Hospital Volume for Orofacial Cleft Repair and Risk of Complications

口面部裂修复的医院数量和并发症风险

• 批准号: 8571132
• 负责人: Jacqueline R Starr
• 金额: $ 23.2万
• 依托单位: ADA FORSYTH INSTITUTE, INC.
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-01 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8571132
• 关键词: Accreditation; Address; Algorithms; American; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Child; Childhood; Cleaved cell; Cleft Lip; Cleft Palate; Comorbidity; Complication; Data; Data Set; Databases; Demographic Factors; Developed Countries; Development; Esthetics; European; Evaluation; Geographic Locations; Health; Healthcare; Healthcare Systems; Hospitals; Infant; Inpatients; Institution; Knowledge; Lead; Life; Link; Live Birth; Methods; Metric; Operative Surgical Procedures; Outcome; Outcomes Research; Palate; Patients; Pediatric Hospitals; Procedures; Provider; Quality of Care; Reconstructive Surgical Procedures; Records; Relative (related person); Research; Risk; Standardization; Stress; Surgeon; Surgical complication; Time; Uncertainty; Underserved Population; United Kingdom; Work; base; cost; craniofacial; demographics; evidence base; hospital readmission; improved; mortality; orofacial; palate repair; programs; public health relevance; repaired; trend

DESCRIPTION (provided by applicant): Orofacial clefts are among the most frequent congenital anomalies, occurring in approximately 1 in 750 live births in the U.S. During the first year of a life, children born with cleft lip and/or cleft palate (CL/CP) in developed countries typically undergo one two reconstructive surgeries. Over 8,000 such primary CL/CP repair procedures are performed in the U.S. each year. In European health care systems, standardization of care and higher patient volume predict better long-term functional and aesthetic outcomes in children with CL/CP. In the U.S., however, there has been little effort to evaluate the quality of craniofacial care, including surgical outcomes. In the United Kingdom, studies of the volume-outcome relationship have led to the centralization of cleft care. Preliminary analysis of year 2000 data indicates that the majority (75%) of U.S. hospitals performing CL/CP repair procedures had low volumes, yet 67% of cleft lip (CL) and 73% of cleft palate (CP) repair procedures occurred in high-volume hospitals. Complication rates were higher in low-volume hospitals. However, centralization could further concentrate providers in a limited number of geographic locations, potentially worsening access to cleft care. Thus centralization could either ameliorate or exaggerate disparities in orofacial cleft outcomes. We propose to quantify the volume-outcome association for orofacial cleft repair procedures by analyzing the Kids' Inpatient Database (KID), a large administrative dataset available through the Agency for Health Research and Quality. We will use the KID datasets from the years 1997 to 2009, and (pending availability) 2012 to 1a) how CL and CP repair procedures are distributed nationally, according to procedure volumes and other hospital- and child-level characteristics, and 1b) whether the distributions have changed over time; 2) whether complication rates following CL or CP repair are higher in low-volume hospitals or with low-volume surgeons; and 3) whether patients from traditionally underserved groups are likelier to receive care in low-volume hospitals. The proposed project will address gaps in knowledge about the costs and distribution of CL/CP care. The results will also enhance evaluations of centralization with evidence regarding its likely effect on health care disparities, whether positive or negative. Quantification of volume-outcome associations has been performed for a wide variety of surgical procedures, frequently leading to formal programs that incorporate procedure volume as a metric for reimbursement or accreditation. Particularly with regard to underserved populations, it is critical to quantify the potential benefits before pursuing similar programs or centralization of cleft care in the U.S. Thus the results of our proposed project will directly infrm efforts to improve quality of care for infants with CL/CP in the U.S.

描述（由申请人提供）：口面裂是最常见的先天性异常之一，在美国大约每750个活产婴儿中就有1个发生。在出生后的第一年，发达国家出生的唇裂和/或腭裂（CL/CP）儿童通常会进行一两次重建手术。在美国，每年有超过8000例这样的初级CL/CP修复手术。在欧洲的卫生保健系统中，标准化的护理和更高的患者数量预示着CL/CP儿童更好的长期功能和美观结果。然而，在美国，很少有人努力评估颅面护理的质量，包括手术结果。在英国，对体积-结果关系的研究导致了唇裂护理的集中。对2000年数据的初步分析表明，大多数（75%）的美国医院进行CL/CP修复手术的规模较小，但67%的唇裂（CL）和73%的腭裂（CP）修复手术发生在规模较大的医院。小容量医院的并发症发生率较高。然而，集中化可能会进一步将服务提供者集中在有限的地理位置，可能会使腭裂护理的可及性恶化。因此，中心化可以改善或扩大唇腭裂结果的差异。我们建议通过分析儿童住院数据库（KID）来量化口腔面部唇腭裂修复手术的体积-结果关联，KID是健康研究与质量局提供的一个大型管理数据集。我们将使用1997年至2009年的KID数据集，以及（待获得）2012年至1a)根据手术量和其他医院和儿童水平的特征，CL和CP修复手术在全国范围内的分布情况，以及1b)分布是否随时间而变化；2)小容量医院或小容量外科医生的CL或CP修复术后并发症发生率是否更高；3)来自传统服务不足群体的患者是否更有可能在小容量医院接受治疗。拟议的项目将解决CL/CP护理的成本和分配方面的知识差距。研究结果还将加强对中央集权的评价，并提供证据证明其可能对保健差距产生的影响，无论是积极的还是消极的。量-结果关联的量化已经在各种各样的外科手术中进行，经常导致将手术量作为报销或认证的度量标准的正式计划。特别是对于服务不足的人群，在美国推行类似的计划或集中唇腭裂护理之前，量化潜在的好处是至关重要的。因此，我们提出的项目的结果将直接加强美国唇腭裂/先天性唇腭裂婴儿护理质量的努力