Rankings versus reality in pancreatic cancer surgery: a real-world comparison.

BACKGROUND: Patients are increasingly confronted with systems for rating hospitals. However, the correlations between publicized ratings and actual outcomes after pancreatectomy are unknown. METHODS: The Massachusetts Division of Health Care Finance and Policy Hospital Inpatient Discharge Database was queried to identify pancreatic cancer resections carried out during 2005-2009. Hospitals performing fewer than 10 pancreatic resections in the 5-year period were excluded. Primary outcomes included mortality, complications, median length of stay (LoS) and a composite outcomes score (COS) combining primary outcomes. Ranks were determined and compared for: (i) volume, and (ii) ratings identified from consumer-directed hospital ratings including the US News & World Report (USN), Consumer Reports, Healthgrades and Hospital Compare. An inter-rater reliability analysis was performed and correlation coefficients (r) between outcomes and ratings, and between rating systems were calculated. RESULTS: Eleven hospitals in which a total of 804 pancreatectomies were conducted were identified. Surgical volume correlated with overall outcome, but was not the strongest indicator. The highest correlation referred to that between USN rank and overall outcome. Mortality was most strongly correlated with Healthgrades ratings (r = 0.50); however, Healthgrades ratings demonstrated poorer correlations with all other outcomes. Consumer Reports ratings showed inverse correlations. CONCLUSIONS: The plethora of publicly available hospital ratings systems demonstrates heterogeneity. Volume remains a good but imperfect indicator of surgical outcomes. Further systematic investigation into which measures predict quality outcomes in pancreatic cancer surgery will benefit both patients and providers.

Effects of label-dose permethrin administration in yearling beef cattle: I. Reproductive function and embryo quality of superovulated heifers.

The objective was to study the effects of a commercial pyrethroid-based pour-on product, permethrin, on reproductive performance in superovulated beef heifers by assessing steroid biosynthesis and embryo quality. Nonpregnant, yearling beef heifers (n = 10; 418 ± 33 kg; 5.5 ± 0.2 body conditioning scores) were assigned by body weight and breed to either (1) saline control or (2) permethrin pour-on administered at label dose (PYR). Superovulation was achieved on all heifers using a timed, 17-day, CIDR-based protocol with GnRH and PGF2α and decreasing total dosage of 240-mg FSH administered twice daily for 4 days. Heifers were artificially inseminated twice (at onset of estrus and 12 hours later) by same technician with frozen semen from single bull collection. To determine short- and long-term effects of permethrin on embryo quality and steroid biosynthesis, superovulation was initiated twice with collection of embryos occurring at 17 and 51 days after treatment. Embryos were recovered 6.5 days after first artificial insemination via nonsurgical flush and were evaluated by International Embryo Transfer Society standards. Blood was collected at standing estrus and day of embryo recovery. Estradiol (E2) and progesterone (P4) concentrations were analyzed via RIA. MIXED and GLIMMIX procedures of SAS were used to analyze continuous and categorical data, respectively. Heifer per flush was the experimental unit. Total embryos recovered did not differ because of treatment (P = 0.30), but did decrease in flush 2 compared with flush 1 (P = 0.02). Quality grade, total transferable quality embryos, and overall flush success did not differ because of treatment (P ≥ 0.16). However, transferable quality embryos were decreased in flush 2 compared with flush 1 (P = 0.05). Total unfertilized oocytes were greater in saline control (P = 0.04). The PYR heifers tended to have less total P4 (P = 0.15) and P4 per CL (P = 0.06) at recovery. E2 per ovulated follicle and E2 per total ovarian structure was greater in flush 2 (P ≤ 0.03) but did not differ because of treatment (P ≥ 0.23). In summary, these data indicate that permethrin administration at label dose in superovulated beef heifers has a tendency to reduce P4, but embryo quality is not affected.

Accuracy of administrative diagnostic data for pathologically confirmed cases of Creutzfeldt-Jakob disease in Massachusetts, 2000-2008.

BACKGROUND: Creutzfeldt-Jakob disease (CJD) is a transmissible disorder that is monitored by public health authorities at the state and national levels in the United States. Little is known about the current accuracy and concurrence of CJD diagnoses across national and state sources of surveillance data. METHODS: Using multiple sources, including the National Prion Disease Pathology Surveillance Center (NPDPSC) registry, we sought to identify all deceased Massachusetts patients with pathologically diagnosed CJD between 2000 and 2008. Pathologically verified CJD cases were then matched to their respective records in the Massachusetts hospital discharge and death certificate datasets. Using these data, we also aimed to estimate the sensitivity and specificity of death certificate diagnoses. RESULTS: Death certificate and hospital discharge dataset diagnoses of CJD combined accounted for 80% (35 of 44) of pathologically confirmed cases. The estimated sensitivity and specificity for death certificate diagnoses alone were 71% (27 of 38) and 75% (9 of 12), respectively. CONCLUSIONS: Death certificate diagnoses were less sensitive for pathologically confirmed CJD than reported previously. Increasing reliance on autopsy over biopsy and an expanding spectrum of health care delivery may be responsible for this discrepancy. The findings reported here underscore the value of using multiple mechanisms in national CJD surveillance.

Perspectives on the Massachusetts Community Health Information Profile (MassCHIP): developing an online data query system to target a variety of user needs and capabilities.

The Massachusetts Community Health Information Profile (MassCHIP) has many distinctive features. These features evolved to maximize the usefulness of this query system for a broad group of users with varied needs, differing levels of knowledge about public health, and diverse experience using public health data. Three major features of MassCHIP help target our large user population. These features are as follows: (1) multiple avenues of entry to initiate queries ranging from an alphabetical list of simple topics to detailed International Classification of Disease codes; (2) the inclusion of data sets from other state agencies in addition to those of the Massachusetts Department of Public Health to reflect a broad view of public health; and (3) the capacity to retrieve data for multiple levels of geography, from the neighborhood through the state, including planning districts and hospitals. In this article, we discuss the history and design of MassCHIP, and focus on the features of MassCHIP that target a great variety of user needs and capabilities, and which are distinctive among Web-based data query systems.