How well do subjective Hospital Compare metrics reflect objective outcomes in spine surgery?

Missios, Symeon; Bekelis, Kimon

doi:10.3171/2016.1.spine151155

Cited by 15 publications

(9 citation statements)

References 24 publications

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“…This can help the public make decisions about their care especially since other reporting initiatives such as Hospital Compare, and the ProPublica Surgeon Scorecard have been criticized for their accuracy. (36–38)…”

Section: Discussionmentioning

confidence: 99%

Correlation of hospital magnet status with the quality of physicians performing neurosurgical procedures in New York State

Bekelis

Missios

MacKenzie

2018

British Journal of Neurosurgery

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Purpose The quality of physicians practicing in hospitals recognized for nursing excellence by the American Nurses Credentialing Center has not been studied before. We investigated whether Magnet hospital recognition is associated with higher quality of physicians performing neurosurgical procedures. Materials and Methods We performed a cohort study of patients undergoing neurosurgical procedures from 2009–2013, who were registered in the New York Statewide Planning and Research Cooperative System (SPARCS) database. Propensity score adjusted multivariable regression models were used to adjust for known confounders, with mixed effects methods to control for clustering at the facility level. An instrumental variable analysis was used to control for unmeasured confounding and simulate the effect of a randomized trial. Results During the study period, 185,277 patients underwent neurosurgical procedures, and met the inclusion criteria. Of these, 66,607 (35.6%) were hospitalized in Magnet hospitals, and 118,670 (64.4%) in non-Magnet institutions. Instrumental variable analysis demonstrated that undergoing neurosurgical operations in Magnet hospitals was associated with a 13.6% higher chance of being treated by a physician with superior performance in terms of mortality (95% CI, 13.2% to 14.1%), and a 4.3% higher chance of being treated by a physician with superior performance in terms of length-of-stay (LOS) (95% CI, 3.8% to 4.7%) in comparison to non-Magnet institutions. The same associations were present in propensity score adjusted mixed effects models. Conclusions Using a comprehensive all-payer cohort of neurosurgical patients in New York State we identified an association of Magnet hospital recognition with superior physician performance.

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Section: Discussionmentioning

confidence: 99%

Correlation of hospital magnet status with the quality of physicians performing neurosurgical procedures in New York State

Bekelis

Missios

MacKenzie

2018

British Journal of Neurosurgery

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“…Some researchers 14 have demonstrated that hospitals achieving higher patient satisfaction were associated with lower rates of mortality, discharge to rehabilitation, and average LOS for patients undergoing spine surgery. They failed to identify such an association for cranial neurosurgery.…”

Section: Discussionmentioning

confidence: 99%

“…5,12 Some researchers 14 have demonstrated that improved patient satisfaction was associated with superior hospital-level outcomes in terms of mortality, length-of-stay, and discharge to rehabilitation for patients undergoing spine surgery. The same group 3 and others 17,20,22 failed to identify a similar relationship for different surgical procedures, raising questions about the reliability of this reporting platform.…”

Section: Introductionmentioning

confidence: 99%

Does Objective Quality of Physicians Correlate with Patient Satisfaction Measured by Hospital Compare Metrics in New York State?

et al. 2017

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Background It is unclear whether publicly reported benchmarks correlate with the quality of physicians and institutions. We investigated the association of patient satisfaction measures from a public reporting platform with the performance of neurosurgeons in New York State. Methods We performed a cohort study involving patients undergoing neurosurgical operations from 2009–2013, who were registered in the Statewide Planning and Research Cooperative System (SPARCS) database. This cohort was merged with publicly available data from the CMS Hospital Compare website. A propensity adjusted regression analysis was used to investigate the association of patient satisfaction metrics with neurosurgeon quality, as measured by their individual rate of mortality and average length-of-stay (LOS). Results Overall, 166,365 patients underwent neurosurgical procedures during the study. Using a propensity adjusted multivariable regression analysis we demonstrated that undergoing neurosurgical operations in hospitals with a greater percentage of patient-assigned “high” score were associated with higher chance of being treated by a physician with superior performance in terms of mortality (OR 1.90; 95% CI, 1.86 to 1.95), and a higher chance of being treated by a physician with superior performance in terms of length-of-stay (LOS) (OR 1.24; 95% CI, 1.21 to 1.27). Similar associations were identified for hospitals with a higher percentage of patients, who claimed they would recommend these institutions to others. Conclusions Merging a comprehensive all-payer cohort of neurosurgery patients in New York State with data from the CMS Hospital Compare website, we observed an association of superior hospital-level patient satisfaction measures with the objective performance of individual neurosurgeons in the corresponding hospitals.

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“…Some of the most prominent such efforts such as Hospital Compare and the ProPublica Surgeon Scorecard have been criticized for their accuracy. [35][36][37] …”

Section: Discussionmentioning

confidence: 99%

Association of Hospitalization for Neurosurgical Operations in Magnet Hospitals With Mortality and Length of Stay

Missios

Bekelis

2017

NEUROSURGERY

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BACKGROUND:The association of Magnet hospital status with improved surgical outcomes remains an issue of debate. OBJECTIVE: To investigate whether hospitalization in a Magnet hospital is associated with improved outcomes for patients undergoing neurosurgical operations. METHODS: A cohort study was executed using all patients undergoing neurosurgical operations in New York registered in the Statewide Planning and Research Cooperative System database from 2009 to 2013. We examined the association of Magnet status hospitalization after neurosurgical operations with inpatient case fatality and length of stay (LOS). We employed an instrumental variable analysis to simulate a randomized trial. RESULTS: Overall, 190 787 patients underwent neurosurgical operations. Of these, 68 046 (35.7%) were hospitalized in Magnet hospitals, and 122 741 (64.3%) in non-Magnet institutions. Instrumental variable analysis demonstrated that hospitalization in Magnet hospitals was associated with decreased case fatality (adjusted difference, -0.8%; -95% confidence interval, -0.7% to -0.6%), and LOS (adjusted difference, -1.9; 95% confidence interval, -2.2 to -1.5) in comparison to non-Magnet hospitals. These associations were also observed in propensity score adjusted mixed effects models. These associations persisted in prespecified subgroups of patients undergoing spine surgery, craniotomy for tumor resection, or neurovascular interventions. CONCLUSION:We identified an association of Magnet hospitals with lower case fatality, and shorter LOS in a comprehensive New York State patient cohort undergoing neurosurgical procedures.

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How well do subjective Hospital Compare metrics reflect objective outcomes in spine surgery?

Cited by 15 publications

References 24 publications

Correlation of hospital magnet status with the quality of physicians performing neurosurgical procedures in New York State

Correlation of hospital magnet status with the quality of physicians performing neurosurgical procedures in New York State

Does Objective Quality of Physicians Correlate with Patient Satisfaction Measured by Hospital Compare Metrics in New York State?

Association of Hospitalization for Neurosurgical Operations in Magnet Hospitals With Mortality and Length of Stay

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