Putting the value framework to work in surgery

Journal of the American College of Surgeons
Kenan W YountR Scott Jones

Abstract

Health policy experts have proposed a framework defining value as outcomes achieved per dollar spent on health care. However, few institutions quantify their delivery of care along these dimensions. Our objective was to measure the value of our surgical services over time. We reviewed the data of patients undergoing general and vascular surgery from 2002 through 2012 at a tertiary care university hospital as abstracted by the American College of Surgeons NSQIP. Morbidity and mortality data from the American College of Surgeons NSQIP database were risk adjusted to calculate observed-to-expected ratios, which were then inverted into a numerator as a surrogate for quality. Costs, the denominator of the value equation, were determined for each patient's hospitalization. The ratio was then transformed by a constant and analyzed with linear regression to analyze and compare values from 2002 through 2012. A total of 25,453 patients met criteria for inclusion. Overall, the value of surgical services increased from 2002 through 2012. The observed increase in value was greater in general surgery than in vascular surgery, and value actually decreased in vascular procedures. Although there was a similar increase in outcomes in vascular sur...Continue Reading

References

Oct 24, 2003·The New England Journal of Medicine·Elliott S Fisher
Aug 21, 2004·Annals of Surgery·R Scott Jones
Mar 11, 2005·Journal of Clinical Gastroenterology·Patrick G Northup, Carl L Berg
Mar 16, 2007·JAMA : the Journal of the American Medical Association·Michael E Porter, Elizabeth Olmsted Teisberg
Jan 30, 2009·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Patrick G NorthupUNKNOWN Adult-to-Adult Living Donor Liver Transplantation Cohort Study Group
Jul 28, 2009·Seminars in Thoracic and Cardiovascular Surgery·Elizabeth O Teisberg, Scott Wallace
Mar 30, 2010·Journal of the American College of Surgeons·Justin B DimickJohn D Birkmeyer
Dec 15, 2010·The New England Journal of Medicine·Thomas H Lee
Dec 15, 2010·The New England Journal of Medicine·Michael E Porter

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Citations

Jul 26, 2015·The Annals of Thoracic Surgery·Kenan W YountGorav Ailawadi
Jul 26, 2015·The Annals of Thoracic Surgery·Kenan W YountChristine L Lau
Feb 27, 2016·Journal of the American College of Surgeons·Henry A PittLarry R Kaiser
Jun 12, 2018·American Journal of Medical Quality : the Official Journal of the American College of Medical Quality·Florence E TurrentineR Scott Jones
Oct 30, 2020·The American Surgeon·William Z ChancellorJennifer L Kirby
Sep 26, 2017·Journal of Vascular Surgery·Thomas C Bower

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