National Healthcare Quality and Disparities Report
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Topics
- Adverse Events (1)
- Cardiovascular Conditions (1)
- Emergency Department (1)
- Healthcare-Associated Infections (HAIs) (1)
- Healthcare Costs (2)
- Heart Disease and Health (1)
- (-) Hospitals (12)
- Medicare (3)
- Mortality (2)
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- Outcomes (4)
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- (-) Surgery (12)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 12 of 12 Research Studies DisplayedChen VW, Chidi AP, Dong Y
Risk-adjusted cumulative sum for early detection of hospitals with excess perioperative mortality.
This study’s goal was to compare the risk-adjusted cumulative sum (CUSUM) with episodic evaluation for early detection of hospitals with excess perioperative mortality. The study cohort included 697,566 patients treated at 104 Veterans’ Affairs hospitals across 24 quarters with a mean age of 60.9 years and 91.4% male. These patients underwent a noncardiac operation at a Veterans Affairs hospital, had a record in the Veterans Affairs Surgical Quality Improvement Program (January 1, 2011, through December 31, 2016), and were aged 18 years or older. For each hospital, the median number of quarters detected with observed to expected ratios, at least 1 CUSUM signal, and more than 1 CUSUM signal was 2 quarters (IQR, 1-4 quarters), 8 quarters (IQR, 4-11 quarters), and 3 quarters (IQR, 1-4 quarters). Outlier hospitals were identified 33.3% of the time (830 quarters) with at least 1 CUSUM signal within a quarter, 12.5% (311 quarters) with more than 1 CUSUM signal, and 11.0% (274 quarters) with observed to expected ratios at the end of the quarter. The CUSUM detection occurred a median of 49 days (IQR, 25-63 days) before observed to expected ratio reporting (1 signal, 35 days [IQR, 17-54 days]; 2 signals, 49 days [IQR, 26-61 days]; 3 signals, 58 days [IQR, 44-69 days]; ≥4 signals, 49 days [IQR, 42-69 days]. Of 274 hospital quarters detected with observed to expected ratios, 72.6% were concurrently detected by at least 1 CUSUM signal vs 42.7% by more than 1 CUSUM signal. There was a dose-response relationship between the number of CUSUM signals in a quarter and the median observed to expected ratio (0 signals, 0.63; 1 signal, 1.28; 2 signals, 1.58; 3 signals, 2.08; ≥4 signals, 2.49).
AHRQ-funded; HS013853.
Citation: Chen VW, Chidi AP, Dong Y .
Risk-adjusted cumulative sum for early detection of hospitals with excess perioperative mortality.
JAMA Surg 2023 Nov; 158(11):1176-83. doi: 10.1001/jamasurg.2023.3673..
Keywords: Quality Improvement, Surgery, Hospitals, Patient Safety, Mortality, Quality of Care
Mullens CL, Lussiez A, Scott JW
Association of health professional shortage area hospital designation with surgical outcomes and expenditures among Medicare beneficiaries.
This study’s objective was to compare surgical outcomes and expenditures at hospitals located in Health Professional Shortage Areas to nonshortage area designated hospitals among Medicare beneficiaries. This cross-sectional retrospective study used data from 842,787 Medicare beneficiary patient admissions to hospitals with and without Health Professional Shortage Area designations for common operations including appendectomy, cholecystectomy, colectomy, and hernia repair from 2014 to 2018. Primary outcomes measures were 30-day mortality, hospital readmissions, and 30-day surgical episode payments. Patients (mean age=75.6 years, males=44.4%) undergoing common surgical procedures in shortage area hospitals were less likely to be White (84.6% vs 88.4%) and less likely to have≥2 Elixhauser comorbidities (75.5% vs 78.2%). Patients undergoing surgery at Health Professional Shortage Area hospitals had lower risk-adjusted rates of 30-day mortality (6.05% vs 6.69%) and readmission (14.99% vs 15.74%). Medicare expenditures at Health Professional Shortage Area hospitals were also lower than nonshortage designated hospitals ($28,517 vs $29,685).
AHRQ-funded; HS028606; HS028672.
Citation: Mullens CL, Lussiez A, Scott JW .
Association of health professional shortage area hospital designation with surgical outcomes and expenditures among Medicare beneficiaries.
Ann Surg 2023 Oct 1; 278(4):e733-e39. doi: 10.1097/sla.0000000000005762..
Keywords: Hospitals, Surgery, Medicare, Healthcare Costs, Workforce, Outcomes
Thumma SR, Dualeh SHA, Kunnath NJ
Outcomes for high-risk surgical procedures across high- and low-competition hospital markets.
The purpose of this retrospective study was to assess whether there is a relationship between hospital market competition and outcomes post high-risk surgery. The study included Medicare beneficiaries 65 years and older who electively underwent 1 of 10 high-risk surgical procedures. Procedures included: bariatric surgery, carotid endarterectomy, esophagectomy hip replacement, knee replacement, mitral lung resection valve repair, open aortic aneurysm repair, pancreatectomy, and rectal resection. Hospitals were categorized into high-competition and low-competition markets based on the hospital market Herfindahl-Hirschman index. The primary outcome was 30-day postoperative mortality and readmissions. The study found that when analyzed by procedure, compared with low-competition hospitals, high-competition market hospitals demonstrated higher 30-day mortality for 2 of 10 procedures (mitral valve repair and carotid endarterectomy) and no difference for 5 of 10 procedures (open aortic aneurysm repair, bariatric surgery, esophagectomy, knee replacement, and hip replacement.) High-competition hospitals also demonstrated 30-day readmissions that were higher for 5 of 10 procedures (carotid endarterectomy, knee replacement, mitral valve repair, open aortic aneurysm repair, and rectal resection) and no difference for 3 procedures (bariatric surgery, esophagectomy: and pancreatectomy.) Hospitals in high-competition compared with low-competition markets cared for patients who were older, were more likely to be racial and ethnic minority individuals and had more comorbidities.
AHRQ-funded; HS028963; HS028606.
Citation: Thumma SR, Dualeh SHA, Kunnath NJ .
Outcomes for high-risk surgical procedures across high- and low-competition hospital markets.
JAMA Surg 2023 Oct; 158(10):1041-48. doi: 10.1001/jamasurg.2023.3221..
Keywords: Surgery, Outcomes, Hospitals
Mullens CL, Lussiez A, Scott JW
High-risk surgery among Medicare beneficiaries living in health professional shortage areas.
This study’s objective was to compare high-risk surgical outcomes at hospitals located in Health Professional Shortage Areas to nonshortage area designated hospitals among Medicare beneficiaries. The authors performed a retrospective review of Medicare beneficiaries living in health professional shortage areas and nonshortage areas who underwent abdominal aortic aneurysm repair, coronary artery bypass graft, esophagectomy, liver resection, pancreatectomy, or rectal resection between 2014 and 2018. They compared rates of postoperative complications and 30-day mortality between the patient cohorts. They used beneficiary and hospital ZIP codes to quantify travel time to obtain care. Compared with patients living in nonshortage areas, patients living in health professional shortage areas traveled longer (median 60.0 vs 28.0 minutes). There were no differences in risk-adjusted rates of complications (28.5% vs 28.6%) and small differences in rates of 30-day mortality (4.2% vs 4.4%) between beneficiaries living in shortage areas versus those not in shortage areas, respectively.
AHRQ-funded; HS028606; HS028672; HS027788.
Citation: Mullens CL, Lussiez A, Scott JW .
High-risk surgery among Medicare beneficiaries living in health professional shortage areas.
J Rural Health 2023 Sep; 39(4):824-32. doi: 10.1111/jrh.12748..
Keywords: Surgery, Hospitals, Workforce, Medicare, Outcomes
Mullens CL, Scott JW, Mead M
Surgical procedures at critical access hospitals within hospital networks.
Critical access hospitals provide vital care to more than 80 million Americans. These facilities, often rural, are located greater than 35 miles away from another hospital and are required to maintain patient transfer agreements with other facilities capable of providing higher levels of care. The purpose of this cross-sectional retrospective study was to assess surgical outcomes and expenditures at critical access hospitals that do participate in a hospital network compared with those who do not participate in a hospital network among Medicare beneficiaries. From 2014 to 2018 the researchers compared 16,128 Medicare beneficiary admissions for appendectomy, cholecystectomy, colectomy, or hernia repair at critical access hospitals. The study found that Medicare beneficiaries who received care at critical access hospitals in a hospital network were more likely to carry 2 or more Elixhauser comorbidities. Rates of 30-day mortality and readmission rates were higher at critical access hospitals in a hospital network. Finally, total payments per episode were discovered to be $960 greater per patient at critical access hospitals that were in a hospital network ($23,878) when compared with critical access hospitals that were not in a hospital network ($22,918).
AHRQ-funded; HS028606; HS028672; HS027788.
Citation: Mullens CL, Scott JW, Mead M .
Surgical procedures at critical access hospitals within hospital networks.
Ann Surg 2023 Sep 1; 278(3):e496-e502. doi: 10.1097/sla.0000000000005772..
Keywords: Surgery, Hospitals, Medicare
Silver CM, Yang AD, Shan Y
Changes in surgical outcomes in a Statewide Quality Improvement Collaborative with introduction of simultaneous, comprehensive interventions.
Researchers investigated whether a comprehensive quality improvement program implemented simultaneously across hospitals at the formation of a quality improvement collaborative (QIC) would improve patient outcomes. They analyzed risk-adjusted rates of postoperative morbidity and mortality for patients who had undergone surgery at hospitals in the Illinois Surgical Quality Improvement Collaborative (ISQIC); analyses compared ISQIC hospitals with hospitals in the NSQIP Participant Use File (PUF). Although complication rates decreased at both ISQIC and PUF hospitals, findings showed that participation in ISQIC was associated with a significantly greater improvement in death or serious morbidity. The researchers concluded that these results emphasize the potential of QICs to improve patient outcomes.
AHRQ-funded; HS024516.
Citation: Silver CM, Yang AD, Shan Y .
Changes in surgical outcomes in a Statewide Quality Improvement Collaborative with introduction of simultaneous, comprehensive interventions.
J Am Coll Surg 2023 Jul 1; 237(1):128-38. doi: 10.1097/xcs.0000000000000679..
Keywords: Surgery, Outcomes, Quality Improvement, Quality of Care, Hospitals
Ye S, Li D, Yu T
The impact of surgical volume on hospital ranking using the standardized infection ratio.
Researchers investigated the effect of surgical volume on the accuracy of identifying poorly performing hospitals. Their research was based on the standardized infection ratio, and they applied their proposed method to data from HCA Healthcare from 2014-2016 on surgical site infections in colon surgery patients. They concluded that minimum surgical volumes and predicted events criteria are required to make hospital evaluation reliable, and that these criteria may vary by overall prevalence and between-hospital variability.
AHRQ-funded; HS027791.
Citation: Ye S, Li D, Yu T .
The impact of surgical volume on hospital ranking using the standardized infection ratio.
Sci Rep 2023 May 10; 13(1):7624. doi: 10.1038/s41598-023-33937-y..
Keywords: Hospitals, Surgery, Healthcare-Associated Infections (HAIs), Provider Performance, Quality of Care
Fernandes-Taylor S, Yang Q, Yang DY
Greater patient sharing between hospitals is associated with better outcomes for transferred emergency general surgery patients.
The availability of emergency surgical services has diminished as the rural workforce has decreased. The growing need for interhospital patient transfers makes care coordination across different settings essential for maintaining high-quality care. The purpose of this study was to investigate the impact of recurrent patient-sharing between hospitals on the outcomes of emergency general surgery (EGS) patient transfers. A multicenter analysis was conducted involving inpatient acute care hospital stays in Wisconsin that required the transfer of EGS patients. Data was sourced from the Wisconsin Hospital Association (WHA), a comprehensive statewide hospital discharge database for the years 2016-2018. We postulated that a higher percentage of patients transferred between hospitals would lead to improved outcomes. The relationship between the proportion of EGS patient transfers and patient outcomes, such as in-hospital morbidity, mortality, and duration of stay, was examined. Additional factors considered were hospital organizational features and patient sociodemographic and clinical attributes. The researchers found that during the two-year study period, 118 hospitals transferred 3,197 EGS patients; 1,131 of these patients experienced in-hospital complications, death, or an extended stay (beyond the 75th percentile). The average patient age was 62 years, with 50% being female and 5% non-white. In the mixed-effects model, the proportion of shared patients between hospitals was linked to a reduced likelihood of in-hospital complications. Specifically, when the proportion of shared patients doubled between two hospitals, the relative odds of any adverse outcome shifted by 0.85.
AHRQ-funded; HS025224
Citation: Fernandes-Taylor S, Yang Q, Yang DY .
Greater patient sharing between hospitals is associated with better outcomes for transferred emergency general surgery patients.
J Trauma Acute Care Surg 2023 Apr;94(5):592-98. doi: 10.1097/ta.0000000000003789.
Keywords: Emergency Department, Hospitals, Surgery, Transitions of Care
Mullens CL, Mead M, Kalata S
Evaluation of prices for surgical procedures within and outside hospital networks in the US.
The authors conducted an economic evaluation to examine variations in prices for surgical procedures under the Hospital Price Transparency Rule at U.S. hospitals in and outside of networks. The results showed that median negotiated prices were significantly higher at hospitals within networks compared with independent hospitals for 15 of the 16 procedures evaluated. The authors noted that these results ought to be interpreted in the context of certain limitations and that it will be important to understand the mechanisms behind these variations in negotiated prices for surgical care in order to identify areas of unwarranted variation.
AHRQ-funded; HS028606; HS000053.
Citation: Mullens CL, Mead M, Kalata S .
Evaluation of prices for surgical procedures within and outside hospital networks in the US.
JAMA Netw Open 2023 Feb; 6(2):e2255849. doi: 10.1001/jamanetworkopen.2022.55849..
Keywords: Surgery, Healthcare Costs, Hospitals
Carey K, Lin MY
Safety-net hospital performance under comprehensive care for joint replacement.
The objective of this study was to investigate the relative progress of safety-net hospitals (SNHs) under Medicare's Comprehensive Care for Joint Replacement (CJR) mandatory bundled payment model and to identify contributors to SNHs' realization of success under the CJR program. Secondary data on all CJR hospitals from 2016-2020 were taken from CMS public use files and from the American Hospital Association. The findings indicated that SNHs were less successful in meeting spending targets when compared to CJR hospitals overall. The authors concluded that the formula used by CMS to determine spending targets may not be sufficient to address disparities in SNH financial performances under mandatory bundled payment.
AHRQ-funded; HS027786.
Citation: Carey K, Lin MY .
Safety-net hospital performance under comprehensive care for joint replacement.
Health Serv Res 2023 Feb; 58(1):101-06. doi: 10.1111/1475-6773.14042..
Keywords: Hospitals, Surgery, Orthopedics, Provider Performance
Diaz A, Lindau ST, Obeng-Gyasi S
Association of hospital quality and neighborhood deprivation with mortality after inpatient surgery among Medicare beneficiaries.
The purpose of this cross-sectional study was to compare postoperative mortality among Medicare beneficiaries based on the level of neighborhood deprivation where they live and the hospital quality where they received care. The researchers examined outcomes among Medicare beneficiaries undergoing one of five common surgical procedures (colon resection, coronary artery bypass, cholecystectomy, appendectomy, or incisional hernia repair) between 2014 and 2018. Hospital quality was assigned using the Centers for Medicare & Medicaid Services Star Rating. Each beneficiary's neighborhood was identified at the census tract level and sorted into quintiles based on its Area Deprivation Index score. A risk matrix across hospital quality and neighborhood deprivation was created to determine the relative contribution of each to mortality after surgery. Data were analyzed from June 1 to December 31, 2021. The study included 1,898,829 Medicare beneficiaries. Patients from all neighborhood deprivation group quintiles sought care at hospitals across hospital quality levels. Thirty-day risk-adjusted mortality varied across high- and low-quality hospitals and across the least and most deprived neighborhoods. When combined, comparing patients from the least deprived neighborhoods going to high-quality hospitals vs patients from the most deprived neighborhoods going to low-quality hospitals, the variation increased further. The researchers concluded that both a patient's neighborhood and the hospital where they received treatment were associated with the risk of death after commonly performed inpatient surgical procedures. The associations of these factors on mortality may be additive. Efforts to address variation in postoperative mortality should include both hospital quality improvement and addressing drivers of neighborhood deprivation.
AHRQ-funded; HS028606.
Citation: Diaz A, Lindau ST, Obeng-Gyasi S .
Association of hospital quality and neighborhood deprivation with mortality after inpatient surgery among Medicare beneficiaries.
JAMA Netw Open 2023 Jan; 6(1):e2253620. doi: 10.1001/jamanetworkopen.2022.53620..
Keywords: Hospitals, Quality of Care, Surgery, Mortality, Social Determinants of Health
Likosky DS, Strobel RJ, Wu X
Interhospital failure to rescue after coronary artery bypass grafting.
Researchers conducted an observational study to evaluate whether interhospital variation in mortality rates for coronary artery bypass grafting was driven by complications and failure to rescue. Subjects were patients undergoing grafting surgery across 90 hospitals between 2011 and 2017. Results indicated the predicted mortality risk was similar across hospital observed:expected mortality terciles. Observed and expected failure to rescue rates were positively correlated among patients with major and overall complications. The researchers concluded that interhospital variability in successful rescue after coronary artery bypass grafting supports the importance of identifying best practices at high-performing hospitals; this includes early recognition and management of complications.
AHRQ-funded; HS026003.
Citation: Likosky DS, Strobel RJ, Wu X .
Interhospital failure to rescue after coronary artery bypass grafting.
J Thorac Cardiovasc Surg 2023 Jan;165(1):134-43.e3. doi: 10.1016/j.jtcvs.2021.01.064..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Surgery, Hospitals, Adverse Events