March 14, 2019
Dive Brief:
- Choosing to have surgery at a
facility affiliated with a highly rated U.S. hospital doesn't guarantee
the same quality experience, a new study in JAMA
Surgery finds.
- In an analysis of hospitals
affiliated with U.S. News & World Report Honor Roll hospitals,
surgical outcomes varied widely both within and across networks.
- Moreover, Honor Roll hospitals
didn't always outperform network
affiliates. While they had lower failure to rescue rates (13.3% versus
15.1%), their complication rates were actually higher (22.1% vs 18%).
Dive Insight:
Ben
Harder, chief of health analysis at U.S. News, noted on Twitter that
the study's findings were not surprising. "That variation is why we
evaluate discrete hospitals, not hospital system brands," he said.
“Surgical
outcomes vary widely across hospitals affiliated with @usnews Honor Roll hospitals,” per @KyleSheetz @AndrewMIbrahim @DrHariNathan @jdimick1
Indeed. That variation is why we evaluate discrete hospitals, not health system brands.https://jamanetwork.com/journals/jamasurgery/fullarticle/2727990 … @JAMASurgery
Indeed. That variation is why we evaluate discrete hospitals, not health system brands.https://jamanetwork.com/journals/jamasurgery/fullarticle/2727990 … @JAMASurgery
The
researchers analyzed data from Medicare beneficiaries who underwent colectomy,
coronary artery bypass graft or hip replacement at 87 hospitals belonging to
one of 16 networks affiliated with Honor Roll hospitals to see how they
differed in risk-adjusted outcomes.
For
failure to rescue, variations in outcomes within networks ranged from as little
as 1.1-fold for failure to as high as 4.9-fold. Across all networks,
complication rates varied by 1.1-fold to 4.3-fold.
The
findings have implications for patients, but also for large hospital systems
looking to expand services at more of their facilities.
"The
wide variation in outcomes suggests that multihospital networks are not
realizing the potential to leverage their combined resources to optimize these
services across the entire clinical delivery system," the authors write.
They
note that while networks often take advantage of economies of scale and
administrative efficiencies to reduce costs and waste, opportunities to impact
quality of care are often overlooked.
Monitoring
for variations within networks could help change that. For example,
systems could centralize care at specified referral centers for rare
conditions, high-risk patients or volume-sensitive procedures. They also could
enhance quality at affiliates by exporting best practices from high-performing
hospitals.
"Networks
choosing to expand services across more affiliated hospitals can use
coordinated peer-to-peer collaborative improvement plans in which hospitals
learn from the experience of the Honor Roll hospital or other centers with the
best outcomes," the authors say. "In this context, the practices of
high-performing affiliates, such as training staff to recognize and
appropriately manage complications, are teachable or exportable to the entire
network."
They
also call for increased transparency around the quality at all network-affiliated
hospitals.
https://www.healthcaredive.com/news/quality-varies-wildly-among-affiliates-linked-with-us-news-top-hospitals-j/550472/
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