Ravishankar Jayadevappa

• PhD, MS
• University of Pennsylvania

Background: Technical efficiency evaluates a hospital’s economic performance and plays an important role in variations in quality of care and outcomes. The study objective was to examine the association between hospital efficiency and quality of care among fee-for-service Medicare beneficiaries with prostate cancer and to assess if race moderates t...

Purpose: Both direct and indirect costs contribute to financial toxicity in prostate cancer. Indirect costs are difficult to assess and quantify and therefore remain understudied. We sought to describe the indirect costs of prostate cancer across risk groups as well as identify any associated sociodemographic factors. Materials and methods: Pati...

Background Hospitals account for approximately 6% of United States’ gross domestic product. We examined the association between hospital competition and outcomes in elderly with localized prostate cancer (PCa). We also assessed if race moderated this association. Methods Retrospective study using Surveillance, Epidemiology, and End Results (SEER)...

e24077 Background: For men with metastatic hormone-sensitive prostate cancer (mHSPC) on androgen deprivation therapy (ADT), guidelines recommend dual-energy X-ray absorptiometry (DXA) screening to identify fracture risk and benefit from antiresorptive therapy. However, only 8% of men with mHSPC receive routine DXA screening. Biomechanical computed...

Simple Summary Prostate cancer is the most common malignancy (after skin cancer) in men, and also the most common cancer among cancer survivors in the US. We assessed the long-term burden of depression across three prostate cancer risk groups, and evaluated the association between regret and long-term depression. A large proportion of localized pro...

Background: Continuity of care is an important element of advanced prostate cancer care due to the availability of multiple treatment options, and associated toxicity. However, the association between continuity of care and outcomes across different racial groups remains unclear. Objective: To assess the association of provider continuity of car...

Introduction: Our objective was to assess whether Medicaid expansion is associated with reduced racial disparity in quality of care measured as 30-day mortality, 90-day mortality, and 30-day readmission in prostate cancer patients receiving surgery. Methods: We used the National Cancer Database to extract a cohort of African American and White m...

We analyzed mortality (all-cause and lung cancer-specific) and time to follow-up treatment in stage I and II non-small cell lung cancer (NSCLC) patients treated with photodynamic therapy (PDT) compared with ablation therapy and radiation therapy. From Surveillance, Epidemiology, and End Results-Medicare linked data, patients diagnosed with stage I...

Continuity of care is important for prostate cancer care due to multiple treatment options, and prolonged disease history. We examined the association between continuity of care and outcomes in Medicare beneficiaries with localized prostate cancer, and the moderating effect of race using Surveillance, Epidemiological, and End Results (SEER) – Medic...

Background: Improved survivorship among persons living with HIV translates into higher risk of medical comorbidities. Objective: We assessed the association between intersection of physical (HIV) and mental health (psychiatric) conditions and intermediate outcomes. Methods: Cross-sectional study of Medical Expenditure Panel Survey (MEPS)-House...

Background Depression is common after a diagnosis of prostate cancer and may contribute to poor outcomes, particularly among African Americans. The authors assessed the incidence and management of depression and its impact on overall mortality among African American and White veterans with localized prostate cancer. Methods The authors used the Ve...

202 Background: Known racial disparities in prostate cancer outcomes between African-American (AA) and non-Hispanic White (W) men may be ameliorated in the Veterans Health Administration (VA), a large national equal-access health system. We examined factors contributing to racial disparities in mortality among men with high-risk localized prostate...

201 Background: Depressive disorder is a common cause of morbidity among men with prostate cancer (PC) and may contribute to known racial disparities in PC outcomes. We estimated the incidence, management, and impact of depressive disorder (depression) on overall mortality among African American (AA) and non-Hispanic White (W) Veterans with localiz...

235 Background: Hospital competition is important for addressing the disparity in quality and cost of prostate cancer care. Study objective was to examine the association of hospital competition with process of care (time to treatment, treatment and overuse) and outcomes (medial care use, complications, mortality and cost) in Medicare fee-for-servi...

223 Background: There is no consistent evidence with respect to the role of hospital efficiency in improving quality of prostate cancer care. Study objective was to examine the association between hospital efficiency and quality of care in African American, Hispanic, and white Medicare beneficiaries with prostate cancer. Methods: Population-based c...

Data regarding the association between photodynamic therapy (PDT) and mortality in lung cancer patients are limited. We analyzed the association between PDT and mortality in patients with stage III or IV non-small cell lung cancer (NSCLC) using data from the National Cancer Database (NCDB) between 2004 and 2016. From the NCDB, we identified patient...

Aims: To describe the development and feasibility of a preference elicitation instrument, OABCare, using choice-based adaptive conjoint analysis (ACA) among patients with overactive bladder (OAB). Methods: This was a two-phase study. In Phase 1, an extensive literature review along with patient and provider focus groups yielded the attributes an...

Information seeking is essential for effective patient-centered decision-making. However, prostate cancer patients report a gap between information needed and information received. The importance of different information sources for treatment decision remains unclear. Thus, using the Comprehensive Model of Health Information (CMIS) framework, we as...

Importance: Conservative management (ie, active surveillance or watchful waiting) is a guideline-based strategy for men with low-risk and intermediate-risk prostate cancer. However, use of conservative management is controversial for African American patients, who have worse prostate cancer outcomes compared with White patients. Objective: To ex...

e19037 Background: Equal access to care may mediate racial disparities among men with localized prostate cancer. We examined the association between African-American race and long-term mortality among men with high-risk prostate cancer in a large equal-access health system. Methods: In this retrospective cohort study, we used the VA Corporate Data...

Background: To assess the interaction of breast cancer, HIV infection, Medicare disability status, cancer stage and its implications for outcomes, after accounting for competing risks among female, fee-for-service Medicare enrollees. Methods: We used data from Surveillance, Epidemiology and End Results (SEER) -Medicare (2000-2013). From primary...

Background: Non-small cell lung cancer (NSCLC) patients with central airway obstruction (CAO) may have better survival on systemic therapy if the airway patency is successfully restored by bronchoscopic interventions. It remains unclear which therapeutic bronchoscopic modality [laser, stenting, external beam radiation, brachytherapy and photodynam...

Objective To analyze the cost associated with sleep apnea, and effects of CPAP treatment on costs among fee-for-service Medicare beneficiaries. Methods Retrospective cohort design using 5% Medicare claims between 2006 and 2010. Medicare beneficiaries with and without sleep apnea diagnosis between 2007 and 2008 were identified and followed retrospe...

Importance The association between androgen deprivation therapy (ADT) exposure and dementia is uncertain. Objective To analyze the association between ADT exposure and diagnosis of Alzheimer disease or dementia among elderly men with prostate cancer. Design, Setting, and Participants This retrospective cohort study used data from the National Can...

Background: To determine the comparative effectiveness of primary radical prostatectomy (RP) compared to external bean radiation therapy (EBRT) with androgen deprivation therapy (ADT), or EBRT plus brachytherapy (BT) with or without ADT among Medicare fee-for-service beneficiaries with high-risk prostate cancer, for 10-year, mortality (overall and...

Objectives. To describe the development of our Patient Preferences for Prostate Cancer Care (PreProCare) tool to aid patient-centered treatment decision among localized prostate cancer patients. Methods. We incorporated patient and provider experiences to develop a patient preference elicitation tool using adaptive conjoint analysis. Our patient-ce...

Purpose: To study the effectiveness of the Patient Preferences for Prostate Cancer Care (PreProCare) intervention in improving the primary outcome of satisfaction with care and secondary outcomes of satisfaction with decision, decision regret, and treatment choice among patients with localized prostate cancer. Methods: In this multicenter random...

72 Background: African-American men with prostate cancer have higher cancer-related and all-cause mortality than their Caucasian counterparts. Differences in adherence to guideline-based survivorship care may contribute to these disparities. Methods: Using the SEER-Medicare database, we conducted a retrospective cohort study of men ≥66 years old tr...

239 Background: Retrospective studies have suggested an association between ADT and cognitive dysfunction among men with prostate cancer. This association may be mediated directly by ADT or indirectly by long-term decreased androgen levels. We hypothesized that there would be no difference in rates of subsequent dementia among elderly men who recei...

Background Overactive bladder (OAB) affects millions of women. It is important to assess knowledge and attitude in affected patients. The study objective was to develop surveys to assess OAB knowledge and OAB related attitude, and its association with OAB treatment status. Methods Systematic literature review and qualitative analysis of patient and...

Background: Recruitment and retention strategies for patient-centered outcomes research are evolving and research on the subject is limited. In this work, we present a conceptual model of patient-centered recruitment and retention, and describe the recruitment and retention activities and related challenges in a patient-centered comparative effect...

Aims To analyze the risk of falls associated with Overactive bladder (OAB), and the effects of OAB treatment on falls among older adult Medicare fee‐for‐service enrollees. Methods Population based retrospective longitudinal cohort design study using 5% Medicare claims between 2006 and 2010. Patients with a diagnosis of OAB (ICD 9: 596.51); Urinary...

Objective To elicit patient stakeholders’ experience and perspectives about patient-centred care. Design Qualitative. Setting A large urban healthcare system. Participants Four patient stakeholders who are prostate cancer survivors. Main outcome measures Experience and perspectives of patient stakeholders regarding patient-centred care and trea...

Background Substance abuse is a growing, but mostly silent, epidemic among older adults. We sought to analyze the trends in admissions for substance abuse treatment among older adults (aged 55 and older). Methods Treatment Episode Data Set - Admissions (TEDS-A) for period between 2000 and 2012 was used. The trends in admission for primary substance...

Objective: To determine whether physician preferences for end-of-life care were associated with variation in health care spending. Method: We studied 737 physicians who completed the life-sustaining treatment questionnaire in 1999 and were linked to end-of-life care data for the years 1999 to 2009 from Medicare-eligible beneficiaries from the Dartm...

Objective: To assess the usability of Minimal Important Difference (MID) and minimal clinically important difference (MCID) for measuring meaningful changes in disease-specific and generic HRQoL outcomes in patient-centered care. Study design and setting: We adopted a two-step literature review process. First, we used PubMed and Google scholar t...

Background In the context of prostate cancer (PCa) characterized by the multiple alternative treatment strategies, comparative effectiveness analysis is essential for informed decision-making. We analyzed the comparative effectiveness of PCa treatments through systematic review and meta-analysis with a focus on outcomes that matter most to newly di...

Patient-centered care that reflects consumer-driven health care decision of an individual as opposed to collective or social choice–based health decision has many implications for clinical decision and resource allocation. With possession of required information and faced with appropriate assessment of preferences, older adults make better choices...

e576Background: To determine the five year survival impact of primary surgery compared to radiation therapy in older men with high risk prostate cancer. Methods: This was a population-based cohort study using Surveillance, Epidemiology, and End Results (SEER)-Medicare patients 66 years or older, diagnosed for prostate cancer between 2004 and 2008....

Objective: To analyze the association between age, substance use, and outcomes in fee-for-service Medicare enrollees with advanced prostate cancer. Methods: Retrospective longitudinal cohort study of elderly men diagnosed with advanced prostate cancer using SEER-Medicare data between 2000 and 2009. Substance use disorder was identified using cla...

Substance use among cancer patients is an important psychosocial comorbidity. Currently, there is a paucity of information regarding racial disparity in substance use among cancer patients. The objective of this study was to analyze racial and ethnic disparity in prevalence of substance use and its effects on outcomes in Medicare elderly with advan...

The aims of the study were to understand the racial/ethnic differences in cost of care and mortality in Medicare elderly with advanced stage prostate cancer. This retrospective, observational study used SEER-Medicare data. Cohort consisted of 10,509 men aged 66 or older and diagnosed with advanced-stage prostate cancer between 2001and 2004. The coh...

Objective Nocturia affects millions of men and women. No prior reviews or meta-analyses have explored the issue of adherence in nocturia patients. The objective of our study was to examine the attributes and their interaction that might impact pharmacological adherence in nocturia care using a conceptual model of adherence. Materials and methods A...

Background: Substance use disorder in patients with cancer has implications for outcomes. The objective of this study was to analyze the effects of the type and timing of substance use on outcomes in elderly Medicare recipients with advanced prostate cancer. Methods: This was an observational cohort study using Surveillance, Epidemiology, and En...

Purpose of review: Incontinence is not an isolated symptom in men, but rather a component of a multifactorial problem that may include other lower urinary tract symptoms (LUTS). Male urinary incontinence is often seen following prostate surgery and procedures, particularly prostate cancer surgery. Men with enlarged prostates experience overactive...

Objective: To identify patient characteristics associated with concordance of Medicare claims with clinically identified depression. Methods: The authors studied a cohort of 742 older primary care patients linked to Medicare claims data using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edit...

131 Background: Limited information is available regarding the association between race/ethnicity, health service use, cost, and mortality in older patients with advanced (T3 or greater) stage prostate cancer. The objective is to analyze the race/ethnic differences in mortality, cost, and assess the mediating effect of prostate cancer screening and...

Abstract Stress is implicated in the pathogenesis and progression of HIV. The Transcendental Meditation (TM) is a behavioral stress reduction program that incorporates mind-body approach, and has demonstrated effectiveness in improving outcomes via stress reduction. We evaluated the feasibility of implementing TM and its effects on outcomes in pers...

We sought to analyze the prevalence and incremental burden of depression among elderly with prostate cancer. We adopted a retrospective cohort design using the Surveillance, Epidemiology and End Results-Medicare linked database between 1995 and 2003. Patients with prostate cancer diagnosed between 1995 and 1998 were identified and followed retrospe...

To determine the minimal important difference (MID) in generic and prostate-specific health-related quality of life (HRQoL) using distribution- and anchor-based methods. Prospective cohort study of 602 newly diagnosed prostate cancer patients recruited from an urban academic hospital and a Veterans Administration hospital. Participants completed ge...

With the aging of the population and the demographic shift of elderly in the healthcare system, the emergency departments will be increasingly challenged with complexities of providing care to geriatric patients. Major consumers of emergency health care in the U.S. hospitals are over 65 years old [1]. In 2009, 25% of adults aged 65 years or older h...

The objective of this study was to assess the racial and ethnic disparities in outcomes and their association with process-of-care measures for elderly Medicare recipients with localized prostate cancer. The Surveillance, Epidemiology, and End Results-Medicare databases for the period from 1995 to 2003 were used to identify African-American men, no...

We analyzed the racial differences in physical well-being, social/family well-being, functional well-being, emotional well-being, and prostate cancer specific worry among men with clinically localized prostate cancer. In this prospective cohort study, we recruited 121 Caucasian and 77 African American men with newly diagnosed prostate cancer. Parti...

To assess the recruitment, adherence, and retention of urban elderly, predominantly African Americans to a falls reduction exercise program. The randomized controlled trial was designed as an intervention development pilot study. The goal was to develop a culturally sensitive intervention for elderly persons who suffered a fall and visited an emerg...