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3 results on '"Bijan A. Niknam"'

1. Adjustment for Atherosclerosis Diagnosis Distorts the Effects of Percutaneous Coronary Intervention and the Ranking of Hospital Performance

Author

Bijan A. Niknam, Alexander F. Arriaga, Paul R. Rosenbaum, Alexander S. Hill, Richard N. Ross, Orit Even‐Shoshan, Patrick S. Romano, and Jeffrey H. Silber

Subjects
atherosclerosis, percutaneous coronary intervention, quality and outcomes, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

BackgroundCoronary atherosclerosis raises the risk of acute myocardial infarction (AMI), and is usually included in AMI risk‐adjustment models. Percutaneous coronary intervention (PCI) does not cause atherosclerosis, but may contribute to the notation of atherosclerosis in administrative claims. We investigated how adjustment for atherosclerosis affects rankings of hospitals that perform PCI. Methods and ResultsThis was a retrospective cohort study of 414 715 Medicare beneficiaries hospitalized for AMI between 2009 and 2011. The outcome was 30‐day mortality. Regression models determined the association between patient characteristics and mortality. Rankings of the 100 largest PCI and non‐PCI hospitals were assessed with and without atherosclerosis adjustment. Patients admitted to PCI hospitals or receiving interventional cardiology more frequently had an atherosclerosis diagnosis. In adjustment models, atherosclerosis was associated, implausibly, with a 42% reduction in odds of mortality (odds ratio=0.58, P

Published
2018
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2. Valuing hospital investments in nursing: multistate matched-cohort study of surgical patients

Author

Alexander S. Hill, Lauren L. Hochman, Linda H. Aiken, Herbert L. Smith, Matthew D. McHugh, Jeffrey H. Silber, Siddharth Jain, Joseph G. Reiter, Bijan A. Niknam, Karen B. Lasater, and Paul R. Rosenbaum

Subjects
Male, business.industry, Health Policy, Health services research, Nursing Staff, Hospital, Article, Hospitals, Patient safety, Matched cohort, Skill mix, Nursing, Medicine, Humans, Female, business, Workplace, Surgical patients, Aged, Retrospective Studies
Abstract

BackgroundThere are known clinical benefits associated with investments in nursing. Less is known about their value.AimsTo compare surgical patient outcomes and costs in hospitals with better versus worse nursing resources and to determine if value differs across these hospitals for patients with different mortality risks.MethodsRetrospective matched-cohort design of patient outcomes at hospitals with better versus worse nursing resources, defined by patient-to-nurse ratios, skill mix, proportions of bachelors-degree nurses and nurse work environments. The sample included 62 715 pairs of surgical patients in 76 better nursing resourced hospitals and 230 worse nursing resourced hospitals from 2013 to 2015. Patients were exactly matched on principal procedures and their hospital’s size category, teaching and technology status, and were closely matched on comorbidities and other risk factors.ResultsPatients in hospitals with better nursing resources had lower 30-day mortality: 2.7% vs 3.1% (pConclusionHospitals with better nursing resources provided better clinical outcomes for surgical patients at a small additional cost. Generally, the sicker the patient, the greater the value at better nursing resourced hospitals.

Published
2020

3. Comparing Outcomes between Antibody Induction Therapies in Kidney Transplantation

Author

Roy D. Bloom, Jeffrey H. Silber, Wei Wang, Joseph G. Reiter, Bijan A. Niknam, Orit Even-Shoshan, Jesse D. Schold, Susanna M. Nazarian, Alexander S. Hill, Neel Koyawala, Jennifer Trofe-Clark, Mary Ann Lim, Deirdre Sawinski, Paul R. Rosenbaum, and Peter P. Reese

Subjects
Male, medicine.medical_specialty, Basiliximab, medicine.medical_treatment, Recombinant Fusion Proteins, 030232 urology & nephrology, 030230 surgery, Lower risk, Antibodies, Monoclonal, Humanized, Antibodies, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Animals, Humans, Clinical Epidemiology, Alemtuzumab, Kidney transplantation, Aged, Antilymphocyte Serum, Retrospective Studies, Aged, 80 and over, business.industry, Proportional hazards model, Hazard ratio, Antibodies, Monoclonal, Immunosuppression, General Medicine, Middle Aged, medicine.disease, Kidney Transplantation, Transplantation, Treatment Outcome, Nephrology, Female, Rabbits, business, Immunosuppressive Agents, medicine.drug
Abstract

Kidney transplant recipients often receive antibody induction. Previous studies of induction therapy were often limited by short follow-up and/or absence of information about complications. After linking Organ Procurement and Transplantation Network data with Medicare claims, we compared outcomes between three induction therapies for kidney recipients. Using novel matching techniques developed on the basis of 15 clinical and demographic characteristics, we generated 1:1 pairs of alemtuzumab-rabbit antithymocyte globulin (rATG) (5330 pairs) and basiliximab-rATG (9378 pairs) recipients. We used paired Cox regression to analyze the primary outcomes of death and death or allograft failure. Secondary outcomes included death or sepsis, death or lymphoma, death or melanoma, and healthcare resource utilization within 1 year. Compared with rATG recipients, alemtuzumab recipients had higher risk of death (hazard ratio [HR], 1.14; 95% confidence interval [95% CI], 1.03 to 1.26; P

Published
2017

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