Regional Variations In Quality Research Articles

National cross-sectional cohort study of the relationship between quality of mental healthcare and death by suicide

BackgroundPatient safety-based interventions aimed at lethal means restriction are effective at reducing death by suicide in inpatient mental health settings but are more challenging in the outpatient arena. As an...

Regional Variations in Quality of Survival Among Men with Prostate Cancer Across the United Kingdom

BackgroundProstate cancer incidence, treatment, and survival rates vary throughout the UK, but little is known about regional differences in quality of survival. ObjectiveTo investigate variations in patient-reported outcomes between UK countries and English Cancer Alliances. Design, setting, and participantsA cross-sectional postal survey of prostate cancer survivors diagnosed 18–42mo previously. Outcome measurements and statistical analysisUrinary, bowel, and sexual problems and vitality were patient reported using the Expanded Prostate Cancer Index Composite (EPIC-26) questionnaire. General health was also self-assessed. Regional variations were identified using multivariable log-linear regression. Results and limitationsA total of 35823 men responded, 60.8% of those invited. Self-assessed health was significantly lower than the UK average in Wales and Scotland. Respondents reported more urinary incontinence in Scotland, more urinary irritation/obstruction in Scotland and Northern Ireland (NI), poorer bowel function in Scotland and NI, worse sexual function in Scotland, and reduced vitality/hormonal function in Scotland, Wales, and NI. Self-assessed health was poorer than the English average in South Yorkshire and North-East and Cumbria, with more urinary incontinence in North-East and Cumbria and Peninsula, greater sexual problems in West Midlands, and poorer vitality in North-East and Cumbria and West Midlands. Limitations include difficulty identifying clinically significant differences and limited information on pretreatment conditions. ConclusionsDespite adjustment for treatment, and clinical and sociodemographic factors, quality of survival among prostate cancer survivors varied by area of residence. Adoption of best practice from areas performing well could support enhanced survival quality in poorer performing areas, particularly with regard to bowel problems and vitality, where clinically relevant differences were reported. Patient summaryWe conducted a UK-wide survey of patient's quality of life after treatment for prostate cancer. Outcomes were found to vary depending upon where patients live. Different service providers need to ensure that all prostate cancer patients receive the same follow-up care.

Regional variation in quality of life in patients with a Fontan circulation: A multinational perspective

Impaired quality of life (QOL) is associated with congenital heart disease (CHD) and country of residence; however, few studies have compared QOL in patients with differing complexities of CHD across regional populations. The current study examined regional variation in QOL outcomes in a large multinational sample of patients with a Fontan relative to patients with atrial septal defects (ASDs) and ventricular septal defects (VSDs). From the Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease-International Study (APPROACH-IS), 405 patients (163 Fontan and 242 ASD/VSD) across Asia, Europe, and North America provided consent for access to their medical records and completed a survey evaluating QOL (0 to 100 linear analog scale). Primary CHD diagnosis, disease complexity, surgical history, and documented history of mood and anxiety disorders were recorded. Differences in QOL, medical complications, and mood and anxiety disorders between Fontan and ASD/VSD patients, and across geographic regions, were examined using analysis of covariance. Hierarchical regression analyses were conducted to identify variables associated with the QOL ratings. Patients with a Fontan reported significantly lower QOL, and greater medical complications and mood and anxiety disorders relative to patients with ASD/VSD. Inpatient cardiac admissions, mood disorders, and anxiety disorders were associated with lower QOL among patients with a Fontan, and mood disorders were associated with lower QOL among patients with ASD/VSD. Regional differences for QOL were not observed in patients with a Fontan; however, significant differences were identified in patients with ASD/VSD. Regional variation of QOL is commonplace in adults with CHD; however, it appears affected by greater disease burden. Among patients with a Fontan, regional variation of QOL is lost. Specific attempts to screen for QOL and mood and anxiety disorders among CHD patients may improve the care of patients with the greatest disease burden.

Regional Variation in Quality of Care for Inflammatory Bowel Disease in the United States: Presidential Poster: ACG Category Award

Regional Variation in Quality of Care for Inflammatory Bowel Disease in the United States: Presidential Poster: ACG Category Award

This Month in Adult Urology

No AccessJournal of UrologyThis Month in Adult Urology1 Apr 2014This Month in Adult Urology William D. Steers William D. SteersWilliam D. Steers More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.01.002AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "This Month in Adult Urology." The Journal of Urology, 191(4), pp. 883–884 References 1 : Prospective comparison of molecular signatures in urothelial cancer of the bladder and the upper urinary tract—is there evidence for discordant biology?. J Urol2014; 191: 926. Link, Google Scholar 2 : Long-term adherence to antimuscarinic therapy in everyday practice: a systematic review. J Urol2014; 191: 1003. Link, Google Scholar 3 : Regional variation in quality of prostate cancer care. J Urol2014; 191: 957. Abstract, Google Scholar 4 : A phase 2, randomized, double-blind, efficacy and safety study of oxybutynin vaginal ring for alleviation of overactive bladder symptoms in women. J Urol2014; 191: 1014. Abstract, Google Scholar 5 : Impact of androgen deprivation therapy on mental and emotional well-being in men with prostate cancer: analysis from the CaPSURE™ registry. J Urol2014; 191: 964. Link, Google Scholar 6 : Intrarenal and extrarenal autonomic nervous system redefined. J Urol2014; 191: 1060. Link, Google Scholar © 2014 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 191Issue 4April 2014Page: 883-884 Advertisement Copyright & Permissions© 2014 by American Urological Association Education and Research, Inc.MetricsAuthor Information William D. Steers More articles by this author Expand All Advertisement PDF downloadLoading ...

Regional Variation in Quality of Prostate Cancer Care

Despite the endorsement of several quality measures for prostate cancer by the National Quality Forum and the Physician Consortium for Performance Improvement, how consistently physicians adhere to these measures has not been examined. We evaluated regional variation in adherence to these quality measures to identify targets for future quality improvement. For this retrospective cohort study we used SEER (Surveillance, Epidemiology, and End Results)-Medicare data for 2001 to 2007 to identify 53,614 patients with newly diagnosed prostate cancer. Patients were assigned to 661 regions (Hospital Service Areas). Hierarchical generalized linear models were used to examine reliability adjusted regional adherence to the endorsed quality measures. Adherence at the patient level was highly variable, ranging from 33% for treatment by a high volume provider to 76% for receipt of adjuvant androgen deprivation therapy while undergoing radiotherapy for high risk cancer. In addition, there was considerable regional variation in adherence to several measures, including pretreatment counseling by a urologist and radiation oncologist (range 9% to 89%, p <0.001), avoiding overuse of bone scans in low risk cancer (range 16% to 96%, p <0.001), treatment by a high volume provider (range 1% to 90%, p <0.001) and followup with radiation oncologists (range 14% to 86%, p <0.001). We found low adherence rates for most established prostate cancer quality of care measures. Within most measures regional variation in adherence was pronounced. Measures with low adherence and a large amount of regional variation may be important low hanging targets for quality improvement.

Regional Differences in Quality of Care and Outcomes for the Treatment of Acute Coronary Syndromes

Geographic differences in the delivery of guideline-driven care following acute myocardial infarction have been described. The effect of hospital participation in a national performance improvement program on regional variation in quality of care and in-hospital outcomes for acute coronary syndromes (ACS) is unknown. We evaluated the variation in conformity to the American Heart Association Get With The Guidelines-Coronary Artery Disease Program quality measures across 4 geographic regions (Northeast, Midwest, South, and East) in 161,236 patients admitted for ACS to 436 Get With The Guidelines hospitals. We evaluated 6 measures (aspirin within 24 hours, aspirin at discharge, ACEI or ARB therapy for left ventricular systolic dysfunction, beta-blocker at discharge, lipid-lowering medication for qualified patients, smoking cessation advice); a binary "all-or-none" process performance measure (primary outcome); an "opportunity-based" overall composite score (secondary outcome); in-hospital length of stay, and in-hospital mortality. Multivariable logistic regression was performed to test the associations between performance measures and short-term outcomes and geographic region. Data were collected from January 2, 2000 to January 2, 2008. There was no significant regional variation in either the "all-or-none" (Northeast: 79.3%; Midwest: 83.2%; South: 78.9%; West: 81.6%) or "opportunity-based" (Northeast: 91.9%; Midwest: 93.6%; South: 91.5%; West: 92.6%) composite performance measures. Both performance measures exhibited significant improvement with participation time irrespective of region. In-hospital mortality was similar among regions. Adjusted hospital length of stay was significantly shorter in the Midwest. Quality improvement program participation may help to facilitate high quality, consistent care for patients with ACS.

The CMS Quality Roadmap: Quality Plus Efficiency

In addition to demonstrating wide variations in costs, resource inputs, and quality in California hospitals, John Wennberg and colleagues demonstrate that higher quality of care might be associated with increased delivery system efficiencies and lower costs. The Centers for Medicare and Medicaid Services (CMS) is attempting to address issues raised by Wennberg in implementation of its Quality Roadmap. The CMS is actively working with health care stakeholders to identify health care efficiency measures, to address opportunities for improvement in health care quality and efficiency, and to consider policy approaches for reducing regional variation in quality and efficiency.

Regional variations in racial differences in the treatment of elderly patients hospitalized with acute myocardial infarction

Racial differences in the treatment of patients with myocardial infarction are often presented as nationally consistent patterns of care, despite known regional variations in quality of care. We sought to determine whether racial differences in myocardial infarction treatment vary by U.S. census region. We conducted a retrospective analysis of medical record data from 138,938 elderly fee-for-service Medicare beneficiaries hospitalized with myocardial infarction between 1994 and 1996. Patients were evaluated for the use (admission, discharge) of aspirin and beta-blockers, and cardiac procedures (cardiac catheterization, any coronary revascularization) within 60 days of admission. Nationally, black patients had lower crude rates of aspirin and beta-blocker use, cardiac catheterization, and coronary revascularization than did white patients. Racial differences in treatment, however, varied by region. Black patients in the Northeast had rates of aspirin use that were similar to those of white patients on admission (50.6% vs. 49.8%, P = 0.58) and at discharge (77.5% vs. 74.2%, P = 0.07), whereas racial differences were observed in the South (admission: 43.7% vs. 48.8%, P <0.001; discharge: 69.5% vs. 73.2%, P <0.001), Midwest (admission: 48.4% vs. 52.3%, P = 0.004), and West (admission: 49.2% vs. 56.2%, P <0.001; discharge: 70.7% vs. 76.2%, P = 0.02). Racial differences in beta-blocker use were comparable across regions (admission: P = 0.59, discharge: P = 0.89). There were no differences in cardiac catheterization use among black and white patients in the Northeast (38.9% vs. 40.5%, P = 0.24), as opposed to the Midwest (43.3% vs. 48.9%, P <0.001), South (39.2% vs. 48.5%, P <0.001), and West (38.3% vs. 48.6%, P <0.001). Similarly, racial differences in any coronary revascularization use were smallest in the Northeast (22.1% vs. 26.7%, P <0.001), greater in the Midwest (24.7% vs. 33.5%, P <0.001), and largest in the South (20.7% vs. 32.0%, P <0.001) and West (22.9% vs. 33.7%, P <0.001). Regional variations in racial differences persisted after multivariable adjustment for aspirin on admission (P = 0.09) and any coronary revascularization (P = 0.10). Racial differences in the use of some therapies for myocardial infarction in patients hospitalized between 1994 and 1996 varied by region, suggesting that national evaluations of racial differences in health care use may obscure potentially important regional variations.

Regional variation in the treatment and outcomes of myocardial infarction: investigating New England’s advantage

Background Previous studies have reported that myocardial infarction (MI) treatment in New England differs from that of other regions of the United States. We sought to determine whether regional differences in MI treatment were independent of regional differences in patient, hospital, or physician characteristics, and whether the New England region’s practice pattern was associated with better outcomes than those of patients in other regions. Methods We evaluated 167,180 patients aged ≥65 years who were hospitalized with MI between 1994 to 1996 to assess regional variations in quality of care. Patients were evaluated for the use of reperfusion therapy, aspirin, and β-blockers on admission and 30-day mortality rate. Hierarchical logistic regression models were used to determine whether practice patterns specific to New England were independent of regional variations in patient, physician, hospital, or other geographic characteristics. Results New England had the highest use of β-blockers (72% vs 52% other regions, P < .001), and aspirin (80% vs 76% other regions, P < .001), a lower use of reperfusion therapy (61% vs 67% other regions, P < .001), and the lowest risk-standardized 30-day mortality rate (15% vs 19% other regions, P < .001). These differences persisted after adjusting for patient, physician, and hospital characteristics. Conclusions Patients with MI in New England have higher rates of medical therapy use and lower 30-day mortality rates than patients in other US regions. This pattern is independent of patient or provider characteristics, suggesting other factors likely contribute to better short-term outcomes in New England.

Regional variation in quality of heart failure care: VA versus medicare

Regional variation in quality of heart failure care: VA versus medicare

Direct Effects of Cholecystokinin on Human Gastric Motility

For a precise analysis of the cholecystokinin (CCK 8) effects on human stomach, we dissected strips of longitudinal and circular muscle from the fundus, corpus and antrum, and circular muscle from the inner and outer pyloric sphincter and duodenum. Specimens were taken during gastrectomy and from stomachs of kidney donors. Mechanical activity was simultaneously recorded under auxotonic conditions. After CCK 8 application, the following effects were observed: (1) direct excitatory effects of CCK 8 with great regional variations in quality and intensity; (2) increases in amplitude of phasic contractions in the outer plyorus and longitudinal antrum (in the other types of preparations the effects were negligible; (3) increases in tonic activity in preparations of the proximal stomach and in strips of longitudinal muscle form the antrum, and (4) remarkable interindividual differences, with negligible responses in one third of the 24 human stomachs examined.