Does a “highest-quality” designation truly signify the highest quality? That’s the question that researchers looked at recent, in a study published online on March 13 in JAMA Surgery. In fact, the researchers found, “Surgical outcomes vary widely within hospital networks,” and “networks should monitor outcomes to characterize and improve the extent to which a uniform standard of care is being delivered.”
Kyle H. Sheetz, M.D., MSc, Andrew M. Ibrahim, M.D., MSc, Hari Nathan, M.D., Ph.D., and Justin B. Dimick, M.D., M.P.H., authored the article, entitled “Variation in Surgical Outcomes Across Networks of the Highest-Rated US Hospitals.” The question the researchers asked was a straightforward one: “What is the consistency of surgical quality across hospitals that are affiliated with the 2018 US News & World Report Honor Roll hospitals?” The answer? “In this population-based study of 87 hospitals and 143,174 patients, outcomes were not consistently better at Honor Roll hospitals. Within networks, the risk-adjusted rates for all outcomes varied widely across affiliated hospitals; for example, the differences in failure to rescue varied by 1.1-fold in some networks to as much as 4.9-fold in others.”
The authors explained that “This longitudinal analysis of 87 hospitals that participated in 1 of 16 networks that are affiliated with US News & World Report Honor Roll hospitals used data from Medicare beneficiaries who were undergoing colectomy, coronary artery bypass graft, or hip replacement between 2005 and 2014 to evaluate the variation in risk-adjusted surgical outcomes at Honor Roll and affiliated hospitals within and across networks. The data were analyzed between April 20, 2018, and June 25, 2018.” The main quality measures they looked at were 30-day postoperative complications, mortality, failure to rescue, and readmissions.
What they found was that “Outcomes were not consistently better at Honor Roll hospitals compared with network affiliates. For example, Honor Roll hospitals had lower failure to rescue rates (13.3 percent versus 15.1 percent; odds ratio, 0.92; 95 percent CI, 0.86-0.98) but higher complication rates (22.1 percent vs 18.0 percent; odds ratio, 1.11; 95 percent CI, 1.03-1.19). Within networks, risk-adjusted outcomes varied widely across affiliated hospitals. The differences in failure to rescue varied by as little as 1.1-fold (range, 12.7–14.3 percent) in some networks to as much as 4.9-fold (range, 7.6–37.3 percent) in others. Similarly, complication rates varied by 1.1-fold (range, 21–23 percent) to 4.3-fold (range, 6–26 percent) across all networks.”
Not surprisingly, the researchers concluded, “Surgical outcomes vary widely across hospitals affiliated with the US News & World Report Honor Roll hospitals. Public reporting mechanisms should provide patients with information on the quality of all network-affiliated hospitals. Networks should monitor variations in outcomes to characterize and improve the extent to which a uniform standard of care is being delivered.”
