Ranking hospitals on surgical quality: does risk-adjustment always matter?

Journal of the American College of Surgeons
Justin B Dimick, John D Birkmeyer

Abstract

It is a widely held belief that detailed risk-adjustment is always necessary in comparative reports of surgical performance. We sought to evaluate the importance of risk-adjustment for two cardiac surgery report cards in New York and Pennsylvania. We abstracted data directly from publicly available cardiac surgery report cards from New York State (2001 and 2002) and Pennsylvania (2000 and 2002). We first estimated the correlation between unadjusted and risk-adjusted mortality rates. We then divided hospitals into three groups of historic performance (best, average, and worst) for both unadjusted and risk-adjusted mortality rankings. We then calculated the risk-adjusted mortality within each of these groups using data from the report card from the subsequent year. Risk-adjusted and unadjusted mortality rates were highly correlated for both New York (Pearson's r=0.95; Spearman's r=0.91) and Pennsylvania (Pearson's r=0.87; Spearman's r=0.89). For both states, risk-adjusted and unadjusted rankings were equally good at predicting subsequent mortality. In New York State, mortality for hospitals in the worst group was 50% higher than that in the best group regardless of whether unadjusted (relative risk [RR], 1.51) or adjusted (RR, 1....Continue Reading

References

Nov 15, 1995·Annals of Internal Medicine·L I IezzoniY D Mackiernan
Jun 1, 1995·International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care·L I IezzoniY D Mackiernan
Jan 1, 1996·Medical Care·L I IezzoniY D Mackiernan
Feb 13, 2001·Annual Review of Medicine·J DaleyS F Khuri
Sep 18, 2001·JAMA : the Journal of the American Medical Association·K W Kizer
Aug 27, 2004·The New England Journal of Medicine·Robert S GalvinFrancois de Brantes

❮ Previous
Next ❯

Citations

Jun 23, 2009·Surgical Laparoscopy, Endoscopy & Percutaneous Techniques·Eldo E Frezza, Mitchell S Wachtel
Sep 2, 2008·Annual Review of Medicine·John D Birkmeyer, Justin B Dimick
Jul 15, 2009·Health Affairs·Onur BaserJohn D Birkmeyer
Apr 22, 2014·The Surgeon : Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland·Alexander J FowlerNick Sevdalis
May 6, 2014·The Annals of Thoracic Surgery·Farhood FarjahDouglas E Wood
Sep 25, 2014·The Annals of Thoracic Surgery·Christina M VassilevaStephen Hazelrigg
Jul 3, 2013·The Annals of Thoracic Surgery·David M ShahianSean M O'Brien
Jun 19, 2012·European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology·J W T DekkerR A E M Tollenaar
Mar 9, 2012·Journal of the American College of Surgeons·Adrian T BilleterSusan Galandiuk
Mar 31, 2011·Journal of the American College of Surgeons·David C ChangRaul Coimbra
Mar 15, 2011·Journal of the American College of Surgeons·Donald E FryRoger J Meimban
Mar 30, 2010·Journal of the American College of Surgeons·Justin B DimickJohn D Birkmeyer
Jul 4, 2009·Urologic Oncology·Matthew R CooperbergMark S Litwin
Sep 19, 2012·Health Services Research·Justin B DimickJohn D Birkmeyer
Apr 23, 2014·Journal of Hospital Medicine : an Official Publication of the Society of Hospital Medicine·Evan S FieldstonNicholas Tsarouhas
Sep 1, 2011·The Annals of Thoracic Surgery·David M ShahianFrederick L Grover
Apr 29, 2011·The Annals of Thoracic Surgery·Karen DonelanArvind K Agnihotri
Jun 2, 2009·Journal of Vascular Surgery·Philip P GoodneyRobert M Zwolak
Apr 14, 2010·Journal of Vascular Surgery·Philip P GoodneySamuel R G Finlayson
Dec 17, 2014·International Journal of Surgery·P D RadfordUNKNOWN Council of the Association of Surgeons in Training
Jan 23, 2010·American Journal of Medical Quality : the Official Journal of the American College of Medical Quality·Robert KlugmanWalter Ettinger
Jul 15, 2009·Health Affairs·Justin B DimickJohn D Birkmeyer
Nov 3, 2016·Circulation. Cardiovascular Quality and Outcomes·Jessica J LiuChaim M Bell
Oct 17, 2018·JAMA : the Journal of the American Medical Association·Junqiao ChenJesse James
May 8, 2019·Population Health Management·Junqiao ChenOlumayowa Tijani-Eniola
Mar 26, 2019·The Journal of Trauma and Acute Care Surgery·Robert D BecherKimberly A Davis
Mar 30, 2020·The Surgeon : Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland·Matthew J DavisEdward P Buchanan
Feb 8, 2020·Journal of the American College of Surgeons·Robert D BecherKimberly A Davis
Jul 14, 2021·Annals of Plastic Surgery·Sarth RajEdward P Buchanan

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.