Benchmarking hospital outcomes for improvement of care in Medicare elective colon surgery - 20/06/16
, Michael Pine, M.D., M.B.A. a, Susan M. Nedza, M.D., M.B.A. a, d, David G. Locke, B.S. a, Agnes M. Reband, B.S. a, Gregory Pine, B.A. aAbstract |
Background |
Risk-adjusted outcomes are essential for hospitals to benchmark care improvement.
Methods |
We used the Medicare Limited Data Set for 2010 to 2012 to create risk models in elective colon surgery for the adverse outcomes (AOs) of inpatient deaths, prolonged length-of-stay outliers, 90-day post-discharge deaths without readmission, and 90-day relevant readmissions. Risk models permitted the prediction of AOs for each hospital and the design of hospital-specific standard deviations (SDs) to define performance from observed values. Risk-adjusted AO rates were computed for hospital comparisons.
Results |
In all, 1,903 hospitals with 129,861 patients were studied. Overall AO rate was 27.8%; 84 hospitals had AO performance that was 2 SDs poorer than average and 66 were 2 SDs better. The top performing decile of hospitals had a risk-adjusted AO rate of 15.8%, whereas the lowest performing hospital's rate was 39.4%.
Conclusions |
Benchmarking risk-adjusted AOs identifies the opportunity for care improvement in elective colon surgery in Medicare patients.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Nationally, more than 25% of elective colon resections among Medicare patients have an adverse outcome of care when followed for 90 days after discharge. |
• | Traditional reports that do not consider the full 90-day period of post-discharge follow-up will understate mortality rates by half. |
• | Most adverse events following colon surgery occur after discharge. |
• | The dramatic differences among hospitals in risk-adjusted adverse outcomes illustrate the opportunity for improved results. |
Keywords : Risk-adjusted hospital outcomes, Colon surgery, Readmissions, Postoperative deaths, Control charts, Complications of care
Plan
| The authors declare no conflicts of interest. |
Vol 212 - N° 1
P. 10-15 - juillet 2016 Retour au numéro
Article précédent
- Packed red blood cell transfusion after surgery: are we “overtranfusing” our patients?
- Donald J. Lucas, Aslam Ejaz, Gaya Spolverato, Yuhree Kim, Faiz Gani, Steven M. Frank, Timothy M. Pawlik
- The nature, patterns, clinical outcomes, and financial impact of intraoperative adverse events in emergency surgery
- Elie P. Ramly, Jordan D. Bohnen, Maha R. Farhat, Shadi Razmdjou, Michael N. Mavros, Daniel D. Yeh, Jarone Lee, Kathryn Butler, Marc De Moya, George C. Velmahos, Haytham M.A. Kaafarani
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?