Variation profiles of common surgical procedures
Variation profiles of common surgical procedures
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DOI：
10.1067/msy.1998.90268
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发表时间：
1998-11-01
期刊：
影响因子：
3.8
通讯作者：
Wennberg, JE
中科院分区：
文献类型：
--
作者：
Birkmeyer, JD;Sharp, SM;Wennberg, JE
背景。许多外科手术的比率在大小地理区域差别很大。虽然医疗保健的变化早已被描述，但很少有研究系统地比较了外科手术过程中的变化概况。这项研究的目的是检查当前的。常见外科手术率的区域差异模式。研究人群包括1995年参加医疗保险的患者，不包括那些参加承担风险的健康维护组织的患者。患者年龄从65岁到99岁不等。利用医院出院摘要的数据，我们计算了美国306个医院转诊地区（HRRs）中11种常见住院手术的发生率。为了评估每个手术的相对可变性，我们确定了低和高异常区域的数量（HRR为全国平均水平的150%）和最高HRR与最低HRR的比率。程序的可变性明显不同。髋部骨折修复、结肠直肠癌切除术和胆囊切除术的比率在hrr中仅变化1.9- 2.9倍（分别为0,0和4个异常区域）。冠状动脉旁路移植术、经尿道前列腺切除术、乳房切除术和全髋关节置换术具有中等程度的差异，不同区域的差异为3.5至4.7倍（分别为8、10、16和17个异常区域）。下肢血运重建术、颈动脉内膜切除术、背部手术和根治性前列腺切除术的变异谱最高，从6.5到10不等。hrr为1倍（分别为25、32、39和56个异常区域）。尽管许多外科手术的使用在不同的地理区域差别很大，但“自由裁量”手术的比率变化最大。为了避免潜在的过度使用或使用不足，在临床决策中增加共识的努力应该集中在这些高变化的程序上。
Background. Rates of many surgical procedures vary widely across both large and small geographic regions. Although variation in health care we has long been described, few studies have systematically compared variation profiles across surgical procedures. The goal of this study was to examine current. Patterns of regional variation in the rates of common surgical procedures.Methods. The study population consisted of patients enrolled in Medicare in 1995, excluding those enrolled in risk-bearing health maintenance organizations. Patients ranged in age from 65 to 99 years. Using data from hospital discharge abstracts, we calculated rates of 11 common inpatient procedures for each of 306 US hospital referral regions (HRRs). To assess the relative variability of each procedure, we determined the number of low and high outlier regions (HRRs with rates 150 % the national average) and the ratio of highest to lowest HRR rates.Results. Procedures differed markedly in their variability. Rates of hip fracture repair, resection for colorectal cancer, and cholecystectomy varied only 1.9- to 2.9-fold across HRRs (0, 0, and 4 outlier regions, respectively). Coronary artery bypass grafting, transurethral prostatectomy, mastectomy, and total hip replacement had intermediate variation profiles, varying 3.5- to 4.7-fold across regions (8, 10, 16, and 17 outlier regions, respectively). Lower extremity revascularization, carotid endarterectomy, back surgery, and radical prostatectomy had the highest variation profiles, varying 6.5- to 10. I-fold across HRRs (25, 32, 39, and 56 outlier regions, respectively).Conclusions. Although the use of many surgical procedures varies widely across geographic areas, rates of "discretionary" procedures are most variable. To avoid potential overuse or underuse, efforts to increase consensus in clinical decision making should focus on these high variation procedures.