2021
How Total Performance Scores of Medicare Value-Based Purchasing Program Hospitals Change Over Time
Ramirez A, Marsh K, McMurry T, Turrentine F, Tracci M, Jones R. How Total Performance Scores of Medicare Value-Based Purchasing Program Hospitals Change Over Time. Journal For Healthcare Quality 2021, 44: 78-87. PMID: 34469925, DOI: 10.1097/jhq.0000000000000321.Peer-Reviewed Original ResearchConceptsPhysician-owned surgical hospitalsTotal performance scoreAccountable care organizationsValue-based purchasingHospital typeCenters for MedicareMedicare Value-Based PurchasingGeneral HospitalPerformance scoresPerformance-based financial incentivesSurgical hospitalsDisproportionate share hospital paymentsLongitudinal linear mixed-effects modelsCase mix indexIndividual domain scoresCare organizationsMedicare daysLinear mixed-effects modelsHospital changesInpatient daysPatient dischargeDomain scoresHospital paymentsPatient satisfactionKaiser hospitals
2020
The ups and downs of general surgery resident experience in endocrine surgery: Analysis of 30 years of ACGME graduate case logs
Ramirez A, Fashandi A, Hanks J, Smith P, Potts J. The ups and downs of general surgery resident experience in endocrine surgery: Analysis of 30 years of ACGME graduate case logs. Surgery 2020, 168: 586-593. PMID: 32811696, DOI: 10.1016/j.surg.2020.07.007.Peer-Reviewed Original ResearchConceptsEndocrine surgery casesGeneral surgery residentsSurgery casesSurgery residentsGeneral surgery resident experienceExperience of general surgery residentsGeneral surgery casesAdrenal operationsParathyroid operationsThyroid operationsMedian numberEndocrine operationsEndocrine surgeryProcedure typeResident surgeonsLinear regression analysisCase-mixDescriptive statisticsSurgeonsResident levelTrainee experienceResident experienceRegression analysisAverage total numberAmerican AssociationNew endocrine fellowship programs do not decrease the endocrine surgery experience of residents in co-located general surgery programs
Fashandi A, Hanks J, Ramirez A, Potts J, Smith P. New endocrine fellowship programs do not decrease the endocrine surgery experience of residents in co-located general surgery programs. Surgery 2020, 169: 185-190. PMID: 32771297, DOI: 10.1016/j.surg.2020.05.043.Peer-Reviewed Original ResearchConceptsEndocrine surgery casesGeneral surgery residentsGeneral surgery programsSurgery casesSurgery residentsSurgery programsSurgical fellowship programsFellowship programsResident operative experienceCase log dataMann-Whitney U testMann-WhitneyU testStatistical significanceYear 5Experiences of residentsNational declineYear 0Decades of increasesDescriptive statisticsYearsResidents
2019
Effect of Travel Time for Thyroid Surgery on Treatment Cost and Morbidity
Ramirez A, Schneider E, Mehaffey J, Zeiger M, Hanks J, Smith P. Effect of Travel Time for Thyroid Surgery on Treatment Cost and Morbidity. The American Surgeon 2019, 85: 949-955. PMID: 31638505, DOI: 10.1177/000313481908500934.Peer-Reviewed Original ResearchConceptsHigh-volume centersThyroid surgeryPrimary outcomeHospital costsSingle high-volume centerMedian operative timeHealth care utilizationCertain patient populationsMultivariable regression modelingPatient's home addressHome addressPostoperative morbidityACS-NSQIPOperative timePatient populationUninsured statusThyroid diseaseEndocrine surgeryMorbidity riskThyroid proceduresSurgical careTime-related differencesPatient differencesDisease processPatientsPolitical priority and pathways to scale-up of childhood cancer care in five nations
Denburg A, Ramirez A, Pavuluri S, McCann E, Shah S, Alcasabas T, Antillon F, Arora R, Fuentes-Alabi S, Renner L, Lam C, Friedrich P, Maser B, Force L, Galindo C, Atun R. Political priority and pathways to scale-up of childhood cancer care in five nations. PLOS ONE 2019, 14: e0221292. PMID: 31425526, PMCID: PMC6699697, DOI: 10.1371/journal.pone.0221292.Peer-Reviewed Original ResearchConceptsChildhood cancer careNon-communicable diseasesUniversal health coverageNational health agendaCancer careChildhood cancerPolitical prioritiesActor powerHealth agendaHealth systemPriority-settingPolitical prioritizationPolitical contextChildhood cancer communityNon-communicable causesHealth system actorsNational priorityHealth system reformEl SalvadorMiddle-income countriesChildren aged 0Civil society organizationsPublic sector investmentIn-depth interviewsCancer policyNext Generation of Global Surgeons: Aligning Interest With Early Access to Global Surgery Education
Scott E, Fallah P, Blitzer D, NeMoyer R, Sifri Z, Alliance G, Acker R, Aharon S, Alty I, Anyanwu C, Beck N, Brandt A, Briggs L, Caminita C, Chaet A, Chan J, Chiu L, Cueto C, Daneshdoost S, Edalatpour R, Garba D, Giles A, Gualy S, Haider A, Hamilton C, Hauser B, He P, Im C, Jayaram A, Jhun R, Joshi A, Kahanu A, Kim N, Kim R, Lauffer S, McHargue C, Meeks M, Mehta A, Mendoza A, Miller M, Nourian M, Ottesen T, Patel P, Peck C, Pyarali M, Ramirez A, Rehman S, Shankar B, Stetson A, Still M, Tutunjian A, Yibrehu B, Yu K, Hanna J, Peck G. Next Generation of Global Surgeons: Aligning Interest With Early Access to Global Surgery Education. Journal Of Surgical Research 2019, 240: 219-226. PMID: 30986637, DOI: 10.1016/j.jss.2019.03.009.Peer-Reviewed Original ResearchConceptsGlobal surgery educationPreclinical yearsMedical educationMedical studentsSurgery educationFuture curriculum developmentCurriculum developmentMedical schoolsGlobal surgeryGlobal surgery electiveGlobal surgeonsEducationAnonymous online surveyStudentsSuch programsSchoolsNext generationOnline surveyEarly exposureDescriptive dataSurgery issuesProgramCurriculumHalf of respondentsChi-squared testing
2018
General Thoracic Surgery in Rwanda: An Assessment of Surgical Volume and of Workforce and Material Resource Deficits
Ramirez A, Nuradin N, Byiringiro F, Ntakiyiruta G, Giles A, Riviello R. General Thoracic Surgery in Rwanda: An Assessment of Surgical Volume and of Workforce and Material Resource Deficits. World Journal Of Surgery 2018, 43: 36-43. PMID: 30132227, PMCID: PMC6318006, DOI: 10.1007/s00268-018-4771-y.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overAnesthesiologyChildChild, PreschoolEquipment and Supplies, HospitalFemaleHealth WorkforceHospitals, PrivateHospitals, UniversityHumansInfantInfant, NewbornMaleMiddle AgedNeeds AssessmentRetrospective StudiesRwandaSimulation TrainingThoracic SurgeryThoracic Surgical ProceduresYoung AdultConceptsUniversity Teaching HospitalHuman Resources for Health (HRH) ProgramThoracic casesSurgical volumeSimulation trainingUniversity Teaching Hospital of KigaliUniversity Teaching Hospital of ButareWorld Health Organization formBaseline patient characteristicsOperative volumeRetrospective cohort studyGeneral surgery proceduresThoracic surgical careGeneral thoracic surgeryOperating room registriesHRH ProgramPearson chi-square testKing Faisal HospitalAddress barriersCapacity building programsChi-square testKruskal-Wallis testNeeds assessmentPatient accessReferral centerPreoperative Gastroesophageal Reflux Disorder Is Associated With Increased Morbidity in Patients Undergoing Abdominal Surgery
Tilak A, Ramirez A, Turrentine F, Sohn M, Jones R. Preoperative Gastroesophageal Reflux Disorder Is Associated With Increased Morbidity in Patients Undergoing Abdominal Surgery. Journal Of Surgical Research 2018, 232: 587-594. PMID: 30463778, PMCID: PMC6251493, DOI: 10.1016/j.jss.2018.07.051.Peer-Reviewed Original ResearchConceptsGastroesophageal reflux disorderPostoperative complication rateEsophageal diseaseReflux disorderComplication rateAbdominal operationsProcedure groupAmerican College of Surgeons National Surgical Quality Improvement ProgramSurgeons National Surgical Quality Improvement ProgramAbdominal aortic aneurysm repairNational Surgical Quality Improvement ProgramAssociated with increased postoperative complication ratesAssociated with increased morbiditySurgical Quality Improvement ProgramIntra-abdominal casesAortic aneurysm repairIntra-abdominal proceduresRisk of morbidityMultivariate logistic regressionVentral hernia repairAortoiliac repairQuality Improvement ProgramAneurysm repairEsophageal strictureWound complicationsObservations on the Medicare Value-Based Ranking of Hospitals During Fiscal Years 2015 and 2016
Jones R, Ramirez A, Stukenborg G, Tracci M, Turrentine F. Observations on the Medicare Value-Based Ranking of Hospitals During Fiscal Years 2015 and 2016. American Journal Of Medical Quality 2018, 34: 136-143. PMID: 30043617, DOI: 10.1177/1062860618791045.Peer-Reviewed Original ResearchConceptsPhysician-owned surgical hospitalsValue-Based Purchasing ProgramTotal performance scoreDomain scoresKaiser hospitalsFiscal yearMedicare's value-based purchasing programAccountable care organization hospitalsWorld Report Honor Roll hospitalsUniversity HealthSystem Consortium hospitalsRankings of hospitalsHospital typeConsortium hospitalsHospital groupMultilevel random coefficient modelingSurgical hospitalsOrganization hospitalsKaiserHospitalPerformance scoresCareMedicareUS NewsPurchase programsScoresIndividual Surgeon’s Contribution to Value
Turrentine F, Sohn M, Tracci M, Ramirez A, Upchurch G, Jones R. Individual Surgeon’s Contribution to Value. American Journal Of Medical Quality 2018, 34: 74-79. PMID: 29888610, DOI: 10.1177/1062860618780347.Peer-Reviewed Original ResearchConceptsRandom effects logistic regression modelEffects logistic regression modelsLogistic regression modelsHealth careAmerican College of Surgeons National Surgical Quality Improvement Program Participant Use FileRisk-adjusted costRandom interceptQuality Improvement Program Participant Use FileNational Surgical Quality Improvement Program Participant Use FileAmerican CollegeRegression modelsParticipant Use FileGeneral surgeryMortalitySurgeon's contributionMorbidityMorbidity valuesComplication ratePostoperative mortalitySurgeonsYearsCareVascular proceduresHealthSurgeryLong-Term Skills Retention Following a Randomized Prospective Trial on Adaptive Procedural Training
Ramirez A, Hu Y, Kim H, Rasmussen S. Long-Term Skills Retention Following a Randomized Prospective Trial on Adaptive Procedural Training. Journal Of Surgical Education 2018, 75: 1589-1597. PMID: 29803772, PMCID: PMC6252163, DOI: 10.1016/j.jsurg.2018.03.007.Peer-Reviewed Original ResearchConceptsCentral venous catheter placementRandomized controlled trialsMedical studentsControlled trialsLong-term skill retentionSurvey assessed confidenceSimulation-based trainingTraining armChi-square testAssess confidenceSkill retentionInvestigate long-term outcomesTraining hospitalsTertiary care centerConventional trainingPractice volumeCare centerTrial completionVenous catheter placementRandomized prospective trialLong-term outcomesTrial outcomesStudy objectiveAverage scorePractice timeCreation, Implementation, and Assessment of a General Thoracic Surgery Simulation Course in Rwanda
Ramirez A, Nuradin N, Byiringiro F, Ssebuufu R, Stukenborg G, Ntakiyiruta G, Daniel T. Creation, Implementation, and Assessment of a General Thoracic Surgery Simulation Course in Rwanda. The Annals Of Thoracic Surgery 2018, 105: 1842-1849. PMID: 29476717, PMCID: PMC5964001, DOI: 10.1016/j.athoracsur.2018.01.043.Peer-Reviewed Original ResearchConceptsGeneral surgery residentsThoracic proceduresSurgery residentsLow-middle income country settingFellowship training opportunitiesSimulation courseDiaphragm repairLow-middle income countriesIncome country settingsStatistically significant improvementUnivariate analysisResident knowledge baseSecondary objectivesSimulated surgeryLocal facultyIncome countriesCountry settingsKnowledge assessmentTraining levelTraining opportunitiesResident feedbackParticipants' responsesLikert scaleEnhance confidenceSignificant improvement
2016
Physician-Owned Surgical Hospitals Outperform Other Hospitals in Medicare Value-Based Purchasing Program
Ramirez A, Tracci M, Stukenborg G, Turrentine F, Kozower B, Jones R. Physician-Owned Surgical Hospitals Outperform Other Hospitals in Medicare Value-Based Purchasing Program. Journal Of The American College Of Surgeons 2016, 223: 559-567. PMID: 27502368, PMCID: PMC5045811, DOI: 10.1016/j.jamcollsurg.2016.07.014.Peer-Reviewed Original ResearchConceptsHospital case mix indexPhysician-owned surgical hospitalsCase mix indexTotal performance scoreHospital performanceKaiser PermanenteHospital Value-Based Purchasing ProgramSurgical hospitalsGeneralized linear model assessed differencesValue-Based Purchasing ProgramCompare hospital performanceWorld Report Honor Roll hospitalsHigh-value hospitalsBusiness modelsPerformance scoresKaiser Permanente hospitalsUS NewsUniversity HealthSystem ConsortiumMedicare hospitalizationsProgram hospitalsConsortium membersQuality improvementFinancial incentivesPolicy-making decisionsMedicareUsing Interdisciplinary Workgroups to Educate Surgery Residents in Systems-Based Practice
Gillen J, Ramirez A, Farineau D, Hoke T, Schirmer B, Williams M, Lau C. Using Interdisciplinary Workgroups to Educate Surgery Residents in Systems-Based Practice. Journal Of Surgical Education 2016, 73: 1052-1059. PMID: 27372271, PMCID: PMC5124388, DOI: 10.1016/j.jsurg.2016.05.017.Peer-Reviewed Original ResearchConceptsSystems-based practiceSystem-based practiceInterdisciplinary workgroupCompetency of systems-based practiceFrontline health care providersAccreditation Council for Graduate Medical Education competenciesHealth care teamHealth care providersHealth care professionalsSurgery residentsEducation of residentsHands-on educational experiencesCare teamInterprofessional collaborationCare providersCare professionalsHealth systemTeam-building exercisesWorkflow issuesInterdisciplinary communicationResident educationMeaningful educationSystem issuesSystems-basedResidentsClinical efficacy of 2-phase versus 4-phase computed tomography for localization in primary hyperparathyroidism
Ramirez A, Shada A, Martin A, Raghavan P, Durst C, Mukherjee S, Gaughen J, Ornan D, Hanks J, Smith P. Clinical efficacy of 2-phase versus 4-phase computed tomography for localization in primary hyperparathyroidism. Surgery 2016, 160: 731-737. PMID: 27302106, PMCID: PMC4975639, DOI: 10.1016/j.surg.2016.04.016.Peer-Reviewed Original ResearchConceptsPositive predictive valueFour-dimensional computed tomographyComputed tomography protocolComputed tomographyMultiglandular diseaseParathyroid localizationOperative findingsPredictive valueFour-phase computed tomographyLocalization of abnormal glandsRadiation doseTechnical surgical successEffective radiation doseFisher's exact testTomography protocolAbnormal glandsPrimary hyperparathyroidismSurgical successReoperative casesParathyroid weightSurgical outcomesTechnical successClinical efficacyOperative treatmentClinical outcomes
2015
Defining the effects of age and gender on immune response and outcomes to melanoma vaccination: a retrospective analysis of a single-institution clinical trials’ experience
Ramirez A, Wages N, Hu Y, Smolkin M, Slingluff C. Defining the effects of age and gender on immune response and outcomes to melanoma vaccination: a retrospective analysis of a single-institution clinical trials’ experience. Cancer Immunology, Immunotherapy 2015, 64: 1531-1539. PMID: 26392296, PMCID: PMC4644444, DOI: 10.1007/s00262-015-1758-5.Peer-Reviewed Original ResearchConceptsDisease-free survivalT cell responsesOverall survivalImmune responseOlder patientsCancer vaccinesClinical outcomesResected stage IIB-IV melanomaCD8+ T cell responsesStage IIB-IV melanomaLonger disease-free survivalImpact of patient ageMelanoma-associated peptidesCancer vaccine trialsClinical trial experienceIncidence of IRCumulative incidence rateKaplan-Meier estimatesClass I MHCMelanoma vaccineMenopausal statusPatient ageSurvival outcomesStratify patientsFemale patients
2014
Cumulative sum: a proficiency metric for basic endoscopic training
Hu Y, Jolissaint J, Ramirez A, Gordon R, Yang Z, Sawyer R. Cumulative sum: a proficiency metric for basic endoscopic training. Journal Of Surgical Research 2014, 192: 62-67. PMID: 24976441, PMCID: PMC4188705, DOI: 10.1016/j.jss.2014.05.056.Peer-Reviewed Original ResearchConceptsPercutaneous endoscopic gastrostomyCUSUM analysisProcedure duration >Postgraduate year 1 surgery residentsPercutaneous endoscopic gastrostomy insertionSensitivity to relapseProcedure durationExpert endoscopistsEndoscopic gastrostomyRelapseSurgical residentsHour restrictionsSurgical traineesTrainee proficiencyLikert-scale surveyFailure rateTask failureTraining backgroundOperator experienceEndoscopy