Assessing Hospital Performance Research Articles

Social Determinants of Health and Risk-Adjusted Sepsis Mortality in the Nationwide Veterans Affairs Healthcare System.

Traditional risk prediction and risk adjustment models have focused on clinical characteristics, but accounting for social determinants of health (SDOH) and complex health conditions could improve understanding of sepsis outcomes and our ability to predict outcomes, treat patients, and assess quality of care. To evaluate the impact of SDOH and health scales in sepsis mortality risk prediction and hospital performance assessment. Observational cohort study. One hundred twenty-nine hospitals in the nationwide Veterans Affairs (VA) Healthcare System between 2017 and 2021. Veterans admitted through emergency departments with community-acquired sepsis. Individual- and community-level SDOH (race, housing instability, marital status, Area Deprivation Index [ADI], and rural residence) and two health scales (the Care Assessment Need [CAN] score and Claims-Based Frailty Index [CFI]). The primary outcome was 90-day mortality from emergency department arrival; secondary outcomes included 30-day mortality and in-hospital mortality. Among 144,889 patients admitted to the hospital with community-acquired sepsis, 139,080 were men (96.0%), median (IQR) age was 71 (64-77) years, and median (IQR) ADI was 60 (38-81). Multivariable regression models had good calibration and discrimination across models that adjusted for different sets of variables (e.g., AUROC, 0.782; Brier score, 1.33; and standardized mortality rate, 1.00). Risk-adjusted hospital performance was similar across all models. Among 129 VA hospitals, three hospitals shifted from the lowest or highest quintile of performance when comparing models that excluded SDOH to models that adjusted for all variables. Models that adjusted for ADI reported odds ratios (CI) of 1.00 (1.00-1.00), indicating that ADI does not significantly predict sepsis mortality in this cohort of patients. In patients with community-acquired sepsis, adjusting for community SDOH variables such as ADI did not improve 90-day sepsis mortality predictions in mortality models and did not substantively alter hospital performance within the VA Healthcare System. Understanding the role of SDOH in risk prediction and risk adjustment models is vital because it could prevent hospitals from being negatively evaluated for treating less advantaged patients. However, we found that in VA hospitals, the potential impact of SDOH on 90-day sepsis mortality was minimal.

Predicting Complications in Head and Neck Surgery: Comparing Calculators to Surgeons.

Objectives: Surgical outcomes determine national ranking, reputation, and funding, and are often assessed with objective surgical risk calculators (SRCs). Surgeons' assessments are not considered. This study aims to determine if surgeons or SRCs are more accurate in predicting outcomes. Methods: This prospective cohort study identified a surgeon's assessment on a patient's risk preoperatively. The patient's risk was also calculated using the SRC. Predictions were compared to patient outcomes and to each other to assess whether surgeons or the SRC were more accurate. Results: Of the 101 patients included, 37 (36.6%) experienced a complication of any kind and 18 (17.8%) experienced a serious complication. Smoking resulted in a 2.49 times higher overall complication rate (P = .04). Laryngectomy patients experienced the highest rate of complications (P = .02) compared to those undergoing free flap reconstruction [odds ratio (OR) 0.9] or any other surgery (OR 0.26). Both surgeons and the American College of Surgeons (ACS) tool performed poorly on the prediction of the outcome of any complication, with a receiver operating characteristic (ROC) area under the curve (AUC) of 0.51 [95% confidence interval (CI): 0.39-0.62] and 0.58 (95% CI: 0.47-0.70), respectively, which was not statistically significant (P = .34). For the prediction of the outcome of serious complication, the AUC for surgeons and the ACS tool were 0.55 (95% CI: 0.41-0.69) and 0.60 (95% CI: 0.46-0.74), respectively, which was not statistically significant (P = .58). Conclusions: Neither validated risk calculators nor surgeons are accurate in predicting perioperative risk. The only risk factor that contributes to improving predictions for complications is preoperative smoking, although age and type of surgery are also significant predictors. Risk calculators may therefore not be appropriate metrics for assessing hospital performance. These findings can help guide preoperative counseling and may help in the development of more accurate predictive tools as the healthcare field continues to incorporate artificial intelligence into surgical planning.

Development and Validation of the Hospital Medicine Safety Sepsis Initiative Mortality Model

When comparing outcomes after sepsis, it is essential to account for patient case mix to make fair comparisons. We developed a model to assess risk-adjusted 30-day mortality in the Michigan Hospital Medicine Safety sepsis initiative (HMS-Sepsis). Can HMS-Sepsis registry data adequately predict risk of 30-day mortality? Do performance assessments using adjusted vsunadjusted data differ? Retrospective cohort of community-onset sepsis hospitalizations in the HMS-Sepsis registry (April 2022-September 2023), with split-derivation (70%) and validation (30%) cohorts. We fit a risk-adjustment model (HMS-Sepsis mortality model) incorporating acute physiologic, demographic, and baseline health data and assessed model performance using concordance (C) statistics, Brier's scores, and comparisons of predicted vsobserved mortality by deciles of risk. We compared hospital performance (first quintile, middle quintiles, fifth quintile) using observed vsadjusted mortality to understand the extent to which risk adjustment impacted hospital performance assessment. Among 17,514 hospitalizations from 66 hospitals during the study period, 12,260 hospitalizations (70%) were used for model derivation and 5,254 hospitalizations (30%) were used for model validation. Thirty-day mortality for the total cohort was 19.4%. The final model included 13 physiologic variables, two physiologic interactions, and 16 demographic and chronic health variables. The most significant variables were age, metastatic solid tumor, temperature, altered mental status, and platelet count. The model C statistic was 0.82 for the derivation cohort, 0.81 for the validation cohort, and≥ 0.78 for all subgroups assessed. Overall calibration error was 0.0%, and mean calibration error across deciles of risk was 1.5%. Standardized mortality ratios yielded different assessments than observed mortality for 33.9%of hospitals. The HMS-Sepsis mortality model showed strong discrimination and adequate calibration and reclassified one-third of hospitals to a different performance category from unadjusted mortality. Based on its strong performance, the HMS-Sepsis mortality model can aid in fair hospital benchmarking, assessment of temporal changes, and observational causal inference analysis.

Epidemiology and current management of cardiovascular disease in China.

The Annual Report on Cardiovascular Health and Diseases in China (2022) intricate landscape of cardiovascular health in China. This is the fourth section of the report with a specific focus on epidemiology and current management of cardiovascular disease (CVD) in China. This section of the report highlights the epidemiological trends of CVD in China. It reveal a concerning rise in prevalence, with approximately 330 million affected individuals, including significant numbers with stroke, coronary artery disease (CAD), heart failure, and other conditions. CVD stands as the primary cause of mortality among both urban and rural populations, accounting for nearly half of all deaths in 2020. Mortality rates are notably higher in rural areas compared to urban centers since 2009. While age-standardized mortality rates have decreased, the absolute number of CVD deaths has increased, primarily due to population aging. Ischemic heart disease, hemorrhagic and ischemic strokes are the leading causes of CVD-related deaths. Notably, the burden of atherosclerotic cardiovascular disease has risen substantially, with atherosclerotic cardiovascular disease-related deaths increasing from 1990 to 2016. The incidence of ischemic stroke and ischemic heart disease has shown similar increasing trends over the past three decades. CAD mortality, particularly acute myocardial infarction, has been on the rise, with higher mortality rates observed in rural areas since 2016. The prevalence of CAD has increased significantly, with over 11 million patients identified in 2013. Studies assessing hospital performance in managing acute coronary syndrome reveal gaps in adherence to guideline-recommended strategies, with disparities in care quality across hospitals. However, initiatives like the China Patient-centered Evaluative Assessment of Cardiac Events (PEACE)-Retrospective AMI Study and the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) project aim to improve patient outcomes through enhanced care protocols. Moreover, advancements in medical technology, such as quantitative flow ratio-guided lesion selection during percutaneous coronary intervention, show promise in improving clinical outcomes for patients undergoing intervention.

Performance Evaluation of Hospitals under Data Uncertainty: An Uncertain Common-Weights Data Envelopment Analysis.

In the context of healthcare systems, the performance evaluation of hospitals plays a crucial role in assessing the quality of healthcare systems and facilitating informed decision-making processes. However, the presence of data uncertainty poses significant challenges to accurate performance measurement. This paper presents a novel uncertain common-weights data envelopment analysis (UCWDEA) approach for evaluating the performance of hospitals under uncertain environments. The proposed UCWDEA approach addresses the limitations of traditional data envelopment analysis (DEA) models by incorporating the uncertainty theory (UT) to model the inherent uncertainty in input and output data. Also, by utilizing a common set of weights (CSW) technique, the UCWDEA method provides a more robust and reliable assessment of hospital performance. The main advantages of the proposed UCWDEA approach can be succinctly summarized as follows. Firstly, it allows for the comparison of all hospitals on a consistent basis to calculate a realistic efficiency score, rather than an overly optimistic efficiency score. Secondly, the uncertain common-weights DEA approach exhibits linearity, enhancing its applicability. Thirdly, it possesses the capability to extend its utility under various other prevalent uncertainty distributions. Moreover, it enhances the discriminatory power of results, facilitates the ranking of hospitals in the presence of data uncertainty, and aids in identifying the sensitivity and stability levels of hospitals towards data uncertainty. Notably, in order to showcase the pragmatic application and efficacy of the uncertain common-weights DEA model, a genuine dataset has been utilized to evaluate the efficiency of 20 public hospitals in Tehran, all of which are affiliated with the Iran University of Medical Sciences. The results of the experiment demonstrate the efficacy of the UCWDEA approach in assessing and ranking hospitals amidst uncertain conditions. In summary, the research outcomes can offer policymakers valuable insights regarding hospital performance amidst data uncertainty. Additionally, it can provide practical recommendations on optimizing resource allocation, benchmarking performance, and formulating effective policies to augment the overall efficiency and effectiveness of healthcare services.

Measuring Equity in Readmission as a Distinct Assessment of Hospital Performance

Equity is an essential domain of health care quality. The Centers for Medicare & Medicaid Services (CMS) developed 2 Disparity Methods that together assess equity in clinical outcomes. To define a measure of equitable readmissions; identify hospitals with equitable readmissions by insurance (dual eligible vs non-dual eligible) or patient race (Black vs White); and compare hospitals with and without equitable readmissions by hospital characteristics and performance on accountability measures (quality, cost, and value). Cross-sectional study of US hospitals eligible for the CMS Hospital-Wide Readmission measure using Medicare data from July 2018 through June 2019. We created a definition of equitable readmissions using CMS Disparity Methods, which evaluate hospitals on 2 methods: outcomes for populations at risk for disparities (across-hospital method); and disparities in care within hospitals' patient populations (within-a-single-hospital method). Hospital patient demographics; hospital characteristics; and 3 measures of hospital performance-quality, cost, and value (quality relative to cost). Of 4638 hospitals, 74% served a sufficient number of dual-eligible patients, and 42% served a sufficient number of Black patients to apply CMS Disparity Methods by insurance and race. Of eligible hospitals, 17% had equitable readmission rates by insurance and 30% by race. Hospitals with equitable readmissions by insurance or race cared for a lower percentage of Black patients (insurance, 1.9% [IQR, 0.2%-8.8%] vs 3.3% [IQR, 0.7%-10.8%], P < .01; race, 7.6% [IQR, 3.2%-16.6%] vs 9.3% [IQR, 4.0%-19.0%], P = .01), and differed from nonequitable hospitals in multiple domains (teaching status, geography, size; P < .01). In examining equity by insurance, hospitals with low costs were more likely to have equitable readmissions (odds ratio, 1.57 [95% CI, 1.38-1.77), and there was no relationship between quality and value, and equity. In examining equity by race, hospitals with high overall quality were more likely to have equitable readmissions (odds ratio, 1.14 [95% CI, 1.03-1.26]), and there was no relationship between cost and value, and equity. A minority of hospitals achieved equitable readmissions. Notably, hospitals with equitable readmissions were characteristically different from those without. For example, hospitals with equitable readmissions served fewer Black patients, reinforcing the role of structural racism in hospital-level inequities. Implementation of an equitable readmission measure must consider unequal distribution of at-risk patients among hospitals.

Hospital standardized mortality ratio: limits and potential of the indicator for assessing hospital performance in the Brazilian Unified National Health System

Comparative analyses based on clinical performance indicators to monitor the quality of hospital care have been carried out for decades in several countries, most notably the hospital standardized mortality ratio (HSMR). In Brazil, studies and the adoption of methodological tools that allow regular analysis of the performance of institutions are still scarce. This study aimed to assess the use of HSMR to compare the performance of hospitals funded by the Brazilian Unified National Health System (SUS). The Hospital Information System was the source of data on adult hospitalizations in Brazil from 2017 to 2019. The methodological approach to estimate HSMR was adapted to the available data and included the causes of hospitalization (main diagnosis) responsible for 80% of deaths. The number of expected deaths was estimated using a logistic regression model that included predictor variables widely described in the literature. The analysis was conducted in two stages: (i) hospitalization level and (ii) hospital level. The final risk adjustment model showed a C-statistic of 0.774, which is considered adequate. The variation in HSMR was wide, especially among the worst-performing hospitals (1.54 to 6.77). Private hospitals performed better than public hospitals. Although the limits of the available data and the challenges still face its more refined use, HSMR is applicable and has the potential to become an important tool for assessing hospital performance in the SUS.

Change in Hospital Risk-standardized Stroke Mortality Performance With and Without the Passive Surveillance Stroke Severity Score

Background: Adjustment for baseline stroke severity is necessary for accurate assessment of hospital performance. We evaluated whether adjusting for the Passive Surveillance Stroke SeVerity (PaSSV) score, a measure of stroke severity derived using administrative data, changed hospital-specific estimated 30-day risk-standardized mortality rate (RSMR) after stroke. Methods: We used linked administrative data to identify adults who were hospitalized with ischemic stroke or intracerebral hemorrhage across 157 hospitals in Ontario, Canada between 2014 and 2019. We fitted a random effects logistic regression model using Markov Chain Monte Carlo methods to estimate hospital-specific 30-day RSMR and 95% credible intervals with adjustment for age, sex, Charlson comorbidity index, and stroke type. In a separate model, we additionally adjusted for stroke severity using PaSSV. Hospitals were defined as low-performing, average-performing, or high-performing depending on whether the RSMR and 95% credible interval were above, overlapping, or below the cohort’s crude mortality rate. Results: We identified 65,082 patients [48.0% were female, the median age (25th,75th percentiles) was 76 years (65,84), and 86.4% had an ischemic stroke]. The crude 30-day all-cause mortality rate was 14.1%. The inclusion of PaSSV in the model reclassified 18.5% (n=29) of the hospitals. Of the 143 hospitals initially classified as average-performing, after adjustment for PaSSV, 20 were reclassified as high-performing and 8 were reclassified as low-performing. Of the 4 hospitals initially classified as low-performing, 1 was reclassified as high-performing. All 10 hospitals initially classified as high-performing remained unchanged. Conclusion: PaSSV may be useful for risk-adjusting mortality when comparing hospital performance. External validation of our findings in other jurisdictions is needed.

Improving Patient Outcomes Through Effective Hospital Administration: A Comprehensive Review.

This comprehensive review delves into the critical role of effective hospital administration in shaping patient outcomes within the healthcare ecosystem. Exploration of key components, strategies, measurement methodologies, and future trends elucidates the multifaceted nature of hospital administration. Key findings underscore the profound impact of administrative decisions and practices on patient safety, satisfaction, and overall well-being. The review highlights the importance of patient-centred care and interdisciplinary collaboration for enhancing patient outcomes. It emphasises the significance of data-driven measurement and benchmarking, which are instrumental in assessing hospital performance and fostering continuous improvement. Looking ahead, emerging technologies, evolving healthcare policies, and persistent challenges are drivers of change in healthcare administration. However, amidst these transformations, the overarching message remains consistent: effective hospital administration is integral to improving patient outcomes. The conclusion calls for a collective commitment from healthcare leaders and policymakers to prioritise the development of capable administrators, invest in technology, promote value-based care, and address healthcare disparities. This collaborative effort ensures that the pursuit of better patient outcomes remains at the forefront of healthcare administration, ultimately shaping the future of healthcare for generations to come.

What Makes a Hospital Excellent? A Qualitative Study on the Organization and Management of Five Leading Public Hospitals in China.

To summarize the organizational and management experiences and explore the organizational theoretical model of five leading public hospitals in China. Purposive sampling was used to select five leading hospitals in different regions of China under the National Health Commission and Provincial Health Commission as study hospitals for the study. From August 2021 to March 2022, 8 leaders and 39 managers from these hospitals were surveyed using semi-structured interviews. The data and information were analyzed in four dimensions using thematic analysis and grounded theory, focused on summarizing the experiences and practices of China's leading hospitals in organizational system, culture, operations and performance management, and employee development. This study complied with the COREQ guidelines for reporting qualitative research. An organizational system model of the characteristics of hospital excellence was developed using four core attributes: organizational system, organizational culture, operations and performance management, and employee development; the model was named the System-Culture-Operation-Performance-Employee (SCOPE) model. Organization and management among leaders and managers in China's leading hospitals are based on the SCOPE process, resulting in employees' well-being, patients' positive outcomes, and organizational excellence. In terms of hospital culture, while adhering to the Hippocratic Oath, the hospital is deeply influenced by traditional Chinese culture, which emphasizes "benevolence" and "love", leading all staff to adhere to "patient-centered care and service." In terms of operations management, a separate operations management department is responsible for hospital operations and performance assessment. As for employee development, the staff's sense of reverence for their profession is emphasized and a reasonable salary system and good practice environment are established to promote staff motivation. The SCOPE model reveals the perspectives of leaders and managers in China's leading hospitals regarding organization and management under a Chinese cultural background. These findings can complement the existing literature on hospital management systems.

Quality Analysis of Outpatient Care at Kepulauan Seribu General Hospital based on Malcolm Baldrige Criteria

The outpatient unit is a part of the hospital. The outpatient unit has an important role because it is the first door or medium for contact and interaction with service users or patients. Outpatient care is also an entry point for other inpatient services. Seribu Islands Regional General Hospital as the only hospital in the Thousand Islands region has not yet reached the required minimum outpatient service standard. This study aims to analyze the quality of outpatient care at Seribu Islands Hospital with the criteria of Malcolm Baldrige. The criteria for evaluating organizations are based on seven criteria, namely leadership, strategic planning, customer focus, measurement, analysis, and knowledge management, staff focus, process management, and performance results. This study uses a descriptive analytic research design with quantitative and qualitative approaches. The data collected was obtained through questionnaires, in-depth interviews, and document review. The results of the study using the Malcolm Baldrige Criteria showed that Seribu Islands Hospital won a score of 379.83 out of a maximum of 1000. This means that for hospital performance assessment based on MBNQA, Kepulauan Seribu Hospital won the average title and was included in the Early Improvement category (point scale 376-475 ). Early improvement means that Seribu Islands Hospital is in a position of early stage improvement in the health service sector. For this reason, it is recommended that Thousand Islands Hospital develop strong leadership and good teamwork in order to determine the right strategic plan.

Introducing value-based healthcare perspectives into hospital performance assessment: A scoping review.

Value-based healthcare (VBHC) puts patient outcomes at the center of the healthcare process while optimizing the use of hospital resources across multiple stakeholders. This scoping review was conducted to summarize how VBHC had been represented in theory and in practice, how it had been applied to assess hospital performance, and how well it had been ultimately implemented. For this review, we followed the PRISMA-ScR protocol and searched five major online databases for articles published between January 2006 and July 2022. We included original articles that used the concept of VBHC to conduct performance assessments of healthcare organizations. We extracted and analyzed key concepts and information on the dimensions of VBHC, specific strategies and methods for using VBHC in performance assessment, and the effectiveness of the assessment. We identified 48 eligible studies from 7866 articles. Nineteen nonempirical studies focused on the development of a VBHC performance assessment indicator system, and 29 empirical studies reported on the ways and points of introducing VBHC into performance assessment and its effectiveness. Ultimately, we summarized the key dimensions, processes, and effects of performance assessment after introducing VBHC. Current healthcare performance assessment has begun to focus on implementing VBHC as an integrated strategy, and future work should further clarify the reliability of metrics and their association with evaluation outcomes and consider the effective integration of clinical outcomes and patient-reported outcomes.

Textbook Outcomes in DIEP Flap Breast Reconstruction: An International Delphi Study to Establish an Expert-Based Consensus

Introduction: Composite measures, like textbook outcomes, may be superior to individual metrics when assessing hospital performance and the quality of care. This study utilized a Delphi process to establish an international, expert-based consensus that defines a textbook outcome in DIEP flap breast reconstruction. Materials and Methods: A two-round Delphi survey defined: 1) A textbook outcome, 2) Exclusion criteria for a study population, and 3) Expert opinion regarding textbook outcomes. An a priori threshold of ≥70% agreement established consensus among tested statements. Results: Out of 85 experts, 48 responded in the first round and 41 in the second. A textbook outcome was defined as one that meets the following within 90-days: 1) No intraoperative complications, 2) Operative duration≤12 hours for bilateral and ≤10 hours for unilateral/stacked reconstruction, 3) No post-surgical complications requiring re-operation, 4) No surgical site infection requiring IV antibiotics, 5) No readmission, 6) No mortality, 7) No systemic complications, and 8) Length of stay ≤5 days. Exclusion criteria for medical and surgical characteristics (e.g., BMI>40, HgbA1c>7) and case-volume cut-offs for providers (≥21) and institutions (≥44) were defined. Most agreed that textbook outcomes should be defined for complex plastic surgery procedures (75%) and utilized to gauge hospital performance for microsurgical breast reconstruction (77%). Conclusion: This international Delphi study identified: 1) Key elements of a textbook outcome for DIEP flap breast reconstruction, 2) Exclusion criteria for future studies, and 3) Characterized expert opinions regarding the utility of textbook outcomes in serving as a quality metric for breast reconstruction care. Future, multi-institutional studies are needed to analyze the incidence and rates of achieving a textbook outcome after DIEP flap breast reconstruction, determine which characteristics may be associated with achieving this outcome, and evaluate how this novel composite measure may be used to assess outcomes across institutions and providers.

The value of analyzing textbook outcomes after laparoscopic hepatectomy-a narrative review.

Guidelines are required because of the wide variability in care provided to patients with similar characteristics and similar medical conditions. Quality indicators were developed many years ago to assess the quality of care provided by hospitals. Since then, it has become evident that a composite set of factors can better characterize the patient's quality of care. The objectives of this review were to analyze the textbook outcomes (TO) applied in surgery, focusing on laparoscopic hepatectomy. Data pertaining to quality indicators used in hospitals and their surgical applications were retrieved from medical literature by searching PubMed and Google Scholar for articles published between 1912 and 2022. Search terms included quality indicators, outcome indicators, TOs, TOs after surgery, TOs after hepatectomy, and clinical indicators. Since their inception, TO have been applied to various procedures and their impacts on patients have been assessed. TO and their implications have been studied for a variety of surgical procedures and were recently extended to laparoscopic hepatectomy. TO of laparoscopic left lateral sectionectomy and right hemihepatectomy were recently assessed, and benchmark values have been defined. TO are useful tools for assessing hospital performance and for optimizing the outcomes of patients undergoing laparoscopic hepatectomy. At present, TO only consider surgeon-related factors. However, it is important to include the patient's perspective when defining TO. Although TO were recently applied to laparoscopic hepatectomy, there is still a need to further evaluate their application in this setting. Achieving TO was shown to have a positive impact on long-term outcomes and this needs to be studied for different liver resection procedures.

Textbook outcomes in DIEP flap breast reconstruction: a Delphi study to establish consensus.

Composite measures, like textbook outcomes, may be superior to individual metrics when assessing hospital performance and quality of care. This study utilized a Delphi process to define a textbook outcome in DIEP flap breast reconstruction. A two-round Delphi survey defined: (1) A textbook outcome, (2) Exclusion criteria for a study population, and (3) Respondent opinion regarding textbook outcomes. An a priori threshold of ≥ 70% agreement among respondents established consensus among the tested statements. Out of 85 invitees, 48 responded in the first round and 41 in the second. A textbook outcome was defined as one that meets the following within 90 days: (1) No intraoperative complications, (2) Operative duration ≤ 12h for bilateral and ≤ 10h for unilateral/stacked reconstruction, (3) No post-surgical complications requiring re-operation, (4) No surgical site infection requiring IV antibiotics, (5) No readmission, (6) No mortality, (7) No systemic complications, and (8) Length of stay < 5days. Exclusion criteria for medical and surgical characteristics (e.g., BMI > 40, HgbA1c > 7) and case-volume cut-offs for providers (≥ 21) and institutions (≥ 44) were defined. Most agreed that textbook outcomes should be defined for complex plastic surgery procedures (75%) and utilized to gauge hospital performance for microsurgical breast reconstruction (77%). This Delphi study identified (1) Key elements of a textbook outcome for DIEP flap breast reconstruction, (2) Exclusion criteria for future studies, and (3) Characterized surgeon opinions regarding the utility of textbook outcomes in serving as quality metric for breast reconstruction care.

Abstract 15739: Utility of 30-Day Risk Adjusted Home Time as a Hospital Performance Metric for Transcatheter Edge-to-Edge Mitral Valve Repair

Introduction: While the utilization of mitral valve transcatheter edge-to-edge repair (TEER) procedures continues to increase over time, a validated, patient-centered, hospital-level performance metric for TEER is lacking Hypothesis: We examined the utility of 30-risk adjusted home time (HT) as a hospital-level performance metric for TEER procedure and compared it with the established volume, 30-day readmission, and 30-day mortality-based measures. Methods: Medicare patients who received TEER from 2013 to 2019 were identified. HT is defined as time spent alive and out of a hospital, skilled nursing facility, or long-term facility 30 days after TEER. Hospital-level risk-standardized measures of 30-day HT, readmission (RSRR), and mortality (RSMR) were developed using standard risk-adjustment models and correlation between these performance metrics was estimated by Pearson correlation. Longer-term patient-level outcomes of 1-year mortality and readmission were also compared across quartiles of hospitals on 30-day HT. Results: Overall, 24,420 patients who underwent TEER in 344 hospitals were included (mean age 80 y, 54% men, 7% Black race). At the hospital level, the median risk-adjusted 30-day HT was 24 days. There was significant inverse correlation between risk adjusted 30-day HT and 30-day RSRR (r=-0.43), 30-day RSMR (r=-0.5), and modest correlation with hospital’s annual TEER volume (r=0.11, P=0.05). The 1-year readmission and mortality among patients undergoing TEER decreased across increasing 30-day HT categories (Figure). 30-day HT (vs. annual TEER volume) meaningfully reclassified hospital performance in 34% of the hospitals with lower 1-year mortality and readmission among hospitals that were up classified (vs. no change) in performance ranking. Conclusions: Risk-adjusted 30-day HT is a patient-centered, comprehensive quality metric to assess hospital performance in TEER that correlates with important short- and long-term outcomes.

Pengaruh Kualitas Pelayanan Terhadap Tingkat Kepuasan Pasien Rawat Inap Rumah Sakit Santa Elisabeth Medan

Patient satisfaction depends on the quality of services provided. Users of hospital services, in this case patients, demand quality services not only regarding healing from physical illness or improving their health status, but also regarding satisfaction with attitudes, always the availability of adequate facilities and infrastructure and a physical environment that can provide comfort. An accurate level of patient satisfaction is needed in an effort to improve the quality of health services. Therefore, measuring the level of patient satisfaction needs to be carried out regularly, regularly, accurately, and continuously. This study was conducted to analyze patient satisfaction and service quality based on the patient's interest in services and hospital performance assessment. The research used is a quantitative study with a cross sectional study design. And to determine satisfaction and service quality at Elisabeth Hospital Medan, we also conducted questionnaire questions to 1,000 respondents. treatment (35%) and as many as 400 respondents were not satisfied when they came to get services at the hospital (40%).

Ninety-Day Risk-Standardized Home Time as a Performance Metric for Cardiac Surgery Hospitals in the United States.

Assessing hospital performance for cardiac surgery necessitates consistent and valid care quality metrics. The association of hospital-level risk-standardized home time for cardiac surgeries with other performance metrics such as mortality rate, readmission rate, and annual surgical volume has not been evaluated previously. The study included Medicare beneficiaries who underwent isolated or concomitant coronary artery bypass graft, aortic valve, or mitral valve surgery from January 1, 2013, to October 1, 2019. Hospital-level performance metrics of annual surgical volume, 90-day risk-standardized mortality rate, 90-day risk-standardized readmission rate, and 90-day risk-standardized home time were estimated starting from the day of surgery using generalized linear mixed models with a random intercept for the hospital. Correlations between the performance metrics were assessed using the Pearson correlation coefficient. Patient-level clinical outcomes were also compared across hospital quartiles by 90-day risk-standardized home time. Last, the temporal stability of performance metrics for each hospital during the study years was also assessed. Overall, 919 698 patients (age 74.2±5.8 years, 32% women) were included from 1179 hospitals. Median 90-day risk-standardized home time was 71.2 days (25th-75th percentile, 66.5-75.6), 90-day risk-standardized readmission rate was 26.0% (19.5%-35.7%), and 90-day risk-standardized mortality rate was 6.0% (4.0%-8.8%). Across 90-day home time quartiles, a graded decline was observed in the rates of in-hospital, 90-day, and 1-year mortality, and 90-day and 1-year readmission. Ninety-day home time had a significant positive correlation with annual surgical volume (r=0.31; P<0.001) and inverse correlation with 90-day risk-standardized readmission rate (r=-0.40; P <0.001) and 90-day risk-standardized mortality rate (r=-0.60; P <0.001). Use of 90-day home time as a performance metric resulted in a meaningful reclassification in performance ranking of 22.8% hospitals compared with annual surgical volume, 11.6% compared with 90-day risk-standardized mortality rate, and 19.9% compared with 90-day risk-standardized readmission rate. Across the 7 years of the study period, 90-day home time demonstrated the most temporal stability of the hospital performance metrics. Ninety-day risk-standardized home time is a feasible, comprehensive, patient-centered metric to assess hospital-level performance in cardiac surgery with greater temporal stability than mortality and readmission measures.

Assessment of Health Performance and Outcome with Disease Profile among Paediatrics Population of a Non COVID Tertiary Care Hospital in Bangladesh in COVID Era

Background: Hospital based data of diseases profile are reflection of community at large. Being in COVID pandemic era, knowledge of disease pattern and outcome in children is crucial for proper resource allocation and health care planning. Performance evaluation of each hospital has become central to the concept of quality improvement. Objective: to evaluate disease pattern and outcome of a non COVID hospital in COVID era. Methodology: This retrospective descriptive study was conducted in pediatric unit (1 months to 14 year) of Sir Salimullah Medical College Mitford Hospital from January, 2021 to December, 2021. Medical records were reviewed and analyzed for age, gender, disease, duration of hospital stay, bed occupancy rate and outcome. Results: Total 4346 patients were admitted of which male is 68%. Most admission was in between 1 month to 12 months of age which is 48.5%. Bronchopneumonia, Dengue and Bronchiolitis became the top 3 cause of admission. 70% patients stayed less than 7 days. 2% patients were referred of which maximum were later diagnosed as COVID-19 patients. Bed Occupancy rate was 138% and Bed Turn Over rate was 72.4 patients/bed/year. Mortality rate was 1.6%. Conclusion: To achieve SDG 3 goal by 2030, assessment of hospital performance as well as disease profile of each hospital is needed for proper resource allocation and community improvement. Sir Salimullah Med Coll J 2022; 30: 168-174

How U.S. Health Policy Embraced Markets and Helped Wall Street Gentrify Medicine

AbstractThis article examines the financial industry’s critical role in retargeting U.S. health policy goals of improving peoples’ health in the 1960s to those of expanding institutional wealth in the 1970s. Government collaborated with finance to support not-for-profit hospitals’ use of debt to build services that augmented capital and operated like for-profit businesses. Certificate of Need, hospital rate review, and national health planning programs came to assess hospital performance in terms of capital formation, returns on investment, and bond ratings. The regulatory programs helped gentrify medicine by reinforcing selective investment in lucrative, high-tech services that market specialty procedures to affluent populations in place of disease control, primary care, and general acute care for all. Their actions laid the groundwork for the 1980s finance industry coup, which employed market ideology to dominate health policy at the expense of equality, effectiveness, and public health governance.