As a health economist and health services researcher, Dr. Xu’s research has focused on identifying factors that influence the delivery of high-quality and high-value care for women and older adults. Her major current projects include:
- Hospital Variation in Costs and Outcomes of Care for Childbirth (R01HS023801, funded by the Agency for Healthcare Research and Quality (AHRQ), PI: Xiao Xu): Maternal and newborn care are the leading reasons for hospital admissions in the U.S. Understanding patterns of care during these hospital stays can provide important insights into strategies to reduce health care costs. Moreover, recent evidence on large variation in intrapartum intervention rates across U.S. hospitals and lack of benefit of excessive intervention rates in improving maternal and perinatal outcomes highlight the need to rigorously examine hospital differences in efficiency and value of care. This R01 study examines hospital variation in costs and outcomes of care for childbirth-related hospitalizations and to identify hospital attributes and practices that are associated with high-value care (i.e., good outcomes and low costs). Both maternal and infant outcomes will be considered when assessing hospital performance, and hospital costs will be evaluated in conjunction with clinical outcomes to identify differences in value of care.
- Occult Uterine Cancer and Power Morcellation in Hysterectomy and Myomectomy (R01HS024702, funded by the Agency for Healthcare Research and Quality (AHRQ), PI: Xiao Xu): Uterine power morcellation is a technique of tissue removal that enables completion of laparoscopic hysterectomy and myomectomy with small incisions, helping improve patient recovery compared to traditional abdominal surgery. However, recent concern about possible spread of occult (i.e., preoperatively undetected) uterine cancer into the peritoneal cavity during power morcellation caused the U.S. Food and Drug Administration (FDA) issuing a safety warning against use of power morcellation in hysterectomy and myomectomy. This R01 study capitalizes on existing, large health care databases to examine the prevalence and characteristics of occult uterine cancer in women undergoing hysterectomy or myomectomy for presumed benign indications and assess the impact of uncontained power morcellation on cancer prognosis, practice changes following the FDA warning, and associated impact on patient safety and health care costs.
In addition, Dr. Xu has led several studies examining hospital variation in the practice of adnexal procedures at the time of hysterectomy; regional variation in medical expenditures among women with breast cancer; gender difference in recovery after acute myocardial infarction; and the impact of medical legal pressure on clinical practice, especially in obstetric care. She also collaborates widely with researchers on campus and across the country studying cost-effectiveness of health care interventions, economic burden of obstetric/gynecologic conditions, and utilization pattern of cancer screening services in women and factors that influence such utilization. Dr. Xu has served as a principal investigator or co-investigator on multiple research studies funded by the Agency for Healthcare Research and Quality (AHRQ), National Institutes of Health (NIH), and various research foundations.
- Xu X, Desai VB. Hospital variation in the practice of bilateral salpingectomy with ovarian conservation in 2012. Obstetrics & Gynecology. 2016;127(2):297-305.
- Xu X, Herrin J, Soulos PR, Saraf A, Roberts KB, Killelea BK, Wang S, Long JB, Wang R, Ma X, Gross CP. The role of patient factors, cancer characteristics and treatment patterns in the cost of care for Medicare beneficiaries with breast cancer. Health Services Research. 2016;51(1):167-186.
- Xu X, Li SX, Lin H, Normand ST, Lagu T, Desai N, Duan M, Kroch EA, Krumholz HM. Hospital phenotypes in the management of patients admitted for acute myocardial infarction. Medical Care. 2016 Jun 3. [Epub ahead of print].
- Xu X, Gariepy A, Lundsberg LS, Sheth SS, Pettker CM, Krumholz HM, Illuzzi JL. Wide variation found in hospital facility costs for maternity stays involving low-risk childbirth. Health Affairs (Millwood) 2015;34(7):1212-9.
- Gariepy AM, Duffy JY, Xu X. Cost-effectiveness of immediate compared with delayed postpartum etonogestrel implant insertion. Obstetrics & Gynecology 2015;126(1):47–55.
- Xu X, Bao H, Strait K, Spertus JA, Lichtman JH, D'Onofrio G, Spatz E, Bucholz EM, Geda M, Lorenze NP, Bueno H, Beltrame JF, Krumholz HM. Sex differences in perceived stress and early recovery in young and middle-aged patients with acute myocardial infarction. Circulation. 2015;131(7):614-23.
- Xu X, Yonkers KA, Ruger JP. Costs of a motivational enhancement therapy coupled with cognitive behavioral therapy versus brief advice for pregnant substance users. PLoS ONE. 2014; 9(4): e95264.
- Gariepy A, Creinin M, Smith K, Xu X. Probability of pregnancy after sterilization: A comparison of hysteroscopic versus laparoscopic sterilization. Contraception. 2014;90(2):174-181.
- McPencow AM, Erekson EA, Guess MK, Martin DK, Patel DA, Xu X. Cost-effectiveness of endometrial evaluation prior to morcellation in surgical procedures for prolapse. American Journal of Obstetrics & Gynecology. 2013;209(1):22.e1-9.
- Xu X, Ivy JS, Patel DA, Patel SN, Smith DG, Ransom SB, Fenner D, DeLancey JOL. Pelvic floor consequences of cesarean delivery on maternal request in women with a single birth: A cost-effectiveness analysis. Journal of Women’s Health. 2010;19(1):147-160.