Surgical Volume Matters: Helping Patients Pick Hospitals

描述：（改编自应用程序）上下文：有详细记录 对于许多高风险操作， 手术特定的住院量和死亡率。 医疗保险中心和 医疗补助服务（CMS）正在考虑大规模的努力， 医院量的信息，以受益人，希望患者将 选择在高容量中心进行手术。 在继续进行 他们的计划，CMS需要学习：什么信息应该沟通，如何 是否应该提出，以及是否有这样的信息将影响 患者如何做出选择 目的：了解医疗保险患者目前如何选择医院， 手术 我们计划对医疗保险受益人进行全国电话调查， 最近接受了手术，以了解他们如何选择医院。 我们将 评估医院数量是否影响他们的选择， 在决策过程中，以及他们使用了哪些资源来了解 医院的 确定如何告知Medicare受益人有关数量和 手术风险 我们计划开发和实地测试教育格式， 手术量信息的呈现。 这些材料将提供一个 容量-结果关联的概述以及医院特异性 体数据 方法：医院选择调查。 根据我们正在进行的调查， 第一稿，我们将与调查研究顾问公司合作， 通过认知访谈和试点测试进行电话访谈， 最近接受手术的医疗保险患者。 最终版本 对随机抽取的全国性医疗保险受益人进行管理， 最近进行了14例高风险手术中的1例， 不同的强度。 教育材料的开发/实地测试：我们将起草 通过内容专家的输入向患者呈现容量结局数据， 教育学、流行病学和认知心理学。 我们将执行 与医疗保险受益人进行半结构化面对面访谈，以确保 理解材料，并观察受试者对替代品的反应， 格式（某些格式是否比其他格式更有效？，患者使用 如果他们必须选择一家医院， 如果是，如何）。 意义：在项目结束时，我们将有一个模板， 提供患者能够理解的手术量信息。 在 此外，我们将深入了解患者是否以及如何使用这种方法， 数据（例如，死亡率的大幅降低会促使病人 更大的医院）。 这些信息将是必不可少的考虑 在决定重点开展哪些行动以传播信息时 关于手术量和手术风险

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.