Comparison of a Potential Hospital Quality Metric With Existing Metrics for Surgical Quality–Associated Readmission

Graham, Laura A.; Mull, Hillary J.; Rosen, Amy K.; Richman, Joshua S.; Whittle, Jeff; Burns, Edith; Copeland, Laurel A.; Itani, Kamal M.F.; Hawn, Mary T.

doi:10.1001/jamanetworkopen.2019.1313

Cited by 19 publications

(28 citation statements)

References 24 publications

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“…In addition, while we do not assess whether a readmission was related to the surgery, it is important to note that typically on 70% of readmissions after a surgical procedure are related to the index surgery. 41 , 42 …”

Section: Discussionmentioning

confidence: 99%

Psychosocial Determinants of Readmission After Surgery

et al. 2021

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Background: Quality of life and psychosocial determinants of health, such as health literacy and social support, are associated with increased health care utilization and adverse outcomes in medical populations. However, the effect on surgical health care utilization is less understood. Objective: We sought to examine the effect of patient-reported quality of life and psychosocial determinants of health on unplanned hospital readmissions in a surgical population. Research Design: This is a prospective cohort study using patient interviews at the time of hospital discharge from a Veterans Affairs hospital. Subjects: We include Veterans undergoing elective inpatient general, vascular, or thoracic surgery (August 1, 2015–June 30, 2017). Measures: We assessed unplanned readmission to any medical facility within 30 days of hospital discharge. Results: A total of 736 patients completed the 30-day postoperative follow-up, and 16.3% experienced readmission. Lower patient-reported physical and mental health, inadequate health literacy, and discharge home with help after surgery or to a skilled nursing or rehabilitation facility were associated with an increased incidence of readmission. Classification regression identified the patient-reported Veterans Short Form 12 (SF12) Mental Component Score <31 as the most important psychosocial determinant of readmission after surgery. Conclusions: Mental health concerns, inadequate health literacy, and lower social support after hospital discharge are significant predictors of increased unplanned readmissions after major general, vascular, or thoracic surgery. These elements should be incorporated into routinely collected electronic health record data. Also, discharge plans should accommodate varying levels of health literacy and consider how the patient’s mental health and social support needs will affect recovery.

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Section: Discussionmentioning

confidence: 99%

Psychosocial Determinants of Readmission After Surgery

et al. 2021

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“…Using only preoperative variables, AUC is 74%, on average (with GBM). These results outperform earlier models, such as the LACE index [27], which has an AUC of 68.4%, and more recent models [28], which yield a 72% AUC in 2 days after admission, and 78-81% at discharge.…”

Section: Plos Onementioning

confidence: 66%

Prescriptive analytics for reducing 30-day hospital readmissions after general surgery

Bertsimas

Paschalidis

et al. 2020

PLoS ONE

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Introduction New financial incentives, such as reduced Medicare reimbursements, have led hospitals to closely monitor their readmission rates and initiate efforts aimed at reducing them. In this context, many surgical departments participate in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), which collects detailed demographic, laboratory, clinical, procedure and perioperative occurrence data. The availability of such data enables the development of data science methods which predict readmissions and, as done in this paper, offer specific recommendations aimed at preventing readmissions. Materials and methods This study leverages NSQIP data for 722,101 surgeries to develop predictive and prescriptive models, predicting readmissions and offering real-time, personalized treatment recommendations for surgical patients during their hospital stay, aimed at reducing the risk of a 30-day readmission. We applied a variety of classification methods to predict 30-day readmissions and developed two prescriptive methods to recommend pre-operative blood transfusions to increase the patient's hematocrit with the objective of preventing readmissions. The effect of these interventions was evaluated using several predictive models. Results Predictions of 30-day readmissions based on the entire collection of NSQIP variables achieve an out-of-sample accuracy of 87% (Area Under the Curve-AUC). Predictions based only on pre-operative variables have an accuracy of 74% AUC, out-of-sample. Personalized interventions, in the form of pre-operative blood transfusions identified by the prescriptive methods, reduce readmissions by 12%, on average, for patients considered as candidates for pre-operative transfusion (pre-operative hematoctic <30). The prediction accuracy of the proposed models exceeds results in the literature.

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“…For example, a previous study showed that a change in definition within the same surgical context increased the occurrence of adverse outcomes from 7 to 27% (20). Similarly, data from one study where the complication rate is defined as the case-mix-adjusted proportion of complications within 14 days post-surgery cannot be pooled with another study where it is defined as non-case-mix-adjusted proportion of complications within 30 days post-surgery (9,21).…”

Section: Introductionmentioning

confidence: 99%

International comparison of variation in performance between hospitals for THA and TKA: Is it even possible? A systematic review including 33 studies and 8 arthroplasty register reports

et al. 2022

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In order to improve care for total hip and knee arthroplasties (THA/TKA), hospitals may want to compare their performance with hospitals in other countries. Pooling data across countries also enable early detection of infrequently occurring safety issues. We therefore aimed to assess the between-hospital variation and definitions used for revision, readmission, and complications across countries. PubMed, Embase, Web of Science, Cochrane library, Emcare, and Academic Search Premier were searched from January 2009 to August 2020 for studies reporting on: (i) primary THA/TKA; (ii) revision, readmission, or complications; and (iii) between-hospital variation. Most recent registry reports of Network of Orthopedic Registries of Europe members were also reviewed. Two reviewers independently screened records, extracted data, and assessed the risk of bias using the Integrated quality Criteria for the Review Of Multiple Study designs tool for studies and relevant domains for registries. We assessed agreement for the following domains: (i) outcome definition; (ii) follow-up and starting point; (iii) case-mix adjustment; and (iv) type of patients and hospitals included. Between-hospital variation was reported in 33 (1 high-quality, 13 moderate-quality, and 19 low-quality) studies and 8 registry reports. The range of variation for revision was 0–33% for THA and 0–27% for TKA varying between assessment within hospital admission until 10 years of follow-up; for readmission, 0–40% and 0–32% for THA and TKA, respectively; and for complications, 0–75% and 0–50% for THA and TKA, respectively. Indicator definitions and methodological variables varied considerably across domains. The large heterogeneity in definitions and methods used likely explains the considerable variation in between-hospital variation reported for revision, readmission, and complications , making it impossible to benchmark hospitals across countries or pool data for earlier detection of safety issues. It is necessary to collaborate internationally and strive for more uniformity in indicator definitions and methods in order to achieve reliable international benchmarking in the future.

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Comparison of a Potential Hospital Quality Metric With Existing Metrics for Surgical Quality–Associated Readmission

Cited by 19 publications

References 24 publications

Psychosocial Determinants of Readmission After Surgery

Psychosocial Determinants of Readmission After Surgery

Prescriptive analytics for reducing 30-day hospital readmissions after general surgery

International comparison of variation in performance between hospitals for THA and TKA: Is it even possible? A systematic review including 33 studies and 8 arthroplasty register reports

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