Barbara J Mcneil
Biographic Data
| ID | 1731425 |
|---|---|
| NAME | Barbara J Mcneil |
| GIVEN NAMES | Barbara J |
| FAMILY NAME | Mcneil |
| SIGNATURE | MCNEIL B J |
| AFFILIATIONS | Brigham and Women's Hospital |
| VERIFIED | No |
| TOTAL WORKS | 22 |
| TOTAL CITATIONS | 16 |
| WORKS AS AUTHOR | 22 |
| WORKS AS EDITOR | 0 |
| FIRST PUBLICATION YEAR | 1982 |
| LATEST PUBLICATION YEAR | 2018 |
| H-INDEX | 3 |
Diffusion of Bevacizumab Across Oncology Practices
BACKGROUND: Technological advances can improve care and outcomes but are a primary driver of health care spending growth. Understanding diffusion and use of new oncology therapies is important, given substantial increases in prices and spending on such treatments. OBJECTIVES: Examine diffusion of bevacizumab, a novel (in 2004) and high-priced biologic cancer therapy, among US oncology practices during 2005-2012 and assess variation in use across …
Racial Disparities in Cancer Care in the Veterans Affairs Health Care System and the Role of Site of Care
Objectives. We assessed cancer care disparities within the Veterans Affairs (VA) health care system and whether between-hospital differences explained disparities. Methods. We linked VA cancer registry data with VA and Medicare administrative data and examined 20 cancer-related quality measures among Black and White veterans diagnosed with colorectal (n = 12 897), lung (n = 25 608), or prostate (n = 38 202) cancer from 2001 to 2004. We used logis…
Area-Level Variations in Cancer Care and Outcomes
BACKGROUND: : Substantial regional variations in health-care spending exist across the United States; yet, care and outcomes are not better in higher-spending areas. Most studies have focused on care in fee-for-service Medicare; whether spillover effects exist in settings without financial incentives for more care is unknown. OBJECTIVE: : We studied care for cancer patients in fee-for-service Medicare and the Veterans Health Administration (VA) t…
The Effect of Managed Care Market Share on Appropriate Use of Coronary Angiography among Traditional Medicare Beneficiaries
Evidence suggests that when managed care market share increases in a geographic area, expenditures in Medicare's fee-for-service sector decrease. But it is unclear how expenditure reductions relate to the quality of medical care for traditional Medicare beneficiaries. We estimated how managed care market share varied with the proportion of fee-for-service Medicare beneficiaries who were admitted for acute myocardial infarction (AMI) and underwent…
Understanding Individual and Small Area Variation in the Underuse of Coronary Angiography Following Acute Myocardial Infarction
BACKGROUND: Underuse of coronary angiography is common among patients with acute myocardial infarction (AMI) and the magnitude of underuse varies across geographic areas. OBJECTIVES: To examine the influence of patient demographic, clinical and hospital characteristics on underuse of coronary angiography, and the contribution of these factors to variation in underuse across geographic regions. RESEARCH DESIGN: Cohort study using data from the Coo…
Validating recommendations for coronary angiography following acute myocardial infarction in the elderly
Impact of Underuse, Overuse, and Discretionary Use on Geographic Variation in the Use of Coronary Angiography After Acute Myocardial Infarction
BACKGROUND: Geographic variation in the use of medical procedures has been well documented. However, it is not known whether this variation is due to differences in use when procedures are indicated, discretionary, or contraindicated. OBJECTIVES: To examine whether use of coronary angiography after acute myocardial infarction (AMI) according to appropriateness criteria varied across geographic regions and whether underuse, overuse, or discretiona…
Variations in the Utilization of Coronary Angiography for Elderly Patients with an Acute Myocardial Infarction
This article reports a study of variations in the utilization of angiography for Medicare recipients who had an acute myocardial infarction. The study cohort consisted of 1987 Medicare beneficiaries who had a recent acute myocardial infarction. Variations were examined from three perspectives: patient characteristics, regional practice patterns, and on-site availability of the procedure. Factors associated with variation within and among states w…
The influence of socioeconomic status on change in health status after hospitalization
Using patient reports to assess health-related quality of life after total hip replacement
The Importance of Co-existent Disease in the Occurrence of Postoperative Complications and One-Year Recovery in Patients Undergoing Total Hip Replacement
Co-existent or comorbid diseases are appreciated as prognostic factors in studies of quality and effectiveness of care when mortality is the end point. The need to measure and adjust for comorbidity in studies of postoperative hospital complications or long-term recovery from surgery has not been documented. In this study, we determined the impact of co-existent disease on post-operative complications and 1-year health-related quality of life in …
Multidimensionality of Health Status in an Elderly Population
Although health is generally accepted to be a multidimensional construct, the relationship among various domains has not been well defined. To understand this issue better we used principal components analysis to examine the relations among a set of health status measures gathered on 590 elderly members of a health maintenance organization (HMO). These included functional health, emotional health, social activity within and outside of the family,…
Modified DRGs as Evidence for Variability in Patient Severity
The authors were interested in exploring the extent to which differences in the complexity of patients could be determined by modifications in combinations of the ICD-9-CM codes used to define DRGs. The 150 most common medical and surgical DRGs in one teaching hospital were studied. With clinical experts they identified 41 DRGs that were believed to have subgroups reflecting quite different types of patients, one group sicker and costlier than th…
Changes in Ambulatory Testing for Hypertensive Patients 1971-1980
To determine temporal changes in the outpatient use of diagnostic tests, the authors studied ambulatory testing for 208 patients diagnosed with uncomplicated hypertension, cared for by 15 private office internists in 1971 through 1980. Patients diagnosed and treated earlier in the decade tended to have significantly higher blood pressure. After adjustment for blood pressure, use of diagnostic tests in terms of total charges for testing per patien…
The Chemistry Laboratory
In order to estimate real cost savings achievable from reductions in laboratory test volume and in order to provide a management tool to help achieve such savings, we developed a management system for our chemistry laboratory. The system estimates the fixed costs (i.e., equipment, direct overhead, and indirect overhead costs), the variable costs (i.e., labor and supplies), and the total costs for each of the 81 tests performed in our hospital's c…
Clinical Decisionmaking
From the Departments of Radiology and Clinical Epidemiology and Preventive Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
The effects of patient characteristics on ambulatory test ordering
The effects of physicians' training and personality on test ordering for ambulatory patients
We studied records of 351 hypertensive patients cared for by 30 internists in private office practice. We correlated the use of outpatient diagnostic tests with personal characteristics of the prescribing physicians. Doctors trained in medical schools with academic orientations used more tests than other physicians. Patterns of use were not strongly related to the number of years since medical school graduation, or physicians "intolerance of ambi…
Office Laboratory Tests
Theoretic modeling suggests that common office tests as a group are profitable. To determine whether practicing internists perceive this profitability and whether their perceptions differ for different tests or for patients with different types of insurance coverage, the authors surveyed 111 physicians in private office practice. Respondents' estimates of receipts for tests done on patients with Medicare or Blue Cross/Blue Shield coverage were hi…
A method of comparing the areas under receiver operating characteristic curves derived from the same cases.
Receiver operating characteristic (ROC) curves are used to describe and compare the performance of diagnostic technology and diagnostic algorithms. This paper refines the statistical comparison of the areas under two ROC curves derived from the same set of patients by taking into account the correlation between the areas that is induced by the paired nature of the data. The correspondence between the area under an ROC curve and the Wilcoxon stati…
On the Elicitation of Preferences for Alternative Therapies
We investigated how variations in the way information is presented to patients influence their choices between alternative therapies. Data were presented summarizing the results of surgery and radiation therapy for lung cancer to 238 ambulatory patients with different chronic medical conditions and to 491 graduate students and 424 physicians. We asked the subjects to imagine that they had lung cancer and to choose between the two therapies on the…
The meaning and use of the area under a receiver operating characteristic (ROC) curve.
A representation and interpretation of the area under a receiver operating characteristic (ROC) curve obtained by the "rating" method, or by mathematical predictions based on patient characteristics, is presented. It is shown that in such a setting the area represents the probability that a randomly chosen diseased subject is (correctly) rated or ranked with greater suspicion than a randomly chosen non-diseased subject. Moreover, this probability…
Racial Disparities in Cancer Care in the Veterans Affairs Health Care System and the Role of Site of Care
Objectives. We assessed cancer care disparities within the Veterans Affairs (VA) health care system and whether between-hospital differences explained disparities. Methods. We linked VA cancer registry data with VA and Medicare administrative data and examined 20 cancer-related quality measures among Black and White veterans diagnosed with colorectal (n = 12 897), lung (n = 25 608), or prostate (n = 38 202) cancer from 2001 to 2004. We used logis…
The influence of socioeconomic status on change in health status after hospitalization
The effects of physicians' training and personality on test ordering for ambulatory patients
We studied records of 351 hypertensive patients cared for by 30 internists in private office practice. We correlated the use of outpatient diagnostic tests with personal characteristics of the prescribing physicians. Doctors trained in medical schools with academic orientations used more tests than other physicians. Patterns of use were not strongly related to the number of years since medical school graduation, or physicians "intolerance of ambi…
On the Elicitation of Preferences for Alternative Therapies
We investigated how variations in the way information is presented to patients influence their choices between alternative therapies. Data were presented summarizing the results of surgery and radiation therapy for lung cancer to 238 ambulatory patients with different chronic medical conditions and to 491 graduate students and 424 physicians. We asked the subjects to imagine that they had lung cancer and to choose between the two therapies on the…
The meaning and use of the area under a receiver operating characteristic (ROC) curve.
A representation and interpretation of the area under a receiver operating characteristic (ROC) curve obtained by the "rating" method, or by mathematical predictions based on patient characteristics, is presented. It is shown that in such a setting the area represents the probability that a randomly chosen diseased subject is (correctly) rated or ranked with greater suspicion than a randomly chosen non-diseased subject. Moreover, this probability…
A method of comparing the areas under receiver operating characteristic curves derived from the same cases.
Receiver operating characteristic (ROC) curves are used to describe and compare the performance of diagnostic technology and diagnostic algorithms. This paper refines the statistical comparison of the areas under two ROC curves derived from the same set of patients by taking into account the correlation between the areas that is induced by the paired nature of the data. The correspondence between the area under an ROC curve and the Wilcoxon stati…
The effects of physicians' training and personality on test ordering for ambulatory patients
We studied records of 351 hypertensive patients cared for by 30 internists in private office practice. We correlated the use of outpatient diagnostic tests with personal characteristics of the prescribing physicians. Doctors trained in medical schools with academic orientations used more tests than other physicians. Patterns of use were not strongly related to the number of years since medical school graduation, or physicians "intolerance of ambi…
Office Laboratory Tests
Theoretic modeling suggests that common office tests as a group are profitable. To determine whether practicing internists perceive this profitability and whether their perceptions differ for different tests or for patients with different types of insurance coverage, the authors surveyed 111 physicians in private office practice. Respondents' estimates of receipts for tests done on patients with Medicare or Blue Cross/Blue Shield coverage were hi…
Clinical Decisionmaking
From the Departments of Radiology and Clinical Epidemiology and Preventive Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
The effects of patient characteristics on ambulatory test ordering
The Chemistry Laboratory
In order to estimate real cost savings achievable from reductions in laboratory test volume and in order to provide a management tool to help achieve such savings, we developed a management system for our chemistry laboratory. The system estimates the fixed costs (i.e., equipment, direct overhead, and indirect overhead costs), the variable costs (i.e., labor and supplies), and the total costs for each of the 81 tests performed in our hospital's c…
Modified DRGs as Evidence for Variability in Patient Severity
The authors were interested in exploring the extent to which differences in the complexity of patients could be determined by modifications in combinations of the ICD-9-CM codes used to define DRGs. The 150 most common medical and surgical DRGs in one teaching hospital were studied. With clinical experts they identified 41 DRGs that were believed to have subgroups reflecting quite different types of patients, one group sicker and costlier than th…
Changes in Ambulatory Testing for Hypertensive Patients 1971-1980
To determine temporal changes in the outpatient use of diagnostic tests, the authors studied ambulatory testing for 208 patients diagnosed with uncomplicated hypertension, cared for by 15 private office internists in 1971 through 1980. Patients diagnosed and treated earlier in the decade tended to have significantly higher blood pressure. After adjustment for blood pressure, use of diagnostic tests in terms of total charges for testing per patien…
Multidimensionality of Health Status in an Elderly Population
Although health is generally accepted to be a multidimensional construct, the relationship among various domains has not been well defined. To understand this issue better we used principal components analysis to examine the relations among a set of health status measures gathered on 590 elderly members of a health maintenance organization (HMO). These included functional health, emotional health, social activity within and outside of the family,…
Using patient reports to assess health-related quality of life after total hip replacement
The Importance of Co-existent Disease in the Occurrence of Postoperative Complications and One-Year Recovery in Patients Undergoing Total Hip Replacement
Co-existent or comorbid diseases are appreciated as prognostic factors in studies of quality and effectiveness of care when mortality is the end point. The need to measure and adjust for comorbidity in studies of postoperative hospital complications or long-term recovery from surgery has not been documented. In this study, we determined the impact of co-existent disease on post-operative complications and 1-year health-related quality of life in …
Variations in the Utilization of Coronary Angiography for Elderly Patients with an Acute Myocardial Infarction
This article reports a study of variations in the utilization of angiography for Medicare recipients who had an acute myocardial infarction. The study cohort consisted of 1987 Medicare beneficiaries who had a recent acute myocardial infarction. Variations were examined from three perspectives: patient characteristics, regional practice patterns, and on-site availability of the procedure. Factors associated with variation within and among states w…
The influence of socioeconomic status on change in health status after hospitalization
Validating recommendations for coronary angiography following acute myocardial infarction in the elderly
Impact of Underuse, Overuse, and Discretionary Use on Geographic Variation in the Use of Coronary Angiography After Acute Myocardial Infarction
BACKGROUND: Geographic variation in the use of medical procedures has been well documented. However, it is not known whether this variation is due to differences in use when procedures are indicated, discretionary, or contraindicated. OBJECTIVES: To examine whether use of coronary angiography after acute myocardial infarction (AMI) according to appropriateness criteria varied across geographic regions and whether underuse, overuse, or discretiona…
Understanding Individual and Small Area Variation in the Underuse of Coronary Angiography Following Acute Myocardial Infarction
BACKGROUND: Underuse of coronary angiography is common among patients with acute myocardial infarction (AMI) and the magnitude of underuse varies across geographic areas. OBJECTIVES: To examine the influence of patient demographic, clinical and hospital characteristics on underuse of coronary angiography, and the contribution of these factors to variation in underuse across geographic regions. RESEARCH DESIGN: Cohort study using data from the Coo…
The Effect of Managed Care Market Share on Appropriate Use of Coronary Angiography among Traditional Medicare Beneficiaries
Evidence suggests that when managed care market share increases in a geographic area, expenditures in Medicare's fee-for-service sector decrease. But it is unclear how expenditure reductions relate to the quality of medical care for traditional Medicare beneficiaries. We estimated how managed care market share varied with the proportion of fee-for-service Medicare beneficiaries who were admitted for acute myocardial infarction (AMI) and underwent…
Area-Level Variations in Cancer Care and Outcomes
BACKGROUND: : Substantial regional variations in health-care spending exist across the United States; yet, care and outcomes are not better in higher-spending areas. Most studies have focused on care in fee-for-service Medicare; whether spillover effects exist in settings without financial incentives for more care is unknown. OBJECTIVE: : We studied care for cancer patients in fee-for-service Medicare and the Veterans Health Administration (VA) t…
Racial Disparities in Cancer Care in the Veterans Affairs Health Care System and the Role of Site of Care
Objectives. We assessed cancer care disparities within the Veterans Affairs (VA) health care system and whether between-hospital differences explained disparities. Methods. We linked VA cancer registry data with VA and Medicare administrative data and examined 20 cancer-related quality measures among Black and White veterans diagnosed with colorectal (n = 12 897), lung (n = 25 608), or prostate (n = 38 202) cancer from 2001 to 2004. We used logis…
Diffusion of Bevacizumab Across Oncology Practices
BACKGROUND: Technological advances can improve care and outcomes but are a primary driver of health care spending growth. Understanding diffusion and use of new oncology therapies is important, given substantial increases in prices and spending on such treatments. OBJECTIVES: Examine diffusion of bevacizumab, a novel (in 2004) and high-priced biologic cancer therapy, among US oncology practices during 2005-2012 and assess variation in use across …
Medicine (21 works) · Internal Medicine (11 works) · Internal Medicine (9 works) · Health Systems, Economic Evaluations, Quality of Life (7 works) · Healthcare Policy and Management (7 works) · Cardiology (5 works) · Myocardial infarction (5 works) · Nursing (5 works) · Population (5 works) · Primary Care and Health Outcomes (5 works)