Archives of surgery (Chicago, Ill. : 1960)
-
Multicenter Study Comparative Study
Hospital process compliance and surgical outcomes in medicare beneficiaries.
To determine whether high rates of compliance with perioperative processes of care used for public reporting and pay-for-performance are associated with lower rates of risk-adjusted mortality and high-risk surgical complications. ⋯ Currently available information on the Hospital Compare Web site will not help patients identify hospitals with better outcomes for high-risk surgery. The Centers for Medicare and Medicaid Services needs to identify higher leverage process measures and devote greater attention to profiling hospitals based on outcomes to improve public reporting and pay-for-performance efforts.
-
Multicenter Study Comparative Study
Accelerating the pace of surgical quality improvement: the power of hospital collaboration.
A regional collaborative approach is an efficient platform for surgical quality improvement. ⋯ A statewide surgical quality improvement collaborative supported by a third-party payer showed significant improvement in quality and high levels of participant satisfaction.
-
Multicenter Study Comparative Study
Reduced access to care resulting from centers of excellence initiatives in bariatric surgery.
To determine the effect on travel distance for Medicare patients before and after Centers for Medicare & Medicaid Services required that bariatric procedures be performed at Centers of Excellence (COEs). ⋯ Center of Excellence requirements have increased the travel distance required for Medicare patients. Prior research has shown that outcomes at COEs are no different than those at non-COEs suggesting that the reduced access to care resulting from requiring COE status is not beneficial.
-
Comparative Study
Effect of blood products transfusion on the development of postinjury multiple organ failure.
Transfusion of fresh frozen plasma (FFP) and platelets is independently associated with the development of multiple organ failure (MOF) in critically injured patients. ⋯ Early transfusion of FFP is associated with an increased risk of postinjury MOF, even after adjusting for age, ISS, and PRBC transfusion. Caution is warranted in developing protocols for empirical FFP transfusion. Specifically, transfusion triggers for FFP should be reexamined, as well as the practice of delivering FFP in fixed ratios to the units of PRBCs transfused.