Outcomes and Health PolicyPatient-oriented research in the perioperative period has often focused on end-points and outcomes that are only transient at best, and apparent at worst. Recent emphasis has been placed on longer term outcome measures for the many interventions patients receive in this intensive and invasive health-care experience. Several members of the department are focusing on how best to alter patient care to improve these long-term outcomes. For example, the chair, Lee Fleisher, has focused on risk assessment and risk reduction strategies in two distinct populations: those with known or risk factors for cardiovascular disease and those undergoing ambulatory surgery. He has an ongoing collaboration with Jeffrey Silber in the Center for Clinical Epidemiology and Biostatistics (CCEB). In addition, David Longnecker and Jeff Silber are exploring the optimal composition of the health-care team in the perioperative period, using long-term morbidity and mortality as measures in large national database studies. Roderic Eckenhoff, also in conjunction with Jeff Silber, is using these same Medicare database-mining approaches to search for associations between surgery and dementia, in the hopes of determining causes for post-operative cognitive dysfunction. Andrew Ochroch is using prospective approaches to understand gender differences in pain-control and subsequent functional outcome. Tom Floyd is also using prospective approaches to determine the causes and extent of cognitive dysfunction inpatients after coronary-bypass graft surgery using either cardiopulmonary bypass pump or the newer "beating-heart" approaches. Finally, David Jobes also using outcomes research, is studying hemostasis and coagulation related to cardiac surgery for adult and pediatric patients. The Department is integrated into two University-wide interdisciplinary programs, the Center for Clinical Epidemiology and Biostatistics (CCEB) and the Leonard Davis Institute for Health Economics (LDI).
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