Lyen C. Huang

What factors influence minority use of National Cancer Institute-designated cancer centers?

National Cancer Institute (NCI) cancer centers provide high‐quality care and are associated with better outcomes. However, racial and ethnic minority populations tend not to use these settings. The current study sought to understand what factors influence minority use of NCI cancer centers.

Factors that influence minority use of high-volume hospitals for colorectal cancer care.

BACKGROUND: Previous studies suggest that minorities cluster in low-quality hospitals despite living close to better performing hospitals. This may contribute to persistent disparities in cancer outcomes. OBJECTIVE: The purpose of this work was to examine how travel distance, insurance status, and neighborhood socioeconomic factors influenced minority underuse of high-volume hospitals for colorectal cancer. DESIGN: The study was a retrospective, cross-sectional, population-based study. SETTINGS: All hospitals in California from 1996 to 2006 were included. PATIENTS: Patients with colorectal cancer diagnosed and treated in California between 1996 and 2006 were identified using California Cancer Registry data. MAIN OUTCOME MEASURES: Multivariable logistic regression models predicting high-volume hospital use were adjusted for age, sex, race, stage, comorbidities, insurance status, and neighborhood socioeconomic factors. RESULTS: A total of 79,231 patients treated in 417 hospitals were included in the study. High-volume hospitals were independently associated with an 8% decrease in the hazard of death compared with other settings. A lower proportion of minorities used high-volume hospitals despite a higher proportion living nearby. Although insurance status and socioeconomic factors were independently associated with high-volume hospital use, only socioeconomic factors attenuated differences in high-volume hospital use of black and Hispanic patients compared with white patients. LIMITATIONS: The use of cross-sectional data and racial and ethnic misclassifications were limitations in this study. CONCLUSIONS: Minority patients do not use high-volume hospitals despite improved outcomes and geographic access. Low socioeconomic status predicts low use of high-volume settings in select minority groups. Our results provide a roadmap for developing interventions to increase the use of and access to higher quality care and outcomes. Increasing minority use of high-volume hospitals may require community outreach programs and changes in physician referral practices.

Surgical Team Member Assessment of the Safety of Surgery Practice in 38 South Carolina Hospitals

We assessed surgical team member perceptions of multiple dimensions of safe surgical practice in 38 South Carolina hospitals participating in a statewide initiative to implement surgical safety checklists. Primary data were collected using a novel 35-item survey. We calculated the percentage of 1,852 respondents with strongly positive, positive, and neutral/negative responses about the safety of surgical practice, compared results by hospital and professional discipline, and examined how readiness, teamwork, and adherence related to staff perception of care quality. Overall, 78% of responses were positive about surgical safety at respondent’s hospitals, but in each survey dimension, from 16% to 40% of responses were neutral/negative, suggesting significant opportunity to improve surgical safety. Respondents not reporting they would feel safe being treated in their operating rooms varied from 0% to 57% among hospitals. Surgeons responded more positively than nonsurgeons. Readiness, teamwork, and practice adherence related directly to staff perceptions of patient safety (p < .001).

Creating a Culture of Safety by Using Checklists

T he modern OR is a marvel of complex, multidisciplinary teamwork. A team of surgeons, anesthesiologists, certified RN anesthetists, nurses, and surgical technologists, backed by numerous support staff members, must work together as a cohesive and coordinated unit to safely care for a patient before, during, and after a surgical procedure. When an OR is functioning at its best, this complexity is nearly invisible, and there appear to be few conflicts or problems as the patient moves from the preoperative area to the OR and then to the postanesthesia care unit. The complexity of an OR is also its greatest weakness. More medical errors occur in the OR than anywhere else in a hospital. These errors often occur despite multiple layers of safety checks and are usually the result of faulty processes or conditions. Many surgery-related errors are preventable; however, preventing errors is not an easy task. Developing a culture of safety is a key step for personnel who wish to reduce errors. This means that patient safety must be the highest priority for every staff member and physician and that anyone should be able to raise concerns or identify problems without fear of repercussions. In a culture of safety, every person is treated with respect, regardless of his or her seniority or role. Mistakes are openly discussed, staff members encourage the reporting of near misses as opportunities for improvement, and teamwork is revered above individual performance. Effective implementation of

The Surgical Safety Checklist and Teamwork Coaching Tools: a study of inter-rater reliability

Objective To assess the inter-rater reliability (IRR) of two novel observation tools for measuring surgical safety checklist performance and teamwork. Summary background Data surgical safety checklists can promote adherence to standards of care and improve teamwork in the operating room. Their use has been associated with reductions in mortality and other postoperative complications. However, checklist effectiveness depends on how well they are performed. Methods Authors from the Safe Surgery 2015 initiative developed a pair of novel observation tools through literature review, expert consultation and end-user testing. In one South Carolina hospital participating in the initiative, two observers jointly attended 50 surgical cases and independently rated surgical teams using both tools. We used descriptive statistics to measure checklist performance and teamwork at the hospital. We assessed IRR by measuring percent agreement, Cohens κ, and weighted κ scores. Results The overall percent agreement and κ between the two observers was 93% and 0.74 (95% CI 0.66 to 0.79), respectively, for the Checklist Coaching Tool and 86% and 0.84 (95% CI 0.77 to 0.90) for the Surgical Teamwork Tool. Percent agreement for individual sections of both tools was 79% or higher. Additionally, κ scores for six of eight sections on the Checklist Coaching Tool and for two of five domains on the Surgical Teamwork Tool achieved the desired 0.7 threshold. However, teamwork scores were high and variation was limited. There were no significant changes in the percent agreement or κ scores between the first 10 and last 10 cases observed. Conclusions Both tools demonstrated substantial IRR and required limited training to use. These instruments may be used to observe checklist performance and teamwork in the operating room. However, further refinement and calibration of observer expectations, particularly in rating teamwork, could improve the utility of the tools.

What factors influence minority use of NCI cancer centers

National Cancer Institute (NCI) cancer centers provide high‐quality care and are associated with better outcomes. However, racial and ethnic minority populations tend not to use these settings. The current study sought to understand what factors influence minority use of NCI cancer centers.

His Upper GI Tract

Upper gastrointestinal complaints such as heartburn, difficulty swallowing, and abdominal pain are common among men. These complaints may be due to uncomplicated disease or harbingers of more serious illness. Careful questioning and physical examination can help guide the diagnostic workup and initial treatment options. Upper endoscopy is often diagnostic and therapeutic for many disorders, but other tests may include radiography, ultrasound, pH monitoring, esophageal manometry, and gastric emptying studies. Most common upper gastrointestinal disorders can be medically managed. However, advanced endoscopic and laparoscopic procedures with low complication rates, short hospital stays, and durable results are now available for the management of refractory and complicated disease.

What factors influence minority use of National Cancer Institute-designated cancer centers?: Influences on Minority Use of NCI Centers

National Cancer Institute (NCI) cancer centers provide high‐quality care and are associated with better outcomes. However, racial and ethnic minority populations tend not to use these settings. The current study sought to understand what factors influence minority use of NCI cancer centers.