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A comparative study of quality outcomes in freestanding ambulatory surgery centers and hospital-based outpatient departments: 1997-2004.

ABSTRACT: RESEARCH OBJECTIVE: To compare quality outcomes from surgical procedures performed at freestanding ambulatory surgery centers (ASCs) and hospital-based outpatient departments (HOPDs). DATA SOURCES: Patient-level ambulatory surgery (1997-2004), hospital discharge (1997-2004), and vital statistics data (1997-2004) for the state of Florida were assembled and analyzed. STUDY DESIGN: We used a pooled, cross-sectional design. Logistic regressions with time fixed-effects were estimated separately for the 12 most common ambulatory surgical procedures. Our quality outcomes were risk-adjusted 7-day and 30-day mortality and 7-day and 30-day unexpected hospitalizations. Risk-adjustment for patient demographic characteristics and severity of illness were calculated using the DCG/HCC methodology adjusting for primary diagnosis only and separately for all available diagnoses. PRINCIPAL FINDINGS: Although neither ASCs nor HOPDs performed better overall, we found some difference by procedure that varied based on the risk-adjustment approach used. CONCLUSIONS: There appear to be important variations in quality outcomes for certain procedures, which may be related to differences in organizational structure, processes, and strategies between ASCs and HOPDs. The study also confirms the importance of risk-adjustment for comorbidities when using administrative data, particularly for procedures that are sensitive to differences in severity.

SUBMITTER: Chukmaitov AS

PROVIDER: S-EPMC2653888 | biostudies-other | 2008 Oct

REPOSITORIES: biostudies-other

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A comparative study of quality outcomes in freestanding ambulatory surgery centers and hospital-based outpatient departments: 1997-2004.

Chukmaitov Askar S AS Menachemi Nir N Brown L Steven LS Saunders Charles C Brooks Robert G RG

Health services research 20071126 5 Pt 1

<h4>Research objective</h4>To compare quality outcomes from surgical procedures performed at freestanding ambulatory surgery centers (ASCs) and hospital-based outpatient departments (HOPDs).<h4>Data sources</h4>Patient-level ambulatory surgery (1997-2004), hospital discharge (1997-2004), and vital statistics data (1997-2004) for the state of Florida were assembled and analyzed.<h4>Study design</h4>We used a pooled, cross-sectional design. Logistic regressions with time fixed-effects were estimat ...[more]

PMID: 22568615

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Project description:ObjectiveOur investigation compared throughput metrics and utilization measures for freestanding emergency departments (FSEDs) versus hospital-based emergency departments (HBEDs) of similar volumes in the United States.MethodsThis study is a cross sectional survey of 183 FSEDs and 317 HBEDs located across the United States using the Emergency Department Benchmarking Alliance (EDBA) Database. We measured common emergency department (ED) throughput metrics. Primary outcomes included overall length of stay, length of stay for admitted, and length of stay for treated and released patients. Outcomes were weighted based on the proportion of ED volume per facility as per a prior pilot study. Multiple linear regression analysis was used to adjust for measured differences between FSEDs and HBEDs. The variables that were controlled for in regression analysis included geographic location of the ED (urban, suburban, and rural), percent of high acuity capacity, ED volume, percentage of patients arriving via emergency medical services (EMS), and percentage of pediatric patients.ResultsNationally, the median length of stay in minutes (104.2 vs 140.0), length of stay for treated and released patients (98.6 vs 122.9), door-to-bed (4.0 vs 8.0), door-to-doctor (11.0 vs 16.0), percentage of patients admitted through the ED (4.0 vs 11.0), and percentage of patients leaving the ED without being seen (LWBS) (0.9 vs 1.5), were significantly lower at FSEDs compared to HBEDs (P < 0.0001 for all comparisons). Length of stay for admitted patients (265.9 vs 241.8) and median boarding time (96.8 vs. 71.3) were significantly lower in HBEDs compared to FSEDs. X-ray, computed tomography, and ECG utilization per 100 patients was significantly lower at the FSEDs compared to HBEDs. Multiple linear regression analysis demonstrated that the length of stay for treated and released patients was 8.67 minutes shorter for FSEDs as compared to HBEDs (95% confidence interval [CI] = -1.4 to -16.0). The length of stay for admitted patients was 44 minutes longer for FSEDs as compared to HBEDs (95% CI = 25.5 to 63.0).ConclusionsIn this study of similarly sized EDs in the United States, throughput metrics for FSEDs tended to be significantly shorter from the arrival of the patient until their departure, except for patients requiring hospital admission. For measures favoring FSEDs, throughput times range from 20%-50% shorter than HBEDs.

Dataset Information

A comparative study of quality outcomes in freestanding ambulatory surgery centers and hospital-based outpatient departments: 1997-2004.

Publications

A comparative study of quality outcomes in freestanding ambulatory surgery centers and hospital-based outpatient departments: 1997-2004.

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