Grants Funded

Abstract
With rising healthcare costs and challenges in access to quality healthcare, an efficient and effective system of care is much in demand. Recent health policy reform initiatives have highlighted the need for a “regionalized, coordinated, and accountable” system of care. Many investigators, from various fields, have evaluated the association between volume and outcome by measuring outcomes such as mortality rate as an adverse outcome for high-risk conditions and procedures. Findings indicate substantially lower mortality rates for surgical procedures such as coronary bypass artery graft or pancreatic cancer surgery performed in high volume centers. Although there has been a large body of research examining volume-outcome association, almost all studies on this topic were limited by not having access to national population-based data. Additionally, little is known about volume-outcome association for high profile but low-mortality risk procedures such as free flaps. Since the 1972's pioneer work of Drs. McLean and Buncke who performed the first free flap surgery on humans, application and use of microsurgical free flap operations has been dramatically advanced. In this unique and innovative study, we will be using 100% of Taiwan's national insurance data from 2000 to 2014 (with coverage rate of 99% of population) to evaluate the association between hospital and surgeon volume, and a range of outcome measures (e.g. success of free flap, complication rate, length of stay in hospital, direct medical cost of operation, and 30-day rehospitalization). Our specific aims include: (1) compare characteristics and outcome measures between high- and low-volume providers; (2) determine hospital, surgeon, and patient factors associated with outcome measures; and (3) design a predictive outcome optimization model to establish surgeon- and hospital-level cutoff volume. We hypothesize substantial differences in characteristics of high-volume, compared with low-volume hospitals and surgeons. Further, we hypothesize better outcome measures among high-volume compared with low-volume hospitals and surgeons, adjusting for patient and other related factors in the model. Findings from this study will provide robust, population-based evidence regarding the minimum cutoff level for surgeons and hospitals in order to optimize the outcome measures, and inform future strategies to improve the effectiveness and efficiency for free flap surgeries.

Biography
Elham Mahmoudi, PhD, joined the Plastic Surgery Section of the Department of Surgery at the University of Michigan as an Assistant Research Professor in July 2014. She earned her PhD in economics from Wayne State University in 2012 and was subsequently accepted into a postdoctoral program at the University of Michigan. In 2009, during her doctoral program she got accepted into an NIH-funded T-32 research-training program through the Institute of Gerontology at Wayne State. This has enabled her to attend national workshops and conferences to acquire expertise in working with large, nationally representative datasets. Prior to completing her dissertation Dr. Mahmoudi completed two studies on racial/ethnic disparities in access to primary care in the United States. Her study on disparities in access to care among older individuals won the Carroll Estes award from the National Gerontological Society. Subsequently, she was awarded independent funding from the Boston College Center for Retirement Research, and Blue Cross Blue Shield of Michigan for her doctoral dissertation on evaluating the effects of Medicare Part D on racial/ethnic disparities in drug utilization and spending. Dr. Mahmoudi has extensive training in working with large datasets, econometric modeling, and quantitative analysis. Her career goal is to become a health economist with the expertise to evaluate treatments and improve the quality of care for a variety of surgically treatable conditions.