Interhospital Variability in Quality Outcomes of Pancreatic Surgery

Erin Brown, Sarah B. Bateni, Debra Burgess, Chin-Shang Li, Richard J Bold

Research output: Contribution to journalArticle

Abstract

Background: Assessment of optimal patient outcomes from health care delivery is critical for success amidst current reform. We developed a composite index of quality for pancreaticoduodenectomy (PD) and compared high and low performers nationwide. Methods: We performed a retrospective analysis of 17,220 patients undergoing elective PD between October 2010 and June 2014 using the Vizient database. A quality index score (QIS) was developed from five variables associated with optimal outcomes: postoperative complication rate, length of stay, 30-d readmission rate, mortality rate, and hospital volume. Value was defined as hospital-based QIS divided by mean hospital charges. High-value centers (top quintile) were compared to low-value centers (bottom quintile). Results: The majority of high-value centers (79%) achieved top performer status in 1-2 of five quality categories though only 11% were low performer in at least one category. Conversely, 41% of low-value centers were top performers in at least one category, although rarely more than one (8%); 63% of low-value centers were low performers in two or more categories. There was no significant association between QIS and hospital charges (−570, 95% CI −1308 to 168, P = 0.13). Conclusions: High-value centers infrequently provided high quality surgical care across all five metrics but instead excelled in a few quality metrics while avoiding low performance in any quality metric. Although low-value centers could achieve excellence in one quality metric, they were frequently low performers in two or more outcomes. Improvements in value of PD can be achieved by a consistent effort across all quality metrics rather than efforts at constraining financial expenditures of health care delivery.

Original languageEnglish (US)
Pages (from-to)453-458
Number of pages6
JournalJournal of Surgical Research
Volume235
DOIs
StatePublished - Mar 1 2019

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Pancreaticoduodenectomy
Hospital Charges
Patient Outcome Assessment
Delivery of Health Care
Quality of Health Care
Health Expenditures
Length of Stay
Databases
Mortality

Keywords

  • Complications
  • Costs
  • Hospital volume
  • Length of stay
  • Mortality
  • Pancreatic surgery
  • Readmission
  • Value

ASJC Scopus subject areas

  • Surgery

Cite this

Interhospital Variability in Quality Outcomes of Pancreatic Surgery. / Brown, Erin; Bateni, Sarah B.; Burgess, Debra; Li, Chin-Shang; Bold, Richard J.

In: Journal of Surgical Research, Vol. 235, 01.03.2019, p. 453-458.

Research output: Contribution to journalArticle

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abstract = "Background: Assessment of optimal patient outcomes from health care delivery is critical for success amidst current reform. We developed a composite index of quality for pancreaticoduodenectomy (PD) and compared high and low performers nationwide. Methods: We performed a retrospective analysis of 17,220 patients undergoing elective PD between October 2010 and June 2014 using the Vizient database. A quality index score (QIS) was developed from five variables associated with optimal outcomes: postoperative complication rate, length of stay, 30-d readmission rate, mortality rate, and hospital volume. Value was defined as hospital-based QIS divided by mean hospital charges. High-value centers (top quintile) were compared to low-value centers (bottom quintile). Results: The majority of high-value centers (79{\%}) achieved top performer status in 1-2 of five quality categories though only 11{\%} were low performer in at least one category. Conversely, 41{\%} of low-value centers were top performers in at least one category, although rarely more than one (8{\%}); 63{\%} of low-value centers were low performers in two or more categories. There was no significant association between QIS and hospital charges (−570, 95{\%} CI −1308 to 168, P = 0.13). Conclusions: High-value centers infrequently provided high quality surgical care across all five metrics but instead excelled in a few quality metrics while avoiding low performance in any quality metric. Although low-value centers could achieve excellence in one quality metric, they were frequently low performers in two or more outcomes. Improvements in value of PD can be achieved by a consistent effort across all quality metrics rather than efforts at constraining financial expenditures of health care delivery.",
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