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Articles by A. K Jha
Total Records ( 2 ) for A. K Jha
  L. M Chen , A. K Jha , S Guterman , A. B Ridgway , E. J Orav and A. M. Epstein

Background  Hospitals face increasing pressure to lower cost of care while improving quality of care. It is unclear if efforts to reduce hospital cost of care will adversely affect quality of care or increase downstream inpatient cost of care.

Methods  We conducted an observational cross-sectional study of US hospitals discharging Medicare patients for congestive heart failure (CHF) or pneumonia in 2006. For each condition, we examined the association between hospital cost of care and the following variables: process quality of care, 30-day mortality rates, readmission rates, and 6-month inpatient cost of care.

Results  Compared with hospitals in the lowest-cost quartile for CHF care, hospitals in the highest-cost quartile had higher quality-of-care scores (89.9% vs 85.5%) and lower mortality for CHF (9.8% vs 10.8%) (P < .001 for both). For pneumonia, the converse was true. Compared with low-cost hospitals, high-cost hospitals had lower quality-of-care scores (85.7% vs 86.6%, P = .002) and higher mortality for pneumonia (11.7% vs 10.9%, P < .001). Low-cost hospitals had similar or slightly higher 30-day readmission rates compared with high-cost hospitals (24.7% vs 22.0%, P < .001 for CHF and 17.9% vs 17.3%, P = .20 for pneumonia). Nevertheless, patients initially seen in low-cost hospitals incurred lower 6-month inpatient cost of care compared with patients initially seen in hospitals with the highest cost of care ($12 715 vs $18 411 for CHF and $10 143 vs $15 138 for pneumonia, P < .001 for both).

Conclusions  The associations are inconsistent between hospitals' cost of care and quality of care and between hospitals' cost of care and mortality rates. Most evidence did not support the "penny wise and pound foolish" hypothesis that low-cost hospitals discharge patients earlier but have higher readmission rates and greater downstream inpatient cost of care.

  N Aziz , A. K Jha , C Thanos , R Basha and A. Bose

We used cryogenic transmission electron microscopy (cryo-TEM) to identify differences in macromolecular structures present in the serum from healthy individuals (HI) and prostate cancer (PCa) patients and show that these differences are potential markers for disease. Using a murine orthotopic model of human PCa, we determined that some of these structural markers in serum are associated with the tumour burden. These findings signify the potential of this nanoscale ex vivo imaging technology of body fluids as a platform for discovering early markers of PCa and other diseases.

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