Fry Donald E, Pine Michael, Nedza Susan, Locke David, Reband Agnes, Pine Gregory
*MPA Healthcare Solutions, Chicago, IL †Departments of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL ‡University of New Mexico School of Medicine, Albuquerque, NM §Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
Ann Surg. 2017 Jan;265(1):178-184. doi: 10.1097/SLA.0000000000001653.
To compare the risk-adjusted outcomes of hospitals in inpatient Medicare laparoscopic cholecystectomy.
Reduced length-of-stay for inpatient surgical care requires the inclusion of objective postdischarge outcomes to provide a comprehensive assessment of hospital and surgeon performance for quality improvement.
The 2010 to 2012 Medicare Limited Data Set was used to develop risk-adjusted prediction models of inpatient deaths, prolonged length-of-stay outliers, 90-day postdischarge deaths, and 90-day readmissions for inpatient laparoscopic cholecystectomy. To define the opportunity for improved performance, prediction models were used to compute z scores and risk-adjusted adverse outcome rates for all hospitals in the database that had 20 or more evaluable cases for the study period.
A total of 83,274 patients from 1570 hospitals had an overall adverse outcome rate of 20.7%; 48 hospitals had outcomes that were 2 z scores better than predicted and 76 had 2 z scores poorer than predicted. Risk-adjusted adverse outcomes were 10.0 % in the best performing decile of hospitals and were 32.1% in the poorest performing decile. Gastrointestinal, infectious, and cardiopulmonary complications of care were the most common causes of readmissions with 46.3% occurring between days 30 and 90 after discharge.
Comparative analysis of overall risk-adjusted inpatient and 90-day postdischarge adverse outcomes identifies considerable opportunity for improved care in this high-risk population of patients.
比较医疗保险住院患者腹腔镜胆囊切除术中医院经风险调整后的结果。
缩短住院手术治疗的住院时间需要纳入出院后的客观结果，以便对医院和外科医生的表现进行全面评估，以改进质量。
使用2010年至2012年医疗保险有限数据集，建立住院患者死亡、住院时间延长异常值、出院后90天死亡和住院腹腔镜胆囊切除术后90天再入院的风险调整预测模型。为了确定改进表现的机会，使用预测模型计算数据库中所有在研究期间有20例或更多可评估病例的医院的z分数和风险调整后的不良结局率。
来自1570家医院的83274名患者的总体不良结局率为20.7%；48家医院的结局比预测的好2个z分数，76家医院的结局比预测的差2个z分数。在表现最佳的十分之一医院中，风险调整后的不良结局为10.0%，在表现最差的十分之一医院中为32.1%。胃肠道、感染和心肺护理并发症是再入院的最常见原因，46.3%发生在出院后30至90天之间。
对总体经风险调整的住院患者和出院后90天不良结局的比较分析表明，在这一高风险患者群体中，改善护理有相当大的机会。
