Troyen A Brennan
Biographic Data
| ID | 3929849 |
|---|---|
| NAME | Troyen A Brennan |
| GIVEN NAMES | Troyen A |
| FAMILY NAME | Brennan |
| SIGNATURE | BRENNAN T A |
| AFFILIATIONS | Harvard University |
| VERIFIED | No |
| TOTAL WORKS | 25 |
| TOTAL CITATIONS | 9 |
| AUTHOR COUNT | 25 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 1983 |
| LATEST PUBLICATION YEAR | 2024 |
| H-INDEX | 2 |
Advancing Interoperability and Prior Authorization Reform
This Viewpoint discusses the provisions and potential of the new Centers for Medicare and Medicaid Services (CMS) Interoperability and Prior Authorization Final Rule
The Settlement of the Blue Cross Blue Shield Antitrust Litigation
These findings suggest that BCBS plans will face competition from their fellow plans for business, and they will be allowed to diversify the services they provide. These changes will be likely to threaten the smaller BCBS plans and could bring consolidation to the health insurance industry. These changes should also promote sharper efforts toward health care cost management, with broad implications for other parts of the health insurance industry…
Health Care Utilization and Spending in Medicare Advantage vs Traditional Medicare
In this cohort study with a difference-in-differences analysis, during the first year of Medicare coverage, MA was associated with large reductions in institutional (Part A) utilization and spending
Longitudinal Patterns of Spending Enhance the Ability to Predict Costly Patients
BACKGROUND: With rising health spending, predicting costs is essential to identify patients for interventions. Many of the existing approaches have moderate predictive ability, which may result, in part, from not considering potentially meaningful changes in spending over time. Group-based trajectory modeling could be used to classify patients into dynamic long-term spending patterns. OBJECTIVES: To classify patients by their spending patterns ov…
Prescription Drug Insurance Coverage and Patient Health Outcomes
Previous reviews have shown that changes in prescription drug insurance benefits can affect medication use and adherence. We conducted a systematic review of the literature to identify studies addressing the association between prescription drug coverage and health outcomes. Studies were included if they collected empirical data on expansions or restrictions of prescription drug coverage and if they reported clinical outcomes. We found 23 studies…
Equity in the Receipt of Oseltamivir in the United States During the H1N1 Pandemic
Objectives. We assessed the relationship between individual characteristics and receipt of oseltamivir (Tamiflu) in the United States during the H1N1 pandemic and other flu seasons. Methods. In a cohort of individuals enrolled in pharmacy benefit plans, we used a multivariate logistic regression model to measure associations between subscriber characteristics and filling a prescription for oseltamivir during 3 flu seasons (October 2006–May 2007, …
Did Hedis Get it Right? Evaluating the Quality of a Quality Measure
BACKGROUND: As an example of the process that could be used to evaluate and optimize the performance of quality measures in routine practice, we evaluated whether the Healthcare Effectiveness Data and Information Set (HEDIS) measure assessing the "persistence of β-blocker treatment after a heart attack" correlates with post-myocardial infarction (MI) outcomes and whether or not there are alternative specifications of this construct which are bett…
Group-based Trajectory Models
BACKGROUND: Classifying medication adherence is important for efficiently targeting adherence improvement interventions. The purpose of this study was to evaluate the use of a novel method, group-based trajectory models, for classifying patients by their long-term adherence. RESEARCH DESIGN: We identified patients who initiated a statin between June 1, 2006 and May 30, 2007 in prescription claims from CVS Caremark and evaluated adherence over the…
Warnings Without Guidance
BACKGROUND: In January 2008, the Food and Drug Administration (FDA) communicated concerns about the efficacy of ezetimibe, but did not provide clear clinical guidance, and substantial media attention ensued. We investigated the proportion of patients who discontinued therapy and switched to a clinically appropriate alternative after the FDA communication. METHODS: Using claims data from a national pharmacy benefits manager, we created a rolling c…
Beyond negligence
Concierge” Practice and the Profession's Contract with Society
Case Dr. Leanne Todd, a primary care physician in a small town, has become tired of constantly apologizing to her patients for the hours they spend in her waiting room, her overbooked appointment book, and the constant rush of having to move on to the next patient. The 15-minute time slots Dr. Todd's scheduler allots do not permit her to have a personal conversation with each patient or allow them to air all of their health concerns
Impact of the National Practitioner Data Bank on Resolution of Malpractice Claims
Policymakers and commentators are concerned that the National Practitioner Data Bank (NPDB) has influenced malpractice litigation dynamics. This study examines whether the introduction of the NPDB changed the outcomes, process, and equity of malpractice litigation. Using pre- and post-NPDB analyses, we examine rates of unpaid claims, trials, resolution time, physician defense costs, and payments on claims with a low/high probability of negligence…
Assessing the Comparability of Various Measures of the Quality of Ambulatory Care
BACKGROUND: Report cards based on various performance measures have become increasingly common for rating hospitals and health care plans. However, little has been done to create report cards at the ambulatory clinic level, nor has there been much comparison of the potential components of report cards. OBJECTIVES: To create a report card for ambulatory clinics based on different data collection methods and to assess the correlations of clinic sco…
Incidence and Types of Adverse Events and Negligent Care in Utah and Colorado
BACKGROUND: The ongoing debate on the incidence and types of iatrogenic injuries in American hospitals has been informed primarily by the Harvard Medical Practice Study, which analyzed hospitalizations in New York in 1984. The generalizability of these findings is unknown and has been questioned by other studies. OBJECTIVE: We used methods similar to the Harvard Medical Practice Study to estimate the incidence and types of adverse events and negl…
Negligent Care and Malpractice Claiming Behavior in Utah and Colorado
BACKGROUND: Previous studies relating the incidence of negligent medical care to malpractice lawsuits in the United States may not be generalizable. These studies are based on data from 2 of the most populous states (California and New York), collected more than a decade ago, during volatile periods in the history of malpractice litigation. OBJECTIVES: The study objectives were (1) to calculate how frequently negligent and nonnegligent management…
Nonurgent Emergency Department Visits
OBJECTIVES: The authors assess the association between having a regular doctor and presentation for nonurgent versus urgent emergency department visits while controlling for potential confounders such as sociodemographics, health status, and comorbidity. METHODS: A cross-sectional study was conducted in emergency departments of five urban teaching hospitals in the northeast. Adult patients presenting with chest pain, abdominal pain, or asthma (n …
HIV Infection and the Americans with Disabilities Act
Architects of the Americans with Disabilities Act (ADA) contemplated that people living with human immunodeficiency virus (HIV) infection and AIDS would attract the act's antidiscrimination protections. Courts have recognized both conditions as covered disabilities. The extent to which the ADA introduces protection against insurers and health care providers who single out AIDS and HIV-related diseases for special treatment is not clear, however. …
Processing the tort deterrent signal
Evaluation of Screening Criteria for Adverse Events in Medical Patients
The goals of this study were to evaluate the sensitivity and specificity of 15 screening criteria for adverse events, preventable adverse events, and severe adverse events in medical patients, and to evaluate combinations of these criteria, including those available through hospital billing data, to determine whether a small subset of generic screens might efficiently identify adverse events. The authors studied 3,137 consecutive admissions to a …
Economics
Liberalism and Medical Ethics
Book reviewed in this article: Just Doctoring: Medical Ethics in the Liberal State. By Troyen A. Brennan. The Ends of Human Life: Medical Ethics in a Liberal Polity. By Ezekiel J. Emanuel
The Nature of Adverse Events in Hospitalized Patients
BACKGROUND: In a sample of 30,195 randomly selected hospital records, we identified 1133 patients (3.7 percent) with disabling injuries caused by medical treatment. We report here an analysis of these adverse events and their relation to error, negligence, and disability. METHODS: Two physician-reviewers independently identified the adverse events and evaluated them with respect to negligence, errors in management, and extent of disability. One o…
Incidence of Adverse Events and Negligence in Hospitalized Patients
BACKGROUND: As part of an interdisciplinary study of medical injury and malpractice litigation, we estimated the incidence of adverse events, defined as injuries caused by medical management, and of the subgroup of such injuries that resulted from negligent or substandard care. METHODS: We reviewed 30,121 randomly selected records from 51 randomly selected acute care, nonpsychiatric hospitals in New York State in 1984. We then developed populatio…
Reliability and Validity of Judgments Concerning Adverse Events Suffered by Hospitalized Patients
To evaluate a process for identifying adverse events through review of medical records, multiple reviews of 360 medical records from two teaching hospital were performed. The data from these multiple reviews provided information about the validity and reliability of our two-phase review process. In particular, it was found that the initial phase, involving review of the medical records by medical-record-room administrators using explicit criteria…
Research Records, Litigation, and Confidentiality
Beyond negligence
Processing the tort deterrent signal
HIV Infection and the Americans with Disabilities Act
Architects of the Americans with Disabilities Act (ADA) contemplated that people living with human immunodeficiency virus (HIV) infection and AIDS would attract the act's antidiscrimination protections. Courts have recognized both conditions as covered disabilities. The extent to which the ADA introduces protection against insurers and health care providers who single out AIDS and HIV-related diseases for special treatment is not clear, however. …
Research Records, Litigation, and Confidentiality
Reliability and Validity of Judgments Concerning Adverse Events Suffered by Hospitalized Patients
To evaluate a process for identifying adverse events through review of medical records, multiple reviews of 360 medical records from two teaching hospital were performed. The data from these multiple reviews provided information about the validity and reliability of our two-phase review process. In particular, it was found that the initial phase, involving review of the medical records by medical-record-room administrators using explicit criteria…
The Nature of Adverse Events in Hospitalized Patients
BACKGROUND: In a sample of 30,195 randomly selected hospital records, we identified 1133 patients (3.7 percent) with disabling injuries caused by medical treatment. We report here an analysis of these adverse events and their relation to error, negligence, and disability. METHODS: Two physician-reviewers independently identified the adverse events and evaluated them with respect to negligence, errors in management, and extent of disability. One o…
Incidence of Adverse Events and Negligence in Hospitalized Patients
BACKGROUND: As part of an interdisciplinary study of medical injury and malpractice litigation, we estimated the incidence of adverse events, defined as injuries caused by medical management, and of the subgroup of such injuries that resulted from negligent or substandard care. METHODS: We reviewed 30,121 randomly selected records from 51 randomly selected acute care, nonpsychiatric hospitals in New York State in 1984. We then developed populatio…
Liberalism and Medical Ethics
Book reviewed in this article: Just Doctoring: Medical Ethics in the Liberal State. By Troyen A. Brennan. The Ends of Human Life: Medical Ethics in a Liberal Polity. By Ezekiel J. Emanuel
Economics
Evaluation of Screening Criteria for Adverse Events in Medical Patients
The goals of this study were to evaluate the sensitivity and specificity of 15 screening criteria for adverse events, preventable adverse events, and severe adverse events in medical patients, and to evaluate combinations of these criteria, including those available through hospital billing data, to determine whether a small subset of generic screens might efficiently identify adverse events. The authors studied 3,137 consecutive admissions to a …
Processing the tort deterrent signal
HIV Infection and the Americans with Disabilities Act
Architects of the Americans with Disabilities Act (ADA) contemplated that people living with human immunodeficiency virus (HIV) infection and AIDS would attract the act's antidiscrimination protections. Courts have recognized both conditions as covered disabilities. The extent to which the ADA introduces protection against insurers and health care providers who single out AIDS and HIV-related diseases for special treatment is not clear, however. …
Nonurgent Emergency Department Visits
OBJECTIVES: The authors assess the association between having a regular doctor and presentation for nonurgent versus urgent emergency department visits while controlling for potential confounders such as sociodemographics, health status, and comorbidity. METHODS: A cross-sectional study was conducted in emergency departments of five urban teaching hospitals in the northeast. Adult patients presenting with chest pain, abdominal pain, or asthma (n …
Incidence and Types of Adverse Events and Negligent Care in Utah and Colorado
BACKGROUND: The ongoing debate on the incidence and types of iatrogenic injuries in American hospitals has been informed primarily by the Harvard Medical Practice Study, which analyzed hospitalizations in New York in 1984. The generalizability of these findings is unknown and has been questioned by other studies. OBJECTIVE: We used methods similar to the Harvard Medical Practice Study to estimate the incidence and types of adverse events and negl…
Negligent Care and Malpractice Claiming Behavior in Utah and Colorado
BACKGROUND: Previous studies relating the incidence of negligent medical care to malpractice lawsuits in the United States may not be generalizable. These studies are based on data from 2 of the most populous states (California and New York), collected more than a decade ago, during volatile periods in the history of malpractice litigation. OBJECTIVES: The study objectives were (1) to calculate how frequently negligent and nonnegligent management…
Assessing the Comparability of Various Measures of the Quality of Ambulatory Care
BACKGROUND: Report cards based on various performance measures have become increasingly common for rating hospitals and health care plans. However, little has been done to create report cards at the ambulatory clinic level, nor has there been much comparison of the potential components of report cards. OBJECTIVES: To create a report card for ambulatory clinics based on different data collection methods and to assess the correlations of clinic sco…
Concierge” Practice and the Profession's Contract with Society
Case Dr. Leanne Todd, a primary care physician in a small town, has become tired of constantly apologizing to her patients for the hours they spend in her waiting room, her overbooked appointment book, and the constant rush of having to move on to the next patient. The 15-minute time slots Dr. Todd's scheduler allots do not permit her to have a personal conversation with each patient or allow them to air all of their health concerns
Impact of the National Practitioner Data Bank on Resolution of Malpractice Claims
Policymakers and commentators are concerned that the National Practitioner Data Bank (NPDB) has influenced malpractice litigation dynamics. This study examines whether the introduction of the NPDB changed the outcomes, process, and equity of malpractice litigation. Using pre- and post-NPDB analyses, we examine rates of unpaid claims, trials, resolution time, physician defense costs, and payments on claims with a low/high probability of negligence…
Beyond negligence
Warnings Without Guidance
BACKGROUND: In January 2008, the Food and Drug Administration (FDA) communicated concerns about the efficacy of ezetimibe, but did not provide clear clinical guidance, and substantial media attention ensued. We investigated the proportion of patients who discontinued therapy and switched to a clinically appropriate alternative after the FDA communication. METHODS: Using claims data from a national pharmacy benefits manager, we created a rolling c…
Group-based Trajectory Models
BACKGROUND: Classifying medication adherence is important for efficiently targeting adherence improvement interventions. The purpose of this study was to evaluate the use of a novel method, group-based trajectory models, for classifying patients by their long-term adherence. RESEARCH DESIGN: We identified patients who initiated a statin between June 1, 2006 and May 30, 2007 in prescription claims from CVS Caremark and evaluated adherence over the…
Equity in the Receipt of Oseltamivir in the United States During the H1N1 Pandemic
Objectives. We assessed the relationship between individual characteristics and receipt of oseltamivir (Tamiflu) in the United States during the H1N1 pandemic and other flu seasons. Methods. In a cohort of individuals enrolled in pharmacy benefit plans, we used a multivariate logistic regression model to measure associations between subscriber characteristics and filling a prescription for oseltamivir during 3 flu seasons (October 2006–May 2007, …
Did Hedis Get it Right? Evaluating the Quality of a Quality Measure
BACKGROUND: As an example of the process that could be used to evaluate and optimize the performance of quality measures in routine practice, we evaluated whether the Healthcare Effectiveness Data and Information Set (HEDIS) measure assessing the "persistence of β-blocker treatment after a heart attack" correlates with post-myocardial infarction (MI) outcomes and whether or not there are alternative specifications of this construct which are bett…
Prescription Drug Insurance Coverage and Patient Health Outcomes
Previous reviews have shown that changes in prescription drug insurance benefits can affect medication use and adherence. We conducted a systematic review of the literature to identify studies addressing the association between prescription drug coverage and health outcomes. Studies were included if they collected empirical data on expansions or restrictions of prescription drug coverage and if they reported clinical outcomes. We found 23 studies…
Longitudinal Patterns of Spending Enhance the Ability to Predict Costly Patients
BACKGROUND: With rising health spending, predicting costs is essential to identify patients for interventions. Many of the existing approaches have moderate predictive ability, which may result, in part, from not considering potentially meaningful changes in spending over time. Group-based trajectory modeling could be used to classify patients into dynamic long-term spending patterns. OBJECTIVES: To classify patients by their spending patterns ov…
Health Care Utilization and Spending in Medicare Advantage vs Traditional Medicare
In this cohort study with a difference-in-differences analysis, during the first year of Medicare coverage, MA was associated with large reductions in institutional (Part A) utilization and spending
The Settlement of the Blue Cross Blue Shield Antitrust Litigation
These findings suggest that BCBS plans will face competition from their fellow plans for business, and they will be allowed to diversify the services they provide. These changes will be likely to threaten the smaller BCBS plans and could bring consolidation to the health insurance industry. These changes should also promote sharper efforts toward health care cost management, with broad implications for other parts of the health insurance industry…
Advancing Interoperability and Prior Authorization Reform
This Viewpoint discusses the provisions and potential of the new Centers for Medicare and Medicaid Services (CMS) Interoperability and Prior Authorization Final Rule
Medicine (18 works) · Internal Medicine (11 works) · Internal Medicine (9 works) · Law (9 works) · Medical Malpractice and Liability Issues (9 works) · Political science (9 works) · Business (8 works) · Emergency Medicine (8 works) · Family medicine (7 works) · Law (7 works)