Cardiac Surgeons and the Quality Movement: the Michigan Experience

Prager, Richard L.; Armenti, Frederick R.; Bassett, Joseph; Bell, Gail F.; Drake, Daniel H.; Hanson, Eric C.; Heiser, John; Johnson, Scott H.; Plasman, F.B.; Shannon, Francis; Share, David; Theurer, Patty; Williams, Jaelene

doi:10.1053/j.semtcvs.2009.03.008

Cited by 85 publications

(51 citation statements)

References 5 publications

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“…5 In adult surgical subspecialties, multicenter quality improvement collaboratives have proven to be successful models for sharing these types of best practices across hospitals, and reducing variation in clinical outcomes and costs. [31][32][33] A regional collaborative in Michigan is estimated to reduce complications after general and vascular surgery in ∼2500 patients each year, translating into annual savings of ∼$20 million. 31 New initiatives in the field of pediatric cardiology and cardiac surgery such as those sponsored by the Pediatric Heart Network and the Pediatric Cardiac Critical Care Consortium (PC 4 ) aim to employ similar approaches.…”

Section: Discussionmentioning

confidence: 99%

Variation in Congenital Heart Surgery Costs Across Hospitals

Pasquali

Jacobs²,

et al. 2014

Pediatrics

117

104

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WHAT'S KNOWN ON THIS SUBJECT: Congenital heart disease is known to be a commonly treated and resource-intense condition across children' s hospitals, yet knowledge regarding the degree of cost variation across hospitals and associated factors is lacking.WHAT THIS STUDY ADDS: Using a linked clinical and administrative data set, we establish benchmarks for hospital costs for common congenital heart operations, and demonstrate wide variation in cost between hospitals related in part to differences in length of stay and complications. abstract BACKGROUND: A better understanding of costs associated with common and resource-intense conditions such as congenital heart disease has become increasingly important as children' s hospitals face growing pressure to both improve quality and reduce costs. We linked clinical information from a large registry with resource utilization data from an administrative data set to describe costs for common congenital cardiac operations and assess variation across hospitals. METHODS:Using linked data from The Society of Thoracic Surgeons and Pediatric Health Information Systems Databases (2006Databases ( -2010, estimated costs/case for 9 operations of varying complexity were calculated. Between-hospital variation in cost and associated factors were assessed by using Bayesian methods, adjusting for important patient characteristics. RESULTS:Of 12 718 operations (27 hospitals) included, median cost/ case increased with operation complexity (atrial septal defect repair, [$25 499] to Norwood operation, [$165 168]). Significant betweenhospital variation (up to ninefold) in adjusted cost was observed across operations. Differences in length of stay (LOS) and complication rates explained an average of 28% of between-hospital cost variation. For the Norwood operation, high versus low cost hospitals had an average LOS of 50.8 vs 31.8 days and a major complication rate of 50% vs 25.3%. High volume hospitals had lower costs for the most complex operations.CONCLUSIONS: This study establishes benchmarks for hospital costs for common congenital heart operations and demonstrates wide variability across hospitals related in part to differences in LOS and complication rates. These data may be useful in designing initiatives aimed at both improving quality of care and reducing cost. Pediatrics 2014;133:e553-e560 AUTHORS:

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Section: Discussionmentioning

confidence: 99%

Variation in Congenital Heart Surgery Costs Across Hospitals

Pasquali

Jacobs²,

et al. 2014

Pediatrics

117

104

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“…5 All programs use the Society of Thoracic Surgeons (STS) data collection form and submit data on a quarterly basis to both the STS database and the MSTCVS-QC data warehouse, which specifically includes other cardiac surgical data including perfusion, readmission and specific mortality data. Participating sites are routinely audited for data validity and accuracy as part of the MSTCVS-QC audit system, with sites on average demonstrating excellent overall scores (>98% data accuracy).…”

Section: Patient Populationmentioning

confidence: 99%

Red Blood Cell Transfusions Impact Pneumonia Rates After Coronary Artery Bypass Grafting

Likosky

Paone

Zhang

et al. 2015

The Annals of Thoracic Surgery

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“…22 The Society of Thoracic Surgeons coordinating center conducts most of the analyses for the Michigan program and provides it with regular reports on hospital-specific and statewide performance.…”

Section: Clinical Improvementsmentioning

confidence: 99%

“…The use of two very expensive therapies in cardiac surgery-intra-aortic balloon pumps and prolonged mechanical ventilation-has fallen substantially. 22,24 Implementation of risk-prediction tools and practice guidelines has reduced the incidence of contrast-induced nephropathy (acute kidney failure triggered by the use of contrast dye in the procedure) and the need for dialysis after percutaneous coronary intervention. 21 Between 2007 and 2009, rates of thirtyday emergency department visits after bariatric surgery fell from 8 percent to 5 percent, with associated savings approaching $1 million annually.…”

Section: Return On Investmentmentioning

confidence: 99%

How A Regional Collaborative Of Hospitals And Physicians In Michigan Cut Costs And Improved The Quality Of Care

et al. 2011

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There is evidence that collaborations between hospitals and physicians in particular regions of the country have led to improvements in the quality of care. Even so, there have not been many of these collaborations. We review one, the Michigan regional collaborative improvement program, which was paid for by a large private insurer, has yielded improvements for a range of clinical conditions, and has reduced costs in several important areas. In general and vascular surgery alone, complications from surgery dropped almost 2.6 percent among participating Michigan hospitals-a change that translates into 2,500 fewer Michigan patients with surgical complications each year. Estimated annual savings from this one collaborative are approximately $20 million, far exceeding the cost of administering the program. Regional collaborative improvement programs should become increasingly attractive to hospitals and physicians, as well as to national policy makers, as they seek to improve health care quality and reduce costs.

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Cardiac Surgeons and the Quality Movement: the Michigan Experience

Cited by 85 publications

References 5 publications

Variation in Congenital Heart Surgery Costs Across Hospitals

Variation in Congenital Heart Surgery Costs Across Hospitals

Red Blood Cell Transfusions Impact Pneumonia Rates After Coronary Artery Bypass Grafting

How A Regional Collaborative Of Hospitals And Physicians In Michigan Cut Costs And Improved The Quality Of Care

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