Predictors of Clostridium Difficile Colitis Infections in Hospitals.

Hospital-level predictors of high rates of \u27Clostridium difficile-associated disease\u27 (CDAD) were evaluated in over 2300 hospitals across California, Arizona, and Minnesota. American Hospital Association data were used to determine hospital characteristics associated with high rates of CDAD. Significant correlations were found between hospital rates of CDAD, common infections and other identified pathogens. Hospitals in urban areas had higher average rates of CDAD; yet, irrespective of geographic location, hospital rates of CDAD were associated with other infections. In addition, hospitals with \u27high CDAD\u27 rates had slower turnover of beds and were more likely to offer transplant services. These results reveal large differences in rates of CDAD across regions. Hospitals with high rates of CDAD have high rates of other common infections, suggesting a need for broad infection control policies

Factors Associated with Preoperative Magnetic Resonance Imaging Use among Medicare Beneficiaries with Nonmetastatic Breast Cancer

Preoperative breast magnetic resonance imaging (MRI) use among Medicare beneficiaries with breast cancer has substantially increased from 2005 to 2009. We sought to identify factors associated with preoperative breast MRI use among women diagnosed with ductal carcinoma in situ (DCIS) or stage I-III invasive breast cancer (IBC)

Breast MRI in the Diagnostic and Preoperative Workup Among Medicare Beneficiaries With Breast Cancer

We compared the frequency and sequence of breast imaging and biopsy use for the diagnostic and preoperative workup of breast cancer according to breast MRI use among older women

Locoregional treatment of breast cancer in women with and without preoperative magnetic resonance imaging

Preoperative magnetic resonance imaging (MRI) use has increased among older women diagnosed with breast cancer. MRI detects additional malignancy, but its impact on locoregional surgery and radiation treatment remains unclear

Costs of diagnostic and preoperative workup with and without breast MRI in older women with a breast cancer diagnosis

Abstract Background Breast cancer in the U.S. - estimated at 232,670 incident cases in 2014 - has the highest aggregate economic burden of care relative to other female cancers. Yet, the amount of cost attributed to diagnostic/preoperative work up has not been characterized. We examined the costs of imaging and biopsy among women enrolled in Medicare who did and did not receive diagnostic/preoperative Magnetic Resonance Imaging (MRI). Methods Using Surveillance, Epidemiology and End Results (SEER)- Medicare data, we compared the per capita costs (PCC) based on amount paid, between diagnosis date and primary surgical treatment for a breast cancer diagnosis (2005–2009) with and without diagnostic/preoperative MRI. We compared the groups with and without MRI using multivariable models, adjusting for woman and tumor characteristics. Results Of the 53,653 women in the cohort, within the diagnostic/preoperative window, 20 % (N = 10,776) received diagnostic/preoperative MRI. Total unadjusted median costs were almost double for women with MRI vs. without ($2,251 vs.$1,152). Adjusted costs were higher among women receiving MRI, with significant differences in total costs ($1,065), imaging costs ($928), and biopsies costs ($138). Conclusion Costs of diagnostic/preoperative workups among women with MRI are higher than those without. Using these cost estimates in comparative effectiveness models should be considered when assessing the benefits and harms of diagnostic/preoperative MRI

Geographic Access to Breast Imaging for US Women

The breast imaging modalities of mammography, ultrasound, and magnetic resonance imaging (MRI) are widely used for screening, diagnosis, treatment, and surveillance of breast cancer. Geographic access to breast imaging modalities is not known at a national level overall or for population subgroups

Physician visits, patient comorbidities, and mammography use among elderly colorectal cancer survivors

Over a million Americans have survived colorectal cancer. This study examined physician visit patterns, patient comorbidities, and mammography use among colorectal cancer survivors based on the competing demands model. Using Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data (2003 merge), study cohorts included female colorectal cancer patients who were diagnosed from 1973 through 1994 and had survived five or more years after the cancer diagnosis (n∈=∈12,681), and a non-cancer comparison population who had no history of cancer and resided in the SEER areas during the study period. Cancer survivors had a significant 6% higher mammography rate during 2000 to 2001 than matched women with no history of cancer (50 vs 47 per 100 persons, respectively). Among cancer survivors, there was a significant and positive association between the number of physician visits for evaluation and management (E&M) and mammography rates. More physician visits for E&M reduced the differences of mammography rates between those with and without additional comorbidities. Cancer survivors who visited gynecologists for E&M were 45% more likely to receive mammograms than those who visited only primary care physicians (multivariate adjusted rate ratio, 1.45; 95% CI, 1.38-1.53). Elderly female colorectal cancer survivors were more likely to receive mammograms than matched women with no history of cancer. Patients with multiple comorbidities might receive more mammograms by increasing the number of office visits for E&M and by visiting gynecologists. Primary care physicians should increase the priority for recommending mammograms among cancer survivors. © 2007 Springer Science+Business Media, LLC

The use of preventive health services among elderly uterine cancer survivors

Objective: The purpose of the study was to determine whether women who survived uterine cancer received 4 recommended preventive services (mammography, colorectal cancer screening, influenza immunization, and bone density testing) at the same rates as women with no history of cancer. Study Design: We used the Surveillance, Epidemiology, and End Results-Medicare database to compare the rates among survivors aged 67 years or older with a matched group of women with no history of cancer. Results: Survivors were significantly more likely to have a mammogram (adjusted odds ratio [OR], 1.40; 95% confidence interval [CI], 1.30-1.50) or a colorectal cancer screening examination (adjusted OR, 1.11; 95% CI, 1.05-1.18). Influenza immunization and bone density testing rates were similar. The 28% of survivors seen by an obstetrician-gynecologist or gynecologic oncologist had the highest rates of use. Conclusion: Efforts need to be made to increase the use of services by all women to achieve the target rates established by Healthy People 2010. © 2008 Mosby, Inc. All rights reserved