Tuesday, July 29, 2014

Keeping up with the Joneses


Just by casual observation, I have asserted that a hospital was more likely to acquire a surgical robot if a nearby competitor hospital had already done so.  But this was an untested conclusion, based on viewing websites and highway signs, particularly from community hospitals, like above.  So I was intrigued to see this great article by Huilin Li (Department of Population Health, New York University) and others in Healthcare.  From the abstract:

Background

The surgical robot has been widely adopted in the United States in spite of its high cost and controversy surrounding its benefit. Some have suggested that a “medical arms race” influences technology adoption. We wanted to determine whether a hospital would acquire a surgical robot if its nearest neighboring hospital already owned one.

Methods

We identified 554 hospitals performing radical prostatectomy from the Healthcare Cost and Utilization Project Statewide Inpatient Databases for seven states. We used publicly available data from the website of the surgical robot's sole manufacturer (Intuitive Surgical, Sunnyvale, CA) combined with data collected from the hospitals to ascertain the timing of robot acquisition during year 2001 to 2008. One hundred thirty four hospitals (24%) had acquired a surgical robot by the end of 2008. We geocoded the address of each hospital and determined a hospital's likelihood to acquire a surgical robot based on whether its nearest neighbor owned a surgical robot. We developed a Markov chain method to model the acquisition process spatially and temporally and quantified the “neighborhood effect” on the acquisition of the surgical robot while adjusting simultaneously for known confounders.

Results

After adjusting for hospital teaching status, surgical volume, urban status and number of hospital beds, the Markov chain analysis demonstrated that a hospital whose nearest neighbor had acquired a surgical robot had a higher likelihood itself acquiring a surgical robot (OR=1.71, 95% CI: 1.07–2.72, p=0.02).

Conclusion

There is a significant spatial and temporal association for hospitals acquiring surgical robots during the study period. Hospitals were more likely to acquire a surgical robot during the robot's early adoption phase if their nearest neighbor had already done so.

Monday, July 28, 2014

In memoriam: Marc Roberts

Sometimes unexpected news takes your breath away, and this was one such instance.  I just learned that Marc Roberts died this past weekend.

We never worked together, but we led parallel lives for decades--he in academia studying and writing about major societal issues like energy and health care, while I would work in organizations in the same fields.

In this announcement from Harvard, Professor Michael Reich said, “Marc’s insights, his intellect, and his humor on all sorts of issues will be sorely missed by his colleagues and his students around the world.”

Exactly: Insights, intellect, and humor.   Missing one, he could have been any of many academics who conduct research and write about topics, but the combination was unbeatable.  I loved his company.  I never tired of it and was left craving more after our visits.

It wasn't always serious stuff, though.  As a house gift for the Cape Cod house he and Mary Ann owned, I gave them a tide clock.  He had a great laugh when I told him to make sure he adjusted it for Daylight Savings Time!

I know we all have to go eventually, but I just wish Marc hadn't had to go so soon.

How to make sure no one will report the next time

From a Washington Post report on the CDC anthrax problem:

Farrell had been reassigned following the June incident, and his future at the CDC was uncertain before his resignation this week. Sean Kaufman, a biosafety expert who also testified at last week’s congressional hearing on lab issues at the CDC, said Farrell had unfairly been made a scapegoat.

“Michael immediately reported this incident. He did what he needed to do as a scientist. And when he did that, the repercussion was a loss of a job,” said Kaufman, a former CDC employee who conducted a training in Farrell’s lab as recently as this spring. “This is nothing but pointing a finger and holding a scientist responsible for something that’s a systemic issue within an organization.”

Kaufman said the hasty departure of Farrell, whom he described as a meticulous scientist, father of two boys and Navy veteran, could discourage other employees from reporting future lab incidents and ultimately undermine safety.


And how motivational is this?

“These events should never have happened,” CDC Director Tom Frieden said, even as he noted that no one had been sickened or harmed. “I’m disappointed, and frankly I’m angry about it.”

Hey, man, this was on your watch.  You arrived in June 2009.  And you were not a stranger to the place, having worked there from 1990 to 2002. 

It is better for a leader to take ownership than to blame others.