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Peter R. Carroll - One of the best experts on this subject based on the ideXlab platform.
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Urologist density and county level urologic cancer mortality
Journal of Clinical Oncology, 2010Co-Authors: Anobel Y. Odisho, Vincent Fradet, Matthew R. Cooperberg, Ardalan E. Ahmad, Peter R. CarrollAbstract:Purpose The surgical work force distribution at the county level varies widely across the United States, and the impact of differential access on cancer outcomes is unclear. We used Urologists as a test case because they are the first care providers for urologic cancers, can easily be identified from available data sources, and are unevenly distributed throughout the country. The goal of this study was to determine the effect of increasing Urologist density on local prostate, bladder, and kidney cancer mortality. Patients and Methods Using county-level data from the Area Resource File, US Census, National Cancer Institute, and Centers for Disease Control, regression models were built for prostate, bladder, and kidney cancer mortality, controlling for categorized Urologist density, county demographics, socioeconomic factors, and preexisting health care infrastructure. Results For each of the three cancers, there was a statistically significant cancer-specific mortality reduction associated with counties th...
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Urologist Density and County-Level Urologic Cancer Mortality
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2010Co-Authors: Anobel Y. Odisho, Vincent Fradet, Matthew R. Cooperberg, Ardalan E. Ahmad, Peter R. CarrollAbstract:The surgical work force distribution at the county level varies widely across the United States, and the impact of differential access on cancer outcomes is unclear. We used Urologists as a test case because they are the first care providers for urologic cancers, can easily be identified from available data sources, and are unevenly distributed throughout the country. The goal of this study was to determine the effect of increasing Urologist density on local prostate, bladder, and kidney cancer mortality. Using county-level data from the Area Resource File, US Census, National Cancer Institute, and Centers for Disease Control, regression models were built for prostate, bladder, and kidney cancer mortality, controlling for categorized Urologist density, county demographics, socioeconomic factors, and preexisting health care infrastructure. For each of the three cancers, there was a statistically significant cancer-specific mortality reduction associated with counties that had more than zero Urologists (16% to 22% reduction for prostate cancer, 17% to 20% reduction for bladder cancer, and 8% to 14% reduction for kidney cancer with increasing Urologist density) relative to zero Urologists. However, increasing density greater than two Urologists per 100,000 people had no statistically significant impact on mortality for any of the tumors studied. The presence of a Urologist is associated with lower mortality for urologic cancers in that county, but increasing Urologist density does not yield further improvements. Therefore, a nuanced and geographically aware policy toward the size and distribution of the future work force is most likely to provide the greatest population-level improvement in cancer mortality outcomes.
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Geographic distribution of Urologists throughout the United States using a county level approach.
The Journal of urology, 2008Co-Authors: Anobel Y. Odisho, Vincent Fradet, Matthew R. Cooperberg, Ardalan E. Ahmad, Peter R. CarrollAbstract:The adequacy of the Urologist work force in absolute numbers and relative distribution is unclear. To develop effective policies addressing the needs of an aging population we must better understand the Urologist work force. We assessed the geographic distribution of Urologists throughout the United States at the county level and determined the county characteristics associated with increased Urologist density. County level data from the Department of Health and Human Services Area Resource File and the United States Census were analyzed in this ecological study. Logistic regression and ordinal logistic regression models were built to identify predictors of Urologist density, defined as the number of Urologists per 100,000 individuals. National patterns of Urologist density were mapped graphically at the county level. Overall 63% of the counties in the United States lack a Urologist. Based on multivariate models Urologists were less likely to be found in nonmetropolitan counties (OR 0.57, 95% CI 0.46-0.72) and rural counties (OR 0.03, 95% CI 0.02-0.06) than in metropolitan counties, which confirmed visually mapped models. Patterns of Urologist density also appeared to be influenced by climate and county education levels rather than by traditional socioeconomic measures. Urologists younger than 45 years old were 3 times less likely to be located in nonmetropolitan and rural counties than their older counterparts. The uneven distribution of Urologists throughout the United States is likely to worsen as younger physicians continue to cluster in urban areas. Governing bodies must consider this distribution in their calls for increasing the number of training positions.
Anobel Y. Odisho - One of the best experts on this subject based on the ideXlab platform.
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geographic analysis of Urologist density and prostate cancer mortality in the united states
PLOS ONE, 2015Co-Authors: Nengliang Yao, Anobel Y. Odisho, Steven M Foltz, David C WheelerAbstract:Author(s): Yao, Nengliang; Foltz, Steven M; Odisho, Anobel Y; Wheeler, David C | Abstract: ContextFinancial and demographic pressures in US require an understanding of the most efficient distribution of physicians to maximize population-level health benefits. Prior work has assumed a constant negative relationship between physician supply and mortality outcomes throughout the US and has not addressed regional variation.MethodsIn this ecological analysis, geographically weighted regression was used to identify spatially varying relationships between local Urologist density and prostate cancer mortality at the county level. Data from 1,492 counties in 30 eastern and southern states from 2006-2010 were analyzed.FindingsThe ordinary least squares (OLS) regression found that, on average, increasing Urologist density by 1 Urologist per 100,000 people resulted in an expected decrease in prostate cancer mortality of -0.499 deaths per 100,000 men (95% CI -0.709 to -0.289, p-value l 0.001), or a 1.5% decrease. Geographic weighted regression demonstrated that the addition of one Urologist per 100,000 people in counties in the southern Mississippi River states of Arkansas, Mississippi, and Louisiana, as well as parts of Illinois, Indiana, and Wisconsin is associated with decrease of 0.411 to 0.916 in prostate cancer mortality per 100,000 men (1.6-3.6%). In contrast, the Urologist density was not significantly associated with the prostate state mortality in the new England region.ConclusionsThe strength of association between Urologist density and prostate cancer mortality varied regionally. Those areas with the highest potential for effects could be targeted for increasing the supply of Urologists, as it associated with the largest predicted improvement in prostate cancer mortality.
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Urologist density and county level urologic cancer mortality
Journal of Clinical Oncology, 2010Co-Authors: Anobel Y. Odisho, Vincent Fradet, Matthew R. Cooperberg, Ardalan E. Ahmad, Peter R. CarrollAbstract:Purpose The surgical work force distribution at the county level varies widely across the United States, and the impact of differential access on cancer outcomes is unclear. We used Urologists as a test case because they are the first care providers for urologic cancers, can easily be identified from available data sources, and are unevenly distributed throughout the country. The goal of this study was to determine the effect of increasing Urologist density on local prostate, bladder, and kidney cancer mortality. Patients and Methods Using county-level data from the Area Resource File, US Census, National Cancer Institute, and Centers for Disease Control, regression models were built for prostate, bladder, and kidney cancer mortality, controlling for categorized Urologist density, county demographics, socioeconomic factors, and preexisting health care infrastructure. Results For each of the three cancers, there was a statistically significant cancer-specific mortality reduction associated with counties th...
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Urologist Density and County-Level Urologic Cancer Mortality
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2010Co-Authors: Anobel Y. Odisho, Vincent Fradet, Matthew R. Cooperberg, Ardalan E. Ahmad, Peter R. CarrollAbstract:The surgical work force distribution at the county level varies widely across the United States, and the impact of differential access on cancer outcomes is unclear. We used Urologists as a test case because they are the first care providers for urologic cancers, can easily be identified from available data sources, and are unevenly distributed throughout the country. The goal of this study was to determine the effect of increasing Urologist density on local prostate, bladder, and kidney cancer mortality. Using county-level data from the Area Resource File, US Census, National Cancer Institute, and Centers for Disease Control, regression models were built for prostate, bladder, and kidney cancer mortality, controlling for categorized Urologist density, county demographics, socioeconomic factors, and preexisting health care infrastructure. For each of the three cancers, there was a statistically significant cancer-specific mortality reduction associated with counties that had more than zero Urologists (16% to 22% reduction for prostate cancer, 17% to 20% reduction for bladder cancer, and 8% to 14% reduction for kidney cancer with increasing Urologist density) relative to zero Urologists. However, increasing density greater than two Urologists per 100,000 people had no statistically significant impact on mortality for any of the tumors studied. The presence of a Urologist is associated with lower mortality for urologic cancers in that county, but increasing Urologist density does not yield further improvements. Therefore, a nuanced and geographically aware policy toward the size and distribution of the future work force is most likely to provide the greatest population-level improvement in cancer mortality outcomes.
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Geographic distribution of Urologists throughout the United States using a county level approach.
The Journal of urology, 2008Co-Authors: Anobel Y. Odisho, Vincent Fradet, Matthew R. Cooperberg, Ardalan E. Ahmad, Peter R. CarrollAbstract:The adequacy of the Urologist work force in absolute numbers and relative distribution is unclear. To develop effective policies addressing the needs of an aging population we must better understand the Urologist work force. We assessed the geographic distribution of Urologists throughout the United States at the county level and determined the county characteristics associated with increased Urologist density. County level data from the Department of Health and Human Services Area Resource File and the United States Census were analyzed in this ecological study. Logistic regression and ordinal logistic regression models were built to identify predictors of Urologist density, defined as the number of Urologists per 100,000 individuals. National patterns of Urologist density were mapped graphically at the county level. Overall 63% of the counties in the United States lack a Urologist. Based on multivariate models Urologists were less likely to be found in nonmetropolitan counties (OR 0.57, 95% CI 0.46-0.72) and rural counties (OR 0.03, 95% CI 0.02-0.06) than in metropolitan counties, which confirmed visually mapped models. Patterns of Urologist density also appeared to be influenced by climate and county education levels rather than by traditional socioeconomic measures. Urologists younger than 45 years old were 3 times less likely to be located in nonmetropolitan and rural counties than their older counterparts. The uneven distribution of Urologists throughout the United States is likely to worsen as younger physicians continue to cluster in urban areas. Governing bodies must consider this distribution in their calls for increasing the number of training positions.
H G T Nijs - One of the best experts on this subject based on the ideXlab platform.
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treatment choice for benign prostatic hyperplasia a matter of Urologist preference
The Journal of Urology, 1999Co-Authors: Herman Stoevelaar, C Van De Beek, A F Casparie, Joseph Mcdonnell, H G T NijsAbstract:AbstractPurpose: New treatment modalities for benign prostatic hyperplasia (BPH) have considerably altered the decision making process in daily clinical practice. Guidelines provide a framework for treatment choice but leave much room for physician personal opinions. We identified and quantified determinants of treatment choice for BPH among Urologists focusing on Urologist treatment preferences.Materials and Methods: The study population consisted of 670 consecutive patients with BPH 50 years old or older newly referred to 1 of 39 Urologists in a stratified sample of 13 hospitals throughout The Netherlands. Data on patient characteristics were retrieved from patient questionnaires (symptomatology, bothersomeness, sexual function), medical records (diagnostic outcomes, co-morbidity) and Urologist questionnaire (initial treatment choice and main considerations for this decision). Urologist treatment preferences were inventoried using a mailed questionnaire. Polychotomous logistic regression analysis was us...
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Treatment choice for benign prostatic hyperplasia: a matter of Urologist preference?
The Journal of urology, 1999Co-Authors: Herman Stoevelaar, C Van De Beek, A F Casparie, Joseph Mcdonnell, H G T NijsAbstract:New treatment modalities for benign prostatic hyperplasia (BPH) have considerably altered the decision making process in daily clinical practice. Guidelines provide a framework for treatment choice but leave much room for physician personal opinions. We identified and quantified determinants of treatment choice for BPH among Urologists focusing on Urologist treatment preferences. The study population consisted of 670 consecutive patients with BPH 50 years old or older newly referred to 1 of 39 Urologists in a stratified sample of 13 hospitals throughout The Netherlands. Data on patient characteristics were retrieved from patient questionnaires (symptomatology, bothersomeness, sexual function), medical records (diagnostic outcomes, co-morbidity) and Urologist questionnaire (initial treatment choice and main considerations for this decision). Urologist treatment preferences were inventoried using a mailed questionnaire. Polychotomous logistic regression analysis was used to study the impact of patient characteristics and Urologist preferences on treatment choice. Among the patient characteristics maximum flow rate, residual urine and prostate volume were strongly associated with the probability of surgery and watchful waiting. However, the influence of Urologist preferences on actual decisions was also significant. Adjusted for case mix the differences in low and high preferences revealed a 2.2 times greater probability of surgery. For alpha-blockers and finasteride these ratios were 1.8 and 9.4, respectively. An additional independent effect was seen for Urologist extent of experience. The influence of Urologist personal preferences on treatment choice in BPH is considerable. Given the different efficacy and side effects of the various treatments, further consensus development is needed to enhance appropriate treatment decisions and eliminate undue costs.
Kevin T Mcvary - One of the best experts on this subject based on the ideXlab platform.
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impact of county rurality and Urologist density on urological cancer mortality in illinois
The Journal of Urology, 2015Co-Authors: Thomas Frye, Daniel J Sadowski, Whitney E Zahnd, Wiley D Jenkins, Danuta Dynda, Georgia Mueller, Shaheen Alanee, Kevin T McvaryAbstract:Purpose: The urology work force is contracting at a time when service demand is increasing due to demographic changes, especially in rural areas. We investigated the impact of rural status and Urologist density on kidney and renal pelvis, bladder and prostate cancer mortality at the county level in Illinois.Materials and Methods: We stratified the 102 Illinois counties by 2003 RUCCs as urban (36, RUCCs 1 to 3) and rural (66, RUCCs 4 to 9). Area Health Resource Files were used for county demographic data and Urologist density. County level age adjusted mortality rates from 1990 to 2010 were derived from National Center for Health Statistics data using SEER*Stat. We examined the associations of urological cancer mortality rates with rural status and Urologist density.Results: Average Urologist density significantly differed between rural and urban counties (1.9 vs 3.4/100,000 population, p <0.01). The kidney and renal pelvis cancer mortality rate in rural counties was higher than in urban counties while tha...
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counseling on sexual side effects from turp
Canadian Journal of Urology, 2015Co-Authors: Diana K Bowen, Michael J Butcher, Albert Botchway, Kevin T McvaryAbstract:INTRODUCTION We designed a pilot study to measure preoperative sexual dysfunction risk counseling between sexual medicine experts (SME) and general Urologists between monopolar/bipolar transuretheral resection of the prostate (TURP) and laser TURP (LT). MATERIALS AND METHODS An emailed electronic survey was distributed to members of the North Central Section (NCS) of the American Urologic Association and the Sexual Medicine Society of North America (SMSNA). Overall, 260 (12.3%) completed the survey. Counseling for ejaculatory disorder (EjD), erectile dysfunction (ED), stricture formation and incontinence was assessed. Additional subset analysis between those SME's versus general Urologist was done. RESULTS Overall, 82% (224) identified as general Urologists and 18% (49) as SME. Two-thirds were in private practice versus academic. Over 90% of all practitioners 'almost always' counsel about the possibility of EjD, with varied risk rate for LT. Overall, 62%(140) for monopolar TURP (MBT) and 60% (110) for LT 'almost always' counsel about ED. There was no statistical difference between groups counseling on incontinence, strictures, EjD or ED between SME and general Urologists. CONCLUSIONS Sexual side effects of treatment for LUTS/BPH are appreciated by Urologists. Most practitioners counsel about EjD, however the incidence varies between MBT and LT. Practitioners counsel their patients on ED less often than EjD. Counseling rates are not improved with those specializing in sexual medicine independent of TURP technique.
David C Wheeler - One of the best experts on this subject based on the ideXlab platform.
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geographic analysis of Urologist density and prostate cancer mortality in the united states
PLOS ONE, 2015Co-Authors: Nengliang Yao, Anobel Y. Odisho, Steven M Foltz, David C WheelerAbstract:Author(s): Yao, Nengliang; Foltz, Steven M; Odisho, Anobel Y; Wheeler, David C | Abstract: ContextFinancial and demographic pressures in US require an understanding of the most efficient distribution of physicians to maximize population-level health benefits. Prior work has assumed a constant negative relationship between physician supply and mortality outcomes throughout the US and has not addressed regional variation.MethodsIn this ecological analysis, geographically weighted regression was used to identify spatially varying relationships between local Urologist density and prostate cancer mortality at the county level. Data from 1,492 counties in 30 eastern and southern states from 2006-2010 were analyzed.FindingsThe ordinary least squares (OLS) regression found that, on average, increasing Urologist density by 1 Urologist per 100,000 people resulted in an expected decrease in prostate cancer mortality of -0.499 deaths per 100,000 men (95% CI -0.709 to -0.289, p-value l 0.001), or a 1.5% decrease. Geographic weighted regression demonstrated that the addition of one Urologist per 100,000 people in counties in the southern Mississippi River states of Arkansas, Mississippi, and Louisiana, as well as parts of Illinois, Indiana, and Wisconsin is associated with decrease of 0.411 to 0.916 in prostate cancer mortality per 100,000 men (1.6-3.6%). In contrast, the Urologist density was not significantly associated with the prostate state mortality in the new England region.ConclusionsThe strength of association between Urologist density and prostate cancer mortality varied regionally. Those areas with the highest potential for effects could be targeted for increasing the supply of Urologists, as it associated with the largest predicted improvement in prostate cancer mortality.
