Technology & Policy

The Effect of the Diffusion of the Surgical Robot on the Hospital-level Utilization of Partial Nephrectomy

The Effect of the Diffusion of the Surgical Robot on the Hospital-level Utilization of Partial Nephrectomy
Medical Care, Vol. 53, no. 1, pp. 71-78. DOI: 10.1097/MLR.0000000000000259

Sivarajan, G., G.B. Taksler, D. Walter, C.P. Gross, R.E. Sosa,and D.V. Makarov

Introduction: The rapid diffusion of the surgical robot has been controversial because of the technology’s high costs and its disputed marginal benefit. Some, however, have suggested that adoption of the robot may have improved care for patients with renal malignancy by facilitating partial nephrectomy, an underutilized, technically challenging procedure believed to be less morbid than radical nephrectomy. We sought to determine whether institutional acquisition of the robot was associated with increased utilization of partial nephrectomy.

Methods: We used all payer data from 7 states to identify 21,569 nephrectomies. These patient-level records were aggregated to the hospital-level then merged with the American Hospital Association Annual Survey and publicly available data on timing of robot acquisition. We used a multivariable difference-in-difference model to assess at the hospital-level whether robot acquisition was associated with an increase in the proportion of partial nephrectomy, adjusting for hospital nephrectomy volume, year of surgery, and several additional hospital-level factors.

Results: In the multivariable-adjusted differences-in-differences model, hospitals acquiring a robot between 2001 and 2004 performed a greater proportion of partial nephrectomy in both 2005 (29.9% increase) and 2008 (34.9% increase). Hospitals acquiring a robot between 2005 and 2008 also demonstrated a greater proportion of partial nephrectomy in 2008 (15.5% increase). In addition, hospital nephrectomy volume and urban location were also significantly associated with increased proportion of partial nephrectomy.

Conclusions: Hospital acquisition of the surgical robot is associated with greater proportion of partial nephrectomy, an underutilized, guideline-encouraged procedure. This is one of the few studies to suggest robot acquisition is associated with improvement in quality of patient care.

Application of global positioning system methods for the study of obesity and hypertension risk among low-income housing residents in New York City: a spatial feasibility study

Application of global positioning system methods for the study of obesity and hypertension risk among low-income housing residents in New York City: a spatial feasibility study
Geospatial Health, Vol. 9, no. 1, pp. 57-70. DOI:

Duncan, D.T., S.D. Regan, D. Shelley, K. Day, R.R. Ruff, M. Al-Bayan, and B. Elbel

The purpose of this study was to evaluate the feasibility of using global positioning system (GPS) methods to understand the spatial context of obesity and hypertension risk among a sample of low-income housing residents in New York City (n = 120). GPS feasibility among participants was measured with a pre- and post-survey as well as adherence to a protocol which included returning the GPS device as well as objective data analysed from the GPS devices. We also conducted qualitative interviews with 21 of the participants. Most of the sample was overweight (26.7%) or obese (40.0%). Almost one-third (30.8%) was pre-hypertensive and 39.2% was hypertensive. Participants reported high ratings of GPS acceptability, ease of use and low levels of wear-related concerns in addition to few concerns related to safety, loss or appearance, which were maintained after the baseline GPS feasibility data collection. Results show that GPS feasibility increased over time. The overall GPS return rate was 95.6%. Out of the total of 114 participants with GPS, 112 (98.2%) delivered at least one hour of GPS data for one day and 84 (73.7%) delivered at least one hour on 7 or more days. The qualitative interviews indicated that overall, participants enjoyed wearing the GPS devices, that they were easy to use and charge and that they generally forgot about the GPS device when wearing it daily. Findings demonstrate that GPS devices may be used in spatial epidemiology research in low-income and potentially other key vulnerable populations to understand geospatial determinants of obesity, hypertension and other diseases that these populations disproportionately experience.

Are hospitals “keeping up with the Joneses”?: Assessing the spatial and temporal diffusion of the surgical robot

Are hospitals “keeping up with the Joneses”?: Assessing the spatial and temporal diffusion of the surgical robot
Healthcare : the Journal of Delivery Science & Innovation, Vol. 2, no. 2, pp. 152-157. DOI: 10.1016/j.hjdsi.2013.10.002

Li, H., M.H. Gail, B.R. Scott, H.T. Gold, D. Walter, D, M. Liu, C.P. Gross, and D.V. Makarov

Background: The surgical robot has been widely adopted in the United States in spite of its high cost and controversy surrounding its benefit. Some have suggested that a “medical arms race” influences technology adoption. We wanted to determine whether a hospital would acquire a surgical robot if its nearest neighboring hospital already owned one.

Methods: We identified 554 hospitals performing radical prostatectomy from the Healthcare Cost and Utilization Project Statewide Inpatient Databases for seven states. We used publicly available data from the website of the surgical robot's sole manufacturer (Intuitive Surgical, Sunnyvale, CA) combined with data collected from the hospitals to ascertain the timing of robot acquisition during year 2001 to 2008. One hundred thirty four hospitals (24%) had acquired a surgical robot by the end of 2008. We geocoded the address of each hospital and determined a hospital's likelihood to acquire a surgical robot based on whether its nearest neighbor owned a surgical robot. We developed a Markov chain method to model the acquisition process spatially and temporally and quantified the “neighborhood effect” on the acquisition of the surgical robot while adjusting simultaneously for known confounders.

Results: After adjusting for hospital teaching status, surgical volume, urban status and number of hospital beds, the Markov chain analysis demonstrated that a hospital whose nearest neighbor had acquired a surgical robot had a higher likelihood itself acquiring a surgical robot (OR=1.71, 95% CI: 1.07–2.72, p=0.02).

Conclusion: There is a significant spatial and temporal association for hospitals acquiring surgical robots during the study period. Hospitals were more likely to acquire a surgical robot during the robot's early adoption phase if their nearest neighbor had already done so.

Twitter Response to the United States Preventive Services Task Force Recommendations against Screening with Prostate Specific Antigen

Twitter Response to the United States Preventive Services Task Force Recommendations against Screening with Prostate Specific Antigen
BJU International. DOI: 10.1111/bju.12748

Prabhu, V., T. Lee, S. Loeb, J.H. Holmes, H.T. Gold, H. Lepor, D.F. Penson, and D.V. Makarov

Objective: To examine public and media response to the United States Preventive Services Task Force's (USPSTF) draft (October 2011) and finalized (May 2012) recommendations against prostate-specific antigen (PSA) testing using Twitter, a popular social network with over 200 million active users.

Materials and Methods: We used a mixed methods design to analyze posts on Twitter, called “tweets.” Using the search term “prostate cancer,” we archived tweets in the 24 hour periods following the release of the USPSTF draft and finalized recommendations. We recorded tweet rate per hour and developed a coding system to assess type of user and sentiment expressed in tweets and linked articles.

Results: After the draft and finalized recommendations, 2042 and 5357 tweets focused on the USPSTF report, respectively. Tweet rate nearly doubled within two hours of both announcements. Fewer than 10% of tweets expressed an opinion about screening, and the majority of these were pro-screening during both periods. In contrast, anti-screening articles were tweeted more frequently in both draft and finalized study periods. From the draft to the finalized recommendations, the proportion of anti-screening tweets and anti-screening article links increased (p= 0.03 and p<0.01, respectively).

Conclusions: There was increased Twitter activity surrounding the USPSTF draft and finalized recommendations. The percentage of anti-screening tweets and articles appeared to increase, perhaps due to the interval public comment period. Despite this, most tweets did not express an opinion, suggesting a missed opportunity in this important arena for advocacy.

Co-Monitoring for Transit Management

Co-Monitoring for Transit Management
NYU Rudin Center for Transportation, February 2014.

Kaufman, Sarah

Emerging technologies offer transit agencies an opportunity to transform fundamental aspects of their operations and the way they communicate with their riders.  With nearly ubiquitous smartphones and social media tools among growing ridership patterns, transit providers can use aggregate mobile phone data and social media posts to improve system management.

Data-based reports can reach the operations center faster than field personnel, with mobile phone networks indicating station crowding or a passenger posting a photo of another pulling the emergency brake. Exceeding traditional reporting mechanisms (exclusive information from personnel) would save time and lower the costs of field monitoring while raising the trust between transit agencies and their customers.

By employing “co-monitoring” - the monitoring of field conditions through a combination of staff reports, data analysis and public observations – transit agencies will save time and costs for information gathering, improve their responsiveness, and establish working partnerships between the agencies and their customers. This report proposes a framework for a co-monitoring system, and discusses the expected benefits and challenges, as well as policy recommendations for agencies pursuing co-monitoring systems. Keys to successful co-monitoring systems are agency openness to new streams of data and respectful dialogue from both management and riders. Well-designed co-monitoring tools will put transit on track to manage smarter, more versatile transit systems for the twenty-first century.

Smart Cities: Big Data, Civic Hackers, and the Quest for a New Utopia

Smart Cities: Big Data, Civic Hackers, and the Quest for a New Utopia
W. W. Norton & Company

Anthony M. Townsend

An unflinching look at the aspiring city-builders of our smart, mobile, connected future.

We live in a world defined by urbanization and digital ubiquity, where mobile broadband connections outnumber fixed ones, machines dominate a new "internet of things," and more people live in cities than in the countryside. In Smart Cities, urbanist and technology expert Anthony Townsend takes a broad historical look at the forces that have shaped the planning and design of cities and information technologies from the rise of the great industrial cities of the nineteenth century to the present. A century ago, the telegraph and the mechanical tabulator were used to tame cities of millions. Today, cellular networks and cloud computing tie together the complex choreography of mega-regions of tens of millions of people.

In response, cities worldwide are deploying technology to address both the timeless challenges of government and the mounting problems posed by human settlements of previously unimaginable size and complexity. In Chicago, GPS sensors on snow plows feed a real-time "plow tracker" map that everyone can access. In Zaragoza, Spain, a "citizen card" can get you on the free city-wide Wi-Fi network, unlock a bike share, check a book out of the library, and pay for your bus ride home. In New York, a guerrilla group of citizen-scientists installed sensors in local sewers to alert you when stormwater runoff overwhelms the system, dumping waste into local waterways.

As technology barons, entrepreneurs, mayors, and an emerging vanguard of civic hackers are trying to shape this new frontier, Smart Cities considers the motivations, aspirations, and shortcomings of them all while offering a new civics to guide our efforts as we build the future together, one click at a time.

What’s the Worst That Can Happen? Social Media Protocols and Policies

What’s the Worst That Can Happen? Social Media Protocols and Policies
In Best Practices for Transportation Agency Use of Social Media, CRC Press, October 2, 2013.

Sarah M. Kaufman and Susan Bregman

Timely updates, increased citizen engagement, and more effective marketing are just a few of the reasons transportation agencies have already started to adopt social media networking tools. Best Practices for Transportation Agency Use of Social Media offers real-world advice for planning and implementing social media from leading government practitioners, academic researchers, and industry experts.

The book provides an overview of the various social media platforms and tools, with examples of how transportation organizations use each platform. It contains a series of interviews that illustrate what creative agencies are doing to improve service, provide real-time updates, garner valuable information from their customers, and better serve their communities. It reveals powerful lessons learned from various transportation agencies, including a regional airport, city and state departments of transportation, and municipal transit agencies. 

Filled with examples from transportation organizations, the text provides ideas that can apply to all modes of transportation including mass transit, highways, aviation, ferries, bicycling, and walking. It describes how to measure the impact of your social media presence and also examines advanced uses of social media for obtaining information by involving customers and analyzing their social media use. 

The book outlines all the resources you will need to maintain a social media presence and describes how to use social media analytical tools to assess service strengths and weaknesses and customer sentiment. Explaining how to overcome the digital divide, language barriers, and accessibility challenges for patrons with disabilities, it provides you with the understanding of the various social media technologies along with the knowhow to determine which one is best for a specific situation and purpose.



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