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Biomedical subjects

William B Weeks

Publications and source records attributed to William B Weeks.

At least 19 recordsLinked to original sources
PubMed2006

Association of race and gender with general surgeons' annual incomes.

BACKGROUND: Specialty, work effort, and gender have been shown to be associated with physicians' annual incomes. Although female plastic, oral, and cardiothoracic surgeons have been shown to have lower incomes than their male counterparts, differences in incomes attributable to gender or race among general surgeons have not been evaluated. STUDY DESIGN: We used survey responses collected during the 1990s from 771 actively practicing general surgeons and linear regression modeling to determine the association of race and gender with general surgeons' annual incomes after controlling for work effort, provider characteristics, and practice characteristics. RESULTS: Compared with Caucasian men, both African-American male and Caucasian female general surgeons reported having fewer patient visits (10% fewer and 17% fewer, respectively), but working more annual hours (14% more and 6.7% more, respectively). Caucasian women were more likely than the other groups to be nonpractice-owner employees. African-American men and Caucasian women were less likely than their Caucasian male counterparts to be board certified. After adjustment for work effort, provider characteristics, and practice characteristics, African-American men's mean annual income was $248,048, or $49,205 (17%) lower than that for Caucasian men (95% CI: $129,645 lower to $31,236 higher, p=0.2); Caucasian women's was $233,397, or $63,856 (21%) lower (95% CI: $120,367 to $7,345 lower, p=0.03). CONCLUSIONS: During the 1990s, among Caucasian general surgeons, female gender was associated with considerably lower annual incomes; among male general surgeons, African-American race was associated with lower annual incomes, but not substantially so. These findings warrant additional exploration to ensure that income differences among physicians are not unjustly determined by race or gender.

Black or African American↗
PubMed2006

Race and gender differences in general internists' annual incomes.

BACKGROUND: Specialty, work effort, and female gender have been shown to be associated with physicians' annual incomes; however, racial differences in physician incomes have not been examined. OBJECTIVE: To determine the influence of race and gender on General Internists' annual incomes after controlling for work effort, provider characteristics, and practice characteristics. DESIGN: Retrospective survey-weighted analysis of survey data. PARTICIPANTS: One thousand seven hundred and forty-eight actively practicing General Internists who responded to the American Medical Association's annual survey of physicians between 1992 and 2001. MEASUREMENTS: Work effort, provider and practice characteristics, and adjusted annual incomes for white male, black male, white female, and black female General Internists. RESULTS: Compared with white males, white females completed 22% fewer patient visits and worked 12.5% fewer hours, while black males and females reported completing 17% and 2.8% more visits and worked 15% and 5.5% more annual hours, respectively. After adjustment for work effort, provider characteristics, and practice characteristics, black males' mean annual income was 188,831 dollars or 7,193 dollars (4%) lower than that for white males (95% CI: -31,054 dollars, 16,669 dollars; P=.6); white females' was 159,415 dollars or 36,609 dollars (19%) lower (95% CI: -25,585 dollars, -47,633 dollars; P<.001); and black females' was 139,572 dollars or 56,452 dollars (29%) lower (95% CI: -93,383 dollars, -19,520 dollars; P=.003). CONCLUSIONS: During the 1990s, both black race and female gender were associated with lower annual incomes among General Internists. Differences for females were substantial. These findings warrant further exploration.

Black People↗
PubMed2006

The influence of provider sex on neurologists' annual incomes.

OBJECTIVE: We sought to determine the influence of provider sex on neurologists' annual incomes after controlling for work effort, provider characteristics, and practice characteristics. METHODS: We used survey responses collected throughout the 1990s from 216 actively practicing neurologists and linear regression modeling to determine the independent influence of provider sex on neurologists' annual incomes. RESULTS: White female neurologists reported seeing 11% fewer visits and working 6% fewer annual hours than their white male counterparts. White female neurologists had practiced medicine for fewer years than white males (p = 0.01). In addition, females were less likely to be employees, as opposed to having an ownership interest in the practice, and were more likely to be board certified, though not statistically significantly so. After adjustment for work effort, provider characteristics, and practice characteristics, white female neurologists' mean annual income was 165,321 dollars, or 47,854 dollars (22%) lower than that for white males (95% CI: 82,710 dollars lower to 12,997 dollars lower, p = 0.007). CONCLUSION: During the 1990s, female sex was associated with lower annual incomes among neurologists. Just as policymakers are exploring sex differences in access to and outcomes health care, they should further explore these findings to ensure that income differences among physicians who provide that care are not unjustly driven by provider sex.

Certification↗
PubMed2006

Gender differences in diagnostic radiologists' annual incomes.

RATIONALE AND OBJECTIVES: Specialty, work effort, and gender have been shown to be associated with physicians' annual incomes; however, careful examination of the association between provider gender and physician incomes after correcting for other factors likely to influence income has not been conducted at the subspecialty level. We sought to determine the association between provider gender and diagnostic radiologists' annual incomes after controlling for work effort, provider characteristics, and practice characteristics. MATERIALS AND METHODS: Using survey responses that were collected throughout the 1990s from 491 actively practicing white diagnostic radiologists, we generated a linear regression model to determine the association between provider gender and radiologists' annual incomes after controlling for work effort, provider characteristics, and practice characteristics. RESULTS: White female radiologists reported working 2% fewer annual hours than their white male counterparts. Female radiologists had practiced medicine for fewer years than males, were more likely to be employees, as opposed to having an ownership interest in the practice, and were equally likely to be board certified. After adjustment for work effort, provider characteristics, and practice characteristics, female radiologists' mean annual income was $273,907, or $80,090 (23%) lower than that for white males (95% CI: $113,930 lower to $46,250 lower, P < .001). CONCLUSIONS: During the 1990s, female gender was associated with lower annual incomes among diagnostic radiologists. Researchers should further explore the relationship between physician gender and incomes to determine what factors might cause the differences that we found.

Income↗
PubMed2006

Women's primary care providers and breast cancer screening: who's following the guidelines?

OBJECTIVE: Screening mammography for woman ages 50 to 69 years has resulted in early breast cancer detection and reduced mortality rates. However, the providers who are responsible for women's preventive health care differ in breast cancer screening guideline adherence. We compared screening practices across provider specialty and training degree types. STUDY DESIGN: Using a retrospective cohort design, we examined 472 patient records that represented 16 million preventive health care visits among women ages 50 to 69 years from the 2000 National Ambulatory Medical Care Survey. We calculated relative risk ratios for breast examination and mammography during preventive visits across provider specialty and training types. RESULTS: Among specialists, gynecologists are more likely than internists or general/family practitioners to follow breast cancer screening guidelines. Across training degree types, mid-level providers are more likely than medical doctors or osteopaths to adhere to guidelines. CONCLUSION: Regardless of specialty type or training degree, women's health care providers should adhere to breast cancer screening guidelines during preventive care visits.

Aged↗
PubMed2006

Who pays for poor surgical quality? Building a business case for quality improvement.

BACKGROUND: Both providers and payors bear the financial risk associated with complications of poor quality care. But the stakeholder who bears the largest burden of this risk has a strong incentive to support quality improvement activities. The goal of the present study was to determine whether hospitals or payors incur a larger burden of increased hospital costs associated with complications. STUDY DESIGN: We merged clinical data for 1,008 surgical patients from the private sector National Surgical Quality Improvement Program to the internal cost-accounting database of a large university hospital. We then determined the marginal costs of surgical complications from the perspective of both hospitals (changes in profit and profit margin) and payors (increase in reimbursement paid to the hospital). In our analyses of cost and reimbursement, we adjusted for procedure complexity and patient characteristics using multivariate linear regression. RESULTS: Reimbursement for patients without complications ($14,266) exceeded hospital costs ($10,978), generating an average hospital profit of $3,288 and a profit margin of 23%. When complications occurred, hospitals still received reimbursement in excess of their costs, but the profit margin declined: reimbursement ($21,911) exceeded hospital costs ($21,156), yielding an average profit of $755 and a profit margin of 3.4%. Complications were always associated with an increase in costs to health-care payors: complications were associated with an average increase in reimbursement of $7,645 (54%) per patient. CONCLUSIONS: Hospitals and payors both suffer financial consequences from poor-quality health care, but the greater burden falls on health-care payors. Strong incentives exist for health-care payors to become more involved in supporting quality improvement activities.

Costs and Cost Analysis↗
PubMed2006

The influence of physician race and gender on obstetrician-gynecologists' annual incomes.

OBJECTIVE: A study using 1998 data concluded that incomes of male and female obstetrician-gynecologists were essentially equivalent, after considering only differences in productivity. We examined the association between gender, race, and obstetrician-gynecologists' incomes, after correcting for productivity and other important practice and provider characteristics. METHODS: Survey responses obtained from 1992 to 2001 from 962 actively practicing obstetrician-gynecologists and linear regression modeling were used to estimate the influence of race and gender on physicians' annual incomes after controlling for work effort, provider characteristics, and practice characteristics. RESULTS: Compared with white male and black female obstetrician-gynecologists, black men reported seeing 5% more patient visits and working 18% more hours, while white women reported seeing 18% fewer visits and working 10% fewer annual hours. Women were more likely to be nonowner employees than men. White female obstetrician-gynecologists were less likely than the other groups to be board certified. After adjustment for work effort, provider characteristics, and practice characteristics, black men's mean reported annual income was 210,859 dollars, or 78,905 dollars (27%) lower than that for white men (95% confidence interval [CI] 120,082 dollars to 37,729 dollars lower; P < .001); white women's was 242,721 dollars, or 47,043 dollars (16%) lower (95% CI 70,127 dollars to 23,958 dollars lower; P < .001); and black women's was 246,355 dollars, or 43,409 dollars (15%) lower (95% CI 92,296 dollars to 5,478 dollars higher, P = .08). CONCLUSION: During the 1990s, both black race and female gender were associated with substantially lower annual incomes among obstetrician-gynecologists. These findings warrant further exploration to ensure that income differences among physicians are not unjustly driven by race or gender.

Adult↗
PubMed2006

Veterans Health Administration patients' use of the private sector for coronary revascularization in New York: opportunities to improve outcomes by directing care to high-performance hospitals.

OBJECTIVE: We sought to quantify Veterans Health Administration (VA) patients' utilization of coronary revascularization in the private sector and to assess the potential impact of directing this care to high-performance hospitals. METHODS: Using VA and New York State administrative and clinical databases, we conducted a retrospective cohort study examining residents of New York State who were enrolled in the VA and underwent either coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI) in 1999 or 2000 (n=6562) in either the VA or the private sector. We first calculated the proportion of revascularizations obtained in the VA and the private sector. We then identified the private sector hospitals in which these men obtained revascularizations and determined potential changes in mortality and travel burden associated with directing private sector care to high performance hospitals. RESULTS: VA patients in New York were much more likely to undergo revascularization in the private sector than in VA hospitals: 83% of CABGs (2341/2829) and 87% of PCIs (4054/4665) were obtained in the private sector. Private sector utilization was distributed evenly across high- and low-mortality hospitals. Directing private-sector CABG surgery to high-performance hospitals could have reduced expected mortality by 24% (from 2.3% to 1.7%) and would only increase median travel time from 21 to 30 minutes. The benefit of redirecting PCI care is minimal. CONCLUSIONS: For high-mortality procedures that veterans frequently obtain in the private sector, like CABG, directing care to high-performance hospitals may be an effective way to improve outcomes for veterans.

Angioplasty, Balloon, Coronary↗
PubMed2006

Tobacco cessation counseling across the ages.

OBJECTIVES: To examine recent rates of tobacco cessation counseling and whether patient age or sex was associated with providers' adherence to tobacco cessation guidelines. DESIGN: Survey study. SETTING: The 2002 National Ambulatory Medical Care Survey (NAMCS). PARTICIPANTS: Analysis of 22,605 records representing 687 million ambulatory care appointments with adults from the 2002 NAMCS. MEASUREMENTS: The proportion of visits by sex and age category during which physicians identified a patient's tobacco use status and counseled tobacco users to quit. RESULTS: The rates at which providers inquired about tobacco use were similar across groups, ranging from 65% of visits with men aged 20 to 44 to 73% of visits with women aged 45 to 59, but providers' rates of tobacco cessation counseling differed by age, ranging from 27% of visits with male tobacco users aged 45 to 59 to 6% of visits with male tobacco users aged 75 old and older. CONCLUSION: Although providers frequently ask their patients about tobacco use, they infrequently counsel patients to quit, especially if those patients are older men. Provider time constraints, misconceptions about older patients' ability and willingness to quit, or doubt about the potential health benefits of tobacco cessation in this age group may explain the lower counseling rates provided to older male patients. Because rates of counseling have declined in the last decade, providers should be reeducated about the need for and effectiveness of tobacco cessation counseling for men and women of all ages.

Adult↗
PubMed2006

Physical and mental health and access to care among nonmetropolitan Veterans Health Administration patients younger than 65 years.

CONTEXT: The 4.5 million military veterans treated by the Veterans Health Administration (VA) are believed to experience poorer physical and mental health than nonveterans. Furthermore, nonmetropolitan residents have less access to medical services, whether or not they are veterans in VA care. A direct comparison of metropolitan and nonmetropolitan veterans and nonveterans on a national health survey has not been reported, so it is not known whether nonmetropolitan VA patients experience similar medical need or access as other nonmetropolitan residents. PURPOSE: We sought to compare the perceptions of health status and access to care among metropolitan and nonmetropolitan veterans in VA care, other veterans, and nonveterans in a large national sample surveyed under the same conditions. METHODS: Male respondents to the 2000 Behavioral Risk Factor Surveillance System health survey were divided into veterans or nonveterans, VA users or nonusers, metropolitan or nonmetropolitan residents, and 1 of 3 age groups (18-44, 45-64, and 65(+)). Responses to questions about current health status, health coverage, and access to care were submitted to chi-square analyses or analyses of variance, using SUDAAN software to compute survey error variance. FINDINGS: Nonmetropolitan VA patients younger than 65 years consistently reported the worst physical and mental health status and reduced access to care. CONCLUSIONS: VA can anticipate increasing demand for mental and physical health care among rural veterans younger than 65 years.

Adolescent↗
PubMed2006

Rural-urban disparities in health-related quality of life within disease categories of Veterans.

CONTEXT: Compared to their urban counterparts, rural veterans have been found to have lower health-related quality of life. PURPOSE: To determine whether these disparities persist when examining disease categories of rural and urban veterans. METHODS: We obtained survey data on 748,216 veterans who were current or anticipated Veterans Health Administration patients. Using International Classification of Diseases (ICD)-9CM codes, we determined whether these veterans had diagnoses that fell into any of 30 physical health disease categories, and we used ZIP codes to determine whether veterans lived in rural or urban settings. We compared rural to urban prevalence of disease categories as well as urban to rural health-related quality-of-life physical health component summary scores (PCS) and mental health component summary scores (MCS) for each disease category. FINDINGS: Physical diagnoses were significantly more prevalent in the rural veteran population for most disease categories examined. For every disease category examined, PCS were significantly lower for veterans who lived in rural, compared to urban, settings (P < .001 for all); rural veterans also experienced lower MCS for all disease categories although differences were modest. Differences persisted after controlling for sociodemographic factors. CONCLUSIONS: Compared to the urban veteran population, within disease categories, the rural veteran population experiences higher disease prevalence and lower physical and mental quality-of-life scores. Policymakers should anticipate greater health care demands from the rural veteran population and work to meet that demand.

Aged↗
PubMed2006

Characteristics of rural and urban cadaveric organ transplant donors and recipients.

CONTEXT: Health disparities have been found when comparing rural and urban populations. PURPOSE: To compare characteristics of rural and urban cadaveric transplant donors and recipients. METHODS: We used deidentified individual-level data on 55,929 cadaveric transplant donor-recipient exchanges between 2000 and 2003 and examined the relative rates of donating and receiving cadaveric transplants for rural compared to urban residents, as defined by ZIP Codes. FINDINGS: When compared to their urban counterparts, rural organ donors were more likely to have died from head trauma, drowning, motor vehicle accidents, or suicide and less likely to have died from cerebrovascular events, cardiac events, or homicide (P < .001 for all). Rural transplant recipients had lower levels of educational attainment and were less likely to have had the transplant financed by private insurance (P < .001 for all). While we found no statistical difference in days wait to organ transplantation, rural residents were more likely to donate than to receive cadaveric organs (P < .001). CONCLUSIONS: The differences in organ donation that we found warrant further exploration.

Adult↗
PubMed2006

Rural and non-rural differences in membership of the American Society of Bioethics and Humanities.

OBJECTIVE: To determine whether bioethicists are distributed along a rural-to-urban continuum in a way that reflects potential need of those resources as determined by the general population, hospital facilities and hospital beds. METHODS: US members of a large, multidisciplinary professional society, the American Society of Bioethics and Humanities (ASBH), the US population, hospital facilities and hospital beds were classified across a four-tier rural-to-urban continuum. The proportion of each group in rural settings was compared with that in urban settings, and odds ratios were calculated with 95% confidence intervals. RESULTS: Although 91% of ASBH members live or work in urban settings, only 66% of the US population did so. In contrast, 2% of ASBH members live or work in rural settings compared with 13% of the population. ASBH members were 10.7 times (95% CI 6.6 to 17.3) as likely to be represented in urban than in rural settings when compared with the general population, 25.6 times (95% CI 15.8 to 41.5) and 6.9 times (95% CI 4.3 to 11.1) as likely with regard to hospital facilities and hospital beds, respectively. CONCLUSIONS: Using various comparisons it was found that ASBH members are under-represented in rural as compared with urban settings. Although not all bioethicists are ASBH members, these findings suggest that the availability of professional bioethical resources may be inadequate in rural America. The disparities that were found may have considerable effect on ethics scholarship, research, ethical committees and education, and adds to the argument that rural American communities are under-served.

Beds↗
PubMed2006

Mental distress among younger veterans before, during, and after the invasion of Iraq.

OBJECTIVE: The purpose of this study was to determine whether patients receiving care from the Department of Veterans Affairs (VA) reported more mental distress as the war in Iraq began or reintensified compared with other respondents to national health surveys. METHODS: Data from the 2000 and 2003 Behavioral Risk Factor Surveillance System (BRFSS) health surveys were analyzed. Unlike in other years, these particular surveys asked respondents whether they were military veterans. As in other years' surveys, these surveys also asked whether respondents used VA medical care. Male respondents were stratified by age and separated into three groups: VA patients, other veterans, and nonveterans. The proportions of respondents who reported five or more recent days of poor mental or physical health were analyzed with chi square tests. RESULTS: Although the number of recent days of poor mental health among nonveterans, other veterans, and older VA patients were stable from 2000 to 2003, younger VA patients in 2003 reported substantially more days of poor mental health in two intervals: during the Iraq war buildup and invasion, and later, when resistance on the ground reintensified. Comparable changes in physical health complaints were not observed. CONCLUSIONS: In times of war, the VA may anticipate more mental health problems among its current patients, particularly younger veterans.

Adolescent↗
PubMed2006

Rural and urban disparities in health-related quality of life among veterans with psychiatric disorders.

OBJECTIVE: The authors studied whether rural and urban disparities in health-related quality of life, demonstrated previously among veterans, persist among veterans with common psychiatric disorders. METHODS: A cohort of 748,216 users or anticipated users of Veterans Affairs services completed the Veterans Short Form Health Survey in 1999. From the survey, the authors determined health-related quality-of-life scores (physical [PCS] and mental [MCS] health component summaries) and used ICD-9-CM codes to identify veterans with six mental health disorders-depression, anxiety, posttraumatic stress disorder, alcohol dependence, schizophrenia, and bipolar disorder. With Rural-Urban Commuting Area codes to determine urban residency, the prevalence of psychiatric illness and health-related quality of life were compared across rural and urban groups. RESULTS: All psychiatric disorders except anxiety disorders not related to posttraumatic stress disorder were more prevalent in urban settings. However, rural veterans within mental illness cohorts had worse PCS and MCS scores. Differences in PCS scores were substantial, ranging between 2.27 for schizophrenia and 3.39 for alcohol dependence (p<.001 for all diagnoses). Differences in MCS scores were statistically significant but modest. In regression models, rural-urban disparities within psychiatric disorder cohorts persisted after sociodemographic factors were controlled for. CONCLUSIONS: Although less likely than their urban counterparts to have mental disorders, rural veterans with mental illness experienced a greater disease burden and were likely to incur greater health care costs. Improving access to mental health care for veterans in rural settings may narrow quality-of-life disparities among rural and urban veterans.

Adult↗
PubMed2005

Using aggregate root cause analysis to reduce falls.

BACKGROUND: In certain categories of adverse events, Department of Veterans Affairs (VA) facilities may combine data to produce an aggregate review of the data. Individual root cause analyses are still required for the more serious adverse events. About 100 of the VA acute and long term care facilities contributed data to an analysis of results of 176 root cause analyses (RCAs) for patient falls occurring in the VA system. METHODS: Success was measured through a decreased report of falls and major injures due to falls after each organization's action plans were implemented. In addition, telephone interviews were conducted to understand success factors as well as barriers to implementation of clinical improvements. RESULTS: Of the 745 actions generated (that addressed the root cause), 435 (61.4%) had been fully implemented and another 148 (20.9%) had been partially implemented; 34.4% of the facilities reported reducing falls and 38.9% reported reducing major injuries due to falls. DISCUSSION: The action plans associated with these reductions focused on making specific clinical changes at the bedside rather than policy changes or educating staff. Specific interventions most highly associated with reductions in falls and injuries included environmental assessments, toileting interventions, and interventions that directly addressed the root cause and were the responsibility of a single person (as opposed to a group).

Accidental Falls↗
PubMed2005

What do we know about financial returns on investments in patient safety? A literature review.

BACKGROUND: A framework was proposed for making a business case for patient safety interventions and to evaluate whether and how thoroughly financial aspects of investments and returns have been reported. METHODS: MEDLINE was searched from inception through January 21, 2005. Articles were selected if they reported on a patient safety intervention or a patient safety related outcome within the United States and indicated that a financial or economic analysis of the intervention was an objective. RESULTS: For 165 articles, a financial or economic analysis was indicated as an objective; 36.4% used original data, 28.5% used referenced data, and 35.2% provided no analysis. Only 13 articles (7.9%) included original data on start-up costs, 45 articles (27.3%) included original data on operating expenses and benefits, and 9 articles (5.5%) provided original financial data on outcomes. Of the 165 articles, 56.4% evaluated technological methods of improving patient safety, such as adoption of computer physician order entry, 20.6% evaluated changes in processes of care, such as staffing changes, and 23% involved other types of interventions or outcomes. DISCUSSION: Few articles provided complete information on the required investment and anticipated return on patient safety interventions. Use of standard financial techniques may strengthen the business case for patient safety interventions.

Costs and Cost Analysis↗