Person: Huckman, Robert
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Huckman
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Huckman, Robert
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Publication Influence of Experience and the Surgical Learning Curve on Long-term Patient Outcomes in Cardiac Surgery(Elsevier BV, 2015-11) Burt, Bryan M.; ElBardissi, Andrew W.; Huckman, Robert; Cohn, Lawrence H.; Cevasco, Marisa W.; Rawn, James D.; Aranki, Sary F.; Byrne, John G.OBJECTIVE: We hypothesized that increased post-graduate surgical experience correlates with improved operative efficiency and long-term survival in standard cardiac surgery procedures. METHODS: Utilizing a prospectively collected retrospective database, we identified patients who underwent isolated CABG (n=3726), AVR (n=1626), MV repair (n=731), MVR (n=324), and MVR+AVR (n=184) from 1/2002-6/2012. After adjusting for patient risk and surgeon variability, we evaluated the impact of surgeon experience on cardiopulmonary bypass and cross-clamp times, and long-term survival. RESULTS: Mean surgeon experience after fellowship graduation was 16.0±11.7 years (1.0-35.2 years). After adjusting for patient risk and surgeon-level fixed effects, learning curve analyses demonstrated improvements in cardiopulmonary bypass and cross-clamp times with increased surgeon experience. There was marginal improvement in the predictability (R2 value) of cardiopulmonary bypass and cross-clamp time for CABG with the addition of surgeon experience, however, all other procedures had marked increases in the R2 following addition of surgeon experience. Cox proportional hazard models revealed that increased surgeon experience was associated with improved long-term survival in AVR (HR=0.85, P<0.0001), MV repair (0.73, p<0.0001), and MVR+AVR (0.95, p=0.006) but not in CABG (HR=0.80, p=0.15), and a trend towards significance in MVR (HR=0.87, p=0.09). CONCLUSIONS: In cardiac surgery, not including CABG, surgeon experience is an important determinant of operative efficiency and of long-term survival.Publication Hospital Board and Management Practices are Strongly Related to Hospital Performance on Clinical Quality Metrics(2015) Tsai, T. C.; Jha, A. K.; Gawande, Atul; Huckman, Robert; Bloom, N.; Sadun, RaffaellaNational policies to improve health care quality have largely focused on clinical provider outcomes and, more recently, payment reform. Yet the association between hospital leadership and quality, although crucial to driving quality improvement, has not been explored in depth. We collected data from surveys of nationally representative groups of hospitals in the United States and England to examine the relationships among hospital boards, management practices of front-line managers, and the quality of care delivered. First, we found that hospitals with more effective management practices provided higher-quality care. Second, higher-rated hospital boards had superior performance by hospital management staff. Finally, we identified two signatures of high-performing hospital boards and management practice. Hospitals with boards that paid greater attention to clinical quality had management that better monitored quality performance. Similarly, we found that hospitals with boards that used clinical quality metrics more effectively had higher performance by hospital management staff on target setting and operations. These findings help increase understanding of the dynamics among boards, front-line management, and quality of care and could provide new targets for improving care delivery.Publication Input Constraints and the Efficiency of Entry: Lessons from Cardiac Surgery(American Economic Association, 2010) Cutler, David; Huckman, Robert; Kolstad, Jonathan T.Prior studies suggest that, with elastically supplied inputs, free entry may lead to an inefficiently high number of firms in equilibrium. Under input scarcity, however, the welfare loss from free entry is reduced. Further, free entry may increase use of high-quality inputs, as oligopolistic firms underuse these inputs when entry is constrained. We assess these predictions by examining how the 1996 repeal of certificate-of-need (CON) legislation in Pennsylvania affected the market for cardiac surgery in the state. We show that entry led to a redistribution of surgeries to higher-quality this entry was approximately welfare neutral.Publication To Batch or Not to Batch: Test-Ordering Variability in the Emergency Department and the Impact on Care Delivery(Harvard Kennedy School, 2023-11) Jameson, Jacob; Saghafian, Soroush; Huckman, Robert; Hodgson, Nicole R.Emergency Department (ED) patients may receive varying diagnostic workups and dispositions based on physician factors instead of solely based on presenting conditions. This study delves into the contrasting practices of batch-ordering multiple tests simultaneously versus the sequential ordering of tests based on previous results. Our analysis revealed stark differences in physician diagnostic approaches, even when working in similar environments. Findings suggest that physicians who predominantly make use of batching (“batchers”) tend to order more tests, which is associated with longer lengths of stay and increased costs. In contrast, other physicians (“non-batchers”) order fewer tests, which is associated with lower lengths of stay and costs, without any impact on primary ED outcome measures, such as the 72-hour rate of return. Thus, our results suggest an “information gain” advantage in the non-batching strategy: by ordering sequentially, non-batchers obtain the diagnostic information needed with a lower number of tests, enabling them to deliver the same quality of care more efficiently (e.g., with a lower length of stay and cost) than batchers. Finally, our study shows that the decision to batch order diagnostic tests can be optimized for each patient using a few variables, including acuity, chief complaints, and the ED volume at arrival.