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Walsan R, Mitchell RJ, Braithwaite J, Westbrook J, Hibbert P, Mumford V, Harrison R. Marked variations in medical provider and out-of-pocket costs for radical prostatectomy procedures in Australia. AUST HEALTH REV 2024; 48:167-171. [PMID: 38479795 DOI: 10.1071/ah24020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/25/2024] [Indexed: 04/05/2024]
Abstract
Objectives Unwarranted clinical variations in radical prostatectomy (RP) procedures are frequently reported, yet less attention is given to the variations in associated costs. This issue can further widen disparities in access to care and provoke questions about the overall value of the procedure. The present paper aimed to delve into the disparities in hospital, medical provider and out-of-pocket costs for RP procedures in Australia, discussing plausible causes and potential policy opportunities. Methods A retrospective cohort study using Medibank Private claims data for RP procedures conducted in Australian hospitals between 1 January 2015 and 31 December 2020 was undertaken. Results Considerable variations in both medical provider and out-of-pocket costs were observed across the country, with variations evident between different states or territories. Particularly striking were the discrepancies in the costs charged by medical providers, with a notable contrast between the 10th and 90th percentiles revealing a substantial difference of A$9925. Hospitals in Australia exhibited relatively comparable charges for RP procedures. Conclusions Initiatives such as enhancing transparency regarding individual medical provider costs and implementing fee regulations with healthcare providers may be useful in curbing the variations in RP procedure costs.
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Affiliation(s)
- Ramya Walsan
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, 75 Talavera Road, North Ryde, Sydney, NSW 2113, Australia
| | - Rebecca J Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, 75 Talavera Road, North Ryde, Sydney, NSW 2113, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, 75 Talavera Road, North Ryde, Sydney, NSW 2113, Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, 75 Talavera Road, North Ryde, Sydney, NSW 2113, Australia
| | - Peter Hibbert
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, 75 Talavera Road, North Ryde, Sydney, NSW 2113, Australia; and IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Virginia Mumford
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, 75 Talavera Road, North Ryde, Sydney, NSW 2113, Australia
| | - Reema Harrison
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, 75 Talavera Road, North Ryde, Sydney, NSW 2113, Australia
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Hansen J, Ahern S, Earnest A. Evaluations of statistical methods for outlier detection when benchmarking in clinical registries: a systematic review. BMJ Open 2023; 13:e069130. [PMID: 37451708 PMCID: PMC10351235 DOI: 10.1136/bmjopen-2022-069130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES Benchmarking is common in clinical registries to support the improvement of health outcomes by identifying underperforming clinician or health service providers. Despite the rise in clinical registries and interest in publicly reporting benchmarking results, appropriate methods for benchmarking and outlier detection within clinical registries are not well established, and the current application of methods is inconsistent. The aim of this review was to determine the current statistical methods of outlier detection that have been evaluated in the context of clinical registry benchmarking. DESIGN A systematic search for studies evaluating the performance of methods to detect outliers when benchmarking in clinical registries was conducted in five databases: EMBASE, ProQuest, Scopus, Web of Science and Google Scholar. A modified healthcare modelling evaluation tool was used to assess quality; data extracted from each study were summarised and presented in a narrative synthesis. RESULTS Nineteen studies evaluating a variety of statistical methods in 20 clinical registries were included. The majority of studies conducted application studies comparing outliers without statistical performance assessment (79%), while only few studies used simulations to conduct more rigorous evaluations (21%). A common comparison was between random effects and fixed effects regression, which provided mixed results. Registry population coverage, provider case volume minimum and missing data handling were all poorly reported. CONCLUSIONS The optimal methods for detecting outliers when benchmarking clinical registry data remains unclear, and the use of different models may provide vastly different results. Further research is needed to address the unresolved methodological considerations and evaluate methods across a range of registry conditions. PROSPERO REGISTRATION NUMBER CRD42022296520.
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Affiliation(s)
- Jessy Hansen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Jesudason E. Surgery should be routinely videoed. JOURNAL OF MEDICAL ETHICS 2023; 49:235-239. [PMID: 35459741 DOI: 10.1136/medethics-2022-108171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/12/2022] [Indexed: 06/14/2023]
Abstract
Video recording is widely available in modern operating rooms. Here, I argue that, if patient consent and suitable technology are in place, video recording of surgery is an ethical duty. I develop this as a duty to protect, arguing for professional and institutional duties, as distinguished for duties of rescueA professional duty to protect is described in mental healthcare. Practitioners have to take reasonable steps to prevent serious, foreseeable harm to their clients and others, even if that entails a non-consensual breach of confidentiality. I argue surgeons have a similar duty to patients which means that, provided the patient consents, surgery should be routinely videoed. This avoids non-consensual breaches of patient confidentiality and is aligned with stated professional obligations.An institutional duty to protect means institutions have to take reasonable steps to prevent serious, foreseeable harm at the hands of their surgeons. Rulli and Millum highlighted how institutions can meet their duty using a more consequentialist approach that balances wider interests.To test the force and scope of such duties, I examine potential impacts of routine videoing on aspects of autonomy, justice, beneficence and non-maleficence. I find routine videoing can benefit areas including safety, candour, consent and fairness in access (to surgical careers and expertise). Countervailing claims, for example, on liability, confidentiality and privacy can be resisted-such that where consent and the technology are in place, routine videoing meets a duty of easy protection In other words, its use should be standard of care.
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Chen J, Miraldo M. The impact of hospital price and quality transparency tools on healthcare spending: a systematic review. HEALTH ECONOMICS REVIEW 2022; 12:62. [PMID: 36515792 PMCID: PMC9749158 DOI: 10.1186/s13561-022-00409-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Global spending on health was continuing to rise over the past 20 years. To reduce the growth rates, alleviate information asymmetry, and improve the efficiency of healthcare markets, global health systems have initiated price and quality transparency tools in the hospital industry in the last two decades. OBJECTIVE : The objective of this review is to synthesize whether, to what extent, and how hospital price and quality transparency tools affected 1) the price of healthcare procedures and services, 2) the payments of consumers, and 3) the premium of health insurance plans bonding with hospital networks. METHODS A literature search of EMBASE, Web of Science, Econlit, Scopus, Pubmed, CINAHL, and PsychINFO was conducted, from inception to Oct 31, 2021. Reference lists and tracked citations of retrieved articles were hand-searched. Study characteristics were extracted, and included studies were scored through a risk of bias assessment framework. This systematic review was reported according to the PRISMA guidelines and registered in PROSPERO with registration No. CRD42022319070. RESULTS Of 2157 records identified, 18 studies met the inclusion criteria. Near 40 percent of studies focused on hospital quality transparency tools, and more than 90 percent of studies were from the US. Hospital price transparency reduced the price of laboratory and imaging tests except for office-visit services. Hospital quality transparency declined the level or growth rates of healthcare spending, while it adversely and significantly raised the price of healthcare services and consumers' payment in higher-ranked or rated facilities, which was referred to as the reputation premium in the healthcare industry. Hospital quality transparency not only leveraged private insurers bonding with a higher-rated hospital network to increase premiums, but also induced their anticipated pricing behaviors. CONCLUSION Hospital price and quality transparency was not effective as expected. Future research should explore the understudied consequences of hospital quality transparency programs, such as the reputation/rating premium and its policy intervention.
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Affiliation(s)
- Jinyang Chen
- School of Public Administration and Policy, Renmin University of China, No.59 Zhongguan Cun Avenue, Beijing, 100872 China
- Centre for Health Economics and Policy Innovation, Business School, Imperial College London, London, UK
| | - Marisa Miraldo
- Centre for Health Economics and Policy Innovation, Business School, Imperial College London, London, UK
- Department of Economics and Public Policy, Business School, Imperial College London, London, UK
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Chen TT, Hsueh YSA, Liaw CK, Shih LN, Huang LY. Does public report card matter? A 10-year interrupted time series analysis on total knee replacement. Eur J Public Health 2021; 30:4-9. [PMID: 31177269 DOI: 10.1093/eurpub/ckz112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is a lack of evidence that shows whether a report card can improve health outcomes in terms of infection rates or unscheduled readmission by using rigorous methods to evaluate its impact. METHODS We used the National Health Insurance Administration's claims database from 1 January 2004 to 30 December 2013 and a time series analysis to evaluate the impact of the quality report card initiative on three negative outcomes of total knee replacement for each quarter of the year, including the rates of superficial infection of a knee replacement, deep infection of knee arthroplasty and unplanned readmissions for surgical site infection. RESULTS These negative outcomes (original scale) do not show significant decreases in terms of superficial infection (-0.05‰, -0.63 to 0.53‰, P = 0.87), deep infection (-0.003‰, -0.19 to 0.18‰, P = 0.97) and unscheduled readmission (0.02‰, -0.21 to 0.25‰, P = 0.88). CONCLUSION The total knee replacement public report card initiative did not improve the rate of infection and unscheduled readmission for surgical site infection. This report card in Taiwan should involve physicians' participation in the design and be tailored to be suitable for reading by patients in order to further enhance the chance of improvement in these negative outcomes.
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Affiliation(s)
- Tsung-Tai Chen
- Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Ya-Seng Arthur Hsueh
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Chen-Kun Liaw
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan.,Division of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Orthopedics, National Taiwan University Hospital, Taipei, Taiwan
| | - Ling-Na Shih
- Lo-Sheng Sanatorium Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.,Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Li-Ying Huang
- Division of Health Technology Assessment, Center for Drug Evaluation, Taipei, Taiwan
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Prang KH, Maritz R, Sabanovic H, Dunt D, Kelaher M. Mechanisms and impact of public reporting on physicians and hospitals' performance: A systematic review (2000-2020). PLoS One 2021; 16:e0247297. [PMID: 33626055 PMCID: PMC7904172 DOI: 10.1371/journal.pone.0247297] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 02/04/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Public performance reporting (PPR) of physician and hospital data aims to improve health outcomes by promoting quality improvement and informing consumer choice. However, previous studies have demonstrated inconsistent effects of PPR, potentially due to the various PPR characteristics examined. The aim of this study was to undertake a systematic review of the impact and mechanisms (selection and change), by which PPR exerts its influence. METHODS Studies published between 2000 and 2020 were retrieved from five databases and eight reviews. Data extraction, quality assessment and synthesis were conducted. Studies were categorised into: user and provider responses to PPR and impact of PPR on quality of care. RESULTS Forty-five studies were identified: 24 on user and provider responses to PPR, 14 on impact of PPR on quality of care, and seven on both. Most of the studies reported positive effects of PPR on the selection of providers by patients, purchasers and providers, quality improvement activities in primary care clinics and hospitals, clinical outcomes and patient experiences. CONCLUSIONS The findings provide moderate level of evidence to support the role of PPR in stimulating quality improvement activities, informing consumer choice and improving clinical outcomes. There was some evidence to demonstrate a relationship between PPR and patient experience. The effects of PPR varied across clinical areas which may be related to the type of indicators, level of data reported and the mode of dissemination. It is important to ensure that the design and implementation of PPR considered the perspectives of different users and the health system in which PPR operates in. There is a need to account for factors such as the structural characteristics and culture of the hospitals that could influence the uptake of PPR.
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Affiliation(s)
- Khic-Houy Prang
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Roxanne Maritz
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
- Rehabilitation Services and Care Unit, Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Hana Sabanovic
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - David Dunt
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
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Ali AM, Loeffler MD, Aylin P, Bottle A. Timing of Readmissions After Elective Total Hip and Knee Arthroplasty: Does a 30-Day All-Cause Rate Capture Surgically Relevant Readmissions? J Arthroplasty 2021; 36:728-733. [PMID: 32972776 DOI: 10.1016/j.arth.2020.07.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/26/2020] [Accepted: 07/30/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The 30-day all-cause readmission rate is a widely used metric of hospital performance. However, there is lack of clarity as to whether 30 days is an appropriate time frame following surgical procedures. Our aim is to determine whether a 90-day time window is superior to a 30-day time window in capturing surgically relevant readmissions after total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS We analyzed readmissions following all primary THAs and TKAs recorded in the English National Health Service Hospital Episode Statistics database from 2008 to 2018. We compared temporal patterns of 30- and 90-day readmission rates for the following types of readmission: all-cause, surgical, return to theater, and those related to specific surgical complications. RESULTS A total of 1.47 million procedures were recorded. After THA and TKA, over three-quarters of 90-day surgical readmissions took place within the first 30 days (78.5% and 75.7%, respectively). All-cause and surgical readmissions both peaked at day 4 and followed a similar temporal course thereafter. The ratio of surgical to medical readmissions was greater for THA than for TKA, with THA dislocation both being one of the most common surgical complications and clustering early after discharge, with 73.5% of 90-day dislocations occurring within the first 30 days. CONCLUSION The 30-day all-cause readmission rate is a good reflection of surgically relevant readmissions that take place in the first 90 days after THA and TKA.
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Affiliation(s)
- Adam M Ali
- London North West University Healthcare NHS Trust, London, UK
| | | | - Paul Aylin
- Dr Foster Unit at Imperial College, London, UK
| | - Alex Bottle
- Dr Foster Unit at Imperial College, London, UK
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Canaway R, Prang KH, Bismark M, Dunt D, Kelaher M. Public disclosure of hospital clinicians' performance data: insights from medical directors. AUST HEALTH REV 2021; 44:228-233. [PMID: 31296279 DOI: 10.1071/ah18128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 01/30/2019] [Indexed: 11/23/2022]
Abstract
Objective This study gathered information from public hospital chief medical officers to better understand underlying mechanisms through which public reporting affects institutional behavioural change and decision making towards quality improvement. Methods This qualitative study used thematic analysis of 17 semistructured, in-depth interviews among a peak group of medical directors representing 26 health services in Victoria, Australia. Results The medical directors indicated a high level of in-principle support for public reporting of identifiable, individual clinician-level data. However, they also described varying conceptual understanding of what public reporting of performance data is. Overall, they considered public reporting of individual clinicians' performance data a means to improve health care quality, increase transparency and inform consumer healthcare decision making. Most identified caveats that would need to be met before such data should be publicly released, in particular the need to resolve issues around data quality and timeliness, context and interpretation and ethics. Acknowledgement of the public's right to access individual clinician-level data was at odds with some medical directors' belief that such reporting may diminish trust between clinicians and their employers, thus eroding rather than motivating quality improvement. Conclusions Public reporting of identifiable individual healthcare clinicians' performance data is an issue that merits robust research and debate given the effects such reporting may have on doctors and on hospital quality and safety. What is known about the topic? The public reporting of individual clinician-level data is a mechanism used in some countries, but not in Australia, for increasing health care transparency and quality. Clinician-level public reporting of doctors' performance attracts contention and debate in Australia. What does this paper add? This paper informs debate around the public reporting of individual clinician-level performance data. Among a discrete cohort of senior hospital administrators in Victoria, Australia, there was strong in-principle support for such public reporting as a means to improve hospital quality and safety. What are the implications for practitioners? Before public reporting of individual clinician performance data could occur in Australia, resolution of issues would be required relating to legality and ethics, data context and interpretation, data quality and timeliness.
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Affiliation(s)
- Rachel Canaway
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Vic. 3010, Australia. ; ; ; and Department of General Practice, Melbourne Medical School, The University of Melbourne, Vic. 3010, Australia.
| | - Khic-Houy Prang
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Vic. 3010, Australia. ; ;
| | - Marie Bismark
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Vic. 3010, Australia. ; ;
| | - David Dunt
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Vic. 3010, Australia. ; ;
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Vic. 3010, Australia. ; ; ; and Corresponding author.
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Explaining health system responses to public reporting of cardiac surgery mortality in England and the USA. HEALTH ECONOMICS POLICY AND LAW 2021; 16:183-200. [PMID: 33455616 DOI: 10.1017/s1744133120000444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Public reporting of clinical performance is increasingly used in many countries to improve quality and enhance accountability of the health system. The assumption is that greater transparency will stimulate improvements by clinicians in response to peer pressure, patient choice or competition. The international diffusion of public reporting might suggest greater similarity between health systems. Alternatively, national and local contexts (including health system imperatives, professional power and organisational culture) might continue to shape its form and impact, implying continued divergence. The paper considers public reporting in the USA and England through the lens of Scott's 'pillars' institutional framework. The USA was arguably the first country to adopt public reporting systematically in the late 1980s. England is a more recent adopter; it is now being widely adopted through the National Health Service (NHS). Drawing on qualitative data from California and England, this paper compares the behavioural and policy responses to public reporting by health system stakeholders at micro, meso and macro levels and through the intersection of ideas, interests, institutions and individuals through. The interplay between the regulative, normative and cultural-cognitive pillars helps explain the observed patterns of on-going divergence.
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Hudson E, Brown K, Pagel C, Wray J, Barron D, Rodrigues W, Stoica S, Tibby SM, Tsang V, Ridout D, Morris S. Costs of postoperative morbidity following paediatric cardiac surgery: observational study. Arch Dis Child 2020; 105:1068-1074. [PMID: 32381518 PMCID: PMC7588404 DOI: 10.1136/archdischild-2019-318499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/27/2020] [Accepted: 04/11/2020] [Indexed: 12/04/2022]
Abstract
OBJECTIVE Early mortality rates for paediatric cardiac surgery have fallen due to advancements in care. Alternative indicators of care quality are needed. Postoperative morbidities are of particular interest. However, while health impacts have been reported, associated costs are unknown. Our objective was to calculate the costs of postoperative morbidities following paediatric cardiac surgery. DESIGN Two methods of data collection were integrated into the main study: (1) case-matched cohort study of children with and without predetermined morbidities; (2) incidence rates of morbidity, measured prospectively. SETTING Five specialist paediatric cardiac surgery centres, accounting for half of UK patients. PATIENTS Cohort study included 666 children (340 with morbidities). Incidence rates were measured in 3090 consecutive procedures. METHODS Risk-adjusted regression modelling to determine marginal effects of morbidities on per-patient costs. Calculation of costs for hospital providers according to incidence rates. Extrapolation using mandatory audit data to report annual financial burden for the health service. OUTCOME MEASURES Impact of postoperative morbidities on per-patient costs, hospital costs and UK health service costs. RESULTS Seven of the 10 morbidity categories resulted in significant costs, with mean (95% CI) additional costs ranging from £7483 (£3-£17 289) to £66 784 (£40 609-£103 539) per patient. On average all morbidities combined increased hospital costs by 22.3%. Total burden to the UK health service exceeded £21 million each year. CONCLUSION Postoperative morbidities are associated with a significant financial burden. Our findings could aid clinical teams and hospital providers to account for costs and contextualise quality improvement initiatives.
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Affiliation(s)
- Emma Hudson
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Katherine Brown
- Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Christina Pagel
- Clinical Operational Research Unit, University College of London, London, UK,Paediatric Intensive Care Unit, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Jo Wray
- Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - David Barron
- Department of Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Warren Rodrigues
- Paediatric Intensive care Unit, NHS Greater Glasgow and Clyde Inverclyde Royal Hospital, Glasgow, UK
| | - Serban Stoica
- Department of Cardiac Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Shane M Tibby
- Department of Paediatric Intensive Care, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Victor Tsang
- Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Deborah Ridout
- Paediatric Epidemiology Biostatistics, Institute of Child Health, London, UK
| | - Stephen Morris
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Tello JE, Barbazza E, Waddell K. Review of 128 quality of care mechanisms: A framework and mapping for health system stewards. Health Policy 2020; 124:12-24. [PMID: 31791717 PMCID: PMC6946442 DOI: 10.1016/j.healthpol.2019.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 10/29/2019] [Accepted: 11/18/2019] [Indexed: 12/30/2022]
Abstract
Health system stewards have the critical task to identify quality of care deficiencies and resolve underlying system limitations. Despite a growing evidence-base on the effectiveness of certain mechanisms for improving quality of care, frameworks to facilitate the oversight function of stewards and the use of mechanisms to improve outcomes remain underdeveloped. This review set out to catalogue a wide range of quality of care mechanisms and evidence on their effectiveness, and to map these in a framework along two dimensions: (i) governance subfunctions; and (ii) targets of quality of care mechanisms. To identify quality of care mechanisms, a series of searches were run in Health Systems Evidence and PubMed. Additional grey literature was reviewed. A total of 128 quality of care mechanisms were identified. For each mechanism, searches were carried out for systematic reviews on their effectiveness. These findings were mapped in the framework defined. The mapping illustrates the range and evidence for mechanisms varies and is more developed for some target areas such as the health workforce. Across the governance sub-functions, more mechanisms and with evidence of effectiveness are found for setting priorities and standards and organizing and monitoring for action. This framework can support system stewards to map the quality of care mechanisms used in their systems and to uncover opportunities for optimization backed by systems thinking.
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Affiliation(s)
- Juan E Tello
- Integrated Prevention and Control of NCDs Programme, Division of NCDs and Promoting Health through the Life-Course, WHO Regional Office for Europe, Copenhagen, Denmark.
| | - Erica Barbazza
- Academic UMC, Department of Public Health, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; WHO European Centre for Primary Health Care, Almaty, Kazakhstan.
| | - Kerry Waddell
- McMaster Health Forum, McMaster University, Hamilton, Canada; WHO European Centre for Primary Health Care, Almaty, Kazakhstan.
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Leeds IL, Efron DT, Lehmann LS. Surgical Gatekeeping - Modifiable Risk Factors and Ethical Decision Making. N Engl J Med 2018; 379:389-394. [PMID: 30044939 DOI: 10.1056/nejmms1802079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Ira L Leeds
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (I.L.L., D.T.E.); the National Center for Ethics in Health Care, Veterans Health Administration, Washington, DC (L.S.L.); and Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston (L.S.L.)
| | - David T Efron
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (I.L.L., D.T.E.); the National Center for Ethics in Health Care, Veterans Health Administration, Washington, DC (L.S.L.); and Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston (L.S.L.)
| | - Lisa S Lehmann
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore (I.L.L., D.T.E.); the National Center for Ethics in Health Care, Veterans Health Administration, Washington, DC (L.S.L.); and Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston (L.S.L.)
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13
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Canaway R, Bismark MM, Dunt D, Kelaher MA. Public reporting of clinician-level data. Med J Aust 2017; 207:231-232. [PMID: 28899319 DOI: 10.5694/mja16.01402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 06/30/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Rachel Canaway
- Centre for Health Policy, University of Melbourne, Melbourne, VIC
| | - Marie M Bismark
- Centre for Health Policy, University of Melbourne, Melbourne, VIC
| | - David Dunt
- Centre for Health Policy, University of Melbourne, Melbourne, VIC
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Ahern S, Hopper I, Evans SM. Clinical quality registries for clinician‐level reporting: strengths and limitations. Med J Aust 2017; 208:323. [DOI: 10.5694/mja16.00659] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 07/10/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Susannah Ahern
- Monash University, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
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