Quality Measure Public Reporting Is Associated with Improved Outcomes Following Hip and Knee Replacement
Autor: | Kevin J. Bozic, Zhenqiu Lin, Susannah M. Bernheim, Karen Dorsey Sheares, Lisa G. Suter, Li Li, Jaymie L Simoes, Huihui Yu, Michael G. Zywiel, Jacqueline N. Grady |
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Rok vydání: | 2020 |
Předmět: |
Male
medicine.medical_specialty Arthroplasty Replacement Hip medicine.medical_treatment media_common.quotation_subject MEDLINE Knee replacement Medicare Patient Readmission Fiscal year 03 medical and health sciences 0302 clinical medicine Interquartile range medicine Humans Orthopedics and Sports Medicine Quality (business) Arthroplasty Replacement Knee Aged media_common 030222 orthopedics business.industry General Medicine Evidence-based medicine Public Reporting of Healthcare Data Quality Improvement United States Emergency medicine Female Surgery Complication business Medicaid 030217 neurology & neurosurgery |
Zdroj: | Journal of Bone and Joint Surgery. 102:1799-1806 |
ISSN: | 1535-1386 0021-9355 |
Popis: | Background Given the inclusion of orthopaedic quality measures in the Centers for Medicare & Medicaid Services national hospital payment programs, the present study sought to assess whether the public reporting of total hip arthroplasty (THA) and total knee arthroplasty (TKA) risk-standardized readmission rates (RSRRs) and complication rates (RSCRs) was temporally associated with a decrease in the rates of these outcomes among Medicare beneficiaries. Methods Annual trends in national observed and hospital-level RSRRs and RSCRs were evaluated for patients who underwent hospital-based inpatient hip and/or knee replacement procedures from fiscal year 2010 to fiscal year 2016. Hospital-level rates were calculated with use of the same measures and methodology that were utilized in public reporting. Annual trends in the distribution of hospital-level outcomes were then examined with use of density plots. Results Complication and readmission rates and variation declined steadily from fiscal year 2010 to fiscal year 2016. Reductions of 33% and 25% were noted in hospital-level RSCRs and RSRRs, respectively. The interquartile range decreased by 18% (relative reduction) for RSCRs and by 34% (relative reduction) for RSRRs. The frequency of risk variables in the complication and readmission models did not systematically change over time, suggesting no evidence of widespread bias or up-coding. Conclusions This study showed that hospital-level complication and readmission rates following THA and TKA and the variation in hospital-level performance declined during a period coinciding with the start of public reporting and financial incentives associated with measurement. The consistently decreasing trend in rates of and variation in outcomes suggests steady improvements and greater consistency among hospitals in clinical outcomes for THA and TKA patients in the 2016 fiscal year compared with the 2010 fiscal year. The interactions between public reporting, payment, and hospital coding practices are complex and require further study. Level of evidence Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. |
Databáze: | OpenAIRE |
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