Surgical quality: review of Californian measures
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《英国医生杂志》
1 Zynx Health, Beverly Hills, CA 90212, USA, 2 California HealthCare Foundation, San Francisco, CA, 3 RAND Health, Santa Monica, CA
Correspondence to: M S Broder mbroder@cerner.com
Introduction
We found few data to help a consumer interested in using quality to select a surgeon or hospital, and the existing data had serious shortcomings. We found no data specific to surgeons, that most outcome measures used administrative risk adjustment, and no reporting of process measures or functional assessments—for example, walking after hip replacement. Most common procedures had no associated quality measures at all. For some complex procedures, researchers have found an inverse association between volume (a commonly reported measure) and mortality.3 However, this association may not hold for most surgeries.4 For common surgical procedures, selecting a high volume hospital may not improve outcomes. Only three new measures are expected over the next three years.
For 88% of surgical patients in California, no publicly reported information exists. These patients must rely on indirect measures, such as academic affiliation, to assess quality. Even consumers who have conditions for which data are reported face difficulties in using these limited data.
Without a new major effort to increase both the number of procedures for which quality measures are available and the validity of those measures, most California consumers will not be able to choose surgical providers based on quality. A competitive market cannot exist under these conditions.
Contributors: MSB collected, analysed, and interpreted the data. RHB had the concept, interpreted the data, and wrote the manuscript. LPS had the concept, collected data, and wrote the manuscript. MSB is guarantor.
Funding: This work was supported in part by a grant from the California HealthCare Foundation and by the UCLA Building Interdisciplinary Research Careers in Women's Health Program.
Competing interests: None declared.
Ethical approval: Not needed.
References
Gillum BS, Graves EJ, Jean L. Trends in hospital utilization: united states, 1988-92. Vital Health Stat 13 1996;(124): 1-71.
Office of Statewide Health Planning and Development. Hospital annual utilization. www.oshpd.state.ca.us/hqad/HIRC/hospital/util/pivot/index.htm. (accessed 7 Jan 2003).
Epstein AM. Volume and outcome: it is time to move ahead. N Engl J Med 2002;346: 1161-4.
Khuri SF, Daley J, Henderson W, Hur K, Hossain M, Soybel D, et al. Relation of surgical volume to outcome in eight common operations: results from the VA national surgical quality improvement program. Ann Surg 1999;230: 414-32.(Michael S Broder, vice pr)
Correspondence to: M S Broder mbroder@cerner.com
Introduction
We found few data to help a consumer interested in using quality to select a surgeon or hospital, and the existing data had serious shortcomings. We found no data specific to surgeons, that most outcome measures used administrative risk adjustment, and no reporting of process measures or functional assessments—for example, walking after hip replacement. Most common procedures had no associated quality measures at all. For some complex procedures, researchers have found an inverse association between volume (a commonly reported measure) and mortality.3 However, this association may not hold for most surgeries.4 For common surgical procedures, selecting a high volume hospital may not improve outcomes. Only three new measures are expected over the next three years.
For 88% of surgical patients in California, no publicly reported information exists. These patients must rely on indirect measures, such as academic affiliation, to assess quality. Even consumers who have conditions for which data are reported face difficulties in using these limited data.
Without a new major effort to increase both the number of procedures for which quality measures are available and the validity of those measures, most California consumers will not be able to choose surgical providers based on quality. A competitive market cannot exist under these conditions.
Contributors: MSB collected, analysed, and interpreted the data. RHB had the concept, interpreted the data, and wrote the manuscript. LPS had the concept, collected data, and wrote the manuscript. MSB is guarantor.
Funding: This work was supported in part by a grant from the California HealthCare Foundation and by the UCLA Building Interdisciplinary Research Careers in Women's Health Program.
Competing interests: None declared.
Ethical approval: Not needed.
References
Gillum BS, Graves EJ, Jean L. Trends in hospital utilization: united states, 1988-92. Vital Health Stat 13 1996;(124): 1-71.
Office of Statewide Health Planning and Development. Hospital annual utilization. www.oshpd.state.ca.us/hqad/HIRC/hospital/util/pivot/index.htm. (accessed 7 Jan 2003).
Epstein AM. Volume and outcome: it is time to move ahead. N Engl J Med 2002;346: 1161-4.
Khuri SF, Daley J, Henderson W, Hur K, Hossain M, Soybel D, et al. Relation of surgical volume to outcome in eight common operations: results from the VA national surgical quality improvement program. Ann Surg 1999;230: 414-32.(Michael S Broder, vice pr)