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 Researchers found variable surgical outcomes across networks
associated with hospitals that received the highest rankings from
U.S. News & World Report, according to the study published in JAMA
Surgery.
The new study shows "you shouldn't assume that a hospital that is
affiliated with a very well known medical center is able to offer
the same services," said the study's lead author, Dr. Kyle Sheetz, a
research fellow at the Center for Healthcare Outcomes and Policy at
the University of Michigan in Ann Arbor. "It may, but it may not.
You just can't make that assumption."
Given the variability within networks, "if patients are within a
bigger system, they should realize it's okay to ask about where and
by whom you would have the safest operation," Sheetz said.
Sheetz and his colleagues analyzed records from 87 hospitals, each
tied to one of 16 networks affiliated with a U.S. News & World
Report Honor Roll hospital. The data came from Medicare records for
surgeries on 143,174 patients between 2005 and 2014.
The researchers focused on outcomes from three significantly
different surgeries: colectomy, in which all or part of the colon is
removed; coronary artery bypass grafting; and hip replacement.
As it turns out, the Honor Roll hospitals didn't always have
consistently better outcomes than their network affiliates, Sheetz
and colleagues found. They tended to have higher complication rates
compared to affiliated hospitals: 22 percent versus 18 percent. But
this may be because the Honor Roll hospitals were getting the more
complicated cases, Sheetz said.
The most telling statistic the researchers gathered may have been
"failure to rescue rates," a measure of how well hospitals cope with
surgical complications. To avoid "failure to rescue," hospital staff
need to recognize a complication early "and manage it and prevent
the accumulation of other complications," Sheetz explained. "So it's
'rescuing' that patient."
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Honor Roll hospitals had lower failure to rescue rates than
affiliated hospitals: 13 percent versus 15 percent.
The researchers also found fairly wide variation between networks in
rates of certain outcomes within the networks. In some networks,
differences between affiliated hospitals in failure to rescue rates
were as little as 1.1-fold, while in other networks, affiliates
varied by as much as 4.9-fold. Complication rates varied in a
similar fashion within networks ranging from a 1.1-fold difference
to a 4.3-fold difference.
"Just because a hospital is affiliated with a really, really
reputable hospital doesn't mean that it is delivering care on par
with that Honor Roll hospital," Sheetz said. "For a lot of services,
that may not matter. For simple care in straightforward patients it
may not make a difference. But if you're having a heart operation or
a colon removed for cancer, you want to talk to your doctor about it
and ask the surgeon what kind of experience he has."
The new study "highlights the variability across hospitals and the
complex choices that patients face when choosing a hospital or
hospital network," said Tami Minnier, chief quality officer at the
University of Pittsburgh Medical Center in Pennsylvania.
But, reassuringly, "the hub hospitals and the majority of affiliated
hospitals have results within a fairly tight range," Minnier, who
wasn't involved in the study, said in an email. "The study does not
provide conclusive evidence that affiliates perform worse than their
flagship hospitals. Future research should explore the
characteristics of hospitals with poorer results."
SOURCE: https://bit.ly/2CnhCA2 JAMA Surgery, online March 13, 2019.
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