Designing Effective Physician Incentives: Assessing the Relationship between Patient Satisfaction and Clinical Quality in an Ambulatory Environment

As the United State healthcare system continues to evolve from a reimbursement system based on volume to one based on value, understanding the relationship between physician quality metrics such as patient satisfaction and clinical quality metrics is extremely important. In order to improve value by effectuating behavior change, physician financial incentives must be designed based on desired outcomes. Understanding the relationship between performance indicators and aligning incentives is integral to successfully incentivizing physician behavior change. This study assessed the relationship between patient satisfaction and clinical quality in an ambulatory setting and determined that they are separate domains, but certain types of clinical quality are identifiable by patients and thus impact satisfaction

International Trade in Health Services: Assessing the Patterns of Trade in Global Healthcare Delivery

This dissertation will contribute to the research on international trade in health services through the analyses of three distinct but related topics within international trade in health services. We recognize that different countries have varying health system structures and that advances in transportation and communication have enabled individuals to seek care outside of their home country, allowed countries to invest in foreign health systems and created a market whereby US health systems are promoting their services abroad. However, we don’t know which factors influence individuals, countries and institutions in seeking services and trade partners in the healthcare sector. This dissertation adds to the literature by bringing together the different Modes of trade in health services, using a new data source on FDI; and qualitatively assessing patterns of trade in health services between major US health systems and other countries

Perioperative outcomes in a nationwide sample of patients undergoing surgical treatment of ovarian endometriomas.

OBJECTIVE: To evaluate the perioperative outcomes of premenopausal women undergoing cystectomy or oophorectomy for ovarian endometriomas (OMAs) and other benign neoplasms. DESIGN: Retrospective cohort study. SETTING: Clinical database containing information from 580 US hospitals. PATIENT(S): Women 18 to 50 years old who underwent ovarian cystectomy or oophorectomy for benign indications between 2010 and 2020. INTERVENTION(S): We compared procedure route, length of hospital stay, and complication rates by surgical indication (OMA vs. other benign neoplasms) and surgical procedure (cystectomy vs. oophorectomy). MAIN OUTCOME MEASURE(S): Thirty-day perioperative adverse events following adnexal surgery, including conversion to laparotomy, blood transfusion, ileus, urinary tract injury, bowel injury, readmission, and death. RESULT(S): We identified 120,208 ovarian cystectomies (28,182 OMAs and 92,026 other indications) and 53,476 oophorectomies (8,622 OMAs and 44,854 other indications). During cystectomy, patients with OMAs more commonly experienced conversion to laparotomy (5.1% vs. 3.1%) and readmission (8.5% vs. 7.1%). For oophorectomies, patients with OMAs less frequently had minimally invasive surgery (55.8% vs. 64.8%) or outpatient procedures (33.8% vs. 41.8%). Urinary tract and bowel injuries were rare. Multivariable logistic regression demonstrated that the presence of OMA predicted composite complications during cystectomy (adjusted odds ratio [aOR] 1.23, 95% confidence interval [CI] 1.18-1.28) but not during oophorectomy (aOR 1.05, 95% CI 0.99-1.12). Patients with OMAs had 1.37 times the odds of a composite complication during oophorectomy than during cystectomy (95% CI 1.28-1.47). CONCLUSION(S): Patients undergoing ovarian cystectomy for OMAs had higher rates of perioperative adverse events than patients undergoing ovarian cystectomy for other benign neoplasms. Laparotomies were performed more often during oophorectomies for OMAs than for other benign indications