Dataset Information

Association of US News & World Report Top Ranking for Gastroenterology and Gastrointestinal Operation With Patient Outcomes in Abdominal Procedures.

ABSTRACT:

Importance

The US News & World Report (USNWR) annual ranking of the best hospitals for gastroenterology and gastrointestinal operations provides guidance and referral of care for medical and surgical gastrointestinal conditions.

Objective

To investigate whether USNWR top-ranked hospitals for gastroenterology and gastrointestinal surgical procedures are associated with improvements in patient outcomes, compared with nonranked hospitals, in common advanced laparoscopic abdominal operations.

Design, setting, and participants

This study used the Vizient database, which contains administrative, clinical, and financial inpatient information of index hospitalizations for US academic centers and their affiliated hospitals that are members of Vizient. Data were obtained on advanced laparoscopic abdominal operations performed from January 1, 2017, through December 31, 2017, at USNWR top-ranked hospitals (n = 16 296 operations) and nonranked hospitals (n = 35 573 operations). Abdominal operations included bariatric, colorectal, and hiatal hernia procedures. Operations on patients younger than 18 years, emergent cases, conversion cases, and patients with extreme severity of illness were excluded.

Main outcomes and measures

Outcome measures included in-hospital mortality, mortality index (observed to expected mortality ratio), serious morbidity, length of stay, and cost.

Results

A total of 51 869 advanced laparoscopic abdominal operations were performed at 351 academic health centers and their community affiliates. Of these procedures, 16 296 (31.4%) were performed at 41 top-ranked hospitals and 35 573 (68.6%) at 310 nonranked hospitals. The annual case volume at top-ranked hospitals was 397 compared with 114 at nonranked hospitals. Between top-ranked and nonranked hospitals, no significant differences were found in in-hospital mortality (0.04% vs 0.07%; P = .33) or serious morbidity (1.06% vs 1.02%; P = .75). Compared with nonranked hospitals, advanced laparoscopic abdominal operations performed at top-ranked hospitals had higher mean costs ($7128 [$4917] vs $7742 [$6787]; P < .01) and longer mean lengths of stay (2.38 [2.60] days vs 2.73 [3.31] days; P < .01).

Conclusions and relevance

Although, among academic centers, the annual volume of advanced laparoscopic abdominal operations was 3-fold higher for USNWR top-ranked hospitals compared with nonranked hospitals, the volume did not appear to be associated with improved patient outcomes.

SUBMITTER: Gambhir S

PROVIDER: S-EPMC6669785 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:ObjectiveTo investigate whether the US News & World Report (USNWR) ranking of the medical school a physician attended is associated with patient outcomes and healthcare spending.DesignObservational study.SettingMedicare, 2011-15.Participants20% random sample of Medicare fee-for-service beneficiaries aged 65 years or older (n=996?212), who were admitted as an emergency to hospital with a medical condition and treated by general internists.Main outcome measuresAssociation between the USNWR ranking of the medical school a physician attended and the physician's patient outcomes (30 day mortality and 30 day readmission rates) and Medicare Part B spending, adjusted for patient and physician characteristics and hospital fixed effects (which effectively compared physicians practicing within the same hospital). A sensitivity analysis employed a natural experiment by focusing on patients treated by hospitalists, because patients are plausibly randomly assigned to hospitalists based on their specific work schedules. Alternative rankings of medical schools based on social mission score or National Institute of Health (NIH) funding were also investigated.Results996?212 admissions treated by 30?322 physicians were examined for the analysis of mortality. When using USNWR primary care rankings, physicians who graduated from higher ranked schools had slightly lower 30 day readmission rates (adjusted rate 15.7% for top 10 schools v 16.1% for schools ranked ?50; adjusted risk difference 0.4%, 95% confidence interval 0.1% to 0.8%; P for trend=0.005) and lower spending (adjusted Part B spending $1029 (£790; €881) v $1066; adjusted difference $36, 95% confidence interval $20 to $52; P for trend <0.001) compared with graduates of lower ranked schools, but no difference in 30 day mortality. When using USNWR research rankings, physicians graduating from higher ranked schools had slightly lower healthcare spending than graduates from lower ranked schools, but no differences in patient mortality or readmissions. A sensitivity analysis restricted to patients treated by hospitalists yielded similar findings. Little or no relation was found between alternative rankings (based on social mission score or NIH funding) and patient outcomes or costs of care.ConclusionsOverall, little or no relation was found between the USNWR ranking of the medical school from which a physician graduated and subsequent patient mortality or readmission rates. Physicians who graduated from highly ranked medical schools had slightly lower spending than graduates of lower ranked schools.

Project description:Second Victim Programs (SVPs) provide support for healthcare providers involved in a near-miss, medical error, or adverse patient outcomes. Little is known about existence and structure of SVPs in top performing US hospitals. We performed a prospective study and interviewed individuals representing SVPs from 20 US News and World Report (USNWR) Honor Roll Hospitals. Telephone interviews were recorded, transcribed, and de-identified. To allow identification of both quantitative and qualitative themes that unified or distinguished programs with SVPs from each other, a content analysis approach was used. Of the Top 20 UNSWR hospitals, nineteen individuals with knowledge of or involvement in SVPs were identified. One individual represented two hospital systems for the same institution. Thirteen representatives agreed to participate, 12 declined, and 5 did not respond. One individual who initially agreed to participate did not attend the interview. Among twelve representatives interviewed, 10 reported establishment of SVPs at their hospitals between 2011 and 2016. Most program representatives reported that participants sought support voluntarily. Four domains were identified in the qualitative analysis: (a) identification of need for Second Victim Program (SVP); (b) challenges to program viability; (c) structural changes following SVP creation, and (d) insights for success. Driving SVP creation was the need support medical providers following a traumatic patient event. Poor physician participation due to the stigma associated with seeking support was commonly reported as a challenge. However, acceptance of the mission of SVPs, growing recognition of the value of the program across hospital departments, and systematic safety enhancements were cited as key advantages. To ensure success, participants suggested training a variety of volunteers and incorporating SVPs within quality improvement processes. In this convenience sample, programs for healthcare providers that experience psychosocial or emotional trauma from clinical care were uncommon. Variation in structure, performance, and measures of success among SVPs was observed. A systematic approach to evaluating SVPs is needed to help inform institutions of how to best serve their second victims.