Rodney A Hayward
Biographic Data
| ID | 1245226 |
|---|---|
| NAME | Rodney A Hayward |
| GIVEN NAMES | Rodney A |
| FAMILY NAME | Hayward |
| SIGNATURE | HAYWARD R A |
| AFFILIATIONS | University of Michigan |
| VERIFIED | No |
| TOTAL WORKS | 21 |
| TOTAL CITATIONS | 11 |
| AUTHOR COUNT | 21 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 1989 |
| LATEST PUBLICATION YEAR | 2023 |
| H-INDEX | 1 |
Carpal Tunnel Syndrome as a Test Case for Value Assessment During the Presurgical Period
BACKGROUND: Few performance measures assess presurgical value (quality and utilization). OBJECTIVES: Using carpal tunnel syndrome (CTS) as a case study: (1) develop a model to evaluate presurgical quality and utilization and (2) identify opportunities for value improvement. RESEARCH DESIGN: A retrospective cohort study utilizing Veterans Affairs (VA) national administrative data. SUBJECTS: Patients who were evaluated in a VA primary care clinic o…
The Veterans Affairs Cardiac Risk Score
BACKGROUND: Accurately estimating cardiovascular risk is fundamental to good decision-making in cardiovascular disease (CVD) prevention, but risk scores developed in one population often perform poorly in dissimilar populations. We sought to examine whether a large integrated health system can use their electronic health data to better predict individual patients' risk of developing CVD. METHODS: We created a cohort using all patients ages 45-80 …
The Effect of Pre-Affordable Care Act (ACA) Medicaid Eligibility Expansion in New York State on Access to Specialty Surgical Care
BACKGROUND: Critics argue that expanding health insurance coverage through Medicaid may not result in improved access to care. The Affordable Care Act provides reimbursement incentives aimed at improving access to primary care services for new Medicaid beneficiaries; however, there are no such incentives for specialty services. Using the natural experiment of Medicaid expansion in New York (NY) State in October 2001, we examined whether Medicaid …
Improving the Reliability of Physician “Report Cards”
BACKGROUND: Performance measures are widely used to profile primary care physicians (PCPs) but their reliability is often limited by small sample sizes. We evaluated the reliability of individual PCP profiles and whether they can be improved by combining measures into composites or by profiling practice groups. METHODS: We performed a cross-sectional analysis of electronic health record data for patients with diabetes (DM), congestive heart failu…
Improved Cardiovascular Risk Prediction Using Nonparametric Regression and Electronic Health Record Data
BACKGROUND: Use of the electronic health record (EHR) is expected to increase rapidly in the near future, yet little research exists on whether analyzing internal EHR data using flexible, adaptive statistical methods could improve clinical risk prediction. Extensive implementation of EHR in the Veterans Health Administration provides an opportunity for exploration. OBJECTIVES: To compare the performance of various approaches for predicting risk o…
How to Make Market Competition Work in Healthcare
From *The Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, MI; †Department of Surgery, University of Michigan, Ann Arbor, MI; ‡Department of Internal Medicine, University of Michigan, Ann Arbor, MI; and §Department of Veterans Affairs, VA Health Services Research & Development Center of Excellence, VA Ann Arbor Health Care System, Ann Arbor, MI. Dr. Holman is a Robert Wood Johnson Foundation (RWJF) Clin…
Specialty Care and the Patient-Centered Medical Home
BACKGROUND: The medical home's success depends, in part, on the degree to which primary care physicians (PCPs) and specialists collaborate to create "medical neighborhoods" based on collective accountability. Such collaboration may require a new equilibrium in chronic disease care, with some of the routine follow-up currently provided by specialists reallocated to PCPs and their medical home teams. OBJECTIVES: To measure the care delivered by spe…
Access to Clinically-Detailed Patient Information
From the Department of Veterans Affairs, VA Center for Practice Management & Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, MI; the Michigan RWJ Clinical Scholars Program; and the Departments of Internal Medicine & Health Management & Policy, University of Michigan Schools of Medicine & Public Health, Ann Arbor, Michigan. Reprints: Rodney A. Hayward, MD, 6312 Medical Science Bldg I, Ann Arbor, MI 48109-0604. E-mail: [email protecte…
Patients, privacy and trust
Building a Better Quality Measure
BACKGROUND: National performance measures monitor the proportion of diabetic patients with low-density lipoprotein (LDL) levels >/=130 mg/dL, but such simple intermediate outcomes measure poor control, not necessarily poor care. "Tightly linked" quality measures define good quality either by a good intermediate outcome (LDL /=130 mg/dL using the simple intermediate outcome measure, only 13% (148 of 1154) were classified as having substandard qual…
Racial Disparities in Diabetes Care Processes, Outcomes, and Treatment Intensity
BACKGROUND: Black Americans with diabetes have a higher burden of illness and mortality than do white Americans. However, the extent to which differences in medical care processes and treatment intensity contribute to poorer diabetes outcomes is unknown. OBJECTIVE: To assess racial disparities in the quality of diabetes care processes, intermediate outcomes, and treatment intensity. METHODS: We conducted an observational study of 801 white and 11…
Discussion Between Reviewers Does Not Improve Reliability of Peer Review of Hospital Quality
OBJECTIVES: Peer review is used to make final judgments about quality of care in many quality assurance activities. To overcome the low reliability of peer review, discussion between several reviewers is often recommended to point out overlooked information or allow for reconsideration of opinions and thus improve reliability. The authors assessed the impact of discussion between 2 reviewers on the reliability of peer review. METHODS: A group of …
Department of Veterans Affairs' Quality Enhancement Research Initiative for Diabetes Mellitus
Diabetes is a common disease, which frequently leads to serious, high-cost complications. Estimates show that in fiscal year 1994 (FY94), 12.5% of outpatients in the Veterans Health Administration (VHA) received diabetes-specific medications, accounted for almost 25% of all VHA pharmacy costs, had a hospitalization rate 1.6 times that of veterans without diabetes, and made 3.6 million outpatient visits to VA clinics. Research demonstrates that mu…
Identifying Poor-Quality Hospitals
OBJECTIVES: Many groups involved in health care are very interested in using external quality indices, such as risk-adjusted mortality rates, to examine hospital quality. The authors evaluated the feasibility of using mortality rates for medical diagnoses to identify poor-quality hospitals. METHODS: The Monte Carlo simulation model was used to examine whether mortality rates could distinguish 172 average-quality hospitals from 19 poor-quality hos…
Can Early Re-Admission Rates Accurately Detect Poor-Quality Hospitals
There is widespread interest in using external quality measures, such as early re-admission rates (ERRs), to evaluate hospital quality. To evaluate the feasibility of using ERRs to identify poor-quality hospitals, a Monte Carlo simulation model was developed that describes the predictive power of ERRs for the 190 hospitals in Michigan using different assumptions concerning the distribution and variability of quality problems, the number of years …
The Integrated Inpatient Management Model
The Integrated Inpatient Management Model was a 2.5-year controlled prospective trial of using a clinical information system to direct and monitor physician and hospital practice on general medicine services of an 880-bed university hospital. For the over 2,000 admissions on both a control service and the intervention service, the mean length of stay (LOS) decreased when compared with historic norms (0.68 and 0.95 days respectively; P < 0.01 for …
In Reply
Depts. of Internal Medicine and Health Services Management and Policy University of Michigan Medical Center Ann Arbor, MI
Do Attending or Resident Physician Practice Styles Account for Variations in Hospital Resource Use
Prospective payment has created incentives for hospitals to identify physicians who are responsible for high or excessive rates of resource use. However, at teaching hospitals it is unclear whether individual attending or resident physicians account for a substantial portion of the observed variations in hospital resource use. To explore this issue, case-mix adjusted hospital length of stay and ancillary resource use at a university teaching hosp…
An Evaluation of Generic Screens for Poor Quality of Hospital Care on a General Medicine Service
In this study, 675 general medicine admissions at a university teaching hospital were reviewed to evaluate six potential generic quality screens: 1) in-hospital death; 2) 28-day early readmission; 3) low patient satisfaction; 4) worsening severity of illness (as determined by an increase in Laboratory Acute Physiology and Chronic Health Evaluation APACHE-L); and 5) deviations from expected hospital length of stay; and 6) expected ancillary resour…
Apache-L
A principal concern regarding Medicare's diagnosis-related group (DRG)-based prospective payment system is whether hospitals caring for more severely ill patients may be undercompensated for the services they provide. Research on possible inequities in hospital payment has been hampered by the absence of an objective, easily obtained, and valid measure of patients' severity of illness. Because laboratory data are objective and computerized in mos…
Utilization of Dental Services
Data from the 1986 Access to Health Care Survey of the Robert Wood Johnson Foundation, a nationwide telephone survey, were used to provide information on changes and trends in dental utilization in the United States. Sixty-three percent of the respondents five years or older (N = 9,352) had had a dental visit within the past year. Being elderly, having lower socioeconomic status, and being black were independent risk factors for having fewer dent…
Utilization of Dental Services
Data from the 1986 Access to Health Care Survey of the Robert Wood Johnson Foundation, a nationwide telephone survey, were used to provide information on changes and trends in dental utilization in the United States. Sixty-three percent of the respondents five years or older (N = 9,352) had had a dental visit within the past year. Being elderly, having lower socioeconomic status, and being black were independent risk factors for having fewer dent…
Apache-L
A principal concern regarding Medicare's diagnosis-related group (DRG)-based prospective payment system is whether hospitals caring for more severely ill patients may be undercompensated for the services they provide. Research on possible inequities in hospital payment has been hampered by the absence of an objective, easily obtained, and valid measure of patients' severity of illness. Because laboratory data are objective and computerized in mos…
An Evaluation of Generic Screens for Poor Quality of Hospital Care on a General Medicine Service
In this study, 675 general medicine admissions at a university teaching hospital were reviewed to evaluate six potential generic quality screens: 1) in-hospital death; 2) 28-day early readmission; 3) low patient satisfaction; 4) worsening severity of illness (as determined by an increase in Laboratory Acute Physiology and Chronic Health Evaluation APACHE-L); and 5) deviations from expected hospital length of stay; and 6) expected ancillary resour…
In Reply
Depts. of Internal Medicine and Health Services Management and Policy University of Michigan Medical Center Ann Arbor, MI
Do Attending or Resident Physician Practice Styles Account for Variations in Hospital Resource Use
Prospective payment has created incentives for hospitals to identify physicians who are responsible for high or excessive rates of resource use. However, at teaching hospitals it is unclear whether individual attending or resident physicians account for a substantial portion of the observed variations in hospital resource use. To explore this issue, case-mix adjusted hospital length of stay and ancillary resource use at a university teaching hosp…
Can Early Re-Admission Rates Accurately Detect Poor-Quality Hospitals
There is widespread interest in using external quality measures, such as early re-admission rates (ERRs), to evaluate hospital quality. To evaluate the feasibility of using ERRs to identify poor-quality hospitals, a Monte Carlo simulation model was developed that describes the predictive power of ERRs for the 190 hospitals in Michigan using different assumptions concerning the distribution and variability of quality problems, the number of years …
The Integrated Inpatient Management Model
The Integrated Inpatient Management Model was a 2.5-year controlled prospective trial of using a clinical information system to direct and monitor physician and hospital practice on general medicine services of an 880-bed university hospital. For the over 2,000 admissions on both a control service and the intervention service, the mean length of stay (LOS) decreased when compared with historic norms (0.68 and 0.95 days respectively; P < 0.01 for …
Identifying Poor-Quality Hospitals
OBJECTIVES: Many groups involved in health care are very interested in using external quality indices, such as risk-adjusted mortality rates, to examine hospital quality. The authors evaluated the feasibility of using mortality rates for medical diagnoses to identify poor-quality hospitals. METHODS: The Monte Carlo simulation model was used to examine whether mortality rates could distinguish 172 average-quality hospitals from 19 poor-quality hos…
Discussion Between Reviewers Does Not Improve Reliability of Peer Review of Hospital Quality
OBJECTIVES: Peer review is used to make final judgments about quality of care in many quality assurance activities. To overcome the low reliability of peer review, discussion between several reviewers is often recommended to point out overlooked information or allow for reconsideration of opinions and thus improve reliability. The authors assessed the impact of discussion between 2 reviewers on the reliability of peer review. METHODS: A group of …
Department of Veterans Affairs' Quality Enhancement Research Initiative for Diabetes Mellitus
Diabetes is a common disease, which frequently leads to serious, high-cost complications. Estimates show that in fiscal year 1994 (FY94), 12.5% of outpatients in the Veterans Health Administration (VHA) received diabetes-specific medications, accounted for almost 25% of all VHA pharmacy costs, had a hospitalization rate 1.6 times that of veterans without diabetes, and made 3.6 million outpatient visits to VA clinics. Research demonstrates that mu…
Building a Better Quality Measure
BACKGROUND: National performance measures monitor the proportion of diabetic patients with low-density lipoprotein (LDL) levels >/=130 mg/dL, but such simple intermediate outcomes measure poor control, not necessarily poor care. "Tightly linked" quality measures define good quality either by a good intermediate outcome (LDL /=130 mg/dL using the simple intermediate outcome measure, only 13% (148 of 1154) were classified as having substandard qual…
Racial Disparities in Diabetes Care Processes, Outcomes, and Treatment Intensity
BACKGROUND: Black Americans with diabetes have a higher burden of illness and mortality than do white Americans. However, the extent to which differences in medical care processes and treatment intensity contribute to poorer diabetes outcomes is unknown. OBJECTIVE: To assess racial disparities in the quality of diabetes care processes, intermediate outcomes, and treatment intensity. METHODS: We conducted an observational study of 801 white and 11…
Patients, privacy and trust
Access to Clinically-Detailed Patient Information
From the Department of Veterans Affairs, VA Center for Practice Management & Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, MI; the Michigan RWJ Clinical Scholars Program; and the Departments of Internal Medicine & Health Management & Policy, University of Michigan Schools of Medicine & Public Health, Ann Arbor, Michigan. Reprints: Rodney A. Hayward, MD, 6312 Medical Science Bldg I, Ann Arbor, MI 48109-0604. E-mail: [email protecte…
How to Make Market Competition Work in Healthcare
From *The Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, MI; †Department of Surgery, University of Michigan, Ann Arbor, MI; ‡Department of Internal Medicine, University of Michigan, Ann Arbor, MI; and §Department of Veterans Affairs, VA Health Services Research & Development Center of Excellence, VA Ann Arbor Health Care System, Ann Arbor, MI. Dr. Holman is a Robert Wood Johnson Foundation (RWJF) Clin…
Specialty Care and the Patient-Centered Medical Home
BACKGROUND: The medical home's success depends, in part, on the degree to which primary care physicians (PCPs) and specialists collaborate to create "medical neighborhoods" based on collective accountability. Such collaboration may require a new equilibrium in chronic disease care, with some of the routine follow-up currently provided by specialists reallocated to PCPs and their medical home teams. OBJECTIVES: To measure the care delivered by spe…
Improving the Reliability of Physician “Report Cards”
BACKGROUND: Performance measures are widely used to profile primary care physicians (PCPs) but their reliability is often limited by small sample sizes. We evaluated the reliability of individual PCP profiles and whether they can be improved by combining measures into composites or by profiling practice groups. METHODS: We performed a cross-sectional analysis of electronic health record data for patients with diabetes (DM), congestive heart failu…
Improved Cardiovascular Risk Prediction Using Nonparametric Regression and Electronic Health Record Data
BACKGROUND: Use of the electronic health record (EHR) is expected to increase rapidly in the near future, yet little research exists on whether analyzing internal EHR data using flexible, adaptive statistical methods could improve clinical risk prediction. Extensive implementation of EHR in the Veterans Health Administration provides an opportunity for exploration. OBJECTIVES: To compare the performance of various approaches for predicting risk o…
The Effect of Pre-Affordable Care Act (ACA) Medicaid Eligibility Expansion in New York State on Access to Specialty Surgical Care
BACKGROUND: Critics argue that expanding health insurance coverage through Medicaid may not result in improved access to care. The Affordable Care Act provides reimbursement incentives aimed at improving access to primary care services for new Medicaid beneficiaries; however, there are no such incentives for specialty services. Using the natural experiment of Medicaid expansion in New York (NY) State in October 2001, we examined whether Medicaid …
The Veterans Affairs Cardiac Risk Score
BACKGROUND: Accurately estimating cardiovascular risk is fundamental to good decision-making in cardiovascular disease (CVD) prevention, but risk scores developed in one population often perform poorly in dissimilar populations. We sought to examine whether a large integrated health system can use their electronic health data to better predict individual patients' risk of developing CVD. METHODS: We created a cohort using all patients ages 45-80 …
Carpal Tunnel Syndrome as a Test Case for Value Assessment During the Presurgical Period
BACKGROUND: Few performance measures assess presurgical value (quality and utilization). OBJECTIVES: Using carpal tunnel syndrome (CTS) as a case study: (1) develop a model to evaluate presurgical quality and utilization and (2) identify opportunities for value improvement. RESEARCH DESIGN: A retrospective cohort study utilizing Veterans Affairs (VA) national administrative data. SUBJECTS: Patients who were evaluated in a VA primary care clinic o…
Medicine (21 works) · Primary Care and Health Outcomes (12 works) · Emergency Medicine (11 works) · Emergency Medicine (11 works) · Family medicine (11 works) · Health care (10 works) · Internal Medicine (10 works) · Internal Medicine (10 works) · Healthcare Policy and Management (8 works) · Patient Satisfaction in Healthcare (6 works)