A Comparison of Surgical Quality and Patient Satisfaction Indicators Between VA Hospitals and Hospitals Near VA Hospitals
A Comparison of Surgical Quality and Patient Satisfaction Indicators Between VA Hospitals and Hospitals Near VA Hospitals
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DOI：
10.1016/j.jss.2020.05.071
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发表时间：
2020-11-01
影响因子：
2.2
通讯作者：
Wong, Sandra L.
中科院分区：
文献类型：
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作者：
Eid, Mark A.;Barnes, J. Aaron;Wong, Sandra L.
背景：《维护内部系统和加强综合外部网络 (MISSION) 法案》建立了一项社区护理计划，允许退伍军人在退伍军人事务医疗中心 (VAMC) 之外接受护理。我们试图比较 VAMC 和周边非 VAMC（非 VA）的患者安全和满意度指标。方法：我们在三个地理区域（西部/西南部、新英格兰和南部腹地）25 英里范围内确定了至少一家非 VA 急症护理医院的 VAMC。儿童医院、专科医院和重症医院被排除在外。使用公开的医院比较数据，我们分析了 VAMC 和周围非 VA 在术后患者安全指标 (PSI) 事件中的表现以及医院消费者对医疗保健提供者和系统的患者满意度评分和医院星级评级。结果：34 家 VAMC 在伤口裂开、意外撕裂、围手术期出血/血肿以及综合 PSI 评级方面的表现优于周围 319 家非 VA（P < 0.05）。在复合手术特异性 PSI 中，VAMC 的表现显着优于非 VA（每 1000 名患者 18.0 例与 51.4 例事件，P < 0.001）。当比较医疗保健提供者的平均线性医院消费者评估和系统评分星级（1-5 级）时，VAMC 与非 VA 相比，在总体医院评级（3.28 对比 3.38，P = 0.48）和住院总结评级（2.87 对比 2.92，P = 0.69）方面表现相似。当比较编制的患者满意度星级评级时，没有差异（2.96 与 2.97，P = 0.9）。 VAMC 在“推荐”评级中的表现比非 VA 差（2.7 与 3.13，P = 0.007）。结论：在不同地区，VAMC 在手术质量指标和患者满意度评级方面与邻近的非 VA 相当或优于邻近的非 VA。在 VAMC 接受手术护理的退伍军人可能会获得与非 VAMC 同等或更好的护理。 (C) 2020 Elsevier Inc. 保留所有权利。
Background: The Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act established a community care program allowing veterans to receive care outside Veteran Affairs Medical Centers (VAMCs). We sought to compare patient safety and satisfaction indicators from VAMCs and surrounding non-VAMCs (non-VAs).Methods: We identified VAMCs with at least one non-VA acute care hospital within 25 miles in three geographic regions (West/Southwest, New England, and Deep South). Children's, specialty, and critical access hospitals were excluded. Using publicly available Hospital Compare data, we analyzed VAMC and surrounding non-VA performance in postsurgical patient safety indicator (PSI) events and Hospital Consumer Assessment of Healthcare Providers and Systems patient satisfaction scores and hospital star ratings.Results: The 34 VAMCs performed better than 319 surrounding non-VAs in rates of wound dehiscence, accidental lacerations, and perioperative hemorrhage/hematoma as well as composite PSI rating (P < 0.05). VAMCs performed significantly better than non-VAs (18.0 versus 51.4 events per 1000 patients, P < 0.001) in composite surgery-specific PSIs. When comparing mean linear Hospital Consumer Assessment of Healthcare Providers and Systems score star ratings (1-5 scale), VAMCs had similar performance in overall hospital rating compared with non-VAs (3.28 versus 3.38, P = 0.48) and summary rating of hospital stays (2.87 versus 2.92, P = 0.69). When compiled patient satisfaction star ratings were compared, there was no difference (2.96 versus 2.97, P = 0.9). VAMCs performed worse than non-VAs in "would recommend" ratings (2.7 versus 3.13, P = 0.007).Conclusions: Across disparate regions, VAMCs match or outperform neighboring non-VAs in surgical quality metrics and patient satisfaction ratings. Veterans receiving surgical care at VAMCs may receive equivalent or better care than at non-VAs. (C) 2020 Elsevier Inc. All rights reserved.