Browse Health
Obstetrician & Gynecologist (OB/GYN)
22 years of experience
Accepting new patients

Education ?

Medical School Score
University of Missouri at Kansas City (1988)
  • Currently 2 of 4 apples

Awards & Distinctions ?

Associations
American Board of Obstetrics and Gynecology

Affiliations ?

Dr. Ransom is affiliated with 2 hospitals.

Hospital Affilations

  • Tarrant County Hospital District/John Peter Smith Hospital
  • Hutzel Hospital, Detroit, Mi
  • Publications & Research

    Dr. Ransom has contributed to 29 publications.
    Title Cost of Racial Disparity in Preterm Birth: Evidence from Michigan.
    Date September 2009
    Journal Journal of Health Care for the Poor and Underserved
    Excerpt

    This study examined the economic costs associated with racial disparity in preterm birth and preterm fetal death in Michigan. Linked 2003 Michigan vital statistics and hospital discharge data were used for data analysis. Thirteen percent of the singleton births among non-Hispanic Blacks were before 37 completed weeks of gestation, compared with only 7.7% among non-Hispanic Whites (risk ratio = 1.66, 95% confidence interval: 1.59-1.72; p<.0001). One thousand one hundred and eighty four (1,184) non-Hispanic Black, singleton preterm births and preterm fetal deaths would have been avoided in 2003 had their preterm birth rate been the same as Michigan non-Hispanic Whites. Economic costs associated with these excess Black preterm births and preterm fetal deaths amounted to $329 million (range: $148 million-$598 million) across their lifespan over and above the costs if they were born at term, including costs associated with the initial hospitalization, productivity loss due to perinatal death, and major developmental disabilities. Hence, racial disparity in preterm birth and preterm fetal death has substantial cost implications for society. Improving pregnancy outcomes for African American women and reducing the disparity between Blacks and Whites should continue to be a focus of future research and interventions.

    Title Malpractice Burden, Rural Location, and Discontinuation of Obstetric Care: a Study of Obstetric Providers in Michigan.
    Date May 2009
    Journal The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association
    Excerpt

    It has long been a concern that professional liability problems disproportionately affect the delivery of obstetrical services to women living in rural areas. Michigan, a state with a large number of rural communities, is considered to be at risk for a medical liability crisis.

    Title The Impact of Malpractice Burden on Michigan Obstetrician-gynecologists' Career Satisfaction.
    Date October 2008
    Journal Women's Health Issues : Official Publication of the Jacobs Institute of Women's Health
    Excerpt

    BACKGROUND: Medical services for pregnancy and childbirth are inherently risky and unpredictable. In many states, obstetrician-gynecologists (OB-GYNS) who attend the majority of childbirths in the United States and provide the most clinically complex obstetric procedures are struggling with increasing malpractice insurance premiums and litigation risk. Despite its significant implications for patient care, the potential impact of malpractice burden on OB-GYN physicians' career satisfaction has not been rigorously tested in previous research. METHODS: Drawing on data from a statewide survey of obstetric providers in Michigan, this paper examined the association between medical liability burden and OB-GYNs' career satisfaction. Malpractice insurance premiums and malpractice claims experience were used as 2 objective measures for medical liability burden. Descriptive statistics were calculated and multivariable logistic regressions estimated for data analysis. RESULTS: Although most respondents reported satisfaction with their overall career in medicine, 43.7% had become less satisfied over the last 5 years and 34.0% would not recommend obstetrics/gynecology to students seeking career advice. Multivariable regression analysis showed that compared to coverage through an employer, paying > or =$50,000/year for liability insurance premium was associated with lower career satisfaction among OB-GYNs (odds ratio, 0.35; 95% confidence interval, 0.13-0.93). We found no significant impact of malpractice claims experience, including both recent malpractice claims (during the last 5 years [2001--2006]) and earlier malpractice claims (>5 years ago), on overall career satisfaction. CONCLUSIONS: The findings of this study suggest that high malpractice premiums negatively affect OB-GYN physicians' career satisfaction. The impact of the current medical liability climate on quality of care for pregnant women warrants further investigation.

    Title The Effects of Medical Liability on Obstetric Care Supply in Michigan.
    Date February 2008
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: The objective of the study was to examine Michigan obstetric providers' provision of obstetric care and the impact of malpractice concerns on their practice decisions. STUDY DESIGN: Data were obtained from 899 Michigan obstetrician-gynecologists, family physicians, and nurse-midwives via a statewide survey. Statistical tests were conducted to examine differences in obstetric care provision and the influence of various factors across specialties. RESULTS: Among providers currently practicing obstetrics, 18.3%, 18.7%, and 11.9% of obstetrician-gynecologists, family physicians, and nurse-midwives, respectively, planned to discontinue delivering babies in the next 5 years, and 35.5%, 24.5%, and 12.6%, respectively, planned to reduce their provision of high-risk obstetric care. "Risk of malpractice litigation" was 1 of the most cited factors affecting providers' decision to include obstetrics in their practice. CONCLUSION: Litigation risk appears to be an important factor influencing Michigan obstetric providers' decisions about provision of care. Its implications for obstetric care supply and patients' access to care warrants further research.

    Title Malpractice Liability Burden in Midwifery: a Survey of Michigan Certified Nurse-midwives.
    Date January 2008
    Journal Journal of Midwifery & Women's Health
    Excerpt

    A statewide survey was conducted among 282 nurse-midwives in Michigan to examine the extent of their current medical liability burden. Two hundred ten responses were received for an adjusted response rate of 76.9%. Data from 145 certified nurse-midwives (CNMs) who were currently engaged in clinical practice in Michigan were used for this analysis. Sixty-nine percent of CNMs reported that liability concerns had a negative impact on their clinical decision making. Most CNMs (88.1%) acquired malpractice insurance coverage through an employer, whereas 4.9% were practicing "bare" due to difficulty in obtaining coverage. Thirty-five percent of the respondents had been named in a malpractice claim at least once in their career, and 15.5% had at least one malpractice payment of $30,000 or more made on their behalf. CNMs who purchased malpractice insurance coverage themselves or were going bare were significantly less likely to include obstetrics in their practice than their counterparts covered through an employer (70.6% versus 87.2%; P = .04). These findings among Michigan CNMs call for further investigation into the consequences of the current malpractice situation surrounding nurse-midwifery practice and its influence on obstetric care, particularly among women from disadvantaged populations.

    Title Robot-assisted Laparoscopic Myomectomy Versus Abdominal Myomectomy: a Comparison of Short-term Surgical Outcomes and Immediate Costs.
    Date December 2007
    Journal Journal of Minimally Invasive Gynecology
    Excerpt

    STUDY OBJECTIVE: To compare surgical outcomes of myomectomy by robot-assisted laparoscopy with those performed by traditional laparotomy and to analyze the financial impact of these 2 approaches. DESIGN: Retrospective case-matched analysis (Canadian Task Force classification III). SETTING: University teaching hospital. PATIENTS: A total of 58 patients with symptomatic leiomyomata. INTERVENTION: Myomectomy by robot-assisted laparoscopy or traditional laparotomy was administered. MEASUREMENTS AND MAIN RESULTS: An equal number of case-matched patients based on age, body mass index, and myoma weight were analyzed in each group. Among these 3 variables, there were no statistically significant differences between the robotic and laparotomy groups. Mean age was 36.59 +/- 4.93 years (95% CI 34.71-38.46 years) versus 34.86 +/- 4.41 years (95% CI 33.18-36.54 years), mean body mass index was 25.22 +/- 3.85 kg/m(2) (90% central range [CR] 20.30-31.20 kg/m2) versus 28.3 +/- 6.95 kg/m2 (90% CR 21.50-42.80 kg/m2), and mean myoma weight was 227.86 +/- 247.54 g (90% CR 11.60-680.00 g) versus 223.76 +/- 228.28 g (90% CR 11.50-660.00 g), respectively. Patients with robot-assisted laparoscopic myomectomy had decreased estimated blood loss (mean 195.69 +/- 228.55 mL [90% CR 50.00-700.00 mL] vs mean 364.66 +/- 473.28 mL [90% CR 75.00-1550.00 mL]) and length of stay (mean 1.48 +/- 0.95 days [90% CR 1.00-3.00 days] vs mean 3.62 +/- 1.50 days [90% CR 3.00-8.00 days]) when compared with the laparotomy group. Both of these differences were statistically significant at p <.05. Operative times were significantly longer in the robotic group: mean 231.38 +/- 85.10 minutes (95% CI 199.01-263.75 minutes) versus mean 154.41 +/- 43.14 minutes (95% CI 138.00-170.82 minutes, p <.05) in the laparotomy group. Complication rates were higher in the laparotomy group. Professional charges (mean $5946.48 +/- $1447.17 [90% CR $4034.46-$8937.00] vs mean $4664.48 +/- $642.11 [90% CR $3944.36-$6010.90, p <.0002]) and hospital charges (mean $30084.20 +/- $6689.29 [90% CR $22939.81-$45588.22] vs mean $13400.62 +/- $7747.26 [90% CR $8703.20-$26771.22, p <.0001]) were statistically higher for the robotic group. Although professional reimbursement was not significantly different between groups (mean $2263.02 +/- $1354.97 [90% CR $0.00- $4831.08] versus mean $1841.99 +/- $827.51 [90% CR $0.00-$3376.97, p = .2831]), mean hospital reimbursement rates for the robotic group were significantly higher: $13181.39 +/- $10752.00 (90% CR $1081.76-$37396.03) versus $7015.24 +/- $3467.97 (90% CR $2492.48-$10394.83, p = .0372). CONCLUSION: As a new technology, it is not unexpected that a robotic approach to myomectomy costs more than a traditional laparotomy. On the other hand, decreased estimated blood loss, complication rates, and length of stay with the robotic approach in the end may prove to have a significant societal benefit that will outweigh upfront financial impact.

    Title Emergency Contraception Provision: a Survey of Michigan Physicians from Five Medical Specialties.
    Date July 2007
    Journal Journal of Women's Health (2002)
    Excerpt

    OBJECTIVE: Despite the controversy over expanding delivery options for emergency contraceptive pills (ECP), little is known about physicians' attitudes toward over-the-counter (OTC) provision of ECP, and prior research on physicians' practices often has focused on a single specialty. This study examined the attitudes and practices regarding advance provision and OTC status of ECP among physicians in five medical specialties likely to encounter patients in need of ECP. METHODS: A mail survey of a random sample of 850 Michigan physicians in family/general medicine, internal medicine, obstetrics/gynecology, pediatrics, and emergency medicine was conducted. Respondents' ECP-related attitudes and practices were assessed, and differences by physician characteristics were examined using chi-square tests and multivariable logistic regression analyses. RESULTS: Two hundred seventy-one physicians responded to the survey (response rate = 32%), with 42% of them favoring OTC provision of ECP and 40% opposing it. Half of respondents never routinely initiated discussions about ECP with their sexually active, female patients, and 77% of respondents did not routinely offer advance prescriptions. After adjusting for other factors, including medical specialty, older physicians ( > or =50 years) were significantly more likely than their younger counterparts to support OTC provision of ECP (OR = 2.9, 95% CI 1.7-4.9) or offer advance prescriptions (OR = 2.5, 95% CI 1.1-5.8). Physicians with a specialty in obstetrics/gynecology were 3.5 times (95% CI 1.3-9.8) as likely as physicians in family/general medicine to offer advance prescriptions for ECP, and female physicians were 2.5 (95% CI 1.05-6.0) times as likely as male physicians to offer advance prescriptions. Graduation from a medical school within the United States and practicing in a private practice were marginally associated with a lower likelihood of supporting OTC status of ECP (OR = 0.5, 95% CI: 0.2-1.0; and OR equals; 0.6, 95% CI 0.3-1.1, respectively). CONCLUSIONS: Certain physician characteristics were significantly associated with their ECP-related attitudes and practices. The majority of physicians surveyed in this study did not offer advance prescriptions for ECP, and few had initiated discussions on ECP with patients, which may pose critical barriers to patients' timely access.

    Title Insurance Coverage and Health Care Use Among Near-elderly Women.
    Date September 2006
    Journal Women's Health Issues : Official Publication of the Jacobs Institute of Women's Health
    Excerpt

    OBJECTIVES: Data on near-elderly (ages 55-64) women's access to and use of health care have been limited. In this study, we sought to examine the status of near-elderly women's health insurance coverage in the United States and how it may influence their use of health care services. METHODS: A nationwide random sample of women aged 55-64 was drawn from the 2002 wave of the Health and Retirement Study. Descriptive statistics were calculated and multivariable regression analyses were performed to quantify the impact of insurance coverage on near-elderly women's use of outpatient services, inpatient services, and prescription medication over a 2-year period. RESULTS: In 2002, 9.4% of near-elderly women in the United States were uninsured and 15.4% had public coverage. Those who had coverage for a particular service were significantly more likely to use that service compared to women without coverage, with odds ratios ranging from 2.0-6.7 for services such as a physician visit, hospital stay, dental visit, and use of prescription medication. Among those who had at least one physician visit, near-elderly women who had some of the cost covered by insurance reported significantly more visits than women without coverage. Likewise, for near-elderly women regularly taking prescription medications, having more extensive coverage significantly increased their likelihood of medication adherence. The frequency of hospitalization was also higher for women who had complete coverage for the cost. CONCLUSIONS: The nature of a near-elderly woman's insurance coverage significantly affects her use of health care services. More attention is needed to improve the health care of near-elderly women with inadequate insurance coverage.

    Title Childbirth and Pelvic Floor Dysfunction: an Epidemiologic Approach to the Assessment of Prevention Opportunities at Delivery.
    Date July 2006
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    Female pelvic floor dysfunction is integral to the woman's role in the reproductive process, largely because of the unique anatomic features that facilitate vaginal birth and also because of the trauma that can occur during that event. Interventions such as primary elective cesarean delivery have been discussed for the primary prevention of pelvic floor dysfunction; however, existing data about potentially causal factors limit our ability to evaluate such strategies critically. Here we consider the conceptual principles of epidemiologic function and the availability of data that are necessary to make informed recommendations about prevention opportunities for pelvic floor dysfunction at delivery. Available epidemiologic data on pelvic floor dysfunction suggest that there may be substantial opportunities for the primary prevention of pelvic organ prolapse at delivery. Although definitive recommendations await further epidemiologic studies of the potential risk and benefits of obstetric practice change, it is hoped that this discussion will provide a novel, quantitative framework for the assessment of pelvic floor dysfunction prevention opportunities.

    Title Willingness or Unwillingness to Perform Cesarean Section for Impending Preterm Delivery at 24 Weeks' Gestation: a Cost-effectiveness Analysis.
    Date October 2005
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: This study was undertaken to compare the costs and health outcomes of 2 management options when encountering a 24-week gestation in labor. STUDY DESIGN: We constructed a decision model for willingness versus unwillingness to perform cesarean section for fetal indication (aggressive vs nonaggressive management). We modeled chance nodes for stillbirth, neonatal death, and long-term survival, with and without major morbidity. Main outcome measures were intact (healthy) infant and live infant. Cost-effectiveness analysis was conducted from a societal perspective to determine the cost-effectiveness of the 2 strategies. RESULTS: The probabilities of both intact survival (16.8% vs 12.9%) and survival with major morbidity (39.2% vs 19.4%) were higher with willingness to perform cesarean section. Nonaggressive management was less costly for delivery at 24 weeks' gestation. Aggressive management strategy would cost dollar 4,680,387 more than nonaggressive management for each additional intact infant, and dollar 766,241 more per additional live infant. CONCLUSION: Although the probability of survival is increased by physician willingness to perform cesarean section, the more cost-effective strategy is unwillingness because of a strong relationship to the increased probability of survival with major morbidity when physicians are willing to perform cesarean section for fetal indications.

    Title Six Keys to Weighing Probability and Achieving Organizational Improvements.
    Date May 2004
    Journal Physician Executive
    Title Reduced Medicolegal Risk by Compliance with Obstetric Clinical Pathways: a Case--control Study.
    Date April 2003
    Journal Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: To estimate whether guideline compliance affected medicolegal risk in obstetrics and whether malpractice claims data can provide useful information on guideline noncompliance by focusing on the claims experience of a large health system delivering approximately 12000 infants annually. METHODS: We retrospectively identified 290 delivery-related (diagnosis-related groups 370-374) malpractice claims and 262 control deliveries at the health system during the period from 1988 to 1998. Clinical pathways for vaginal and cesarean delivery implemented in 1998 were used as a "standard of care." We compared rates of noncompliance with the pathways in the claims and control groups, calculated an odds ratio for increased risk of being sued given departure from the guideline standards, and calculated the elevated risk of litigation introduced by noncompliance. We also compared the frequencies of different types of departures across claims and control groups. RESULTS: Claims closely resembled controls on several descriptive measures (mother's age, location of delivery, type of delivery, and complication rates), but noncompliance with the clinical pathway was significantly more common among claims than controls (43.2% versus 11.7%, P <.001; odds ratio = 5.76, 95% confidence interval 3.59, 9.2). In 81 (79.4%) of the claims involving noncompliance with the pathway, the main allegation in the claim related directly to the departure from the pathway. The excess malpractice risk attributable to noncompliance explained approximately one third (104 of 290) of the claims filed (attributable risk = 82.6%). There were no significant differences in the types of deviation from the guidelines across claims and control groups. CONCLUSION: In addition to reducing clinical variation and improving clinical quality of care, adherence to clinical pathways might protect clinicians and institutions against malpractice litigation. Malpractice data might also be a useful resource in understanding breakdowns in processes of care.

    Title Multifetal Pregnancy Reduction: Perinatal and Fiscal Outcomes.
    Date July 2000
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: This study was undertaken to compare the birth outcomes of a multifetal pregnancy reduction population with those of other patients delivered at Hutzel Hospital, Detroit, and to determine the fiscal impact of the multifetal pregnancy reduction program. STUDY DESIGN: In a retrospective review patients who were delivered after multifetal pregnancy reduction were compared with a general obstetric population who were delivered at Hutzel Hospital from January 1, 1986, through June 30, 1998. Outcome data were determined through a comprehensive perinatal database. The chi(2) analysis was used to examine the relationship between gestational age and delivery group. Financial data were estimated from published reports of neonatal intensive care unit admissions, cost estimates for neonatal intensive care unit care, and charges for multifetal pregnancy reduction. RESULTS: Pregnancies reduced to triplets, twins, and singletons had outcomes at least comparable to unreduced pregnancies starting at these numbers and substantially better than unreduced pregnancies with the same starting number. Financial estimates of hospitalization costs averted in the multifetal pregnancy reduction population exceeded $28 million. CONCLUSION: Use of multifetal pregnancy reduction improved obstetric outcomes for pregnancies with multiple gestations and also was associated with significant fiscal savings.

    Title Fiscal Impact of a Potential Legislative Ban on Second Trimester Elective Terminations for Prenatally Diagnosed Abnormalities.
    Date May 2000
    Journal American Journal of Medical Genetics
    Excerpt

    This study was designed to determine the fiscal impact of a theoretical legislative ban on elective terminations for prenatally diagnosed abnormalities at Hutzel Hospital/Wayne State University. A fiscal comparison was completed for patients who had second trimester elective terminations for prenatally diagnosed abnormalities versus not allowing the procedure. An eight-year database of genetics cases and hospital and physician cost estimates for performing elective terminations for prenatally diagnosed abnormalities, and published reports of the average lifetime costs per selected birth defects, were used to calculate the net cost. The estimated lifetime cost for an average cohort year of a legislative ban on elective terminations for prenatally diagnosed abnormalities was found to be at least $8.5 million for patients treated at Hutzel Hospital. Extrapolated, a similar ban on second trimester elective terminations would have a net cost of $74 million in Michigan and $2 billion annually in the United States.

    Title Cost-effectiveness of Routine Blood Type and Screen Testing for Cesarean Section.
    Date October 1999
    Journal The Journal of Reproductive Medicine
    Excerpt

    OBJECTIVE: To evaluate the usefulness and cost-effectiveness of admission blood type and screen testing for cesarean section. STUDY DESIGN: A retrospective review was conducted on patients transfused with blood during an admission that required a cesarean section over a three-year period at a tertiary care hospital. RESULTS: Of 3,962 patients who underwent cesarean section, 132 (3.3%) required a blood transfusion during their hospital stay. Medical records of 125 of the 132 patients were evaluated as to urgency and risk factors. (Seven charts could not be located.) Most of the blood transfusions were related to previously identified risk factors, including previous cesarean section, chorioamnionitis, placenta previa, abnormal presentation (breech or transverse lie), multiple pregnancies, abruptio placentae and admission anemia. Three patients received an urgent blood transfusion without a previously identifiable risk factor. Thus, we found an overall urgent blood transfusion rate without admission risk factors to be 0.8 per 1,000 cesarean sections. CONCLUSION: In the absence of significant risk factors, routine admission blood type and screen testing for cesarean section does not enhance patient care and should be eliminated. In the rare event that a patient without a previously identified risk factor requires an urgent blood transfusion, O negative blood could be given in the interim pending formal determination of type and cross-match.

    Title Oral Metronidazole Vs. Metrogel Vaginal for Treating Bacterial Vaginosis. Cost-effectiveness Evaluation.
    Date June 1999
    Journal The Journal of Reproductive Medicine
    Excerpt

    OBJECTIVE: To compare the cost-effectiveness of metronidazole versus Metrogel Vaginal in the treatment of bacterial vaginosis. STUDY DESIGN: Sixty consecutive patients with a clinical diagnosis of bacterial vaginosis were randomly assigned prospectively into either the metronidazole, 500 mg (twice daily for seven days by mouth) or Metrogel Vaginal (one applicator twice daily for five days) treatment group. The study patients were aged 18-30 years, without other medical problems. The patients proceeded with outpatient therapy and returned 7-10 days after the completion of treatment for reevaluation. During the study, patients refrained from sexual relations, avoided alcohol and drugs, and avoided all medication. The physician evaluated the patients for bacterial vaginosis through standard wet preparation, whiff test and pH testing prior to and after treatment. The patients were randomized by a nurse and were blinded for study purposes to the evaluating physician. RESULTS: Successful treatment outcomes for bacterial vaginosis occurred in 27 and 28 patients for Metrogel Vaginal and metronidazole, respectively, out of the original 30 patients in each study group. All patients introduced into the study completed the study without difficulty. No significant complications were found in either treatment group. Three patients treated with metronidazole experienced nausea during the treatment interval. The entire cost of treatment was $19.71 and $1.51 for Metrogel Vaginal and metronidazole, respectively. CONCLUSION: The most cost-effective treatment for bacterial vaginosis was generic metronidazole. While the use of the more expensive Metrogel Vaginal may be reasonable for patients experiencing side effects of oral metronidazole, most patients should be treated with the less expensive generic metronidazole.

    Title Synthetic Graft Placement in the Treatment of Fascial Dehiscence with Necrosis and Infection.
    Date January 1999
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: The objective of this study was to describe the use of synthetic grafts in repairing fascial dehiscence complicated by fascial necrosis and infection after obstetric and gynecologic operations. STUDY DESIGN: A retrospective review of the operating room records at Hutzel Hospital (Detroit, Mich) was performed to find all cases of fascial dehiscence repaired during a 6-year period between January 1, 1991, and December 31, 1996. Patients with partial or complete disruption of the fascia with evidence of fascial necrosis and infection were included in this study. Demographic information; the initial surgical procedure, including type of incision; suture material; use of synthetic graft and closure technique for repair of dehiscence; postoperative complications, microbiologic results; antibiotic therapy; subsequent operations; length of hospital stay; and late complications were recorded. RESULTS: During the study period 52 patients underwent repair of fascial dehiscence; 36 of these had concurrent fascial necrosis and infection, including 4 women with necrotizing fasciitis. Eighteen patients were from the obstetric service and 18 were from the benign or cancer gynecology service. Ninety-one bacterial isolates were recovered from the infected wounds. Extensive fascial resection precluded closure without tension in 18 cases and necessitated synthetic graft placement to prevent evisceration. Graft materials included polypropylene (11 cases) and polyglactin (7 cases). Late complications of graft placement included extrusion of the graft in 3 patients and incisional hernia in 1. CONCLUSIONS: Extensive fascial d├ębridement with resection prevents primary closure of wound dehiscence. Synthetic grafts permit primary closure of large fascial defects and can be used with extensive d├ębridement in the presence of infection.

    Title The Cost-effectiveness of Routine Type and Screen Admission Testing for Expected Vaginal Delivery.
    Date November 1998
    Journal Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: To evaluate the cost effectiveness of routine admission type and screen testing for expected vaginal delivery. METHODS: A retrospective review was conducted in patients transfused with blood during an admission that anticipated a vaginal delivery over a 3-year period, at Hutzel Hospital, in Detroit, Michigan. RESULTS: Of 16,291 patients admitted for an expectant vaginal delivery, 76 (.47%) (95% confidence interval [CI] .37%, .58%) required blood transfusion during the time of their admission. Medical records of these 76 patients were evaluated as to urgency and risk factors. Most of the blood transfusions were related to previously identified risk factors, including previous postpartum hemorrhage, multiple pregnancies, previous cesarean delivery, abruptio placentae, and admission anemia. Four patients received an urgent blood transfusion without a previously identifiable risk factor. We found an overall urgent blood transfusion rate without admission risk factors to be 2.5 per 10,000 vaginal deliveries (95% CI .9 per 10,000, 6.3 per 10,000) CONCLUSION: Routine admission type and screen testing for an expected normal vaginal delivery does not seem to enhance patient care and should be eliminated for patients without substantial risk factors. In the rare event that a patient without a previously identified risk factor required an urgent blood transfusion, O negative blood could be given in the interim pending formal type and cross match.

    Title An Information System Model for Negotiating Capitation Contracts.
    Date July 1998
    Journal Physician Executive
    Excerpt

    Capitation contracts require health care organizations to negotiate on a much more sophisticated and risky level. Understanding whether a capitation contract will allow a hospital to remain financially viable while providing quality care requires estimating the number of patients to be served, the amount and types of services to be offered, and the cost to provide them. This article presents an information system model designed to assist a large hospital, not only in determining true patient cost, but also in aggregating the cost information in different ways, such as conducting a case-mix analysis, to perform a more informed quote analysis for capitated contracts.

    Title Medically Sound, Cost-effective Treatment for Pelvic Inflammatory Disease and Tuboovarian Abscess.
    Date July 1998
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: Our purpose was to determine the clinical effectiveness and cost-effectiveness of three antibiotic regimens for the treatment of pelvic inflammatory disease and tuboovarian abscess. STUDY DESIGN: A review of all patients' hospitalized at Hutzel Hospital, Detroit, Michigan, for treatment of pelvic inflammatory disease and tuboovarian abscess between Jan. 1, 1993, and April 30, 1997, was performed. Demographic data, antibiotic choices, changes in therapy, operative interventions, and cost of therapy were assessed. RESULTS: Two hundred three patients were admitted for treatment of pelvic inflammatory disease during the study period. We were able to evaluate the clinical efficacy of antibiotic treatment in 179 patients, including 105 patients with pelvic inflammatory disease alone (uncomplicated pelvic inflammatory disease) and 74 women whose infection was complicated by tuboovarian abscess. The three antibiotic regimens evaluated were cefotetan plus doxycycline, clindamycin plus gentamicin, and ampicillin plus clindamycin plus gentamicin. All regimens demonstrated comparable efficacy in treating uncomplicated genital tract infections. Ampicillin plus clindamycin plus gentamicin was significantly better than clindamycin plus gentamicin and cefotetan plus doxycycline in treatment of tuboovarian abscess (p = 0.001). Fifteen women with tuboovarian abscess responded to a change to ampicillin plus gentamicin plus clindamycin antibiotic therapy alone. The hospital stay was prolonged by approximately 3 days in women failing to respond to initial antibiotic therapy, and operative interventions were common in this group of patients. CONCLUSIONS: Cefotetan plus oral doxycycline is the most cost-effective regimen for treating uncomplicated pelvic inflammatory disease, whereas triple-antibiotic therapy is the treatment of choice in women with tuboovarian abscess.

    Title The Development and Implementation of Normal Vaginal Delivery Clinical Pathways in a Large Multihospital Health System.
    Date July 1998
    Journal The American Journal of Managed Care
    Excerpt

    The entire country has become more concerned with healthcare costs due to managed care, capitation risk-based contracts, and the near elimination of the cost-plus reimbursement system. Clinical pathways have become one way to reduce unnecessary resource consumption by reducing provider variance, improving clinical outcomes, and reducing cost. We present here our rationale and process for developing a common clinical pathway for normal vaginal delivery in a large and varied multihospital system. We also discuss how this new pathway is expected to improve quality of care and reduce costs.

    Title A Cost-effectiveness Evaluation of Laparoscopic Disposable Versus Nondisposable Infraumbilical Cannulas.
    Date April 1997
    Journal The Journal of the American Association of Gynecologic Laparoscopists
    Excerpt

    STUDY OBJECTIVE: To compare the safety and cost-effectiveness of disposable and nondisposable infraumbilical laparoscopic cannulas. DESIGN: Retrospective review of consecutive laparoscopic procedures performed from July 1, 1988, to June 30, 1994. SETTING: A university-affiliated hospital. Patients. The 10,459 consecutive women who underwent laparoscopies. INTERVENTIONS: A 10-mm disposable cannula was used in 529 laparoscopies and a nondisposable cannula in 9930, based on physician preference. MEASUREMENTS AND MAIN RESULTS: The only intraabdominal injuries associated with insertion of disposable and nondisposable cannulas were bowel injuries in one and three patients, respectively. The injury rates for the instruments were 19 and 3/10,000 cases, respectively, but were not statistically different (P <0.05, Fisher's two-tail exact test). The hospital cost per disposable cannula in 1994 was $63.71; the cost per procedure with the nondisposable cannula was amortized and was less than $1.35, including maintenance. CONCLUSION: Disposable cannulas were not cost effective and were associated with a higher but not statistically significant complication rate. Therefore, the more expensive disposable cannulas are not recommended.

    Title A Cost Analysis of Endometrial Ablation, Abdominal Hysterectomy, Vaginal Hysterectomy, and Laparoscopic-assisted Vaginal Hysterectomy in the Treatment of Primary Menorrhagia.
    Date April 1997
    Journal The Journal of the American Association of Gynecologic Laparoscopists
    Excerpt

    STUDY OBJECTIVE: To assess the cost of four procedures performed to treat primary menorrhagia. DESIGN: Retrospective analysis. Setting. A 394-bed womens' teaching hospital. PATIENTS: Eighty healthy women undergoing one of the four procedures. Interventions. The study patients were equally divided among vaginal hysterectomy (VH), total abdominal hysterectomy (TAH), laparoscopic-assisted vaginal hysterectomy (LAVH), and endometrial ablation (EA). MEASUREMENTS AND MAIN RESULTS: Endometrial ablation was associated with significantly reduced hospital costs and a shorter recovery period than the other modalities. Hospital costs were less for VH and return to work was quicker after LAVH and VH. This study did not evaluate long-term failures or complications unless they occurred within the first 2 months after the procedure. CONCLUSION: Among women who could be treated by any of these techniques, VH was significantly more cost effective for the permanent management of primary menorrhagia than LAVH and TAH. The cost efficiency of EA was clearly implied, but further studies must be completed to evaluate the long-term costs associated with treatment failures. Although physicians should not choose a procedure based exclusively on cost, the expense of a less efficient or more costly procedure may affect a hospital's competitiveness in this era of managed care.

    Title A Cost-effectiveness Evaluation of Preoperative Type-and-screen Testing for Vaginal Hysterectomy.
    Date January 1997
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: Our purpose was to evaluate the usefulness and cost-effectiveness of routine preoperative type-and-screen testing before vaginal hysterectomy. STUDY DESIGN: A retrospective review of all vaginal hysterectomies performed at Hutzel Hospital between 1988 and 1994 with an emphasis on those that required blood transfusion was done. All vaginal hysterectomies completed at Hutzel Hospital were included in this 6-year time period for all noncancerous indications, including fibroid uterus, endometriosis, menorrhagia, uterine prolapse, pelvic pain, cervical dysplasia, and adenomyosis. RESULTS: Among 1063 patients who underwent vaginal hysterectomy, 26 needed a blood transfusion at the time of hospitalization. Medical records of the patients who needed blood transfusions were reviewed to determine the urgency and indication. Ten of the transfusions were given preoperatively because of anemia, 7 were given intraoperatively, and 9 were given postoperatively. The seven intraoperative transfusions were given because of the physician's perception of excessive blood loss; however, none of the patients received an emergency transfusion with extreme urgency. That is, the need for the intraoperative transfusion was not immediate. All patients who received a transfusion could have waited for 20 to 30 minutes for proper type and crossmatching and subsequent transfusion. CONCLUSION: In the absence of preoperative indications, routine preoperative type-and-screen testing of blood before vaginal hysterectomy is not cost-effective, does not enhance patient care, and should be eliminated.

    Title The Effect of Capitated and Fee-for-service Remuneration on Physician Decision Making in Gynecology.
    Date August 1996
    Journal Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: To evaluate the variations in physician behavior leading to performance of gynecologic surgical procedures related to fee-for-service and capitation reimbursement systems. METHODS: This study compared the physician practice utilization of surgical services for fee-for-service and capitated contract reimbursement systems within a gynecology clinic. Attending gynecologists were reimbursed on a fee-for-service basis for all surgical services performed during a 6-month interval; subsequently, the same physicians were reimbursed on a capitated basis for 6 months and received a fixed payment for the clinical and surgical services provided. RESULTS: Three thousand seven hundred eighty consecutive outpatient gynecology visits were evaluated at the university gynecology clinic during 1994. We found a 15% overall decrease in the number of surgical procedures that were performed during the capitated reimbursement period compared with the fee-for-service time interval. The procedure most responsible for the reduction of surgical services was elective sterilization by laparoscopy, which underwent a statistically significant decrease (P < .01). CONCLUSION: The remuneration system in our review seemed to affect physician decision making for only the most elective procedures, whereas physicians maintained similar practice patterns for more severe conditions. Fee-for-service seems to encourage, whereas capitation seems to discourage, gynecologist from performing elective procedures.

    Title The Economic Cost of the Medical-legal Tort System.
    Date August 1996
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: Our goal was to evaluate the financial expenditures of the medical-legal tort system on the single largest medical campus in the United States. STUDY DESIGN: The true financial expenditures directed to the medical-legal system were determined and related to the total revenue and expenses of the Detroit Medical Center. All costs were determined, including malpractice premiums, paid claims information, accrual expense information, and risk management administrative expenses for the fiscal years 1992, 1993, and 1994. RESULTS: The total medical-legal expenses for the years 1992, 1993, and 1994 were $73,732,000, $70,490,000, and $79,043,000, respectively. The claims paid to plaintiffs were 35.9%, 28.1%, and 28.1% for the same years. CONCLUSION: The medical-legal system process in the United States is very long and fraught with many inequities and inefficiencies. It was found that approximately 12% of the medical-legal expenditures of the Detroit Medical Center go to the individual alleged victim after defense and plaintiff attorney fees and costs and administrative costs. The failure of the American health care system could be in jeopardy if the nation's leaders do not reform the process to provide a more cost-effective system.

    Title Cost-effectiveness of Routine Blood Type and Screen Testing Before Elective Laparoscopy.
    Date September 1995
    Journal Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: To evaluate the usefulness and cost-effectiveness of the routine preoperative evaluation of blood type and screen testing before laparoscopy. METHODS: A retrospective review was conducted in patients transfused with blood during or after laparoscopy over a 3-year period at Hutzel Hospital, Detroit, Michigan; Grace Hospital, Southfield, Michigan; and Bixby Medical Center, Adrian, Michigan. RESULTS: Of 7529 women receiving laparoscopic procedures, 57 required blood transfusion at laparoscopy. Medical records of the 57 patients requiring blood transfusion were evaluated as to urgency and indication. All 57 subsequent blood transfusions were found to be the result of previously identifiable problems, including ectopic pregnancy and preoperative anemia. No patient required transfusion for a vascular injury. CONCLUSION: In the absence of preoperative indications, routine preoperative type and screen testing for elective and emergency laparoscopic procedures does not enhance patient care and should be eliminated.

    Title Evaluation of a Grief Group for Women in Residential Substance Abuse Treatment.
    Date
    Journal Substance Abuse : Official Publication of the Association for Medical Education and Research in Substance Abuse
    Excerpt

    Most women in substance abuse treatment have experienced significant losses. This preliminary study examined the effectiveness of a therapy group addressing grief and loss among women enrolled in a gender-specific residential substance abuse treatment program. The intervention group consisted of 24 grief group participants and the comparison group consisted of 31 nonparticipants. Qualitative analysis revealed a pattern: participants identified traumatic loss, moved to emotional loss and abandonment by their own mothers, then focused on their own children. Data obtained at induction and at exit or follow-up were used for quantitative analysis. Length of stay, self-esteem, depression, mood, and parenting attitudes were assessed using standardized instruments. Women who participated in the grief group remained in treatment longer. While both groups were depressed and had low self-esteem at induction, the self-esteem of nonparticipants was significantly lower than that of participants. Both groups improved over time on mood, depression, and parenting. At exit or follow-up, participants had higher self-esteem. Based on these findings, we hypothesized that higher self-esteem at induction made it possible for women to participate in and benefit from the grief group, thus contributing to length of stay. To test this hypothesis we conducted regression analyses which found that, individually, group status (participation) and self-esteem explained 11% of the variance in length of stay. However, since the number of women with available data varied for group status and self-esteem, group status was a significant predictor of length of stay and self-esteem showed only a trend toward significance. These findings support our hypothesis. The women's pattern of disclosure and the hypotheses drawn from the results of this preliminary analysis will be examined further in an evaluation of a series of groups focused on loss and grief.

    Title Pelvic Floor Consequences of Cesarean Delivery on Maternal Request in Women with a Single Birth: a Cost-effectiveness Analysis.
    Date
    Journal Journal of Women's Health (2002)
    Excerpt

    The potential benefit in preventing pelvic floor disorders (PFDs) is a frequently cited reason for requesting or performing cesarean delivery on maternal request (CDMR). However, for primigravid women without medical/obstetric indications, the lifetime cost-effectiveness of CDMR remains unknown, particularly with regard to lifelong pelvic floor consequences. Our objective was to assess the cost-effectiveness of CDMR in comparison to trial of labor (TOL) for primigravid women without medical/obstetric indications with a single childbirth over their lifetime, while explicitly accounting for the management of PFD throughout the lifetime.

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