A comparison of clinical outcomes from carotid artery stenting among US hospitals.
A comparison of clinical outcomes from carotid artery stenting among US hospitals.
复制标题
美国医院颈动脉支架置入术临床结果的比较。
DOI：
10.1161/circoutcomes.113.000819
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Groeneveld,PeterW
中科院分区：
文献类型：
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作者：
Epstein,AndrewJ;Yang,Lin;Yang,Feifei;Groeneveld,PeterW
背景医疗保险和医疗补助服务中心要求进行颈动脉支架植入术(CAS)的医院每两年重新认证一次其计划的质量，但目前这并不涉及各医院之间术后死亡率的明确比较。因此，目前的重新认证过程可能无法识别与同行机构相比表现较差的医院。我们的目标是比较所有接受CAS的美国医院的风险标准化程序结果，并确定术后死亡率在统计学上较高的医院。方法和结果我们对2009年7月至2011年6月在927家美国医院接受CAS的联邦医疗保险受益人进行了一项回顾性队列研究。使用医院比较统计方法计算了30天的风险标准化死亡率，这是一种经过充分验证的分层广义线性模型，包括患者水平和医院水平的预测因素。对22708名接受CAS的患者进行了索赔审查，30天的粗略死亡率为2.0%。CAS术后30天的风险标准化死亡率从1.1%到5.1%不等(P<；差值为0.001)。有13家医院的风险标准化死亡率在统计上(P<；0.05)高于全国平均水平。相反，5家医院的风险标化死亡率在统计学上(P<；0.05)低于全国平均水平。结论我们使用行政声明确定了几家CAS医院颈动脉支架术后30d死亡率过高。当与Medicare目前用于CAS重新认证的信息(如临床登记数据和计划报告)相结合时，临床结果比较可以增强Medicare识别有问题的重新认证候选医院的能力。
BackgroundThe Centers for Medicare and Medicaid Services require hospitals performing carotid artery stenting (CAS) to recertify the quality of their programs every 2 years, but currently this involves no explicit comparisons of postprocedure mortality across hospitals. Hence, the current recertification process may fail to identify hospitals that are performing poorly in relation to peer institutions. Our objective was to compare risk-standardized procedural outcomes across US hospitals that performed CAS and to identify hospitals with statistically high postprocedure mortality rates.Methods and ResultsWe conducted a retrospective cohort study of Medicare beneficiaries who underwent CAS from July 2009 to June 2011 at 927 US hospitals. Thirty-day risk-standardized mortality rates were calculated using the Hospital Compare statistical method, a well-validated hierarchical generalized linear model that included both patient-level and hospital-level predictors. Claims were examined from 22 708 patients undergoing CAS, with a crude 30-day mortality rate of 2.0%. Risk-standardized 30-day mortality rates after CAS varied from 1.1% to 5.1% (P<0.001 for the difference). Thirteen hospitals had risk-standardized mortality rates that were statistically (P<0.05) higher than the national mean. Conversely, 5 hospitals had risk-standardized mortality rates that were statistically (P<0.05) lower than the national mean.ConclusionsWe used administrative claims to identify several CAS hospitals with excessively high 30-day mortality after carotid stenting. When combined with information currently used by Medicare for CAS recertification, such as clinical registry data and program reports, clinical outcomes comparisons could enhance Medicare’s ability to identify hospitals that are questionable candidates for recertification.