Biomedical subjects

Mark E Cowen

Publications and source records attributed to Mark E Cowen.

6 recordsLinked to original sources

PubMed2006

Predictors and outcomes of emergency department visits within 30 days following percutaneous coronary intervention.

Our objective was to determine the frequency and predictive factors for cardiac-related emergency department (ED) encounters within 30 days after percutaneous coronary intervention (PCI). The data source was an electronic database of 2,731 patients who had PCI from 2002 to 2004. Almost all underwent stent placement. Risk factors for returning to the ED were identified from clinical, anatomic, and demographic candidate variables using multivariate logistic regression. Approximately 9% of the cohort (255 of 2,731 patients) returned to the ED for cardiac reasons within 30 days, peaking around 3 days. ED visits were more likely in those whose index PCI was emergent or urgent (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.3 to 3.0), in women (OR 1.9, 95% CI 1.5 to 2.5), and in those who had previous encounters with the ED or hospital (OR 1.7, 95% CI 1.5 to 2.0). Patients receiving stents were somewhat less likely to return (OR 0.7, 95% CI 0.5 to 1.0). In conclusion, the clinical courses of the 255 returning patients were generally benign, but 12% had a subsequent myocardial infarction or repeat PCI within 30 days of the ED encounter.

Angioplasty, Balloon, Coronary↗

PubMed2006

Predicting life expectancy in men with clinically localized prostate cancer.

PURPOSE: The choice of appropriate management for localized prostate cancer depends in part on the estimated life expectancy of a man. Little is known about the accuracy of existing rules for deriving these estimates. We developed a new prediction rule and examined the accuracy of 2 others in our data set. MATERIALS AND METHODS: A retrospective cohort was assembled, consisting of 506 men who were diagnosed or received initial treatment at a community based, tertiary care health center between 1987 and 1989 for clinically localized prostate cancer (stages A, B, I, II or T1-2N0M0) and had at least 13 years of followup. Most patients did not have prostate specific antigen levels available. Proportional hazards regression was used to create a nomogram for deriving survival estimates. Discrimination of the new and external prediction rules was assessed by the c-statistic. Calibration curves compared predicted to actual survival at 10 years. RESULTS: Estimates for survival at 5, 10 and 15 years, and for median life expectancy were determined. Discrimination was modest with a c-statistic of 0.73. The rules of Albertsen and Tewari et al had comparable discrimination in our data with a c-statistic of 0.71 and 0.70, respectively. Predicted life expectancy according to our rule and that of Tewari approximated actual survival experience. Predictions according to the Albertsen study underestimated actual survival in our group but in consistent fashion. CONCLUSIONS: Overall life expectancy can be predicted with a moderate degree of accuracy, sufficient for informing patient-clinician discussions but inadequate as the only determinant of the optimal management approach.

Aged↗

PubMed2005

A comparison of two hospitalist models with traditional care in a community teaching hospital.

PURPOSE: Many studies have documented significant length of stay reduction and cost savings when hospitalist care is compared with traditional care. However, less is known about the concurrent performance of more than one hospitalist model in a single site. SUBJECTS AND METHODS: This retrospective cohort study of 10595 patients was conducted between July 2001 and June 2002 in a tertiary care community-based teaching hospital. Risk-adjusted length of stay, variable costs, 30-day readmission rates, and in-hospital and 30-day mortality were measured for patients treated by Community Physicians, Private Hospitalists and Academic Hospitalists. RESULTS: There was a 20% reduction in length of stay on the Academic Hospitalist service (p <.0001) and 8% on the Private Hospitalist service (P = .049) compared with Community Physicians. Similarly, total costs were 10% less on the Academic (P <.0001) and 6% less on the Private Hospitalist (P = .02) services compared with Community Physicians. The length of stay of Academic Hospitalists was 13% shorter than that of Private Hospitalists (P = .002); differences in costs between hospitalist groups were not statistically significant. Differences in in-hospital and 30-day mortality and 30-day readmission rates among the 3 physician groups were also not statistically significant. CONCLUSIONS: The impact on patient outcomes and resource utilization may vary with the hospitalist model used. Future studies should examine the specific organizational characteristics of hospitalists that contribute to improved patient care and resource utilization.

Adult↗

PubMed2003

The impact of a celebrity promotional campaign on the use of colon cancer screening: the Katie Couric effect.

BACKGROUND: Public participation in many preventive health programs is suboptimal. While various interventions to increase participation have been studied, the impact of a celebrity spokesperson on cancer screening has not been rigorously examined. The objective of this study was to assess the impact of Katie Couric's March 2000 Today Show colorectal cancer awareness campaign on colonoscopy rates. METHODS: A population-based observational study was conducted using 2 different data sources: (1) The Clinical Outcomes Research Initiative (CORI) database-a voluntary consortium of 400 endoscopists who performed 95 000 colonoscopies from July 1998 to December 2000; and (2) 44 000 adult members of a managed care organization. Using change point analyses and linear regression models, we compared colonoscopy utilization rates before and after Ms Couric's March 2000 television series. RESULTS: The number of colonoscopies performed per CORI physician per month after Ms Couric's campaign increased significantly (15.0 per month before campaign; 18.1 after campaign; P<.001). After adjusting for temporal trends, a significantly higher postcampaign colonoscopy rate was sustained for 9 months. Analysis also demonstrated a trend toward an increase in the percentage of colonoscopies performed on women (43.4% before campaign; 47.4% after campaign; P =.054). Colonoscopy rates also increased significantly in the managed care organization after Ms Couric's campaign (1.3 per 1000 members per month before; 1.8 after; P<.001). CONCLUSIONS: Katie Couric's televised colon cancer awareness campaign was temporally associated with an increase in colonoscopy use in 2 different data sets. These findings suggest that a celebrity spokesperson can have a substantial impact on public participation in preventive care programs.

Chi-Square Distribution↗

PubMed2002

Quantifying the physician contribution to managed care pharmacy expenses: a random effects approach.

BACKGROUND: Despite the availability of more sophisticated techniques, few alternatives to ordinary least squares (OLS) regression have been utilized to profile physician prescribing in managed care. It is not known to what extent the modest R values derived from OLS models reflect incomplete risk adjustment or widely varying physician prescribing patterns. OBJECTIVES: To quantify the role of interphysician variability relative to overall variability in managed care pharmacy expenses, and to examine the extent to which different statistical approaches generate meaningful differences in profile results. RESEARCH DESIGN: Comparison of three basic statistical modeling approaches: OLS, fixed effects regression, and random effects (ie, hierarchical) regression models. SETTING: Two managed care populations that differed more than 2-fold in per member pharmacy expenditures in 1999, one from the Midwestern United States, the other from three Western States. MAIN OUTCOME MEASURES: The intraclass correlation coefficient (ICC, the proportion of variability in expenses attributable to differences among physicians) and the range of projected expenses attributed to each physician's prescribing style. RESULTS: The ICCs were small for aggregated pharmacy expenditures, 0.04 or less in both populations. As determined by OLS, the most costly physician contributed 94,399 U.S. dollars in excess expenses to the organization whereas the most parsimonious saved 89,940 U.S. dollars. When derived from random effects models, the range in performance was 63% of that derived from OLS. CONCLUSIONS: In the populations studied, systematic prescribing differences among physicians were small relative to the overall variability in pharmacy expenses, suggesting other factors were more likely driving these costs. Random effects models generated smaller estimates of the individual physicians' contribution to costs, sometimes considerably, relative to those derived from OLS and fixed effects approaches.

Adolescent↗

PubMedDate not supplied

Preference assessment method affects decision-analytic recommendations: a prostate cancer treatment example.

PURPOSE: To evaluate the effect of preference assessment method on treatment recommended by an individualized decision-analytic model for early prostate cancer. METHODS: Health state preferences were elicited by time tradeoff, rating scale, and a power transformation of the rating scale from 63 men ages 55 to 75. The authors used these values in a Markov model to determine whether radical prostatectomy or watchful waiting yielded the greater quality-adjusted life expectancy. RESULTS: Time tradeoff and transformed rating scale recommendations differed widely. Time tradeoff and transformed rating scale utilities differed in their treatment recommendation for 21% to 52% of men, and the mean difference in quality-adjusted life years varied from less than 0.5 to greater than 1.0. CONCLUSIONS: Treatment recommendations from the prostate cancer decision model were sensitive to the method of preference assessment. If decision analysis is used to counsel individual patients, careful consideration must be given to the method of preference elicitation.

Aged↗