@article {526446,
	title = {The Association Between Medicare Eligibility and Gains in Access to Rehabilitative Care: A National Regression Discontinuity Assessment of Patients Ages 64 Versus 65 Years},
	journal = {Ann SurgAnn Surg},
	volume = {265},
	year = {2017},
	note = {Zogg, Cheryl KScott, John WMetcalfe, DavidSeshadri, Anupamaa JTsai, Thomas CDavis, W AustinRose, John A JrOlufajo, Olubode AZafar, Syed NabeelSalim, AliHaider, Adil Heng2017/03/08 06:00Ann Surg. 2017 Apr;265(4):734-742. doi: 10.1097/SLA.0000000000001754.},
	month = {Apr},
	pages = {734-742},
	abstract = {OBJECTIVES: The aims of this study were to assess for changes in uninsured rates among trauma patients at age 64 versus 65 years and whether there are associated changes in post-discharge rehabilitation; determine whether changes are driven by rehabilitation provided at home, skilled nursing facilities (SNFs), or acute inpatient facilities; and determine whether changes vary among stratified subgroups of trauma-related "best-practice" factors. SUMMARY BACKGROUND DATA: Rehabilitation is an important component of high-quality trauma systems with access heavily influenced by insurance status. In the wake of policy changes affecting insurance coverage, it remains unknown the extent to which insurance changes associate with variations in rehabilitation access/use among otherwise similar patients. METHODS: Regression discontinuity models were used to assess for changes in insurance status and rehabilitation at age 64 versus 65 years among adults ages 54 to 75 years (+/-10 years age-related Medicare eligibility). Data were extracted from the 2007-2012 National Trauma Data Bank. RESULTS: A total of 305,198 patients were included; 40.1\% were discharged to rehabilitation. Medicare eligibility was associated with an abrupt 6.4 (95\% confidence interval: 5.8-7.0) percentage-point decline in uninsured and a 9.6 (95\% confidence interval: 6.5-12.6) percentage-point increase in rehabilitation at age 64 versus 65 years, enabling an additional 1-in-10 patients to access rehabilitation. Differences were driven by SNF use and were greatest among patients with less-severe clinical presentations. Restriction based on Medicare-payment eligibility to patients with length of stay >/=3days (SNF requirement) and >/=1 "presumptive diagnosis codes" (inpatient facilities{\textquoteright} 60\% rule) demonstrated abrupt gains in both SNF and inpatient care. CONCLUSIONS: The results reveal the magnitude of changes in access to rehabilitation associated with changes in insurance coverage at age 65 years. Use of quasiexperimental models enabled meaningful consideration of health-policy change.},
	isbn = {1528-1140 (Electronic)0003-4932 (Linking)},
	author = {Zogg, C. K. and Scott, J. W. and Metcalfe, D. and Seshadri, A. J. and Tsai, T. C. and Davis, W. A. and Rose, J. A., Jr. and Olufajo, O. A. and Zafar, S. N. and Salim, A. and Haider, A. H.}
}
@article {526451,
	title = {Cured into Destitution: Catastrophic Health Expenditure Risk Among Uninsured Trauma Patients in the United States},
	journal = {Ann SurgAnn Surg},
	year = {2017},
	note = {Scott, John WRaykar, Nakul PRose, John ATsai, Thomas CZogg, Cheryl KHaider, Adil HSalim, AliMeara, John GShrime, Mark Geng2017/04/11 06:00Ann Surg. 2017 Apr 7. doi: 10.1097/SLA.0000000000002254.},
	month = {Apr 07},
	abstract = {OBJECTIVE: To characterize the economic hardship for uninsured patients admitted for trauma using catastrophic health expenditure (CHE) risk. BACKGROUND: Medical debts are the greatest cause of bankruptcies in the United States. Injuries are often unpredictable, expensive to treat, and disproportionally affect uninsured patients. Current measures of economic hardship are insufficient and exclude those at greatest risk. METHODS: We performed a retrospective review, using data from the 2007-2011 Nationwide Inpatient Samples of all uninsured nonelderly adults (18-64 yrs) admitted with primary diagnoses of trauma. We used US Census data to estimate annual postsubsistence income and inhospital charges for trauma-related admission. Our primary outcome measure was catastrophic health expenditure risk, defined as any charges >/=40\% of annual postsubsistence income. RESULTS: Our sample represented 579,683 admissions for uninsured nonelderly adults over the 5-year study period. Median estimated annual income was $40,867 (interquartile range: $21,286-$71.733). Median inpatient charges were $27,420 (interquartile range: $15,196-$49,694). Overall, 70.8\% (95\% posterior confidence interval: 70.7\%-71.1\%) of patients were at risk for CHE. The risk of CHE was similar across most demographic subgroups. The greatest risk, however, was concentrated among patients from low-income communities (77.5\% among patients in the lowest community income quartile) and among patients with severe injuries (81.8\% among those with ISS >/= 16). CONCLUSIONS: Over 7 in 10 uninsured patients admitted for trauma are at risk of catastrophic health expenditures. This analysis is the first application of CHE to a US trauma population and will be an important measure to evaluate the effectiveness of health care and coverage strategies to improve financial risk protection.},
	isbn = {1528-1140 (Electronic)0003-4932 (Linking)},
	author = {Scott, J. W. and Raykar, N. P. and Rose, J. A. and Tsai, T. C. and Zogg, C. K. and Haider, A. H. and Salim, A. and Meara, J. G. and Shrime, M. G.}
}
@article {526466,
	title = {The effect of Massachusetts health reform on access to care for Medicaid beneficiaries},
	journal = {Am J Manag CareAm J Manag Care},
	volume = {23},
	year = {2017},
	note = {Burke, Laura GTsai, Thomas CZheng, JieOrav, E JohnJha, Ashish Keng2017/02/01 06:00Am J Manag Care. 2017 Jan 1;23(1):e24-e30.},
	month = {Jan 01},
	pages = {e24-e30},
	abstract = {OBJECTIVES: To address concerns that expanding insurance coverage without expanding provider supply can lead to worse access for the previously insured, we examined whether previously insured Medicaid beneficiaries faced greater difficulties accessing primary care after statewide insurance expansion in Massachusetts. STUDY DESIGN: We used the Medicaid Analytic eXtract databases for Massachusetts and 3 New England control states for 2006 and 2009. We calculated rates of overall, acute, and chronic preventable admissions (or Prevention Quality Indicators [PQIs]) and a composite of control conditions for adults aged 21 to 64 years. METHODS: We used multivariate Poisson regression models, adjusting for age, race, gender, reason for Medicaid eligibility, and state-level physician supply, as well as a difference-in-differences (DID) approach to compare the change in the rate of PQIs and control admissions in Massachusetts versus control states before and after health reform. RESULTS: Massachusetts and control states had increases in unadjusted rates of overall, acute, and chronic PQIs. When adjusting for age, race, gender, reason for eligibility, and physician supply, this increase persisted for overall and chronic PQIs in control states, with no significant difference in the relative increase between the 2 groups for any of the PQI measures. For the within-Massachusetts analysis, low-uptake counties had a significant increase in admission for chronic PQIs that was greater than that observed for high-uptake counties (+148.0 vs +36.0; P = .045 for DID). There was no significant DID for acute or overall PQIs between the 2 groups. CONCLUSIONS: We found no evidence that insurance expansion in Massachusetts, compared with control states, reduced access to primary care for vulnerable Medicaid beneficiaries.},
	isbn = {1936-2692 (Electronic)1088-0224 (Linking)},
	author = {Burke, L. G. and Tsai, T. C. and Zheng, J. and Orav, E. J. and Jha, A. K.}
}
@article {526461,
	title = {Hospital Factors Associated With Care Discontinuity Following Emergency General Surgery},
	journal = {JAMA SurgJAMA Surg},
	volume = {152},
	year = {2017},
	note = {Havens, Joaquim MOlufajo, Olubode ATsai, Thomas CJiang, WeiColumbus, Alexandra BNitzschke, Stephanie LCooper, ZaraSalim, Alieng2016/11/17 06:00JAMA Surg. 2017 Mar 1;152(3):242-249. doi: 10.1001/jamasurg.2016.4078.},
	month = {Mar 01},
	pages = {242-249},
	abstract = {Importance: Although there is evidence that changes in clinicians during the continuum of care (care discontinuity) are associated with higher mortality and complications among surgical patients, little is known regarding the drivers of care discontinuity among emergency general surgery (EGS) patients. Objective: To identify hospital factors associated with care discontinuity among EGS patients. Design, Setting, and Participants: We performed a retrospective analysis of the 100\% Medicare inpatient claims file, from January 1, 2008, to November 30, 2011, and matched patient details to hospital information in the 2011 American Hospital Association Annual Survey database. We selected patients aged 65 years and older who had the most common procedures associated with the previously defined American Association for the Surgery of Trauma EGS diagnosis categories and survived to hospital discharge across the United States. The current analysis was conducted from February 1, 2016, to March 24, 2016. Main Outcomes and Measures: Care discontinuity defined as readmission within 30 days to nonindex hospitals. Results: There were 109443 EGS patients readmitted within 30 days of discharge and 20396 (18.6\%) were readmitted to nonindex hospitals. Of the readmitted patients, 61340 (56\%) were female. Care discontinuity was higher among patients who were male (19.5\% vs 18.0\%), those younger than 85 years old (19.0\% vs 16.6\%), and those who lived 12.8 km (8 miles) or more away from the index hospitals (23.7\% vs 14.8\%) (all P < .001). Care discontinuity was independently associated with mortality (adjusted odds ratio [aOR], 1.16; 95\% CI, 1.08-1.25). Hospital factors associated with care discontinuity included bed size of 200 or more (aOR, 1.45; 95\% CI, 1.36-1.54), safety-net status (aOR, 1.35; 95\% CI, 1.27-1.43), and teaching status (aOR, 1.18; 95\% CI, 1.09-1.28). Care discontinuity was significantly lower among designated trauma centers (aOR, 0.89; 95\% CI, 0.83-0.94) and highest among hospitals in the Midwest (aOR, 1.15; 95\% CI, 1.05-1.26). Conclusions and Relevance: Nearly 1 in 5 older EGS patients is readmitted to a hospital other than where their original procedure was performed. This care discontinuity is independently associated with mortality and is highest among EGS patients who are treated at large, teaching, safety-net hospitals. These data underscore the need for sustained efforts in increasing continuity of care among these hospitals and highlight the importance of accounting for these factors in risk-adjusted hospital comparisons.},
	isbn = {2168-6262 (Electronic)2168-6254 (Linking)},
	author = {Havens, J. M. and Olufajo, O. A. and Tsai, T. C. and Jiang, W. and Columbus, A. B. and Nitzschke, S. L. and Cooper, Z. and Salim, A.}
}
@article {526456,
	title = {Potential impact of Affordable Care Act-related insurance expansion on trauma care reimbursement},
	journal = {J Trauma Acute Care SurgJ Trauma Acute Care Surg},
	volume = {82},
	year = {2017},
	note = {Scott, John WNeiman, Pooja UNajjar, Peter ATsai, Thomas CScott, Kirstin WShrime, Mark GCutler, David MSalim, AliHaider, Adil Heng2017/04/22 06:00J Trauma Acute Care Surg. 2017 May;82(5):887-895. doi: 10.1097/TA.0000000000001400.},
	month = {May},
	pages = {887-895},
	abstract = {BACKGROUND: Nearly one quarter of trauma patients are uninsured and hospitals recoup less than 20\% of inpatient costs for their care. This study examines changes to hospital reimbursement for inpatient trauma care if the full coverage expansion provisions of the Affordable Care Act (ACA) were in effect. METHODS: We abstracted nonelderly adults (ages 18-64 years) admitted for trauma from the Nationwide Inpatient Sample during 2010-the last year before most major ACA coverage expansion policies. We calculated national and facility-level reimbursements and trauma-related contribution margins using Nationwide Inpatient Sample-supplied cost-to-charge ratios and published reimbursement rates for each payer type. Using US census data, we developed a probabilistic microsimulation model to determine the proportion of pre-ACA uninsured trauma patients that would be expected to gain private insurance, Medicaid, or remain uninsured after full implementation of the ACA. We then estimated the impact of these coverage changes on national and facility-level trauma reimbursement for this population. RESULTS: There were 145,849 patients (representing 737,852 patients nationwide) included. National inpatient trauma costs for patients aged 18 years to 64 years totaled US $14.8 billion (95\% confidence interval [CI], 12.5,17.1). Preexpansion reimbursements totaled US $13.7 billion (95\% CI, 10.8-14.7), yielding a national margin of -7.9\% (95\% CI, -10.6 to -5.1). Postexpansion projected reimbursements totaled US $15.0 billion (95\% CI, 12.7-17.3), increasing the margin by 9.3 absolute percentage points to +1.4\% (95\% CI, -0.3 to +3.2). Of the 263 eligible facilities, 90 (34.2\%) had a positive trauma-related contribution margin in 2010, which increased to 171 (65.0\%) using postexpansion projections. Those facilities with the highest proportion of uninsured and racial/ethnic minorities experienced the greatest gains. CONCLUSION: Health insurance coverage expansion for uninsured trauma patients has the potential to increase national reimbursement for inpatient trauma care by over one billion dollars and nearly double the proportion of hospitals with a positive margin for trauma care. These data suggest that insurance coverage expansion has the potential to improve trauma centers{\textquoteright} financial viability and their ability to provide care for their communities. LEVEL OF EVIDENCE: Economic analysis, level II.},
	isbn = {2163-0763 (Electronic)2163-0755 (Linking)},
	author = {Scott, J. W. and Neiman, P. U. and Najjar, P. A. and Tsai, T. C. and Scott, K. W. and Shrime, M. G. and Cutler, D. M. and Salim, A. and Haider, A. H.}
}
@article {526481,
	title = {Better Patient Care At High-Quality Hospitals May Save Medicare Money And Bolster Episode-Based Payment Models},
	journal = {Health Aff (Millwood)Health Aff (Millwood)},
	volume = {35},
	year = {2016},
	note = {Tsai, Thomas CGreaves, FelixZheng, JieOrav, E JohnZinner, Michael JJha, Ashish Keng2016/09/09 06:00Health Aff (Millwood). 2016 Sep 1;35(9):1681-9. doi: 10.1377/hlthaff.2016.0361.},
	month = {Sep 01},
	pages = {1681-9},
	abstract = {US policy makers are making efforts to simultaneously improve the quality of and reduce spending on health care through alternative payment models such as bundled payment. Bundled payment models are predicated on the theory that aligning financial incentives for all providers across an episode of care will lower health care spending while improving quality. Whether this is true remains unknown. Using national Medicare fee-for-service claims for the period 2011-12 and data on hospital quality, we evaluated how thirty- and ninety-day episode-based spending were related to two validated measures of surgical quality-patient satisfaction and surgical mortality. We found that patients who had major surgery at high-quality hospitals cost Medicare less than those who had surgery at low-quality institutions, for both thirty- and ninety-day periods. The difference in Medicare spending between low- and high-quality hospitals was driven primarily by postacute care, which accounted for 59.5 percent of the difference in thirty-day episode spending, and readmissions, which accounted for 19.9 percent. These findings suggest that efforts to achieve value through bundled payment should focus on improving care at low-quality hospitals and reducing unnecessary use of postacute care.},
	keywords = {Cost of Health Care, Health reform, Health Spending, Quality Of Care},
	isbn = {1544-5208 (Electronic)0278-2715 (Linking)},
	author = {Tsai, T. C. and Greaves, F. and Zheng, J. and Orav, E. J. and Zinner, M. J. and Jha, A. K.}
}
@article {526471,
	title = {Implications of the Patient Protection and Affordable Care Act on Insurance Coverage and Rehabilitation Use Among Young Adult Trauma Patients},
	journal = {JAMA SurgJAMA Surg},
	volume = {151},
	year = {2016},
	note = {Zogg, Cheryl KPayro Chew, FernandoScott, John WWolf, Lindsey LTsai, Thomas CNajjar, PeterOlufajo, Olubode ASchneider, Eric BHaut, Elliott RHaider, Adil HCanner, Joseph Keng2016/10/21 06:00JAMA Surg. 2016 Dec 21;151(12):e163609. doi: 10.1001/jamasurg.2016.3609. Epub 2016 Dec 21.},
	month = {Dec 21},
	pages = {e163609},
	abstract = {Importance: Trauma is the leading cause of death and disability among young adults, who are also among the most likely to be uninsured. Efforts to increase insurance coverage, including passage of the Patient Protection and Affordable Care Act (ACA), were intended to improve access to care and promote improvements in outcomes. However, despite reported gains in coverage, the ACA{\textquoteright}s success in promoting use of high-quality care and enacting changes in clinical end points remains unclear. Objectives: To assess for observed changes in insurance coverage and rehabilitation use among young adult trauma patients associated with the ACA, including the Dependent Coverage Provision (DCP) and Medicaid expansion/open enrollment, and to consider possible insurance and rehabilitation differences between DCP-eligible vs -ineligible patients and among stratified demographic and community subgroups. Design, Setting, and Participants: A longitudinal assessment of DCP implementation and Medicaid expansion/open enrollment using risk-adjusted before-and-after, difference-in-difference, and interrupted time-series analyses was conducted. Eleven years (January 1, 2005, to September 31, 2015) of Maryland Health Services Cost Review Commission data, representing complete patient records from all payers within the state, were used to identify all hospitalized young adult (aged 18-34 years) trauma patients in Maryland during the study period. Results: Of the 69507 hospitalized patients included, 50548 (72.7\%) were male, and the mean (SD) age was 25 (5) years. Before implementation of the DCP, 1 of 4 patients was uninsured. After ACA implementation, the number fell to less than 1 of 10, with similar patterns emerging in emergency department and outpatient settings. The change was primarily driven by Medicaid expansion/open enrollment, which corresponded to a 20.1 percentage-point increase in Medicaid (95\% CI, 18.9-21.3) and an 18.2 percentage-point decrease in uninsured (95\% CI, -19.3 to -17.2). No changes were detected among privately insured patients. Rehabilitation use increased by 5.4 percentage points (95\% CI, 4.5-6.2)-a 60\% relative increase from a baseline of 9\%. Mortality (-0.5; 95\% CI, -0.9 to -0.1) and failure-to-rescue rates (-4.5; 95\% CI, -7.4 to -1.6) also significantly declined. Stratified changes point to significant differences in the percentage of uninsured patients and rehabilitation access across the board, mitigating or even eradicating disparities in certain cases. Conclusions and Relevance: For patients who are injured, young, and uninsured, Medicaid expansion/open enrollment in Maryland changed insurance coverage and altered patient outcomes in ways that the DCP alone was never intended to do. Implementation of Medicaid expansion/open enrollment transformed the landscape of trauma coverage, directly affecting the health of one of the country{\textquoteright}s most vulnerable at-risk groups.},
	isbn = {2168-6262 (Electronic)2168-6254 (Linking)},
	author = {Zogg, C. K. and Payro Chew, F. and Scott, J. W. and Wolf, L. L. and Tsai, T. C. and Najjar, P. and Olufajo, O. A. and Schneider, E. B. and Haut, E. R. and Haider, A. H. and Canner, J. K.}
}
@article {526476,
	title = {Rethinking Priorities: Cost of Complications After Elective Colectomy},
	journal = {Ann SurgAnn Surg},
	volume = {264},
	year = {2016},
	note = {Zogg, Cheryl KNajjar, PeterDiaz, Arturo J RiosZogg, Donald LTsai, Thomas CRose, John A JrScott, John WGani, FaizAlshaikh, HusainCanner, Joseph KSchneider, Eric BGoldberg, Joel EHaider, Adil Heng2015/10/27 06:00Ann Surg. 2016 Aug;264(2):312-22. doi: 10.1097/SLA.0000000000001511.},
	month = {Aug},
	pages = {312-22},
	abstract = {OBJECTIVE: To compare incremental costs associated with complications of elective colectomy using nationally representative data among patients undergoing laparoscopic/open resections for the 4 most frequent diagnoses. SUMMARY BACKGROUND DATA: Rising healthcare costs have led to increasing focus on the need to achieve a better understanding of the association between costs and quality. Among elective colectomies, a focus of surgical quality-improvement initiatives, interpretable evidence to support existing approaches is lacking. METHODS: The 2009 to 2011 Nationwide Inpatient Sample (NIS) data were queried for adult (>/=18 years) patients undergoing elective colectomy. Patients with primary diagnoses for colon cancer, diverticular disease, benign colonic neoplasm, and ulcerative colitis/regional enteritis were included. Based on system-based complications considered relevant to long-term treatment of elective colectomy, stratified differences in risk-adjusted incremental hospital costs and complications probabilities were compared. RESULTS: A total of 68,462 patients were included, weighted to represent 337,887 patients nationwide. A total of 16.4\% experienced complications. Annual risk-adjusted incremental costs amounted to >$150 million. Magnitudes of complication prevalences/costs varied by primary diagnosis, operative technique, and complication group. Infectious complications contributed the most ($55 million), followed by gastrointestinal ($53 million), pulmonary ($22 million), and cardiovascular ($11 million) complications. Total annual costs for elective colectomies amounted to >$1.7 billion: 11.3\% was due to complications [1.9\% due to current Centers for Medicare and Medicaid Services (CMS) complications]. CONCLUSIONS: The results highlight a need to consider the varied/broad impact of complications, offering a stratified paradigm for priority setting in surgery. As we move forward in the development of novel/adaptation of existing interventions, it will be essential to weigh the cost of complications in an evidence-based way.},
	isbn = {1528-1140 (Electronic)0003-4932 (Linking)},
	author = {Zogg, C. K. and Najjar, P. and Diaz, A. J. and Zogg, D. L. and Tsai, T. C. and Rose, J. A., Jr. and Scott, J. W. and Gani, F. and Alshaikh, H. and Canner, J. K. and Schneider, E. B. and Goldberg, J. E. and Haider, A. H.}
}
@article {452126,
	title = {Better Patient Care At High-Quality Hospitals May Save Medicare Money And Bolster Episode-Based Payment Models.},
	journal = {Health Aff (Millwood)},
	volume = {35},
	number = {9},
	year = {2016},
	month = {2016 Sep 1},
	pages = {1681-9},
	abstract = {US policy makers are making efforts to simultaneously improve the quality of and reduce spending on health care through alternative payment models such as bundled payment. Bundled payment models are predicated on the theory that aligning financial incentives for all providers across an episode of care will lower health care spending while improving quality. Whether this is true remains unknown. Using national Medicare fee-for-service claims for the period 2011-12 and data on hospital quality, we evaluated how thirty- and ninety-day episode-based spending were related to two validated measures of surgical quality-patient satisfaction and surgical mortality. We found that patients who had major surgery at high-quality hospitals cost Medicare less than those who had surgery at low-quality institutions, for both thirty- and ninety-day periods. The difference in Medicare spending between low- and high-quality hospitals was driven primarily by postacute care, which accounted for 59.5~percent of the difference in thirty-day episode spending, and readmissions, which accounted for 19.9~percent. These findings suggest that efforts to achieve value through bundled payment should focus on improving care at low-quality hospitals and reducing unnecessary use of postacute care.},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2016.0361},
	author = {Tsai, Thomas C. and Greaves, Felix and Zheng, Jie and Orav, E. John and Zinner, Michael J and Jha, Ashish K}
}
@article {452131,
	title = {Impact of ACA Insurance Coverage Expansion on Perforated Appendix Rates Among Young Adults.},
	journal = {Med Care},
	volume = {54},
	number = {9},
	year = {2016},
	month = {2016 Sep},
	pages = {818-26},
	abstract = {BACKGROUND: The 2010 Dependent Coverage Provision (DCP) of the Affordable Care Act allowed young adults to remain on their parents{\textquoteright} health insurance plans until age 26 years. Although the provision improved coverage and survey-reported access to care, little is known regarding its impact on timely access for acute conditions. This study aims to assess changes in insurance coverage and perforation rates among young adults with acute appendicitis-an established metric for population-level health care access-after the DCP.

METHODS: The National Inpatient Sample and difference-in-differences linear regression were used to assess prepolicy/postpolicy changes for policy-eligible young adults (aged 19-25 y) compared with a slightly older, policy-ineligible comparator group (aged 26-34 y).

RESULTS: After adjustment for covariates, 19-25 year olds experienced a 3.6-percentage point decline in the uninsured rate after the DCP (baseline 22.5\%), compared with 26-34 year olds (P,
	issn = {1537-1948},
	doi = {10.1097/MLR.0000000000000586},
	author = {Scott, John W and Rose, John A and Tsai, Thomas C. and Zogg, Cheryl K and Mark G. Shrime and Benjamin D Sommers and Salim, Ali and Haider, Adil H}
}
@article {413191,
	title = {Delivering value by focusing on patient experience.},
	journal = {Am J Manag Care},
	volume = {21},
	number = {10},
	year = {2015},
	month = {2015 Oct},
	pages = {735-7},
	abstract = {The use of patient experience as a quality metric in healthcare remains controversial. Clinicians have expressed concern that incentives focused on patient experience may lead to lower quality care. However, empirical evidence from the United States and abroad suggests that hospitals and ambulatory care providers with higher patient satisfaction scores also perform better on clinical process and outcome measures. While it may be that high-performing providers simply have more resources to devote to both patient experience and the technical aspects of care, we suspect that these providers{\textquoteright} performance is also driven by a conscious commitment to quality. As the country shifts toward new payment models, we should encourage this type of commitment to quality. Perhaps most importantly, improving the patient experience will build trust in the healthcare system, guard against withholding of services in the face of changing provider incentives, and promote collaboration between clinicians and patients. Therefore, patient experience measures should play a critical role in how we judge high-quality, value-based care.},
	issn = {1936-2692},
	author = {Chatterjee, Paula and Tsai, Thomas C. and Jha, Ashish K}
}
@article {413196,
	title = {Rethinking Priorities: Cost of Complications After Elective Colectomy.},
	journal = {Ann Surg},
	year = {2015},
	month = {2015 Oct 31},
	abstract = {OBJECTIVE: To compare incremental costs associated with complications of elective colectomy using nationally representative data among patients undergoing laparoscopic/open resections for the 4 most frequent diagnoses.

SUMMARY BACKGROUND DATA: Rising healthcare costs have led to increasing focus on the need to achieve a better understanding of the association between costs and quality. Among elective colectomies, a focus of surgical quality-improvement initiatives, interpretable evidence to support existing approaches is lacking.

METHODS: The 2009 to 2011 Nationwide Inpatient Sample (NIS) data were queried for adult (>=18 years) patients undergoing elective colectomy. Patients with primary diagnoses for colon cancer, diverticular disease, benign colonic neoplasm, and ulcerative colitis/regional enteritis were included. Based on system-based complications considered relevant to long-term treatment of elective colectomy, stratified differences in risk-adjusted incremental hospital costs and complications probabilities were compared.

RESULTS: A total of 68,462 patients were included, weighted to represent 337,887 patients nationwide. A total of 16.4\% experienced complications. Annual risk-adjusted incremental costs amounted to >$150 million. Magnitudes of complication prevalences/costs varied by primary diagnosis, operative technique, and complication group. Infectious complications contributed the most ($55 million), followed by gastrointestinal ($53 million), pulmonary ($22 million), and cardiovascular ($11 million) complications. Total annual costs for elective colectomies amounted to >$1.7 billion: 11.3\% was due to complications [1.9\% due to current Centers for Medicare and Medicaid Services (CMS) complications].

CONCLUSIONS: The results highlight a need to consider the varied/broad impact of complications, offering a stratified paradigm for priority setting in surgery. As we move forward in the development of novel/adaptation of existing interventions, it will be essential to weigh the cost of complications in an evidence-based way.},
	issn = {1528-1140},
	doi = {10.1097/SLA.0000000000001511},
	author = {Zogg, Cheryl K and Najjar, Peter and Rios Diaz, Arturo J and Zogg, Donald L and Tsai, Thomas C. and Rose, John A and Scott, John W and Gani, Faiz and Alshaikh, Husain and Nagarajan, Neeraja and Canner, Joseph K and Schneider, Eric B and Goldberg, Joel E and Haider, Adil H}
}
@article {tsai2015bundling,
	title = {Bundling Payments for Episodes of Surgical Care},
	journal = {JAMA surgery},
	year = {2015},
	author = {Tsai, Thomas C. and Miller, David C}
}
@article {tsai2015hospital,
	title = {Hospital Board And Management Practices Are Strongly Related To Hospital Performance On Clinical Quality Metrics},
	journal = {Health Affairs},
	volume = {34},
	year = {2015},
	pages = {1304{\textendash}1311},
	publisher = {Project HOPE-The People-to-People Health Foundation, Inc.},
	author = {Tsai, Thomas C. and Jha, Ashish K and Gawande, Atul A and Robert S. Huckman and Bloom, Nicholas and Raffaella Sadun}
}
@article {scott2015racial,
	title = {Racial and Regional Disparities in the Effect of the Affordable Care Act{\textquoteright}s Dependent Coverage Provision on Young Adult Trauma Patients},
	journal = {Journal of the American College of Surgeons},
	year = {2015},
	publisher = {Elsevier},
	author = {Scott, John W and Salim, Ali and Benjamin D Sommers and Tsai, Thomas C. and Scott, Kirstin W and Zirui Song}
}
@article {238311,
	title = {Medicare{\textquoteright}s Bundled Payment Initiative: Most Hospitals Are Focused On A Few High-Volume Conditions.},
	journal = {Health Aff (Millwood)},
	volume = {34},
	number = {3},
	year = {2015},
	month = {2015 Mar 1},
	pages = {371-80},
	abstract = {The Bundled Payments for Care Improvement initiative is a federally funded innovation model mandated by the Affordable Care Act. It is designed to help transition Medicare away from fee-for-service payments and toward bundling a single payment for an episode of acute care in a hospital and related postacute care in an appropriate setting. While results from the initiative will not be available for several years, current data can help provide critical early insights. However, little is known about the participating organizations and how they are focusing their efforts. We identified participating hospitals and used national Medicare claims data to assess their characteristics and previous spending patterns. These hospitals are mostly large, nonprofit, teaching hospitals in the Northeast, and they have selectively enrolled in the bundled payment initiative covering patient conditions with high clinical volumes. We found no significant differences in episode-based spending between participating and nonparticipating hospitals. Postacute care explains the largest variation in overall episode-based spending, signaling an opportunity to align incentives across providers. However, the focus on a few selected clinical conditions and the high degree of integration that already exists between enrolled hospitals and postacute care providers may limit the generalizability of bundled payment across the Medicare system.},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2014.0900},
	author = {Tsai, Thomas C. and Joynt, Karen E and Wild, Robert C and Orav, E. John and Jha, Ashish K}
}
@article {238316,
	title = {Racial disparities in the type of postmastectomy reconstruction chosen.},
	journal = {J Surg Res},
	year = {2015},
	month = {2015 Jan 13},
	abstract = {BACKGROUND: Racial disparities remain for women undergoing immediate breast reconstruction (IBR) after mastectomy. Understanding patterns of racial disparities in IBR utilization may present opportunities to tailor policies aimed at optimizing care across racial groups. The aim of this study was to determine if racial disparities exist for types of IBR chosen.

METHODS: A national, retrospective cohort study used the 2005-2011 American College of Surgeons National Surgical Quality Improvement Program database. Multivariable logistic regression models were created to detect the odds by race for receiving each subtype of IBR after mastectomy-prosthetic, pedicled-transfer autologous tissue, or free-transfer autologous tissue. Secondary outcome was trends in IBR rates over time.

RESULTS: There were 44,597 women identified in the data set who underwent mastectomy. Thirty-seven percent of women (N~=~16, 642) were noted to undergo IBR after mastectomy. Prosthetic reconstruction (84.4\%, n~=~37, 640) was the most common form of IBR compared with pedicled-autologous reconstruction (15.4\%, n~=~6868) and free transfer autologous reconstruction (4.9\%, n~=~2185), P~,
	issn = {1095-8673},
	doi = {10.1016/j.jss.2015.01.013},
	author = {Offodile, Anaeze C and Tsai, Thomas C. and Wenger, Julia B and Guo, Lifei}
}
@article {232266,
	title = {Care fragmentation in the postdischarge period: surgical readmissions, distance of travel, and postoperative mortality.},
	journal = {JAMA Surg},
	volume = {150},
	number = {1},
	year = {2015},
	month = {2015 Jan 1},
	pages = {59-64},
	abstract = {IMPORTANCE: Despite policies aimed at incentivizing clinical integration, few data exist on whether fragmentation of care is associated with worse outcomes for elderly patients undergoing major surgery.

OBJECTIVE: To determine whether postdischarge surgical care fragmentation is associated with worse outcomes and whether distances between hospitals explain differences in patient outcomes.

DESIGN, SETTING, AND PARTICIPANTS: We used the 100\% Medicare inpatient file for claims from January 1, 2009, through November 30, 2011. Data on hospital structural features, including zip code of location, were obtained from the 2011 American Hospital Association Annual Survey. We identified patients who underwent coronary artery bypass grafting, pulmonary lobectomy, endovascular abdominal aortic aneurysm repair, open abdominal aortic aneurysm repair, colectomy, and hip replacement.

MAIN OUTCOMES AND MEASURES: Thirty-day surgical mortality.

RESULTS: A total of 93 062 patients who underwent the surgical procedures of interest were subsequently readmitted within 30 days of discharge; 23 278 of these patients (25.0\%) were readmitted to a hospital other than the one where their procedure was performed. Patients who were readmitted to a different hospital generally lived farther from the index hospital than those who were readmitted to the index hospital (20.7 vs 7.4 miles, P ,
	issn = {2168-6262},
	doi = {10.1001/jamasurg.2014.2071},
	author = {Tsai, Thomas C. and Orav, E. John and Jha, Ashish K}
}
@article {232261,
	title = {Complication timing and association with mortality in the American College of Surgeons{\textquoteright} National Surgical Quality Improvement Program database.},
	journal = {J Surg Res},
	volume = {193},
	number = {1},
	year = {2015},
	month = {2015 Jan},
	pages = {77-87},
	abstract = {BACKGROUND: The relationship between timing of postoperative complications on mortality is unknown. We investigated the time-variable mortality risks of common surgical complications.

METHODS: We identified patients undergoing nonemergent, in-patient surgery in the National Surgical Quality Improvement Program (NSQIP) database during 2005-2011 who experienced any of 13 complications within 2~wk of surgery. "Expected timing" was defined as the median postoperative day of occurrence. Hazard ratios (HRs) for complications earlier or later than expected were calculated using Cox proportional hazards, adjusted for~age, procedure, American Society of Anesthesiology (ASA), and functional status. A secondary analysis evaluated the effect of preceding complication burden on the relationship between complication timing and mortality.

RESULTS: Among 77,443 patients experiencing complications, significantly higher mortality was observed with early wound infections (superficial HR 1.30, confidence interval [CI] 1.01-1.70; deep HR 1.52, CI 1.07-2.16; and organ space HR 1.38, CI 1.11-1.70) despite adjustment for patient and operative factors and complication burden. Early cardiac arrest and unplanned intubation were associated with lower mortality, which persisted after adjustment (HR 0.59, CI 0.51-0.68; HR 0.38, CI 0.33-0.43, respectively). By contrast, late occurrence of acute myocardial infarction, pneumonia, and cerebrovascular accident was associated with significantly greater mortality risk (HR 1.41, CI 1.18-1.69; HR 1.37, CI 1.24-1.52; and HR 1.61, CI 1.31-1.98, respectively), but these associations became nonsignificant after adjustment for complication burden.

CONCLUSIONS: Timing of complications plays an important role in mortality. Surgeons and trainees should be aware of these patterns and tailor their clinical care and monitoring practices to account for the implications of complication timing on mortality.},
	issn = {1095-8673},
	doi = {10.1016/j.jss.2014.08.025},
	author = {Wakeam, Elliot and Hyder, Joseph A and Tsai, Thomas C. and Lipsitz, Stuart R and Dennis P. Orgill and Finlayson, Sam R G}
}
@article {232271,
	title = {Dependent coverage provision led to uneven insurance gains and unchanged mortality rates in young adult trauma patients.},
	journal = {Health Aff (Millwood)},
	volume = {34},
	number = {1},
	year = {2015},
	month = {2015 Jan 1},
	pages = {125-33},
	abstract = {Insurance coverage has increased among young adults as a result of the Affordable Care Act (ACA) provision that allows young adults to remain covered under their parents{\textquoteright} plans until age twenty-six. However, little is known about the provision{\textquoteright}s effects on the clinical outcomes and insurance coverage of patients with trauma-the most frequent cause of death and physical disability among young adults. Using 2007-12 data from the National Trauma Data Bank, we conducted a difference-in-differences analysis of coverage rates among trauma patients ages~19-25 (compared to patients ages~26-34, who served as the control group), and we examined trauma-relevant outcomes by patient, injury, and hospital characteristics. We found a 3.4-percentage-point decrease in uninsurance status among younger trauma patients following the policy change. The decrease was concentrated among men, non-Hispanic whites, those with relatively less severe injuries, and those who presented to nonteaching hospitals. We did not detect significant changes in the use of intensive care or in overall mortality. The heterogeneous coverage impact of the ACA dependent coverage provision on high- versus low-risk trauma patients has implications for future efforts to expand coverage.},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2014.0880},
	author = {Scott, John W and Benjamin D Sommers and Tsai, Thomas C. and Scott, Kirstin W and Schwartz, Aaron L and Zirui Song}
}
@article {232276,
	title = {Underlying reasons associated with hospital readmission following surgery in the United States.},
	journal = {JAMA},
	volume = {313},
	number = {5},
	year = {2015},
	month = {2015 Feb 3},
	pages = {483-95},
	abstract = {IMPORTANCE: Financial penalties for readmission have been expanded beyond medical conditions to include surgical procedures. Hospitals are working to reduce readmissions; however, little is known about the reasons for surgical readmission.

OBJECTIVE: To characterize the reasons, timing, and factors associated with unplanned postoperative readmissions.

DESIGN, SETTING, AND PARTICIPANTS: Patients undergoing surgery at one of 346 continuously enrolled US hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) between January 1, 2012, and December 31, 2012, had clinically abstracted information examined. Readmission rates and reasons (ascertained by clinical data abstractors at each hospital) were assessed for all surgical procedures and for 6 representative operations: bariatric procedures, colectomy or proctectomy, hysterectomy, total hip or knee arthroplasty, ventral hernia repair, and lower extremity vascular bypass.

MAIN OUTCOMES AND MEASURES: Unplanned 30-day readmission and reason for readmission.

RESULTS: The unplanned readmission rate for the 498,875 operations was 5.7\%. For the individual procedures, the readmission rate ranged from 3.8\% for hysterectomy to 14.9\% for lower extremity vascular bypass. The most common reason for unplanned readmission was surgical site infection (SSI) overall (19.5\%) and also after colectomy or proctectomy (25.8\%), ventral hernia repair (26.5\%), hysterectomy (28.8\%), arthroplasty (18.8\%), and lower extremity vascular bypass (36.4\%). Obstruction or ileus was the most common reason for readmission after bariatric surgery (24.5\%) and the second most common reason overall (10.3\%), after colectomy or proctectomy (18.1\%), ventral hernia repair (16.7\%), and hysterectomy (13.4\%). Only 2.3\% of patients were readmitted for the same complication they had experienced during their index hospitalization. Only 3.3\% of patients readmitted for SSIs had experienced an SSI during their index hospitalization. There was no time pattern for readmission, and early (<=7 days postdischarge) and late (>7 days postdischarge) readmissions were associated with the same 3 most common reasons: SSI, ileus or obstruction, and bleeding. Patient comorbidities, index surgical admission complications, non-home discharge (hazard ratio [HR], 1.40 [95\% CI, 1.35-1.46]), teaching hospital status (HR, 1.14 [95\% CI 1.07-1.21]), and higher surgical volume (HR, 1.15 [95\% CI, 1.07-1.25]) were associated with a higher risk of hospital readmission.

CONCLUSIONS AND RELEVANCE: Readmissions after surgery were associated with new postdischarge complications related to the procedure and not exacerbation of prior index hospitalization complications, suggesting that readmissions after surgery are a measure of postdischarge complications. These data should be considered when developing quality indicators and any policies penalizing hospitals for surgical readmission.},
	issn = {1538-3598},
	doi = {10.1001/jama.2014.18614},
	author = {Merkow, Ryan P and Ju, Mila H and Chung, Jeanette W and Hall, Bruce L and Cohen, Mark E and Williams, Mark V and Tsai, Thomas C. and Ko, Clifford Y and Bilimoria, Karl Y}
}
@article {204026,
	title = {Hospital consolidation, competition, and quality: Is bigger necessarily better?},
	journal = {JAMA},
	volume = {312},
	number = {1},
	year = {2014},
	note = {10.1001/jama.2014.4692},
	month = {2014/07/02},
	pages = {29 - 30},
	abstract = {A wave of hospital mergers during the last several years has raised concerns among US policy makers, regulators, and employers that increasing market consolidation may lead to higher health care spending as larger systems with greater market power extract higher prices from private payers. The number of hospital mergers or acquisitions has doubled since 2009, and many observers have pointed to the Affordable Care Act for transforming the economics of health care in ways that incentivize the creation of larger hospital systems.1 Although regulators are concerned about the effects of consolidation on health care prices, hospitals seeking to merge argue that larger, integrated systems will be able to provide substantially better care and achieve greater efficiencies.2 Whether these benefits result from consolidation is unclear. As federal regulators and policy makers weigh these issues, an assessment of the arguments that underlie the consolidation of the medical marketplace, and the potential influence of these arguments on clinical care, is warranted.},
	isbn = {0098-7484},
	url = {http://dx.doi.org/10.1001/jama.2014.4692},
	author = {Tsai TC and Jha AK}
}
@article {204031,
	title = {Using a composite readmission measure to assess surgical quality in the veterans health administration: How well does it correlate with established surgical measures?},
	journal = {JAMA Surgery},
	year = {2014},
	note = {10.1001/jamasurg.2014.1095},
	month = {2014/09/10},
	pages = { - },
	abstract = {Preventing readmissions is a top priority in the current health care landscape. Although medical conditions have been the focus of these efforts, the Centers for Medicare and Medicaid Services recently added 30-day all-cause readmissions after total hip/knee replacement to their 2014 public reporting and pay-for-performance programs.1 Compared with medical conditions, readmissions after surgery have been poorly studied. Furthermore, whether they truly reflect hospital surgical quality is not clear. To address this gap, we developed a hospital-level readmission composite measure that included 7 major surgical procedures frequently performed in Veterans Affairs (VA) hospitals and assessed how well it correlated with other well-established surgical quality metrics.},
	isbn = {2168-6254},
	url = {http://dx.doi.org/10.1001/jamasurg.2014.1095},
	author = {Chen Q and Tsai TC and Mull HJ and Rosen AK and Itani KF}
}
@article {176231,
	title = {Disparities in Surgical 30-Day Readmission Rates for Medicare Beneficiaries by Race and Site of Care},
	journal = {Annals of surgery},
	year = {2014},
	note = {Tsai, Thomas COrav, E JohnJoynt, Karen EENGAnn Surg. 2014 Jan 16.},
	month = {Jan 16},
	edition = {2014/01/21},
	abstract = {OBJECTIVE:: To determine whether black patients have higher odds of readmission than white patients after major surgery, and to ascertain whether these disparities are related to where black patients receive care. BACKGROUND:: Racial disparities are known to exist for many aspects of surgical care. However, it is unknown if disparities exist in readmissions after a surgical procedure, an area which is becoming a prime focus for clinical leaders and policymakers. METHODS:: Using national Medicare data from 2007 to 2010, we examined 30-day readmissions for patients undergoing coronary artery bypass grafting, pulmonary lobectomy, endovascular abdominal aortic aneurysm repair, open abdominal aortic aneurysm repair, colectomy, and hip replacement. The main outcome measure was risk-adjusted odds of all-cause 30-day readmission. We used multivariate logistic regression to determine if black patients had higher readmission rates than white patients, and if so, whether this effect was mediated by the hospitals at which patients received care, or by poverty. RESULTS:: Black patients had higher readmission rates than white patients (14.8\% vs 12.8\%, odds ratio [OR] 1.19; 95\% confidence interval [CI], 1.16-1.22; P \&lt; 0.001). Patients undergoing major surgery at minority-serving hospitals also had higher readmission rates (14.3\% vs 12.8\%, OR 1.14, 95\% CI 1.09-1.19; P \&lt; 0.001). In multivariate analyses, black patients at minority-serving hospitals had the highest overall odds of readmissions (OR 1.34). White patients at minority-serving hospitals (OR 1.15) and black patients at non-minority-serving hospitals (OR 1.20) also had higher odds of readmission than the reference group of white patients at non-minority-serving hospitals. Racial disparities were mediated in part by poverty. CONCLUSIONS:: Among Medicare beneficiaries, black patients were more likely to be readmitted after hospitalization for surgical procedures. Since racial disparities in readmission rates are mediated both by patients{\textquoteright} race and the hospital at which care is delivered, efforts at reducing disparities should focus not only on race-based measures but also on improving outcomes of care at minority-serving hospitals.},
	isbn = {1528-1140 (Electronic)0003-4932 (Linking)},
	author = {Tsai, T. C. and Orav, E. J. and Joynt, K. E.}
}
@article {176226,
	title = {Patient Satisfaction and Quality of Surgical Care in US Hospitals},
	journal = {Annals of surgery},
	year = {2014},
	note = {Tsai, Thomas COrav, E JohnJha, Ashish KENG2014/06/03 06:00Ann Surg. 2014 May 30.},
	month = {May 30},
	abstract = {OBJECTIVE:: The relationship between patient satisfaction and surgical quality is unclear for US hospitals. Using national data, we examined if hospitals with high patient satisfaction have lower levels of performance on accepted measures of the quality and efficiency of surgical care. BACKGROUND:: Federal policymakers have made patient satisfaction a core measure for the way hospitals are evaluated and paid through the value-based purchasing program. There is broad concern that performance on patient satisfaction may have little or even a negative correlation with the quality of surgical care, leading to potential trade-offs in efforts to improve patient experience with other surgical quality measures. METHODS:: We used the Hospital Consumer Assessment of Healthcare Providers and Systems survey data from 2010 and 2011 to assess performance on patient experience. We used national Medicare data on 6 common surgical procedures to calculate measures of surgical efficiency and quality: risk-adjusted length of stay, process score, risk-adjusted mortality rate, risk-adjusted readmission rate, and a composite z score across all 4 metrics. Multivariate models adjusting for hospital characteristics were used to assess the independent relationships between patient satisfaction and measures of surgical efficiency and quality. RESULTS:: Of the 2953 US hospitals that perform one of these 6 procedures, the median patient satisfaction score was 69.5\% (interquartile range, 63\%-75.5\%). Length of stay was shorter in hospitals with the highest levels of patient satisfaction (7.1 days vs 7.7 days, P \&lt; 0.001). Adjusting for procedural volume and structural characteristics, institutions in the highest quartile of patient satisfaction had the higher process of care performance (96.5 vs 95.5, P \&lt; 0.001), lower readmission rates (12.3\% vs 13.6\%, P \&lt; 0.001), and lower mortality (3.1\% vs 3.6\%) than those in the lowest quartile. Hospitals with high patient satisfaction also had a higher composite score for quality across all measures (P \&lt; 0.001). CONCLUSIONS:: Among US hospitals that perform major surgical procedures, hospitals with high patient satisfaction provided more efficient care and were associated with higher surgical quality. Our findings suggest there need not be a trade-off between good quality of care for surgical patients and ensuring a positive patient experience.},
	isbn = {1528-1140 (Electronic)0003-4932 (Linking)},
	author = {Tsai, T. C. and Orav, E. J. and Jha, AK}
}
@article {106006,
	title = {Variation in Surgical-Readmission Rates and Quality of Hospital Care},
	journal = {New England Journal of Medicine},
	volume = {369},
	year = {2013},
	pages = {1134-1142},
	author = {Tsai, Thomas C. and Joynt, Karen E and Orav, E. John and Gawande, Atul A and Jha, Ashish K}
}
@article {106001,
	title = {Responding to the Boston marathon bombing: the unheralded role of graduate medical education},
	journal = {Journal of Surgical Education},
	volume = {70},
	number = {5},
	year = {2013},
	pages = {555-556},
	author = {Tsai, Thomas C. and Smink, Douglas S}
}
@article {53671,
	title = {The contribution of international medical students to Taiwanese medical school classes},
	journal = {Med TeachMed TeachMed Teach},
	volume = {35},
	year = {2013},
	note = {Fan, A PTran, D TMandell, G ASu, T PChiu, A WKosik, R OTsai, T CMorisky, D EengEngland2012/09/21 06:00Med Teach. 2013;35(1):100-1. doi: 10.3109/0142159X.2012.716560. Epub 2012 Sep 19.},
	pages = {100-1},
	isbn = {1466-187X (Electronic)0142-159X (Linking)},
	author = {Fan, A. P. and Tran, D. T. and Mandell, G. A. and Su, T. P. and Chiu, A. W. and Kosik, R. O. and Tsai, T. C. and Morisky, D. E.}
}
@article {53681,
	title = {Patient Safety Education Should Start in the Preclinical Years},
	journal = {Academic MedicineAcademic Medicine},
	volume = {86},
	year = {2011},
	pages = {4 10.1097/ACM.0b013e318201098f},
	keywords = {00001888-201101000-00008},
	isbn = {1040-2446},
	author = {Goldstein, Matthew and Tsai, Thomas C.}
}
@article {53701,
	title = {Combined endovascular and open operative approach for mycotic carotid aneurysm},
	journal = {J Vasc SurgJ Vasc SurgJ Vasc Surg},
	volume = {51},
	year = {2010},
	note = {Tsai, Thomas CBarot, NikhilDalman, RonaldMihm, FrederickengCase Reports2010/03/23 06:00J Vasc Surg. 2010 Jun;51(6):1514-6. doi: 10.1016/j.jvs.2009.12.067. Epub 2010 Mar 20.},
	month = {Jun},
	pages = {1514-6},
	abstract = {Mycotic aneurysms of the extracranial carotid artery are rare and warrant surgical intervention. Management involves open and endovascular approaches. We report the case of a 67-year-old woman with an Escherichia coli soft-tissue infection of the right retropharyngeal space and subsequent mycotic carotid aneurysm and thrombosis of the internal jugular vein. The patient presented with a pulsatile mass and right middle cerebral artery stroke. Our surgical management involved coil embolization of the aneurysm to provide for vascular control, with resection of the common carotid artery, internal carotid artery, and extracranial carotid artery branches, along with the internal jugular vein.},
	keywords = {*Embolization, Therapeutic, *Vascular Surgical Procedures, Aged, Aneurysm, Infected/microbiology/radiography/surgery/*therapy, Anti-Bacterial Agents/therapeutic use, Carotid Arteries/microbiology/radiography/*surgery, Carotid Artery Diseases/microbiology/radiography/surgery/*therapy, Combined Modality Therapy, Escherichia coli/*isolation \& purification, Female, Humans, Infarction, Middle Cerebral Artery/microbiology, Jugular Veins/microbiology/surgery, Tomography, X-Ray Computed, Treatment Outcome, Venous Thrombosis/microbiology/surgery},
	isbn = {1097-6809 (Electronic)0741-5214 (Linking)},
	author = {Tsai, T. C. and Barot, N. and Dalman, R. and Mihm, F.}
}
@article {53691,
	title = {Food crisis no longer taboo in Niger},
	journal = {LancetLancetLancet},
	volume = {375},
	year = {2010},
	note = {Tsai, Thomas CengNewsEngland2010/04/07 06:00Lancet. 2010 Apr 3;375(9721):1151-2.},
	month = {Apr 3},
	pages = {1151-2},
	keywords = {*International Cooperation, Agriculture, Child, Child Nutrition Disorders/epidemiology, Food Supply, Humans, Niger/epidemiology, Politics, Starvation/*epidemiology},
	isbn = {1474-547X (Electronic)0140-6736 (Linking)},
	author = {Tsai, T. C.}
}
@article {53706,
	title = {Instruction in quality improvement and patient safety must be a priority in medical students{\textquoteright} education},
	journal = {Acad MedAcad MedAcad Med},
	volume = {85},
	year = {2010},
	note = {Tsai, Thomas CBohnen, Jordan DHafiz, ShabnamengLetter2010/06/04 06:00Acad Med. 2010 May;85(5):743-4. doi: 10.1097/ACM.0b013e3181d6c823.},
	month = {May},
	pages = {743-4},
	keywords = {*Curriculum, *Education, Medical, Undergraduate, *Quality of Health Care, *Safety Management, Humans, Students, Medical, United States},
	isbn = {1938-808X (Electronic)1040-2446 (Linking)},
	author = {Tsai, T. C. and Bohnen, J. D. and Hafiz, S.}
}
@article {53676,
	title = {A longitudinal study of the impact of interviews on medical school admissions in Taiwan},
	journal = {Eval Health ProfEval Health ProfEval Health Prof},
	volume = {33},
	year = {2010},
	note = {Fan, A PTsai, T CSu, T PKosik, R OMorisky, D EChen, C HShih, W JLee, C HengResearch Support, Non-U.S. Gov{\textquoteright}t2010/04/02 06:00Eval Health Prof. 2010 Jun;33(2):140-63. doi: 10.1177/0163278710361920. Epub 2010 Mar 31.},
	month = {Jun},
	pages = {140-63},
	abstract = {Medical schools in Taiwan have recently adopted the U.S. medical school admissions model by incorporating interviews into the selection process. The objective of this study was to investigate factors that contribute to successful medical school applications through the national entrance examination and interview admission routes. The sample consisted of survey data from five entry cohorts of medical students admitted to the National Yang-Ming University Faculty of Medicine from 2003 to 2007. Of the 513 students, 62\% were admitted through the traditional national entrance examination route and 38\% were admitted early after achieving a threshold score on the composite national exam followed by a structured interview. Students admitted through the interview route were more likely to be female, with an odds ratio (OR) of 2.17 (1.20-3.93). Maternal education level was an independent predictor of both early admission through a successful interview and higher medical school grade point average (GPA). Students admitted through the interview route had a 3.20 point higher first-year medical school GPA (p < .001) as determined by regression analyses. Those students who were admitted via interview did not have significantly different personality traits than those admitted through the traditional route. This study calls into question the ability of an admissions interview to select for noncognitive character traits.},
	keywords = {*School Admission Criteria, *Schools, Medical, Female, Humans, Interviews as Topic/*utilization, Likelihood Functions, Longitudinal Studies, Male, Students, Medical/*psychology, Taiwan},
	isbn = {1552-3918 (Electronic)0163-2787 (Linking)},
	author = {Fan, A. P. and Tsai, T. C. and Su, T. P. and Kosik, R. O. and Morisky, D. E. and Chen, C. H. and Shih, W. J. and Lee, C. H.}
}
@article {53711,
	title = {Role of factor VII in correcting dilutional coagulopathy and reducing re-operations for bleeding following non-traumatic major gastrointestinal and abdominal surgery},
	journal = {J Gastrointest SurgJ Gastrointest SurgJ Gastrointest Surg},
	volume = {14},
	year = {2010},
	note = {Tsai, Thomas CRosing, James HNorton, Jeffrey AengComparative Study2010/06/03 06:00J Gastrointest Surg. 2010 Aug;14(8):1311-8. doi: 10.1007/s11605-010-1227-6. Epub 2010 Jun 2.},
	month = {Aug},
	pages = {1311-8},
	abstract = {OBJECTIVE: The objective of this study is to evaluate the effectiveness of rfVIIa in reducing blood product requirements and re-operation for postoperative bleeding after major abdominal surgery. BACKGROUND: Hemorrhage is a significant complication after major gastrointestinal and abdominal surgery. Clinically significant bleeding can lead to shock, transfusion of blood products, and re-operation. Recent reports suggest that activated rfVIIa may be effective in correcting coagulopathy and decreasing the need for re-operation. METHODS: This study was a retrospective review over a 4-year period of 17 consecutive bleeding postoperative patients who received rfVIIa to control hemorrhage and avoid re-operation. Outcome measures were blood and clotting factor transfusions, deaths, thromboembolic complications, and number of re-operations for bleeding. RESULTS: Seventeen patients with postoperative hemorrhage following major abdominal gastrointestinal surgery (nine pancreas, four sarcoma, two gastric, one carcinoid, and one fistula) were treated with rfVIIa. In these 17 patients, rfVIIa was administered for 18 episodes of bleeding (dose 2,400-9,600 mcg, 29.8-100.8 mcg/kg). Transfusion requirement of pRBC and FFP were each significantly less than pre-rfVIIa. Out of the 18 episodes, bleeding was controlled in 17 (94\%) without surgery, and only one patient returned to the operating room for hemorrhage. There were no deaths and two thrombotic complications. Coagulopathy was corrected by rfVIIa from 1.37 to 0.96 (p < 0.0001). CONCLUSION: Use of rfVIIa in resuscitation for hemorrhage after non-traumatic major abdominal and gastrointestinal surgery can correct dilutional coagulopathy, reducing blood product requirements and need for re-operation.},
	keywords = {Adult, Aged, Aged, 80 and over, Blood Coagulation Disorders/blood/*drug therapy/etiology, Digestive System Surgical Procedures/*adverse effects, Factor VII/*therapeutic use, Gastrointestinal Diseases/*surgery, Hemostasis/*physiology, Humans, Middle Aged, Postoperative Hemorrhage/blood/*drug therapy/etiology, Prognosis, Prospective Studies, Recombinant Proteins, Reoperation/*statistics \& numerical data},
	isbn = {1873-4626 (Electronic)1091-255X (Linking)},
	author = {Tsai, T. C. and Rosing, J. H. and Norton, J. A.}
}
@article {53696,
	title = {Second chance for health reform in Colombia},
	journal = {LancetLancetLancet},
	volume = {375},
	year = {2010},
	note = {Tsai, Thomas CengNewsEngland2010/01/30 06:00Lancet. 2010 Jan 9;375(9709):109-10. doi: 10.1016/S0140-6736(10)60033-5.},
	month = {Jan 9},
	pages = {109-10},
	keywords = {*Health Care Reform, *Insurance Coverage, *Insurance, Health, *Universal Coverage/economics, Colombia, Financing, Government, Health Expenditures, Health Policy, Health Services Accessibility/legislation \& jurisprudence, Humans, Medically Uninsured/statistics \& numerical data, Taxes},
	isbn = {1474-547X (Electronic)0140-6736 (Linking)},
	author = {Tsai, T. C.}
}
@article {53686,
	title = {Public health and peace building in Nepal},
	journal = {LancetLancetLancet},
	volume = {374},
	year = {2009},
	note = {Tsai, Thomas CengNewsEngland2009/08/20 09:00Lancet. 2009 Aug 15;374(9689):515-6.},
	month = {Aug 15},
	pages = {515-6},
	keywords = {*Health Status Indicators, *Public Health/legislation \& jurisprudence/trends, *War, Communism, Hinduism, Human Rights/*legislation \& jurisprudence, Humans, Maternal Mortality/trends, Nepal/epidemiology},
	isbn = {1474-547X (Electronic)0140-6736 (Linking)},
	author = {Tsai, T. C.}
}
@article {53666,
	title = {Massive transfusion protocols: the role of aggressive resuscitation versus product ratio in mortality reduction},
	journal = {J Am Coll SurgJ Am Coll SurgJ Am Coll Surg},
	volume = {209},
	year = {2009},
	note = {Riskin, Daniel JTsai, Thomas CRiskin, LorenHernandez-Boussard, TinaPurtill, MaryanneMaggio, Paul MSpain, David ABrundage, Susan Ieng2009/07/28 09:00J Am Coll Surg. 2009 Aug;209(2):198-205. doi: 10.1016/j.jamcollsurg.2009.04.016. Epub 2009 Jul 9.},
	month = {Aug},
	pages = {198-205},
	abstract = {BACKGROUND: Exsanguinating hemorrhage necessitating massive blood product transfusion is associated with high mortality rates. Recent data suggest that altering the fresh frozen plasma to packed red blood cell ratio (FFP:PRBC) results in significant mortality reductions. Our purpose was to evaluate mortality and blood product use in the context of a newly initiated massive transfusion protocol (MTP). STUDY DESIGN: In July 2005, our American College of Surgeons-verified Level I trauma center implemented an MTP supporting a 1:1.5 FFP:PRBC ratio, improved communications, and enhanced systems flow to optimize rapid blood product availability. During the 4 years surrounding protocol implementation, we reviewed data on trauma patients directly admitted through the emergency department and requiring 10 or more units PRBCs during the first 24 hours. RESULTS: For the 2 years before and subsequent to MTP initiation, there were 4,223 and 4,414 trauma activations, of which 40 and 37 patients, respectively, met study criteria. The FFP:PRBC ratios were identical, at 1:1.8 and 1:1.8 (p = 0.97). Despite no change in FFP:PRBC ratio, mortality decreased from 45\% to 19\% (p = 0.02). Other significant findings included decreased mean time to first product: cross-matched RBCs (115 to 71 minutes; p = 0.02), FFP (254 to 169 minutes; p = 0.04), and platelets (418 to 241 minutes; p = 0.01). CONCLUSIONS: MTP implementation is associated with mortality reductions that have been ascribed principally to increased plasma use and decreased FFP:PRBC ratios. Our study found a significant reduction in mortality despite unchanged FFP:PRBC ratios and equivalent overall mean numbers of transfusions. Our data underscore the importance of expeditious product availability and emphasize that massive transfusion is a complex process in which product ratio and time to transfusion represent only the beginning of understanding.},
	keywords = {*Clinical Protocols, *Hospital Mortality, Adult, Blood Transfusion/*methods/*mortality, Chi-Square Distribution, Erythrocyte Transfusion, Female, Hemorrhage/*mortality/*therapy, Humans, Logistic Models, Male, Middle Aged, Plasma, Resuscitation/methods, Trauma Centers, Treatment Outcome},
	isbn = {1879-1190 (Electronic)1072-7515 (Linking)},
	author = {Riskin, D. J. and Tsai, T. C. and Riskin, L. and Hernandez-Boussard, T. and Purtill, M. and Maggio, P. M. and Spain, D. A. and Brundage, S. I.}
}
