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.
Hospital variation in the practice of bilateral salpingectomy with ovarian conservation in 2012
Xu X, Desai VB. Hospital variation in the practice of bilateral salpingectomy with ovarian conservation in 2012. Obstetrics & Gynecology. 2016;127(2):297-305.
The role of patient factors, cancer characteristics and treatment patterns in the cost of care for Medicare beneficiaries with breast cancer.
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.
Hospital phenotypes in the management of patients admitted for acute myocardial infarction.
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].
Wide variation found in hospital facility costs for maternity stays involving low-risk childbirth.
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.
Cost-effectiveness of immediate compared with delayed postpartum etonogestrel implant insertion.
Gariepy AM, Duffy JY, Xu X. Cost-effectiveness of immediate compared with delayed postpartum etonogestrel implant insertion. Obstetrics & Gynecology 2015;126(1):47–55.
Sex differences in perceived stress and early recovery in young and middle-aged patients with acute myocardial infarction.
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.
Costs of a motivational enhancement therapy coupled with cognitive behavioral therapy versus brief advice for pregnant substance users.
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.
Probability of pregnancy after sterilization: A comparison of hysteroscopic versus laparoscopic sterilization.
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.
Cost-effectiveness of endometrial evaluation prior to morcellation in surgical procedures for prolapse.
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.
Pelvic floor consequences of cesarean delivery on maternal request in women with a single birth: A cost-effectiveness analysis.
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.
Full List of PubMed Publications
- Desai VB, Wright JD, Schwartz PE, Jorgensen EM, Fan L, Litkouhi B, Lin H, Gross CP, Xu X: Occult Gynecologic Cancer in Women Undergoing Hysterectomy or Myomectomy for Benign Indications. Obstet Gynecol. 2018 Mar 8; 2018 Mar 8. PMID: 29528920
- Oliveira CR, Rock RM, Shapiro ED, Xu X, Lundsberg L, Zhang LB, Gariepy A, Illuzzi JL, Sheth SS: Missed opportunities for HPV immunization among young adult women. Am J Obstet Gynecol. 2018 Mar; 2017 Dec 6. PMID: 29223597
- Lundsberg LS, Lee HC, Dueñas GV, Gregory KD, Grossetta Nardini HK, Pettker CM, Illuzzi JL, Xu X: Quality Assurance Practices in Obstetric Care: A Survey of Hospitals in California. Obstet Gynecol. 2018 Feb. PMID: 29324608
- Lundsberg LS, Xu X, Schwarz EB, Gariepy AM: Measuring health utility in varying pregnancy contexts among a diverse cohort of pregnant women. Contraception. 2017 Dec; 2017 Aug 17. PMID: 28823842
- Tannenbaum S, Soulos PR, Herrin J, Mougalian S, Long JB, Wang R, Ma X, Gross CP, Xu X: Regional Medicare Expenditures and Survival Among Older Women With Localized Breast Cancer. Med Care. 2017 Dec. PMID: 29068906
- Collins SC, Xu X, Mak W: Cost-effectiveness of preimplantation genetic screening for women older than 37 undergoing in vitro fertilization. J Assist Reprod Genet. 2017 Nov; 2017 Jul 27. PMID: 28748493
- Wang R, Zeidan AM, Halene S, Xu X, Davidoff AJ, Huntington SF, Podoltsev NA, Gross CP, Gore SD, Ma X: Health Care Use by Older Adults With Acute Myeloid Leukemia at the End of Life. J Clin Oncol. 2017 Oct 20; 2017 Aug 7. PMID: 28783450
- Pollack CE, Soulos PR, Herrin J, Xu X, Christakis NA, Forman HP, Yu JB, Killelea BK, Wang SY, Gross CP: The Impact of Social Contagion on Physician Adoption of Advanced Imaging Tests in Breast Cancer. J Natl Cancer Inst. 2017 Aug 1. PMID: 28376191
- Dhruva SS, Huang C, Spatz ES, Coppi AC, Warner F, Li SX, Lin H, Xu X, Furberg CD, Davis BR, Pressel SL, Coifman RR, Krumholz HM: Heterogeneity in Early Responses in ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial). Hypertension. 2017 Jul; 2017 May 30. PMID: 28559399
- Li J, Li X, Ross JS, Wang Q, Wang Y, Desai NR, Xu X, Nuti SV, Masoudi FA, Spertus JA, Krumholz HM, Jiang L, China PEACE Collaborative Group.: Fibrinolytic therapy in hospitals without percutaneous coronary intervention capabilities in China from 2001 to 2011: China PEACE-retrospective AMI study. Eur Heart J Acute Cardiovasc Care. 2017 Apr; 2016 Jan 19. PMID: 26787648
- Xu X, Yonkers KA, Ruger JP: Economic evaluation of a behavioral intervention versus brief advice for substance use treatment in pregnant women: results from a randomized controlled trial. BMC Pregnancy Childbirth. 2017 Mar 7; 2017 Mar 7. PMID: 28270105
- Desai VB, Guo XM, Fan L, Wright JD, Xu X: Inpatient Laparoscopic Hysterectomy in the United States: Trends and Factors Associated With Approach Selection. J Minim Invasive Gynecol. 2017 Jan 1; 2016 Sep 7. PMID: 27614151
- Xu X, Bao H, Strait KM, Edmondson DE, Davidson KW, Beltrame JF, Bueno H, Lin H, Dreyer RP, Brush JE, Spertus JA, Lichtman JH, DʼOnofrio G, Krumholz HM: Perceived Stress After Acute Myocardial Infarction: A Comparison Between Young and Middle-Aged Women Versus Men. Psychosom Med. 2017 Jan. PMID: 27984507
- Yeboa DN, Xu X, Jones BA, Soulos P, Gross C, Yu JB: Trend in Age and Racial Disparities in the Receipt of Postlumpectomy Radiation Therapy for Stage I Breast Cancer: 2004-2009. Am J Clin Oncol. 2016 Dec. PMID: 24879475
- Du X, Pi Y, Dreyer RP, Li J, Li X, Downing NS, Li L, Feng F, Zhan L, Zhang H, Guan W, Xu X, Li SX, Lin Z, Masoudi FA, Spertus JA, Krumholz HM, Jiang L, China PEACE Collaborative Group.: The china patient-centered evaluative assessment of cardiac events (PEACE) prospective study of percutaneous coronary intervention: Study design. Catheter Cardiovasc Interv. 2016 Dec; 2016 Mar 4. PMID: 26945565
- Silvestri MT, Pettker CM, Raney JH, Xu X, Ross JS: Frequency and Importance of Incomplete Screening Fetal Anatomic Sonography in Pregnancy. J Ultrasound Med. 2016 Dec; 2016 Nov 7. PMID: 27821652
- Beckman AL, Bucholz EM, Zhang W, Xu X, Dreyer RP, Strait KM, Spertus JA, Krumholz HM, Spatz ES: Sex Differences in Financial Barriers and the Relationship to Recovery After Acute Myocardial Infarction. J Am Heart Assoc. 2016 Oct 14; 2016 Oct 14. PMID: 27742618
- Xu X, Li SX, Lin H, Normand SL, Lagu T, Desai N, Duan M, Kroch EA, Krumholz HM: Hospital Phenotypes in the Management of Patients Admitted for Acute Myocardial Infarction. Med Care. 2016 Oct. PMID: 27261637
- Shih T, Peneva D, Xu X, Sutton A, Triche E, Ehrenkranz RA, Paidas M, Stevens W: The Rising Burden of Preeclampsia in the United States Impacts Both Maternal and Child Health. Am J Perinatol. 2016 Mar; 2015 Oct 19. PMID: 26479171
- Dreyer RP, Xu X, Zhang W, Du X, Strait KM, Bierlein M, Bucholz EM, Geda M, Fox J, D'Onofrio G, Lichtman JH, Bueno H, Spertus JA, Krumholz HM: Return to Work After Acute Myocardial Infarction: Comparison Between Young Women and Men. Circ Cardiovasc Qual Outcomes. 2016 Feb. PMID: 26908859
- Xu X, Herrin J, Soulos PR, Saraf A, Roberts KB, Killelea BK, Wang SY, 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 Serv Res. 2016 Feb; 2015 Jun 29. PMID: 26119176
- Xu X, Desai VB: Hospital Variation in the Practice of Bilateral Salpingectomy With Ovarian Conservation in 2012. Obstet Gynecol. 2016 Feb. PMID: 26942357
- Chen SI, Wang Y, Dreyer R, Strait KM, Spatz ES, Xu X, Smolderen KG, Desai NR, Lorenze NP, Lichtman JH, Spertus JA, D'Onofrio G, Bueno H, Masoudi FA, Krumholz HM: Insurance and Prehospital Delay in Patients ≤55 Years With Acute Myocardial Infarction. Am J Cardiol. 2015 Dec 15; 2015 Oct 9. PMID: 26541907
- Desai VB, Xu X: An update on inpatient hysterectomy routes in the United States. Am J Obstet Gynecol. 2015 Nov; 2015 Jul 28. PMID: 26226555
- Xu X, Buta E, Anhang Price R, Elliott MN, Hays RD, Cleary PD: Methodological Considerations When Studying the Association between Patient-Reported Care Experiences and Mortality. Health Serv Res. 2015 Aug; 2014 Dec 7. PMID: 25483571
- 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 Aff (Millwood). 2015 Jul. PMID: 26153317
- Xu X, Liang J, Bennett JM, Botoseneanu A, Allore HG: Socioeconomic stratification and multidimensional health trajectories: evidence of convergence in later old age. J Gerontol B Psychol Sci Soc Sci. 2015 Jul; 2014 Aug 26. PMID: 25161216
- Gariepy AM, Duffy JY, Xu X: Cost-Effectiveness of Immediate Compared With Delayed Postpartum Etonogestrel Implant Insertion. Obstet Gynecol. 2015 Jul. PMID: 26241255
- Gariepy AM, Creinin MD, Smith KJ, Xu X: Probability of pregnancy after sterilization: a comparison of hysteroscopic versus laparoscopic sterilization. Contraception. 2015 Jun; 2015 Mar 10. PMID: 25769439
- Kim N, Bernheim SM, Ott LS, Han L, Spivack SB, Xu X, Volpe M, Liu A, Krumholz HM: An administrative claims measure of payments made for Medicare patients for a 30-day episode of care for acute myocardial infarction. Med Care. 2015 Jun. PMID: 25970575
- Desai VB, Guo XM, Xu X: Alterations in surgical technique after FDA statement on power morcellation. Am J Obstet Gynecol. 2015 May; 2015 Feb 28. PMID: 25735888
- 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 Feb 17; 2015 Feb 9. PMID: 25679303
- Murphy TE, Allore HG, Han L, Peduzzi PN, Gill TM, Xu X, Lin H: A longitudinal, observational study with many repeated measures demonstrated improved precision of individual survival curves using Bayesian joint modeling of disability and survival. Exp Aging Res. 2015. PMID: 25978444
- Gressel GM, Lundsberg LS, Illuzzi JL, Danton CM, Sheth SS, Xu X, Gariepy A: Patient and provider perspectives on Bedsider.org, an online contraceptive information tool, in a low income, racially diverse clinic population. Contraception. 2014 Dec; 2014 Jul 25. PMID: 25139723
- Xu X, Li SX, Lin H, Normand SL, Kim N, Ott LS, Lagu T, Duan M, Kroch EA, Krumholz HM: "Phenotyping" hospital value of care for patients with heart failure. Health Serv Res. 2014 Dec; 2014 Jun 28. PMID: 24974769
- Bikdeli B, Wayda B, Bao H, Ross JS, Xu X, Chaudhry SI, Spertus JA, Bernheim SM, Lindenauer PK, Krumholz HM: Place of residence and outcomes of patients with heart failure: analysis from the telemonitoring to improve heart failure outcomes trial. Circ Cardiovasc Qual Outcomes. 2014 Sep; 2014 Jul 29. PMID: 25074375
- Gariepy AM, Creinin MD, Smith KJ, Xu X: Probability of pregnancy after sterilization: a comparison of hysteroscopic versus laparoscopic sterilization. Contraception. 2014 Aug; 2014 Apr 25. PMID: 24767963
- Wang SY, Wang R, Yu JB, Ma X, Xu X, Kim SP, Soulos PR, Saraf A, Gross CP: Understanding regional variation in Medicare expenditures for initial episodes of prostate cancer care. Med Care. 2014 Aug. PMID: 25023913
- Menderes G, Azodi M, Clark L, Xu X, Lu L, Ratner E, Schwartz PE, Rutherford TJ, Santin AD, Silasi DA: Impact of body mass index on surgical outcomes and analysis of disease recurrence for patients with endometrial cancer undergoing robotic-assisted staging. Int J Gynecol Cancer. 2014 Jul. PMID: 24927247
- DeNoble AE, Hall KS, Xu X, Zochowski MK, Piehl K, Dalton VK: Receipt of prescription contraception by commercially insured women with chronic medical conditions. Obstet Gynecol. 2014 Jun. PMID: 24807345
- Xu X, Grossetta Nardini HK, Ruger JP: Micro-costing studies in the health and medical literature: protocol for a systematic review. Syst Rev. 2014 May 21; 2014 May 21. PMID: 24887208
- 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; 2014 Apr 23. PMID: 24760017
- Lundsberg LS, Pal L, Gariepy AM, Xu X, Chu MC, Illuzzi JL: Knowledge, attitudes, and practices regarding conception and fertility: a population-based survey among reproductive-age United States women. Fertil Steril. 2014 Mar; 2014 Jan 30. PMID: 24484995
- Xu X, Spurr SJ, Nan B, Fendrick AM: The effect of medical malpractice liability on rate of referrals received by specialist physicians. Health Econ Policy Law. 2013 Oct; 2013 Mar 26. PMID: 23527533
- Partovian C, Li SX, Xu X, Lin H, Strait KM, Hwa J, Krumholz HM: Patterns of change in nesiritide use in patients with heart failure: how hospitals react to new information. JACC Heart Fail. 2013 Aug; 2013 Aug 5. PMID: 24621935
- 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. Am J Obstet Gynecol. 2013 Jul; 2013 Mar 29. PMID: 23545164
- Wang R, Gross CP, Frick K, Xu X, Long J, Raza A, Galili N, Zikria J, Guan Y, Ma X: The impact of hypomethylating agents on the cost of care and survival of elderly patients with myelodysplastic syndromes. Leuk Res. 2012 Nov; 2012 Aug 20. PMID: 22917770
- Xu X, Menees SB, Zochowski MK, Fenner DE: Economic cost of fecal incontinence. Dis Colon Rectum. 2012 May. PMID: 22513438
- Cramer JA, Brandenburg NA, Xu X, Vera-Llonch M, Oster G: The impact of seizures and adverse effects on global health ratings. Epilepsy Behav. 2007 Sep; 2007 Jul 27. PMID: 17681863
- Cramer JA, Brandenburg N, Xu X: Differentiating anxiety and depression symptoms in patients with partial epilepsy. Epilepsy Behav. 2005 Jun; 2005 Apr 26. PMID: 15907750