The Impact of System Factors on Quality and Safety in Arterial Surgery: A Systematic Review

Lear, Rachael; Godfrey, Anthony; Riga, Celia; Norton, Christine; Vincent, Charles; Bicknell, Colin

doi:10.1016/j.ejvs.2017.03.014

Cited by 10 publications

(9 citation statements)

References 43 publications

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“…The standardisation of definitions, assessment tools, clinically relevant endpoints, and adherence to national reporting guidelines would help improve the investigation of system factors that influence vascular outcomes. 24 In addition, combining FTR with other composite outcome measures, for example TO, could improve quality assessment and create awareness regarding the performance of individual hospitals. 15 An advantage of FTR is that it reflects the ability of the surgical team to treat complications and avoid (consequential) death.…”

Section: Discussionmentioning

confidence: 99%

Failure to Rescue – a Closer Look at Mortality Rates Has No Added Value for Hospital Comparisons but Is Useful for Team Quality Assessment in Abdominal Aortic Aneurysm Surgery in The Netherlands

Lijftogt

Karthaus

Vahl

et al. 2018

European Journal of Vascular and Endovascular Surgery

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Section: Discussionmentioning

confidence: 99%

Failure to Rescue – a Closer Look at Mortality Rates Has No Added Value for Hospital Comparisons but Is Useful for Team Quality Assessment in Abdominal Aortic Aneurysm Surgery in The Netherlands

Lijftogt

Karthaus

Vahl

et al. 2018

European Journal of Vascular and Endovascular Surgery

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“…Screening of papers to analyse in the next steps followed the original PRISMA 2009 Flow Diagram. This four‐phase flow diagram (identification; screening; eligibility; included), widely used in the literature in systematic reviews on healthcare quality and efficiency, 44,66–68 facilitates not only the conduction of the systematic review but also the report of the assessment.…”

Section: Methodsmentioning

confidence: 99%

“…This four-phase flow diagram (identification; screening; eligibility; included), widely used in the literature in systematic reviews on F I G U R E 1 Conceptual framework for the performance assessment of vertical integration in healthcare. Bckw, backward integration; Fwd, Forward integration [Colour figure can be viewed at wileyonlinelibrary.com] healthcare quality and efficiency, 44,[66][67][68] facilitates not only the conduction of the systematic review but also the report of the assessment.…”

Section: Screeningmentioning

confidence: 99%

Vertical integration in healthcare: What does literature say about improvements on quality, access, efficiency, and costs containment?

Amado

Marques

Nunes

2022

Health Planning & Management

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Introduction: Vertical integration models involve integrating services from different levels of care (e.g., primary care, acute care, post-acute care). Therefore, one of their main objectives is to increase continuity of care, potentially improving outcomes like efficiency, quality, and access or even enabling cost containment.Objectives: This study conducts a literature review and aims at contributing to the contentious discussion regarding the effects of vertical integration reforms in terms of efficiency, costs containment, quality, and access.Methods: We performed a systematic search of the literature published until February 2020. The articles respecting the conceptual framework were included in an exhaustive analysis to study the impact of vertical integration on costs, prices of care, efficiency, quality, and access.Results: A sample of 64 papers resulted from the screening process. The impact of vertical integration on costs and prices of care appears to be negative. Decreases in technical efficiency upon vertical integration are practically out of the question. Nevertheless, there is no substantial inclination to visualise a positive influence. The same happens with the quality of care. Regarding access, the lack of available articles on this outcome limits conjectures.Conclusions: In summary, it is not clear yet whether vertically integrated healthcare providers positively impact the overall delivery care system. Nevertheless, the recent grow-

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“…This is similar to a recent systematic review's methodology. 10 Abstracts, review articles, case reports, editorials, opinions, and commentaries were excluded as were studies examining the volume-outcome relationship as a systematic review have recently been published on this topic. 11 …”

Section: Methodsmentioning

confidence: 99%

Improving Quality of Carotid Interventions: Identifying Hospital-Level Structural Factors that can Improve Outcomes

Gaba

Morris

Halliday

et al. 2021

Annals of Vascular Surgery

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Background “Structural factors” relating to organization of hospitals may affect procedural outcomes. This study's aim was to clarify associations between structural factors and outcomes after carotid endarterectomy (CEA) and carotid endarterectomy stenting (CAS). Methods A systematic review of studies published in English since 2005 was conducted. Structural factors assessed were as follows: population size served by the vascular department; number of hospital beds; availability of dedicated vascular beds; established clinical pathways; surgical intensive care unit (SICU) size; and specialty of surgeon/interventionalist. Primary outcomes were as follows: mortality; stroke; cardiac complications; length of hospital stay (LOS); and cost. Results There were 11 studies ( n = 95,100 patients) included in this systematic review. For CEA, reduced mortality ( P < 0.0001) and stroke rates ( P = 0.001) were associated with vascular departments serving >75,000 people. Larger hospitals were associated with lower mortality, stroke rate, and cardiac events, compared with smaller hospitals (less than 130 beds). Provision of vascular beds after CEA was associated with lower mortality ( P = 0.0008) and fewer cardiac events ( P = 0.03). Adherence to established clinical pathways was associated with reduced stroke and cardiac event rates while reducing CEA costs. Large SICUs (≥7 beds) and dedicated intensivists were associated with decreased mortality after CEA while a large SICU was associated with reduced stroke rate ( P = 0.001). Vascular surgeons performing CEA were associated with lower stroke rates and shorter LOS ( P = 0.0001) than other specialists. CAS outcomes were not influenced by specialty but costless when performed by vascular surgeons ( P < 0.0001). Conclusions Structural factors affect CEA outcomes, but data on CAS were limited. These findings may inform reconfiguration of vascular services, reducing risks and costs associated with carotid interventions.

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The Impact of System Factors on Quality and Safety in Arterial Surgery: A Systematic Review

Cited by 10 publications

References 43 publications

Failure to Rescue – a Closer Look at Mortality Rates Has No Added Value for Hospital Comparisons but Is Useful for Team Quality Assessment in Abdominal Aortic Aneurysm Surgery in The Netherlands

Failure to Rescue – a Closer Look at Mortality Rates Has No Added Value for Hospital Comparisons but Is Useful for Team Quality Assessment in Abdominal Aortic Aneurysm Surgery in The Netherlands

Vertical integration in healthcare: What does literature say about improvements on quality, access, efficiency, and costs containment?

Improving Quality of Carotid Interventions: Identifying Hospital-Level Structural Factors that can Improve Outcomes

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