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To what extent should quality of care decisions be based on health outcomes data? Application to carotid endarterectomy.

Publication ,  Journal Article
Samsa, G; Oddone, EZ; Horner, R; Daley, J; Henderson, W; Matchar, DB
Published in: Stroke
December 2002

BACKGROUND AND PURPOSE: Most quality improvement methods implicitly assume that facilities with high complication rates are likely to have substandard processes of care, a stable characteristic that, in the absence of intervention, will persist over time. We assessed the extent to which this holds true for carotid endarterectomy. METHODS: Using data from the Department of Veterans Affairs National Surgical Quality Improvement Project, we classified facilities on the basis of 30-day complications of carotid endarterectomy (stroke, myocardial infarction, death) during 1994 to 1995 (period 1, n=3389) and then compared these groups of facilities for complication rates during 1996 to 1997 (period 2, n=4453). RESULTS: Despite wide variation in facility-specific complication rates, the correlation between rates in periods 1 and 2 was low (Spearman correlation coefficient, 0.04; P=0.01) Facility-specific rates did not show greater correlation when we examined only facilities with higher volumes patients in different clinical categories (asymptomatic, transient ischemic attack, stroke). Comorbid illness profiles were similar between the 2 time periods. CONCLUSIONS: Most of the facility-specific differences in complication rates in period 1 were not maintained into period 2. Many apparent quality improvement problems may not be as large as they first appear, especially when based on few complications per facility. The inability, in practice, to estimate complication rates at a high degree of precision is a fundamental difficulty for clinical policy making regarding procedures with complication rates such as carotid endarterectomy.

Duke Scholars

Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

December 2002

Volume

33

Issue

12

Start / End Page

2944 / 2949

Location

United States

Related Subject Headings

  • United States
  • Total Quality Management
  • Quality Indicators, Health Care
  • Prospective Studies
  • Postoperative Complications
  • Outcome Assessment, Health Care
  • Neurology & Neurosurgery
  • Male
  • Humans
  • Hospitals, Veterans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Samsa, G., Oddone, E. Z., Horner, R., Daley, J., Henderson, W., & Matchar, D. B. (2002). To what extent should quality of care decisions be based on health outcomes data? Application to carotid endarterectomy. Stroke, 33(12), 2944–2949. https://doi.org/10.1161/01.str.0000038095.20079.f6
Samsa, Gregory, Eugene Z. Oddone, Ronnie Horner, Jennifer Daley, William Henderson, and David B. Matchar. “To what extent should quality of care decisions be based on health outcomes data? Application to carotid endarterectomy.Stroke 33, no. 12 (December 2002): 2944–49. https://doi.org/10.1161/01.str.0000038095.20079.f6.
Samsa G, Oddone EZ, Horner R, Daley J, Henderson W, Matchar DB. To what extent should quality of care decisions be based on health outcomes data? Application to carotid endarterectomy. Stroke. 2002 Dec;33(12):2944–9.
Samsa, Gregory, et al. “To what extent should quality of care decisions be based on health outcomes data? Application to carotid endarterectomy.Stroke, vol. 33, no. 12, Dec. 2002, pp. 2944–49. Pubmed, doi:10.1161/01.str.0000038095.20079.f6.
Samsa G, Oddone EZ, Horner R, Daley J, Henderson W, Matchar DB. To what extent should quality of care decisions be based on health outcomes data? Application to carotid endarterectomy. Stroke. 2002 Dec;33(12):2944–2949.

Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

December 2002

Volume

33

Issue

12

Start / End Page

2944 / 2949

Location

United States

Related Subject Headings

  • United States
  • Total Quality Management
  • Quality Indicators, Health Care
  • Prospective Studies
  • Postoperative Complications
  • Outcome Assessment, Health Care
  • Neurology & Neurosurgery
  • Male
  • Humans
  • Hospitals, Veterans