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Pallavi Solanki
Heart failure is the leading cause of hospitalization in the USA. Despite major advances in the medical and device-related therapy including chronic resynchronization therapy for management of heart failure, significant number of patients eventually require advanced cardiac therapy including mechanical circulatory support or heart transplant. Heart transplant is a gold standard for end-stage heart failure but is limited by the donor heart shortage creating a definite need for alternative effective therapies...
April 2014: Journal of Cardiovascular Translational Research
David M Shahian, Xiu Liu, Gregg S Meyer, David F Torchiana, Sharon-Lise T Normand
BACKGROUND: Under the Affordable Care Act, health care reimbursement will increasingly be linked to quality and costs. In this environment, teaching hospitals will be closely scrutinized, as their care is often more expensive. Furthermore, although they serve vital roles in education, research, management of complex diseases, and care of vulnerable populations, debate continues as to whether teaching hospitals deliver better outcomes for common conditions. OBJECTIVE: To determine the association between risk-standardized mortality and teaching intensity for 3 common conditions...
January 2014: Medical Care
David F Torchiana, Deborah G Colton, Sandhya K Rao, Sarah K Lenz, Gregg S Meyer, Timothy G Ferris
Physicians are increasingly becoming salaried employees of hospitals or large physician groups. Yet few published reports have evaluated provider-driven quality incentive programs for salaried physicians. In 2006 the Massachusetts General Physicians Organization began a quality incentive program for its salaried physicians. Eligible physicians were given performance targets for three quality measures every six months. The incentive payments could be as much as 2 percent of a physician's annual income. Over thirteen six-month terms, the program used 130 different quality measures...
October 2013: Health Affairs
Karen C Nanji, Timothy G Ferris, David F Torchiana, Gregg S Meyer
The management literature reveals that many successful organisations have strategic plans that include a bold 'stretch-goal' to stimulate progress over a ten-to-thirty-year period. A stretch goal is clear, compelling and easily understood. It serves as a unifying focal point for organisational efforts. The ambitiousness of such goals has been emphasised with the phrase Big Hairy Audacious Goal ('BHAG'). President Kennedy's proclamation in 1961 that 'this Nation should commit itself to achieving the goal, before this decade is out, of landing a man on the moon and returning him safely to earth' provides a famous example...
March 2013: BMJ Quality & Safety
David M Shahian, Gregg S Meyer, Robert W Yeh, Michael A Fifer, David F Torchiana
No abstract text is available yet for this article.
May 10, 2012: New England Journal of Medicine
David M Shahian, Paul Nordberg, Gregg S Meyer, Bonnie B Blanchfield, Elizabeth A Mort, David F Torchiana, Sharon-Lise T Normand
PURPOSE: To compare the performance of U.S. teaching and nonteaching hospitals using a portfolio of contemporary, publicly reported metrics. METHOD: The authors classified acute care general hospitals filing a Medicare Institutional Cost Report according to teaching intensity: nonteaching, teaching, or Council of Teaching Hospitals member. They compared aggregate results across categories for Hospital Compare process compliance, mortality, and readmission rates (acute myocardial infarction [AMI], heart failure, pneumonia); Surgical Care Improvement Project (SCIP) performance; compliance with Leapfrog standards; patient experience; patient services and key technologies; safety (computerized physician order entry, intensive care unit staffing, National Quality Forum safe practices, hospital-acquired conditions); and cost/resource utilization (Medicare-adjusted expense per case; Leapfrog efficiency and resource use standards)...
June 2012: Academic Medicine: Journal of the Association of American Medical Colleges
Jeremy W Cannon, Jeffrey A Stoll, Shaun D Selha, Pierre E Dupont, Robert D Howe, David F Torchiana
Properly selected port sites for robot-assisted coronary artery bypass graft (CABG) improve the efficiency and quality of these procedures. In clinical practice, surgeons select port locations using external anatomic landmarks to estimate a patient's internal anatomy. This paper proposes an automated approach to port selection based on a preoperative image of the patient, thus avoiding the need to estimate internal anatomy. Using this image as input, port sites are chosen from a grid of surgeon-approved options by defining a performance measure for each possible port triad...
October 2003: IEEE Transactions on Robotics and Automation: a Publication of the IEEE Robotics and Automation Society
Timothy G Ferris, David F Torchiana
No abstract text is available yet for this article.
October 21, 2010: New England Journal of Medicine
Louis-Mathieu Stevens, Arvind K Agnihotri, Paul Khairy, David F Torchiana
BACKGROUND: In 2003, a satellite cardiac surgery program (SAT) was implemented at an affiliated community hospital located in an area historically served by an academic medical center (AMC). This study assessed the financial consequences and the changes in case-mix that occurred at the AMC after SAT implementation. METHODS: From June 2002 through December 2005, 4593 adult patients underwent cardiac operations at the AMC. Excluded were 400 patients operated on during the 4-month transition period after SAT implementation and 1210 patients living more than 35 miles from the AMC...
September 2010: Annals of Thoracic Surgery
Nancy J Gagliano, Timothy Ferris, Deborah Colton, Anne Dubitzky, James Hefferman, David Torchiana
To achieve care integration required for efficient high-quality care, physicians are increasingly organized into large multispecialty groups. The success of these groups depends in large part on the ability of leadership to successfully navigate the shifting reimbursement, regulatory, and quality and safety terrain, while simultaneously providing their physicians with a rewarding practice environment. The knowledge and management tools required for such leadership are not taught in medical school or residency and are rarely acquired as a product of day-to-day physician activities...
July 2010: Quality Management in Health Care
Daniel R Wong, Imtiaz S Ali, David F Torchiana, Arvind K Agnihotri, Richard M J Bohmer, Thomas J Vander Salm
BACKGROUND: Few studies of learning in the health care sector have analyzed measures of process, as opposed to outcomes. We assessed the learning curve for a new cardiac surgical center using precursor events (incidents or circumstances required for the occurrence of adverse outcomes). METHODS: Intraoperative precursor events were recorded prospectively during major adult cardiac operations, categorized by blinded adjudicators, and counted for each case (overall and according to these categories)...
February 2009: Surgery
Thomas H Lee, David F Torchiana, James E Lock
No abstract text is available yet for this article.
July 12, 2007: New England Journal of Medicine
Daniel R Wong, David F Torchiana, Thomas J Vander Salm, Arvind K Agnihotri, Richard M J Bohmer, Imtiaz S Ali
BACKGROUND: Although extensive study has been directed at the influence of patient factors and comorbidities on cardiac surgical outcomes, less attention has been focused on process. We sought to examine the relationship between intraoperative precursor events (those events that precede and are requisite for the occurrence of an adverse event) and adverse outcomes themselves. METHODS: Anonymous, prospectively collected intraoperative data was merged with database outcomes for 450 patients undergoing major adult cardiac operations...
June 2007: Surgery
Brendan M Everett, Robert Yeh, Shi Yin Foo, David Criss, Elizabeth M Van Cott, Michael Laposata, Edwin G Avery, William D Hoffman, Jennifer Walker, David Torchiana, Ik-Kyung Jang
BACKGROUND: The clinical significance of heparin/platelet factor 4 (PF4) antibodies in subjects undergoing cardiac surgery has not been systematically studied. We prospectively investigated whether the presence of heparin/PF4 antibodies would predict clinical thrombosis in this population. METHODS: In 299 patients scheduled for cardiac surgery between October 2003 and March 2005, the heparin/PF4 antibodies and platelet count were measured immediately prior to, and 5 days after, surgery...
February 2007: Annals of Thoracic Surgery
Abeel A Mangi, David F Torchiana
No abstract text is available yet for this article.
April 2006: Annals of Thoracic Surgery
Daniel R Wong, Thomas J Vander Salm, Imtiaz S Ali, Arvind K Agnihotri, Richard M J Bohmer, David F Torchiana
OBJECTIVE: Increasing attention has been afforded to the ubiquity of medical error and associated adverse events in medicine. There remains little data on the frequency and nature of precursor events in cardiac surgery, and we sought to characterize this. METHODS: Detailed, anonymous information regarding intraoperative precursor events (which may result in adverse events) was collected prospectively from six key members of the operating team during 464 major adult cardiac surgical cases at three hospitals and were analyzed with univariable statistical methods...
April 2006: European Journal of Cardio-thoracic Surgery
David M Shahian, David F Torchiana, Richard J Shemin, James D Rawn, Sharon-Lise T Normand
BACKGROUND: Choice of statistical methodology may significantly impact the results of provider profiling, including cardiac surgery report cards. Because of sample size and clustering issues, logistic regression may overestimate systematic interprovider variability, leading to false outlier classification. Theoretically, the use of hierarchical models should result in more accurate representation of provider performance. METHODS: Extensively validated and audited data were available for all 4,603 isolated coronary artery bypass grafting procedures performed at 13 Massachusetts hospitals during 2002...
December 2005: Annals of Thoracic Surgery
David M Shahian, David F Torchiana, Sharon-Lise T Normand
Demand is increasing for public accountability in health care. In 2000, the Massachusetts legislature mandated a state report card for cardiac surgery and percutaneous coronary interventions. During the planning and implementation of this report card, a number of observations were made that may prove useful to other states faced with similar mandates. These include the necessity for constructive, nonadversarial collaboration between regulators, clinicians, and statisticians; the advantages of preemptive adoption of The Society of Thoracic Surgeons [STS] National Cardiac Database, preferably before a report card is mandated; the support and resources available to cardiac surgeons through the STS, the National Cardiac Database Committee, and the Duke Clinical Research Institute; the value of a state STS organization; and the importance of media education to facilitate fair and dispassionate press coverage...
September 2005: Annals of Thoracic Surgery
Jennifer K White, Arvind K Agnihotri, James S Titus, David F Torchiana
PURPOSE: The purpose of this study was to investigate the function of a trileaflet pulmonary valve constructed from a sheet of porcine small intestinal submucosa. DESCRIPTION: In four sheep, the native pulmonary valve and a segment of the pulmonary trunk was excised and replaced with a trileaflet valve constructed from decellularized porcine small intestinal submucosa. The valve construct was created from a sheet of the xenograft material by a method of involuting flaps of tissue inside a cylinder of itself...
August 2005: Annals of Thoracic Surgery
Daniel R Wong, Arvind K Agnihotri, Judy W Hung, Gus J Vlahakes, Cary W Akins, Alan D Hilgenberg, Joren C Madsen, Thomas E MacGillivray, Michael H Picard, David F Torchiana
BACKGROUND: We sought to characterize patient survival and degree of late mitral regurgitation (MR) in patients undergoing surgical revascularization with moderate ischemic MR. METHODS: We retrospectively reviewed 251 patients undergoing coronary artery bypass graft (CABG) surgery between 1991 and 2001 with 3+ ischemic MR, including 31 patients who had concomitant mitral annuloplasty. Univariate and multivariable testing was employed. RESULTS: Actuarial 1-, 5-, and 10-year survival was 84...
August 2005: Annals of Thoracic Surgery
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