Risk-adjusted regional outcomes in elective medicare colorectal surgery - 24/04/18
, Susan M. Nedza a, d, Michael Pine a, Agnes M. Reband a, Chun-Jung Huang a, Gregory Pine aAbstract |
Background |
Regional differences in utilization of services in healthcare are commonly understood, but risk-adjusted evaluation of outcomes has not been done.
Methods |
Risk-adjusted adverse outcomes (AOs) for elective Medicare colorectal resections were studied for 2012–2014. Risk-adjusted metrics were inpatient deaths, prolonged postoperative length-of-stay, 90-day post-discharge deaths, and 90-day relevant post-discharge readmissions. The nine Census Bureau regions of the U.S. were evaluated by using standard deviations of predicted adverse outcomes to evaluate observed versus expected events.
Results |
Overall AO rate was 24.3% from 86,624 patients in 1497 hospitals. Region 9 (Pacific) had the best outcomes (z-score = −3.06; risk-adjusted AO rate = 22.9%) and Region 1 (New England) the poorest (z-score = +1.86; risk-adjusted AO rate = 25.4%).
Conclusions |
A 4.9 SD difference exists among the best and poorest performing regions in risk-adjusted colorectal surgery outcomes. Alternative Payment Models should consider regional benchmarks as a variable for the evaluation of quality and pricing of episodes of care.
Le texte complet de cet article est disponible en PDF.Highlights |
• | This manuscript review of elective colorectal resections that are evaluated by hospital and by region of the country. |
• | The results identify differences among hospital performances and modest differences are seen between regions of the country. |
• | Hospital and regional differences will have significance as alternative payment models are being advanced. |
Keywords : Colorectal resections, Risk-adjusted outcomes, Post-operative mortality rates, 90-Day readmissions, Complications in colorectal surgery
Plan
Vol 215 - N° 3
P. 430-433 - mars 2018 Retour au numéro
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- Discussion of: The impact of the repeal of Michigan's universal helmet law on traumatic brain injury: A statewide analysis
- Discussion of: Risk-adjusted regional outcomes in elective medicare colorectal surgery
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