Comparing cataract surgery complication rates in veterans receiving VA and community care
Comparing cataract surgery complication rates in veterans receiving VA and community care
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DOI：
10.1111/1475-6773.13320
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发表时间：
2020-07-27
影响因子：
3.4
通讯作者：
Shwartz, Michael
中科院分区：
文献类型：
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作者：
Rosen, Amy K.;Vanneman, Megan E.;Shwartz, Michael
目的 比较退伍军人选择法实施第一年期间在 VA 与社区护理 (CC) 接受白内障手术的退伍军人 90 天术后并发症发生率。数据来源 2015 财年 (FY) VA 和 CC 门诊数据来自 VA 企业数据仓库 (CDW) 10/01/14-9/30/2015)。 2014 财年数据用于获取手术前的基线临床信息。研究设计 使用二手数据进行为期一年的回顾性研究，比较 VA 与 CC 中白内障手术后 90 天的并发症发生率（使用国家质量论坛 (NQF) 标准进行测量）。 NQF 从当前程序术语 (CPT) 代码的指定列表中定义了主要并发症。我们运行了一系列逻辑回归模型来预测 90 天的并发症发生率，并根据退伍军人的社会人口学特征、合并症、术前眼部状况、眼部风险群体和白内障手术类型（分为常规手术与复杂手术）进行调整。数据收集 我们通过从 CDW 文件中获得的患者标识符将 VA 和 CC 用户联系起来。我们的样本包括 2015 财年期间在 VA 或通过 CC 接受门诊白内障手术的所有入伍退伍军人。白内障手术通过 CPT 代码 66 984（常规）和 66 982（复杂）进行识别。主要发现 在 2015 财年进行的 83,879 例白内障手术中，31% 是通过 CC 进行的。接受复杂手术和拥有高风险眼睛（基于术前眼部状况）是术后 90 天并发症的最强临床预测因素。总体而言，我们发现并发症发生率较低，低风险眼睛的并发症发生率为 1.1%，高风险眼睛的并发症发生率为 3.6%。在调整重要的混杂因素（例如种族、农村地区和术前眼部状况）后，VA 与 CC 中接受白内障手术的退伍军人之间 90 天并发症发生率没有统计学上的显着差异。结论 随着越来越多的退伍军人通过 CC 寻求护理，未来的研究应继续监测两种护理环境的护理质量，以帮助为 VA 的“自制还是购买决策”提供信息。
Objectives To compare 90-day postoperative complication rates between Veterans receiving cataract surgery in VA vs Community Care (CC) during the first year of implementation of the Veterans Choice Act. Data Sources Fiscal Year (FY) 2015 VA and CC outpatient data from VA's Corporate Data Warehouse (CDW) 10/01/14-9/30/15). FY14 data were used to obtain baseline clinical information prior to surgery. Study Design Retrospective one-year study using secondary data to compare 90-day complication rates following cataract surgery (measured using National Quality Forum (NQF) criteria) in VA vs CC. NQF defines major complications from a specified list of Current Procedural Terminology (CPT) codes. We ran a series of logistic regression models to predict 90-day complication rates, adjusting for Veterans' sociodemographic characteristics, comorbidities, preoperative ocular conditions, eye risk group, and type of cataract surgery (classified as routine vs complex). Data Collection We linked VA and CC users through patient identifiers obtained from the CDW files. Our sample included all enrolled Veterans who received outpatient cataract surgery either in the VA or through CC during FY15. Cataract surgeries were identified through CPT codes 66 984 (routine) and 66 982 (complex). Principal Findings Of the 83,879 cataract surgeries performed in FY15, 31 percent occurred through CC. Undergoing complex surgery and having a high-risk eye (based on preoperative ocular conditions) were the strongest clinical predictors of 90-day postoperative complications. Overall, we found low complication rates, ranging from 1.1 percent in low-risk eyes to 3.6 percent in high-risk eyes. After adjustment for important confounders (eg, race, rurality, and preoperative ocular conditions), there were no statistically significant differences in 90-day complication rates between Veterans receiving cataract surgery in VA vs CC. Conclusions As more Veterans seek care through CC, future studies should continue to monitor quality of care across the two care settings to help inform VA's "make vs buy decisions."