Textbook Outcomes Among Medicare Patients Undergoing Hepatopancreatic Surgery

To define and test "Textbook Outcome" (TO)-a composite measure for healthcare quality-among Medicare patients undergoing hepatopancreatic resections. Hospital variation in TO and Medicare payments were analyzed. Composite measures of quality may be superior to individual measures for the a...

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Bibliographic Details
Published in:Annals of surgery Vol. 271; no. 6; p. 1116
Main Authors: Merath, Katiuscha, Chen, Qinyu, Bagante, Fabio, Beal, Eliza, Akgul, Ozgur, Dillhoff, Mary, Cloyd, Jordan M, Pawlik, Timothy M
Format: Journal Article
Language:English
Published: United States 01.06.2020
Subjects:
Aged
Aged, 80 and over
Female
Health Care Costs - statistics & numerical data
Health Expenditures - statistics & numerical data
Hepatectomy - economics
Humans
Male
Medicare - statistics & numerical data
Pancreatectomy - economics
Quality Indicators, Health Care
Retrospective Studies
United States
United States
ISSN:1528-1140, 1528-1140
Online Access:Get more information
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Summary:To define and test "Textbook Outcome" (TO)-a composite measure for healthcare quality-among Medicare patients undergoing hepatopancreatic resections. Hospital variation in TO and Medicare payments were analyzed. Composite measures of quality may be superior to individual measures for the analysis of hospital performance. The Medicare Provider Analysis and Review (MEDPAR) Inpatient Files were reviewed to identify Medicare patients who underwent pancreatic and liver procedures between 2013 and 2015. TO was defined as: no postoperative surgical complications, no prolonged length of hospital stay, no readmission ≤ 90 days after discharge, and no postoperative mortality ≤ 90 days after surgery. Medicare payments were compared among patients who achieved TO versus patients who did not. Multivariable logistic regression was used to investigate patient factors associated with TO. A nomogram to predict probability of TO was developed and validated. TO was achieved in 44% (n = 5919) of 13,467 patients undergoing hepatopancreatic surgery. Adjusted TO rates at the hospital level varied from 11.1% to 69.6% for pancreatic procedures and from 16.6% to 78.7% for liver procedures. Prolonged length of hospital stay represented the major obstacle to achieve TO. Average Medicare payments were substantially higher among patients who did not have a TO. Factors associated with TO on multivariable analysis were age, sex, Charlson comorbidity score, previous hospital admissions, procedure type, and surgical approach (all P > 0.05). Less than one-half of Medicare patients achieved a TO following hepatopancreatic procedures with a wide variation in the rates of TO among hospitals. There was a discrepancy in Medicare payments for patients who achieved a TO versus patients who did not. TO could be useful for the public reporting of patient level hospital performance and hospital variation.
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ISSN:1528-1140
1528-1140
DOI:10.1097/SLA.0000000000003105