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Rocke, Daniel James

Positions:

Assistant Professor of Surgery

Surgery, Head and Neck Surgery and Communication Sciences
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2009

M.D. — University of Michigan at Ann Arbor

Publications:

Variation in tonsillectomy rates by health care system type.

To analyze variation in tonsillectomy procedure rates between health care system types around the world.International database analysis.The 2015 Organization for Economic Co-operation and Development (OECD) Health Statistics surgical procedures database was used to ascertain tonsillectomy procedure volumes for 31 countries. Each country's health system type and structure were classified by overall system type, and by health care regulation, financing, and provision methods. Each system type and structure variable were compared using the rate of tonsillectomy procedures per 100,000 citizens.10.5 million tonsillectomy procedures completed between 1993 and 2014 were analyzed. Overall, social health insurance system types had higher total tonsillectomy rates versus other health care system types (p < 0.05 for each comparison). Health systems with private care provision had a higher procedure rate versus state provided care (159.1 vs. 131.1 per 100,000 citizens; p = 0.002). Health care systems with societal regulation and financing had a higher procedure count versus state regulated or financed care (regulation 193.3 vs. 139.7 per 100,000 citizens, p < 0.0001; financing 168.2 vs. 135.0 per 100,000 citizens, p = 0.0004).The volume of tonsillectomy procedures is associated with a health care system's overall structure, regulation, financing, and provision methods. International health care systems with state mediated provision, regulation, and financing had lower tonsillectomy rates versus systems with private provision, and societal regulation or financing. Further study is needed to determine differences in indications for tonsillectomy between countries, but these results underscore potential variation in health care delivery in different systems.

Authors
Crowson, MG; Ryan, MA; Rocke, DJ; Raynor, EM; Puscas, L
MLA Citation
Crowson, MG, Ryan, MA, Rocke, DJ, Raynor, EM, and Puscas, L. "Variation in tonsillectomy rates by health care system type." International journal of pediatric otorhinolaryngology 94 (March 2017): 40-44.
PMID
28167009
Source
epmc
Published In
International Journal of Pediatric Otorhinolaryngology
Volume
94
Publish Date
2017
Start Page
40
End Page
44
DOI
10.1016/j.ijporl.2017.01.014

Osseointegrated implants for auricular defects: operative techniques and complication management.

OBJECTIVE: Auricular defects are challenging to reconstruct with native tissue. We describe operative techniques and complication management for patients undergoing osseointegrated implants for auriculectomy defects and microtia. SETTING: Tertiary referral center. PATIENTS: All patients at Duke University Medical Center with auricular defects treated with osseointegrated implants for prosthetic (OIP) auricles from January 1, 2010, until September 16, 2013. INTERVENTIONS: Osseointegrated implantation for auricular defects. MAIN OUTCOME MEASURE: Description of operative techniques, complications, and complication management. RESULTS: Sixteen patients met inclusion criteria. Five patients had microtia and atresia. Two of these patients had bilateral microtia and atresia and underwent bilateral simultaneous implantation of both OIP and osseointegrated hearing implants (OHIs). Two other microtia/atresia patients underwent simultaneous unilateral OIP and OHI. Eleven patients had unilateral defects from either trauma or skin cancer resection. Three patients received adjuvant radiation before implantation. Complications included tissue overgrowth requiring revision surgery (two patients), inadequate bone stock requiring split calvarial bone graft and later implantation, loss of implant secondary to osteoradionecrosis requiring hyperbaric oxygen therapy, and skin infection requiring antibiotic therapy. CONCLUSION: Reconstruction of auriculectomy defects and microtia is difficult to accomplish using native tissue. Complications are common, and these complications can have devastating consequences on the final result. Osseointegrated implantation offers an outstanding alternative for reconstructing these defects. We describe our multidisciplinary team approach, examine operative techniques, and focus on the unique challenges of simultaneous and bilateral simultaneous OIP and OHI implantation.

Authors
Rocke, DJ; Tucci, DL; Marcus, J; McClennen, J; Kaylie, D
MLA Citation
Rocke, DJ, Tucci, DL, Marcus, J, McClennen, J, and Kaylie, D. "Osseointegrated implants for auricular defects: operative techniques and complication management." Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 35.9 (October 2014): 1609-1614.
PMID
25153666
Source
epmc
Published In
Otology and Neurotology
Volume
35
Issue
9
Publish Date
2014
Start Page
1609
End Page
1614
DOI
10.1097/mao.0000000000000545

Physician and Patient and Caregiver Health Attitudes and Their Effect on Medicare Resource Allocation for Patients With Advanced Cancer.

Physicians must participate in end-of-life discussions, but they understand poorly their patients' end-of-life values and preferences. A better understanding of these preferences and the effect of baseline attitudes will improve end-of-life discussions.To determine how baseline attitudes toward quality vs quantity of life affect end-of-life resource allocation.Otolaryngology-head and neck surgery (OHNS) physicians were recruited to use a validated online tool to create a Medicare health plan for advanced cancer patients. During the exercise, participants allocated a limited pool of resources among 15 benefit categories. These data were compared with preliminary data from patients with cancer and their caregivers obtained from a separate study using the same tool. Attitudes toward quality vs quantity of life were assessed for both physicians and patients and caregivers.Participation in online assessment exercise.Medicare resource allocation.Of 9120 OHNS physicians e-mailed, 767 participated. Data collected from this group were compared with data collected from 146 patients and 114 caregivers. Compared with patients and caregivers, OHNS physician allocations differed significantly in all 15 benefit categories except home care. When stratified by answers to 3 questions about baseline attitudes toward quality vs quantity of life, there were 3 categories in which allocations of patients and caregivers differed significantly from the group with the opposite attitude for at least 2 questions: other medical care (question 1, P < .001; question 2, P = .005), palliative care (question 1, P = .008; question 2, P = .006; question 3, P = .009), and treatment for cancer (questions 1 and 2, P < .001). In contrast, physician preferences showed significant differences in only 1, nonmatching category for each attitude question: cash (question 1, P = .02), drugs (question 2, P = .03), and home care (question 3, P = .048).Patients with cancer and their caregivers have different preferences from physicians. These preferences are, for these patients and their caregivers, affected by their baseline health attitudes, but physician preferences are not. Understanding the effect of baseline attitudes is important for effective end-of-life discussions.

Authors
Rocke, DJ; Beumer, HW; Taylor, DH; Thomas, S; Puscas, L; Lee, WT
MLA Citation
Rocke, DJ, Beumer, HW, Taylor, DH, Thomas, S, Puscas, L, and Lee, WT. "Physician and Patient and Caregiver Health Attitudes and Their Effect on Medicare Resource Allocation for Patients With Advanced Cancer." JAMA otolaryngology-- head & neck surgery 140.6 (June 2014): 497-503.
PMID
24763550
Source
epmc
Published In
JAMA Otolaryngology - Head and Neck Surgery
Volume
140
Issue
6
Publish Date
2014
Start Page
497
End Page
503
DOI
10.1001/jamaoto.2014.494

Effect of physician perspective on allocation of Medicare resources for patients with advanced cancer.

OBJECTIVES: To assess how physician perspective (perspective of patient vs perspective of physician) affects Medicare resource allocation for patients with advanced cancer and compare physician allocations with actual cancer patient and caregiver allocations. STUDY DESIGN: Cross-sectional assessment. SETTING: National assessment. SUBJECTS: Otolaryngologists. METHODS: Physicians used a validated tool to create a Medicare plan for patients with advanced cancer. Participants took the perspective of an advanced cancer patient and made resource allocations between 15 benefit categories (assessment 2, November/December 2012). Results were compared with data from a prior assessment made from a physician's perspective (assessment 1, February/March 2012) and with data from a separate study with patients with cancer and caregivers. RESULTS: In total, 767 physicians completed assessment 1 and 237 completed assessment 2. Results were compared with 146 cancer patient and 114 caregiver assessments. Assessment 1 physician responses differed significantly from patients/caregivers in 14 categories (P < .05), while assessment 2 differed in 11. When comparing physician data, assessment 2 allocations differed significantly from assessment 1 in 7 categories. When these 7 categories were compared with patient/caregiver data, assessment 2 allocations in emotional care, drug coverage, and nursing facility categories were not significantly different. Assessment 1 allocations in cosmetic care, dental, home care, and primary care categories were more similar to patient/caregiver preferences, although all but home care were still significantly different. CONCLUSIONS: Otolaryngology-head and neck surgery physician perspectives on end-of-life care differ significantly from cancer patient/caregiver perspectives, even when physicians take a patient's perspective when allocating resources. This demonstrates the challenges inherent in end-of-life discussions.

Authors
Rocke, DJ; Beumer, HW; Thomas, S; Lee, WT
MLA Citation
Rocke, DJ, Beumer, HW, Thomas, S, and Lee, WT. "Effect of physician perspective on allocation of Medicare resources for patients with advanced cancer." Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 150.5 (May 2014): 792-800.
PMID
24474714
Source
epmc
Published In
Otolaryngology - Head and Neck Surgery
Volume
150
Issue
5
Publish Date
2014
Start Page
792
End Page
800
DOI
10.1177/0194599814520689

Surgical innovation, industry partnership, and the enemy within.

Authors
Lee, WT; Rocke, D; Holsinger, FC
MLA Citation
Lee, WT, Rocke, D, and Holsinger, FC. "Surgical innovation, industry partnership, and the enemy within." Head Neck 36.4 (April 2014): 461-465.
PMID
23996465
Source
pubmed
Published In
Head & Neck: Journal for the Sciences & Specialties of the Head and Neck
Volume
36
Issue
4
Publish Date
2014
Start Page
461
End Page
465
DOI
10.1002/hed.23476

Physician knowledge of and attitudes toward the Patient Protection and Affordable Care Act.

OBJECTIVE: To assess otolaryngology physician knowledge of and attitudes toward the Patient Protection and Affordable Care Act (PPACA) and compare the association of bias toward the PPACA with knowledge of the provisions of the PPACA. STUDY DESIGN: Cross-sectional survey. SETTING: Nationwide assessment. SUBJECTS: Members of the American Academy of Otolaryngology-Head and Neck Surgery. METHODS: Otolaryngology physicians answered 10 true/false questions about major provisions of the PPACA. They also indicated their level of agreement with 9 statements about health care and the PPACA. Basic demographic information was collected. RESULTS: Email solicitation was sent to 9972 otolaryngologists and 647 responses were obtained (6.5% response rate). Overall correct response rate was 74%. Fewer than 60% of physicians correctly answered questions on whether small businesses receive tax credits for providing health insurance, the effect of the PPACA on Medicare benefits, and whether a government-run health insurance plan was created. Academic center practice setting, bias toward the PPACA, and Democratic Party affiliation were associated with significantly more correct responses. CONCLUSION: Overall physician knowledge of the PPACA is assessed as fair, although better than the general public in 2010. There are several areas where knowledge of physicians regarding the PPACA is poor, and this knowledge deficit is more pronounced within certain subgroups. These knowledge issues should be addressed by individual physicians and medical societies.

Authors
Rocke, DJ; Thomas, S; Puscas, L; Lee, WT
MLA Citation
Rocke, DJ, Thomas, S, Puscas, L, and Lee, WT. "Physician knowledge of and attitudes toward the Patient Protection and Affordable Care Act." Otolaryngol Head Neck Surg 150.2 (February 2014): 229-234.
PMID
24334959
Source
pubmed
Published In
Otolaryngology
Volume
150
Issue
2
Publish Date
2014
Start Page
229
End Page
234
DOI
10.1177/0194599813515839

Surgical innovation, industry partnership, and the enemy within

Authors
Lee, WT; Rocke, D; Holsinger, FC
MLA Citation
Lee, WT, Rocke, D, and Holsinger, FC. "Surgical innovation, industry partnership, and the enemy within." Head and Neck 36.4 (2014): 461-465.
Source
scival
Published In
Head & Neck: Journal for the Sciences & Specialties of the Head and Neck
Volume
36
Issue
4
Publish Date
2014
Start Page
461
End Page
465
DOI
10.1002/hed.23476

Medical Errors: Teachable Moments in Doing the Right Thing

Authors
Rocke, D; Lee, WT
MLA Citation
Rocke, D, and Lee, WT. "Medical Errors: Teachable Moments in Doing the Right Thing." Journal of Graduate Medical Education 5.4 (December 2013): 550-552.
Source
crossref
Published In
Journal of graduate medical education
Volume
5
Issue
4
Publish Date
2013
Start Page
550
End Page
552
DOI
10.4300/JGME-D-13-00110.1

Physician allocation of Medicare resources for patients with advanced cancer.

BACKGROUND: Little is known about what patients and physicians value in end-of-life care, or how these groups would craft a health plan for those with advanced cancer. OBJECTIVE: The study objective was to assess how otolaryngology, head and neck surgery (OHNS) physicians would structure a Medicare benefit plan for patients with advanced cancer, and to compare this with cancer patient and cancer patient caregiver preferences. DESIGN: OHNS physicians used an online version of a validated tool for assessing preferences for health plans in the setting of limited resources. These data were compared to cancer patient and caregiver preferences. SETTING AND PARTICIPANTS: OHNS physicians nationwide were assessed with comparison to similar data obtained in a separate study of cancer patients and their caregivers treated at Duke University Medical Center. RESULTS: Otolaryngology physicians (n=767) completed the online assessment and this was compared with data from 146 patients and 114 caregivers. OHNS physician allocations differed significantly in 14 of the 15 benefit categories when compared with patients and caregivers. Physicians elected more coverage in the Advice, Emotional Care, Palliative Care, and Treatment for Cancer benefit categories. Patients and their caregivers elected more coverage in the Cash, Complementary Care, Cosmetic Care, Dental and Vision, Drug Coverage, Home Improvement, House Calls, Nursing Facility, Other Medical Care, and Primary Care benefit categories. CONCLUSIONS: Otolaryngology physicians have significantly different values in end-of-life care than cancer patients and their caregivers. This information is important for efficient allocation of scarce Medicare resources and for effective end-of-life discussions, both of which are key for developing appropriate health policy.

Authors
Rocke, DJ; Lee, WT; Beumer, HW; Taylor, DH; Schulz, K; Thomas, S; Puscas, L
MLA Citation
Rocke, DJ, Lee, WT, Beumer, HW, Taylor, DH, Schulz, K, Thomas, S, and Puscas, L. "Physician allocation of Medicare resources for patients with advanced cancer." J Palliat Med 16.8 (August 2013): 857-866.
PMID
23802131
Source
pubmed
Published In
Journal of Palliative Medicine
Volume
16
Issue
8
Publish Date
2013
Start Page
857
End Page
866
DOI
10.1089/jpm.2012.0636

Effectiveness of a postoperative disposition protocol for sleep apnea surgery.

PURPOSE: 1) Evaluate the effectiveness of a postoperative disposition protocol for upper airway surgery in patients with sleep apnea. 2) Compare the cost-effectiveness of outpatient and overnight observational sleep apnea surgery versus surgical intensive care admission determined by preoperative screening criteria. MATERIALS AND METHODS: A new preoperative protocol for sleep apnea surgery was instituted at the Durham Veterans Affairs Medical Center in 2008 to triage patients undergoing sleep apnea surgery to one of three postoperative dispositions: intensive care, routine ward bed, or discharge home. An Institutional Review Board approved retrospective chart review of patients undergoing sleep apnea surgery between May 2008 and January 2012 was performed. Postoperative complications and cost comparisons were assessed between each of the three postoperative disposition groups. RESULTS: 115 patients underwent sleep apnea surgery between July 2008 and January 2012. 11 patients were excluded leaving 104 patients in the final analysis. Median follow-up was 1.25months. Overall complication rate was 12.5%. Eight complications occurred in the group triaged to intensive care, and 5 occurred in those triaged to lesser levels of postoperative care. All serious complications occurred during the immediate postoperative period. Based on only room charges, $125,275 was saved over the 3.6years of this study. CONCLUSION: A post operative disposition protocol can be effectively used to triage patients to less than intensive postoperative care. In institutions like the Durham VA, where sleep apnea patients were routinely triaged to intensive care, postoperative resources will be more efficiently utilized.

Authors
Rocke, D; Sharp, S; Wiener, D; Puscas, L; Lee, WT
MLA Citation
Rocke, D, Sharp, S, Wiener, D, Puscas, L, and Lee, WT. "Effectiveness of a postoperative disposition protocol for sleep apnea surgery." Am J Otolaryngol 34.4 (July 2013): 273-277.
PMID
23332409
Source
pubmed
Published In
American Journal of Otolaryngology
Volume
34
Issue
4
Publish Date
2013
Start Page
273
End Page
277
DOI
10.1016/j.amjoto.2012.11.017

Effectiveness of a postoperative disposition protocol for sleep apnea surgery

Purpose 1) Evaluate the effectiveness of a postoperative disposition protocol for upper airway surgery in patients with sleep apnea. 2) Compare the cost-effectiveness of outpatient and overnight observational sleep apnea surgery versus surgical intensive care admission determined by preoperative screening criteria. Materials and methods A new preoperative protocol for sleep apnea surgery was instituted at the Durham Veterans Affairs Medical Center in 2008 to triage patients undergoing sleep apnea surgery to one of three postoperative dispositions: intensive care, routine ward bed, or discharge home. An Institutional Review Board approved retrospective chart review of patients undergoing sleep apnea surgery between May 2008 and January 2012 was performed. Postoperative complications and cost comparisons were assessed between each of the three postoperative disposition groups. Results 115 patients underwent sleep apnea surgery between July 2008 and January 2012. 11 patients were excluded leaving 104 patients in the final analysis. Median follow-up was 1.25 months. Overall complication rate was 12.5%. Eight complications occurred in the group triaged to intensive care, and 5 occurred in those triaged to lesser levels of postoperative care. All serious complications occurred during the immediate postoperative period. Based on only room charges, $125,275 was saved over the 3.6 years of this study. Conclusion A post operative disposition protocol can be effectively used to triage patients to less than intensive postoperative care. In institutions like the Durham VA, where sleep apnea patients were routinely triaged to intensive care, postoperative resources will be more efficiently utilized.

Authors
Rocke, D; Sharp, S; Wiener, D; Puscas, L; Lee, WT
MLA Citation
Rocke, D, Sharp, S, Wiener, D, Puscas, L, and Lee, WT. "Effectiveness of a postoperative disposition protocol for sleep apnea surgery." American Journal of Otolaryngology - Head and Neck Medicine and Surgery 34.4 (2013): 273-277.
Source
scival
Published In
American Journal of Otolaryngology
Volume
34
Issue
4
Publish Date
2013
Start Page
273
End Page
277
DOI
10.1016/j.amjoto.2012.11.017

Tongue entrapment in metal drinking bottle.

Authors
Whited, CW; Rocke, DJ; Lee, WT
MLA Citation
Whited, CW, Rocke, DJ, and Lee, WT. "Tongue entrapment in metal drinking bottle." Arch Otolaryngol Head Neck Surg 137.6 (June 2011): 625-627.
PMID
21690517
Source
pubmed
Published In
Archives of Otolaryngology - Head and Neck Surgery
Volume
137
Issue
6
Publish Date
2011
Start Page
625
End Page
627
DOI
10.1001/archoto.2011.94
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