Evaluation of a Center of Excellence Program for Spine Surgery

Datos Bibliográficos

ID9099552
AutoresAteev Mehrotra (0000-0003-2223-1582, University of Pittsburgh, autor de correspondencia), Elizabeth M Sloss (RAND Corporation, autor de correspondencia), Peter S Hussey (RAND Corporation, autor de correspondencia), John Adams (0000-0002-2727-615X, RAND Corporation, autor de correspondencia), John L Adams, Susan Lovejoy, Susan L Lovejoy (RAND Corporation, autor de correspondencia), Nelson F SooHoo (0000-0002-3943-2631, University of California, Los Angeles)
Año2013
Volumen51
Número8
Páginas748-757
Fecha de publicación2013-08-01
Peer ReviewedSí
Open AccessNo
TipoARTICLE
RevistaMedical Care (JOURNAL)
Identificadores de la revistaISSN: 0025-7079 • E-ISSN: 1537-1948
EditorialOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0b013e31829b091d
PMID23774514
PMCIDPMC4091772
OpenAlexW2038443507
IdiomaEN
Referencias citadas13

BACKGROUND: The Centers for Medicare and Medicaid Services and many private health plans are encouraging patients to seek orthopedic care at hospitals designated as centers of excellence. No evaluations have been conducted to compare patient outcomes and costs at centers of excellence versus other hospitals. The objective of our study was to assess whether hospitals designated as spine surgery centers of excellence by a group of over 25 health plans provided higher quality care. METHODS: Claims representing approximately 54 million commercially insured individuals were used to identify individuals aged 18-64 years with 1 of 3 types of spine surgery in 2007-2009: 1-level or 2-level cervical fusion (referred to as cervical simple fusion), 1-level or 2-level lumbar fusion (referred to as lumbar simple fusion), or lumbar discectomy and/or decompression without fusion. The primary outcomes were any complication (7 complications were captured) and 30-day readmission. The multivariate models controlled for differences in age, sex, and comorbidities between the 2 sets of hospitals. RESULTS: A total of 29,295 cervical simple fusions, 27,214 lumbar simple fusions, and 28,911 lumbar discectomy/decompressions were identified, of which 42%, 42%, and 47%, respectively, were performed at a hospital designated as a spine surgery center of excellence. Designated hospitals had a larger number of beds and were more likely to be an academic center. Across the 3 types of spine surgery (cervical fusions, lumbar fusions, or lumbar discectomies/decompressions), there was no difference in the composite complication rate [OR 0.90 (95% CI, 0.72-1.12); OR 0.98 (95% CI, 0.85-1.13); OR 0.95 (95% CI, 0.82-1.07), respectively] or readmission rate [OR 1.03 (95% CI, 0.87-1.21); OR 1.01 (95% CI, 0.89-1.13); OR 0.91 (95%, CI 0.79-1.04), respectively] at designated hospitals compared with other hospitals. CONCLUSIONS: On average, spine surgery centers of excellence had similar complication rates and readmission rates compared with other hospitals. These results highlight the importance of empirical evaluations of centers of excellence programs

Center (category theory) · Center of excellence · Excellence · Medical physics · Political science · Computer Science · Healthcare Policy and Management · Medicine · Primary Care and Health Outcomes · Spine and Intervertebral Disc Pathology