Outcomes Research
The Outcomes Group in the Department of Anesthesiology conducts healthcare research to improve quality of care. Our work focuses on outcomes measurement and risk-adjustment.
Research Focus: Laurent Glance, M.D.
Laurent G. Glance, MD, is Professor and Vice-Chair of Research and has a secondary appointment at RAND Health. He has extensive experience working with large clinical and administrative data sets, quasi-experimental methods, multivariable modeling, risk adjustment, simulations, and bootstrapping techniques. His research has focused on the following areas:
Understanding the Limitations of Risk Adjustments for Measuring Quality-of-Care. I was the recipient of a Research Career Development Grant (K08 HS11295) from AHRQ, which focused on the optimization of risk-adjustment methodologies for measuring Intensive Care Unit quality. We found that different ICU scoring systems frequently disagreed on which hospitals were quality outliers. We also showed that hospital performance is partly a function of the choice of statistical methodology. Most recently, we have shown that the prediction models recommended by the American Heart Association to risk stratify patients undergoing non-cardiac surgery frequently disagree on patients’ cardiac risk. These studies point to the necessity of identifying best-of-class prediction models for use in performance reporting and clinical decision-making.
The Impact of the Present-on-Admission Indicator on Quality Reporting. With funding from AHRQ (R01 HS 13617), we focused on the implications of the present-on-admission (POA) indicator in administrative data to differentiate preexisting conditions from complications. This work led to publications showing that the addition of the present-on-admission (POA) indicator enhances the ability of existing comorbidity algorithms to map ICD-9-CM codes to diagnostic categories accurately, and that the use of routine administrative data without POA information to construct hospital quality report cards may result in the misidentification of hospital quality outliers.
Optimizing Injury Severity Scoring. With funding from AHRQ (R01 HS016737), we used the National Trauma Databank as a platform to determine whether providing hospitals with trauma report cards will lead to improved population outcomes in trauma. This work has led to the development of a highly innovative empiric-based approach to trauma injury scoring using either clinical data or ICD-9-CM codes as an alternative to existing expert-based injury severity scoring systems. To address one of the primary limitations of trauma registry data, this project validated the use of multiple imputation for handling missing data in the context of quality measurement. This grant also examined whether higher-quality trauma care is associated with lower cost and whether failure-to-rescue is an important mechanism driving outcome differences across trauma centers.
Impact of Non-public reporting on Trauma Outcomes. As part of our AHRQ-funded R01, we conducted a prospective observational study to examine the impact of non-public reporting on trauma outcomes. We also examined the validity of trauma severity scoring by examining the ability of past hospital performance to predict future hospital performance. Finally, we examined the association between hospital structural characteristics and trauma outcomes.
Impact of Health Care Reform on Disparities. Healthcare reform aims to improve healthcare quality, expand access to healthcare, and lower the cost of health care. CMS created the Comprehensive Care of Joint Replacement (CJR) program to address the large variation in cost and quality for patients undergoing hip and knee replacements. The CJR program does not, however, adjust hospital payments for sociodemographic risk to compensate safety-net hospitals for the higher cost and worse outcomes of socially vulnerable patients. The CJR program also does not include disparity-sensitive metrics to incentivize hospitals to address the substantial gap in joint replacements between Black and White beneficiaries. Our work has shown that safety-net hospitals were less likely to receive rewards and more likely to be penalized by the CJR program. We also found that the CJR was associated with a widening of disparities in the utilization of total knee replacements.
View a complete list of published works in Dr. Glance's bibliography.
Research Focus: Heather Lander, M.D.
Dr. Heather Lander’s primary research interest is the medical optimization of older patients who need surgery. As a Cardiothoracic Anesthesiologist and the Associate Director of Academic Practice, she is integrally involved in Geriatric Perioperative Excellence and committed to efforts around Age-Friendly Health Systems and the Geriatric Surgical Verification Program.
She is funded by the URMFG Health Innovations Grant for her project "The PROMIS of an Equitable, Innovative, Geriatric Perioperative Surgical Home." This interdisciplinary project focuses on creating and implementing a geriatric perioperative surgical home that will utilize provider and patient-reported geriatric assessments to deliver targeted education, optimization, and risk discussions in older surgical patients.
Research Focus: Daryl I. Smith, MD
Dr. Daryl Smith’s research focuses on two general areas. First, Dr. Smith has worked on the development of devices that will allow clinicians to more efficiently perform peripheral nerve blockade using assistive technologies. Second, Dr. Smith has focused on expanding the use of regional anesthesia to include the treatment of intractable malignant pain, complex traumatic injuries, and VT storm.
Research Focus: Richard N. Wissler, MD, PhD, FASA
Dr. Wissler is Professor Emeritus of Anesthesiology and Perioperative Medicine, and Director Emeritus of Obstetric Anesthesia at Strong Memorial Hospital. His academic interests include outcomes research primarily related to improving the health of pregnant women and addressing health care disparities in this population. His current clinical research interests are centered on pain relief during labor and following cesarean delivery. As an Associate Scholar in the URMC Quality Institute, his current quality improvement activities are focused on perioperative and peripartum monitoring related to early identification and therapeutic interventions to minimize adverse patient outcomes. Mentoring and formal teaching sessions in quality improvement are aimed at developing the next generation of academic anesthesiologists.
Research Focus: Isaac Y. Wu, MD, FASE
Isaac Y. Wu, MD, FASE is a cardiothoracic anesthesiologist and Division Chief of Cardiac Anesthesiology at the University of Rochester Medical Center. His early research investigated the use of echocardiography in structural heart interventions for transcatheter valve sizing, and in cardiac surgical operations for assessing blood flow dynamics and energetics. He was the recipient of a grant from the Society of Cardiovascular Anesthesiologists to investigate the impact of transcatheter edge-to-edge repair of the mitral valve on right ventricular function, and has co-authored peer-reviewed publications in JACC Cardiovascular Imaging, JASE, and Anesthesiology. More recently, Dr. Wu has engaged in outcomes research, related to both cardiac and non-cardiac surgical patient populations, to identify opportunities to optimize health care practice and improve outcomes. One of his current projects focuses on identifying the association between operating room team characteristics and patient outcomes after cardiac surgery.
Research Focus: Julie Wyrobek, MD
Dr. Julie Wyrobek is an Associate Professor in the department of Anesthesiology and Perioperative Medicine. Trained in cardiothoracic anesthesiology, she is a clinician scientist who seeks to understand the pathophysiology of severe cardiac disease in patients undergoing general anesthesia. Areas of investigation have included anesthetic management in the electrophysiology lab, comparing 2D and 3D assessments of tricuspid regurgitation, and enhanced recovery after left ventricular assist device (LVAD) implantation. Her current projects include the intraoperative management of patient’s with LVADs undergoing non-cardiac surgery, and echocardiographic indications of outcome after liver transplantation.
Research Focus: Raymond Zollo, M.D.
Dr. Raymond Zollo’s general area of interest is in medical education at all levels. How can advances in medical education lead to the early acquisition of non-technical skills to improve perioperative outcomes, enhance provider expertise and wellness? How can the advances in simulation be leveraged to enhance residency and faculty education?How can better signal to noise detection in clinical competency data detect problems while they are small and correctible? Working as an Associate Scholar at the Quality Institute, how can the same process on a larger scale improve the quality of our systems throughout the hospital with improvements in patient safety and outcomes?
Dr. Zollo also has interests in medical and research ethics and the role of true informed consent in allowing patients to make informed decisions regarding their therapeutic care and allowing research subjects to make informed decisions regarding their willingness to participate in research while avoiding therapeutic misconception. As the Vice Chair and a Senior Scientific Reviewer for the Research Subjects Review Board, Dr. Zollo has reviewed thousands of studies and research protocols and serves as a research consultant for medical students, residents, and faculty members. He also serves as a medical consultant for the University on research matters