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ObjectivesAlthough demand for price transparency in healthcare is growing, variation in private payors' payments to surgeons for oncologic resection has not been well characterised. Our aim was to assess variation of private payors' payments to surgeons for cancer resection using data based on fee-for-service allowed amounts, billed by a large mix of commercial payors and third-party administrators.SettingFair Health (FH), an independent, not-for-profit organisation that collects and compiles claims data from payors nationwide. FH maintains the nation's largest repository of privately billed medical and dental claims representing over 125 million covered lives in the USA.ParticipantsWe performed a cross-sectional study assessing private payer data for five common types of cancer surgery: simple mastectomy (SM), modified radical mastectomy (MRM), open lobectomy, video-assisted thoracoscopic surgery (VATS) lobectomy and radical prostatectomy during 2012 and 2013.Primary and secondary outcome measuresTo assess variation across regions, we compared regional median allowed payments. To assess intraregion variability, we evaluated the distribution of regional IQRs of allowed payments.ResultsMedian allowed payments varied substantially across regions. For SM, median allowed payments ranged from $550 in the least expensive to $1380 in the costliest region. For MRM, the range was $842-$1760, for lobectomy $326-$3066, for VATS $317-$3307 and for prostatectomy $1716-$4867. There was also substantial variation within geographic areas. For example, the mean IQRs in surgeon payment within regions were: SM $577 (25th percentile) to $1132 (75th percentile); MRM $850-$1620; lobectomy $861-$2767; VATS $1024-$3122; and prostatectomy $2286-$3563.ConclusionsThere is a wide range of variation both across and within geographic regions in allowed amounts of surgeon payments for common oncologic resections. Transparency about these allowed amounts may have a profound impact on patient and employer choice and facilitate future assessments of value in cancer care.

Reports on a session of the PACE conference held on February 1, 2019, that brought together experts to discuss a set of essential questions California must consider as it develops a new coordinated data system.Governor Gavin Newsom’s budget proposal for 2019–2020 includes $10 million to develop a statewide longitudinal data system—including early education, K–12, and higher education institutions as well as health and human services agencies— to better track student outcomes and improve alignment of the education system to workforce needs. California’s lack of a coherent education database serves as a substantial barrier to fulfilling the state’s continuous improvement policy goal and ensuring all students have access to robust learning opportunities to enable them to be successful in school and beyond. This brief reports on a session of the PACE conference held on February 1, 2019, that brought together experts to discuss a set of essential questions California must consider as it develops a new coordinated data system.This work has been supported, in part, by the University of California Multicampus Research Programs and Initiatives grant MRP-19-600774.

ContextDespite established guidelines for the treatment of muscle-invasive bladder cancer, it has been reported that radical cystectomy (RC) is markedly underused, especially among patients of advanced age and those with higher comorbidity burden and lower access to care. Understanding the interactions between patient, provider, and hospital factors may inform targeted interventions to optimize RC utilization.ObjectiveTo systematically review the literature regarding factors associated with RC utilization.Evidence acquisitionA systematic search was conducted using Ovid and Medline according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify studies between 1970 and 2017 reporting on RC utilization. Prospective and retrospective studies were included.Evidence synthesisThere are no published randomized control trials on RC utilization. Variations in study quality and design precluded a formal statistical meta-analysis. RC receipt significantly depended on patient, provider, and hospital factors. Patient factors associated with lower RC use included advanced age, African American and Hispanic race/ethnicity, higher comorbidity burden, unmarried marital status, higher tumor stage and grade, and lower socioeconomic status. Provider factors associated with underutilization included lower surgeon volume and a metropolitan location. Finally, hospital factors associated with lower RC use included low hospital volume, nonacademic affiliation, and hospital location in the Midwest.ConclusionsRC is reportedly underutilized. We found that age, race, marital status, socioeconomic factors, cancer severity, comorbidity burden, surgeon volume, and facility type and location significantly determined RC receipt. Improved understanding of the varying contributions of the risk factors according to patient, provider, and hospital determinants may assist in developing targeted interventions to improve RC utilization.Patient summaryIn this review we explored the clinical evidence for factors predicting the utilization of radical cystectomy for muscle-invasive bladder cancer. Many factors related to the patient, provider, and hospital determine whether patients receive this guideline-recommended treatment. However, there remains a lack of understanding on characterization and targeted interventions according to these levels, which may improve use.

PurposeRadical cystectomy is a surgical treatment for recurrent non-muscle-invasive and muscle-invasive bladder cancer; however, many patients may not receive this treatment.MethodsA total of 27,578 patients diagnosed with clinical stage I-IV bladder cancer from 1 January 2007 to 31 December 2013 were identified from the Surveillance, Epidemiology, and End Results (SEER) registry database. We used multivariable regression analyses to identify factors predicting the use of radical cystectomy and pelvic lymph node dissection. Cox proportional hazards models were used to analyze survival outcomes.ResultsA total of 1,693 (6.1%) patients with bladder cancer underwent radical cystectomy. Most patients (92.4%) who underwent radical cystectomy also underwent pelvic lymph node dissection. When compared with white patients, non-Hispanic blacks were less likely to undergo a radical cystectomy [odds ratio (OR) 0.79, 95% confidence interval (CI) 0.64-0.96, p = 0.019]. Moreover, recent year of surgery 2013 versus 2007 (OR 2.32, 95% CI 1.90-2.83, p

BackgroundThe objective of this study was to compare the overall survival of patients who undergo radical prostatectomy or radiotherapy versus noncancer controls to discern whether there is a survival advantage according to prostate cancer treatment and the impact of selection bias on these results.MethodsA matched cohort study was performed using the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database. In total, 34,473 patients ages 66 to 75 years were identified who were without significant comorbidity, were diagnosed with localized prostate cancer, and received treatment treated with surgery or radiotherapy between 2004 and 2011. These patients were matched to a noncancer control cohort. The rates of all-cause mortality that occurred within the study period were compared. Cox proportional hazards regression analysis was used to identify determinants associated with overall survival.ResultsOf 34,473 patients who were included in the analysis, 21,740 (63%) received radiation therapy, and 12,733 (37%) underwent surgery. There was improved survival in patients who underwent surgery (hazard ratio, 0.35; 95% confidence interval, 0.32-0.38) and in those who received radiotherapy (hazard ratio, 0.72; 95% confidence interval, 0.68-0.75) compared with noncancer controls. Overall survival improved significantly in both treatment groups, with the greatest benefit observed among patients who underwent surgery (log rank P

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Prostate Cancer Early Detection provide recommendations for prostate cancer screening in healthy men who have elected to participate in an early detection program. The NCCN Guidelines focus on minimizing unnecessary procedures and limiting the detection of indolent disease. These NCCN Guidelines Insights summarize the NCCN Prostate Cancer Early Detection Panel's most significant discussions for the 2016 guideline update, which included issues surrounding screening in high-risk populations (ie, African Americans, BRCA1/2 mutation carriers), approaches to refine patient selection for initial and repeat biopsies, and approaches to improve biopsy specificity.

A growing number of single-gender and after-school programs for youth continue to gain popularity within schools despite little empirical research regarding how these programs should be designed to achieve maximum success. The present study examined the effectiveness of a comprehensive middle school male academy program in terms of student achievement and attitudes toward learning. The results indicated that students who participated in the program improved their algebra readiness and interest in mathematics. Furthermore, there were gains in students' perceived importance of assignment completion, attitudes toward learning, goals for college, and self-concept. Implications for similar programs and future studies are discussed. (Contains 9 figures.)

Elementary school mathematics teaching begins with the teacher's understanding of the mathematical content to be taught. The teacher knows how to "do" the mathematics, i. e., understands the concepts and truths concerning that mathematics. The teacher then decides how to present the mathematics. Based on the students' background in mathematics, the teacher selects the explanations and instructional strategies that will help the students build on their current background and develop a thorough understanding. After selecting the strategies, the teacher designs and implements a series of activities aimed at facilitating all students' learning of the mathematics. These activities may include direct instruction, group work, guided discovery, or any other of the many pedagogical tools available. The teacher then assesses the students' level of understanding, diagnosing areas of misunderstanding, and designs additional activities to alleviate those misunderstandings. Based on this description of elementary school mathematics teaching, an elementary school teacher certainly needs a strong conceptual understanding of mathematical content and an equally thorough understanding of pedagogical skills and practices. However, the lack of any research conclusively connecting either of these two sets of knowledge with student success in learning mathematics seems to indicate that something is missing. The National Council for Accreditation of Teacher Education (NCATE) recently recognized pedagogical content knowledge as a distinct and important aspect of a teacher's knowledge base. In the 2002 edition of its "Professional Standards for the Accreditation of Schools, Colleges and Departments of Education," NCATE discusses three types of Candidate Knowledge, Skills and Dispositions (Standard 1). They are: (1) Content Knowledge for Teacher Candidates; (2) Pedagogical Content Knowledge for Teacher Candidates; and (3) Professional and Pedagogical Knowledge and Skills for Teacher Candidates. NCATE will begin evaluating teacher preparation programs on the strength of their candidates' pedagogical content knowledge, in addition to their content knowledge and pedagogical skills, in 2002. This article explores pedagogical content knowledge in the context of elementary school mathematics, and its relationship to students' learning of mathematics.