Variations In The Quality Of Care For Very-Low-Birthweight Infants: Implications For Policy

Rogowski, Jeannette; Staiger, Douglas O.; Horbar, Jeffrey D.

doi:10.1377/hlthaff.23.5.88

Cited by 53 publications

(40 citation statements)

References 21 publications

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“…Explicit consideration is given to the degree of relatedness between procedures, and the exact contribution of each operation to another operation's prediction is estimated using sophisticated weighting techniques. Methods that integrate multiple domains of quality have yielded promising results for measuring quality of care after acute myocardial infarction (19) and neonatal intensive care (15), but could be readily extended to surgery.…”

Section: Discussionmentioning

confidence: 99%

Are Mortality Rates for Different Operations Related?

Dimick¹,

Staiger²,

Birkmeyer³

2006

Medical Care

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Background-Except in cardiac surgery, measuring quality with procedure-specific mortality rates is unreliable due to small sample sizes at individual hospitals. Statistical power can be improved by combining mortality data from multiple operations. We sought to determine whether this approach would still be useful in understanding performance with individual procedures.Methods-We studied eleven high-risk operations performed in the national Medicare population (1996)(1997)(1998)(1999). For each operation, we calculated 1) the risk-adjusted mortality rate for the procedure and 2) the mortality rate with up to ten other operations combined ("other" mortality). To test for an association between these mortality rates, we calculated the correlation coefficient adjusting for random variation. We then collapsed hospitals into quintiles of other mortality and calculated procedure-specific mortality rates within each of these quintiles.Results-Mortality with specific operations was modestly correlated with other mortality: coefficients ranged from 0.14 for pneumonectomy to 0.35 for esophagectomy. Despite small to moderate correlations, other mortality was a good predictor of procedure-specific mortality for 10 of the 11 operations. Pancreatic resection had the strongest relationship, with procedure-specific mortality rates at hospitals in the worst quintile of other mortality 3-fold higher than those in the best quintile (15.2% vs. 6.3%, p<.001). Pneumonectomy had the weakest relationship, with no significant relationship between other mortality and procedure-specific mortality.Conclusions-Hospitals with low mortality rates for one operation tend to have lower mortality rates for other operations. These relationships suggest that different operations share important structures and processes of care related to performance. Future efforts aimed at predicting procedurespecific performance should consider incorporating data from other operations at that hospital. KeywordsMeasurement; surgery; quality; performance; hospitals IntroductionBecause of widespread recognition that surgical quality varies widely, there is growing demand from patients, providers, and payers for better measures of surgical outcomes (1,2). Riskadjusted mortality rates are a simple and reliable measure of surgical quality and have been used to good effect in cardiac surgery (3,4 frequently enough to reliably discriminate quality among individual hospitals using this approach (5,6).One way to improve outcomes measurement in non-cardiac surgery is to combine several operations together when assessing hospital mortality rates (7). However, this approach will only be useful to the extent that hospital performance with different operations is correlatedi.e., that hospitals good at one operation are also good at others. While previous studies show relatively weak relationships between outcomes for different medical diagnoses, there is some reason to believe these relationships may be stronger in surgery (8,9). Many high-risk operations are dependent ...

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Section: Discussionmentioning

confidence: 99%

Are Mortality Rates for Different Operations Related?

Dimick¹,

Staiger²,

Birkmeyer³

2006

Medical Care

Self Cite

View full text Add to dashboard Cite

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“…demonstrated, despite adjustment for socio-demographic variables, significant differences between centres in antenatal and post-natal approaches to resuscitation and use of steroids. 177 Collaborative quality improvement exercises systematically identify 'best practice' from hospitals with the best outcomes and encourage such practice in all hospitals.…”

Section: Factors In Service Deliverymentioning

confidence: 99%

Understanding why children die in high-income countries

et al. 2014

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Copyright and reuse:The Warwick Research Archive Portal (WRAP) makes this work of researchers of the University of Warwick available open access under the following conditions. Copyright © and all moral rights to the version of the paper presented here belong to the individual author(s) and/or other copyright owners. To the extent reasonable and practicable the material made available in WRAP has been checked for eligibility before being made available.Copies of full items can be used for personal research or study, educational, or not-forprofit purposes without prior permission or charge. Provided that the authors, title and full bibliographic details are credited, a hyperlink and/or URL is given for the original metadata page and the content is not changed in any way. AbstractThrough a structured narrative review of the literature, we have identified a wide range of factors influencing child and adolescent mortality in high income countries. These can be conceptualised within the four domains of intrinsic factors, the physical environment, the social environment, and service delivery factors. The most prominent factors in the literature are socio-economic gradients, although the mechanisms through which these gradients exert their effects are complex, affecting all four domains, and often poorly understood. While some factors are relatively fixed, including the child's gender, age, ethnicity and inherent genetic make-up, some parental characteristics, and some wider 3 environmental conditions, others may be amenable to interventions that could lessen risks and help to prevent future child deaths. A number of examples of systemic health service factors that may impact child survival are given, along with interventions such as modifications to the physical or social environmental that may impact more distal factors.

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“…Although the maternal and patient demographic base may explain some of this, there remains a strong argument that the implementation of effective interventions varies as well. 62 If serious neonatal morbidities other than CLABSI were to match those of the best quartile, thousands of infants and families would be spared their damaging consequences. The corollary would be to spare the system of unnecessary expenditures.…”

Section: Quality Improvementmentioning

confidence: 99%

Evidence, Quality, and Waste: Solving the Value Equation in Neonatology

et al. 2016

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Rising health care costs challenge governments, payers, and providers in delivering health care services. Tremendous pressures result to deliver better quality care while simultaneously reducing costs. This has led to a wholesale re-examination of current practice methods, including explicit consideration of efficiency and waste. Traditionally, reductions in the costs of care have been considered as independent, and sometimes even antithetical, to the practice of high-quality, intensive medicine. However, it is evident that provision of evidence-based, locally relevant care can result in improved outcomes, lower resource utilization, and opportunities to reallocate resources. This is particularly relevant to the practice of neonatology. In the United States, 12% of the annual birth cohort is affected by preterm birth, and 3% is affected by congenital anomalies. Both of these conditions are associated with costly health care during, and often long after, the NICU admission. We will discuss how 3 drivers of clinical practice in neonatal care (evidence-based medicine, evidence-based economics, and quality improvement) can together optimize clinical and fiscal outcomes.

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Variations In The Quality Of Care For Very-Low-Birthweight Infants: Implications For Policy

Cited by 53 publications

References 21 publications

Are Mortality Rates for Different Operations Related?

Are Mortality Rates for Different Operations Related?

Understanding why children die in high-income countries

Evidence, Quality, and Waste: Solving the Value Equation in Neonatology

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