Comparative Outcomes Analysis of Procedures Performed in Physician Offices and Ambulatory Surgery Centers

Vila, Hector; Soto, Roy G.; Cantor, Alan; Mackey, David C.

doi:10.1001/archsurg.138.9.991

Cited by 146 publications

(17 citation statements)

References 13 publications

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“…Our results are concordant with prior research, showing ASCs and hospitals to have similar risk-adjusted postoperative mortality. 5 However, unlike Vila and colleagues, 16 we found death rates at ASCs and the office to be both low and comparable. This finding may relate, in part, to increased state-level regulation of office-based surgery.…”

Section: Discussioncontrasting

confidence: 71%

Surgical Quality Among Medicare Beneficiaries Undergoing Outpatient Urological Surgery

et al. 2012

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Introduction and objective The cost-efficiency gains achieved from moving procedures to ASCs and the office may be mitigated if the quality of surgical care at these facilities is not comparable to that of the hospital. Motivated by this, we assessed short-term morbidity and mortality for patients by location of care. Methods Using a national sample of Medicare claims (1998 – 2006), we identified elderly beneficiaries who underwent one of 22 common outpatient urologic procedures. After determining the facility type at which each procedure was performed, we then measured 30-day mortality, unexpected admissions, and postoperative complications. Finally, we fit multivariable logistic regression models to evaluate the association between occurrence of an adverse event and the ambulatory setting where surgical care was delivered. Results Over the study period, there was a substantial increase in the frequency of nonhospital-based outpatient surgery. Compared to ASCs and the office, hospitals treated more women (P<0.001). Their patients also tended to be less healthy (P<0.001). While patients experienced fewer postoperative complications following surgery at an ASC, procedures performed outside the hospital were associated with a higher likelihood of a same-day admission [ASC: OR, 6.96 (95% CI, 4.44 – 10.90); office: OR, 3.64 (95% CI, 2.48 – 5.36)]. However, it is important to note that, with case-mix adjustment, the probability of any adverse event was exceedingly low across all ambulatory settings. Conclusions These data indicate that small, but measurable variation in surgical quality exists by location of care delivery.

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Section: Discussioncontrasting

confidence: 71%

Surgical Quality Among Medicare Beneficiaries Undergoing Outpatient Urological Surgery

et al. 2012

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“…Even though mortality related to the ambulatory surgical setting is rare, this indicator has been used to flag potential quality problems associated with ambulatory surgery [6,7,9,25]. Other researchers have also used mortality as an outcome for comparing quality of care provided in the outpatient setting [8,12,26,27]. We used 7-day indicators since, as a shorter measure, it can reduce the effects of extraneous factors unrelated to outpatient procedures [6].…”

Section: Outcome Variablementioning

confidence: 99%

“…Due to the significant growth in the number of ambulatory surgical procedures provided in the U.S. and associated overall costs [4], researchers have begun to examine differences in quality outcomes for procedures performed in freestanding ambulatory surgical centers (ASCs) and hospital-based outpatient departments (HOPDs) [5][6][7][8][9][10][11][12][13][14][15]. Overall, these studies have utilized varying risk-adjustment approaches and have generally produced mixed results.…”

Section: Introductionmentioning

confidence: 99%

How well does diagnosis-based risk-adjustment work for comparing ambulatory clinical outcomes?

Chukmaitov

Harless

Menachemi

et al. 2009

Health Care Manag Sci

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This paper examines the empirical consistency of the Diagnosis Cost Groups/Hierarchical Condition Categories (DCG/HCC) risk-adjustment method for comparing 7-day mortality between hospital-based outpatient departments (HOPDs) and freestanding ambulatory surgery centers (ASCs). We used patient level data for the three most common outpatient procedures provided during the 1997-2004 period in Florida. We estimated base-line logistic regression models without any diagnosis-based risk adjustment and compared them to logistic regression models with the DCG/HCC risk-adjustment, and to conditional logit models with a matched cohort risk-adjustment approach. We also evaluated models that adjusted for primary diagnoses only, and then for all available diagnoses, to assess how the frequently absent secondary diagnoses fields in ambulatory surgical data affect risk-adjustment. We found that risk-adjustment using both diagnosis-based methods resulted in similar 7-day mortality estimates for HOPD patients in comparison with ASC patients in two out of three procedures. We conclude that the DCG/HCC risk-adjustment method is relatively consistent and stable, and recommend this risk-adjustment method for health policy research and practice with ambulatory surgery data. We also recommend using risk-adjustment with all available diagnoses.

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“…The question of differential risk by outpatient setting has primarily been raised within the field of cosmetic/plastic surgery, following public concerns about patient safety in offices in the 1990s and subsequent efforts to address concerns through state office-based surgery laws, facility accreditation, mandated reporting of adverse events, and quality improvement activities. The State of Florida’s adverse event registry, in particular, has been used by researchers to understand risk in physician offices [ 4 – 12 ]. Other researchers have used claims data to study differences in offices and ASCs, with particular attention to patient risk factors in each setting [ 13 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

The effect of facility characteristics on patient safety, patient experience, and service availability for procedures in non-hospital-affiliated outpatient settings: A systematic review

et al. 2018

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BackgroundOver recent decades, numerous medical procedures have migrated out of hospitals and into freestanding ambulatory surgery centers (ASCs) and physician offices, with possible implications for patient outcomes. In response, states have passed regulations for office-based surgeries, private organizations have established standards for facility accreditation, and professional associations have developed clinical guidelines. While abortions have been performed in office setting for decades, states have also enacted laws requiring that facilities that perform abortions meet specific requirements. The extent to which facility requirements have an impact on patient outcomes—for any procedure—is unclear.Methods and findingsWe conducted a systematic review to examine the effect of outpatient facility type (ASC vs. office) and specific facility characteristics (e.g., facility accreditation, emergency response protocols, clinician qualifications, physical plant characteristics, other policies) on patient safety, patient experience and service availability in non-hospital-affiliated outpatient settings. To identify relevant research, we searched databases of the published academic literature (PubMed, EMBASE, Web of Science) and websites of governmental and non-governmental organizations. Two investigators reviewed 3049 abstracts and full-text articles against inclusion/exclusion criteria and assessed the quality of 22 identified articles. Most studies were hampered by methodological challenges, with 12 of 22 not meeting minimum quality criteria. Of 10 studies included in the review, most (6) examined the effect of facility type on patient safety. Existing research appears to indicate no difference in patient safety for outpatient procedures performed in ASCs vs. physician offices. Research about specific facility characteristics is insufficient to draw conclusions.ConclusionsMore and higher quality research is needed to determine if there is a public health problem to be addressed through facility regulation and, if so, which facility characteristics may result in consistent improvements to patient safety while not adversely affecting patient experience or service availability.

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Comparative Outcomes Analysis of Procedures Performed in Physician Offices and Ambulatory Surgery Centers

Cited by 146 publications

References 13 publications

Surgical Quality Among Medicare Beneficiaries Undergoing Outpatient Urological Surgery

Surgical Quality Among Medicare Beneficiaries Undergoing Outpatient Urological Surgery

How well does diagnosis-based risk-adjustment work for comparing ambulatory clinical outcomes?

The effect of facility characteristics on patient safety, patient experience, and service availability for procedures in non-hospital-affiliated outpatient settings: A systematic review

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