Hospital Process Compliance and Surgical Outcomes in Medicare Beneficiaries
Hospital Process Compliance and Surgical Outcomes in Medicare Beneficiaries
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DOI：
10.1001/archsurg.2010.191
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发表时间：
2010-10-01
影响因子：
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通讯作者：
Dimick, Justin B.
中科院分区：
文献类型：
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作者：
Nicholas, Lauren H.;Osborne, Nicholas H.;Dimick, Justin B.
目的：确定用于公共报告和绩效付费的围术期护理流程的高遵从率是否与较低的风险调整死亡率和高风险手术并发症相关。设计：对2005年1月1日至2006年12月31日期间的医疗保险住院患者索赔数据进行回顾分析。分层Logistic回归模型评估了不良结局和医院对手术护理流程的遵从性之间的关系。研究对象：2000家美国医院。参与者：在2005年和2006年接受了6例高风险手术中的1例。主要观察指标：术后30天死亡率、静脉血栓栓塞症和手术部位感染。结果：低遵从性医院的手术依从性为53.7%，高遵从性医院为91.4%。在死亡率(优势比0.98；95%可信区间0.92-1.05)、手术部位感染(1.01；0.901.13)或静脉血栓栓塞症(1.04；0.89-1.20)方面，高依从性医院与中等依从性医院的风险调整结果没有差异。低依从性医院的结果也没有变化。按手术类型进行的分层分析分别证实了这6种手术的这些趋势。结论：医院比较网站上现有的信息不能帮助患者确定高风险手术结果更好的医院。医疗保险和医疗补助服务中心需要确定更高杠杆的流程措施，并更多地关注基于结果的医院概况，以改进公共报告和按绩效付费的努力。
Objectives: To determine whether high rates of compliance with perioperative processes of care used for public reporting and pay-for-performance are associated with lower rates of risk-adjusted mortality and high-risk surgical complications.Design: Retrospective analysis of Medicare inpatient claims data (from January 1, 2005, through December 31, 2006). Hierarchical logistic regression models assessed the relationship between adverse outcomes and hospital compliance with the surgical processes of care reported on the Hospital Compare Web site.Setting: Two thousand US hospitals.Participants: Beneficiaries who underwent 1 of 6 high-risk operations in 2005 and 2006.Main Outcome Measures: Thirty-day postoperative mortality rate, venous thromboembolism, and surgical site infection.Results: Process compliance ranged from 53.7% in low compliance hospitals to 91.4% in high compliance hospitals. Risk-adjusted outcomes did not vary at high compliance hospitals relative to medium compliance hospitals for mortality rate (odds ratio, 0.98; 95% confidence interval, 0.92-1.05), surgical site infection (1.01; 0.901.13), or venous thromboembolism (1.04; 0.89-1.20). Outcomes also did not vary at low compliance hospitals. Stratified analyses by operation type confirm these trends for the 6 procedures individually.Conclusions: Currently available information on the Hospital Compare Web site will not help patients identify hospitals with better outcomes for high-risk surgery. The Centers for Medicare and Medicaid Services needs to identify higher leverage process measures and devote greater attention to profiling hospitals based on outcomes to improve public reporting and pay-for-performance efforts.