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Technology Burden Alters Hospital Quality and Cost
Vol. 223, No. 4S2, October 2016
The Center for Disease Control’s 2013 Behavioral Risk Factor Surveillance System survey was analyzed to determine estimates of bariatric surgery qualified adults, aged 18 to 70 years, with BMI >40 or >35 with diabetes. The number of bariatric surgeons was determined from 4 online sources: searches of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program accredited bariatric programs, American Society for Metabolic and Bariatric Surgery membership, and 2 adjustable gastric band manufacturer “find a surgeon” search tools. Crude and demographic-adjusted associations between surgeon and procedure volume were determined. RESULTS: The defined bariatric surgery eligible population comprised between 3.6% (New England) to 6.8% (East South Central) of the total division population (p<0.001). Incident rates of bariatric surgery ranged from 0.9% in East South Central to 2.2% in New England (p<0.001). The rate of bariatric surgery by division was negatively correlated with division morbid obesity rates (r¼-0.65) and strongly positively correlated with surgeon availability (r¼0.91). After adjusting for demographic differences between divisions, surgeon availability remained highly associated with surgery utilization (p<0.001). CONCLUSIONS: Rates of bariatric surgery procedures in the US are strongly correlated with the number of available bariatric surgeons. Effective therapy for the morbidly obese may be limited by the lack of qualified surgeons. Technology Burden Alters Hospital Quality and Cost Aaron A Sorenson, MPH, Susan G Fisher, PhD, Arthur M Feldman, MD, PhD, Frederick V Ramsey, PhD, Henry A Pitt, MD, FACS Lewis Katz School of Medicine at Temple Univesity, Temple University Health System, Philadelphia, PA INTRODUCTION: Hospital revenue is increasingly at risk as reimbursement transitions from volume to value. However, many of the quality metrics employed to adjust payments do not account for the technologies provided. Advanced technologies also are likely to increase costs. Therefore, we tested the hypothesis that increased technology burden results in decreased quality at increased cost. METHODS: University HeathSystem Consortium data from 246 academic and community hospitals were analyzed. Quality metrics included mortality (Observed/Expected [O/E]) ratios, five Patient Safety Indicators (PSIs), two patient satisfaction (HCAHPS) scores and 30-day readmission rates. Cost included length of stay (LOS) and direct cost ratios (O/E). Technology burden included 12 Table. Technology Mortality PSI Satisfaction Readmission LOS Cost Burden (O/E) (rates) (%) (%) (O/E) (O/E) Low 1.01 41.0* 71.1* 9.8* 0.88* 0.78* 70.9y 12.1y 0.98y 0.92y Medium 0.95 64.8y High 0.94 86.6 77.5 14.0 1.03 1.10
*y p<0.01 vs medium and high p<0.01 vs high
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services with robust volumes including cardiac surgery, cardiology, neurosurgery, transplantation (heart, kidney/pancreas, liver, lung or bone marrow), Level I Trauma designation as well as abdominal aortic aneurysm, esophageal and pancreatic surgery. Statistical analyses were performed by ANOVA. RESULTS: Hospital technology was categorized as low (0, n¼61), medium (1-8, n¼119) or high (9-12, n¼66) service burden. Outcomes by technology burden are presented in the Table. CONCLUSIONS: Technology burden is not associated with patient mortality, is related to improved patient satisfaction, but adversely influences patient safety, readmissions, length of stay, and cost. Quality and cost data employed to alter reimbursement should be risk-adjusted for technology burden. Effect of American College of Surgeons Trauma Center Designation on Outcomes: Measurable Benefit at the Extremes of Age Michael D Grossman, MD, FACS, Aparna Kolli, MD, Jay A Yelon, FACS, Lisa Szydziak, Christopher Anderson Southside Hospital/Northwell Health System, Bayshore, NY INTRODUCTION: Designation by the American College of Surgeons (ACS) is believed to provide benefits for trauma patients but is associated with direct costs related to ACS standards. We hypothesized that improvement in outcomes could be shown for patients treated in ACS vs non-ACS centers METHODS: We reviewed the National Sample Program (NSP) of the National Trauma Data Bank (NTDB) for 2012. Patients separated into 3 categories PED (0-14), ADULT (15-64) and ELD (> 65). We created multiple logistic regression model to determine significance of ACS verification on mortality, complications and adverse outcome (mortality plus complications), controlling for age, ISS, GCS, shock, sex, co-morbidities, and mechanism. ISS and GCS analyzed as categorical variables (low, moderate, high). We recorded information on length of stay (LOS) for descriptive purposes. SAS used to perform logistic regression. Statistical significance set at p¼.05. RESULTS: There were 265,306 patients treated in ACS centers, 130,813 in non-ACS centers. PEDs 4.3%, ADULT 64.7%, ELD 31%. For ADULTS, no significant differences in any primary outcome ACS vs non-ACS centers (p ¼.132, .067, .084 for mortality, complications, adverse outcomes, respectively). For PEDS, complications and adverse outcomes more likely in non-ACS centers, no difference in mortality [p <.001, OR 2.68 (1.4-5.0) and p¼.003, OR 2.56 (1.4-4.8)]. For ELD, complications and adverse outcomes more likely in non-ACS centers, no difference in mortality [p < .0001, OR 3.15 (2.2-4.5) and p <.0001; OR 3.04 (2.14.3)]. Length of stay higher in all groups with complications (PEDS 7.0 vs 2.9, ADULT 12.7 vs 5.0, ELD 10.9 vs 5.6). CONCLUSIONS: Treatment in ACS trauma centers results in decreased complications/adverse outcomes for PEDS and ELD but not ADULTs. Length of stay may be influenced by complications.
The Center for Disease Control’s 2013 Behavioral Risk Factor Surveillance System survey was analyzed to determine estimates of bariatric surgery qualified adults, aged 18 to 70 years, with BMI >40 or >35 with diabetes. The number of bariatric surgeons was determined from 4 online sources: searches of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program accredited bariatric programs, American Society for Metabolic and Bariatric Surgery membership, and 2 adjustable gastric band manufacturer “find a surgeon” search tools. Crude and demographic-adjusted associations between surgeon and procedure volume were determined. RESULTS: The defined bariatric surgery eligible population comprised between 3.6% (New England) to 6.8% (East South Central) of the total division population (p<0.001). Incident rates of bariatric surgery ranged from 0.9% in East South Central to 2.2% in New England (p<0.001). The rate of bariatric surgery by division was negatively correlated with division morbid obesity rates (r¼-0.65) and strongly positively correlated with surgeon availability (r¼0.91). After adjusting for demographic differences between divisions, surgeon availability remained highly associated with surgery utilization (p<0.001). CONCLUSIONS: Rates of bariatric surgery procedures in the US are strongly correlated with the number of available bariatric surgeons. Effective therapy for the morbidly obese may be limited by the lack of qualified surgeons. Technology Burden Alters Hospital Quality and Cost Aaron A Sorenson, MPH, Susan G Fisher, PhD, Arthur M Feldman, MD, PhD, Frederick V Ramsey, PhD, Henry A Pitt, MD, FACS Lewis Katz School of Medicine at Temple Univesity, Temple University Health System, Philadelphia, PA INTRODUCTION: Hospital revenue is increasingly at risk as reimbursement transitions from volume to value. However, many of the quality metrics employed to adjust payments do not account for the technologies provided. Advanced technologies also are likely to increase costs. Therefore, we tested the hypothesis that increased technology burden results in decreased quality at increased cost. METHODS: University HeathSystem Consortium data from 246 academic and community hospitals were analyzed. Quality metrics included mortality (Observed/Expected [O/E]) ratios, five Patient Safety Indicators (PSIs), two patient satisfaction (HCAHPS) scores and 30-day readmission rates. Cost included length of stay (LOS) and direct cost ratios (O/E). Technology burden included 12 Table. Technology Mortality PSI Satisfaction Readmission LOS Cost Burden (O/E) (rates) (%) (%) (O/E) (O/E) Low 1.01 41.0* 71.1* 9.8* 0.88* 0.78* 70.9y 12.1y 0.98y 0.92y Medium 0.95 64.8y High 0.94 86.6 77.5 14.0 1.03 1.10
*y p<0.01 vs medium and high p<0.01 vs high
Scientific Forum: 2016 Clinical Congress
e37
services with robust volumes including cardiac surgery, cardiology, neurosurgery, transplantation (heart, kidney/pancreas, liver, lung or bone marrow), Level I Trauma designation as well as abdominal aortic aneurysm, esophageal and pancreatic surgery. Statistical analyses were performed by ANOVA. RESULTS: Hospital technology was categorized as low (0, n¼61), medium (1-8, n¼119) or high (9-12, n¼66) service burden. Outcomes by technology burden are presented in the Table. CONCLUSIONS: Technology burden is not associated with patient mortality, is related to improved patient satisfaction, but adversely influences patient safety, readmissions, length of stay, and cost. Quality and cost data employed to alter reimbursement should be risk-adjusted for technology burden. Effect of American College of Surgeons Trauma Center Designation on Outcomes: Measurable Benefit at the Extremes of Age Michael D Grossman, MD, FACS, Aparna Kolli, MD, Jay A Yelon, FACS, Lisa Szydziak, Christopher Anderson Southside Hospital/Northwell Health System, Bayshore, NY INTRODUCTION: Designation by the American College of Surgeons (ACS) is believed to provide benefits for trauma patients but is associated with direct costs related to ACS standards. We hypothesized that improvement in outcomes could be shown for patients treated in ACS vs non-ACS centers METHODS: We reviewed the National Sample Program (NSP) of the National Trauma Data Bank (NTDB) for 2012. Patients separated into 3 categories PED (0-14), ADULT (15-64) and ELD (> 65). We created multiple logistic regression model to determine significance of ACS verification on mortality, complications and adverse outcome (mortality plus complications), controlling for age, ISS, GCS, shock, sex, co-morbidities, and mechanism. ISS and GCS analyzed as categorical variables (low, moderate, high). We recorded information on length of stay (LOS) for descriptive purposes. SAS used to perform logistic regression. Statistical significance set at p¼.05. RESULTS: There were 265,306 patients treated in ACS centers, 130,813 in non-ACS centers. PEDs 4.3%, ADULT 64.7%, ELD 31%. For ADULTS, no significant differences in any primary outcome ACS vs non-ACS centers (p ¼.132, .067, .084 for mortality, complications, adverse outcomes, respectively). For PEDS, complications and adverse outcomes more likely in non-ACS centers, no difference in mortality [p <.001, OR 2.68 (1.4-5.0) and p¼.003, OR 2.56 (1.4-4.8)]. For ELD, complications and adverse outcomes more likely in non-ACS centers, no difference in mortality [p < .0001, OR 3.15 (2.2-4.5) and p <.0001; OR 3.04 (2.14.3)]. Length of stay higher in all groups with complications (PEDS 7.0 vs 2.9, ADULT 12.7 vs 5.0, ELD 10.9 vs 5.6). CONCLUSIONS: Treatment in ACS trauma centers results in decreased complications/adverse outcomes for PEDS and ELD but not ADULTs. Length of stay may be influenced by complications.