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: 8670376
• 负责人: Sara Pasquali
• 金额: $ 63.08万
• 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 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8670376
• 关键词: Accounting; Address; Area; Bayesian Method; Benchmarking; Birth; Cardiac Surgery procedures; Caring; Case Mixes; Child; Childhood; Clinical; Collaborations; Congenital Abnormality; Congenital Heart Defects; 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; Metric; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Noise; Operative Surgical Procedures; Outcome; Participant; Patients; Pediatric Hospitals; Performance; Policies; Policy Maker; Population; Process; Process Measure; Proxy; Quality Control; Quality Indicator; Quality of Care; Registries; Reporting; Research; Resources; Risk Adjustment; Schedule; Severity of illness; Societies; Structure; Survivors; Techniques; Testing; Thoracic Surgeon; Variant; abstracting; 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.

摘要先天性心脏缺陷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的资源利用率最高。虽然近年来总体结果有所改善，但各医院之间的差异仍然很大，许多利益相关者的目标是提高对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