National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
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- Adverse Events (2)
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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 17 of 17 Research Studies DisplayedMullens 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
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
Taylor K, Diaz A, Nuliyalu U
Association of dual Medicare and Medicaid eligibility with outcomes and spending for cancer surgery in high-quality hospitals.
The purpose of this study was to assess whether treatment at high-quality hospitals mitigates dual-eligibility-associated disparities in outcomes and spending for cancer surgery. Medicare beneficiaries 65 years or older who underwent colectomy, rectal resection, lung resection, or pancreatectomy were evaluated. The findings indicate that, even among the highest-quality hospitals, dual-eligibility patients had poorer outcomes and higher spending. Dually eligible patients were more likely to be discharged to a facility and thus incurred higher post-acute care costs. Although treatment at high-quality hospitals is associated with reduced differences in outcomes, dual-eligibility patients remain at high risk for adverse post-operative outcomes as well as increased readmissions and post-acute care use.
AHRQ-funded; HS024763.
Citation: Taylor K, Diaz A, Nuliyalu U .
Association of dual Medicare and Medicaid eligibility with outcomes and spending for cancer surgery in high-quality hospitals.
JAMA Surg 2022 Apr;157(4):e217586. doi: 10.1001/jamasurg.2021.7586..
Keywords: Cancer, Surgery, Medicare, Medicaid, Outcomes, Hospitals
Chhabra KR, Sheetz KH, Regenbogen SE
Wide variation in surgical spending within hospital systems: a missed opportunity for bundled payment success.
Researchers sought to measure the extent of variation in episode spending around total hip replacement for fee-for-service Medicare patients within and across hospital systems identified in the American Hospital Association Annual Survey. They found that average episode payments varied nearly as much within hospital systems as they did between the lowest- and highest-cost quintiles of systems, with variation driven by post-acute care utilization.
AHRQ-funded; HS000053.
Citation: Chhabra KR, Sheetz KH, Regenbogen SE .
Wide variation in surgical spending within hospital systems: a missed opportunity for bundled payment success.
Ann Surg 2021 Dec 1;274(6):e1078-e84. doi: 10.1097/sla.0000000000003741..
Keywords: Surgery, Health Systems, Medicare, Healthcare Costs, Hospitals
Liao JM, Gupta A, Zhao Y
Association between hospital voluntary participation, mandatory participation, or nonparticipation in bundled payments and Medicare episodic spending for hip and knee replacements.
The purpose of this study was to examine and compare 2011-2017 spending for hip and joint replacements between hospitals with voluntary participation, mandatory participation and nonparticipation in the Medicare Bundled Payments for Care Improvement program.
Citation: Liao JM, Gupta A, Zhao Y .
Association between hospital voluntary participation, mandatory participation, or nonparticipation in bundled payments and Medicare episodic spending for hip and knee replacements.
JAMA 2021 Aug 3;326(5):438-40. doi: 10.1001/jama.2021.10046..
Keywords: Medicare, Hospitals, Payment, Surgery, Orthopedics, Healthcare Costs
Smith ME, Shubeck SP, Nuliyalu U
Local referral of high-risk patients to high-quality hospitals: surgical outcomes, cost savings, and travel burdens.
In this study, the investigators sought to assess the potential changes in Medicare payments and clinical outcomes of referring high-risk surgical patients to local high-quality hospitals within small geographic areas. The investigators concluded that complication rates and Medicare payments were significantly lower for high-risk patients treated at local high-quality hospitals. The investigators suggest that triaging high-risk patients to local high-quality hospitals within small geographic areas may serve as a template for improving the value of surgical care.
AHRQ-funded; HS024763.
Citation: Smith ME, Shubeck SP, Nuliyalu U .
Local referral of high-risk patients to high-quality hospitals: surgical outcomes, cost savings, and travel burdens.
Ann Surg 2020 Jun;271(6):1065-71. doi: 10.1097/sla.0000000000003208..
Keywords: Surgery, Healthcare Costs, Hospitals, Medicare, Outcomes
Sheetz KH, Chhabra K, Nathan H
The quality of surgical care at hospitals associated with America's highest-rated medical centers.
The objective of this study was to assess whether the quality of surgical care changes as hospitals form networks with established, high-quality medical centers. The investigators concluded that network formation was not associated with a significant improvement in quality or reduction in Medicare expenditures across all procedures studied for hospitals joining the networks of America’s highest rated medical centers.
AHRQ-funded; HS023597.
Citation: Sheetz KH, Chhabra K, Nathan H .
The quality of surgical care at hospitals associated with America's highest-rated medical centers.
Ann Surg 2020 May;271(5):862-67. doi: 10.1097/sla.0000000000003195..
Keywords: Surgery, Hospitals, Quality of Care, Medicare, Health Systems
Schwarzkopf R, Behery OA, Yu H
Patterns and costs of 90-day readmission for surgical and medical complications following total hip and knee arthroplasty.
Unplanned readmissions following elective total hip (THA) and knee (TKA) arthroplasty as a result of surgical complications likely have different quality improvement targets and cost implications than those for nonsurgical readmissions. In this study, the investigators compared payments, timing, and location of unplanned readmissions with Center for Medicare and Medicaid Services (CMS)-defined surgical complications to readmissions without such complications.
AHRQ-funded; HS022882.
Citation: Schwarzkopf R, Behery OA, Yu H .
Patterns and costs of 90-day readmission for surgical and medical complications following total hip and knee arthroplasty.
J Arthroplasty 2019 Oct;34(10):2304-07. doi: 10.1016/j.arth.2019.05.046..
Keywords: Orthopedics, Surgery, Hospital Readmissions, Adverse Events, Quality Improvement, Quality of Care, Medicare, Hospitals
Sheetz KH, Dimick JB, Regenbogen SE
How patient complexity and surgical approach influence episode-based payment models for colectomy.
This study looked into how the use of bundled payment programs would affect hospital reimbursements for colectomies. National data from the 100% Medicare Provider Analysis and Review files for the years 2010 to 2014 was used. Patients undergoing colectomies were identified using diagnosis-related group codes and ICD-9, Clinical Modification codes. Reconciliation payments were simulated as the difference between actual price-standardized 90-day episode payments and estimated regional spending benchmarks. The simulated bundled payment conditions showed 51.8% of hospitals would achieve shared savings, but the average case would incur reconciliation penalties. Laparoscopies would achieve the highest savings.
AHRQ-funded; HS023597.
Citation: Sheetz KH, Dimick JB, Regenbogen SE .
How patient complexity and surgical approach influence episode-based payment models for colectomy.
Dis Colon Rectum 2019 Jun;62(6):739-46. doi: 10.1097/dcr.0000000000001372..
Keywords: Surgery, Payment, Healthcare Costs, Medicare, Hospitals
Borza T, Oerline MK, Skolarus TA
Association between hospital participation in Medicare Shared Savings Program Accountable Care Organizations and readmission following major surgery.
Accountable Care Organizations (ACOs) and readmission rates following major surgery. A retrospective cohort study was conducted using a 20% national Medicare sample to identify beneficiaries undergoing 1 of 7 common surgical procedures: abdominal aortic aneurysm repair, colectomy, cystectomy, prostatectomy, lung resection, total knee arthroplasty, and total hip arthroplasty between 2010 and 2014. Thirty-day risk-adjusted readmission rates was the primary outcome studied. Out of 2974 hospitals in the study, 389 were ACO affiliated. While rates fell for both cohorts, ACO hospitals had a higher decrease in hospitalizations over the same time period.
AHRQ-funded; HS024728; HS024525.
Citation: Borza T, Oerline MK, Skolarus TA .
Association between hospital participation in Medicare Shared Savings Program Accountable Care Organizations and readmission following major surgery.
Ann Surg 2019 May;269(5):873-78. doi: 10.1097/sla.0000000000002737..
Keywords: Hospitals, Surgery, Hospital Readmissions, Medicare, Healthcare Costs, Healthcare Delivery
Nathan H, Thumma JR, Ryan AM
Early impact of Medicare accountable care organizations on inpatient surgical spending.
This study evaluated whether hospital participation in accountable care organizations (ACOs) is associated with reduced Medicare spending for inpatient surgery. Medicare Shared Savings Programs (MSSP) have shown some modest success in reducing overall medical spending, but has not been studied on its impact in reducing surgical spending. Medicare claims from 2010 to 2014 were evaluated for patients aged 65 to 99 years undergoing 6 common elective surgical procedures: abdominal aortic aneurysm, colectomy, coronary artery bypass grafting, hip or knee replacement, or lung resection. A total of 341,675 patients at 427 ACO hospitals and over 1 million matched controls at non-ACO hospitals were used to compare surgical costs. There was not an overall reducing in total Medicare patients between the two hospital types.
AHRQ-funded; HS024763.
Citation: Nathan H, Thumma JR, Ryan AM .
Early impact of Medicare accountable care organizations on inpatient surgical spending.
Ann Surg 2019 Feb;269(2):191-96. doi: 10.1097/sla.0000000000002819..
Keywords: Healthcare Costs, Hospitals, Inpatient Care, Medicare, Surgery, Quality of Care
Nathan H, Thumma JR, Norton EC
Strategies for reducing population surgical costs in Medicare: local referrals to low-cost hospitals.
An analysis was done of hospital cost variations for elective inpatient surgery in a small geographic area. Medicare payment data was used to calculate 30-day surgical episode costs for elderly patients undergoing 1 of 7 elective surgeries during 2010-2012. The highest and lowest cost hospitals were identified in their metropolitan statistical area. It was found that high-cost hospitals had higher complication and readmission rates than their lower-cost peers. Medicare expenditures at the high-cost hospitals were $4424 to $10,417 higher than the lowest-cost hospitals.
AHRQ-funded; HS024763.
Citation: Nathan H, Thumma JR, Norton EC .
Strategies for reducing population surgical costs in Medicare: local referrals to low-cost hospitals.
Ann Surg 2018 May;267(5):878-85. doi: 10.1097/sla.0000000000002340..
Keywords: Elderly, Healthcare Costs, Hospitals, Medicare, Surgery
Chen LM, Norton EC, Banerjee M
Spending on care after surgery driven by choice of care settings instead of intensity of services.
The rising popularity of episode-based payment models for surgery underscores the need to better understand the drivers of variability in spending on postacute care. Examining postacute care spending for fee-for-service Medicare beneficiaries the researchers found that it varied widely between hospitals in the lowest versus highest spending quintiles but the variation diminished considerably after adjustment for postacute care setting (home health care, outpatient rehabilitation, skilled nursing facility, or inpatient rehabilitation facility).
AHRQ-funded; HS020671.
Citation: Chen LM, Norton EC, Banerjee M .
Spending on care after surgery driven by choice of care settings instead of intensity of services.
Health Aff 2017 Jan;36(1):83-90. doi: 10.1377/hlthaff.2016.0668.
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Keywords: Elderly, Healthcare Costs, Hospitals, Medicare, Surgery
Murugiah K, Wang Y, Desai NR
Hospital variation in outcomes for transcatheter aortic valve replacement among Medicare beneficiaries, 2011 to 2013.
The researchers studied hospital performance on transcatheter aortic valve replacement (TAVR) using data from all Medicare fee-for-service (FFS) beneficiaries 65 years of age and older who underwent TAVR from January 1, 2011, to December 31, 2013. They found that for an individual patient, the between-hospital variation translates to a great than 2-fold higher risk of dying within 30 days for a patient undergoing TAVR at a hospital 1 SD above the national average compared with undergoing TAVR at a hospital 1 SD below; the between-hospital variation was
AHRQ-funded; HS023000.
Citation: Murugiah K, Wang Y, Desai NR .
Hospital variation in outcomes for transcatheter aortic valve replacement among Medicare beneficiaries, 2011 to 2013.
J Am Coll Cardiol 2015 Dec 15;66(23):2678-79. doi: 10.1016/j.jacc.2015.10.008.
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Keywords: Cardiovascular Conditions, Hospitals, Medicare, Patient-Centered Outcomes Research, Surgery
Shih T, Ryan AM, Gonzalez AA
Medicare's hospital readmissions reduction program in surgery may disproportionately affect minority-serving hospitals.
The authors aimed to project readmission penalties for hospitals performing cardiac surgery and examine how these penalties will affect minority-serving hospitals. They found that minority-serving hospitals would disproportionately bear the burden of readmission penalties if expanded to include cardiac surgery.
AHRQ-funded; HS018546.
Citation: Shih T, Ryan AM, Gonzalez AA .
Medicare's hospital readmissions reduction program in surgery may disproportionately affect minority-serving hospitals.
Ann Surg 2015 Jun;261(6):1027-31. doi: 10.1097/sla.0000000000000778.
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Keywords: Hospitals, Medicare, Racial and Ethnic Minorities, Hospital Readmissions, Surgery
Calderwood MS, Kleinman K, Bratzler DW
Medicare claims can be used to identify US hospitals with higher rates of surgical site infection following vascular surgery.
This study found that among Medicare patients who underwent vascular surgery at 2,512 U.S. hospitals, a patient undergoing surgery in a hospital ranked in the worst-performing decile based on claims had a 2.5 times greater likelihood of developing a chart-confirmed surgical site infection relative to a patient characteristics in a hospital in the best-performing decile.
AHRQ-funded; HS018878
Citation: Calderwood MS, Kleinman K, Bratzler DW .
Medicare claims can be used to identify US hospitals with higher rates of surgical site infection following vascular surgery.
Med Care. 2014 Oct;52(10):918-25. doi: 10.1097/MLR.0000000000000212..
Keywords: Medicare, Surgery, Healthcare-Associated Infections (HAIs), Patient Safety, Hospitals, Adverse Events