Waljee Jennifer F, Ghaferi Amir, Finks Jonathan F, Cassidy Ruth, Varban Oliver, Carlin Arthur, Carlozzi Noelle, Dimick Justin
*Department of Surgery, Center for Health Outcomes and Policy †Michigan Bariatric Surgery Collaborative, Center for Health Outcomes and Policy, University of Michigan, Ann Arbor ‡Department of Surgery, Division of General Surgery, Henry Ford Health System, Wayne State University School of Medicine, Detroit §Department of Physical Medicine & Rehabilitation, Center for Clinical Outcomes Development and Application, University of Michigan, Ann Arbor, MI.
Med Care. 2015 Nov;53(11):960-6. doi: 10.1097/MLR.0000000000000425.
Although there is growing interest in applying patient-reported outcomes (PROs) toward surgical quality, the extent to which PROs vary across hospitals following surgical procedures is unknown.
We examined variation in PROs, specifically health-related quality of life (HRQOL), across hospitals performing bariatric surgery.
A retrospective cohort study.
The Michigan Bariatric Surgery Collaborative is a statewide consortium of 39 hospitals performing laparoscopic gastric bypass, gastric banding, or sleeve gastrectomy (n=11,420 patients between 2008 and 2012).
We examined generic and disease-specific HRQOL measured by the Health and Activities Limitations Index (HALex) and Bariatric Quality of Life index (BQL) preoperatively and at 1 year. We measured the variation in postoperative HRQOL across hospitals, and the effect of risk and reliability adjustment on hospital ranking.
In this cohort, HRQOL varied by 56% (HALex) and 37% (BQL) across hospitals. Patient factors accounted for 58% (HALex) to 71% (BQL) of the variation in HRQOL across hospitals. After risk and reliability adjustment, HRQOL varied by 18% (by HALex) and 14.5% (by BQL) across hospitals, and the proportion of patients who experienced a large improvement in HRQOL by HALex ranged from 33% to 69% and 67% to 92% by BQL. After adjusting for patient factors and reliability, these differences diminished to 55%-64% (HALex) and 79%-84% (BQL).
Patient factors explain a large proportion of hospital-level variation in PROs following bariatric surgery, underscoring the importance of risk adjustment. However, some variation in PROs across hospitals remains unexplained, suggesting PROs may represent a viable indicator of hospital performance.
尽管将患者报告的结局（PROs）应用于手术质量的兴趣日益浓厚，但手术后不同医院间PROs的差异程度尚不清楚。
我们研究了进行减肥手术的不同医院间PROs的差异，特别是与健康相关的生活质量（HRQOL）。
一项回顾性队列研究。
密歇根减肥手术协作组是一个全州范围的联盟，由39家进行腹腔镜胃旁路术、胃束带术或袖状胃切除术的医院组成（2008年至2012年间有11420例患者）。
我们通过健康与活动受限指数（HALex）和减肥生活质量指数（BQL）在术前及术后1年检查一般和特定疾病的HRQOL。我们测量了不同医院术后HRQOL的差异，以及风险和可靠性调整对医院排名的影响。
在这个队列中，不同医院间的HRQOL差异为56%（HALex）和37%（BQL）。患者因素占不同医院间HRQOL差异的58%（HALex）至71%（BQL）。在进行风险和可靠性调整后，不同医院间的HRQOL差异为18%（HALex）和14.5%（BQL），通过HALex显示HRQOL有大幅改善的患者比例在33%至69%之间，通过BQL则在67%至92%之间。在调整患者因素和可靠性后，这些差异降至55% - 64%（HALex）和79% - 84%（BQL）。
患者因素解释了减肥手术后医院层面PROs差异的很大一部分，凸显了风险调整的重要性。然而，不同医院间PROs仍存在一些无法解释的差异，这表明PROs可能是医院绩效的一个可行指标。
