2024
Impact of medicaid expansion on cervical cancer screening: A state-specific difference in difference analysis
Bergstein A, Huang Y, Hershman D, Xu X, Wright J. Impact of medicaid expansion on cervical cancer screening: A state-specific difference in difference analysis. Gynecologic Oncology 2024, 189: 49-55. PMID: 39013240, DOI: 10.1016/j.ygyno.2024.06.028.Peer-Reviewed Original ResearchConceptsCervical cancer screeningBaseline screening ratesNon-expansion statesCancer screeningMedicaid expansion statesScreening ratesExpansion statesMedicaid expansionBehavioral Risk Factor Surveillance SystemRisk Factor Surveillance SystemImpact of Medicaid expansionPre-expansion periodPost-expansion periodAffordable Care ActEffect of Medicaid expansionOutcome measuresCare ActMedicaid coverageHousehold incomeEvaluate trendsSurveillance systemMedicaidDiD analysisState-specific differencesFemale respondents
2023
Timeliness of diagnostic evaluation for postmenopausal bleeding: A retrospective cohort study using claims data
Xu X, Chen L, Nunez-Smith M, Clark M, Wright J. Timeliness of diagnostic evaluation for postmenopausal bleeding: A retrospective cohort study using claims data. PLOS ONE 2023, 18: e0289692. PMID: 37682914, PMCID: PMC10490884, DOI: 10.1371/journal.pone.0289692.Peer-Reviewed Original ResearchConceptsPostmenopausal bleedingFirst diagnostic procedureDiagnostic evaluationDiagnostic proceduresGynecologic conditionsMedicaid patientsCox proportional hazards modelPrompt diagnostic evaluationRetrospective cohort studyMarketScan Research DatabasesAdditional risk factorsNon-clinical factorsCommon gynecologic conditionProportional hazards modelLower ratesCohort studyMost patientsPatient characteristicsBenign etiologyGynecologic cancerCancer patientsPreventive careUterine cancerInsurance typeRisk factorsRacial disparities in diagnostic evaluation of uterine cancer among Medicaid beneficiaries
Xu X, Chen L, Nunez-Smith M, Clark M, Wright J. Racial disparities in diagnostic evaluation of uterine cancer among Medicaid beneficiaries. Journal Of The National Cancer Institute 2023, 115: 636-643. PMID: 36788453, PMCID: PMC10248843, DOI: 10.1093/jnci/djad027.Peer-Reviewed Original ResearchMeSH KeywordsBlack or African AmericanFemaleHealthcare DisparitiesHumansMedicaidUnited StatesUterine NeoplasmsWhiteConceptsAbnormal uterine bleedingWhite patientsUterine cancerFirst diagnostic procedureDiagnostic evaluationBlack patientsDiagnostic proceduresBlack-White disparitiesManagement visitsMarketScan Multi-State Medicaid DatabaseMulti-State Medicaid DatabaseUterine bleedingPatient characteristicsMedicaid databaseEarly diagnosisMedicaid beneficiariesMultivariable regressionPatientsCancerRacial disparitiesDiagnosisVisitsMore evaluationDisparitiesBleeding
2022
Perioperative magnetic resonance imaging in breast cancer care: Distinct adoption trajectories among physician patient-sharing networks
Xu X, Soulos PR, Herrin J, Wang SY, Pollack CE, Killelea BK, Forman HP, Gross CP. Perioperative magnetic resonance imaging in breast cancer care: Distinct adoption trajectories among physician patient-sharing networks. PLOS ONE 2022, 17: e0265188. PMID: 35290417, PMCID: PMC8923453, DOI: 10.1371/journal.pone.0265188.Peer-Reviewed Original ResearchConceptsPhysician patient-sharing networksPerioperative magnetic resonance imagingClinical risk factorsMagnetic resonance imagingPatient clinical risk factorsPatient-sharing networksBreast cancer careRisk-adjusted ratesMastectomy usePhysician networksCancer careRisk factorsEnd Results-Medicare databaseCharacteristics of patientsProportion of patientsBreast cancer surgeryComposition of patientsMRI adoptionDistinct trajectoriesMore patientsCancer surgeryClinical outcomesCancer specialistsMRI usePatients
2020
Hospital variation in responses to safety warnings about power morcellation in hysterectomy
Xu X, Desai VB, Wright JD, Lin H, Schwartz PE, Gross CP. Hospital variation in responses to safety warnings about power morcellation in hysterectomy. American Journal Of Obstetrics And Gynecology 2020, 224: 589.e1-589.e13. PMID: 33359176, PMCID: PMC8180513, DOI: 10.1016/j.ajog.2020.12.1207.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overFemaleGuideline AdherenceHealthcare DisparitiesHospitalsHumansHysterectomyIntraoperative ComplicationsLaparoscopyLogistic ModelsMiddle AgedMorcellationOutcome Assessment, Health CarePatient SafetyPostoperative ComplicationsPractice Guidelines as TopicPractice Patterns, Physicians'Retrospective StudiesRisk AssessmentUnited StatesYoung AdultConceptsLaparoscopic supracervical hysterectomyOpen abdominal hysterectomySupracervical hysterectomyPower morcellationAbdominal hysterectomySurgical complicationsMajor complicationsPatient clinical risk factorsNew York Statewide PlanningClinical risk factorsDistinct trajectory patternsState Ambulatory SurgeryState Inpatient DatabasesSafety warningsTrajectory groupsResearch Cooperative SystemLow useHigher useHysterectomy practiceMinor complicationsBenign hysterectomyBenign indicationsComplication riskHospital variationCorpus uteriUnanticipated Uterine and Cervical Malignancy in Women Undergoing Hysterectomy for Uterovaginal Prolapse.
Andiman SE, Bui AH, Hardart A, Xu X. Unanticipated Uterine and Cervical Malignancy in Women Undergoing Hysterectomy for Uterovaginal Prolapse. Urogynecology 2020, 27: e549-e554. PMID: 33208657, DOI: 10.1097/spv.0000000000000990.Peer-Reviewed Original ResearchConceptsMultivariable logistic regressionUterovaginal prolapseUterine cancerCervical cancerSurgeons National Surgical Quality Improvement ProgramNational Surgical Quality Improvement ProgramSurgical Quality Improvement ProgramLogistic regressionUnexpected uterine malignancyQuality Improvement ProgramSample eligibility criteriaPathology-confirmed diagnosisUterine malignanciesRadical hysterectomyTotal hysterectomyPatient characteristicsUterine weightCervical malignancyGynecologic cancerOutcome measuresHysterectomyAmerican CollegeEligibility criteriaBivariate statistical testsConcurrent proceduresPhysician trajectories of abandoning long‐course breast radiotherapy and their cost impact
Xu X, Soulos PR, Herrin J, Wang S, Pollack CE, Evans SB, Yu JB, Gross CP. Physician trajectories of abandoning long‐course breast radiotherapy and their cost impact. Health Services Research 2020, 56: 497-506. PMID: 33070305, PMCID: PMC8143683, DOI: 10.1111/1475-6773.13572.Peer-Reviewed Original ResearchConceptsPhysician peer groupsWhole breast irradiationCF-WBIRisk-adjusted ratesBreast radiotherapyPractice patternsLow useChronic Conditions Data WarehouseDistinct practice patternsPatients' clinical characteristicsSetting of radiotherapyAdjuvant breast radiotherapyYears of ageDistinct trajectoriesImportant cost implicationsHigher useAdjuvant radiotherapyClinical characteristicsEligible womenBreast cancerCost implicationsLatent class growth analysisService beneficiariesMedicare programRadiotherapy
2019
Laparoscopic Hysterectomy Route, Resource Use, and Outcomes: Change After Power Morcellation Warning.
Desai VB, Wright JD, Lin H, Gross CP, Sallah YH, Schwartz PE, Xu X. Laparoscopic Hysterectomy Route, Resource Use, and Outcomes: Change After Power Morcellation Warning. Obstetrics And Gynecology 2019, 134: 227-238. PMID: 31348209, DOI: 10.1097/aog.0000000000003375.Peer-Reviewed Original ResearchConceptsLaparoscopic supracervical hysterectomyTotal laparoscopic hysterectomyLaparoscopic hysterectomySupracervical hysterectomySurgical outcomesFDA warningOperative timeSurgeons National Surgical Quality Improvement ProgramNational Surgical Quality Improvement ProgramSurgical Quality Improvement ProgramLength of stayInterrupted time series analysisQuality Improvement ProgramHysterectomy routePatient characteristicsBenign indicationsInpatient stayPower morcellationPatient outcomesHysterectomyAmerican CollegeSurgical settingU.S. FoodOutcomesStayPrevalence, characteristics, and risk factors of occult uterine cancer in presumed benign hysterectomy
Desai VB, Wright JD, Gross CP, Lin H, Boscoe FP, Hutchison LM, Schwartz PE, Xu X. Prevalence, characteristics, and risk factors of occult uterine cancer in presumed benign hysterectomy. American Journal Of Obstetrics And Gynecology 2019, 221: 39.e1-39.e14. PMID: 30853364, PMCID: PMC7006101, DOI: 10.1016/j.ajog.2019.02.051.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAsianBlack or African AmericanComorbidityEndometrial NeoplasmsEndometriosisEthnicityFemaleHispanic or LatinoHumansHysterectomyIncidental FindingsLeiomyomaLeiomyosarcomaMenstruation DisturbancesMetrorrhagiaMiddle AgedObesityPrevalenceRisk AssessmentRisk FactorsSarcomaUnited StatesUterine NeoplasmsUterine ProlapseWhite PeopleYoung AdultConceptsOccult uterine cancerUterine cancerBenign indicationsRisk factorsUterine sarcomaBenign hysterectomyEndometrial carcinomaPredictive valueResearch Cooperative System databaseState cancer registry dataNew York Statewide PlanningHigh negative predictive valueLow positive predictive valueAssociated risk factorsCorpus uteri cancerLarge population-based sampleCancer registry dataPopulation-based sampleAmbulatory surgery centersNegative predictive valuePositive predictive valueRisk prediction modelRace/ethnicityPostmenopausal bleedingPatient characteristics
2017
Regional Medicare Expenditures and Survival Among Older Women With Localized Breast Cancer
Tannenbaum S, Soulos PR, Herrin J, Mougalian S, Long JB, Wang R, Ma X, Gross CP, Xu X. Regional Medicare Expenditures and Survival Among Older Women With Localized Breast Cancer. Medical Care 2017, 55: 1030-1038. PMID: 29068906, PMCID: PMC5863278, DOI: 10.1097/mlr.0000000000000822.Peer-Reviewed Original ResearchConceptsBreast cancer careHospital referral regionsNonmetastatic breast cancerBreast cancerCancer careMedicare beneficiariesMedicare expendituresCancer expendituresBetter survivalEnd Results-MedicareRetrospective cohort studyPatients 3 yearsClinical characteristicsCohort studyOverall survivalCancer stagePatient outcomesOutcome measuresReferral regionsOlder womenSignificant associationStage IIBivariate analysisCancerQuintile
2016
Inpatient Laparoscopic Hysterectomy in the United States: Trends and Factors Associated With Approach Selection
Desai VB, Guo XM, Fan L, Wright JD, Xu X. Inpatient Laparoscopic Hysterectomy in the United States: Trends and Factors Associated With Approach Selection. Journal Of Minimally Invasive Gynecology 2016, 24: 151-158.e1. PMID: 27614151, DOI: 10.1016/j.jmig.2016.08.830.Peer-Reviewed Original ResearchConceptsLaparoscopic supracervical hysterectomyTotal laparoscopic hysterectomyLaparoscopic approachLaparoscopic hysterectomyNational Inpatient SampleHospital characteristicsPatient race/ethnicityFemale adult patientsClinical Modification codesDifferent laparoscopic approachesAssociation of patientHospital teaching statusHospital inpatient careBenign laparoscopic hysterectomyRace/ethnicityNonobstetric indicationsAdult patientsVaginal hysterectomyClinical factorsSupracervical hysterectomyBenign indicationsComorbid conditionsRetrospective studyNinth RevisionNIS databaseHospital Variation in the Practice of Bilateral Salpingectomy With Ovarian Conservation in 2012
Xu X, Desai VB. Hospital Variation in the Practice of Bilateral Salpingectomy With Ovarian Conservation in 2012. Obstetrics And Gynecology 2016, 127: 297-305. PMID: 26942357, DOI: 10.1097/aog.0000000000001203.Peer-Reviewed Original ResearchConceptsLow-risk womenBilateral salpingectomyLow-risk patientsOvarian conservationBenign hysterectomyHospital variationOvarian cancerAdult womenNational Inpatient SampleCross-sectional studyMultivariable regression analysisOvarian surgeryHighest tertileWhite patientsInpatient SampleSalpingectomyHysterectomyHospital's likelihoodLower riskHospital practiceHospitalPatientsWomenHospitalizationTertile
2015
Wide Variation Found In Hospital Facility Costs For Maternity Stays Involving Low-Risk Childbirth
Xu X, Gariepy A, Lundsberg LS, Sheth SS, Pettker CM, Krumholz HM, Illuzzi JL. Wide Variation Found In Hospital Facility Costs For Maternity Stays Involving Low-Risk Childbirth. Health Affairs 2015, 34: 1212-1219. PMID: 26153317, DOI: 10.1377/hlthaff.2014.1088.Peer-Reviewed Original ResearchConceptsCesarean deliveryHospital costsMaternity staysSerious maternal morbidityNationwide Inpatient SampleCoordination of careValue of careMaternal morbidityHospital admissionInpatient SampleDelivery system reformRural hospitalsUS hospitalsHospital practiceSafe reductionHospitalChildbirthStayLong stayHigh rateCareLower proportionUnited StatesFacility costsCost-Effectiveness of Immediate Compared With Delayed Postpartum Etonogestrel Implant Insertion
Gariepy AM, Duffy JY, Xu X. Cost-Effectiveness of Immediate Compared With Delayed Postpartum Etonogestrel Implant Insertion. Obstetrics And Gynecology 2015, 126: 47-55. PMID: 26241255, PMCID: PMC4526123, DOI: 10.1097/aog.0000000000000907.Peer-Reviewed Original ResearchConceptsImplant insertionUnintended pregnancyContraceptive implantsImmediate postpartum implant insertionHealth care system perspectiveEtonogestrel implant insertionImmediate implant insertionImmediate postpartum provisionIncremental cost-effectiveness ratioFirst postpartum yearFuture unintended pregnanciesAlternative contraceptive methodsOne-way sensitivity analysesCost-effectiveness ratioForm of contraceptionDecision analytic modelPostpartum visitPostpartum yearYear postpartumPostpartum placementContraceptive failureMedical costsContraceptive methodsPregnancyImmediate insertionThe Role of Patient Factors, Cancer Characteristics, and Treatment Patterns in the Cost of Care for Medicare Beneficiaries with Breast Cancer
Xu X, Herrin J, Soulos PR, Saraf A, Roberts KB, Killelea BK, Wang SY, Long JB, Wang R, Ma X, Gross CP. The Role of Patient Factors, Cancer Characteristics, and Treatment Patterns in the Cost of Care for Medicare Beneficiaries with Breast Cancer. Health Services Research 2015, 51: 167-186. PMID: 26119176, PMCID: PMC4722219, DOI: 10.1111/1475-6773.12328.Peer-Reviewed Original ResearchConceptsBreast cancer careHospital referral regionsCancer careMedicare expendituresBreast cancerRadiation therapyTreatment factorsMean Medicare expendituresEnd Results-MedicareSpecific treatment modalitiesContribution of patientCost of careHighest spending quintilePatient factorsTreatment patternsTumor characteristicsCancer characteristicsTreatment modalitiesReferral regionsMedicare beneficiariesQuintilePatientsCancerCareTherapy
2014
Socioeconomic Stratification and Multidimensional Health Trajectories: Evidence of Convergence in Later Old Age
Xu X, Liang J, Bennett JM, Botoseneanu A, Allore HG. Socioeconomic Stratification and Multidimensional Health Trajectories: Evidence of Convergence in Later Old Age. The Journals Of Gerontology Series B 2014, 70: 661-671. PMID: 25161216, PMCID: PMC4462671, DOI: 10.1093/geronb/gbu095.Peer-Reviewed Original ResearchConceptsNet worthProbability of pregnancy after sterilization: a comparison of hysteroscopic versus laparoscopic sterilization
Gariepy AM, Creinin MD, Smith KJ, Xu X. Probability of pregnancy after sterilization: a comparison of hysteroscopic versus laparoscopic sterilization. Contraception 2014, 90: 174-181. PMID: 24767963, DOI: 10.1016/j.contraception.2014.03.010.Peer-Reviewed Original ResearchConceptsProbability of pregnancyLaparoscopic bipolar coagulationLaparoscopic sterilizationPregnancy rateBipolar coagulationHysteroscopic sterilizationCumulative pregnancy rateRisk of pregnancyBase-case analysisUse failure ratesFemale sterilization proceduresSterilization proceduresLaparoscopic bandPregnancy riskProcedure successHysteroscopicPregnancy probabilityCumulative riskPregnancyPopulation riskCoil placementWomenRiskAvailable dataFailure rate
2013
The effect of medical malpractice liability on rate of referrals received by specialist physicians
Xu X, Spurr SJ, Nan B, Fendrick AM. The effect of medical malpractice liability on rate of referrals received by specialist physicians. Health Economics Policy And Law 2013, 8: 453-475. PMID: 23527533, PMCID: PMC3706535, DOI: 10.1017/s1744133113000157.Peer-Reviewed Original ResearchConceptsSpecialist physiciansMedical malpractice environmentMalpractice environmentState malpractice environmentOffice-based settingRate of referralAmbulatory visitsPotential confoundersReferral visitCare doctorsMalpractice insurance premiumsMedical malpractice claimsMedical malpractice insurance premiumsReferral behaviourAnalytic sampleLower likelihoodMalpractice claimsPhysiciansVisitsMedical malpractice liabilityReferralMalpractice liability
2006
Health Effects of Managed Care Among the Near-Elderly
Xu X, Jensen GA. Health Effects of Managed Care Among the Near-Elderly. Journal Of Aging And Health 2006, 18: 507-533. PMID: 16835387, DOI: 10.1177/0898264306289626.Peer-Reviewed Original ResearchConceptsHealth maintenance organizationChronic health conditionsSelf-reported general health statusHealth statusHealth conditionsGeneral health statusObserved beneficial effectsAdults age 55Care plansNationwide random sampleAge 55Maintenance organizationBeneficial effectsEmployer-sponsored health insuranceOlder adultsNear ElderlyHealth effectsHealth insuranceManaged CareRetirement StudySelection biasRandom sampleCareAdultsProvider organizationsInsurance coverage and health care use among near-elderly women
Xu X, Patel DA, Vahratian A, Ransom SB. Insurance coverage and health care use among near-elderly women. Women's Health Issues 2006, 16: 139-148. PMID: 16765290, DOI: 10.1016/j.whi.2006.02.005.Peer-Reviewed Original ResearchConceptsElderly womenPrescription medicationsHealth care servicesHealth insurance coverageInsurance coveragePhysician visitsCare servicesFrequency of hospitalizationHealth care useHealth careMultivariable regression analysisInadequate insurance coverageWomen's health insurance coverageDental visitsHospital stayMedication adherenceCare useOdds ratioOutpatient servicesNationwide random sampleInpatient servicesMore visitsMedicationsWomenVisits