Evaluation of a Center of Excellence Program for Spine Surgery

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

• Hospital Volume and Surgical Mortality in the United States

  John D Birkmeyer, Andrea E Siewers et al.•New England Journal of Medicine•2002

  Incluir item

• The Implications of Regional Variations in Medicare Spending. Part 2

  Open Access•Elliott S Fisher, David E Wennberg et al.•Annals of Internal Medicine•2003

  Incluir item

• Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction

  Linda H Aiken•JAMA•2002

  Incluir item

• Comprehensive Discharge Planning and Home Follow-up of Hospitalized Elders

  Mary D Naylor, Dorothy Brooten et al.•JAMA•1999

  Incluir item

• The Association of Registered Nurse Staffing Levels and Patient Outcomes

  Robert L Kane, Tatyana A Shamliyan et al.•Medical Care•2007

  Incluir item