Understanding Quality and Costs in Congenital Heart Surgery

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在美国儿童医院中的资源利用率最高。虽然近年来总体结果有所改善，但不同医院之间的差异仍然很大，许多利益攸关方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 计划在未来几年生效，这将把补偿与儿童医院挂钩，不仅要实现高质量，还要节省成本。这些举措的成功既取决于可靠的质量衡量标准，也取决于对质量和成本之间关系的了解，特别是对于先天性心脏病等常见和资源密集型疾病。不幸的是，这一人群中现有的质量指标 有缺陷的，可靠地区分医院的能力有限。综合测量在经验上结合了多个相关质量领域的信息，已被证明是各种子专业的更可靠的质量指标，但迄今尚未在先天性心脏病手术中开发出来。此外，现有的质量指标和替代办法没有对照资源利用的衡量标准进行评估，这在当前环境中变得越来越重要。该项目旨在通过应用先进的贝叶斯方法来经验性地结合多个质量领域的信息来解决这些知识差距，以开发先天性心脏手术的综合质量指标。这一衡量标准将通过测试其区分医院和预测未来绩效的能力进行验证，并与现有的个人衡量标准进行比较。其次，我们将检查我们的质量和成本的综合衡量标准之间的关系，并调查与劣质最相关的成本类型。为了进行这些分析，我们将利用该领域两个主要利益攸关方之间的创新合作，并将胸外科协会(STS)先天性心脏病手术数据库(丰富的临床登记)与儿童医院协会(CHA)数据库(一个包含重要资源利用信息的大型付费管理数据库)连接起来，从而创建一个几乎涵盖美国所有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具有直接价值。此外，该项目产生的信息将立即包括在向参与STS和CHA(几乎所有美国儿科心脏中心)的美国儿童医院的定期反馈报告中，这将使医院能够更好地根据国家数据和需要改进的目标领域来衡量和基准他们的表现。

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.