 I (1987): 971-976.
Source
scival
Published In
Journal of the American Academy of Dermatology
Volume
16
Issue
5 I
Publish Date
1987
Start Page
971
End Page
976

Long-term follow-up of men with male pattern baldness treated with topical minoxidil

Forty-one men with male pattern baldness completed 132 study weeks (2 years 9 months) with topical minoxidil and had follow-up 1-inch target-area vertex scalp hair counts. Initially these men were treated with either twice-daily 2% topical minoxidil for 12 months or 3% topical minoxidil for 8 to 12 months (one third of the subjects received placebo for the first 4 months). After 12 months all subjects continued to apply 3% topical minoxidil twice daily for 1 more year, after which they were randomized to once- versus twice-daily topical minoxidil for an additional 9 months. Those subjects who changed to once-daily application of topical minoxidil at 2 years had a mean change from baseline nonvellus hair count at 1 year of 291.2 (range of hairs four to 553) and at 2 years 9 months of 235 (two to 592 hairs). Those subjects who continued with twice-daily application of topical minoxidil throughout the study had a mean change from baseline nonvellus hair count at 1 year of 323 (15 to 589 hairs) and 335 (13 to 808 hairs) at 2 years 9 months with maintenance topical minoxidil. There were subjects on both maintenance schedules of topical minoxidil who lost some of the nonvellus hair they had initially gained with topical minoxidil; however, there was a greater mean loss in those patients following the once-daily versus twice-daily topical minoxidil regimen (p = 0.05). No subject los nonvellus target hair as compared with baseline. Subject and investigator assessments of hair growth as compared with baseline diminished during the maintenance course of treatment with topical minoxidil; this was not related to the frequency of topical minoxidil application. However, by the completion of the 2-year 9-month period, the investigator felt that 82.9% of subjects still had minimal regrowth and 4.9% had moderate regrowth over baseline; subjects consistently graded their hair growth as greater than did the investigator. Side effects were minimal and well tolerated. These results indicate that continued use of topical minoxidil sustains the majority of vertex nonvellus hair growth initiated during the first 12-month period of topical minoxidil use and that twice-daily application of topical minoxidil is preferable to once-daily application for maintenance therapy.

Authors
Olsen, EA; DeLong, ER; Weiner, MS
MLA Citation
Olsen, EA, DeLong, ER, and Weiner, MS. "Long-term follow-up of men with male pattern baldness treated with topical minoxidil." Journal of the American Academy of Dermatology 16.3 II SUPPL. (1987): 688-695.
Source
scival
Published In
Journal of the American Academy of Dermatology
Volume
16
Issue
3 II SUPPL.
Publish Date
1987
Start Page
688
End Page
695

A Comparison of Methods for the Estimation of Plasma Low- and Very Low-Density Lipoprotein Cholesterol: The Lipid Research Clinics Prevalence Study

Using data from over 10 000 men, women, and children who participated in the Lipid Research Clinics prevalence studies, we have examined the formula adopted by Friedewald et al 1 for estimating plasma or serum concentrations of low-density lipoprotein cholesterol (LDL-C) when (for economy, or in the absence of an ultracentrifuge) only fasting total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) concentrations are measured in milligrams per liter, ie, LDL-C=TC—(HDL-C+0.20XTG). Values for LDL-C obtained by use of the Friedewald formula were compared with values derived from the Lipid Research Clinics ultracentrifugal procedure for LDL-C, which was used as a reference. Participants who were pregnant, who had not fasted, or whose plasma contained chylomicrons or floating 0-lipoproteins were excluded. We concluded that a better estimator for LDL-C was provided by the equation LDL-C-TC—(HDL-C+0.16XTG), since it produced an error (relative to the reference method) of lesser magnitude than the previous formula. The expression 0.16XTG (0.37XTG when measurements are reported in millimoles per liter) also produced a more accurate estimate of very low-density lipoprotein cholesterol relative to values obtained by the standard Lipid Research Clinics procedure for this component. The proposed formula is more precise for plasmas or sera with a TG concentration within the normal range. © 1986, American Medical Association. All rights reserved.

Authors
Delong, DM; Delong, ER; Wood, PD; Lippel, K; Rifkind, BM
MLA Citation
Delong, DM, Delong, ER, Wood, PD, Lippel, K, and Rifkind, BM. "A Comparison of Methods for the Estimation of Plasma Low- and Very Low-Density Lipoprotein Cholesterol: The Lipid Research Clinics Prevalence Study." JAMA: The Journal of the American Medical Association 256.17 (November 7, 1986): 2372-2377.
Source
scopus
Published In
JAMA : the journal of the American Medical Association
Volume
256
Issue
17
Publish Date
1986
Start Page
2372
End Page
2377
DOI
10.1001/jama.1986.03380170088024

A comparison of methods for the estimation of plasma low- and very low-density lipoprotein cholesterol. The Lipid Research Clinics Prevalence Study.

Using data from over 10 000 men, women, and children who participated in the Lipid Research Clinics prevalence studies, we have examined the formula adopted by Friedewald et al for estimating plasma or serum concentrations of low-density lipoprotein cholesterol (LDL-C) when (for economy, or in the absence of an ultracentrifuge) only fasting total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) concentrations are measured in milligrams per liter, ie, LDL-C = TC-(HDL-C + 0.20 X TG). Values for LDL-C obtained by use of the Friedewald formula were compared with values derived from the Lipid Research Clinics ultracentrifugal procedure for LDL-C, which was used as a reference. Participants who were pregnant, who had not fasted, or whose plasma contained chylomicrons or floating beta-lipoproteins were excluded. We concluded that a better estimator for LDL-C was provided by the equation LDL-C = TC-(HDL-C + 0.16 X TG), since it produced an error (relative to the reference method) of lesser magnitude than the previous formula. The expression 0.16 X TG (0.37 X TG when measurements are reported in millimoles per liter) also produced a more accurate estimate of very low-density lipoprotein cholesterol relative to values obtained by the standard Lipid Research Clinics procedure for this component. The proposed formula is more precise for plasmas or sera with a TG concentration within the normal range.

Authors
DeLong, DM; DeLong, ER; Wood, PD; Lippel, K; Rifkind, BM
MLA Citation
DeLong, DM, DeLong, ER, Wood, PD, Lippel, K, and Rifkind, BM. "A comparison of methods for the estimation of plasma low- and very low-density lipoprotein cholesterol. The Lipid Research Clinics Prevalence Study." JAMA 256.17 (November 7, 1986): 2372-2377.
PMID
3464768
Source
pubmed
Published In
JAMA : the journal of the American Medical Association
Volume
256
Issue
17
Publish Date
1986
Start Page
2372
End Page
2377

Observer variability in the pulmonary examination.

Observer variability in the pulmonary examination was assessed by having four blindfolded observers (two medical students and two pulmonary physicians) twice examine 31 patients with abnormal pulmonary findings. Examiners were consistent in the repetitive detection of pulmonary abnormalities in 74-89% of the examinations; conversely, 11-26% of the time they disagreed with themselves. Although pulmonary specialists recorded fewer (55% of observations) abnormal findings than did medical students (74%), they were significantly (p = 0.008) less self-consistent than were the students. There was no clear trend in agreement between examiners (kappa = 0.20-0.49). Each examiner's findings were compared with those of physicians specially trained in pulmonary examination. Dichotomous variables (wheezes, crackles, rubs) were more reliably detected (kappa = 0.30-0.70) than graded variables (tympany, dullness, breath sound intensity), where kappa = 0.16-0.43. The authors suggest that dichotomous variables deserve greatest clinical reliance; that time in training, alone, does not improve clinical performance; and that there is a disconcertingly large amount of inter- and intraobserver disagreement in this fundamental clinical task.

Authors
Mulrow, CD; Dolmatch, BL; Delong, ER; Feussner, JR; Benyunes, MC; Dietz, JL; Lucas, SK; Pisano, ED; Svetkey, LP; Volpp, BD
MLA Citation
Mulrow, CD, Dolmatch, BL, Delong, ER, Feussner, JR, Benyunes, MC, Dietz, JL, Lucas, SK, Pisano, ED, Svetkey, LP, and Volpp, BD. "Observer variability in the pulmonary examination." J Gen Intern Med 1.6 (November 1986): 364-367.
PMID
3794835
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
1
Issue
6
Publish Date
1986
Start Page
364
End Page
367

Dose-response study of topical minoxidil in male pattern baldness.

Eighty-nine healthy men with male pattern baldness completed a 6-month double-blind, placebo-controlled study of 0.01%, 0.1%, 1%, and 2% topical minoxidil. Subjects on 2% topical minoxidil had a statistically significant increase in mean total target area hair count over baseline compared to the placebo, 0.01%, and 0.1% topical minoxidil groups (p = 0.04). Changes from baseline were more impressive with the 2% topical minoxidil group but not significantly different from the 1% topical minoxidil group in all parameters of objective response to treatment. The investigator, however, rated more subjects as having at least a moderate cosmetic response to treatment in the 2% versus 1% topical minoxidil treatment group. These results indicate that 1% topical minoxidil is the lowest effective concentration of topical minoxidil for male pattern baldness of those tested. Because of the more impressive changes in hair counts and the cosmetic preference for the 2% versus 1% topical minoxidil, 2% topical minoxidil may be the standard preferred treatment for male pattern baldness.

Authors
Olsen, EA; DeLong, ER; Weiner, MS
MLA Citation
Olsen, EA, DeLong, ER, and Weiner, MS. "Dose-response study of topical minoxidil in male pattern baldness." J Am Acad Dermatol 15.1 (July 1986): 30-37.
PMID
3722507
Source
pubmed
Published In
Journal of The American Academy of Dermatology
Volume
15
Issue
1
Publish Date
1986
Start Page
30
End Page
37

EVALUATION TECHNIQUES FOR MALE PATTERN BALDNESS - REPLY

Authors
OLSEN, EA; PINNELL, SR; WEINER, MS; DELONG, E
MLA Citation
OLSEN, EA, PINNELL, SR, WEINER, MS, and DELONG, E. "EVALUATION TECHNIQUES FOR MALE PATTERN BALDNESS - REPLY." JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY 14.5 (May 1986): 850-851.
Source
wos-lite
Published In
Journal of The American Academy of Dermatology
Volume
14
Issue
5
Publish Date
1986
Start Page
850
End Page
851
DOI
10.1016/S0190-9622(86)80550-3

ACCURACY AND RELIABILITY OF AUSCULTATION OF THE S3 GALLOP

Authors
FEUSSNER, JR; MATCHAR, DB; MULROW, CD; DELONG, ER; WAUGH, RA
MLA Citation
FEUSSNER, JR, MATCHAR, DB, MULROW, CD, DELONG, ER, and WAUGH, RA. "ACCURACY AND RELIABILITY OF AUSCULTATION OF THE S3 GALLOP." CLINICAL RESEARCH 34.2 (April 1986): A816-A816.
Source
wos-lite
Published In
Clinical Research
Volume
34
Issue
2
Publish Date
1986
Start Page
A816
End Page
A816

The resident leaves the clinic: the effects of changing physicians on appointment-keeping behavior.

To understand the effect that termination of an established physician-patient relationship has on patient attendance patterns in a medical clinic, appointment scheduling and patient attendance were measured for 210 patients before and after 11 senior resident physicians left the clinic. There was no significant change in appointment scheduling, although the number of unscheduled or "drop-in" visits increased (p = 0.02). Likewise, patient attendance patterns did not differ between study periods. Overall the termination of an established relationship between an internist and a patient in this hospital-based general medicine clinic had no effect on appointment scheduling and patient attendance.

Authors
Brown, JT; Fulkerson, CC; Delong, ER
MLA Citation
Brown, JT, Fulkerson, CC, and Delong, ER. "The resident leaves the clinic: the effects of changing physicians on appointment-keeping behavior." J Gen Intern Med 1.2 (March 1986): 98-100.
PMID
3772580
Source
pubmed
Published In
Journal of General Internal Medicine
Volume
1
Issue
2
Publish Date
1986
Start Page
98
End Page
100

ASSESSING THE CARDIOVASCULAR DIAGNOSTIC SKILLS OF MEDICAL RESIDENTS USING A CARDIOLOGY PATIENT SIMULATOR

Authors
STCLAIR, EW; FEUSSNER, JR; WAUGH, RA; WADE, LL; DELONG, ER; COREY, GR
MLA Citation
STCLAIR, EW, FEUSSNER, JR, WAUGH, RA, WADE, LL, DELONG, ER, and COREY, GR. "ASSESSING THE CARDIOVASCULAR DIAGNOSTIC SKILLS OF MEDICAL RESIDENTS USING A CARDIOLOGY PATIENT SIMULATOR." CLINICAL RESEARCH 34.1 (January 1986): A272-A272.
Source
wos-lite
Published In
Clinical Research
Volume
34
Issue
1
Publish Date
1986
Start Page
A272
End Page
A272

INTERMEDIATE, INDETERMINATE, AND UNINTERPRETABLE DIAGNOSTIC-TEST RESULTS - A BETTER BAYES

Authors
SIMEL, DL; DELONG, ER; FEUSSNER, JR
MLA Citation
SIMEL, DL, DELONG, ER, and FEUSSNER, JR. "INTERMEDIATE, INDETERMINATE, AND UNINTERPRETABLE DIAGNOSTIC-TEST RESULTS - A BETTER BAYES." CLINICAL RESEARCH 34.1 (January 1986): A272-A272.
Source
wos-lite
Published In
Clinical Research
Volume
34
Issue
1
Publish Date
1986
Start Page
A272
End Page
A272

ACCURACY AND RELIABILITY OF AUSCULTATION OF THE S3 GALLOP

Authors
FEUSSNER, JR; MATCHAR, DB; MULROW, CD; DELONG, ER; WAUGH, RA
MLA Citation
FEUSSNER, JR, MATCHAR, DB, MULROW, CD, DELONG, ER, and WAUGH, RA. "ACCURACY AND RELIABILITY OF AUSCULTATION OF THE S3 GALLOP." CLINICAL RESEARCH 34.1 (January 1986): A270-A270.
Source
wos-lite
Published In
Clinical Research
Volume
34
Issue
1
Publish Date
1986
Start Page
A270
End Page
A270

Effects of bombesin on fasting bile formation

Adult dogs were previously prepared by cholecystectomy, ligation of the lesser pancreatic duct, and insertion of cannulae into the duodenum and stomach. After a 2-week period of postoperative recovery and an overnight fast, bile ducts were cannulated, gastric cannulae placed to open drainage and sodium taurocholate 500 mg hr-1 was administered to replace bile acids lost from the interrupted enterohepatic circuit. Bombesin was infused IV for 1 hour over the dose range, 0.625-10 ng kg-1 min-1. In control experiments 0.15 N NaCl was infused. Bombesin caused a significant increase in fasting bile flow, 3.0 ± 0.2 ml/15 min to 4.2 ± 0.3 ml/15 min (40%). Bile acid and phospholipid outputs were unchanged during bombesin. Bile cholesterol output decreased significantly during bombesin, 1029 ± 142 μg/15 min to 856 ± 109 μg/15 min (17%). The increase in bile flow was linearly related to the logarithm of the bombesin dose. In dogs with pyloric occlusion, to prevent acid from reaching the duodenum, bombesin increased bile flow and bicarbonate output but had no effect on 14C erythritol biliary clearance. Bombesin stimulated ductular bile acid independent bile formation in a dose-dependent manner. Bombesin also inhibited bile cholesterol output.

Authors
Kortz, WJ; Nashold, JRB; Delong, E; Meyers, WC
MLA Citation
Kortz, WJ, Nashold, JRB, Delong, E, and Meyers, WC. "Effects of bombesin on fasting bile formation." Annals of Surgery 203.1 (1986): 1-7.
PMID
3510590
Source
scival
Published In
Annals of Surgery
Volume
203
Issue
1
Publish Date
1986
Start Page
1
End Page
7

Resident turnover

Authors
Matz, R; Lichstein, PR; Retchin, SM; Sigmann, P; Fulkerson, C; Brown, JT; DeLong, ER
MLA Citation
Matz, R, Lichstein, PR, Retchin, SM, Sigmann, P, Fulkerson, C, Brown, JT, and DeLong, ER. "Resident turnover." Journal of General Internal Medicine 1.5 (1986): 345-346.
PMID
3772625
Source
scival
Published In
Journal of General Internal Medicine
Volume
1
Issue
5
Publish Date
1986
Start Page
345
End Page
346
DOI
10.1007/BF02596220

RESIDENT TURNOVER - REPLY

Authors
FULKERSON, C; BROWN, JT; DELONG, ER
MLA Citation
FULKERSON, C, BROWN, JT, and DELONG, ER. "RESIDENT TURNOVER - REPLY." JOURNAL OF GENERAL INTERNAL MEDICINE 1.5 (1986): 346-346.
Source
wos-lite
Published In
Journal of General Internal Medicine
Volume
1
Issue
5
Publish Date
1986
Start Page
346
End Page
346

Sensitivity and specificity of a monitoring test.

The usefulness of a diagnostic test is generally assessed by calculating the sensitivity and specificity, or the predictive value positive and predictive value negative of the test. When subjects are monitored periodically for evidence of disease, these calculations must incorporate the varying amounts of information per individual. If in addition, the test results lie on a continuous scale, these quantities vary with the cutoff value (cutpoint) used to define a positive test. They are usually calculated for a spectrum of potential cutpoints in order to produce receiver-operator characteristic curves. In this paper we use a partial likelihood solution to the discrete logistic model in order to obtain estimates of the diagnostic test indices and to provide a significance test when the diagnostic test is administered repeatedly to individuals.

Authors
DeLong, ER; Vernon, WB; Bollinger, RR
MLA Citation
DeLong, ER, Vernon, WB, and Bollinger, RR. "Sensitivity and specificity of a monitoring test." Biometrics 41.4 (December 1985): 947-958.
PMID
3913467
Source
pubmed
Published In
Biometrics
Volume
41
Issue
4
Publish Date
1985
Start Page
947
End Page
958

Multiple myeloma and family history of cancer. A case-control study.

A hospital-based case-control study was done to examine the hypothesis that persons with a family history of multiple myeloma (MM) or other cancers are at increased risk of multiple myeloma. Study members were 439 cases of multiple myeloma and 1317 matched controls seen at the Duke University Medical Center. Only 3 cases and 4 controls reported multiple myeloma in their families. The relative risk (RR) was 2.3, but the 95% confidence interval (CI) was 0.5-10.1, allowing no firm conclusion about the risk associated with familial MM. A family history of cancer of any type resulted in a relative risk of MM of 1.4 (CI: 1.1-1.8). This association was strongest (RR = 2.5, CI: 1.1-5.3) among young study members (age less than or equal to 49). A family history of hematologic malignancy (ICD 200-208) resulted in a RR of 2.4 (95% CI: 1.4-4.0). The data also suggested that a family history of lung cancer, breast cancer, and genitourinary cancer may be associated with increased risk of myeloma in older persons.

Authors
Bourguet, CC; Grufferman, S; Delzell, E; DeLong, ER; Cohen, HJ
MLA Citation
Bourguet, CC, Grufferman, S, Delzell, E, DeLong, ER, and Cohen, HJ. "Multiple myeloma and family history of cancer. A case-control study." Cancer 56.8 (October 15, 1985): 2133-2139.
PMID
4027940
Source
pubmed
Published In
Cancer
Volume
56
Issue
8
Publish Date
1985
Start Page
2133
End Page
2139

Topical minoxidil in early male pattern baldness.

One-hundred twenty-six healthy men with early male pattern baldness completed a 12-month double-blind, controlled trial of 2% and 3% topical minoxidil. Subjects were initially randomly assigned to use placebo or 2% or 3% topical minoxidil. After 4 months of study, the placebo group was crossed over to 3% topical minoxidil. Both objective measurement of hair growth by counting of vellus, terminal, and total hairs in a vertex target balding area and subjective assessment by subject and investigator were done. Treatment of subjects with topical minoxidil for 4 months resulted in a statistically significant increase in terminal hair growth in comparison with placebo therapy. In addition, subjects initially treated with placebo, when crossed over to topical minoxidil, showed a significant increase in the number of terminal hairs. No subject had a net hair loss in the target area during the study. These results indicate that topical minoxidil can increase terminal hair growth in early male pattern baldness.

Authors
Olsen, EA; Weiner, MS; Delong, ER; Pinnell, SR
MLA Citation
Olsen, EA, Weiner, MS, Delong, ER, and Pinnell, SR. "Topical minoxidil in early male pattern baldness." J Am Acad Dermatol 13.2 Pt 1 (August 1985): 185-192.
PMID
3900155
Source
pubmed
Published In
Journal of The American Academy of Dermatology
Volume
13
Issue
2 Pt 1
Publish Date
1985
Start Page
185
End Page
192

Socioeconomic status and risk of multiple myeloma.

A case control study was conducted to test the hypothesis that socioeconomic status is positively associated with multiple myeloma incidence. One hundred and fifty-three myeloma cases and 459 controls were identified at the Duke University Medical Center at Durham, North Carolina. Study members were interviewed regarding indicators of socioeconomic status. The association of myeloma with family income (current and highest), education, occupation, home ownership, dwelling size, and an index of crowding in the home was examined by estimating relative risks. Among these indicators, only home ownership showed any association with multiple myeloma incidence (RR = 1.6, 95% CI: 1.0-2.6). The association of multiple myeloma with socioeconomic status that has been seen in earlier studies may have been due to underascertainment of disease in less advantaged groups. This association is disappearing as access to health care becomes more uniform across socioeconomic groups.

Authors
Johnston, JM; Grufferman, S; Bourguet, CC; Delzell, E; Delong, ER; Cohen, HJ
MLA Citation
Johnston, JM, Grufferman, S, Bourguet, CC, Delzell, E, Delong, ER, and Cohen, HJ. "Socioeconomic status and risk of multiple myeloma." J Epidemiol Community Health 39.2 (June 1985): 175-178.
PMID
4009102
Source
pubmed
Published In
Journal of Epidemiology and Community Health
Volume
39
Issue
2
Publish Date
1985
Start Page
175
End Page
178

Influence of tumour size on human prostate tumour metastasis in athymic nude mice.

Authors
Ware, JL; DeLong, ER
MLA Citation
Ware, JL, and DeLong, ER. "Influence of tumour size on human prostate tumour metastasis in athymic nude mice." Br J Cancer 51.3 (March 1985): 419-423.
PMID
3970818
Source
pubmed
Published In
British Journal of Cancer
Volume
51
Issue
3
Publish Date
1985
Start Page
419
End Page
423

Tumor-associated antigen TAG-72: correlation of expression in primary and metastatic breast carcinoma lesions.

Variability of tumor-associated antigens among and within human tumor cell groups presents a potential problem in the development and optimization of immunodiagnostic and therapeutic procedures for cancer. We determined the degree of expression of a tumor-associated antigen in the primary and metastatic lesions of 23 patients with infiltrating ductal carcinoma; this was accomplished using monoclonal antibody B72.3, an IgG1 generated against membrane-enriched fractions of human metastatic breast carcinomas and reactive with a 220,000-400,000 d glycoprotein complex, termed TAG-72, and the avidin-biotin complex immunoperoxidase method on fixed tissue sections. Sixteen of the 23 breast carcinomas (70%) demonstrated MAb B72.3 reactivity (range 5% to 100% of tumor cells staining). Reactivity of lymph node metastases was present in 14 of 21 patients (67%). MAb reactivity in metastases to distant sites, including bone, adrenals, liver, skin and effusions, was present in 10 of 18 patients (56%). In one patient, neither the primary carcinoma nor the metastasis to the lymph node demonstrated reactivity. There was a statistically significant positive correlation between MAb B72.3 reactivity in both primary and lymph node metastases (Kendall's Correlation Coefficient = 0.60, p = 0.0006) and between lymph node and distant metastases (Kendall's Correlation Coefficient = 0.48, p = 0.02) of the same patient. No correlation existed between antibody reactivity seen in the primary and that found in the distant lesions of that patient. These studies thus demonstrate that monoclonal antibody B72.3 can detect expression of a tumor-associated antigen in both primary and metastatic infiltrating ductal carcinoma lesions, and may prove valuable in the understanding of tumor biology of metastases and as a means for diagnosing occult disease.

Authors
Lottich, SC; Johnston, WW; Szpak, CA; Delong, ER; Thor, A; Schlom, J
MLA Citation
Lottich, SC, Johnston, WW, Szpak, CA, Delong, ER, Thor, A, and Schlom, J. "Tumor-associated antigen TAG-72: correlation of expression in primary and metastatic breast carcinoma lesions." Breast Cancer Res Treat 6.1 (1985): 49-56.
PMID
2996665
Source
pubmed
Published In
Breast Cancer Research and Treatment
Volume
6
Issue
1
Publish Date
1985
Start Page
49
End Page
56

Topical minoxidil in early male pattern baldness

One-hundred twenty-six healthy men with early male pattern baldness completed a 12-month double-blind, controlled trial of 2% and 3% topical minoxidil. Subjects were initially randomly assigned to use placebo or 2% or 3% topical minoxidil. After 4 months of study, the placebo group was crossed over to 3% topical minoxidil. Both objective measurement of hair growth by counting of vellus, terminal, and total hairs in a vertex target balding area and subjective assessment by subject and investigator were done. Treatment of subjects with topical minoxidil for 4 months resulted in a statistically significant increase in terminal hair growth in comparison with placebo therapy. In addition, subjects initially treated with placebo, when crossed over to topical minoxidil, showed a significant increase in the number of terminal hairs. No subject had a net hair loss in the target area during the study. These results indicate that topical minoxidil can increase terminal hair growth in early male pattern baldness.

Authors
Olsen, EA; Weiner, MS; Delong, ER; Pinnell, SR
MLA Citation
Olsen, EA, Weiner, MS, Delong, ER, and Pinnell, SR. "Topical minoxidil in early male pattern baldness." Journal of the American Academy of Dermatology 13.2 I (1985): 185-192.
Source
scival
Published In
Journal of the American Academy of Dermatology
Volume
13
Issue
2 I
Publish Date
1985
Start Page
185
End Page
192

Renal transplant monitoring with serum β-2-microglobulin and creatinine

Authors
Vernon, WB; DeLong, ER; Briner, WH; Bollinger, RR
MLA Citation
Vernon, WB, DeLong, ER, Briner, WH, and Bollinger, RR. "Renal transplant monitoring with serum β-2-microglobulin and creatinine." Transplantation Proceedings 17.1 I (1985): 646-651.
Source
scival
Published In
Transplantation Proceedings
Volume
17
Issue
1 I
Publish Date
1985
Start Page
646
End Page
651

RENAL-TRANSPLANT MONITORING WITH SERUM BETA-2-MICROGLOBULIN AND CREATININE

Authors
VERNON, WB; DELONG, ER; BRINER, WH; BOLLINGER, RR
MLA Citation
VERNON, WB, DELONG, ER, BRINER, WH, and BOLLINGER, RR. "RENAL-TRANSPLANT MONITORING WITH SERUM BETA-2-MICROGLOBULIN AND CREATININE." TRANSPLANTATION PROCEEDINGS 17.1 (1985): 646-651.
Source
wos-lite
Published In
Transplantation Proceedings
Volume
17
Issue
1
Publish Date
1985
Start Page
646
End Page
651

TOPICAL MINOXIDIL IN EARLY MALE PATTERN BALDNESS

Authors
OLSEN, EA; WEINER, MS; DELONG, ER; PINNELL, SR
MLA Citation
OLSEN, EA, WEINER, MS, DELONG, ER, and PINNELL, SR. "TOPICAL MINOXIDIL IN EARLY MALE PATTERN BALDNESS." JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY 13.2 (1985): 185-192.
Source
wos-lite
Published In
Journal of The American Academy of Dermatology
Volume
13
Issue
2
Publish Date
1985
Start Page
185
End Page
192
DOI
10.1016/S0190-9622(85)70157-0

Complications of low-dose heparin prophylaxis in gynecologic oncology surgery.

The clinical and laboratory effects of low-dose heparin prophylaxis was prospectively studied in a controlled trial of 182 patients undergoing major surgery for gynecologic malignancy. Low-dose heparin was given in 5000 U subcutaneously two hours preoperatively and every 12 hours for seven days postoperatively. Low-dose heparin-treated patients had a significantly increased daily retroperitoneal hemovac drainage. Although not statistically significant, low-dose heparin was associated with increased estimated intraoperative blood loss, transfusion requirements, and wound hematomas. Fifteen percent of patients receiving low-dose heparin were found to have an activated partial thromboplastin time greater than 1.5 times the control value. In these patients, all clinical bleeding parameters were significantly increased. Low-dose heparin-treated patients also had significantly prolonged activated partial thromboplastin time and lower final platelet counts as compared with the control patients. When using low-dose heparin for thromboembolism prophylaxis, patients should be closely observed for clinical hemorrhagic complications. Activated partial thromboplastin times and platelet counts should be monitored throughout therapy.

Authors
Clarke-Pearson, DL; DeLong, ER; Synan, IS; Creasman, WT
MLA Citation
Clarke-Pearson, DL, DeLong, ER, Synan, IS, and Creasman, WT. "Complications of low-dose heparin prophylaxis in gynecologic oncology surgery." Obstet Gynecol 64.5 (November 1984): 689-694.
PMID
6493660
Source
pubmed
Published In
Obstetrics & Gynecology (Elsevier)
Volume
64
Issue
5
Publish Date
1984
Start Page
689
End Page
694

An approach to conducting epidemiologic research within cooperative clinical trials groups.

Cooperative clinical trials groups offer exciting opportunities for conducting epidemiologic research for several reasons: they facilitate accrual of sufficient numbers of subjects in a short period of time, even for studies of rare diseases; they provide uniform pathologic review and uniform collection of subjects' entry data; and they provide a more representative sample of cases than a single-institution study. Despite these advantages, few epidemiologic studies of etiologic factors have been done through these groups because methods for selecting appropriate control subjects and for obtaining information from geographically scattered subjects have not been available. An approach that can serve as a model for this type of research has been developed. A collaborative case-control study of childhood rhabdomyosarcoma (RMS) with the Intergroup Rhabdomyosarcoma Study (IRS) was recently begun. The study, which is independently funded, evaluates the role of environmental factors in the etiology of RMS. Parents of subjects were interviewed by telephone and control subjects were selected from the same communities as patients by random digit dialing . Interview data are supplemented by information from birth certificates and, for patients, by IRS data. This new methodology permits a large study of a rare tumor in a relatively short period of time.

Authors
Grufferman, S; Delzell, E; Delong, ER
MLA Citation
Grufferman, S, Delzell, E, and Delong, ER. "An approach to conducting epidemiologic research within cooperative clinical trials groups." J Clin Oncol 2.6 (June 1984): 670-675.
PMID
6726305
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
2
Issue
6
Publish Date
1984
Start Page
670
End Page
675
DOI
10.1200/JCO.1984.2.6.670

Climate, socioeconomic status and Hodgkin's disease mortality in the United States.

This study examines the relative effects of climate and socioeconomic status (SES) on standard mortality ratios (SMR) from both young adult and older adult Hodgkin's disease (HD) in the United States. Climate variables explain a greater percentage of the variation in the SMR for HD than do SES variables. After adjusting for SES, indicators of climate exhibit a strong correlation with the young adult SMR, but not with the older adult SMR. These findings suggest that environmental factors play an important role in the etiology of young adult HD and support the hypothesis that young adult HD is a different disease from the older adult form.

Authors
DeLong, ER; Maile, MC; Grufferman, S
MLA Citation
DeLong, ER, Maile, MC, and Grufferman, S. "Climate, socioeconomic status and Hodgkin's disease mortality in the United States." J Chronic Dis 37.3 (1984): 209-213.
PMID
6699125
Source
pubmed
Published In
Journal of Chronic Diseases
Volume
37
Issue
3
Publish Date
1984
Start Page
209
End Page
213

Articulation development in children with cleft lip/palate

This longitudinal study analyzed the articulation development of 108 children with cleft lip/palate from three through eight years of age. The data suggest that as the severity of clefting increases the severity of the articulation deficit does also. Age and type of cleft were statistically significant factors in the development of normal articulation skills. Children with cleft lip appeared to be a homogeneous speaking group characterized by normal articulation development. However, children with palatal clefts remained at a heterogeneous group with regard to their articulation test performance through eight years of age. Future comparisons of articulatory proficient and articulatory deficient cleft palate children may shed light in morphological and other reasons for the articulation deficiency in some children.

Authors
Riski, JE; DeLong, E
MLA Citation
Riski, JE, and DeLong, E. "Articulation development in children with cleft lip/palate." Cleft Palate Journal 21.2 (1984): 57-64.
PMID
6587948
Source
scival
Published In
Cleft Palate Journal
Volume
21
Issue
2
Publish Date
1984
Start Page
57
End Page
64

ANTIGENIC HETEROGENEITY OF PRIMARY AND METASTATIC BREAST-CANCER LESIONS AS DEMONSTRATED BY MONOCLONAL-ANTIBODY B72.3

Authors
LOTTICH, SC; SZPAK, CA; DELONG, ER; SCHLOM, J; JOHNSTON, WW
MLA Citation
LOTTICH, SC, SZPAK, CA, DELONG, ER, SCHLOM, J, and JOHNSTON, WW. "ANTIGENIC HETEROGENEITY OF PRIMARY AND METASTATIC BREAST-CANCER LESIONS AS DEMONSTRATED BY MONOCLONAL-ANTIBODY B72.3." BREAST CANCER RESEARCH AND TREATMENT 4.4 (1984): 337-337.
Source
wos-lite
Published In
Breast Cancer Research and Treatment
Volume
4
Issue
4
Publish Date
1984
Start Page
337
End Page
337

SPONTANEOUS LYMPHATIC METASTASIS BY HUMAN-PROSTATE CARCINOMA-CELLS IN TUMOR-BEARING ATHYMIC NUDE-MICE

Authors
WARE, JL; WEBB, KS; DELONG, ER
MLA Citation
WARE, JL, WEBB, KS, and DELONG, ER. "SPONTANEOUS LYMPHATIC METASTASIS BY HUMAN-PROSTATE CARCINOMA-CELLS IN TUMOR-BEARING ATHYMIC NUDE-MICE." PROCEEDINGS OF THE AMERICAN ASSOCIATION FOR CANCER RESEARCH 25.MAR (1984): 56-56.
Source
wos-lite
Published In
Proceedings of the Annual Meeting- American Association for Cancer Research
Volume
25
Issue
MAR
Publish Date
1984
Start Page
56
End Page
56

Secular trends in ischemic heart disease mortality: regional variation.

We compared secular trends in ischemic heart disease (IHD) mortality in four southeastern states (North Carolina, Georgia, South Carolina, and Virginia) with those in three selected other states (California, New York, and Utah). Mortality data were obtained from U.S. vital statistics and population information from the U.S. Census Bureau. Age-adjusted IHD mortality increased until 1968 in the southeastern states and then declined and declines were greatest in the nonwhite female population. In contrast, IHD mortality in all groups in California and in the female population in New York and Utah began to decline in the early 1950s, with accelerated declines since 1968. In all states the decline in rates in nonwhite populations have been greatest in the younger age groups. This has not been true in the white populations. Declining IHD mortality correlated moderately well with the decline in death from all cardiovascular disease and from all causes, but not with the declining cerebrovascular disease mortality. Respiratory cancer mortality increased in similar proportions in California and South Carolina, two states with dissimilar IHD trends. These findings suggest that improved control of hypertension and changing patterns of cigarette smoking may not be responsible for the recent decline in IHD mortality.

Authors
Kimm, SY; Ornstein, SM; DeLong, ER; Grufferman, S
MLA Citation
Kimm, SY, Ornstein, SM, DeLong, ER, and Grufferman, S. "Secular trends in ischemic heart disease mortality: regional variation." Circulation 68.1 (July 1983): 3-8.
PMID
6851051
Source
pubmed
Published In
Circulation
Volume
68
Issue
1
Publish Date
1983
Start Page
3
End Page
8

OBSERVER VARIABILITY AND RELIABILITY IN THE PULMONARY EXAM

Authors
MULROW, CD; DOLMATCH, B; DELONG, ER; BENYUNES, M; DIETZ, J; FEUSSNER, JR; LUCAS, S; PISANO, E; SVETKEY, L; VOLPP, B; WARE, R; NEELON, FA
MLA Citation
MULROW, CD, DOLMATCH, B, DELONG, ER, BENYUNES, M, DIETZ, J, FEUSSNER, JR, LUCAS, S, PISANO, E, SVETKEY, L, VOLPP, B, WARE, R, and NEELON, FA. "OBSERVER VARIABILITY AND RELIABILITY IN THE PULMONARY EXAM." CLINICAL RESEARCH 31.5 (1983): A925-A925.
Source
wos-lite
Published In
Clinical Research
Volume
31
Issue
5
Publish Date
1983
Start Page
A925
End Page
A925

AN APPROACH TO CONDUCTING EPIDEMIOLOGIC RESEARCH IN COOPERATIVE CLINICAL-TRIALS GROUPS

Authors
GRUFFERMAN, S; DELZELL, ES; DELONG, ER; MAILE, MC
MLA Citation
GRUFFERMAN, S, DELZELL, ES, DELONG, ER, and MAILE, MC. "AN APPROACH TO CONDUCTING EPIDEMIOLOGIC RESEARCH IN COOPERATIVE CLINICAL-TRIALS GROUPS." PROCEEDINGS OF THE AMERICAN ASSOCIATION FOR CANCER RESEARCH 24.MAR (1983): 190-190.
Source
wos-lite
Published In
Proceedings of the Annual Meeting- American Association for Cancer Research
Volume
24
Issue
MAR
Publish Date
1983
Start Page
190
End Page
190

Environmental factors in the etiology of rhabdomyosarcoma in childhood.

In a case-control study of childhood rhabdomyosarcoma (RMS), families of 33 cases and 99 controls were interviewed. A relative risk (RR) of 3.9 was found associated with fathers' (but not mothers') cigarette smoking (P = 0.003). Cases had had fewer immunizations than controls, particularly smallpox vaccination (RR = 0.2; P = 0.001), and conversely had more preventable infections. An RR of 3.2 (P = 0.03) was found associated with exposure to chemicals and and RR of 3.7 (P = 0.004) was found associated with diets that included organ meats. Mothers of cases were more likely to be over age 30 years at subject's birth, to have used antibiotics preceding or during pregnancy, and to have had an overdue and/or assisted delivery. Other findings suggest that low socioeconomic status is associated with an increased risk of RMS. These aggregate findings imply that environmental factors may play an important role in the etiology of childhood RMS.

Authors
Grufferman, S; Wang, HH; DeLong, ER; Kimm, SY; Delzell, ES; Falletta, JM
MLA Citation
Grufferman, S, Wang, HH, DeLong, ER, Kimm, SY, Delzell, ES, and Falletta, JM. "Environmental factors in the etiology of rhabdomyosarcoma in childhood." J Natl Cancer Inst 68.1 (January 1982): 107-113.
PMID
6948120
Source
pubmed
Published In
Journal of the National Cancer Institute
Volume
68
Issue
1
Publish Date
1982
Start Page
107
End Page
113

FAMILIAL AGGREGATION OF MULTIPLE-MYELOMA AND CENTRAL NERVOUS-SYSTEM DISEASE

Authors
GRUFFERMAN, S; COHEN, HJ; MORRISON, MC; DELZELL, ES; SCHOLD, SC; DELONG, ER
MLA Citation
GRUFFERMAN, S, COHEN, HJ, MORRISON, MC, DELZELL, ES, SCHOLD, SC, and DELONG, ER. "FAMILIAL AGGREGATION OF MULTIPLE-MYELOMA AND CENTRAL NERVOUS-SYSTEM DISEASE." CLINICAL RESEARCH 30.2 (1982): A418-A418.
Source
wos-lite
Published In
Clinical Research
Volume
30
Issue
2
Publish Date
1982
Start Page
A418
End Page
A418

Urine and serum lactic dehydrogenase, lactic dehydrogenase isoenzymes, and alkaline phosphatase in the nephrotic syndrome

Urinary and serum lactic dehydrogenase (LDH), its isoenzymes, and alkaline phosphatase (AP) activities were determined for children with known nephrotic syndrome (NS) (N = 31) and for normal controls (N = 35 for urine, N = 56 for serum). Patients with NS were grouped as being in relapse, in remission without prednisone, in remission for greater than 21 days with prednisone therapy, or in remission for less than 21 days with prednisone therapy. The relapse group had significant elevations of urinary LDH and AP when compared with each of the other groups. The highest urinary LDH values were seen in the relapse group, and the lowest in normal controls. The groups in remission had intermediate values of urinary LDH, which decreased as the length of time in remission increased. Although urinary AP activities were elevated in patients in relapse, they were subnormal in patients in remission greater than 21 days with prednisone therapy, suggesting membrane stabilization with resultant reduction in enzyme release into the urinary tract. The urinary and serum LDH isoenzyme patterns in the relapse group did not resemble each other, indicating the increased urinary activity was not due solely to renal clearance of serum enzymes. Serum LDH was elevated in the relapse group (P < 0.01), but it was not statistically different in the remission group when compared with controls. This study demonstrates increased urinary LDH, AP, and serum LDH activities in patients with the relapsed NS. In relapsed patients, the different serum and urine LDH isoenzyme patterns suggest that the urinary activity may be a result of diseased renal tissue and not a reflection of increased glomerular filtration. Monitoring the urinary LDH activity may allow for detecting the continuing disease at a time when other clinical signs have normalized.

Authors
Murdock, CB; Baker, PJ; DeLong, E; Roe, CR; Osofsky, SG
MLA Citation
Murdock, CB, Baker, PJ, DeLong, E, Roe, CR, and Osofsky, SG. "Urine and serum lactic dehydrogenase, lactic dehydrogenase isoenzymes, and alkaline phosphatase in the nephrotic syndrome." Kidney International 19.5 (1981): 710-715.
PMID
7289400
Source
scival
Published In
Kidney international
Volume
19
Issue
5
Publish Date
1981
Start Page
710
End Page
715

ANALYSES OF REGIONAL VARIATIONS IN ISCHEMIC-HEART-DISEASE MORTALITY TRENDS

Authors
ORNSTEIN, SM; KIMM, SYS; DELONG, ER; GRUFFERMAN, S
MLA Citation
ORNSTEIN, SM, KIMM, SYS, DELONG, ER, and GRUFFERMAN, S. "ANALYSES OF REGIONAL VARIATIONS IN ISCHEMIC-HEART-DISEASE MORTALITY TRENDS." CIRCULATION 64.4 (1981): 250-250.
Source
wos-lite
Published In
Circulation
Volume
64
Issue
4
Publish Date
1981
Start Page
250
End Page
250

ANALYSES OF SECULAR TRENDS IN ISCHEMIC-HEART-DISEASE MORTALITY IN NORTH-CAROLINA

Authors
ORNSTEIN, S; KIMM, SYS; DELONG, ER; GRUFFERMAN, S
MLA Citation
ORNSTEIN, S, KIMM, SYS, DELONG, ER, and GRUFFERMAN, S. "ANALYSES OF SECULAR TRENDS IN ISCHEMIC-HEART-DISEASE MORTALITY IN NORTH-CAROLINA." AMERICAN JOURNAL OF EPIDEMIOLOGY 114.3 (1981): 448-448.
Source
wos-lite
Published In
American Journal of Epidemiology
Volume
114
Issue
3
Publish Date
1981
Start Page
448
End Page
448

ESTIMATION OF P(X-GREATER-THAN-Y) BASED ON PROGRESSIVELY TRUNCATED VERSIONS OF THE WILCOXON-MANN-WHITNEY STATISTICS

Authors
DELONG, ER; SEN, PK
MLA Citation
DELONG, ER, and SEN, PK. "ESTIMATION OF P(X-GREATER-THAN-Y) BASED ON PROGRESSIVELY TRUNCATED VERSIONS OF THE WILCOXON-MANN-WHITNEY STATISTICS." COMMUNICATIONS IN STATISTICS PART A-THEORY AND METHODS 10.10 (1981): 963-981.
Source
wos-lite
Published In
Communication in Statistics Part A - Theory & Methods
Volume
10
Issue
10
Publish Date
1981
Start Page
963
End Page
981
DOI
10.1080/03610928108828088

ENVIRONMENTAL-FACTORS IN THE ETIOLOGY OF CHILDHOOD RHABDOMYOSARCOMA

Authors
GRUFFERMAN, S; WANG, HH; DELONG, ER; KIMM, SYS
MLA Citation
GRUFFERMAN, S, WANG, HH, DELONG, ER, and KIMM, SYS. "ENVIRONMENTAL-FACTORS IN THE ETIOLOGY OF CHILDHOOD RHABDOMYOSARCOMA." AMERICAN JOURNAL OF EPIDEMIOLOGY 112.3 (1980): 423-423.
Source
wos-lite
Published In
American Journal of Epidemiology
Volume
112
Issue
3
Publish Date
1980
Start Page
423
End Page
423
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Research Areas:

  • Case-Control Studies
  • Confounding Factors (Epidemiology)
  • Coronary Artery Bypass
  • Coronary Artery Disease
  • Data Interpretation, Statistical
  • Decision Making
  • Diagnostic Errors
  • Follow-Up Studies
  • Health Policy
  • Health Services Research
  • Heart Diseases
  • Laboratories
  • Linear Models
  • Logistic Models
  • Multivariate Analysis
  • Outcome Assessment (Health Care)
  • Predictive Value of Tests
  • Prospective Studies
  • ROC Curve
  • Registries
  • Regression Analysis
  • Research Design
  • Risk Assessment
  • Rural Population
  • Survival Analysis