Improving quality of breast cancer surgery through development of a national breast cancer surgical outcomes (BRCASO) research database

<p>Abstract</p> <p>Background</p> <p>Common measures of surgical quality are 30-day morbidity and mortality, which poorly describe breast cancer surgical quality with extremely low morbidity and mortality rates. Several national quality programs have collected additional surgical quality measures; however, program participation is voluntary and results may not be generalizable to all surgeons. We developed the Breast Cancer Surgical Outcomes (BRCASO) database to capture meaningful breast cancer surgical quality measures among a non-voluntary sample, and study variation in these measures across providers, facilities, and health plans. This paper describes our study protocol, data collection methods, and summarizes the strengths and limitations of these data.</p> <p>Methods</p> <p>We included 4524 women ≥18 years diagnosed with breast cancer between 2003-2008. All women with initial breast cancer surgery performed by a surgeon employed at the University of Vermont or three Cancer Research Network (CRN) health plans were eligible for inclusion. From the CRN institutions, we collected electronic administrative data including tumor registry information, Current Procedure Terminology codes for breast cancer surgeries, surgeons, surgical facilities, and patient demographics. We supplemented electronic data with medical record abstraction to collect additional pathology and surgery detail. All data were manually abstracted at the University of Vermont.</p> <p>Results</p> <p>The CRN institutions pre-filled 30% (22 out of 72) of elements using electronic data. The remaining elements, including detailed pathology margin status and breast and lymph node surgeries, required chart abstraction. The mean age was 61 years (range 20-98 years); 70% of women were diagnosed with invasive ductal carcinoma, 20% with ductal carcinoma in situ, and 10% with invasive lobular carcinoma.</p> <p>Conclusions</p> <p>The BRCASO database is one of the largest, multi-site research resources of meaningful breast cancer surgical quality data in the United States. Assembling data from electronic administrative databases and manual chart review balanced efficiency with high-quality, unbiased data collection. Using the BRCASO database, we will evaluate surgical quality measures including mastectomy rates, positive margin rates, and partial mastectomy re-excision rates among a diverse, non-voluntary population of patients, providers, and facilities.</p

Measuring patient-perceived quality of care in US hospitals using Twitter

ABSTRACT Background Patients routinely use Twitter to share feedback about their experience receiving healthcare. Identifying and analysing the content of posts sent to hospitals may provide a novel real-time measure of quality, supplementing traditional, survey-based approaches. Objective To assess the use of Twitter as a supplemental data stream for measuring patientperceived quality of care in US hospitals and compare patient sentiments about hospitals with established quality measures. Design 404 065 tweets directed to 2349 US hospitals over a 1-year period were classified as having to do with patient experience using a machine learning approach. Sentiment was calculated for these tweets using natural language processing. 11 602 tweets were manually categorised into patient experience topics. Finally, hospitals with ≥50 patient experience tweets were surveyed to understand how they use Twitter to interact with patients. Key results Roughly half of the hospitals in the US have a presence on Twitter. Of the tweets directed toward these hospitals, 34 725 (9.4%) were related to patient experience and covered diverse topics. Analyses limited to hospitals with ≥50 patient experience tweets revealed that they were more active on Twitter, more likely to be below the national median of Medicare patients ( p&lt;0.001) and above the national median for nurse/patient ratio ( p=0.006), and to be a nonprofit hospital ( p&lt;0.001). After adjusting for hospital characteristics, we found that Twitter sentiment was not associated with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings (but having a Twitter account was), although there was a weak association with 30-day hospital readmission rates ( p=0.003). Conclusions Tweets describing patient experiences in hospitals cover a wide range of patient care aspects and can be identified using automated approaches. These tweets represen

Measuring patient-perceived quality of care in US hospitals using Twitter

Background: Patients routinely use Twitter to share feedback about their experience receiving healthcare. Identifying and analysing the content of posts sent to hospitals may provide a novel real-time measure of quality, supplementing traditional, survey-based approaches. Objective: To assess the use of Twitter as a supplemental data stream for measuring patient-perceived quality of care in US hospitals and compare patient sentiments about hospitals with established quality measures. Design: 404 065 tweets directed to 2349 US hospitals over a 1-year period were classified as having to do with patient experience using a machine learning approach. Sentiment was calculated for these tweets using natural language processing. 11 602 tweets were manually categorised into patient experience topics. Finally, hospitals with ≥50 patient experience tweets were surveyed to understand how they use Twitter to interact with patients. Key results Roughly half of the hospitals in the US have a presence on Twitter. Of the tweets directed toward these hospitals, 34 725 (9.4%) were related to patient experience and covered diverse topics. Analyses limited to hospitals with ≥50 patient experience tweets revealed that they were more active on Twitter, more likely to be below the national median of Medicare patients (p<0.001) and above the national median for nurse/patient ratio (p=0.006), and to be a non-profit hospital (p<0.001). After adjusting for hospital characteristics, we found that Twitter sentiment was not associated with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings (but having a Twitter account was), although there was a weak association with 30-day hospital readmission rates (p=0.003). Conclusions: Tweets describing patient experiences in hospitals cover a wide range of patient care aspects and can be identified using automated approaches. These tweets represent a potentially untapped indicator of quality and may be valuable to patients, researchers, policy makers and hospital administrators

Glacial‐interglacial changes in central tropical Pacific surface seawater property gradients

Much uncertainty exists about the state of the oceanic and atmospheric circulation in the tropical Pacific over the last glacial cycle. Studies have been hampered by the fact that sediment cores suitable for study were concentrated in the western and eastern parts of the tropical Pacific, with little information from the central tropical Pacific. Here we present information from a suite of sediment cores collected from the Line Islands Ridge in the central tropical Pacific, which show sedimentation rates and stratigraphies suitable for paleoceanographic investigations. Based on the radiocarbon and oxygen isotope measurements on the planktonic foraminifera Globigerinoides ruber, we construct preliminary age models for selected cores and show that the gradient in the oxygen isotope ratio of G. ruber between the equator and 8 degrees N is enhanced during glacial stages relative to interglacial stages. This stronger gradient could reflect enhanced equatorial cooling (perhaps reflecting a stronger Walker circulation) or an enhanced salinity gradient (perhaps reflecting increased rainfall in the central tropical Pacific)

Slow release of fossil carbon during the Palaeocene–Eocene Thermal Maximum

The transient global warming event known as the Palaeocene–Eocene Thermal Maximum occurred about 55.9?Myr ago. The warming was accompanied by a rapid shift in the isotopic signature of sedimentary carbonates, suggesting that the event was triggered by a massive release of carbon to the ocean–atmosphere system. However, the source, rate of emission and total amount of carbon involved remain poorly constrained. Here we use an expanded marine sedimentary section from Spitsbergen to reconstruct the carbon isotope excursion as recorded in marine organic matter. We find that the total magnitude of the carbon isotope excursion in the ocean–atmosphere system was about 4‰. We then force an Earth system model of intermediate complexity to conform to our isotope record, allowing us to generate a continuous estimate of the rate of carbon emissions to the atmosphere. Our simulations show that the peak rate of carbon addition was probably in the range of 0.3–1.7?Pg?C?yr?1, much slower than the present rate of carbon emissions