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Hospital variation in quality of car...

Yale University.

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Hospital variation in quality of care for patients with colon cancer.

Record Type:	Language materials, printed : Monograph/item
Title/Author:	Hospital variation in quality of care for patients with colon cancer./
Author:	Cramer, Laura Denise.
Description:	161 p.
Notes:	Adviser: Elizabeth H. Bradley.
Contained By:	Dissertation Abstracts International69-05B.
Subject:	Health Sciences, Health Care Management. -
Online resource:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3317083
ISBN:	9780549650386

Hospital variation in quality of care for patients with colon cancer.
Cramer, Laura Denise.

Hospital variation in quality of care for patients with colon cancer. - 161 p.

Adviser: Elizabeth H. Bradley.

Thesis (Ph.D.)--Yale University, 2008.

Background. Understanding sources of variation in care and outcomes is essential to policy-makers charged with designing interventions to reduce variation and improve outcomes for patients with colon cancer. However, relatively few provider-level measures have been studied in this context. Further, rigorous methods appropriate for multilevel data describing patients treated within hospitals and useful for exploring sources of variation are not often employed. Using such methods, this thesis sought to identify hospital characteristics related to variation in three patient measures meant to reflect quality of care for patients undergoing resection for colon cancer.

ISBN: 9780549650386Subjects--Topical Terms:

1017922
Health Sciences, Health Care Management.

Hospital variation in quality of care for patients with colon cancer.
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020 $a 9780549650386
035 $a (UMI)AAI3317083
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040 $a UMI $c UMI
100 1 $a Cramer, Laura Denise. $3 1029467
245 1 0 $a Hospital variation in quality of care for patients with colon cancer.
300 $a 161 p.
500 $a Adviser: Elizabeth H. Bradley.
500 $a Source: Dissertation Abstracts International, Volume: 69-05, Section: B, page: 2891.
502 $a Thesis (Ph.D.)--Yale University, 2008.
520 $a Background. Understanding sources of variation in care and outcomes is essential to policy-makers charged with designing interventions to reduce variation and improve outcomes for patients with colon cancer. However, relatively few provider-level measures have been studied in this context. Further, rigorous methods appropriate for multilevel data describing patients treated within hospitals and useful for exploring sources of variation are not often employed. Using such methods, this thesis sought to identify hospital characteristics related to variation in three patient measures meant to reflect quality of care for patients undergoing resection for colon cancer.
520 $a Methods. Using a population-based study design and the SEER-Medicare database, the sample included patients receiving resection for stage II/III colon cancer diagnosed 1992--2002. Hierarchical generalized linear models (HGLMs) were used to explore hospital-level measures while adjusting for patient-level characteristics. This method also allowed exploration of components of variance according to patient and hospital levels. Outcomes included 30-day mortality and receipt of two guideline-based care processes: adequate lymph node examination and timely perioperative evaluation for synchronous tumors. Hospital characteristics included procedure volume, ownership, teaching status, and other descriptors for affiliations, staffing, and patient composition.
520 $a Results. Fewer than half of patients had adequate nodal examination and 70.7% underwent perioperative evaluation. Approximately 5% died within 30 days of surgery. Hospitals varied with respect to these measures and a few hospital characteristics were found to be associated with each after adjusting for important patient clinical factors. Though hospital-level variation was greater for the process-related outcomes than for mortality, overall variation was largely attributable to patient-level factors.
520 $a Conclusions. For patients undergoing resection for colon cancer, adherence to recommended standards of care was sub-optimal. Yet targeting improvement at the hospital level is complicated by variation in patient level characteristics. Results also suggest a need to explore other hospital characteristics beyond those included here in an effort to identify the facets of hospital-based care that explain why hospitals vary. This may require a more thorough inquiry into the contribution of physician characteristics as a means to parse out hospital- versus physician-level variation in the delivery and outcomes of care for patients with colon cancer.
590 $a School code: 0265.
650 4 $a Health Sciences, Health Care Management. $3 1017922
650 4 $a Health Sciences, Oncology. $3 1018566
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710 2 $a Yale University. $3 515640
773 0 $t Dissertation Abstracts International $g 69-05B.
790 $a 0265
790 1 0 $a Bradley, Elizabeth H., $e advisor
791 $a Ph.D.
792 $a 2008
856 4 0 $u http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3317083