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Marcia A. Ciol

Bio: Marcia A. Ciol is an academic researcher from University of Washington. The author has contributed to research in topics: Randomized controlled trial & Health care. The author has an hindex of 43, co-authored 168 publications receiving 18187 citations. Previous affiliations of Marcia A. Ciol include Boston Children's Hospital & Veterans Health Administration.


Papers
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Journal ArticleDOI
TL;DR: It is concluded that the adapted comorbidity index will be useful in studies of disease outcome and resource use employing administrative databases.

9,805 citations

Journal ArticleDOI
01 Jan 1995-Spine
TL;DR: A lack of consensus among physicians about treatment efficacy for patients with low back pain could be attributable to the absence of clear evidencebsed clinical guidelines, ignorance or rejection of existing scientific evidence, excessive commitment to a particular mode of therapy, or a tendency to discount the efficacy of competing treatments.
Abstract: Study Design.Physicians were surveyed regarding their beliefs about treatment efficacy for patients with low back pain.Objective.To document physician beliefs about the efficacy of specific treatmets and the extent to which these beliefs correspond to current knowledge.Summary of Background Data.Lit

545 citations

Journal ArticleDOI
TL;DR: Complications, length of hospitalization, and charges were higher for patients who had had a spinal arthrodesis than for those who had not, and operations for conditions other than a herniated disc were associated with more complications and greater use of resources than were operations for removal of a hernia.
Abstract: We examined the rates of postoperative complications and mortality, as recorded in a hospital discharge registry for the State of Washington for the years 1986 through 1988, for patients who had had an operation on the lumbar spine. When patients who had had a malignant lesion, infection, or fracture are excluded, there were 18,122 hospitalizations for procedures on the lumbar spine, 84 per cent of which involved a herniated disc or spinal stenosis. The rates of morbidity and mortality during hospitalization, as well as the hospital charges, increased with the ages of the patients. The rate of complications was 18 per cent for patients who were seventy-five years or older. Nearly 7 per cent of patients who were seventy-five years old or more were discharged to nursing homes. Complications were most frequent among patients who had spinal stenosis, but multivariate analysis suggested that the complications associated with procedures for this condition were primarily related to the patient's age and the type of procedure. Complications, length of hospitalization, and charges were higher for patients who had had a spinal arthrodesis than for those who had not. Over-all, operations for conditions other than a herniated disc were associated with more complications and greater use of resources, particularly when arthrodesis was performed, than were operations for removal of a herniated disc. No data on symptoms or functional results were available.

517 citations

Journal ArticleDOI
19 Aug 1992-JAMA
TL;DR: Clinical outcomes did not differ by diagnosis or fusion technique, but were worse in studies with a greater number of previously operated patients, and complications of fusions are common.
Abstract: Objectives. —To determine success and complication rates for lumbar spinal fusion surgery, predictors of good outcomes, and whether fusion improves success rates of laminectomy for specific low back disorders. Data Sources. —English-language journal articles published from 1966 through April 1991, identified through MEDLINE searching ( spinalfusion plus limiting terms), bibliography review, and expert consultation. Study Selection. —Articles were selected only if they reported at least 1 year of follow-up data enabling the classification of clinical outcomes as satisfactory or unsatisfactory for at least 30 patients. Data Extraction. —Two reviewers independently extracted data on patient characteristics, surgical methods, patient outcomes, and quality of study methods. Data Synthesis. —Of 47 articles, there were no randomized trials. Four nonrandomized studies compared surgery with and without fusion for herniated disks; three found no advantage for fusion. On average, 68% of patients had a satisfactory outcome after fusion, but the range was wide (16% to 95%), and the satisfactory outcome rate was lower in prospective than in retrospective studies. The most frequently reported complications were pseudarthrosis (14%) and chronic pain at the bone graft donor site (9%). Clinical outcomes did not differ by diagnosis or fusion technique, but were worse in studies with a greater number of previously operated patients. Conclusions. —For several low back disorders no advantage has been demonstrated for fusion over surgery without fusion, and complications of fusions are common. Randomized controlled trials are needed to compare fusion, surgery without fusion, and nonsurgical treatments in rigorously defined patient groups. ( JAMA . 1992;268:907-911)

491 citations

Journal ArticleDOI
TL;DR: To study temporal trends and geographic variations in the use of surgery for spinal stenosis, estimate short‐term morbidity and mortality of the procedure, and examine the likelihood of repeat back surgery after surgical repair.
Abstract: OBJECTIVE: To study temporal trends and geographic variations in the use of surgery for spinal stenosis, estimate short-term morbidity and mortality of the procedure, and examine the likelihood of repeat back surgery after surgical repair. DESIGN: Cohort study based on Medicare claims. SETTING: Hospital care. SUBJECTS: All Medicare beneficiaries 65 years of age or older who received a lumbar spine operation for spinal stenosis in 1985 or 1989 were followed through 1991 (10,260 patients from the 1985 cohort and 18,655 from the 1989 cohort). MAIN OUTCOME MEASURES: Two outcomes were measured: (1) rates of operation for spinal stenosis by state and (2) on an individual level, operative complications (cardiopulmonary, vascular, or infectious), postoperative mortality, and time between first operation and any subsequent reoperation. RESULTS: Rates of surgery for spinal stenosis increased eightfold from 1979 to 1992 for patients aged 65 and older and varied almost fivefold among US states. Mortality and operative complications increased with age and comorbidity. Complications were more likely for men and for individuals receiving spinal fusions. The 1989 cohort experienced a slightly higher probability of reoperation than the 1985 cohort for the first 3 years of follow-up. CONCLUSIONS: A rapid increase in surgery rates for spinal stenosis was identified over a 14-year period. The wide geographic variations and substantial complication rate from this elective surgical procedure (partly related to patient age) suggest a need for more information on the relative efficacy of surgical and nonsurgical treatments for this condition. The risks and benefits of particular surgical procedures for specific clinical and demographic subgroups as well as individual patient preferences regarding surgical risks and possible outcomes should also be evaluated further. These issues are likely to become increasingly important with the aging of the US population. J Am Geriatr Soc 44:285–290, 1996.

451 citations


Cited by
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Journal ArticleDOI
TL;DR: It is concluded that the adapted comorbidity index will be useful in studies of disease outcome and resource use employing administrative databases.

9,805 citations

01 Jan 2014
TL;DR: These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care.
Abstract: XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

9,618 citations

Journal ArticleDOI
TL;DR: The present method addresses some of the limitations of previous measures and produces an expanded set of comorbidities that easily is applied without further refinement to administrative data for a wide range of diseases.
Abstract: Objectives.This study attempts to develop a comprehensive set of comorbidity measures for use with large administrative inpatient datasets.Methods.The study involved clinical and empirical review of comorbidity measures, development of a framework that attempts to segregate comorbidities from other

8,138 citations

Journal ArticleDOI
TL;DR: A multistep process to develop ICD-10 coding algorithms to define Charlson and Elixhauser comorbidities in administrative data and assess the performance of the resulting algorithms found these newly developed algorithms produce similar estimates ofComorbidity prevalence in administrativeData, and may outperform existing I CD-9-CM coding algorithms.
Abstract: Objectives:Implementation of the International Statistical Classification of Disease and Related Health Problems, 10th Revision (ICD-10) coding system presents challenges for using administrative data. Recognizing this, we conducted a multistep process to develop ICD-10 coding algorithms to define C

8,020 citations

Journal ArticleDOI
TL;DR: Severe sepsis is a common, expensive, and frequently fatal condition, with as many deaths annually as those from acute myocardial infarction, and is especially common in the elderly and is likely to increase substantially as the U.S. population ages.
Abstract: ObjectiveTo determine the incidence, cost, and outcome of severe sepsis in the United States.DesignObservational cohort study.SettingAll nonfederal hospitals (n = 847) in seven U.S. states.PatientsAll patients (n = 192,980) meeting criteria for severe sepsis based on the International Classification

7,888 citations