Health and Medical News and Resources

General interest items edited by Janice Flahiff

Surgical metrics do not provide a clear path to improvement

Surgical metrics do not provide a clear path to improvement 

From the 4 February 2015 Mayo Clinic press release

PHOENIX – While surgical outcomes have improved nationally over time, surgical outcome reporting does not necessarily lead to better outcomes, according to a Mayo Clinic study published this week in the Journal of the American Medical Association.

Systems that capture, analyze, and report surgical outcomes are an increasingly important part of the quality improvement movement in health care in the United States.  Within the U.S., the most widely used surgical outcomes reporting system is the National Surgical Quality Improvement Program (NSQIP), which is coordinated through the American College of Surgeons.

The study analyzed data regarding surgical outcomes — complications, serious complications, and mortality — in over 345,000 patients treated between 2009 and 2013 at academic hospitals throughout the United States.  Of these patients, approximately half were treated at hospitals that participated in the NSQIP.  The study showed that surgical outcomes significantly improved overall in both study groups during the period of analysis.

“In our study we weren’t interested in whether patients had better outcomes in NSQIP vs. non-NSQIP hospitals,” says David Etzioni, M.D., chair of Colorectal Surgery at Mayo Clinic in Arizona and the study author. “We wanted to know whether the outcomes experienced by patients treated at NSQIP hospitals improved, over time, in a way that was different from patients treated at non-NSQIP hospitals.”

The study found no association between hospital-based participation in the NSQIP and improvements in postoperative outcomes over time, suggesting that a surgical outcomes reporting system does not provide a clear mechanism for quality improvement.  According to the research team, the failure of these types of outcomes monitoring systems to produce measurable improvements in outcomes may be related to difficulties in identifying mechanisms that translate reports into changes in how surgical care is provided.

“I think if there is one lesson that we have learned at Mayo Clinic; real quality is achieved through a system — not just a doctor, not just a nurse or other staff,” Dr. Etzioni says. “All of these elements of care have to work together closely to provide patients with the best possible outcomes.”

February 5, 2015 Posted by | health care | , , , , | Leave a comment

[press release] Reducing Hospital Readmission Rates Will Require Community-Focused Effort

From the Wiley press release (February 2015)

Recent research indicates that most of the variation in hospital readmission rates in the United States is related to geography and other factors over which hospitals have little or no control. Access and quality of care outside of the hospital setting seem to be especially important.

A new editorial that addresses these findings notes that a broader focus on community health systems, not just performance of individual hospitals, may be needed to reduce hospital readmissions.

Because high readmission rates trigger reductions in Medicare reimbursements to hospitals, facilities in socioeconomically disadvantaged and underserved communities may be disproportionately penalized. The editorial is published in Health Services Research.

Access and quality outside the hospital may affect the degree to which the HRRP can achieve its intended outcome, fewer readmissions, but other factors are likely to determine whether the policy is an operational success. For the HRRP, operational success could be defined as whether hospitals respond in a manner consistent with the underlying motivations of improving quality of care and reducing costs. In terms of improving quality, a recent meta-analysis of randomized trials found that interventions designed to prevent readmissions tended be moderately effective (relative risk of 30-day readmission 0.82, 95 percent CI, 0.73–0.91). The studied interventions addressed care both during and after hospitalization, such as through case management, patient education, home visits, and patient self-management support, among other activities. Multifaceted interventions were more common and were 30–40 percent more effective than one-dimensional ones (Leppin et al. 2014), yet they may also be more challenging to implement and more costly. The degree to which hospitals nationwide are implementing quality improvement interventions that target readmissions does not appear to have been described.

February 5, 2015 Posted by | health care | , , , | Leave a comment

   

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