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来说， 特定手术的医院数量和死亡率。 医疗保险中心和 医疗补助服务 (CMS) 正在考虑大规模努力传播 医院向受益人提供大量信息，希望患者能够 选择在高容量中心进行手术。 在继续之前 他们的计划，CMS 需要学习：应该传达哪些信息，如何传达 应该提供这些信息，以及拥有此类信息是否会影响 患者如何做出选择。 目标：了解 Medicare 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一次全国电话调查 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，以及他们使用哪些资源来了解 医院。 确定如何告知 Medicare 受益人有关金额和金额的信息 手术风险。 我们计划开发并现场测试教育形式 手术量信息的呈现。 这些材料将提供 容量-结果关联的概述以及针对医院的具体情况 体积数据。 方法：医院选择调查。 以我们正在进行的调查为基础 第一稿，我们将与调查研究顾问合作制定一个 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。 最终版本将是 向全国随机抽取的 Medicare 受益人样本进行管理 最近进行了 14 项高风险手术中的 1 项，其数量与结果相关性为 强度不同。 教育材料的开发/现场测试：我们将起草格式 向患者提供容量结果数据，并听取内容专家的意见 教育、流行病学和认知心理学。 我们将表演 与医疗保险受益人进行半结构化面对面访谈，以确保 材料被理解并观察受试者对替代方案的反应 格式（某些格式比其他格式更有效吗？患者会使用 量大的话要选择医院吗？ 如果是这样，如何）。 意义：在项目结束时，我们将获得一个模板 提供患者可以理解的有关手术量的信息。 在 此外，我们将深入了解患者是否以及如何使用此类药物 数据（例如，死亡率的降低幅度有多大会促使患者转移 到容量更大的医院）。 该信息对于考虑至关重要 在决定重点关注哪些操作来传播信息时 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.