Frank A. Sloan

Bio: Frank A. Sloan is an academic researcher from Duke University. The author has contributed to research in topics: Health care & Medicaid. The author has an hindex of 72, co-authored 443 publications receiving 18010 citations. Previous affiliations of Frank A. Sloan include National Bureau of Economic Research & University of North Carolina at Chapel Hill.

Benefits of smoking cessation for longevity.

Abstract: Objectives. This study determined the life extension obtained from stopping smoking at various ages. Methods. We estimated the relation between smoking and mortality among 877 243 respondents to the Cancer Prevention Study II. These estimates were applied to the 1990 US census population to examine the longevity benefits of smoking cessation. Results. Life expectancy among smokers who quit at age 35 exceeded that of continuing smokers by 6.9 to 8.5 years for men and 6.1 to 7.7 years for women. Smokers who quit at younger ages realized greater life extensions. However, even those who quit much later in life gained some benefits: among smokers who quit at age 65 years, men gained 1.4 to 2.0 years of life, and women gained 2.7 to 3.7 years. Conclusions. Stopping smoking as early as possible is important, but cessation at any age provides meaningful life extensions. (Am J Public Health. 2002;92:990–996)

Factors That Prompted Families to File Medical Malpractice Claims Following Perinatal Injuries

Abstract: Objective. —To identify self-reported reasons that prompt families to file malpractice claims following perinatal injuries. Design. —Families were interviewed by telephone using a questionnaire that contained structured and open-ended questions. Participants. —Mothers of infants who had experienced permanent injuries or deaths and had closed malpractice claims in Florida between 1986 and August 1989 were interviewed. Questionnaires were completed by 127 (35%) of a total of 368 such families. Outcome Measures. —Reasons prompting families to file and families' descriptions of medical events, advice from acquaintances, and the quality of physician-family communication. Results. —Families volunteered numerous reasons for filing: advised by knowledgeable acquaintances (33% of respondents), recognized cover-up (24%), needed money (24%), recognized that their child would have no future (23%), needed information (20%), and decided to seek revenge or protect others from harm (19%). Over one third of all families indicated that they were told by medical personnel prior to filing that the care provided had caused their children's injuries. Families expressed dissatisfaction with physician-patient communication. Families believed that physicians would not listen (13% of sample), would not talk openly (32%), attempted to mislead them (48%), or did not warn about long-term neurodevelopmental problems (70%). Conclusion. —Families give many reasons for filing a claim. Obtaining money may not be the only goal for some families who file suit. (JAMA. 1992;267:1359-1363)

Obstetricians' prior malpractice experience and patients' satisfaction with care.

Abstract: Objective. —To examine the relationship between prior physician malpractice experience and patients' satisfaction with care. Design. —Women were interviewed using a questionnaire that contained structured and open-ended questions. Participants. —Mothers of all stillborn infants, infant deaths, and a random sampling of viable infants drawn from 1987 Florida Vital Statistics were sorted into four groups based on the malpractice claims experience of their obstetricians between 1983 and 1986. Interviews were completed with 963 of 1536 women, most by telephone, 53 by in-person interview. Main Outcome Measures. —Mothers' responses to closed-ended and open-ended questions about their perceptions of the care they received during their pregnancy, labor, and delivery. Results. —Even though none of the women actually filed a claim, a consistent pattern of differences emerged when comparing women's perceptions of care received. Patients seeing physicians with the most frequent numbers of claims but without high payments were significantly more likely to complain that they felt rushed, never received explanations for tests, and were ignored. In response to the open-ended question, "What part of your care were you least satisfied with?" women seeing physicians in the High Frequency malpractice risk group offered twice as many complaints as those seeing physicians who had never been sued. Problems with physician-patient communication were the most commonly offered complaints. Conclusion. —Physicians who have been sued frequently are more often the objects of complaints about the interpersonal care they provide even by their patients who do not sue. (JAMA. 1994;272:1583-1587)

Chapter 21 Not-for-profit ownership and hospital behavior

Abstract: The for-profit hospital is in the minority numerically in all developed countries Although the for-profits' market share has been quite stable for decades, for-profit chains have grown in share and influence in the United States By contrast, for-profit chains have made few inroads in other countries The literature on hospital ownership addresses three fundamental questions First, why do private not-for-profit organizations dominate the hospital industry? Second, how do private not-for-profits differ from for-profits in their behavior? Third, is the private not-for-profit form more efficient in this industry? The main difference between for-profit and private not-for-profit organizations is in the distribution of accounting profit The latter do not distribute profits to equity holders and enjoy some competitive advantages, including tax exemptions and the ability to receive private donations Various reasons for why the not-for-profit form is dominant are explored Reasons involve: transactions costs of various ownership forms; fiduciary relationships between patients and providers; public goods; implicit and explicit subsidies; inertia; cartelization; and lack of profit opportunities The review concludes that there is merit in an number of explanations, but no single explanation works perfectly Certainly the transactions cost of various ownership forms must provide a partial explanation for observed patterns of hospital ownership There is a rich empirical literature on hospital behavior This chapter discusses comparative evidence by hospital ownership form on hospital cost, profitability, pricing and cost-shifting, uncompensated care, diffusion of technology, quality of care, and hospital capital funds and investment In recent years, changes in hospital ownership have been common in the United States Changes have occurred in all directions — from private not-for-profit to for-profit and the reverse, for example Comparing hospital behavior before and after the conversion, the fact that a hospital converted seems to be more important than the type of ownership change that occurred As competition among hospitals increases, differences in behavior among hospitals with different ownership forms should narrow Privately owned hospitals in the US were more alike than different Private not-for-profit hospitals will have less latitude than previously to produce outputs they deem to be socially worthy The chapter ends with the author's agenda for future research

How much are patients willing to pay to avoid postoperative nausea and vomiting

Abstract: Postoperative nausea and vomiting (PONV) are unpleasant experiences. However, there is no drug that is completely effective in preventing PONV. Whereas cost effectiveness analyses rely on specific health outcomes (e.g., years of life saved), cost-benefit analyses assess the cost and benefit of medic

Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction

Abstract: ContextThe worsening hospital nurse shortage and recent California legislation mandating minimum hospital patient-to-nurse ratios demand an understanding of how nurse staffing levels affect patient outcomes and nurse retention in hospital practice.ObjectiveTo determine the association between the patient-to-nurse ratio and patient mortality, failure-to-rescue (deaths following complications) among surgical patients, and factors related to nurse retention.Design, Setting, and ParticipantsCross-sectional analyses of linked data from 10 184 staff nurses surveyed, 232 342 general, orthopedic, and vascular surgery patients discharged from the hospital between April 1, 1998, and November 30, 1999, and administrative data from 168 nonfederal adult general hospitals in Pennsylvania.Main Outcome MeasuresRisk-adjusted patient mortality and failure-to-rescue within 30 days of admission, and nurse-reported job dissatisfaction and job-related burnout.ResultsAfter adjusting for patient and hospital characteristics (size, teaching status, and technology), each additional patient per nurse was associated with a 7% (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.03-1.12) increase in the likelihood of dying within 30 days of admission and a 7% (OR, 1.07; 95% CI, 1.02-1.11) increase in the odds of failure-to-rescue. After adjusting for nurse and hospital characteristics, each additional patient per nurse was associated with a 23% (OR, 1.23; 95% CI, 1.13-1.34) increase in the odds of burnout and a 15% (OR, 1.15; 95% CI, 1.07-1.25) increase in the odds of job dissatisfaction.ConclusionsIn hospitals with high patient-to-nurse ratios, surgical patients experience higher risk-adjusted 30-day mortality and failure-to-rescue rates, and nurses are more likely to experience burnout and job dissatisfaction.

Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association

Abstract: The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines.

Hospital Volume and Surgical Mortality in the United States

Abstract: Background Although numerous studies suggest that there is an inverse relation between hospital volume of surgical procedures and surgical mortality, the relative importance of hospital volume in various surgical procedures is disputed. Methods Using information from the national Medicare claims data base and the Nationwide Inpatient Sample, we examined the mortality associated with six different types of cardiovascular procedures and eight types of major cancer resections between 1994 and 1999 (total number of procedures, 2.5 million). Regression techniques were used to describe relations between hospital volume (total number of procedures performed per year) and mortality (in-hospital or within 30 days), with adjustment for characteristics of the patients. Results Mortality decreased as volume increased for all 14 types of procedures, but the relative importance of volume varied markedly according to the type of procedure. Absolute differences in adjusted mortality rates between very-low-volume hospitals and very-high-volume hospitals ranged from over 12 percent (for pancreatic resection, 16.3 percent vs. 3.8 percent) to only 0.2 percent (for carotid endarterectomy, 1.7 percent vs. 1.5 percent). The absolute differences in adjusted mortality rates between very-low-volume hospitals and very-high-volume hospitals were greater than 5 percent for esophagectomy and pneumonectomy, 2 to 5 percent for gastrectomy, cystectomy, repair of a nonruptured abdominal aneurysm, and replacement of an aortic or mitral valve, and less than 2 percent for coronary-artery bypass grafting, lower-extremity bypass, colectomy, lobectomy, and nephrectomy. Conclusions In the absence of other information about the quality of surgery at the hospitals near them, Medicare patients undergoing selected cardiovascular or cancer procedures can significantly reduce their risk of operative death by selecting a high-volume hospital.

Estimation and Inference in Econometrics

Abstract: Offering a unifying theoretical perspective not readily available in any other text, this innovative guide to econometrics uses simple geometrical arguments to develop students' intuitive understanding of basic and advanced topics, emphasizing throughout the practical applications of modern theory and nonlinear techniques of estimation. One theme of the text is the use of artificial regressions for estimation, reference, and specification testing of nonlinear models, including diagnostic tests for parameter constancy, serial correlation, heteroscedasticity, and other types of mis-specification. Explaining how estimates can be obtained and tests can be carried out, the authors go beyond a mere algebraic description to one that can be easily translated into the commands of a standard econometric software package. Covering an unprecedented range of problems with a consistent emphasis on those that arise in applied work, this accessible and coherent guide to the most vital topics in econometrics today is indispensable for advanced students of econometrics and students of statistics interested in regression and related topics. It will also suit practising econometricians who want to update their skills. Flexibly designed to accommodate a variety of course levels, it offers both complete coverage of the basic material and separate chapters on areas of specialized interest.

Evolution and Rationality Some Recent Game-Theoretic Results. Identification and Estimation of Local Average Treatment Effects

Abstract: We investigate conditions sufficient for identification of average treatment effects using instrumental variables. First we show that the existence of valid instruments is not sufficient to identify any meaningful average treatment effect. We then establish that the combination of an instrument and a condition on the relation between the instrument and the participation status is sufficient for identification of a local average treatment effect for those who can be induced to change their participation status by changing the value of the instrument. Finally we derive the probability limit of the standard IV estimator under these conditions. It is seen to be a weighted average of local average treatment effects.