Department of Surgery, University of Michigan, Ann Arbor.
Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan.
JAMA Surg. 2019 Jun 1;154(6):510-515. doi: 10.1001/jamasurg.2019.0090.
Hospitals are rapidly consolidating into regional delivery networks. To our knowledge, whether these multihospital networks leverage their combined assets to improve quality and provide a uniform standard of care has not been explored.
To evaluate the extent to which surgical outcomes varied across hospitals within the networks of the highest-rated US hospitals.
DESIGN, SETTINGS, AND PARTICIPANTS: This longitudinal analysis of 87 hospitals that participated in 1 of 16 networks that are affiliated with US News & World Report Honor Roll hospitals used data from Medicare beneficiaries who were undergoing colectomy, coronary artery bypass graft, or hip replacement between 2005 and 2014 to evaluate the variation in risk-adjusted surgical outcomes at Honor Roll and affiliated hospitals within and across networks. The data were analyzed between April 20, 2018, and June 25, 2018.
Thirty-day postoperative complications, mortality, failure to rescue, and readmissions.
Of 143 174 patients, 68 718 (48.0%) were men, 124 427 (86.9%) were white, and the mean (SD) age was 71.8 (9.9) years and 73.5 (9.1) years in Honor Roll and affiliated hospitals, respectively. Outcomes were not consistently better at Honor Roll hospitals compared with network affiliates. For example, Honor Roll hospitals had lower failure to rescue rates (13.3% vs 15.1%; odds ratio, 0.92; 95% CI, 0.86-0.98) but higher complication rates (22.1% vs 18.0%; odds ratio, 1.11; 95% CI, 1.03-1.19). Within networks, risk-adjusted outcomes varied widely across affiliated hospitals. The differences in failure to rescue varied by as little as 1.1-fold (range, 12.7%-14.3%) in some networks to as much as 4.9-fold (range, 7.6%-37.3%) in others. Similarly, complication rates varied by 1.1-fold (range, 21%-23%) to 4.3-fold (range, 6%-26%) across all networks.
Surgical outcomes vary widely across hospitals affiliated with the US News & World Report Honor Roll hospitals. Public reporting mechanisms should provide patients with information on the quality of all network-affiliated hospitals. Networks should monitor variations in outcomes to characterize and improve the extent to which a uniform standard of care is being delivered.
医院正在迅速整合为区域性医疗服务网络。据我们所知，这些多医院网络是否利用其共同的资产来提高质量并提供统一的护理标准尚未得到探索。
评估在最高评级的美国医院的网络内，手术结果在医院之间的差异程度。
设计、设置和参与者：这项对 87 家医院的纵向分析，这些医院参与了 16 个网络中的 1 个，这些网络与美国新闻与世界报道荣誉榜医院有关联。该研究使用了 2005 年至 2014 年间接受结肠切除术、冠状动脉旁路移植术或髋关节置换术的 Medicare 受益人的数据，以评估荣誉榜医院和附属网络内和网络间的手术结果在风险调整后的差异。数据分析于 2018 年 4 月 20 日至 6 月 25 日进行。
术后 30 天的并发症、死亡率、救援失败和再入院率。
在 143174 名患者中，68718 名（48.0%）为男性，124427 名（86.9%）为白人，平均（标准差）年龄分别为 71.8（9.9）岁和 73.5（9.1）岁，分别在荣誉榜医院和附属医院。结果在荣誉榜医院并不总是优于网络附属机构。例如，荣誉榜医院的救援失败率较低（13.3%比 15.1%；比值比，0.92；95%置信区间，0.86-0.98），但并发症发生率较高（22.1%比 18.0%；比值比，1.11；95%置信区间，1.03-1.19）。在网络内，附属医院的风险调整后结果差异很大。救援失败的差异最小为 1.1 倍（范围，12.7%-14.3%），最大为 4.9 倍（范围，7.6%-37.3%）。同样，并发症发生率在所有网络中差异为 1.1 倍（范围，21%-23%）至 4.3 倍（范围，6%-26%）。
附属美国新闻与世界报道荣誉榜医院的医院的手术结果差异很大。公共报告机制应为患者提供有关所有网络附属医院质量的信息。网络应监测结果的变化，以描述和提高统一护理标准的实施程度。
