In the News
Here you can find citings of the Center's work and people in the news.
Auditing Practice Style Variation in Pediatric Inpatient Asthma Care
A study lead by Jeffrey H. Silber, published in the September issue of JAMA Pediatrics, sought to implement a new auditing process examining whether differences in hospital practice style may be associated with potential resource savings or inefficiencies in treating pediatric asthma admissions. A retrospective matched-cohort design study, matched for asthma severity, compared practice patterns for patients admitted to Children's Hospital Association hospitals contributing data to the Pediatric Hospital Information System (PHIS) database. With 3 years of PHIS data on 48 887 children, an asthma template was constructed consisting of representative children hospitalized for asthma between April 1, 2011, and March 31, 2014. For children with asthma who had similar characteristics, we observed different hospital resource utilization; some values differed greatly, with important differences by initial patient risk. Through the template matching audit, hospitals and stakeholders can better understand where this excess variation occurs and can help to pinpoint practice styles that should be emulated or avoided.
Practice Patterns in Medicaid and Non-Medicaid Asthma Admissions
A study lead by Jeffrey H. Silber, published in the August issue of Pediatrics, looked at 17 739 matched pairs of children (Medicaid to non-Medicaid) admitted for asthma in the hospital between April 1, 2011 and March 31, 2014 in 40 Children's Hospital Association hospitals contributing data to the Pediatric Hospital Information System database. Patients were matched on age, sex, asthma severity, and other patient characteristics. For closely matched patients within the same hospital, Medicaid status did not importantly influence costs, LOS, or ICU use.
Drawing Lessons from Philadelphia's Large-Scale Ob Unit Closures
A study lead by Scott A. Lorch, published in the December issue of Health Affairs, interviewed twenty-three key informants from eleven hospitals finding there to be a sharp surge in patient volume in the remaining units in Philadelphia, where 13 out of 19 obstetric units closed in a 15-year period. This strained the healthcare system, eroded workforce morale, and fragmented care for mothers and babies until hospitals adjusted to added demands. These findings were presented on 12/8/14 at a forum focused on children's health sponsored by Health Affairs at the National Press Club in Washington.
Racial Disparities in Colon Cancer Survival
A study lead by Jeffrey H. Silber, published in the December issue of Annals of Internal Medicine, found that after matching for age, sex, diagnosis year, and Survey, Epidemiology, and End Results (SEER) site, racial disparities in colon cancer survival did not decrease among patients diagnosed between 1991 and 2005. This persistent disparity seemed to be more related to presentation characteristics at diagnosis than to subsequent treatment differences.
An answer to "But my hospital's patient population is sicker..."
The Penn Leonard Davis Institute of Health Economics highlighted the matching methodologies utilized by Jeffrey H. Silber and colleagues for auditing hospital quality and their promise to bolster confidence that hospital quality measures reflect true differences in quality among hospitals.
Nearly 1 in 25 U.S. Babies Are Born too Soon
A study in which Scott A. Lorch collaborated with Katy B. Kozhimannil, Ph.D., MPA of the University of Minnesota School of Public Health, published in the July issue of Medical Care, found that 1 in 25 U.S. babies are born earlier than medically justified, increasing the chance of respiratory disease or for ventilation.
Grading Hospitals on Quality Using a Fair Exam
Jeffrey H. Silber describes in an interview with Knowledge@Wharton the key findings from a study he led, "Template Matching for Auditing Hospital Cost and Quality," published in Health Services Research on March 3, 2014. Rather than use indirect standardization to rank hospital quality -- the technique used by Hospital Compare, Consumer Reports and others in their hospital quality report cards -- the study applied direct standardization through multivariate matching, which helps to level the playing field for hospitals by comparing very similar patients.
Presentation Factors More Important than Treatment Factors in Race Disparity in Breast Cancer
A study led by Jeffrey H. Silber and published in the July 24, 2013 issue of the Journal of the American Medical Association found that the racial disparity in breast cancer survival rates has not improved after 20 years, and differences in presentation, such as tumor size, disease stage and comorbidities, account for more of the disparity than treatment differences.
Higher Death Rates Among Poor Children Admitted to Neonatal Units
Scott A. Lorch comments on a study performed by the University of Missouri-Kansas City School of Medicine that found socioeconomic disparity in pediatric hospital death rates.
Which Hospital Would You Choose?
The "failure to rescue" metric of surgical risk originally established by Jeffrey H. Silber was a focus of Atul Gawande's presentation at a New Yorker Festival. Gawande, a Professor of Surgery at Harvard Medical School and New Yorker writer, illustrated "failure to rescue" with an example of two hospitals and the question of which would YOU prefer?
Impact of Closure of Obstetrical Units in Philadelphia
A research study led by Scott A. Lorch published in the April 2013 issue of the journal Health Services Research found negative impacts from a higher volume of deliveries in the handful of maternity units that remained open after a wave of closures in Philadelphia hospitals between 1997 and 2009. Infant mortality rates in the city spiked immediately following the first several closures but then improved following subsequent closures.
High-level Neonatal Intensive Care Units Better for Premature Infants
A research study led by Scott A. Lorch and published in the August 1, 2012 issue of the journal Pediatrics found that death rates of premature infants were higher in low-technology, low-volume neonatal intensive care units than high-level units.
Jeffrey Silber and Robert Kaestner Win Article of the Year Award at AcademyHealth's 2011 Annual Research Meeting
Two companion papers -- "Aggressive Treatment Style and Surgical Outcomes,” published in the December 2010 issue of the journal Health Services Research, and “Evidence on the Efficacy of Inpatient Spending on Medicare Patients,” published the same month in The Milbank Quarterly, co-written by Jeffrey H. Silber and colleague Robert Kaestner of the University of Illinois at Chicago -- together won the 2011 Article of the Year Award. The findings that more aggressive treatment style can increase survival rates contradict the Dartmouth Institute's cost-cutting argument.
Aggressive Treatment of Surgical Patients May be Cost-Effective
A research study led by Jeffrey H. Silber and published in the December 2010 issue of the journal Health Services Research found that more aggressive treatment style for elderly surgical patients was associated with significantly reduced odds of mortality and failure-to-rescue.
Waste in Health Care
The article uses the paper by Robert Kaestner and Jeffrey H. Silber “Evidence on the Efficacy of Inpatient Spending on Medicare Patients,” published in Milbank Quarterly, as a jumping board to question the theory propogated by the Dartmouth Instiute and others that additional spending does not produce more value in health care.
Racial Disparities in Surgical Outcomes
Looking at Medicare data between 2000-2005, Jeffrey H. Silber and colleagues found evidence for a survival advantage among white patients who underwent surgery at teaching hospitals, but no advantage among black surgical patients. Study results were published in the February 2009 issue of the journal Archives of Surgery.
