Association of Quality of Care With Where Veterans Choose to Get Knee Replacement Surgery.
Association of Quality of Care With Where Veterans Choose to Get Knee Replacement Surgery.
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DOI：
10.1001/jamanetworkopen.2022.33259
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发表时间：
2022-09-01
影响因子：
13.8
通讯作者：
Rosen AK
中科院分区：
文献类型：
--
作者：
Giori NJ;Beilstein-Wedel EE;Shwartz M;Harris AHS;Vanneman ME;Wagner TH;Rosen AK
由退伍军人健康管理局（VA）设施实施（与购买）的全膝关节置换术（tka）的比例与所提供的护理质量之间是否存在关联？这项为期3年的队列研究，采用医疗保险和医疗补助服务中心对短期tka相关并发症的定义，对43371名退伍军人进行tka，发现在VA设施中进行tka的比例与VA执行的tka的风险标准化并发症发生率之间没有关联，VA购买的tka也没有关联。这些发现表明，退伍军人事务部应该监测和报告退伍军人事务部执行或购买的tka手术质量的有意义的措施，以优化退伍军人护理并告知质量改进。本队列研究考察了在每个退伍军人健康管理机构进行（与购买）全膝关节置换术的比例与通过短期并发症发生率衡量的护理质量之间是否存在关联。最近的立法扩大了退伍军人获得退伍军人健康管理局（VA）购买的医疗服务的机会。在选择何处进行全膝关节置换术（TKA）时应考虑质量，但目前可用的质量指标提供的指导很少。确定在每个VA设施执行tka的比例（与购买的比例）与提供的护理质量（以短期并发症发生率衡量）之间是否存在关联。这项为期3年的队列研究使用了VA企业数据仓库中的VA和社区护理数据（2017财年至2019财年）。并发症的定义遵循医疗保险和医疗补助服务中心的方法。该环境包括140家VA医疗保健机构执行或购买tka。参与者包括在研究期间有43 371例由va执行或va购买的初级TKA手术的退伍军人。在43 371例初级TKA手术中，18 964例（43.7%）为va购买。主要结局是风险标准化的短期并发症发生率，即va实施或va购买的tka。在每个VA设施进行tka的比例与VA执行和VA购买的护理质量之间的关系使用回归模型进行了检验。对于并发症发生率高于或低于总体平均并发症发生率的设施，以及执行超过或少于设施tka的一半的设施，还确定了亚组。在接受43 371次tka的41 775名退伍军人样本中，38 725名（89.3%）为男性，6406名（14.8%）为黑人，33 211名（76.6%）为白人，1367名（3.2%）为其他种族或民族（包括美洲印第安人或阿拉斯加原住民，亚洲人和夏威夷原住民或其他太平洋岛民）；平均（SD）年龄为66.9（8.5）岁。进行和购买va tka的平均（SD）原始总短期并发症发生率为2.97%（0.08%）。在VA设施中进行tka的比例与VA执行的tka的风险标准化并发症发生率之间没有关联，VA购买的tka也没有关联。在这项队列研究中，手术质量与退伍军人TKA的发生地点没有关联，可能是因为缺乏有意义的比较数据。报告当地和社区风险标准化并发症发生率可以为退伍军人的决策提供信息并改善护理。将这些数据与每个地点实施tka的比例相结合，可以促进行政决策，决定应在何处分配资源以改善护理。
Is there an association between the proportion of total knee arthroplasties (TKAs) performed (vs purchased) by Veterans Health Administration (VA) facilities and the quality of care provided? This 3-year cohort study of 43 371 TKAs on veterans, using Centers for Medicare and Medicaid Services’ definition of short-term TKA-related complications, found no association between the proportion of TKAs performed in VA facilities and risk-standardized complication rates for VA-performed TKAs, and no association for VA-purchased TKAs. These findings suggest that the VA should monitor and report meaningful measures of surgical quality for VA-performed or purchased TKAs to optimize veteran care and inform quality improvement. This cohort study examines whether an association exists between the proportion of total knee arthroplasties performed (vs purchased) at each Veterans Health Administration facility and the quality of care provided as measured by short-term complication rates. Recent legislation expanded veterans’ access to Veterans Health Administration (VA)-purchased care. Quality should be considered when choosing where to get total knee arthroplasty (TKA), but currently available quality metrics provide little guidance. To determine whether an association exists between the proportion of TKAs performed (vs purchased) at each VA facility and the quality of care provided (as measured by short-term complication rates). This 3-year cohort study used VA and community care data (fiscal year 2017 to fiscal year 2019) from the VA’s Corporate Data Warehouse. Complications were defined following the Centers for Medicare and Medicaid Services’ methodology. The setting included 140 VA health care facilities performing or purchasing TKAs. Participants included veterans who had 43 371 primary TKA procedures that were either VA-performed or VA-purchased during the study period. Of the 43 371 primary TKA procedures, 18 964 (43.7%) were VA-purchased. The primary outcome was risk-standardized short-term complication rates of VA-performed or VA-purchased TKAs. The association between the proportion of TKAs performed at each VA facility and quality of VA-performed and VA-purchased care was examined using a regression model. Subgroups were also identified for facilities that had complication rates above or below the overall mean complication rate and for facilities that performed more or less than half of the facility’s TKAs. Among the study sample’s 41 775 veterans who underwent 43 371 TKAs, 38 725 (89.3%) were male, 6406 (14.8%) were Black, 33 211 (76.6%) were White, and 1367 (3.2%) had other race or ethnicity (including American Indian or Alaska Native, Asian, and Native Hawaiian or other Pacific Islander); mean (SD) age was 66.9 (8.5) years. VA-performed and VA-purchased TKAs had a mean (SD) raw overall short-term complication rate of 2.97% (0.08%). There was no association between the proportion of TKAs performed in VA facilities and risk-standardized complication rates for VA-performed TKAs, and no association for VA-purchased TKAs. In this cohort study, surgical quality did not have an association with where veterans had TKA, possibly because meaningful comparative data are lacking. Reporting local and community risk-standardized complication rates may inform veterans’ decisions and improve care. Combining these data with the proportion of TKAs performed at each site could facilitate administrative decisions on where resources should be allocated to improve care.
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影响因子：
9.7
作者：
Vanneman, Megan E.;Wagner, Todd H.;Shwartz, Michael;Meterko, Mark;Francis, Joseph;Greenstone, Clinton L.;Rosen, Amy K.
通讯作者：
Rosen, Amy K.
影响因子：
4.2
作者：
Memtsoudis, Stavros G.;Hargett, Mary;Sculco, Thomas P.
通讯作者：
Sculco, Thomas P.
影响因子：
3
作者：
Rosen, Amy K.;Beilstein-Wedel, Erin E.;Giori, Nicholas J.
通讯作者：
Giori, Nicholas J.
影响因子：
2.2
作者：
Eid, Mark A.;Barnes, J. Aaron;Wong, Sandra L.
通讯作者：
Wong, Sandra L.
影响因子：
3.4
作者：
Rosen, Amy K.;Vanneman, Megan E.;Shwartz, Michael
通讯作者：
Shwartz, Michael