Queer(y)ing Agent-Based Modeling for Use in LGBTQ Studies: An Example from Workplace Inequalities.

This article explores the contribution agent-based modeling (ABM) can make to the study of LGBTQ workplace inequalities and, conversely, how ABM can adapt to theoretical traditions integral to LGBTQ studies. It introduces an example LGBTQ workplace model, developed as part of the CILIA-LGBTQI+ project, to illustrate how ABM complements existing methods, can address methodological binarism and bridge macro and micro accounts within LGBTQ studies of the workplace. The model is intended as an important starting point in developing the role of ABM in LGBTQ research and for bridging qualitative- and quantitative-derived insights. Likewise, the article discusses some approaches for negotiating theoretical and methodological tensions identified when integrating queer and intersectional insight with ABM.

Hospital Costs Related to Early Extubation After Infant Cardiac Surgery.

BACKGROUND: The Pediatric Heart Network Collaborative Learning Study (PHN CLS) increased early extubation rates after infant tetralogy of Fallot (TOF) and coarctation of the aorta (CoA) repair across participating sites by implementing a clinical practice guideline (CPG). The impact of the CPG on hospital costs has not been studied. METHODS: PHN CLS clinical data were linked to cost data from Children's Hospital Association by matching on indirect identifiers. Hospital costs were evaluated across active and control sites in the pre- and post-CPG periods using generalized linear mixed-effects models. A difference-in-difference approach was used to assess whether changes in cost observed in active sites were beyond secular trends in control sites. RESULTS: Data were successfully linked on 410 of 428 eligible patients (96%) from four active and four control sites. Mean adjusted cost per case for TOF repair was significantly reduced in the post-CPG period at active sites ($42,833 vs $56,304, p < 0.01) and unchanged at control sites ($47,007 vs $46,476, p = 0.91), with an overall cost reduction of 27% in active versus control sites (p = 0.03). Specific categories of cost reduced in the TOF cohort included clinical (-66%, p < 0.01), pharmacy (-46%, p = 0.04), lab (-44%, p < 0.01), and imaging (-32%, p < 0.01). There was no change in costs for CoA repair at active or control sites. CONCLUSIONS: The early extubation CPG was associated with a reduction in hospital costs for infants undergoing repair of TOF but not CoA. This CPG represents an opportunity to both optimize clinical outcome and reduce costs for certain infant cardiac surgeries.

Cost Variation Across Centers for the Norwood Operation.

BACKGROUND: The Norwood operation is associated with high health care utilization, and prior studies reported substantial variability in Norwood costs across centers. However, specific factors driving this cost variation are unclear. We assessed center variability in Norwood costs and underlying mechanisms in a multicenter cohort. METHODS: Clinical data from the Pediatric Heart Network Single Ventricle Reconstruction trial were linked with cost data from the Children's Hospital Association Inpatient Essentials database. Center variation was assessed by modeling Norwood costs adjusted for baseline patient characteristics, and the relationship with complications, length of stay (LOS), and specific cost categories was examined. Patients undergoing transplantation or stage 2 palliation during the Norwood admission were excluded. RESULTS: Nine centers (332 patients) were included. Adjusted mean cost/case varied 4.6-fold across centers (range: $50,559 to $230,851, p < 0.001). In addition, variation was found across centers in the adjusted mean number of complications/case (2.6-fold variation) and adjusted mean LOS/case (1.9-fold variation). Differences in complications explained 63% of the cost variation across centers. After accounting for complications, differences in LOS explained 66% of the remaining cost variation. Seven specific complications were found to occur more frequently at high-cost centers: pleural effusion, seizures, wound infection, thrombus, liver dysfunction, sepsis, necrotizing enterocolitis (all p < 0.001). With regard to types of cost, room and board/supplies and laboratory costs were the primary drivers of cost variation across centers. CONCLUSIONS: This study identified several factors associated with center variation in Norwood costs, which may be targeted in subsequent initiatives aimed at both improving quality of care and reducing costs.

Impact of postoperative complications on hospital costs following the Norwood operation.

UNLABELLED: Introduction Patients undergoing the Norwood operation consume considerable healthcare resources; however, detailed information regarding factors impacting hospitalisation costs is lacking. We evaluated the association of postoperative complications with hospital costs. METHODS: In the present study, we utilised a unique data set consisting of prospectively collected clinical data from the Pediatric Heart Network Single Ventricle Reconstruction trial linked at the patient level with cost data for 10 hospitals participating in the Children's Hospital Association Case Mix database during the trial period. The relationship between complications and cost was modelled using linear regression, accounting for the skewed distribution of cost, adjusting for within-centre clustering and baseline patient characteristics. RESULTS: A total of 334 eligible Norwood records (97.5%) were matched between data sets. Overall, 82% suffered from at least one complication (median 2; with a range from 0 to 33). Those with complications had longer postoperative length of stay (25 versus 12 days, p<0.001), more total ventilator days (7 versus 5 days, p<0.001), and higher in-hospital mortality (17.6 versus 3.4%, p<0.006). Mean adjusted hospital cost in those with a complication was $190,689 (95% CI $111,344-$326,577) versus $120,584 (95% CI $69,246-$209,983) in those without complications (p=0.002). Costs increased with the number of complications (1-2 complications=$132,800 versus 3-4 complications=$182,353 versus ⩾5 complications=$309,372 [p<0.001]). CONCLUSIONS: This merged data set of clinical trial and cost data demonstrated that postoperative complications are common following the Norwood operation and are associated with worse clinical outcomes and higher costs. Efforts to reduce complications in this population may lead to improved outcomes and cost savings.

Cancer information needs in rural areas.

Although cancer presents obstacles for all who experience it, persons in rural communities must negotiate additional challenges. This study determined the cancer information (CI) needs and the CI-seeking behavior and preferences among rural-dwelling persons. Patients (N = 801) = 50 years of age seen in 36 rural Kansas primary care practices completed a Cancer Care Information Needs Survey (CCINS); physicians completed a cancer resource knowledge and preference survey. Of the 801 patients, 184 (23%) reported a CI need. Of these 184 patients, 45% reported either not discussing cancer or having insufficient discussion time with their physicians; 44% needed more information after consulting their physician. Patients more likely to report a CI need were young, female, Internet users, persons with a prior cancer diagnosis, and persons seeing male physicians or physicians in group/multispecialty practices. Patients and physicians were unfamiliar with services provided by national cancer organizations. Physicians are a primary CI source; however, patients who need CI report insufficient cancer discussion time with their physician and need more CI after consulting their physician. Promoting access to national CI sources could bridge the CI needs gap that exists in rural areas currently.