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Objective: To estimate a commercially available ambulatory electronic health record's (EHR's) impact on workflow and financial measures.Data Sources/study Setting: Administrative, payroll, and billing data were collected for 26 primary care practices in a fee-for-service network that rolled out an EHR on a staggered schedule from June 2006 through December 2008.Study Design: An interrupted time series design was used. Staffing, visit intensity, productivity, volume, practice expense, payments received, and net income data were collected monthly for 2004-2009. Changes were evaluated 1-6, 7-12, and >12 months postimplementation.Data Collection/extraction Methods: Data were accessed through a SQLserver database, transformed into SAS®, and aggregated by practice. Practice-level data were divided by full-time physician equivalents for comparisons across practices by month.Principal Findings: Staffing and practice expenses increased following EHR implementation (3 and 6 percent after 12 months). Productivity, volume, and net income decreased initially but recovered to/close to preimplementation levels after 12 months. Visit intensity did not change significantly, and a secular trend offset the decrease in payments received.Conclusions: Expenses increased and productivity decreased following EHR implementation, but not as much or as persistently as might be expected. Longer term effects still need to be examined. [ABSTRACT FROM AUTHOR]

BACKGROUND: In November 2009, the US Preventive Service Task Force (USPSTF) published updated breast cancer screening guidelines. This marked a change from the 2002 recommendations and a significant divergence from the American Cancer Society (ACS) guidelines. In the current study, the potential effect of using the revised 2009 USPSTF guidelines on patient disease stage and survival were evaluated and compared with those actually observed and to predicted under ACS recommendations. METHODS: A retrospective chart review was performed for 84 patients who were diagnosed with stage I through III breast cancer at Grady Memorial Hospital during 2008. Previously published tumor volume doubling times were used to model an equation that would estimate tumor sizes. For each patient, a disease stage at diagnosis was predicted, and outcomes were modeled as though the patient had been screened according to the recommended versions of the ACS and USPSTF guidelines. Patient survival rates were then estimated based on prognostic data according to disease stage. RESULTS: The average age of patients in the study was 55 years, and 85% were African American. The USPSTF guidelines predicted later stages at diagnosis (14% stage I, 73% stage II), whereas the ACS guidelines predicted earlier stages (47% stage I, 53% stage II). CONCLUSIONS: A large stage migration was predicted, indicating significantly earlier diagnosis, when the ACS-recommended screening guidelines were followed. The authors concluded that practitioners should understand how race and/or socioeconomic factors increase the risk of breast cancer and should be encouraged to prioritize discussions regarding the benefits and risks of annual mammographic screening, especially among women who have a potentially greater risk of developing breast cancer at a younger age. Cancer 2013. © 2012 American Cancer Society. [ABSTRACT FROM AUTHOR]

To estimate the savings in labor costs per primary care visit that might be realized from increased use of physician assistants (PAs) and nurse practitioners (NPs) in the primary care practices of a managed care organization (MCO). Twenty-six capitated primary care practices of a group model MCO. Data on approximately two million visits provided by 206 practitioners were extracted from computerized visit records for 1997–2000. Computerized payroll ledgers were the source of annual labor costs per practice from 1997–2000. Likelihood of a visit attended by a PA/NP versus MD was modeled using logistic regression, with practice fixed effects, by department (adult medicine, pediatrics) and year. Parameter estimates and practice fixed effects from these regressions were used to predict the proportion of PA/NP visits per practice per year given a standard case mix. Least squares regressions, with practice fixed effects, were used to estimate the association of this standardized predicted proportion of PA/NP visits with average annual practitioner and total labor costs per visit, controlling for other practice characteristics. Primary care practices that used more PAs/NPs in care delivery realized lower practitioner labor costs per visit than practices that used less. Future research should investigate the cost savings and cost-effectiveness potential of delivery designs that change staffing mix and division of labor among clinical disciplines. [ABSTRACT FROM AUTHOR]

Examines the property rights theory of hospitals in the U.S. Profitability of the profit, private nonprofit and public hospitals; Analysis in the managerial performance of hospitals; Distinction between chain and independent hospitals.

The purpose of this paper is to empirically test the general implications of Golbe's theoretical analysis by examining differences in the earnings advantage associated with board certification for male and female physicians. Examining differences in earnings related to board certification between male and female physicians provides a good test of the generality of the implications of Golbe's model. First, physicians may be separated into samples of self-employed and employee physicians. Although affirmative action has no direct effect on the earnings of self-employed physicians, patients who have a pre-existing bias against female physicians may be more likely to overcome this bias if they can be assured that the services rendered by these physicians are at least as high in quality as the services of other physicians. Such assurance may be offered through the mechanism of market signaling. For employee physicians, potential employers facing an affirmative action constraint may use board certification as an indicator of the likelihood of costly termination of employment for physicians who provide poor quality services. In the presence of either affirmative action or differential signaling costs, female physicians are expected to have a higher earnings advantage associated with board certification than males. Our analysis of the relationship between physician characteristics and the economic advantages associated with board certification yields several important findings. The earnings advantage associated with board certification appears to be higher for female physicians than for male physicians for both self-employed and employee physicians. Self-employed female physicians who are board certified in two specialties earn substantially more than self-employed female physicians who are only board certified in one specialty, whereas male physicians are board certified in two specialties do not have significantly higher hourly earnings than other board certified... [ABSTRACT FROM AUTHOR]

Background: Hospitals identify the type of coronary artery bypass graft (CABG) surgery admission as routine, urgent, or emergency, and identify CABG admissions as elective, from another hospital, from a long-term healthcare facility, and an admission that results from an emergency room visit. No research has analyzed the importance of these admission characteristics on CABG outcomes., Methods: Using the Nationwide Inpatient Sample data from the Healthcare Cost and Utilization Project database for 1998 through 2002, 1.7 million CABG admissions are analyzed using descriptive and logistic regression techniques to evaluate the extent of differences in in-hospital CABG mortality rates by the type of admission and the source of admission., Results: While there has been 22% decline over our 5-year study period regardless of the source or type of admission, we find that a 2.5-fold difference exists in the in-hospital CABG mortality rates among categories that distinguish the type of admission and the source of admission in the nation's hospital. In 2002, CABG admissions that are routine elective-surgeries have a CABG mortality rate of 1.49%, while urgent CABG admissions from a long-term care facility have an in-hospital mortality rate that is 3.64%., Conclusions: While significant progress has been made lowering in-hospital CABG mortality, sizable differences still remain among the types and sources of CABG admissions. Clinical trial research on CABG patients where the end points include mortality need to be especially mindful of the potential differences and distortions in their data that can be generated due to these various sources of hospital admissions.