Hospital variability in modifiable factors driving coronary artery bypass charges |
| |
| Institution: | 1. Division of Cardiac Surgery, University of Maryland Saint Joseph Medical Center, Towson, Md;2. Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md;3. Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md;4. Maryland Cardiac Surgery Quality Initiative, Inc, Baltimore, Md;5. Division of Cardiothoracic Surgery, Suburban Hospital, Bethesda, Md;6. Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md;7. Adventist Healthcare White Oak Medical Center, Silver Spring, Md;1. Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn;2. Department of Heart Failure and Heart Transplantation, Centro Médico Nacional Siglo XXI, Hospital de Cardiología, Instituto Mexicano del Seguro Social, Mexico City, Mexico;3. Heart Failure and Heart Transplant Unit, Hospital Clínic de Barcelona, Barcelona, Spain;4. Department of Echocardiography, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico;1. Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY;2. Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY;3. Center for Innovation and Outcomes Research, Department of Surgery, Columbia University Medical Center, New York, NY;1. Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY;2. Department of Cardiovascular and Thoracic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY;1. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea;2. Department of Thoracic and Cardiovascular Surgery, Yongin Severance Hospital, Gyeonggi-do, Republic of Korea;1. Department of Cardiac Surgery, Royal Children''s Hospital, Melbourne, Australia;2. Department of Paediatrics, University of Melbourne, Melbourne, Australia;3. Heart Research Group, Murdoch Children''s Research Institute, Melbourne, Australia;4. Department of Cardiac Surgery, The Royal Melbourne Hospital, Melbourne, Australia;5. Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia;6. Heart Research Institute, Newtown, Sydney, Australia;7. Green Lane Paediatric and Congenital Cardiac Service, Starship Children''s Health, Auckland, New Zealand;8. Department of Surgery, University of Auckland, Auckland, New Zealand;9. Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia;10. Department of Cardiology, Women''s and Children''s Hospital, Adelaide, Australia;11. Faculty of Health and Medical Sciences, Department of Paediatrics, The University of Adelaide, Adelaide, Australia;12. Department of Cardiology, Perth Children''s Hospital, Perth, Australia;13. Division Cardiovascular Medicine, Adult Congenital Cardiology, Sir Charles Gardiner Hospital, Perth, Australia;14. The Heart Centre for Children, The Children''s Hospital at Westmead, Sydney, Australia;15. Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia;p. Department of Cardiac Surgery, Queensland Children''s Hospital, Brisbane, Australia;q. Queensland Paediatric Cardiac Research, Child Health Research Centre, University of Queensland, Brisbane, Australia;r. The Division of Cardiovascular Surgery, Children''s National Heart Institute, Washington, DC;s. Melbourne Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia |
| |
| Abstract: | ObjectiveCoronary artery bypass grafting is associated with significant interhospital variability in charges. Drivers of hospital charge variability remain elusive. We identified modifiable factors associated with statewide interhospital variability in hospital charges for coronary artery bypass grafting.MethodsCharge data were used as a surrogate for cost. Society of Thoracic Surgeons data from Maryland institutions and charge data from the Maryland Health Care Commission were linked to characterize interhospital charge variability for coronary artery bypass grafting. Multivariable linear regression was used to identify perioperative factors independently related to coronary artery bypass grafting charges. Of the factors independently associated with charges, we analyzed which factors varied between hospitals.ResultsA total of 10,337 patients underwent isolated coronary artery bypass grafting at 9 Maryland hospitals from 2012 to 2016, of whom 7532 patients were available for analyses. Mean normalized charges for isolated coronary artery bypass grafting varied significantly among hospitals, ranging from $30,000 to $57,000 (P < .001). Longer preoperative length of stay, operating room time, and major postoperative morbidity including stroke, renal failure, prolonged ventilation, reoperation, and deep sternal wound infection were associated with greater hospital charges. Incidence of major postoperative events, except stroke and deep sternal wound infection, was variable between hospitals. In a univariate linear regression model, patient risk profile only accounted for approximately 10% of statistical variance in charges.ConclusionsThere is significant charge variability for coronary artery bypass grafting among hospitals within the same state. By targeting variation in preoperative length of stay, operating room time, postoperative renal failure, prolonged ventilation, and reoperation, cardiac surgery programs can realize cost savings while improving quality of care for this resource-intense patient population. |
| |
| Keywords: | CABG cardiac surgery charge variability cost containment cost variability health economics quality improvement CABG"} {"#name":"keyword" "$":{"id":"kwrd0050"} "$$":[{"#name":"text" "_":"coronary artery bypass grafting DSWI"} {"#name":"keyword" "$":{"id":"kwrd0060"} "$$":[{"#name":"text" "_":"deep sternal wound infection LOS"} {"#name":"keyword" "$":{"id":"kwrd0070"} "$$":[{"#name":"text" "_":"length of stay OR"} {"#name":"keyword" "$":{"id":"kwrd0080"} "$$":[{"#name":"text" "_":"operating room PROM"} {"#name":"keyword" "$":{"id":"kwrd0090"} "$$":[{"#name":"text" "_":"Predicted Risk of Mortality STS"} {"#name":"keyword" "$":{"id":"kwrd0100"} "$$":[{"#name":"text" "_":"Society of Thoracic Surgeons |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
