Surgical Volume Matters: Helping Patients Pick Hospitals

描述：(改编自应用程序)上下文：它有很好的文档 对于许多高风险的行动来说，两者之间有很强的联系 特定程序的医院容量和死亡率。医疗保险和医疗保险中心 医疗补助服务(CMS)正在考虑大规模传播 向受益者提供医院容量信息，希望患者 选择在高流量中心进行手术。在继续与 他们的计划，CMS需要学习：应该交流什么信息，如何交流 它应该被提交，以及拥有这样的信息是否会影响 病人如何做出选择。 目标：了解医疗保险患者目前是如何选择医院的 做手术。我们计划在全国范围内对医疗保险受益人进行电话调查 最近接受了手术，以了解他们是如何选择医院的。我们会 评估医院数量是否影响他们的选择，以及他们的参与程度 在决策过程中，以及他们使用了哪些资源来了解 医院。确定如何通知联邦医疗保险受益人有关数量和 手术风险。我们计划开发并现场测试以下教育模式 手术量信息的呈现。这些材料将提供 量-结果关联的概述以及特定医院的 卷数据。 方法：医院选择调查。建立在我们作为一个 第一稿，我们将与调查研究顾问合作制定一份 通过认知访谈和试点测试进行电话采访 最近接受手术的医疗保险患者。最终版本将是 对全国随机抽样的医疗保险受益人进行管理 最近有14次高风险手术中的1次，其数量与结果相关 力量参差不齐。 开发/实地测试教育材料：我们将起草格式 使用内容专家的意见向患者展示容量结果数据 教育学、流行病学和认知心理学。我们将表演 与联邦医疗保险受益人进行半结构化面谈，以确保 材料被理解，并了解受试者对替代方案的反应 格式(某些格式是否比其他格式更有效？患者是否会使用 如果他们必须选择一家医院，会有多少钱？如果是这样，是如何做到的)。 意义：在项目结束时，我们将有一个模板 介绍患者能够理解的有关手术量的信息。在……里面 此外，我们将深入了解患者是否以及如何使用这些 数据(例如，死亡率的降低将促使患者 到容量更大的医院)。这些信息将是必须考虑的 在决定将重点放在哪些行动以传播信息时 关于体积和手术风险。

DESCRIPTION: (Adapted from the application) Context: It is well documented that for many high-risk operations, there is a strong association between procedure-specific hospital volume and mortality. The Center for Medicare and Medicaid Services (CMS) is considering a large-scale effort to disseminate hospital volume information to beneficiaries in the hope that patients will select to have surgery at high volume centers. Before moving forward with their plan, CMS needs to learn: what information should be communicated, how it should be presented, and whether having such information would influence how patients make choices. Objectives: To learn how Medicare patients currently choose hospitals for surgery. We plan a national telephone survey of Medicare beneficiaries who recently underwent surgery to find out how they chose their hospital. We will assess whether hospital volume influenced their choice, how involved they were in the decision process, and what resources they used to find out about hospitals. To determine how to inform Medicare beneficiaries about volume and surgical risk. We plan to develop and field test educational formats for presentation of surgical volume information. These materials will provide an overview of the volume-outcome association as well as give hospital-specific volume data. Methods: Hospital selection survey. Building on our ongoing survey as a first draft, we will work with survey research consultants to develop a telephone interview through cognitive interviews and pilot testing with Medicare patients who recently underwent surgery. The final version will be administered to a random national sample of Medicare beneficiaries who recently had 1 of 14 high-risk operations with volume-outcome associations of varying strength. Development/field testing of educational materials: We will draft formats for presenting volume-outcomes data to patients with input from content experts in education, epidemiology, and cognitive psychology. We will perform semi-structured in-person interviews with Medicare beneficiaries to ensure that materials are understood and to see how subjects respond to alternative formats (Are some formats more effective than others?, Would patients use volume if they had to select a hospital? And if so, how). Significance: At the conclusion of the project, we will have a template for presenting information about surgical volume that patients can understand. In addition, we will gain insight into whether and how patients might use such data (e.g., how great a reduction in mortality would prompt patients to move to higher volume hospitals). This information will be essential to consider when deciding which operations to focus on for dissemination of information about volume and surgical risk.