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 respondentsImplementation of a multi-site neonatal simulation improvement program: a cost analysis
Xu X, Yao J, Bohnert J, Yamada N, Lee H. Implementation of a multi-site neonatal simulation improvement program: a cost analysis. BMC Health Services Research 2024, 24: 623. PMID: 38741098, PMCID: PMC11090826, DOI: 10.1186/s12913-024-11075-z.Peer-Reviewed Original ResearchConceptsNeonatal resuscitation trainingCalifornia Perinatal Quality Care CollaborativePre-implementation periodResuscitation trainingParticipating sitesPre-implementationNon-financial benefitsSuccessful programsConfidence intervalsMonthly costProgram implementation periodImprovement programsData collection formQuality Improvement ProgramMicro-costing approachCost accountingCare CollaborativeHealthcare sector perspectiveAssist hospitalsU.S. dollarsImplementation periodTeam practiceCollection formMean costTraining curriculum
2023
Quality, outcome, and cost of care provided to very low birth weight infants in California
Lapcharoensap W, Bennett M, Xu X, Lee H, Profit J, Dukhovny D. Quality, outcome, and cost of care provided to very low birth weight infants in California. Journal Of Perinatology 2023, 44: 224-230. PMID: 37805592, DOI: 10.1038/s41372-023-01792-4.Peer-Reviewed Original ResearchConceptsVery low birth weightCare of VLBW infantsLow birth weightRisk-adjusted costVLBW infantsQuality of careMethodsRetrospective studyBirth weightClinical outcomesHospital discharge recordsClinical factorsCost of careClinical dataHierarchical generalized linear modelsResultsIn totalBirth certificatesPatient outcomesInfantsPearson correlation coefficientAssociation of costDischarge recordsHospitalMeasures of costOutcomesCareTimeliness 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 factorsIn Situ Simulation and Clinical Outcomes in Infants Born Preterm
Chitkara R, Bennett M, Bohnert J, Yamada N, Fuerch J, Halamek L, Quinn J, Padua K, Gould J, Profit J, Xu X, Lee H. In Situ Simulation and Clinical Outcomes in Infants Born Preterm. The Journal Of Pediatrics 2023, 263: 113715. PMID: 37659586, PMCID: PMC10841094, DOI: 10.1016/j.jpeds.2023.113715.Peer-Reviewed Original ResearchConceptsChronic lung diseaseClinical outcomesNeonatal resuscitationDelivery room continuous positive airway pressureVery low birth weight birthsNeonatal intensive care unit admissionCalifornia Perinatal Quality Care CollaborativeContinuous positive airway pressureVery low birth weightSecondary outcomesNeonatal intensive care unitInfants born pretermLow birth weight birthsSevere intraventricular hemorrhageIntensive care unit admissionPositive airway pressureLow birth weightInfant born pretermEvaluate clinical outcomesIntensive care unitParticipating sitesIntraventricular hemorrhageWeeks gestationBorn pretermCollaborative quality improvement projectRacial 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 ResearchConceptsAbnormal 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
Maternal Outcomes in Subsequent Pregnancies After Classical Cesarean Delivery
Thompson BB, Reddy UM, Burn M, Abdel-Razeq S, Xu X. Maternal Outcomes in Subsequent Pregnancies After Classical Cesarean Delivery. Obstetrics And Gynecology 2022, 140: 212-219. PMID: 35852271, DOI: 10.1097/aog.0000000000004869.Peer-Reviewed Original ResearchConceptsPrior classical cesarean deliveryLow transverse cesarean deliveryPrior low transverse cesarean deliveryClassical cesarean deliverySevere maternal morbidityClinical risk factorsCesarean deliveryUterine ruptureMaternal outcomesSubsequent pregnancyHospital characteristicsRate of SMMPatient clinical risk factorsNational Inpatient Sample databaseLive singleton birthsWeeks of gestationMode of deliveryCross-sectional analysisMaternal morbiditySingleton birthsRisk factorsOutcome measuresMultivariable regressionHigh riskPropensity score methodsPerioperative 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 usePatientsSurgical Complications and Hospital Costs in Robot-Assisted Versus Conventional Laparoscopic Hysterectomy With Concurrent Sacrocolpopexy: Analysis of the Nationwide Readmissions Database
Andiman SE, Bui A, Ascher-Walsh C, Wright J, Xu X. Surgical Complications and Hospital Costs in Robot-Assisted Versus Conventional Laparoscopic Hysterectomy With Concurrent Sacrocolpopexy: Analysis of the Nationwide Readmissions Database. Urogynecology 2022, 28: e142-e148. PMID: 35113048, DOI: 10.1097/spv.0000000000001133.Peer-Reviewed Original ResearchConceptsConventional laparoscopic procedureConventional laparoscopic hysterectomyNationwide Readmissions DatabasePerioperative complicationsLaparoscopic hysterectomyLaparoscopic proceduresHospital costsMajor perioperative complicationsConventional laparoscopic approachMultivariable regression analysisRobot-assisted approachLarge national databaseProcedure codesSurgical complicationsInvasive hysterectomyLaparoscopic approachHysterectomyLower riskComplicationsReadmissionSacrocolpopexyPatient linkageNational databaseWeighted samplePatients
2021
Endometrial Sampling for Preoperative Diagnosis of Uterine Leiomyosarcoma
Kho RM, Desai VB, Schwartz PE, Wright JD, Gross CP, Hutchison LM, Boscoe FP, Lin H, Xu X. Endometrial Sampling for Preoperative Diagnosis of Uterine Leiomyosarcoma. Journal Of Minimally Invasive Gynecology 2021, 29: 119-127. PMID: 34265441, PMCID: PMC8752465, DOI: 10.1016/j.jmig.2021.07.004.Peer-Reviewed Original ResearchConceptsEndometrial samplingUterine leiomyosarcomaPreoperative diagnosisPreoperative detectionNew York State Cancer RegistryNew York Statewide PlanningPreoperative endometrial samplingSuboptimal surgical managementUse of hysteroscopyOutcomes of patientsRetrospective cohort studyState Cancer RegistryMultivariable regression analysisResearch Cooperative SystemAmbulatory surgery centersSample eligibility criteriaRace/ethnicityIndex surgeryCohort studyLocalized stageSupracervical hysterectomyCancer RegistryOutpatient encountersSurgical managementTumor size
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 programRadiotherapyHospital variation in admissions to neonatal intensive care units by diagnosis severity and category
Haidari ES, Lee HC, Illuzzi JL, Phibbs CS, Lin H, Xu X. Hospital variation in admissions to neonatal intensive care units by diagnosis severity and category. Journal Of Perinatology 2020, 41: 468-477. PMID: 32801351, PMCID: PMC7427695, DOI: 10.1038/s41372-020-00775-z.Peer-Reviewed Original ResearchConceptsNeonatal intensive care unitNICU admission ratesIntensive care unitNICU admissionMild diagnosesCare unitHospital variationInterhospital variationAdmission ratesPatient/hospital characteristicsHospital discharge dataRisk-adjusted ratesWeeks' gestationNICU bedsBirth weightHospital characteristicsSevere diagnosisLive birthsMultivariable regressionAdmissionPotential overuseBirth certificatesDiagnosisHigher likelihoodDiagnosis severityTrial of Labor After Two Prior Cesarean Deliveries: Patient and Hospital Characteristics and Birth Outcomes.
Dombrowski M, Illuzzi JL, Reddy UM, Lipkind HS, Lee HC, Lin H, Lundsberg LS, Xu X. Trial of Labor After Two Prior Cesarean Deliveries: Patient and Hospital Characteristics and Birth Outcomes. Obstetrics And Gynecology 2020, 136: 109-117. PMID: 32541284, PMCID: PMC7321852, DOI: 10.1097/aog.0000000000003845.Peer-Reviewed Original ResearchConceptsComposite severe maternal morbidityTrial of laborPrior cesarean deliverySevere maternal morbidityCesarean deliveryMaternal morbidityNewborn complicationsHospital characteristicsPropensity score-matched analysisSevere neonatal morbiditySuccessful vaginal birthSingleton live birthsAssociation of patientCohort of mothersBirth certificate dataSample eligibility criteriaModest increaseNeonatal morbidityNeonatal outcomesHospital dischargeBirth outcomesVaginal birthClear contraindicationsLive birthsMultivariable regressionUse and Costs of Breast Cancer Screening for Women in Their 40s in a US Population With Private Insurance
Kunst N, Long JB, Xu X, Busch SH, Kyanko KA, Richman IB, Gross CP. Use and Costs of Breast Cancer Screening for Women in Their 40s in a US Population With Private Insurance. JAMA Internal Medicine 2020, 180: 799-801. PMID: 32202606, PMCID: PMC7147248, DOI: 10.1001/jamainternmed.2020.0262.Peer-Reviewed Original Research
2019
Association Between Power Morcellation and Mortality in Women With Unexpected Uterine Cancer Undergoing Hysterectomy or Myomectomy.
Xu X, Lin H, Wright JD, Gross CP, Boscoe FP, Hutchison LM, Schwartz PE, Desai VB. Association Between Power Morcellation and Mortality in Women With Unexpected Uterine Cancer Undergoing Hysterectomy or Myomectomy. Journal Of Clinical Oncology 2019, 37: 3412-3424. PMID: 31518176, PMCID: PMC6901279, DOI: 10.1200/jco.19.00562.Peer-Reviewed Original ResearchConceptsTotal abdominal hysterectomyOccult uterine sarcomaUncontained power morcellationDisease-specific mortalityOccult uterine cancerSupracervical abdominal hysterectomyPower morcellationOccult endometrial carcinomaAbdominal hysterectomyUterine sarcomaUterine cancerEndometrial carcinomaMortality riskMultivariable Cox regressionPrognosis of patientsSubset of womenTime of hysterectomyHospital discharge recordsCancer registry dataHigher mortality riskOccult leiomyosarcomaCause mortalityLaparoscopic myomectomyPatient characteristicsBenign indicationsLow‐Interventional Approaches to Intrapartum Care: Hospital Variation in Practice and Associated Factors
Lundsberg LS, Main EK, Lee HC, Lin H, Illuzzi JL, Xu X. Low‐Interventional Approaches to Intrapartum Care: Hospital Variation in Practice and Associated Factors. Journal Of Midwifery & Women's Health 2019, 65: 33-44. PMID: 31502407, DOI: 10.1111/jmwh.13017.Peer-Reviewed Original ResearchConceptsIntrapartum careMultivariable logistic regressionHigh intervention groupLow-intervention groupMedical-legal concernsIntrapartum practicesNewborn morbidityHospital variationCesarean birthAssociated FactorsPatient outcomesInterventional approachesProcedure ratesAmerican CollegeHospital useHospital's likelihoodHospital groupHospitalBivariate analysisLogistic regressionMidwifery modelCalifornia hospitalsCareLatent class analysisHospital cultureLaparoscopic 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. FoodOutcomesStayRisk of unexpected uterine Cancer in women undergoing myomectomy: A population-based study
Desai VB, Wright J, Gross C, Lin H, Boscoe F, Schwartz P, Xu X. Risk of unexpected uterine Cancer in women undergoing myomectomy: A population-based study. European Journal Of Obstetrics & Gynecology And Reproductive Biology 2019, 238: 188-190. PMID: 31103353, DOI: 10.1016/j.ejogrb.2019.03.021.Peer-Reviewed Original Research