Comparison of Simulated Outcomes of Colorectal Cancer Surgery at the Highest-Performing vs Chosen Local Hospitals.
Comparison of Simulated Outcomes of Colorectal Cancer Surgery at the Highest-Performing vs Chosen Local Hospitals.
复制标题
DOI：
10.1001/jamanetworkopen.2022.55999
复制
发表时间：
2023-02-01
影响因子：
13.8
通讯作者：
Kelz, Rachel R.
中科院分区：
文献类型：
--
作者：
Finn, Caitlin B.;Wirtalla, Chris;Roberts, Sanford E.;Collier, Karole;Mehta, Shivan J.;Guerra, Carmen E.;Airoldi, Edoardo;Zhang, Xu;Keele, Luke;Aarons, Cary B.;Jensen, Shane T.;Kelz, Rachel R.
这项经济评估评估了在接受结直肠切除术的成人中，医院转诊选择与死亡风险之间的关系，以及这些选择的成本。选择医院对结直肠癌患者的手术结果有何影响？在这项涉及21名接受择期结直肠切除术的 098名患者的经济评估中，这些患者被模拟转诊到表现更好的当地医院进行手术，这与患者和社会福利的改善有关。这项研究的结果表明，特定程序的结果数据可以用来改变结直肠癌手术中的护理和指导政策。不同医院的结果不同，会对手术患者产生不利影响。高质量医院的使用因人口而异，这可能导致外科差异。模拟数据驱动的医院选择对接受结直肠癌手术的患者的社会福利的影响。这项经济评估使用了佛罗里达州卫生保健管理局的医院住院文件。2016年1月1日至2018年12月31日期间接受治疗的患者的手术结果(培训队列)被用来评估医院绩效。评估了在2019年1月1日至2019年12月31日期间接受治疗的患者在替代医院的护理成本和好处(测试队列)。队列包括18岁或以上的患者，他们因良性肿瘤或恶性肿瘤而接受选择性结直肠切除术。对2022年3月至10月的数据进行了分析。使用分层Logistic回归，我们估计了培训队列中患者医院选择对住院死亡风险的影响。这些估计被应用于测试队列中的患者，使用贝叶斯模拟来比较每个患者在表现最好的医院和选择的当地医院的结果。分析按种族和族裔分层，以评估对公平的潜在影响。主要结果是平均患者水平的社会福利变化，这是一个综合指标，平衡了降低死亡率的价值和表现更好的医院的相关护理成本。共有21例 患者(平均年龄67.312.0岁；男性10 782例(51.1%)；黑人2232例(10.6%)；白人18866例(89.4%))在178家医院接受治疗。在测试队列中的5000名患者中，有3057人(61.1%)被确定为更高质量的当地医院。选择表现最好的医院与死亡率风险相对降低26.5%(95%可信区间，24.5%~29.0%)和绝对降低0.24%(95%可信区间，0.23%~0.25%)相关。每名接受治疗的患者平均获得1953美元(95%可信区间，1744-2162美元)的社会福利收益。模拟重新分配到更高质量的当地医院与黑人患者的死亡风险相对降低23.5%(95%CI，19.3%-32.9%)和绝对降低0.26%(95%CI，0.21%-0.30%)相关，并获得2427美元(95%CI，1697-3158美元)的社会福利收益。在这项经济评估中，将特定程序的医院绩效作为选择当地医院进行结直肠癌手术的主要因素，与患者和社会的改善结果相关。手术结果数据可以用来改变结直肠癌的护理和指导政策。
This economic evaluation assesses the association of hospital referral choices with mortality risk, and the cost of these choices, in adults who underwent colorectal resection. What are the implications of hospital selection for surgical outcomes in patients with colorectal cancer? In this economic evaluation involving 21 098 patients who underwent elective colorectal resection, simulated referral of these patients to higher-performing local hospitals for surgery was associated with improved welfare for patients and society. Findings of this study suggest that procedure-specific outcomes data can be used to transform care and guide policy in colorectal cancer surgery. Variation in outcomes across hospitals adversely affects surgical patients. The use of high-quality hospitals varies by population, which may contribute to surgical disparities. To simulate the implications of data-driven hospital selection for social welfare among patients who underwent colorectal cancer surgery. This economic evaluation used the hospital inpatient file from the Florida Agency for Health Care Administration. Surgical outcomes of patients who were treated between January 1, 2016, and December 31, 2018 (training cohort), were used to estimate hospital performance. Costs and benefits of care at alternative hospitals were assessed in patients who were treated between January 1, 2019, and December 31, 2019 (testing cohort). The cohorts comprised patients 18 years or older who underwent elective colorectal resection for benign or malignant neoplasms. Data were analyzed from March to October 2022. Using hierarchical logistic regression, we estimated the implications of hospital selection for in-hospital mortality risk in patients in the training cohort. These estimates were applied to patients in the testing cohort using bayesian simulations to compare outcomes at each patient’s highest-performing and chosen local hospitals. Analyses were stratified by race and ethnicity to evaluate the potential implications for equity. The primary outcome was the mean patient-level change in social welfare, a composite measure balancing the value of reduced mortality with associated costs of care at higher-performing hospitals. A total of 21 098 patients (mean [SD] age, 67.3 [12.0] years; 10 782 males [51.1%]; 2232 Black [10.6%] and 18 866 White [89.4%] individuals) who were treated at 178 hospitals were included. A higher-quality local hospital was identified for 3057 of 5000 patients (61.1%) in the testing cohort. Selecting the highest-performing hospital was associated with a 26.5% (95% CI, 24.5%-29.0%) relative reduction and 0.24% (95% CI, 0.23%-0.25%) absolute reduction in mortality risk. A mean amount of $1953 (95% CI, $1744-$2162) was gained in social welfare per patient treated. Simulated reassignment to a higher-quality local hospital was associated with a 23.5% (95% CI, 19.3%-32.9%) relative reduction and 0.26% (95% CI, 0.21%-0.30%) absolute reduction in mortality risk for Black patients, with $2427 (95% CI, $1697-$3158) gained in social welfare. In this economic evaluation, using procedure-specific hospital performance as the primary factor in the selection of a local hospital for colorectal cancer surgery was associated with improved outcomes for both patients and society. Surgical outcomes data can be used to transform care and guide policy in colorectal cancer.
登录
查看更多内容
影响因子：
13.8
作者：
Lam MB;Raphael K;Mehtsun WT;Phelan J;Orav EJ;Jha AK;Figueroa JF
通讯作者：
Figueroa JF
影响因子：
3.5
作者：
Brouwer, Werner B. F.;Culyer, Anthony J.;Rutten, Frans F. H.
通讯作者：
Rutten, Frans F. H.
影响因子：
3
作者：
Adam, Mohamed Abdelgadir;Turner, Megan C.;Mantyh, Christopher R.
通讯作者：
Mantyh, Christopher R.
影响因子：
9.7
作者：
Dimick, Justin;Ruhter, Joel;Birkmeyer, John D.
通讯作者：
Birkmeyer, John D.
影响因子：
120.7
作者：
Liu, Jerome H.;Zingmond, David S.;Ko, Clifford Y.
通讯作者：
Ko, Clifford Y.