Lung Resection Outcomes and Costs in Washington State: A Case for Regional Quality Improvement

被引:11
作者
Farjah, Farhood [1 ]
Varghese, Thomas K.
Costas, Kimberley
Krishnadasan, Bahirathan
Farivar, Alexander S.
Hubka, Michal
Louie, Brian E.
Backhus, Leah M.
Chong, Nyen
Gorden, Jed
Cheng, Aaron M.
He, Hao
Flum, David R.
Low, Donald
Aye, Ralph
Vallieres, Eric
Mulligan, Michael S.
Wood, Douglas E.
机构
[1] Univ Washington, Div Cardiothorac Surg, Seattle, WA 98195 USA
关键词
LENGTH-OF-STAY; SURGICAL MORTALITY; SURGERY DATABASE; THORACIC-SURGERY; RELIABILITY ADJUSTMENT; INCENTIVE SPIROMETRY; PHYSICIAN LEADERSHIP; ATRIAL-FIBRILLATION; RANKING HOSPITALS; CANCER RESECTION;
D O I
10.1016/j.athoracsur.2014.03.014
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. A regional quality improvement effort does not exist for thoracic surgery in the United States. To initiate the development of one, we sought to describe temporal trends and hospital-level variability in associated outcomes and costs of pulmonary resection in Washington (WA) State. Methods. A cohort study (2000-2011) was conducted of operated-on lung cancer patients. The WA State discharge database was used to describe outcomes and costs for operations performed at all nonfederal hospitals within the state. Results. Over 12 years, 8,457 lung cancer patients underwent pulmonary resection across 49 hospitals. Inpatient deaths decreased over time (adjusted p-trend = 0.023) but prolonged length of stay did not (adjusted p-trend = 0.880). Inflation-adjusted hospital costs increased over time (adjusted p-trend < 0.001). Among 24 hospitals performing at least 1 resection per year, 5 hospitals were statistical outliers in rates of death (4 lower and 1 higher than the state average), and 13 were outliers with respect to prolonged length of stay (7 higher and 6 lower than the state average) and costs (5 higher and 8 lower than the state average). When evaluated for rates of death and costs, there were hospitals with fewer deaths/lower costs, fewer deaths/higher costs, more deaths/lower costs, and more deaths/higher costs. Conclusions. Variability in outcomes and costs over time and across hospitals suggest opportunities to improve the quality and value of thoracic surgery in WA State. Examples from cardiac surgery suggest that a regional quality improvement collaborative is an effective way to meaningfully and rapidly act upon these opportunities. (C) 2014 by The Society of Thoracic Surgeons
引用
收藏
页码:175 / 181
页数:7
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