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Welch JM, Gomez GI, Chatterjee M, Shapiro LM, Morris AM, Gardner MJ, Sox-Harris AHS, Baker L, Koltsov JCB, Castillo T, Giori N, Salyapongse A, Kamal RN. Contextual Determinants of Time to Surgery for Patients With Hip Fracture. JAMA Netw Open 2023; 6:e2347834. [PMID: 38100104 PMCID: PMC10724766 DOI: 10.1001/jamanetworkopen.2023.47834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023] Open
Abstract
Importance Surgery within 24 hours after a hip fracture improves patient morbidity and mortality, which has led some hospitals to launch quality improvement programs (eg, targeted resource management, documented protocols) to address delays. However, these programs have had mixed results in terms of decreased time to surgery (TTS), identifying an opportunity to improve the effectiveness of interventions. Objective To identify the contextual determinants (site-specific barriers and facilitators) of TTS for patients with hip fracture across diverse hospitals. Design, Setting, and Participants This qualitative mixed-methods study used an exploratory sequential design that comprised 2 phases. In phase 1, qualitative semistructured interviews were conducted with stakeholders involved in hip fracture care (orthopedic surgeons or residents, emergency medicine physicians, hospitalists, anesthesiologists, nurses, and clinical or support staff) at 4 hospitals with differing financial, operational, and educational structures. Interviews were completed between May and July 2021. In phase 2, a quantitative survey assessing contextual determinants of TTS within 24 hours for adult patients with hip fracture was completed by orthopedic surgeon leaders representing 23 diverse hospitals across the US between May and July 2022. Data analysis was performed in August 2022. Main Outcomes and Measures Thematic analysis of the interviews identified themes of contextual determinants of TTS within 24 hours for patients with hip fracture. The emergent contextual determinants were then measured across multiple hospitals, and frequency and distribution were used to assess associations between determinants and various hospital characteristics (eg, setting, number of beds). Results A total of 34 stakeholders were interviewed in phase 1, and 23 surveys were completed in phase 2. More than half of respondents in both phases were men (19 [56%] and 18 [78%], respectively). The following 4 themes of contextual determinants of TTS within 24 hours were identified: availability, care coordination, improvement climate, and incentive structure. Within these themes, the most commonly identified determinants across the various hospitals involved operating room availability, a formal comanagement system between orthopedics and medicine or geriatrics, the presence of a physician champion focused on timely surgery, and a program that facilitates improvement work. Conclusions and Relevance In this study, contextual determinants of TTS within 24 hours for patients with hip fracture varied across hospital sites and could not be generalized across various hospital contexts because no 2 sites had identical profiles. As such, these findings suggest that guidance on strategies for improving TTS should be based on the contextual determinants unique to each hospital.
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Affiliation(s)
- Jessica M. Welch
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, California
- Duke University School of Medicine, Durham, North Carolina
| | - Giselle I. Gomez
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, California
- Stanford University School of Medicine, Stanford, California
| | - Maya Chatterjee
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, California
- Department of Human Development and Family Studies, Colorado State University, Fort Collins
| | - Lauren M. Shapiro
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, California
- Department of Orthopaedic Surgery, University of California, San Francisco
| | - Arden M. Morris
- Department of Surgery, Stanford University, Stanford, California
| | - Michael J. Gardner
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, California
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Alex H. S. Sox-Harris
- Department of Surgery, Stanford University, Stanford, California
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Laurence Baker
- Department of Health Policy, Stanford University, Stanford, California
| | - Jayme C. B. Koltsov
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Tiffany Castillo
- Department of Orthopaedic Surgery, Santa Clara Valley Medical Center, San Jose, California
| | - Nicholas Giori
- Department of Orthopaedic Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Aaron Salyapongse
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Robin N. Kamal
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, California
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
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Tewari P, Sweeney BF, Lemos JL, Shapiro L, Gardner MJ, Morris AM, Baker LC, Harris AS, Kamal RN. Evaluation of Systemwide Improvement Programs to Optimize Time to Surgery for Patients With Hip Fractures: A Systematic Review. JAMA Netw Open 2022; 5:e2231911. [PMID: 36112373 PMCID: PMC9482052 DOI: 10.1001/jamanetworkopen.2022.31911] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Longer time to surgery (TTS) for hip fractures has been associated with higher rates of postoperative complications and mortality. Given that more than 300 000 adults are hospitalized for hip fractures in the United States each year, various improvement programs have been implemented to reduce TTS with variable results, attributed to contextual patient- and system-level factors. OBJECTIVE To catalog TTS improvement programs, identify their results, and categorize program strategies according to Expert Recommendations for Implementing Change (ERIC), highlighting components of successful improvement programs within their associated contexts and seeking to guide health care systems in implementing programs designed to reduce TTS. EVIDENCE REVIEW A systematic review was conducted per the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline. Three databases (MEDLINE/PubMed, EMBASE, and Cochrane Trials) were searched for studies published between 2000 and 2021 that reported on improvement programs for hip fracture TTS. Observational studies in high-income country settings, including patients with surgical, low-impact, nonpathological hip fractures aged 50 years or older, were considered for review. Improvement programs were assessed for their association with decreased TTS, and ERIC strategies were matched to improvement program components. FINDINGS Preliminary literature searches yielded 1683 articles, of which 69 articles were included for final analysis. Among the 69 improvement programs, 49 were associated with significantly decreased TTS, and 20 programs did not report significant decreases in TTS. Among 49 successful improvement programs, the 5 most common ERIC strategies were (1) assess for readiness and identify barriers and facilitators, (2) develop a formal implementation blueprint, (3) identify and prepare champions, (4) promote network weaving, and (5) develop resource-sharing agreements. CONCLUSIONS AND RELEVANCE In this systematic review, certain components (eg, identifying barriers and facilitators to program implementation, developing a formal implementation blueprint, preparing intervention champions) are common among improvement programs that were associated with reducing TTS and may inform the approach of hospital systems developing similar programs. Other strategies had mixed results, suggesting local contextual factors (eg, operating room availability) may affect their success. To contextualize the success of a given improvement program across different clinical settings, subsequent investigation must elucidate the association between interventional success and facility-level factors influencing TTS, such as hospital census and type, teaching status, annual surgical volume, and other factors.
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Affiliation(s)
- Pariswi Tewari
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Brian F. Sweeney
- Stanford University School of Medicine, Mountain View, California
| | - Jacie L. Lemos
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Lauren Shapiro
- Department of Orthopaedic Surgery, University of California, San Francisco
| | - Michael J. Gardner
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Arden M. Morris
- Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University, Stanford, California
| | - Laurence C. Baker
- Department of Health Research and Policy, Stanford University, Stanford, California
| | - Alex S. Harris
- Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University, Stanford, California
| | - Robin N. Kamal
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
- VOICES Health Policy Research Center, Stanford University, Stanford, California
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The Impact of the COVID-19 Pandemic on the Neck of the Femur and Hip Fracture Surgery Volumes in the Lazio Region. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084704. [PMID: 35457568 PMCID: PMC9032655 DOI: 10.3390/ijerph19084704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 02/04/2023]
Abstract
This study compares surgery volumes for fractures of the neck of the femur (FNF) and hip replacements during the COVID-19 pandemic compared with previous years. Historical (2018–2019) and pandemic (2020–2021) surgery rates for FNF and hip replacement in Lazio, adjusted for age and gender, were calculated per period and compared with a Poisson regression model. For hip replacement surgery, a comparison of different types of hospitals was also made. Before COVID-19’s spread, no difference was found in the volume of surgery of both interventions. From the lockdown to the end of 2021, a decrease in surgery volumes for FNF with stabilization between summer 2020 and summer 2021, as well as an additional decline beginning at the start of Omicron’s spread, were found. Hip replacement surgeries showed a greater decline during the lockdown period and increased during summer 2020 and during the Delta wave period. The increment in hip replacements, mainly observed in 2021, is due to private and religious hospitals. These results highlight that the pandemic emergency, caused by SARS-CoV-2, has had an important indirect effect on the population’s health assistance in the field of orthopedics.
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Tayfun Şahiner İ, Esen E, Deniz Uçar A, Serdar Karaca A, Çınar Yastı A. Pay for performance system in Turkey and the world; a global overview. Turk J Surg 2022; 38:46-54. [DOI: 10.47717/turkjsurg.2022.5439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/08/2021] [Indexed: 11/23/2022]
Abstract
Objective: This study aimed to compare the pay for performance system applied nationally in Turkey and in other countries around the world and to reveal the effects of the system applied in our country on the general surgery.
Material and Methods: Current literature and countries’ programs on the implementation of the pay for performance system were recorded. The results of the Turkish Surgical Association’s performance and Healthcare Implementation Communique (HIC) commission studies were evaluated in light of the literature.
Results: Many countries have implemented performance systems on a limited scale to improve quality, speed up the diagnosis, treatment, and control of certain diseases, and they have generally applied it as a financial promotion by receiving the support of health insurance companies and nongovernmental organizations. It turns out that surgeons in our country feel that they are being wronged because of the injustice in the current system because the property of their works is not appreciated and they cannot get the reward for the work they do. This is also the reason for the reluctance of medical school graduates to choose general surgery.
Conclusion: Authorities should pay attention to the opinions of associations and experts in the related field when creating lists of interventional procedures related to surgery. Equal pay should be given to equal work nationally, and surgeons should be encouraged by incentives to perform detailed, qualified surgeries. There is a possibility that the staff positions opened for general surgery, as well as, all surgical branches will remain empty in the near future.
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Kristensen PK, Falstie-Jensen AM, Madsen M, Johnsen SP. Patient-related healthcare disparities in the quality of acute hip fracture care: a 10-year nationwide population-based cohort study. BMJ Open 2021; 11:e051424. [PMID: 35446782 PMCID: PMC8718470 DOI: 10.1136/bmjopen-2021-051424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To characterise and quantify possible patient-related disparities in hip fracture care including temporal changes. DESIGN Population-based cohort study. SETTING All Danish hospitals treating patients with hip fracture. PARTICIPANTS 60 275 hip fracture patients from 2007 to 2016. INTERVENTIONS Quality of care was defined as fulfilment of eligible care process measures for the individual patient recommended by an expert panel. Using yearly logistic regression models, we predicted the individual patient's probability for receiving high-quality care, resulting in a distribution of adjusted probabilities based on age, sex, comorbidity, fracture type, education, family mean income, migration status, cohabitation status, employment status, nursing home residence and type of municipality. Based on the distribution, we identified best-off patients (ie, the 10% of patients with the highest probability) and worst-off patients (ie, the 10% of patients with the lowest probability). We evaluated disparities in quality of care by measuring the distance in fulfilment of outcomes between the best-off and worst-off patients. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was fulfilment of all-or-none, defined as receiving all relevant process measures. Secondary outcomes were fulfilment of the individual process measures including preoperative optimisation, early surgery, early mobilisation, assessment of pain, basic mobility, nutritional risk and need for antiosteoporotic medication, fall prevention and a postdischarge rehabilitation programme. RESULTS The proportion of patients receiving high-quality care varied over time for both best-off and worst-off patients. The absolute difference in percentage points between the best-off and worst-off patients for receiving all-or-none of the eligible process measures was 12 (95% CI 6 to 18) in 2007 and 23 (95% CI 19 to 28) in 2016. Disparities were consistent for a range of care processes, including assessment of pain, mobilisation within 24 hours, assessment of need for antiosteoporotic medication and nutritional risk assessment. CONCLUSIONS Disparity of care between best-off and worst-off patients remained substantial over time.
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Affiliation(s)
- Pia Kjær Kristensen
- Department of Orthopedic Surgery, Regional Hospital Horsens, Horsens, Denmark
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | | | - Morten Madsen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Aalborg Universitet, Aalborg, Denmark
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Di Martino M, Alagna M, Lallo A, Gilmore KJ, Francesconi P, Profili F, Scondotto S, Fantaci G, Trifirò G, Isgrò V, Davoli M, Fusco D. Chronic polytherapy after myocardial infarction: the trade-off between hospital and community-based providers in determining adherence to medication. BMC Cardiovasc Disord 2021; 21:180. [PMID: 33853534 PMCID: PMC8048349 DOI: 10.1186/s12872-021-01969-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 03/29/2021] [Indexed: 11/17/2022] Open
Abstract
Background The benefits of chronic polytherapy in reducing readmissions and death after myocardial infarction (MI) have been clearly shown. However, real-world evidence shows poor medication adherence and large geographic variation, suggesting critical issues in access to optimal care. Our objectives were to measure adherence to polytherapy, to compare the amount of variation attributable to hospitals of discharge and to community-based providers, and to identify determinants of adherence to medications. Methods This is a population-based study. Data were obtained from the information systems of the Lazio and Tuscany Regions, Italy (9.5 million inhabitants). Patients hospitalized with incident MI in 2010–2014 were analyzed. The outcome measure was medication adherence, defined as a Medication Possession Ratio (MPR) ≥ 0.75 for at least 3 of the following drugs: antiplatelets, β-blockers, ACEI/ARBs, statins. A 2-year cohort-study was performed. Cross-classified multilevel models were applied to analyze geographic variation. The variance components attributable to hospitals of discharge and community-based providers were expressed as Median Odds Ratio (MOR). Results A total of 32,962 patients were enrolled. About 63% of patients in the Lazio cohort and 59% of the Tuscan cohort were adherent to chronic polytherapy. Women and patients aged 85 years and over were most at risk of non-adherence. In both regions, adherence was higher for patients discharged from cardiology wards (Lazio: OR = 1.58, p < 0.001, Tuscany: OR = 1.59, p < 0.001) and for patients with a percutaneous coronary intervention during the index admission. Relevant variation between community-based providers was observed, though when the hospital of discharge was included as a cross-classified level, in both Lazio and Tuscany regions the variation attributable to hospitals of discharge was the only significant component (Lazio: MOR = 1.30, p = 0.001; Tuscany: MOR = 1.31, p = 0.001). Conclusion Adherence to best practice treatments after MI is not consistent with clinical guidelines, and varies between patient groups as well as within and between regions. The variation attributable to providers is affected by the hospital of discharge, up to two years from the acute episode. This variation is likely to be attributable to hospital discharge processes, and could be reduced through appropriate policy levers. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-01969-9.
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Affiliation(s)
- Mirko Di Martino
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Via Cristoforo Colombo, 112, 00147, Rome, Italy.
| | - Michela Alagna
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Via Cristoforo Colombo, 112, 00147, Rome, Italy
| | - Adele Lallo
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Via Cristoforo Colombo, 112, 00147, Rome, Italy
| | | | - Paolo Francesconi
- Epidemiology Unit, Regional Health Agency (ARS) of Tuscany, Florence, Italy
| | - Francesco Profili
- Epidemiology Unit, Regional Health Agency (ARS) of Tuscany, Florence, Italy
| | - Salvatore Scondotto
- Department of Epidemiologic Observatory, Health Department of Sicily, Palermo, Italy
| | - Giovanna Fantaci
- Department of Epidemiologic Observatory, Health Department of Sicily, Palermo, Italy
| | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Valentina Isgrò
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Via Cristoforo Colombo, 112, 00147, Rome, Italy
| | - Danilo Fusco
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Via Cristoforo Colombo, 112, 00147, Rome, Italy
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Asanuma D, Momosaki R. Characteristics of rehabilitation services in high-FIM efficiency hospitals after hip fracture. THE JOURNAL OF MEDICAL INVESTIGATION 2020; 66:324-327. [PMID: 31656298 DOI: 10.2152/jmi.66.324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Characteristics of rehabilitation services probably explain a large proportion of the variation in clinical outcomes following hip fracture. The aim of this study was to clarify rehabilitation characteristics of high-performance hospitals after hip fracture. This is a retrospective observational study using the Japan Rehabilitation Database for the period 2005-2015. We divided facilities into high-FIM efficiency and low-FIM efficiency hospitals by using the mean of Functional Independence Measure efficiency for each hospital. We compared rehabilitation characteristics between high- and low-FIM efficiency hospitals. We identified 1247 patients with hip fracture from 12 hospitals who were eligible for analysis after applying exclusion criteria. Using one-to-one random matching on admission Functional Independence Measure, 880 pairs of patients were included for final analysis. More patients were discharged home in the high-FIM efficiency hospitals compared with low-FIM efficiency hospitals. High-FIM efficiency hospitals had significantly shorter length of stay. Patients in high-FIM efficiency hospitals received higher amounts of daily rehabilitation, early rehabilitation, and preoperative rehabilitation. Patients in high-FIM efficiency hospitals engaged in more weekend exercise and self-exercise. Our data suggested that the amount, timing, and type of rehabilitation are essential indicators of performance in acute hip fracture. J. Med. Invest. 66 : 324-327, August, 2019.
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Affiliation(s)
- Daichi Asanuma
- Department of Rehabilitation, Teikyo University School of Medicine University Hospital, Mizonokuchi, Kanagawa, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Teikyo University School of Medicine University Hospital, Mizonokuchi, Kanagawa, Japan
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A Reimbursement System Based on a 48-Hour Target Time for Surgery Shortens the Waiting Time for Hip Fracture Fixation in Elderly Patients. J Orthop Trauma 2020; 34:248-251. [PMID: 31688436 DOI: 10.1097/bot.0000000000001681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate whether a pay-for-performance reimbursement system, aimed at expediting surgical fixation of hip fractures in elderly patients, has, in fact, succeeded in shortening the waiting time for surgery. DESIGN Retrospective analysis of prospectively collected data. SETTING Academic Level II trauma center. PATIENTS/PARTICIPANTS One hundred fifty patients older than 70 years with femoral neck fractures (OTA/AO 31 A1-A3). INTERVENTION Implementation of a reimbursement system which incentivizes meeting a 48-hour target time for surgical fixation of hip fractures in elderly patients. METHODS Medical records of 75 consecutive patients operated on 1 year before the implementation of the reimbursement system were compared with records of 75 consecutive patients operated on 1 year after the implementation of the reimbursement system. The collected data included age, sex, American Society of Anesthesiologist score, time from injury to hospital admission, time from admission to surgery, reason for surgical delay beyond 48 hours, perioperative complication rate, and length of postoperative hospitalization. RESULTS Patients' mean age, sex distribution, American Society of Anesthesiologist score, and time from injury to hospital admission were similar in both groups. The average waiting time for surgery shortened from a mean of 77 hours before implementing the reimbursement system to 28 hours after the implementation (P < 0.001). Before the reimbursement system implementation, 41% of the surgeries were delayed beyond 48 hours due to medical causes, compared with 20% only after the implementation (P < 0.001). Fewer patients developed perioperative complications in the postimplementation group in comparison with the preimplementation group (9% vs. 13%, respectively); however, because the study was not powered to examine differences in complication rate, the significance of this difference remains unclear. CONCLUSIONS A reimbursement system which incentivizes meeting a 48-hour target time for surgery has led to a substantial shortening in the waiting time for surgical fixation of hip fractures in elderly patients in our institution.
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Yamamoto H, Miyata H, Tanemoto K, Saiki Y, Yokoyama H, Fukuchi E, Motomura N, Ueda Y, Takamoto S. Quality improvement in cardiovascular surgery: results of a surgical quality improvement programme using a nationwide clinical database and database-driven site visits in Japan. BMJ Qual Saf 2019; 29:560-568. [DOI: 10.1136/bmjqs-2019-009955] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/23/2019] [Accepted: 10/26/2019] [Indexed: 01/03/2023]
Abstract
BackgroundIn 2015, an academic-led surgical quality improvement (QI) programme was initiated in Japan to use database information entered from 2013 to 2014 to identify institutions needing improvement, to which cardiovascular surgery experts were sent for site visits. Here, posthoc analyses were used to estimate the effectiveness of the QI programme in reducing surgical mortality (30-day and in-hospital mortality).MethodsPatients were selected from the Japan Cardiovascular Surgery Database, which includes almost all cardiovascular surgeries in Japan, if they underwent isolated coronary artery bypass graft (CABG), valve or thoracic aortic surgery from 2013 to 2016. Difference-in-difference methods based on a generalised estimating equation logistic regression model were used for pre-post comparison after adjustment for patient-level expected surgical mortality.ResultsIn total, 238 778 patients (10 172 deaths) from 590 hospitals, including 3556 patients seen at 10 hospitals with site visits, were included from January 2013 to December 2016. Preprogramme, the crude surgical mortality for site visit and non-site visit institutions was 9.0% and 2.7%, respectively, for CABG surgery, 10.7% and 4.0%, respectively, for valve surgery and 20.7% and 7.5%, respectively, for aortic surgery. Postprogramme, moderate improvement was observed at site visit hospitals (3.6%, 9.6% and 18.8%, respectively). A difference-in-difference estimator showed significant improvement in CABG (0.29 (95% CI 0.15 to 0.54), p<0.001) and valve surgery (0.74 (0.55 to 1.00); p=0.047). Improvement was observed within 1 year for CABG surgery but was delayed for valve and aortic surgery. During the programme, institutions did not refrain from surgery.ConclusionsCombining traditional site visits with modern database methodologies effectively improved surgical mortality in Japan. These universal methods could be applied via a similar approach to contribute to achieving QI in surgery for many other procedures worldwide.
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Colais P, Bontempi K, Pinnarelli L, Piscicelli C, Mappa I, Fusco D, Davoli M. Vaginal birth after caesarean birth in Italy: variations among areas of residence and hospitals. BMC Pregnancy Childbirth 2018; 18:383. [PMID: 30249198 PMCID: PMC6154898 DOI: 10.1186/s12884-018-2018-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 09/19/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The rates of caesarean section (CS) are increasing globally. CS rates are one of the most frequently used indicators of health care quality. Vaginal Birth After Caesarean (VBAC) could be considered a reasonable and safe option for most women with a previous CS. Despite this fact, in some European countries, many women who had a previous CS will have a routine CS subsequently and VBAC rates are extremely variable across countries. VBAC use is inversely related to caesarean use. The objective of the present study was to analyze VBAC rates with respect to caesarean rates and the variations among areas of residence, hospitals and hospital ownership types in Italy. METHODS This study was based on information from the Hospital Information System (HIS). We collected data from all deliveries in Italy from January 1, 2010 to December 31, 2014 and we considered only deliveries with a previous caesarean section. Applying multivariate logistic regression analysis, the adjusted proportions of VBAC for each Local Health Units (LHU), each hospital and by hospital ownership types were calculated. Cross-classified logistic multilevel models were performed to analyze within geographic, hospitals and hospital ownership types variations. RESULTS We studied a total of 77,850 deliveries with a previous caesarean section in Italy between January 1, 2010 and December 31, 2014. The proportion of VBAC in Italy slightly increased in the last few years, from 5.8% in 2010 to 7.5% in 2014. Proportions of VBAC ranged from 0.29 to 50.05% in Italian LHUs. The LHUs with lower proportions of VBAC deliveries were characterized by higher values for primary caesarean deliveries. Private hospitals showed the lowest mean of crude VBAC proportions but the highest variation among hospitals, ranging from 0 to 47.1%. CONCLUSIONS Hospital rates of caesarean section for women with at least one previous caesarean section vary widely, and only some of the variation can be explained by case-mix and hospital-level factors, suggesting that additional factors influence practices. Identifying disparities in VBAC may have important implications for health services planning and targeted efforts to reduce overall rates of caesarean deliveries.
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Affiliation(s)
- Paola Colais
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00142 Rome, Italy
| | - Katia Bontempi
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00142 Rome, Italy
| | - Luigi Pinnarelli
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00142 Rome, Italy
| | - Carlo Piscicelli
- Cristo Re Hospital, Via delle Calasanziane, 25, 00167 Rome, Italy
| | - Ilenia Mappa
- Cristo Re Hospital, Via delle Calasanziane, 25, 00167 Rome, Italy
| | - Danilo Fusco
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00142 Rome, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00142 Rome, Italy
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Abraha I, Serraino D, Montedori A, Fusco M, Giovannini G, Casucci P, Cozzolino F, Orso M, Granata A, De Giorgi M, Collarile P, Chiari R, Foglietta J, Vitale MF, Stracci F, Orlandi W, Bidoli E. Sensitivity and specificity of breast cancer ICD-9-CM codes in three Italian administrative healthcare databases: a diagnostic accuracy study. BMJ Open 2018; 8:e020627. [PMID: 30037866 PMCID: PMC6059298 DOI: 10.1136/bmjopen-2017-020627] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/25/2018] [Accepted: 05/14/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To assess the accuracy of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes in identifying patients diagnosed with incident carcinoma in situ and invasive breast cancer in three Italian administrative databases. DESIGN A diagnostic accuracy study comparing ICD-9-CM codes for carcinoma in situ (233.0) and for invasive breast cancer (174.x) with medical chart (as a reference standard). Case definition: (1) presence of a primary nodular lesion in the breast and (2) cytological or histological documentation of cancer from a primary or metastatic site. SETTING Administrative databases from Umbria Region, Azienda Sanitaria Locale (ASL) Napoli 3 Sud (NA) and Friuli VeneziaGiulia (FVG) Region. PARTICIPANTS Women with breast carcinoma in situ (n=246) or invasive breast cancer (n=384) diagnosed (in primary position) between 2012 and 2014. OUTCOME MEASURES Sensitivity and specificity for codes 233.0 and 174.x. RESULTS For invasive breast cancer the sensitivities were 98% (95% CI 93% to 99%) for Umbria, 96% (95% CI 91% to 99%) for NA and 100% (95% CI 97% to 100%) for FVG. Specificities were 90% (95% CI 82% to 95%) for Umbria, 91% (95% CI 83% to 96%) for NA and 91% (95% CI 84% to 96%) for FVG.For carcinoma in situ the sensitivities were 100% (95% CI 93% to 100%) for Umbria, 100% (95% CI 95% to 100%) for NA and 100% (95% CI 96% to 100%) for FVG. Specificities were 98% (95% CI 93% to 100%) for Umbria, 86% (95% CI 78% to 92%) for NA and 90% (95% CI 82% to 95%) for FVG. CONCLUSIONS Administrative healthcare databases from Umbria, NA and FVG are accurate in identifying hospitalised news cases of carcinoma of the breast. The proposed case definition is a powerful tool to perform research on large populations of newly diagnosed patients with breast cancer.
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Affiliation(s)
- Iosief Abraha
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
- Innovation and Development, Agenzia Nazionale per i Servizi Sanitari Regionali (Age.Na.S.), Rome, Italy
| | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico Aviano, Aviano, Italy
| | | | - Mario Fusco
- Registro Tumori Regione Campania, ASL Napoli 3 Sud, Brusciano, Italy
| | - Gianni Giovannini
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Paola Casucci
- Health ICT Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Francesco Cozzolino
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Massimiliano Orso
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Annalisa Granata
- Health ICT Service, Regional Health Authority of Umbria, Perugia, Italy
| | | | - Paolo Collarile
- SOC Epidemiologia Oncologica, Centro di Riferimento Oncologico Aviano, Aviano, Italy
| | - Rita Chiari
- Dipartimento di Oncologia, Azienda Ospedaliera Perugia, Perugia, Italy
| | | | | | | | - Walter Orlandi
- Direzione Sanità, Regional Health Authority of Umbria, Perugia, Italy
| | - Ettore Bidoli
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico Aviano, Aviano, Italy
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Orso M, Serraino D, Abraha I, Fusco M, Giovannini G, Casucci P, Cozzolino F, Granata A, Gobbato M, Stracci F, Ciullo V, Vitale MF, Eusebi P, Orlandi W, Montedori A, Bidoli E. Validating malignant melanoma ICD-9-CM codes in Umbria, ASL Napoli 3 Sud and Friuli Venezia Giulia administrative healthcare databases: a diagnostic accuracy study. BMJ Open 2018; 8:e020631. [PMID: 29678984 PMCID: PMC5914898 DOI: 10.1136/bmjopen-2017-020631] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To assess the accuracy of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes in identifying subjects with melanoma. DESIGN A diagnostic accuracy study comparing melanoma ICD-9-CM codes (index test) with medical chart (reference standard). Case ascertainment was based on neoplastic lesion of the skin and a histological diagnosis from a primary or metastatic site positive for melanoma. SETTING Administrative databases from Umbria Region, Azienda Sanitaria Locale (ASL) Napoli 3 Sud (NA) and Friuli Venezia Giulia (FVG) Region. PARTICIPANTS 112, 130 and 130 cases (subjects with melanoma) were randomly selected from Umbria, NA and FVG, respectively; 94 non-cases (subjects without melanoma) were randomly selected from each unit. OUTCOME MEASURES Sensitivity and specificity for ICD-9-CM code 172.x located in primary position. RESULTS The most common melanoma subtype was malignant melanoma of skin of trunk, except scrotum (ICD-9-CM code: 172.5), followed by malignant melanoma of skin of lower limb, including hip (ICD-9-CM code: 172.7). The mean age of the patients ranged from 60 to 61 years. Most of the diagnoses were performed in surgical departments.The sensitivities were 100% (95% CI 96% to 100%) for Umbria, 99% (95% CI 94% to 100%) for NA and 98% (95% CI 93% to 100%) for FVG. The specificities were 88% (95% CI 80% to 93%) for Umbria, 77% (95% CI 69% to 85%) for NA and 79% (95% CI 71% to 86%) for FVG. CONCLUSIONS The case definition for melanoma based on clinical or instrumental diagnosis, confirmed by histological examination, showed excellent sensitivities and good specificities in the three operative units. Administrative databases from the three operative units can be used for epidemiological and outcome research of melanoma.
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Affiliation(s)
- Massimiliano Orso
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico Aviano, Aviano, Italy
| | - Iosief Abraha
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
- Innovation and development, Agenzia Nazionale per i Servizi Sanitari Regionali (Agenas), Rome, Italy
| | - Mario Fusco
- Registro Tumori Regione Campania, ASL Napoli 3 Sud, Brusciano, Italy
| | - Gianni Giovannini
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Paola Casucci
- SOC Epidemiologia Oncologica, Centro di Riferimento Oncologico Aviano, Aviano, Italy
| | - Francesco Cozzolino
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Annalisa Granata
- Registro Tumori Regione Campania, ASL Napoli 3 Sud, Brusciano, Italy
| | - Michele Gobbato
- SOC Epidemiologia Oncologica, Centro di Riferimento Oncologico Aviano, Aviano, Italy
| | | | - Valerio Ciullo
- Registro Tumori Regione Campania, ASL Napoli 3 Sud, Brusciano, Italy
| | | | - Paolo Eusebi
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Walter Orlandi
- Direzione Regionale Salute, Regional Health Authority of Umbria, Perugia, Italy
| | | | - Ettore Bidoli
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico Aviano, Aviano, Italy
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Regional Outcome Evaluation Program (P.Re.Val.E.): Reduction of inequality in access to effective health care in the Lazio region of Italy (2012-2015). PLoS One 2018; 13:e0194972. [PMID: 29584783 PMCID: PMC5870986 DOI: 10.1371/journal.pone.0194972] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 03/14/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Inequalities in health among groups of various socio-economic status (as measured by education, occupation, and income) constitute one of the main challenges for public health. Since 2006, the Lazio Regional Outcome Evaluation Program (P.Re.Val.E.), presents a set of indicators of hospital performance based on quality standards driven by strong clinical recommendations, and measures the variation in the access to effective health care for different population groups and providers in the Lazio Region. One of the aims of the program was to compare population subgroups in order to promote equity in service provision. Since June 2013, a new management strategy has been put in place that assigned specific goals based on performance assessment to the chief executive officers of the hospitals. AIM To evaluate whether, in recent years, there has been a reduction in the differential access to effective health care, among individuals with different educational levels. METHODS We enrolled all patients discharged from both public and private hospitals of the Lazio region between 2012 and 2015, living in Lazio region. We analysed the proportion of patients with ST-elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention within 90 minutes (primary PCI), the proportion of patients with hip fracture (HF) who underwent surgery within 2 days, and the proportion of women with primary C-section. We applied multivariate logistic regression models to assess the effect of educational level on health outcomes, adjusting for demographic characteristics and comorbidities that could affect the outcomes. For each year of the study period, we compared adjusted proportions of outcomes for the highest and the lowest level of education by using percentage differences. RESULTS In the Lazio region, 44.6% of STEMI patients (N = 3,299) were treated with primary PCI, 54.4% of patients with hip fractures (N = 6,602) underwent surgery within 2 days, and 27.7% of women without a previous C-section (N = 34,718) delivered via C-section, in 2015. The corresponding proportions in 2012 were 27.8%, 31.3% and 31.5%, respectively. By comparing the adjusted proportions in patients with the highest education level (a university degree or higher) to those with the lowest level education level (None/Primary school), a decrease in the percentage difference was observed during the study period. In STEMI and delivery cohorts, the improvement of outcomes involved the least and the most educated patients, respectively, and the difference between the two educational levels was close to zero in 2015, whereas for hip patients, the improvement was more evident among the less educated patients. CONCLUSIONS In the Lazio region, we observed a reduction in the differential access to effective heath care by educational level, in different clinical areas. Different factors might explain these results. On top of the public disclosure of outcome data, the management strategy applied in mid-2013 might have driven the overall improvement of the health system for the considered conditions, helping to achieve a fairer access to health.
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Abstract
OBJECTIVES It is disputed whether the time a patient waits for surgery after hip fracture increases the risk of in-hospital death. This uncertainty matters as access to surgery following hip fracture may be underprioritised due to a lack of definitive evidence. Uncertainty in the available evidence may be due to differences in characteristics of patients, their injury and their care. We summarised the literature on patients and system factors associated with time to surgery, and collated proposed mechanisms for the associations. METHODS We used the framework developed by Arksey and O'Malley and Levac et al for synthesis of factors and mechanisms of time to surgery after hip fracture in adults aged >50 years, published in English, between 1 January 2000 and 28 February 2017, and indexed in MEDLINE, EMBASE, CINAHL or Ageline. Proposed mechanisms for reported associations were extracted from discussion sections. RESULTS We summarised evidence from 26 articles that reported on 24 patient and system factors of time to surgery post hip fracture. In total, 16 factors were reported by only one article. For 16 factors we found proposed mechanisms for their association with time to surgery which included surgical readiness, available resources, prioritisation and out-of-hours admission. CONCLUSIONS We identified patient and system factors associated with time to surgery after hip fracture. This new knowledge will inform evaluation of the putative timing-death association. Future interventions should be designed to influence factors with modifiable mechanisms for delay.
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Affiliation(s)
- Katie J Sheehan
- Academic Department of Physiotherapy, Division of Health and Social Care Research, King's College London, London, UK
| | - Boris Sobolev
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | | | - Pierre Guy
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, Canada
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Cozzolino F, Abraha I, Orso M, Mengoni A, Cerasa MF, Eusebi P, Ambrosio G, Montedori A. Protocol for validating cardiovascular and cerebrovascular ICD-9-CM codes in healthcare administrative databases: the Umbria Data Value Project. BMJ Open 2017; 7:e013785. [PMID: 28360241 PMCID: PMC5372118 DOI: 10.1136/bmjopen-2016-013785] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 01/19/2017] [Accepted: 01/23/2017] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Administrative healthcare databases can provide a comprehensive assessment of the burden of diseases in terms of major outcomes, such as mortality, hospital readmissions and use of healthcare resources, thus providing answers to a wide spectrum of research questions. However, a crucial issue is the reliability of information gathered. Aim of this protocol is to validate International Classification of Diseases, 9th Revision-Clinical Modification (ICD-9-CM) codes for major cardiovascular diseases, including acute myocardial infarction (AMI), heart failure (HF), atrial fibrillation (AF) and stroke. METHODS AND ANALYSIS Data from the centralised administrative database of the entire Umbria Region (910 000 residents, located in Central Italy) will be considered. Patients with a first hospital discharge for AMI, HF, AF or stroke, between 2012 and 2014, will be identified in the administrative database using the following groups of ICD-9-CM codes located in primary position: (1) 410.x for AMI; (2) 427.31 for AF; (3) 428 for HF; (4) 433.x1, 434 (excluding 434.x0), 436 for ischaemic stroke, 430 and 431 for haemorrhagic stroke (subarachnoid haemorrhage and intracerebral haemorrhage). A random sample of cases, and of non-cases, will be selected, and the corresponding medical charts retrieved and reviewed for validation by pairs of trained, independent reviewers. For each condition considered, case adjudication of disease will be based on symptoms, laboratory and diagnostic tests, as available in medical charts. Divergences will be resolved by consensus. Sensitivity and specificity with 95% CIs will be calculated. ETHICS AND DISSEMINATION Research protocol has been granted approval by the Regional Ethics Committee. Study results will be disseminated widely through peer-reviewed publications and presentations at national and international conferences.
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Affiliation(s)
- Francesco Cozzolino
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Iosief Abraha
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Massimiliano Orso
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Anna Mengoni
- Division of Cardiology, Santa Maria della Misericordia Hospital, University of Perugia School of Medicine, Perugia, Italy
| | - Maria Francesca Cerasa
- Division of Cardiology, Santa Maria della Misericordia Hospital, University of Perugia School of Medicine, Perugia, Italy
| | - Paolo Eusebi
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Giuseppe Ambrosio
- Division of Cardiology, Santa Maria della Misericordia Hospital, University of Perugia School of Medicine, Perugia, Italy
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Milstein R, Schreyoegg J. Pay for performance in the inpatient sector: A review of 34 P4P programs in 14 OECD countries. Health Policy 2016; 120:1125-1140. [DOI: 10.1016/j.healthpol.2016.08.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 08/21/2016] [Accepted: 08/25/2016] [Indexed: 11/26/2022]
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Abstract
BACKGROUND Despite declines in both the incidence of and mortality following hip fracture, there are racial and socioeconomic disparities in treatment access and outcomes. We evaluated the presence and implications of disparities in delivery of care, hypothesizing that race and community socioeconomic characteristics would influence quality of care for patients with a hip fracture. METHODS We collected data from the New York State Department of Health Statewide Planning and Research Cooperative System (SPARCS), which prospectively captures information on all discharges from nonfederal acute-care hospitals in New York State. Records for 197,290 New York State residents who underwent surgery for a hip fracture between 1998 and 2010 in New York State were identified from SPARCS using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Multivariable regression models were used to evaluate the association of patient characteristics, social deprivation, and hospital/surgeon volume with time from admission to surgery, in-hospital complications, readmission, and 1-year mortality. RESULTS After adjusting for patient and surgery characteristics, hospital/surgeon volume, social deprivation, and other variables, black patients were at greater risk for delayed surgery (odds ratio [OR] = 1.49; 95% confidence interval [CI] = 1.42, 1.57), a reoperation (hazard ratio [HR] = 1.21; CI = 1.11, 1.32), readmission (OR = 1.17; CI = 1.11, 1.22), and 1-year mortality (HR = 1.13; CI = 1.07, 1.21) than white patients. Subgroup analyses showed a greater risk for delayed surgery for black and Asian patients compared with white patients, regardless of social deprivation. Additionally, there was a greater risk for readmission for black patients compared with white patients, regardless of social deprivation. Compared with Medicare patients, Medicaid patients were at increased risk for delayed surgery (OR = 1.17; CI = 1.10, 1.24) whereas privately insured patients were at decreased risk for delayed surgery (OR = 0.77; CI = 0.74, 0.81), readmission (OR = 0.77; CI = 0.74, 0.81), complications (OR = 0.80; CI = 0.77, 0.84), and 1-year mortality (HR = 0.80; CI = 0.75, 0.85). CONCLUSIONS There are race and insurance-based disparities in delivery of care for patients with hip fracture, some of which persist after adjusting for social deprivation. In addition to investigation into reasons contributing to disparities, targeted interventions should be developed to mitigate effects of disparities on patients at greatest risk. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Christopher J Dy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Joseph M Lane
- Department of Orthopaedic Surgery (J.M.L. and M.L.P.) and Healthcare Research Institute (J.M.L., T.J.P., M.L.P., and S.L.), Hospital for Special Surgery, New York, NY Weill Cornell Medical College, New York, NY
| | - Ting Jung Pan
- Department of Orthopaedic Surgery (J.M.L. and M.L.P.) and Healthcare Research Institute (J.M.L., T.J.P., M.L.P., and S.L.), Hospital for Special Surgery, New York, NY
| | - Michael L Parks
- Department of Orthopaedic Surgery (J.M.L. and M.L.P.) and Healthcare Research Institute (J.M.L., T.J.P., M.L.P., and S.L.), Hospital for Special Surgery, New York, NY
| | - Stephen Lyman
- Department of Orthopaedic Surgery (J.M.L. and M.L.P.) and Healthcare Research Institute (J.M.L., T.J.P., M.L.P., and S.L.), Hospital for Special Surgery, New York, NY Weill Cornell Medical College, New York, NY
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Abraha I, Serraino D, Giovannini G, Stracci F, Casucci P, Alessandrini G, Bidoli E, Chiari R, Cirocchi R, De Giorgi M, Franchini D, Vitale MF, Fusco M, Montedori A. Validity of ICD-9-CM codes for breast, lung and colorectal cancers in three Italian administrative healthcare databases: a diagnostic accuracy study protocol. BMJ Open 2016; 6:e010547. [PMID: 27016247 PMCID: PMC4809074 DOI: 10.1136/bmjopen-2015-010547] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/31/2016] [Accepted: 02/22/2016] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Administrative healthcare databases are useful tools to study healthcare outcomes and to monitor the health status of a population. Patients with cancer can be identified through disease-specific codes, prescriptions and physician claims, but prior validation is required to achieve an accurate case definition. The objective of this protocol is to assess the accuracy of International Classification of Diseases Ninth Revision-Clinical Modification (ICD-9-CM) codes for breast, lung and colorectal cancers in identifying patients diagnosed with the relative disease in three Italian administrative databases. METHODS AND ANALYSIS Data from the administrative databases of Umbria Region (910,000 residents), Local Health Unit 3 of Napoli (1,170,000 residents) and Friuli--Venezia Giulia Region (1,227,000 residents) will be considered. In each administrative database, patients with the first occurrence of diagnosis of breast, lung or colorectal cancer between 2012 and 2014 will be identified using the following groups of ICD-9-CM codes in primary position: (1) 233.0 and (2) 174.x for breast cancer; (3) 162.x for lung cancer; (4) 153.x for colon cancer and (5) 154.0-154.1 and 154.8 for rectal cancer. Only incident cases will be considered, that is, excluding cases that have the same diagnosis in the 5 years (2007-2011) before the period of interest. A random sample of cases and non-cases will be selected from each administrative database and the corresponding medical charts will be assessed for validation by pairs of trained, independent reviewers. Case ascertainment within the medical charts will be based on (1) the presence of a primary nodular lesion in the breast, lung or colon-rectum, documented with imaging or endoscopy and (2) a cytological or histological documentation of cancer from a primary or metastatic site. Sensitivity and specificity with 95% CIs will be calculated. DISSEMINATION Study results will be disseminated widely through peer-reviewed publications and presentations at national and international conferences.
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Affiliation(s)
- Iosief Abraha
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Diego Serraino
- Epidemiology and Biostatistic Unit, Centro di Riferimento Oncologico Aviano, Aviano, Italy
| | - Gianni Giovannini
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | | | - Paola Casucci
- Health ICT Service, Regional Health Authority of Umbria, Perugia, Italy
| | | | - Ettore Bidoli
- Epidemiology and Biostatistic Unit, Centro di Riferimento Oncologico Aviano, Aviano, Italy
| | - Rita Chiari
- Dipartimento di Oncologia, Azienda Ospedaliera Perugia, Perugia, Italy
| | - Roberto Cirocchi
- Department of Digestive Surgery and Liver Unit, University of Perugia, Perugia, Italy
| | | | - David Franchini
- Health ICT Service, Regional Health Authority of Umbria, Perugia, Italy
| | | | - Mario Fusco
- Registro Tumori Regione Campania, ASL NA3 Sud, Brusciano, Italy
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Dash SK, Panigrahi R, Palo N, Priyadarshi A, Biswal M. Fragility Hip Fractures in Elderly Patients in Bhubaneswar, India (2012-2014): A Prospective Multicenter Study of 1031 Elderly Patients. Geriatr Orthop Surg Rehabil 2015; 6:11-5. [PMID: 26246947 DOI: 10.1177/2151458514555570] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Elderly patients with hip fracture constitute Single Largest Group of Emergency Orthopaedics Admissions. In 2050, 6.26 million hip fractures worldwide, approximately 50%, will occur in Asia. Only small number of reports on incidence of hip fractures in the Asian population exist. India lacks data registry for fragility hip fractures, therefore, the magnitude and standard of patient care are not known. A prospective multicenter study was conducted from January 2012 to April 2014 to describe population-based longitudinal trends, namely, age-specific incidence, fracture type, timing of presentation, kilometers traveled, timing of surgery, hospital stay, man hours lost, pressure ulcers, weight bearing, 30-day return, 3-month mortality, and so on, of fragility hip fractures. A total of 1031 patients were included with 59.7% females and 40.3% of male patients, with a female-male ratio of 1.5:1. Commonest mode: Falls 45%. 56.4% IT fractures. 66.2%patients operated, Operative/Conservative Ratio of 2.8:1. Patients travel a mean distance of 86.4 kilometers for quality treatment. Of the patients, 85.9 % presented late due to ignorance and misguiding quack practice. Incidence of delayed surgery was 69.3%. Persistent electrolytes imbalance and hyperglycemia normalized in 81.2% by second or third postoperative day. The man hours lost was 157.85 hours/person. Medical complications was more (90%) in patients who had delays in surgeries and presentation. Mortality rate was 6.2 %. Patients travel long for quality treatment, most of them are misguided, present late with significant complications and sufferings, and their pockets half drained depriving them off best treatment. Early presentation and operation have better prognosis and rehabilitation, facilitates early return to work, and independence. Increased pressure sores, infections, hospital stay, treatment cost, depression, and mortality are directly related to delays in surgeries and presentation. Estimated losses according to lost man hours may go up to 10 million dollars.
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Affiliation(s)
- Sunil K Dash
- Department of Orthopaedics, Hi-Tech Medical College, Bhubaneswar, Odisha, India
| | - Ranajit Panigrahi
- Department of Orthopaedics, Hi-Tech Medical College, Bhubaneswar, Odisha, India
| | - Nishit Palo
- Department of Orthopaedics, Hi-Tech Medical College, Bhubaneswar, Odisha, India
| | - Ashok Priyadarshi
- Department of Orthopaedics, Hi-Tech Medical College, Bhubaneswar, Odisha, India
| | - Manas Biswal
- Department of Orthopaedics, Hi-Tech Medical College, Bhubaneswar, Odisha, India
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Ferrua M, Fourcade A, Lalloué B, Girault A, Jiang S, Loirat P, Minvielle E. Incitation Financière à l’Amélioration de la Qualité (IFAQ) pour les établissements de santé français : Résultats de l’expérimentation (2012-2014). ACTA ACUST UNITED AC 2015. [DOI: 10.3917/jgem.154.0277] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Khan SK, Shirley MDF, Glennie C, Fearon PV, Deehan DJ. Achieving best practice tariff may not reflect improved survival after hip fracture treatment. Clin Interv Aging 2014; 9:2097-102. [PMID: 25489240 PMCID: PMC4257023 DOI: 10.2147/cia.s65736] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective The best practice tariff (BPT) incentivizes hospitals in the England and Wales National Health Service to provide multiprofessional care to patients with hip fractures. The initial six targets included: 1) admission under consultant-led joint orthopedic–geriatric care, 2) multidisciplinary assessment protocol on admission, 3) surgery within 36 hours, 4) geriatrician review within 72 hours, 5) multiprofessional rehabilitation, and 6) assessment for falls and bone protection. We aimed to examine the relationship between BPT achievement and important patient outcomes and whether the BPT could predict these independently of other validated predictors. Materials and methods A retrospective review was conducted on 516 patient episodes. Four outcomes were defined: 1) 30-day mortality, 2) 365-day mortality, 3) postoperative length of stay on trauma ward (LOS-T), and 4) total post-operative hospital LOS (LOS-H). Patient episodes were grouped as follows: 1) group 1, pre-BPT, 2) group 2, BPT achievers, 3) group 3, BPT fails. These were compared for mortality (χ2 test) and for LOS (Kruskal–Wallis test). Event analysis was done for groups 2 and 3 using generalized linear modeling, with age, sex, American Society of Anesthesiologists grade, hemoglobin, albumin, creatinine, and BPT achievement evaluated as predictors. Results The three groups did not differ significantly in baseline characteristics or outcomes. In the event analysis, the risk of 30-day mortality was related only to abnormal creatinine (P=0.025); mortality at 365 days was related significantly to low albumin (P=0.023) and weakly to abnormal creatinine (P=0.089). The risks of both increased LOS-T and LOS-H were related to age only (P=0.052, P<0.001, respectively). Conclusion Achieving BPT does not predict any outcome of interest on its own.
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Affiliation(s)
- Sameer K Khan
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Mark D F Shirley
- School of Biology, Newcastle University, Newcastle upon Tyne, UK
| | - Clare Glennie
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Paul V Fearon
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - David J Deehan
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| |
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