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Yap EN, Dusendang JR, Ng KP, Keny HV, Solomon MD, Cohn BR, Corley DA, Herrinton LJ. Limitations to Health Care Quality Measurement: Assessing Hospital Variation in Risk of Cardiac Events After Noncardiac Surgery. Popul Health Manag 2022; 25:712-720. [PMID: 36095257 DOI: 10.1089/pop.2022.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Limited sample size, incomplete measures, and inadequate risk adjustment adversely influence accurate health care quality measurements, surgical quality measurements, and accurate comparisons among hospitals. Since these measures are linked to resources for quality improvement and reimbursement, improving the accuracy of measurement has substantial implications for patients, clinicians, hospital administrators, insurers, and purchasers. The team examined risk-adjusted differences of postoperative cardiac events among 20 geographically dispersed, community-based medical centers within an integrated health care system and compared it with the National Surgical Quality Improvement Program (NSQIP) hospital-specific differences. The exposure included the hospital at which patients received noncardiac surgical care, with stratification of patients by the acuity of surgery (elective vs. urgent/emergent). Among 157,075 surgery patients, the unadjusted risk of cardiac event per 1000 ranged among hospitals from 2.1 to 6.9 for elective surgery and from 10.3 to 44.5 for urgent/emergent surgery. Across the 20 hospitals, hospital rankings estimated in the present analysis differed significantly from ranking reported by NSQIP (P for difference: elective, P = 0.0001; urgent/emergent, P < 0.0001) with significantly and substantially lower variation after risk adjustment. Current surgical quality measures may not adequately account for limitations of sample size, data capture, adequate risk adjustment, and surgical acuity in a given hospital, particularly for rare outcomes. These differences have implications for quality reporting and may introduce bias into hospital comparisons, particularly for hospitals with incomplete capture of their patients' baseline risk and acuity.
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Affiliation(s)
- Edward N Yap
- Department of Anesthesia, The Permanente Medical Group, Oakland, California, USA.,Department of Anesthesia and Perioperative Care, University of California, San Francisco, California, USA
| | - Jennifer R Dusendang
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Kevin P Ng
- Department of Anesthesia, The Permanente Medical Group, Oakland, California, USA
| | - Hemant V Keny
- Department of Surgery, The Permanente Medical Group, Oakland, California, USA
| | - Matthew D Solomon
- Department of Cardiology, and The Permanente Medical Group, Oakland, California, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Bradley R Cohn
- Department of Anesthesia, The Permanente Medical Group, Oakland, California, USA
| | - Douglas A Corley
- Department of Gastroenterology, The Permanente Medical Group, Oakland, California, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Lisa J Herrinton
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
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Abstract
The process group for staff and trainees in institutional settings has become increasingly unpopular as a resource, although ironically, the need for such a group has grown. The author presents the idea that the process group is not used more often because of a general lack of understanding of the nature of such groups as well as a failure to clearly distinguish process groups from traditional psychotherapy groups. The author goes on to give a clear definition of the task and the boundaries of a process group and, using knowledge of systems thinking, discusses special techniques for running such groups with illustrative examples.
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Affiliation(s)
- B R Cohn
- Roosevelt Site of St. Luke's/Roosevelt Hospital Center
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