Identifying Patient Preoperative Risk Factors and Postoperative Adverse Events in Administrative Databases: Results From The Department of Veterans Affairs National Surgical Quality Improvement Program

Best, William R.; Khuri, Shukri F.; Phelan, Maureen; Hur, Kwan; Henderson, William G.; Demakis, John G.; Daley, Jennifer

doi:10.1016/s1072-7515(01)01183-8

Cited by 238 publications

(132 citation statements)

References 35 publications

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“…11,12 Others questioned whether claims based administrative data could adequately control for variations in patient variables, which may drive outcomes to a greater extent than hospital volume. 13,14 An analysis of the Health Care Utilization Project data showed that hospitals meeting standards set by the Leapfrog Group, a coalition of 160 large payors that purchase insurance for more than 34 million Americans, 15 for volume for 5 tracked procedures (coronary artery bypass graft, percutaneous coronary intervention, pancreatic resection, esophageal cancer surgery and abdominal aortic aneurysm repair) did not have substantially different in-hospital mortality rates than those not meeting the standards, while applying volume standards would significantly impact the revenue of low volume hospitals and substantially increase patient travel time. 16 Indeed, many rural areas simply lack the referral base to support even a single high volume center for some procedures.…”

Section: Discussionmentioning

confidence: 99%

Trends in Regionalization of Inpatient Care for Urological Malignancies, 1988 to 2002

2007

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Purpose: Higher hospital and clinician volumes may be associated with improved patient outcomes for complex surgical and medical care, although the strength and consistency of this association varies markedly across specific conditions and procedures. Pressures from payors and policymakers exist to move complex care to high volume hospitals. The net effect of these pressures may be the regionalization of care. We quantified trends in the regionalization of inpatient care for urological oncology in a national administrative database. Materials and Methods: The Nationwide Inpatient Sample, a 20% stratified sample of United States community hospital admissions, was queried for surgical and nonsurgical admissions for bladder, renal and prostate cancer care between 1988 and 2002. Hospitals were grouped into tertiles by annual surgical volume. Trends over time in the annual discharge rate by hospital volume tertile, geographic region and insurance status were analyzed. Results: High volume hospitals were defined by at least 22, 12 and 26 cases per year for bladder, renal and prostate cancer, respectively. High volume hospital discharges increased significantly as a proportion of all discharges for bladder (67% to 70%) and renal (67% to 73%) cancer surgery, and they were essentially constant for prostate surgery (76%). Trends were similar for Medicare and Medicaid patients except high volume hospital discharges for prostate cancer decreased during the study period. Significant regional variation was observed for the regionalization of surgical and nonsurgical care. Conclusions: Nationwide Inpatient Sample data demonstrate the ongoing regionalization of urological oncology care. The policy implications of this trend are complex with potentially important benefits and risks in terms of access to and quality of care.

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Section: Discussionmentioning

confidence: 99%

Trends in Regionalization of Inpatient Care for Urological Malignancies, 1988 to 2002

2007

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“…However, such initiatives were slowed down by the changing medicolegal climate (lawsuits) and the enormous costs of data collection. Instead, administrative databases are being increasingly used; however, these are associated with significant lower reliability [10]. Clinical databases, on the other hand (made and controlled by clinicians), might underreport complications [11]; nevertheless, such databases are frequently used for benchmarking between hospitals.…”

Section: Large (National) Databasesmentioning

confidence: 99%

Quality assessment in surgery: where do we stand now and where should we be heading?

et al. 2014

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While surgery is gaining in efficiency it is equally getting more and more complex. Meanwhile patients are getting more and more demanding. In the past decades, safety and quality have become prominent criteria by which surgical care is evaluated. Several important factors can be identified which are influencing the quality of surgical care, in our view these factors can be classified into four major groups: the team of caretakers, the patient, the material, and the procedure. For all of these factors, a high level of knowledge and optimal communication is crucial to guarantee a high standard of care and minimize the chance of complications. Different quality assessment tools are currently used in surgery. Databases of surgical procedures have the potential to offer an enormous amount of information on the quality of care. However, the implementation of comprehensive databases is difficult and expensive, while its value is overshadowed by possible underreporting. Introducing surgical checklists is a cheap yet efficient way to increase both the safety and the quality of surgical care. Nevertheless, its implementation is sometimes opposed since they slow down the patient flow. The risk of complications tends to increase when a new technique is introduced. Therefore, quality assurance (QA) programs have to be implemented. Surgical simulation training is rapidly becoming a necessary adjunct to traditional patient-based training models. Finally, key performance indicators (KPI) can be used for measuring the success of medical interventions such as surgery. For the near future, the introduction of one comprehensive medical file per patient could be a major step in increasing the safety and efficiency of our medical deeds. In parallel, a nationwide prospective registry for surgical interventions should be introduced. Postgraduate surgical training should be organized by the national professional groups and should be adapted to the local needs. A system of accreditation for specific interventions should be introduced guaranteeing their state-of-the-art application.

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“…Several studies have contrasted the NSQIP approach with claims-based analysis for risk-prediction, yielding mixed results [32][33][34][35]. Best et al compared NSQIP data to the VA's ICD-9 code-based administrative database, finding that the administrative data performed poorly in predicting both preoperative risk factors (positive predictive value [PPV] 0.34) and postoperative outcomes (PPV 0.23) identified in NSQIP [32].…”

Section: Challenges and Conclusionmentioning

confidence: 99%

“…Best et al compared NSQIP data to the VA's ICD-9 code-based administrative database, finding that the administrative data performed poorly in predicting both preoperative risk factors (positive predictive value [PPV] 0.34) and postoperative outcomes (PPV 0.23) identified in NSQIP [32]. Atherly et al likewise found that NSQIP outperformed both the Charlson Comorbidity Index and a proprietary risk model developed by DxCG (Boston, MA) [33].…”

Section: Challenges and Conclusionmentioning

confidence: 99%

Defining high quality health care

Cooperberg

Birkmeyer

Litwin

2009

Urologic Oncology: Seminars and Original Investigations

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Most health care quality improvement efforts target measures of health care structures, processes, and/or outcomes. Structural measures examine relatively fixed aspects of health care delivery such as physical plant and human resources. Process measures, the focus of the largest proportion of quality improvement efforts, assess specific transactions in clinical-patient encounters, such as use of appropriate surgical antibiotic prophylaxis, which are expected to improve outcomes. Outcome measures, which comprise quality of life endpoints as well as morbidity and mortality, are of greatest interest to clinicians and patients, but entail the greatest complexity, as the majority of variance in outcomes is attributable to patient and environmental factors that may not be readily modifiable. Selecting among structure, process, and outcome measures for quality improvement efforts generally will be dictated by the specific clinical situation for which improvement is desired.One aspect of health care quality that has received a great deal of attention in recent years is the relationship between surgical volume and health outcomes. Volume, an inherent characteristic of a health care facility or provider, is generally considered a structural measure of quality. Many studies have demonstrated a positive association between volume and outcomes, and policymakers in the private and public sectors have begun to consider volume in certification and reimbursement decisions. The volume-outcome association is not without controversy, however. Most studies in the field are limited by the nature of the administrative data on which they are based, and some studies have found that variation in quality within volume quantiles exceeds differences between quantiles. Moreover, regionalization driven by a focus on volume may exert adverse effects on access to care.The movement for health care quality improvement faces substantial methodological, clinical, financial, and political challenges. Despite these challenges, it is a movement that is gaining momentum, and the emphasis on quality in health care delivery is likely only to increase in the future. It is crucial, therefore, that physicians assume increasing leadership roles in efforts to define, measure, report, and improve quality of care.

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Identifying Patient Preoperative Risk Factors and Postoperative Adverse Events in Administrative Databases: Results From The Department of Veterans Affairs National Surgical Quality Improvement Program

Cited by 238 publications

References 35 publications

Trends in Regionalization of Inpatient Care for Urological Malignancies, 1988 to 2002

Trends in Regionalization of Inpatient Care for Urological Malignancies, 1988 to 2002

Quality assessment in surgery: where do we stand now and where should we be heading?

Defining high quality health care

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