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105. Assessment of minority frequency pretreatment HIV drug-resistant variants in pregnant women and associations with virologic non-suppression at term

Author

Boyce, Ceejay L., primary, Beck, Ingrid A., additional, Styrchak, Sheila M., additional, Hardy, Samantha R., additional, Wallner, Jackson J., additional, Milne, Ross S., additional, Morrison, R. Leavitt, additional, Shapiro, David E., additional, João, Esaú C., additional, Mirochnick, Mark H., additional, and Frenkel, Lisa M., additional

Published
2022
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111. Cascading effects of social dynamics on the reproduction, survival, and population growth of mountain gorillas.

Author

Morrison, R. E., Hirwa, J. P., Ndagijimana, F., Vecellio, V., Eckardt, W., and Stoinski, T. S.

Subjects
*REPRODUCTION, *SOCIAL dynamics, *SOCIAL reproduction, *HABITATS, *GORILLA (Genus), *FRAGMENTED landscapes, *BIOLOGICAL fitness
Abstract

Whilst the conservation impacts of density‐dependent population effects have been well studied, the impact that socially‐driven changes (e.g. group fissions that increase group density) can have on population growth in social species have only recently come to light. An increase in group density and intergroup encounters in a subpopulation of mountain gorillas Gorilla beringei beringei was shown to have driven a more than fourfold increase in infanticide, slowing population growth. In this study, we delve deeper into the consequences of these socially‐driven changes in group density, examining how patterns of reproduction and survival have changed in this subpopulation across more than 50 years. We show that adult female survival increased with strengthening conservation efforts early in the study, then remained stable, while age at first birth remained stable across the entire study. Interbirth intervals and female reproductive success did not vary significantly across time overall. However, socially‐driven increases in group density since the mid‐2000s appear to have had a cascade of effects. In addition to the increase in infant and adult male mortality from violence during intergroup encounters, higher encounter rates, and mortality were likely responsible for an increase in female transfers, which delayed reproduction. Females faced a 7.5‐month delay when transferring once and a 1.5‐year delay when transferring twice or more between births. We show these changes correspond with a 26.63% reduction in female reproductive success in 2007 to 2018, compared to 1994 to 2006, with females taking more than 2 years longer to produce an offspring that survived infancy. These findings demonstrate that social dynamics can have consequences for population growth beyond the immediate mortality effects of violent encounters. This further highlights the critical importance of social dynamics in the conservation of social species, particularly when populations are restricted to small or fragmented regions of habitat. [ABSTRACT FROM AUTHOR]

Published
2023
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114. Identifying older adults with serious illness: A critical step toward improving the value of health care

Author

Kelley, Amy S., Covinsky, Kenneth E., Gorges, Rebecca J., McKendrick, Karen, Bollens-Eund, Evan, Morrison, R. Sean, and Ritchie, Christine S.

Subjects
Medical research -- Analysis -- Models, Medicine, Experimental -- Analysis -- Models, Activities of daily living -- Reports, Nursing homes -- Reports, Business, Health care industry
Abstract

Objective. To create and test three prospective, increasingly restrictive definitions of serious illness. Data Sources. Health and Retirement Study, 2000-2012. Study Design. We evaluated subjects' 1-year outcomes from the interview [...]

Published
2017
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120. Palliative care for chronic illness: driving change

Author

Rocker, Graeme, Downar, James, and Morrison, R. Sean

Subjects
Chronic diseases -- Health aspects -- Reports -- Care and treatment, Evidence-based medicine -- Health aspects -- Reports -- Analysis, Palliative care -- Health aspects -- Reports -- Management, Company business management, Health
Abstract

In its 2015 Quality of Death Index report, the Economist Intelligence Unit ranked Canada 11th in overall quality of death and 18th in availability of palliative care services. (1) For [...]

Published
2016
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125. Elevated Rates of Prolonged Grief Disorder in African Americans

Author

Goldsmith, B., Morrison, R. S., and Vanderwerker, L. C.

Abstract

The prevalence of Prolonged Grief Disorder (PGD) in non-Whites is currently unknown. This study was performed to explore the prevalence of PGD in African Americans (AAs). Multivariable analysis of two studies of recently bereaved individuals found AAs to have significantly higher rates of PGD than Whites (21% [14 of 66] vs. 12% [55 of 471], respectively; p = 0.03). Experiencing a loved one's death as sudden or unexpected was also significantly associated with PGD over and above the effects of race/ethnicity. AAs may be at increased risk for the development of PGD. The development of effective interventions to treat PGD highlights the need to identify high-risk individuals and refer them to therapy and suggests the potential need for such therapies to adopt culturally sensitive approaches to care. (Contains 3 tables.)

Published
2008
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126. Pain Management

Author

Morrison, R. Sean, Carney, Maria Torroella, Manfredi, Paolo L., Rosenthal, Ronnie A., editor, Zenilman, Michael E., editor, and Katlic, Mark R., editor

Published
2001
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128. 2022 taxonomic update of phylum Negarnaviricota (Riboviria: Orthornavirae), including the large orders Bunyavirales and Mononegavirales

Author

Kuhn, J, Adkins, S, Alkhovsky, S, Avšič-Županc, T, Ayllón, M, Bahl, J, Balkema-Buschmann, A, Ballinger, M, Bandte, M, Beer, M, Bejerman, N, Bergeron, É, Biedenkopf, N, Bigarré, L, Blair, C, Blasdell, K, Bradfute, S, Briese, T, Brown, P, Bruggmann, R, Buchholz, U, Buchmeier, M, Bukreyev, A, Burt, F, Büttner, C, Calisher, C, Candresse, T, Carson, J, Casas, I, Chandran, K, Charrel, R, Chiaki, Y, Crane, A, Crane, M, Dacheux, L, Bó, E, de la Torre, J, de Lamballerie, X, de Souza, W, de Swart, R, Dheilly, N, Di Paola, N, Di Serio, F, Dietzgen, R, Digiaro, M, Drexler, J, Duprex, W, Dürrwald, R, Easton, A, Elbeaino, T, Ergünay, K, Feng, G, Feuvrier, C, Firth, A, Fooks, A, Formenty, P, Freitas-Astúa, J, Gago-Zachert, S, García, M, García-Sastre, A, Garrison, A, Godwin, S, Gonzalez, J, de Bellocq, J, Griffiths, A, Groschup, M, Günther, S, Hammond, J, Hepojoki, J, Hierweger, M, Hongō, S, Horie, M, Horikawa, H, Hughes, H, Hume, A, Hyndman, T, Jiāng, D, Jonson, G, Junglen, S, Kadono, F, Karlin, D, Klempa, B, Klingström, J, Koch, M, Kondō, H, Koonin, E, Krásová, J, Krupovic, M, Kubota, K, Kuzmin, I, Laenen, L, Lambert, A, Lǐ, J, Li, J, Lieffrig, F, Lukashevich, I, Luo, D, Maes, P, Marklewitz, M, Marshall, S, Marzano, S, Mccauley, J, Mirazimi, A, Mohr, P, Moody, N, Morita, Y, Morrison, R, Mühlberger, E, Naidu, R, Natsuaki, T, Navarro, J, Neriya, Y, Netesov, S, Neumann, G, Nowotny, N, Ochoa-Corona, F, Palacios, G, Pallandre, L, Pallás, V, Papa, A, Paraskevopoulou, S, Parrish, C, Pauvolid-Corrêa, A, Pawęska, J, Pérez, D, Pfaff, F, Plemper, R, Postler, T, Pozet, F, Radoshitzky, S, Ramos-González, P, Rehanek, M, Resende, R, Reyes, C, Romanowski, V, Rubbenstroth, D, Rubino, L, Rumbou, A, Runstadler, J, Rupp, M, Sabanadzovic, S, Sasaya, T, Schmidt-Posthaus, H, Schwemmle, M, Seuberlich, T, Sharpe, S, Shi, M, Sironi, M, Smither, S, Song, J, Spann, K, Spengler, J, Stenglein, M, Takada, A, Tesh, R, Těšíková, J, Thornburg, N, Tischler, N, Tomitaka, Y, Tomonaga, K, Tordo, N, Tsunekawa, K, Turina, M, Tzanetakis, I, Vaira, A, van den Hoogen, B, Vanmechelen, B, Vasilakis, N, Verbeek, M, von Bargen, S, Wada, J, Wahl, V, Walker, P, Whitfield, A, Williams, J, Wolf, Y, Yamasaki, J, Yanagisawa, H, Ye, G, Zhang, Y, Økland, A, Kuhn JH, Adkins S, Alkhovsky SV, Avšič-Županc T, Ayllón MA, Bahl J, Balkema-Buschmann A, Ballinger MJ, Bandte M, Beer M, Bejerman N, Bergeron É, Biedenkopf N, Bigarré L, Blair CD, Blasdell KR, Bradfute SB, Briese T, Brown PA, Bruggmann R, Buchholz UJ, Buchmeier MJ, Bukreyev A, Burt F, Büttner C, Calisher CH, Candresse T, Carson J, Casas I, Chandran K, Charrel RN, Chiaki Y, Crane A, Crane M, Dacheux L, Bó ED, de la Torre JC, de Lamballerie X, de Souza WM, de Swart RL, Dheilly NM, Di Paola N, Di Serio F, Dietzgen RG, Digiaro M, Drexler JF, Duprex WP, Dürrwald R, Easton AJ, Elbeaino T, Ergünay K, Feng G, Feuvrier C, Firth AE, Fooks AR, Formenty PBH, Freitas-Astúa J, Gago-Zachert S, García ML, García-Sastre A, Garrison AR, Godwin SE, Gonzalez JJ, de Bellocq JG, Griffiths A, Groschup MH, Günther S, Hammond J, Hepojoki J, Hierweger MM, Hongō S, Horie M, Horikawa H, Hughes HR, Hume AJ, Hyndman TH, Jiāng D, Jonson GB, Junglen S, Kadono F, Karlin DG, Klempa B, Klingström J, Koch MC, Kondō H, Koonin EV, Krásová J, Krupovic M, Kubota K, Kuzmin IV, Laenen L, Lambert AJ, Lǐ J, Li JM, Lieffrig F, Lukashevich IS, Luo D, Maes P, Marklewitz M, Marshall SH, Marzano SL, McCauley JW, Mirazimi A, Mohr PG, Moody NJG, Morita Y, Morrison RN, Mühlberger E, Naidu R, Natsuaki T, Navarro JA, Neriya Y, Netesov SV, Neumann G, Nowotny N, Ochoa-Corona FM, Palacios G, Pallandre L, Pallás V, Papa A, Paraskevopoulou S, Parrish CR, Pauvolid-Corrêa A, Pawęska JT, Pérez DR, Pfaff F, Plemper RK, Postler TS, Pozet F, Radoshitzky SR, Ramos-González PL, Rehanek M, Resende RO, Reyes CA, Romanowski V, Rubbenstroth D, Rubino L, Rumbou A, Runstadler JA, Rupp M, Sabanadzovic S, Sasaya T, Schmidt-Posthaus H, Schwemmle M, Seuberlich T, Sharpe SR, Shi M, Sironi M, Smither S, Song JW, Spann KM, Spengler JR, Stenglein MD, Takada A, Tesh RB, Těšíková J, Thornburg NJ, Tischler ND, Tomitaka Y, Tomonaga K, Tordo N, Tsunekawa K, Turina M, Tzanetakis IE, Vaira AM, van den Hoogen B, Vanmechelen B, Vasilakis N, Verbeek M, von Bargen S, Wada J, Wahl V, Walker PJ, Whitfield AE, Williams JV, Wolf YI, Yamasaki J, Yanagisawa H, Ye G, Zhang YZ, Økland AL., Kuhn, J, Adkins, S, Alkhovsky, S, Avšič-Županc, T, Ayllón, M, Bahl, J, Balkema-Buschmann, A, Ballinger, M, Bandte, M, Beer, M, Bejerman, N, Bergeron, É, Biedenkopf, N, Bigarré, L, Blair, C, Blasdell, K, Bradfute, S, Briese, T, Brown, P, Bruggmann, R, Buchholz, U, Buchmeier, M, Bukreyev, A, Burt, F, Büttner, C, Calisher, C, Candresse, T, Carson, J, Casas, I, Chandran, K, Charrel, R, Chiaki, Y, Crane, A, Crane, M, Dacheux, L, Bó, E, de la Torre, J, de Lamballerie, X, de Souza, W, de Swart, R, Dheilly, N, Di Paola, N, Di Serio, F, Dietzgen, R, Digiaro, M, Drexler, J, Duprex, W, Dürrwald, R, Easton, A, Elbeaino, T, Ergünay, K, Feng, G, Feuvrier, C, Firth, A, Fooks, A, Formenty, P, Freitas-Astúa, J, Gago-Zachert, S, García, M, García-Sastre, A, Garrison, A, Godwin, S, Gonzalez, J, de Bellocq, J, Griffiths, A, Groschup, M, Günther, S, Hammond, J, Hepojoki, J, Hierweger, M, Hongō, S, Horie, M, Horikawa, H, Hughes, H, Hume, A, Hyndman, T, Jiāng, D, Jonson, G, Junglen, S, Kadono, F, Karlin, D, Klempa, B, Klingström, J, Koch, M, Kondō, H, Koonin, E, Krásová, J, Krupovic, M, Kubota, K, Kuzmin, I, Laenen, L, Lambert, A, Lǐ, J, Li, J, Lieffrig, F, Lukashevich, I, Luo, D, Maes, P, Marklewitz, M, Marshall, S, Marzano, S, Mccauley, J, Mirazimi, A, Mohr, P, Moody, N, Morita, Y, Morrison, R, Mühlberger, E, Naidu, R, Natsuaki, T, Navarro, J, Neriya, Y, Netesov, S, Neumann, G, Nowotny, N, Ochoa-Corona, F, Palacios, G, Pallandre, L, Pallás, V, Papa, A, Paraskevopoulou, S, Parrish, C, Pauvolid-Corrêa, A, Pawęska, J, Pérez, D, Pfaff, F, Plemper, R, Postler, T, Pozet, F, Radoshitzky, S, Ramos-González, P, Rehanek, M, Resende, R, Reyes, C, Romanowski, V, Rubbenstroth, D, Rubino, L, Rumbou, A, Runstadler, J, Rupp, M, Sabanadzovic, S, Sasaya, T, Schmidt-Posthaus, H, Schwemmle, M, Seuberlich, T, Sharpe, S, Shi, M, Sironi, M, Smither, S, Song, J, Spann, K, Spengler, J, Stenglein, M, Takada, A, Tesh, R, Těšíková, J, Thornburg, N, Tischler, N, Tomitaka, Y, Tomonaga, K, Tordo, N, Tsunekawa, K, Turina, M, Tzanetakis, I, Vaira, A, van den Hoogen, B, Vanmechelen, B, Vasilakis, N, Verbeek, M, von Bargen, S, Wada, J, Wahl, V, Walker, P, Whitfield, A, Williams, J, Wolf, Y, Yamasaki, J, Yanagisawa, H, Ye, G, Zhang, Y, Økland, A, Kuhn JH, Adkins S, Alkhovsky SV, Avšič-Županc T, Ayllón MA, Bahl J, Balkema-Buschmann A, Ballinger MJ, Bandte M, Beer M, Bejerman N, Bergeron É, Biedenkopf N, Bigarré L, Blair CD, Blasdell KR, Bradfute SB, Briese T, Brown PA, Bruggmann R, Buchholz UJ, Buchmeier MJ, Bukreyev A, Burt F, Büttner C, Calisher CH, Candresse T, Carson J, Casas I, Chandran K, Charrel RN, Chiaki Y, Crane A, Crane M, Dacheux L, Bó ED, de la Torre JC, de Lamballerie X, de Souza WM, de Swart RL, Dheilly NM, Di Paola N, Di Serio F, Dietzgen RG, Digiaro M, Drexler JF, Duprex WP, Dürrwald R, Easton AJ, Elbeaino T, Ergünay K, Feng G, Feuvrier C, Firth AE, Fooks AR, Formenty PBH, Freitas-Astúa J, Gago-Zachert S, García ML, García-Sastre A, Garrison AR, Godwin SE, Gonzalez JJ, de Bellocq JG, Griffiths A, Groschup MH, Günther S, Hammond J, Hepojoki J, Hierweger MM, Hongō S, Horie M, Horikawa H, Hughes HR, Hume AJ, Hyndman TH, Jiāng D, Jonson GB, Junglen S, Kadono F, Karlin DG, Klempa B, Klingström J, Koch MC, Kondō H, Koonin EV, Krásová J, Krupovic M, Kubota K, Kuzmin IV, Laenen L, Lambert AJ, Lǐ J, Li JM, Lieffrig F, Lukashevich IS, Luo D, Maes P, Marklewitz M, Marshall SH, Marzano SL, McCauley JW, Mirazimi A, Mohr PG, Moody NJG, Morita Y, Morrison RN, Mühlberger E, Naidu R, Natsuaki T, Navarro JA, Neriya Y, Netesov SV, Neumann G, Nowotny N, Ochoa-Corona FM, Palacios G, Pallandre L, Pallás V, Papa A, Paraskevopoulou S, Parrish CR, Pauvolid-Corrêa A, Pawęska JT, Pérez DR, Pfaff F, Plemper RK, Postler TS, Pozet F, Radoshitzky SR, Ramos-González PL, Rehanek M, Resende RO, Reyes CA, Romanowski V, Rubbenstroth D, Rubino L, Rumbou A, Runstadler JA, Rupp M, Sabanadzovic S, Sasaya T, Schmidt-Posthaus H, Schwemmle M, Seuberlich T, Sharpe SR, Shi M, Sironi M, Smither S, Song JW, Spann KM, Spengler JR, Stenglein MD, Takada A, Tesh RB, Těšíková J, Thornburg NJ, Tischler ND, Tomitaka Y, Tomonaga K, Tordo N, Tsunekawa K, Turina M, Tzanetakis IE, Vaira AM, van den Hoogen B, Vanmechelen B, Vasilakis N, Verbeek M, von Bargen S, Wada J, Wahl V, Walker PJ, Whitfield AE, Williams JV, Wolf YI, Yamasaki J, Yanagisawa H, Ye G, Zhang YZ, and Økland AL.

Abstract

In March 2022, following the annual International Committee on Taxonomy of Viruses (ICTV) ratification vote on newly proposed taxa, the phylum Negarnaviricota was amended and emended. The phylum was expanded by two new families (bunyaviral Discoviridae and Tulasviridae), 41 new genera, and 98 new species. Three hundred forty-nine species were renamed and/or moved. The accidentally misspelled names of seven species were corrected. This article presents the updated taxonomy of Negarnaviricota as now accepted by the ICTV.

Published
2022

129. Responsible agriculture must adapt to the wetland character of mid‐latitude peatlands

Author

Freeman, B.W.J., Evans, C.D., Musarika, S., Morrison, R., Newman, T.R., Page, S.E., Wiggs, G.F.S., Bell, N.G.A., Styles, D., Wen, Y., Chadwick, D.R., Jones, D.L., Freeman, B.W.J., Evans, C.D., Musarika, S., Morrison, R., Newman, T.R., Page, S.E., Wiggs, G.F.S., Bell, N.G.A., Styles, D., Wen, Y., Chadwick, D.R., and Jones, D.L.

Abstract

Drained, lowland agricultural peatlands are greenhouse gas (GHG) emission hotspots and a large but vulnerable store of irrecoverable carbon. They exhibit soil loss rates of ~2.0 cm yr−1 and are estimated to account for 32% of global cropland emissions while producing only 1.1% of crop kilocalories. Carbon dioxide emissions account for >80% of their terrestrial GHG emissions and are largely controlled by water table depth. Reducing drainage depths is, therefore, essential for responsible peatland management. Peatland restoration can substantially reduce emissions. However, this may conflict with societal needs to maintain productive use, to protect food security and livelihoods. Wetland agriculture strategies will, therefore, be required to adapt agriculture to the wetland character of peatlands, and balance GHG mitigation against productivity, where halting emissions is not immediately possible. Paludiculture may substantially reduce GHG emissions but will not always be viable in the current economic landscape. Reduced drainage intensity systems may deliver partial reductions in the rate of emissions, with smaller modifications to existing systems. These compromise systems may face fewer hurdles to adoption and minimize environmental harm until societal conditions favour strategies that can halt emissions. Wetland agriculture will face agronomic, socio-economic and water management challenges, and careful implementation will be required. Diversity of values and priorities among stakeholders creates the potential for conflict. Successful implementation will require participatory research approaches and co-creation of workable solutions. Policymakers, private sector funders and researchers have key roles to play but adoption risks would fall predominantly on land managers. Development of a robust wetland agriculture paradigm is essential to deliver resilient production systems and wider environmental benefits. The challenge of responsible use presents an opportunity t

Published
2022

131. An Update: National Institutes of Health Research Funding for Palliative Medicine 2016–2020.

Author

Buehler, Nicholas J., Frydman, Julia L., Morrison, R. Sean, and Gelfman, Laura P.

Subjects
HOSPICE care, ALZHEIMER'S disease, PALLIATIVE medicine, ENDOWMENT of research, DESCRIPTIVE statistics, DEMENTIA, PALLIATIVE treatment
Abstract

Background: The evidence base to support palliative care clinical practice is inadequate and opportunities to improve the evidence base remain despite the field's rapid growth. Objective: The aim of this study was to examine current National Institutes of Health (NIH) funding of palliative medicine research and trends over time. Design: We sought to identify NIH funding of palliative medicine (2016–2020) in two stages: (1) we searched the NIH grant database, RePORTER, for grants with the keywords, "palliative care," "end-of-life care," "hospice," and "end of life," and (2) identified palliative care researchers likely to have secured NIH funding using three strategies. Methods: We abstracted (1) the first and last authors' names from original investigations published in major palliative medicine journals from 2016 to 2018; (2) names from a PubMed-generated list of original articles published in major medicine, nursing, and subspecialty journals using the above keywords; and (3) palliative medicine journal editorial board members and members of key palliative medicine initiatives. We cross-matched the pooled names against NIH grants funded from 2016 to 2021. Results: A crosswalk analysis of the author search and NIH RePORTER search identified 1658 grants. Of those, 541 were categorized as relevant to palliative medicine, which represented 419 unique principal investigators (mean of 1.34 grants per investigator). Compared with 2011–2015, the number of NIH-funded grants increased by 25%, NIH dollars increased by 35%, and the distribution of grant types remained stable. Conclusions: Despite the challenging NIH funding climate, the number of NIH grants and funding to palliative care have increased. Given the increased funding allocation toward Alzheimer's dementia and related dementia research at the congressional level, this increase in funding reflects this funding allocation and does not represent overall growth. Dedicated federal funding for palliative care research remains critical to grow the evidence base for persons living with serious illnesses and their families. [ABSTRACT FROM AUTHOR]

Published
2023
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139. Erratum zu: Nichtoperative und operative Behandlung der osteoporotischen Wirbelkörperfraktur: Empfehlungen der Sektion Wirbelsäule der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie (DGOU)

Author

Blattert, T. R., Schnake, K. J., Gonschorek, O., Katscher, S., Ullrich, B. W., Gercek, E., Hartmann, F., Mörk, S., Morrison, R., Müller, M. L., Partenheimer, A., Piltz, S., Scherer, M. A., Verheyden, A., Zimmermann, V., and Sektion Wirbelsäule der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie

Published
2019
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140. Improving the Approach to Defining, Classifying, Reporting and Monitoring Adverse Events in Seriously Ill Older Adults: Recommendations from a Multi-stakeholder Convening

Author

Baim-Lance, Abigail, primary, Ferreira, Katelyn B., additional, Cohen, Harvey Jay, additional, Ellenberg, Susan S., additional, Kuchel, George A., additional, Ritchie, Christine, additional, Sachs, Greg A., additional, Kitzman, Dalane, additional, Morrison, R. Sean, additional, and Siu, Albert, additional

Published
2022
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146. Suitability of Artificial Nests

Author

Faaborg, John, Mckinnon, L., Smith, P. A., Nol, E., Martin, J. L., Doyle, F. I., Abraham, K. F., Gilchrist, H. G., Morrison, R. I. G., and Bêty, J.

Published
2010

150. Using length of stay to control for unobserved heterogeneity when estimating treatment effect on hospital costs with observational data: issues of reliability, robustness, and usefulness

Author

May, Peter, Garrido, Melissa M., Cassel, J. Brian, Morrison, R. Sean, and Normand, Charles

Subjects
Health care costs -- Economic aspects -- Analysis -- Usage -- Forecasts and trends, Evidence-based medicine -- Economic aspects -- Analysis -- Usage, Palliative care -- Economic aspects -- Analysis -- Usage, Market trend/market analysis, Business, Health care industry
Abstract

Objective. To evaluate the sensitivity of treatment effect estimates when length of stay (LOS) is used to control for unobserved heterogeneity when estimating treatment effect on cost of hospital admission with observational data. Data Sources/Study Setting. We used data from a prospective cohort study on the impact of palliative care consultation teams (PCCTs) on direct cost of hospital care. Adult patients with an advanced cancer diagnosis admitted to five large medical and cancer centers in the United States between 2007 and 2011 were eligible for this study. Study Design. Costs were modeled using generalized linear models with a gamma distribution and a log link. We compared variability in estimates of PCCT impact on hospitalization costs when LOS was used as a covariate, as a sample parameter, and as an outcome denominator. We used propensity scores to account for patient characteristics associated with both PCCT use and total direct hospitalization costs. Data Collection/Extraction Methods. We analyzed data from hospital cost databases, medical records, and questionnaires. Our propensity score weighted sample included 969 patients who were discharged alive. Principal Findings. In analyses of hospitalization costs, treatment effect estimates are highly sensitive to methods that control for LOS, complicating interpretation. Both the magnitude and significance of results varied widely with the method of controlling for LOS. When we incorporated intervention timing into our analyses, results were robust to LOS-controls. Conclusions. Treatment effect estimates using LOS-controls are not only suboptimal in terms of reliability (given concerns over endogeneity and bias) and usefulness (given the need to validate the cost-effectiveness of an intervention using overall resource use for a sample defined at baseline) but also in terms of robustness (results depend on the approach taken, and there is little evidence to guide this choice). To derive results that minimize endogeneity concerns and maximize external validity, investigators should match and analyze treatment and comparison arms on baseline factors only. Incorporating intervention timing may deliver results that are more reliable, more robust, and more useful than those derived using LOS-controls. Key Words. Costs and cost analysis, palliative care, length of stay, endogeneity, validity, A randomized controlled trial is the strongest way to maximize internal validity when evaluating causal effects, but many interventions cannot be randomized, leaving health service researchers to analyze observational data [...]

Published
2016
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