No abstract

Background Medicare and private plans are encouraging individuals to seek care at hospitals which are designated as centers of excellence. Few evaluations of such programs have been conducted. The Blue Cross Blue Shield Association, whose member plans insure one in three Americans, has established an initiative to designate hospitals as centers of excellence for knee and hip replacement. Objective Comparison of outcomes and costs associated with knee and hip replacement at designated hospitals and other hospitals. Research design Retrospective claims analysis of approximately 54 million enrollees. Study population Individuals with Blue Cross Blue Shield insurance who underwent a primary knee or hip replacement in 2007-2009. Outcomes Primary outcomes were any complication within 30 days of discharge and costs within 90 days following the procedure. Results 80,931 patients had a knee replacement and 39,532 patients had a hip replacement of which 52.2% and 56.5%, respectively, were performed at a designated hospital. Designated hospitals had a larger number of beds and were more likely to be an academic center. Patients with a knee replacement at designated hospitals did not have a statistically significantly lower overall complication rate with an odds ratio of 0.90 (p=0.08). Patients with a hip replacement treated at designated hospitals had a statistically significantly lower risk of complications with an odds ratio of 0.80 (p=0.002). There was no significant difference in 90-day costs for either procedure. Conclusions Hospitals designated as joint replacement centers of excellence had lower rates of complications for hip replacement, but there was no statistically significant difference for knee replacement. It is important to validate the criteria used to designate centers of excellence.

This study confirms that there are important differences between self-reported and externally rated measures of QI success and provides researchers with a methodology and criteria to externally rate measures of QI success.

This study evaluated how the Perfecting Patient Care (PPC) University, a quality improvement (QI) training program for health care leaders and clinicians, affected the ability of organizations to improve the health care they provide. This training program teaches improvement methods based on Lean concepts and principles of the Toyota Production System and is offered in several formats. A retrospective evaluation was performed that gathered data on training, other process factors, and outcomes after staff completed the PPC training. A majority of respondents reported gaining QI competencies and cultural achievements from the training. Organizations had high average scores for the success measures of "outcomes improved" and "sustainable monitoring" but lower scores for diffusion of QI efforts. Total training dosage was significantly associated with the measures of QI success. This evaluation provides evidence that organizations gained the PPC competencies and cultural achievements and that training dosage is a driver of QI success.