Brent K Hollenbeck

..To understand how physician ownership of ambulatory surgery centers (ASCs) relates to surgery use...

..9 per 1000 population; P < .01). The presence of an ASC is associated with higher utilization of common outpatient procedures in the elderly. Whether ASCs are meeting unmet clinical demand or spurring overutilization is not clear...

..We use a tailored approach to laparoscopic partial nephrectomy based on tumor depth of penetration and proximity to the renal sinus. We evaluated differences in perioperative outcomes to determine the value of this paradigm...

..We examined associations between initial treatment intensity and subsequent outcomes...

..Characterization of these factors could enhance preoperative patient counseling and facilitate perioperative management, thereby improving the quality of patient care...

..The authors performed a study to prospectively assess relationships between intraoperative processes and early functional recovery after surgery...

..Restaging bladder tumor resection improves staging accuracy and the response to intravesical therapy. However, its use outside of a tertiary care setting, and its subsequent clinical implications, are unknown...

..In this review, we discuss the broad concepts of health care quality and describe their relationships with small renal tumors...

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..However, the processes of care that mediate this effect are unknown. We sought to identify the processes that underlie the volume-outcome relationship for cystectomy...

..We studied the relationship between certificate of need laws and market level adoption of robotic prostatectomy...

..To study the evolution of surgical margins in robotic prostatectomy (DVP), to ascertain the surgical volume necessary to provide quality cancer care...

..Although screening currently is not recommended, better medical care of patients who are at risk (ie, those with hematuria) has the potential to improve outcomes...

..We developed and validated a reliable, responsive multidimensional instrument to measure disease specific health related quality of life in bladder cancer survivors treated with local cancer therapy...

..To evaluate the relationship between ownership and use of ambulatory surgical centers (ASCs)...

..We examined associations between hospital stay and short-term outcomes for a low risk procedure (prostatectomy) and high risk procedure (cystectomy)...

..Therefore, we determined whether payments for outpatient surgery vary by location of care...

..As health care delivery reforms gain traction, policy makers must balance the promotion of new, yet unproven, technology with the risk of overuse...

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..For this reason, the relative importance of broadening indications for aggressive therapy has unclear implications...

..For this reason, we undertook a study to better understand the relationships between large prostate size and robotic prostatectomy outcomes with respect to intraoperative and pathologic factors...

..To develop a generic instrument for measuring short-term health status in the recovery period among patients undergoing abdominal and pelvic surgery...

..Investigators should be cognizant of this bias and exercise caution when interpreting these relationships when using SEER-Medicare data alone...

..CONCLUSIONS: These data quantify a target population for whom greater use of expectant approaches may reduce overtreatment and improve the quality of localized prostate cancer care...

..This study compared oncologic and health-related quality-of-life outcomes among patients undergoing intraperitoneal or extraperitoneal robotic prostatectomy...

..Urologists who acquired partnership shares were incentivized to perform shock wave lithotripsy preferentially over URS. Because of ownership expansion, the rates of URS might have decreased...

..Thus, Medicare's transplant experience allows us to examine the role of payer leverage in motivating hospital benchmark compliance...

..We evaluated the impact of the specialized medical and ancillary services available at low vs. high volume prostatectomy centers on prolonged length of stay (LOS) outcomes after radical prostatectomy...

..Despite their potential benefits to patients, the adoption of partial nephrectomy and laparoscopic kidney cancer surgery has been both gradual and concentrated in select hospitals...

..For this reason, a multilevel analysis was conducted using a population-based cohort to evaluate the amount of variation in laparoscopic donor nephrectomy use attributable to the individual, provider, and hospital levels...

..Despite growing calls for using lymph node counts as a hospital quality indicator, it has not been established that hospitals that obtain more lymph node have better outcomes...

..Therefore, we compared the use of laparoscopy by procedure indication (kidney donor, and benign and malignant kidney disease) to examine potential specialty specific associations with the slow uptake of this technology...

..All stakeholders, including physicians, the Medicare program and hospitals, will be affected by these changes...

..Practice guidelines for nonmuscle invasive (ie, early stage) bladder cancer are ambiguous, resulting in substantial practice variation without a clear patient benefit...

..To better understand the relationships between case-mix, processes of care, and recovery after laparoscopic surgery...

..Despite these findings obese patients should not be dissuaded from considering prostatectomy as definitive treatment for localized prostate cancer...

..During this period short-term outcomes following cystectomy improved, while the use of subacute care facilities and home health services increased dramatically, underscoring a shift in the burden of care in this patient population...

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..Mounting evidence suggests a relationship between hospital volume and outcomes after major cancer surgery; however, the absolute benefits of volume-based referral on a national basis are unclear...

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..To this end, urologic professional societies and their surgeons should aim to identify underwriters for and participate in large clinical registries and surgical quality collaboratives...

..Weekend hospital admission is associated with different and poorer quality care in certain clinical settings...

..Early stage bladder cancer is a heterogeneous disease with a variable risk of progression and mortality. Uncertainty surrounding the optimal care for these patients may result in a mismatch between disease risk and treatment intensity...

..Motivated by these concerns we evaluated how opening of an ambulatory surgery center impacts stone surgery use in a health care market and assessed the effect of its opening on the patient mix at nearby hospitals...

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..The fact that increased detection and treatment of small tumors is not reducing mortality argues for a reassessment of the current treatment paradigm...

..To better understand the associations between the certificate of need regulations and intensity-modulated radiotherapy dissemination...

..Motivated by this, we assessed short-term morbidity and mortality for patients by location of care...

..Although early results suggest that RARC is safe, with favorable perioperative and early oncologic outcomes, limited data exist comparing ORC and RARC...

..For this reason, the authors measured relations between increasing fragmentation of cancer care, expenditures, and quality of care among prostate cancer survivors...

..To obtain a better understanding of this issue, we review the current state of bladder cancer disparities research...

..To quantify the degree to which overall urologic oncology volume either reduces or enhances the effect of single procedure volume on short-term outcomes after urologic oncology surgery...

..Alternatively, black patients may receive a lower quality of care, which may explain this difference...

..To prospectively compare the relevant in-hospital and postdischarge short-term health outcomes in a contemporary group of patients undergoing either robotic or conventional radical prostatectomy...

..Using a population-based cohort, a competing risk analysis was performed to estimate patient survival after surgery for kidney cancer, as a function of patient age and tumor size at diagnosis...

..The authors of this report linked cancer registry data with medical claims to identify the sources of variation and opportunities for improving the value of cancer care...

..As a result, survivors have a protracted course, harboring considerable clinical and economic implications. Thus, we investigated the extent to which health service use and expenditures vary during continuing prostate cancer care...

..The histologic classification of kidney cancer has been revised to reflect this new paradigm...

..04). CONCLUSIONS: LPN with closure using fibrin glue products provides adequate hemostasis when the CS or renal sinus is not entered. When the CS or renal sinus is entered, a sutured bolster is recommended...

..To better understand the barriers to the dissemination of medical expulsive therapy we analyzed health care claims of working age adults with urinary stone disease...

..From a quality-of-care perspective, the underuse of partial nephrectomy may represent suboptimal delivery of healthcare...

..The impact of this increasing burden of care on tertiary centers is unclear but may be problematic in the current reimbursement environment...

..We sought to elicit the influence of local pressures (in the form of the technologic imperative exerted by laparoscopy) on discharge physician practice style as measured by LOS...

..In testis cancer, the use of tumor markers is an important component of care and may represent a measurable quality indicator. We analyzed the use of testis cancer tumor markers across the United States...

..Additional study using detailed clinical data is necessary to identify the underlying causes of these differences...

..The implications of stage divergence on survival are ill defined in the context of those treated by surgery alone and would facilitate patient counseling and enhance prognostication...

..To explore this possibility, we measured the impact of the opening of an ASC in a health care market, as defined by the hospital service area (HSA), on rates of procedure use...

..Growth in prostate cancer spending continues to outpace that for overall health expenditures, garnering nearly $7 billion annually...

..To better understand care coordination in the context of prostate cancer we examined how the delivery of prostate cancer care is partitioned across primary care providers and specialists...

..We report our experience with hand assisted laparoscopic (HALS) nephroureterectomy and describe the associations of preoperative, operative and pathological factors with outcome...

..Recent health care legislation contains several delivery system reforms that will attempt to address these issues. We review these programs and discuss the implications for practicing urologists...

..Post-operative morbidity leads to dramatically increased resource utilization. Prospective studies are needed to identify pre-operative risk factors and intraoperative process measures to optimize the quality of care...

..Complex surgical procedures are migrating out of hospitals and into ambulatory surgery centers. We evaluated the extent to which surgery for urolithiasis could be a candidate for such migration...

..We sought to assess whether robot assistance would decrease the technical challenges and mitigate the considerable morbidity associated with the procedure...

..We determined the extent to which the regionalization of nephrectomy has occurred and describe the potential causes and implications of any observed regionalization...

..We evaluated factors that impact the ability to learn hand-assisted laparoscopic donor nephrectomy (HALDN) to identify impediments to diffusion of this procedure...

..We sought to measure the impact of both case mix and physician practice (perioperative process/risk factors) on length of stay (LOS)-a common benchmark- after laparoscopic surgery...

..The National Quality Forum and other organizations recently endorsed a 12-node minimum as a measure of hospital quality...

..From a quality of care perspective, overuse of partial cystectomy may signify inappropriate delivery of health care...

..Surgeon discomfort is also dependent on the type of hand-assist device. The long-term consequences of physical strain on the laparoscopic surgeon are unknown currently, but measures to minimize neuromuscular strain should be considered...

..The impact of the increasing role of the primary care physician on the use of benign prostatic hyperplasia related health services remains unknown...

..Risk adjustment tools should be used to identify patients (young and old) who would be better served by less aggressive management...

..Although follow-up is fairly short, no renal-cell carcinoma recurrences have appeared. At this point in time, the oncologic efficacy of a laparoscopic approach appears to mirror that of the open surgical technique...

..We studied the influence of socioeconomic status and race on use of ASCs...

..This study used a recently validated instrument, the Convalescence and Recovery Evaluation (CARE), to measure return to baseline health after surgery and explore clinical factors associated with recovery...

..Historically, stone disease has been more common among men than women. However, differential changes in dietary intake patterns, fluid intake, and obesity in men and women may cause shifts in stone disease incidence and prevalence...

..Finally, we provide a framework for future research by presenting an overview of recent work pertaining to cystectomy and quality of care...

..Stratifying patient reported sexual function by the principal determinants of age, nerve sparing and prostate size provides a basis for counseling patients...

..These factors should be taken into consideration when counseling patients with localized prostate cancer regarding the expected, postimplantation sexual HRQOL outcome...

..The risk is proportional to the number of renal units treated and may be assumed at once (e.g., same-session) or over time (e.g., staged) as it applies to patients requiring bilateral ureteroscopy...

..Initial results with the lockout valve reservoir in preventing autoinflation are encouraging though additional study is warranted to justify their routine use...