Testing the Feasibility of a Cross-Setting Measure to Address the Rising Trend in Hospital Outpatient TJA Procedures.

Autor:	Wallace LR; Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, New Haven, Connecticut.; Yale University School of Medicine, New Haven, Connecticut., Tan Z; Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, New Haven, Connecticut.; Yale University School of Medicine, New Haven, Connecticut., Barthel A; Genesis Research Group, Hoboken, New Jersey., Sáenz MP; Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, New Haven, Connecticut., Grady JN; Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, New Haven, Connecticut., Balestracci KMB; Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, New Haven, Connecticut.; Yale University School of Medicine, New Haven, Connecticut., Bozic KJ; Dell Medical School, The University of Texas at Austin, Austin, Texas., Myers R; Center for Clinical Standards and Quality, Centers for Medicare & Medicaid Services, Baltimore, Maryland., McDonough DL; Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services, Baltimore, Maryland., Lin Z; Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, New Haven, Connecticut.; Yale University School of Medicine, New Haven, Connecticut., Suter LG; Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, New Haven, Connecticut.; Yale University School of Medicine, New Haven, Connecticut.
Jazyk:	angličtina
Zdroj:	The Journal of bone and joint surgery. American volume [J Bone Joint Surg Am] 2024 Dec 05. Date of Electronic Publication: 2024 Dec 05.
DOI:	10.2106/JBJS.23.01395
Abstrakt:	Background: Elective primary total hip and total knee arthroplasty (collectively, total joint arthroplasties [TJAs]) are commonly performed procedures that can reduce pain and improve function. TJAs are generally safe, but complications can occur. Although historically performed as inpatient procedures, TJAs are increasingly being performed in the outpatient setting. We sought to develop a scientifically acceptable cross-setting measure for evaluating care quality across inpatient and outpatient settings. Methods: Using Medicare administrative claims and enrollment data for qualifying TJA patients, we respecified the Centers for Medicare & Medicaid Services (CMS) inpatient-only risk-standardized TJA complications measure to assess complication rates following elective primary TJAs performed in an inpatient or outpatient setting. We aligned inpatient and outpatient coding practices and used hierarchical logistic regression to calculate hospital-specific, risk-standardized complication rates (RSCRs). Lower rates correspond to better quality. Using accepted approaches for CMS measures, we tested measure reliability and vetted key measure decisions with patient and provider input. Results: A single combined model including the procedure setting as a risk variable produced the highest discrimination (C-statistic for a single combined model with a setting indicator: 0.664, C-statistic for the inpatient-only model: 0.651, C-statistic for the outpatient-only model: 0.638). Among the 2,747 hospitals with at least 25 TJAs, the mean RSCR (using the combined model with a setting indicator) was 2.91% (median RSCR: 2.85%; interquartile range: 2.59% to 3.18%). The median odds ratio for complication occurrence at a higher-risk hospital compared with a lower-risk hospital was 1.33. Conclusions: We respecified a measure to assess hospital inpatient or outpatient TJA performance and evaluated the reliability and validity of the measure. The findings showed variation in hospital-level complication rates across settings as indicated by this measure, supporting the feasibility of evaluating hospital performance using a more representative population than inpatient TJAs alone. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. Competing Interests: Disclosure: The analyses in this publication were performed under Measure & Instrument Development and Support (MIDS) contract HHSM-75FCMC18D0042, Task Order HHSM-75FCMC19F0001, funded by the Centers for Medicare & Medicaid Services, an agency of the U.S. Department of Health and Human Services (HHS). The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/I312). (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu