Understanding Quality and Costs in Congenital Heart Surgery

了解先天性心脏病手术的质量和成本

• 批准号: 9458788
• 负责人: Sara Pasquali
• 金额: $ 56.54万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9458788
• 关键词: Address; Affordable Care Act; Area; Bayesian Method; Benchmarking; Birth; Cardiac Surgery procedures; Case Mixes; Child; Childhood; Clinical; Collaborations; Congenital Abnormality; Congenital Heart Defects; Cost Control; Cost Savings; Data; Data Set; Databases; Environment; Feedback; Funding; Future; Goals; Healthcare Systems; Heart; Hospitalization; Hospitalized Child; Hospitals; Incentives; Individual; Knowledge; Lesion; Link; Measures; Methodology; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Noise; Operative Surgical Procedures; Outcome; Participant; Patient Care; Patient-Focused Outcomes; Pediatric Hospitals; Performance; Policies; Policy Maker; Population; Process; Process Measure; Proxy; Quality Control; Quality Indicator; Quality of Care; Registries; Reporting; Resources; Risk Adjustment; Schedule; Severity of illness; Societies; Standardization; Structure; Survivors; Techniques; Testing; Thoracic Surgeon; Variant; administrative database; base; congenital heart disorder; cost; data registry; design; experience; improved; innovation; mortality; public health relevance; response; success

DESCRIPTION (provided by applicant): Understanding Quality and Costs in Congenital Heart Surgery Abstract Congenital heart defects are the most common birth defects, and children requiring heart surgery account for the highest resource utilization across US children's hospitals. While overall outcomes have improved in recent years, wide variation across hospitals remains, and numerous stakeholders aim to improve quality of care for these patients. These efforts include federal initiatives such as the pediatric sections of the Affordable Care Act scheduled to take effect over the next several years, which will tie reimbursements to children's hospitals to achieving not only high quality but also cost savings. The success of these initiatives is dependent on both reliable measures of quality and an understanding of the relationship between quality and costs, particularly for common and resource-intense conditions such as congenital heart disease. Unfortunately, existing quality indicators in this population and flawed, with limited ability to reliably discriminate between hospitals. Composite measures, which empirically combine information across multiple relevant quality domains, have been shown to be more reliable indicators of quality across a variety of subspecialties, but have not been developed to date in congenital heart surgery. In addition, existing quality metrics and alternatives have not been evaluated against measures of resource utilization, which has become increasingly important in the current environment. This project aims to address these knowledge gaps through applying advanced Bayesian methods to empirically combine information across multiple quality domains to develop a composite quality metric in congenital heart surgery. The measure will be validated through testing its ability to discriminate between hospitals, and forecast future performance, in comparison to existing individual metrics. Second, we will examine the relationship between our composite measure of quality and cost, and investigate the types of costs most associated with poor quality. To conduct these analyses, we will leverage an innovative collaboration between two major stakeholders in the field, and link the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database (a rich clinical registry) with the Children's Hospital Association (CHA) Database (a large all-payer administrative database containing important resource utilization information), which will create a unique dataset encompassing nearly all US pediatric heart centers. Our results will have immediate value to policy makers and payers currently designing incentives aimed at improving quality and reducing costs across children's hospitals. In addition, the information generated from this project will be available for immediate inclusion in the regular feedback reports to US children's hospitals participating in STS and CHA (nearly all US pediatric heart centers), which will allow hospitals to better measure and benchmark their performance against national data and target areas for improvement.

描述（由申请人提供）：了解先天性心脏病手术的质量和成本摘要先天性心脏病是最常见的出生缺陷，需要心脏手术的儿童占美国儿童医院资源利用率最高。虽然近年来总体结果有所改善，但医院之间的差异仍然很大，许多利益相关者的目标是提高这些患者的护理质量。这些努力包括联邦倡议，如《平价医疗法案》的儿科部分 计划在未来几年内生效，这将使儿童医院的报销不仅与实现高质量，而且与节约成本挂钩。这些举措的成功取决于可靠的质量衡量标准和对质量与成本之间关系的理解，特别是对于常见和资源密集型疾病，如先天性心脏病。不幸的是，现有的质量指标在这一人口和 有缺陷的，有限的能力，可靠地区分医院之间。综合指标根据经验将多个相关质量领域的信息联合收割机组合在一起，已被证明是各种亚专业质量的更可靠指标，但迄今为止尚未在先天性心脏病手术中开发出来。此外，还没有对照资源利用的衡量标准对现有质量衡量标准和替代办法进行评价，而资源利用在当前环境中变得越来越重要。本项目旨在通过应用先进的贝叶斯方法，以经验为基础，将多个质量领域的信息联合收割机结合起来，开发先天性心脏病手术的综合质量指标，从而解决这些知识差距。该措施将通过测试其区分医院的能力进行验证，并预测未来的表现，与现有的个人指标相比。其次，我们将检查我们的质量和成本的综合措施之间的关系，并调查类型的成本最相关的质量差。为了进行这些分析，我们将利用该领域两个主要利益相关者之间的创新合作，并链接胸外科医生协会（STS）先天性心脏手术数据库（丰富的临床注册）与儿童医院协会（CHA）数据库（包含重要资源利用信息的大型所有付款人管理数据库），这将创建一个包含几乎所有美国儿科心脏中心的独特数据集。我们的结果将对目前正在设计旨在提高儿童医院质量和降低成本的激励措施的政策制定者和支付者产生直接价值。此外，该项目产生的信息将立即纳入定期反馈报告，以供参与STS和CHA的美国儿童医院（几乎所有美国儿科心脏中心）使用，这将使医院能够根据国家数据和目标改进领域更好地衡量和衡量其绩效。

项目成果

Estimating Resource Utilization in Congenital Heart Surgery.

• DOI: 10.1016/j.athoracsur.2020.01.013
• 发表时间: 2020-09
• 期刊: The Annals of thoracic surgery
• 作者: Pasquali SK;Chiswell K;Hall M;Thibault D;Romano JC;Gaynor JW;Shahian DM;Jacobs ML;Gaies MG;O'Brien SM;Norton EC;Hill KD;Cowper PA;Pinto NM;Shah SS;Mayer JE;Jacobs JP
• 通讯作者: Jacobs JP

The Society of Thoracic Surgeons Congenital Heart Surgery Database: 2019 Update on Research.

• DOI: 10.1016/j.athoracsur.2019.07.002
• 发表时间: 2019-09
• 期刊: The Annals of thoracic surgery
• 作者: Jacobs ML;Jacobs JP;Hill KD;O'Brien SM;Pasquali SK;Vener D;Kumar SR;Chiswell K;St Louis JD;Mayer JE;Habib RH;Shahian DM;Fernandez FG
• 通讯作者: Fernandez FG

National Variation in Congenital Heart Surgery Outcomes.

• DOI: 10.1161/circulationaha.120.046962
• 发表时间: 2020-10-06
• 期刊: Circulation
• 影响因子: 37.8
• 作者: Pasquali SK;Thibault D;O'Brien SM;Jacobs JP;Gaynor JW;Romano JC;Gaies M;Hill KD;Jacobs ML;Shahian DM;Backer CL;Mayer JE
• 通讯作者: Mayer JE