Researching Strategies for High-Quality, High-Value Care to Improve Patient Outcomes
Xiao Xu, Ph.D.
Associate Professor of Obstetrics, Gynecology and Reproductive Sciences
Yale School of Medicine
“I was trained in health economics and outcomes research, and have always been interested in improving quality and outcomes of care while balancing the cost implications. AHRQ funding has helped to elevate the quality of my research and the breadth of my projects.”
Helping patients get care that is safe, equitable, efficient, and cost-effective is the goal of Xiao Xu, Ph.D., associate professor of Obstetrics, Gynecology and Reproductive Sciences at Yale School of Medicine, New Haven. A health economist and health services researcher, Dr. Xu studies and identifies strategies to promote high-quality and high-value care, particularly for women and the elderly.
Among her major areas of study, Dr. Xu has explored the impact of health insurance (managed care versus traditional fee-for-service) on healthcare use by older adults and identified hospital variation in practices related to childbirth care. More recently, she has examined the incidence of unsuspected uterine cancer at the time of hysterectomy.
In the early 2000s, managed care was gaining a lot of momentum for its emphasis on reducing costs, according to Dr. Xu. Less understood was what she identifies as the other side of the “value” equation—whether managed care might have unintended consequences on health outcomes.
She led an AHRQ-funded study to analyze the effects of managed care plans {e.g., health maintenance organization (HMO) or preferred provider organization (PPO)} on the health of enrollees, in comparison to conventional fee-for-service plans.
“I focused on adults ages 55-64, because that is a critical age range when many individuals start experiencing health decline,” according to Dr. Xu. Her study found that HMOs did not negatively impact the health status of enrollees. Additionally, older adults with a history of chronic health conditions actually fared better upon enrolling in these plans, likely due to many HMOs’ strong emphasis on preventive care.
While a wide range of payment and delivery reforms were introduced to help incentivize high-value care, obstetric care did not receive much attention at the beginning, according to Dr. Xu. “There is a wide spectrum of women’s health issues that have major clinical, public health, and policy impact but are under-studied, ranging from the high cost of childbirth delivery to disparities in cancer prevention and treatment,” she noted.
To help address this gap, Dr Xu received a second AHRQ grant in 2015 to examine hospital variation in cost and outcomes of care for childbirth-related hospitalizations. Her team also sought to identify hospital practices associated with high-value care, such as use of low-interventional care. Dr. Xu’s research helped inform the feasibility of identifying high-value institutions and benchmarking hospital performance.
Continuing her focus on improving quality and outcomes of care, Dr. Xu undertook another AHRQ-funded study in 2016 to examine the prevalence and characteristics of undetected uterine cancer in women undergoing hysterectomy (surgical removal of the uterus) or myomectomy (surgical removal of uterine fibroids). Approximately 600,000 hysterectomies are performed each year. Most hysterectomies are performed for benign indications such as uterine fibroids, but some patients may have unrecognized uterine cancer.
Dr. Xu studied how laparoscopic power morcellation—a technique once commonly used in hysterectomies for specimen removal - affected survival outcomes of these patients. This topic was the result of a safety warning from the Food and Drug Administration that laparoscopic power morcellation may inadvertently spread cancer cells and adversely affect survival if a patient has unexpected uterine cancer.
Her research highlighted the importance of pre-operative evaluation. “Women who undergo a hysterectomy or myomectomy should have an appropriate assessment before surgery to rule out uterine cancer, even if their surgery may be for presumed non-cancerous conditions,” Dr. Xu said.
Dr. Xu is a member of AcademyHealth, the Gerontological Society of America, and the International Health Economics Association. She received the Carol Weisman & Gary Chase Gender-Based Research Award from AcademyHealth in 2017.
Principal Investigator: Xiao Xu, Ph.D.
Institution: Yale School of Medicine
Grantee Since: 2003
Type of Grant: Various
Consistent with its mission, AHRQ provides a broad range of extramural research grants and contracts, research training, conference grants, and intramural research activities. AHRQ is committed to fostering the next generation of health services researchers who can focus on some of the most important challenges facing our Nation's health care system.
To learn more about AHRQ's Research Education and Training Programs, please visit https://www.ahrq.gov/training.
