Regenstrief Center for Healthcare Engineering at Purdue University

Catalyze transformation of healthcare delivery by applying principles of engineering, management and science

2006 Annual Report of the Regenstrief Center for Healthcare Engineering

2006 Annual Report of the Regnestrief Center for Healthcare Engineerin

System-Wide Prediction of General, All-Cause, Preventable Hospital Readmissions

Existing studies of hospital readmissions typically focus on specific diagnoses, age groups, discharge dispositions, payer classes, or hospitals, and often use small samples. It is not clear how predictive models generated from such studies generalize across diseases, hospitals, or time periods. In this study, a logistic regression model of readmission risk within 30 days based on hospital administrative data was constructed and validated across hospitals and time periods. The hospitals included both general and specialty hospitals such as long-term care, women’s, and children’s hospitals. The administrative data included information on patient’s demographics, diagnoses, procedures, and discharge disposition. Derivation and validation samples for the cross-hospital analysis yielded C-statistics of 0.722 and 0.706, respectively. The cross-time period analysis yielded C-statistics from 0.736 to 0.755 for five derivation samples, and from 0.681 to 0.701 for fifteen validation samples. The findings indicate that a prediction model can be used with relative success to extrapolate beyond the estimation sample both in terms of hospital and time period. Such risk estimates can be used to inform discharge intervention decisions and increase care coordination

Timed sequential chemotherapy with concomitant Granulocyte Colony-Stimulating Factor for high-risk acute myelogenous leukemia: a single arm clinical trial

BACKGROUND: The timed-sequential chemotherapy regimen consisting of etoposide, mitoxantrone and cytarabine (EMA) is an effective therapy for relapsed or refractory acute myelogenous leukemia (AML). We postulated that granulocyte colony-stimulating factor (G-CSF) might enhance the cytotoxicity of EMA by increasing the proportion of leukemic blasts in S-phase. We added G-CSF to EMA (EMA-G) for therapy of advanced high-risk AML patients. METHODS: High-risk AML was defined as refractory, relapsed or secondary to either an antecedent hematologic disorder or exposure to cytotoxic agents. The patients were treated with one course of EMA-G consisting of mitoxantrone and cytarabine on days 1–3, and etoposide and cytarabine on days 8–10. G-CSF was started on day 4 and continued until absolute neutrophil count recovered. RESULTS: Thirty patients were enrolled. The median age was 51 years (range, 25–75). Seventeen (61%) patients had unfavorable cytogenetic karyotypes. Twenty (69%) patients had secondary AML. Ten (34%) had relapsed disease. Four (14%) had refractory AML. Three (10%) patients died from febrile neutropenia and sepsis. Major non-hematologic toxicity included hyperbilirubimenia, renal insufficiency, mucositis, diarrhea, nausea and vomiting, skin rash. A complete remission was achieved in 13 (46%) patients. Median overall survival was 9 months (range, 0.5–66). Median relapse-free survival (RFS) for those who had a CR was 3 months (range, 0.5–63) with RFS censored at the time of allogeneic bone marrow transplantation or peripheral stem cell transplantation for 6 of the patients. CONCLUSIONS: EMA-G is a safe and efficacious option for induction chemotherapy in advanced, high-risk AML patients. The activity of EMA may be increased if applied in patients with less advanced disease

Report to the Regenstrief Foundation Board

Purpose of presentatin: 1. Provide a summary of activities deuring the second year, 2. Identify future direction for RCHE, 3. Address questions

The Regenstrief Center for Healthcare Engineering: Designing, Implementing and Sustaining Interdisciplinary Solutions to Transform Healthcare Delivery Systems

With start-up funding provided by the Regenstrief Foundation, Purdue University has created the Regenstrief Center for Healthcare Engineering (RCHE) to design, implement, and sustain interdisciplinary solutions to improve the safety, quality, efficiency and accessibility of healthcare delivery systems. RCHE’s primary goal is to bring a systems-analysis approach to improving the processes of healthcare delivery, not to provide tools or techniques for medical research, diagnosis, or treatment. This article will describe RCHE’s business model; that is, how RCHE “engineers” interdisciplinary solutions, using the multiple perspectives of healthcare and multiple project time scales to organize and leverage healthcare delivery transformation. We then illustrate the model through the description of projects conducted with RCHE’s “partnerships” with various healthcare delivery organizations. We conclude with a discussion of future directions for RCHE

Unsung Hero Robert C. Gallo

Awarding the Nobel prize in physiology or medicine to Francoise Barré-Sinoussi and Luc Montagnier for the discovery of HIV-1, the causative agent of AIDS, is timely given the harm that the virus continues to inflict on the people of the world. While these awardees fully deserve the award, it is equally important to recognize the contributions of Robert C. Gallo. Gallo definitively proved HIV-1 as the cause of AIDS through the successful isolation and long-term cultivation of HIV-1 and developed a diagnostic kit that prevented new infections and saved thousands of lives. These contributions, together with Gallo's earlier discovery of interleukin-2 (fundamental for growing HIV-1 in vitro) and of HTLV-1, the first human pathogenic retrovirus, warrant equal recognition