|Grant Number:||1R01CA169121-01A1 Interpret this number|
|Primary Investigator:||Wright, Jason|
|Organization:||Columbia University Health Sciences|
|Project Title:||The Influence of Hospital Variability on the Management of Cancer-Associated Comp|
DESCRIPTION (provided by applicant): The quality of treatment for cancer-associated complications, those complications directly attributable to the cancer itself or that result from chemotherapy and/or radiation, have received little attention. This is particularly problematic as cancer-associated complications are associated with significant morbidity, are often accompanied by pain and discomfort, and require the expenditure of substantial healthcare resources for treatment. The management of cancer-associated complications is compounded by the availability of a myriad of treatment options, many of which are unproven and associated with significant cost. Little is known about the factors that influence allocation of care for thes complications and what factors influence outcome. The health care a patient receives and its associated outcomes are influenced by the interplay of a number of patient, physician, and hospital factors. For acute inpatient medical conditions the characteristics of the hospital in which a patient is treated play a crucial role. There is growing recognition that there is widespread between-hospital variation in how care is allocated and that these differences in practice patterns explain a large portion of treatment variability. Uninsured and minority patients are particularly vulnerable to these hospital level disparities as these patients are disproportionately more likely to receive care at facilities with limited clinical and financial resources that may adversely affect quality. In this proposal we will determine the quality of treatment for hospitalized patients admitted with a primary diagnosis of: febrile neutropenia, hypercalcemia of malignancy, esophagitis, and acute cancer-associated pain. For each cancer-associated complication we will determine patterns of treatment, the factors that underlie treatment decisions, and the effect of prompt initiation of guideline-based therapy on outcomes. For each condition we will first examine the utilization of guideline-based and non-indicated treatments. We will then comprehensively examine the influence of patient, physician, and hospital characteristics as well as between- hospital variations on the allocation of guideline-based care. We hypothesize that there is substantial variation in treatment between hospitals that is unexplained by traditional measures. Finally, we will perform novel causal inference and mediation analyses to determine the direct and indirect effects operating through a mediator of prompt guideline-based treatment on outcomes (length of stay, readmission, cost, non-routine discharge and mortality) for each complication. In addition to including a number of novel statistical methodologies, this proposal will utilize a unique database ideally suited to the study of these complications. The data from these studies will lead to immediately actionable results that can be used to guide the implementation pragmatic hospital-based interventions to improve the quality of care for patients with cancer-associated complications.
Uterine pathology in women undergoing minimally invasive hysterectomy using morcellation.
Authors: Wright JD, Tergas AI, Burke WM, Cui RR, Ananth CV, Chen L, Hershman DL
Source: JAMA, 2014 Sep 24;312(12), p. 1253-5.
An economic analysis of robotically assisted hysterectomy.
Authors: Wright JD, Ananth CV, Tergas AI, Herzog TJ, Burke WM, Lewin SN, Lu YS, Neugut AI, Hershman DL
Source: Obstet Gynecol, 2014 May;123(5), p. 1038-48.
Safety and tolerance of radical hysterectomy for cervical cancer in the elderly.
Authors: George EM, Tergas AI, Ananth CV, Burke WM, Lewin SN, Prendergast E, Neugut AI, Hershman DL, Wright JD
Source: Gynecol Oncol, 2014 Jul;134(1), p. 36-41.
EPub date: 2014 Apr 24.
Comparative effectiveness of upfront treatment strategies in elderly women with ovarian cancer.
Authors: Wright JD, Ananth CV, Tsui J, Glied SA, Burke WM, Lu YS, Neugut AI, Herzog TJ, Hershman DL
Source: Cancer, 2014 Apr 15;120(8), p. 1246-54.
EPub date: 2014 Jan 17.
Use of guideline-based antibiotic prophylaxis in women undergoing gynecologic surgery.
Authors: Wright JD, Hassan K, Ananth CV, Herzog TJ, Lewin SN, Burke WM, Lu YS, Neugut AI, Hershman DL
Source: Obstet Gynecol, 2013 Dec;122(6), p. 1145-53.
Contraindicated use of bevacizumab and toxicity in elderly patients with cancer.
Authors: Hershman DL, Wright JD, Lim E, Buono DL, Tsai WY, Neugut AI
Source: J Clin Oncol, 2013 Oct 1;31(28), p. 3592-9.
EPub date: 2013 Sep 3.
Nationwide trends in the performance of inpatient hysterectomy in the United States.
Authors: Wright JD, Herzog TJ, Tsui J, Ananth CV, Lewin SN, Lu YS, Neugut AI, Hershman DL
Source: Obstet Gynecol, 2013 Aug;122(2 Pt 1), p. 233-41.
Failure to rescue after major gynecologic surgery.
Authors: Wright JD, Ananth CV, Ojalvo L, Herzog TJ, Lewin SN, Lu YS, Neugut AI, Hershman DL
Source: Am J Obstet Gynecol, 2013 Nov;209(5), p. 420.e1-8.
EPub date: 2013 Aug 9.
Prognostic significance of mucinous differentiation of endometrioid adenocarcinoma of the endometrium.
Authors: Galic V, Schiavone MB, Herzog TJ, Holcomb K, Lewin SN, Lu YS, Neugut AI, Hershman DL, Wright JD
Source: Cancer Invest, 2013 Aug;31(7), p. 500-4.
Carcinosarcoma of the ovary: natural history, patterns of treatment, and outcome.
Authors: George EM, Herzog TJ, Neugut AI, Lu YS, Burke WM, Lewin SN, Hershman DL, Wright JD
Source: Gynecol Oncol, 2013 Oct;131(1), p. 42-5.
EPub date: 2013 Jul 6.
Deviations from guideline-based therapy for febrile neutropenia in cancer patients and their effect on outcomes.
Authors: Wright JD, Neugut AI, Ananth CV, Lewin SN, Wilde ET, Lu YS, Herzog TJ, Hershman DL
Source: JAMA Intern Med, 2013 Apr 8;173(7), p. 559-68.