Isuru Ranasinghe1, Craig S Parzynski1, Rana Searfoss1, Julia Montague1, Zhenqiu Lin1, John Allen2, Ronald Vender2, Kanchana Bhat1, Joseph S Ross3, Susannah Bernheim4, Harlan M Krumholz5, Elizabeth E Drye6. 1. Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, Connecticut. 2. Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut. 3. Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, Connecticut; Section of General Internal Medicine, Department of Internal Medicine, Yale University, New Haven, Connecticut; Health Policy and Management, School of Public Health, Yale University, New Haven, Connecticut; Section of Cardiovascular Medicine and the Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University, New Haven, Connecticut; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut. 4. Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, Connecticut; Section of General Internal Medicine, Department of Internal Medicine, Yale University, New Haven, Connecticut; Section of Cardiovascular Medicine and the Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University, New Haven, Connecticut. 5. Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine and the Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University, New Haven, Connecticut; Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut. 6. Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, Connecticut; Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut. Electronic address: Elizabeth.drye@yale.edu.
Abstract
BACKGROUND & AIMS: Colonoscopy is a common procedure, yet little is known about variations in colonoscopy quality among outpatient facilities. We developed an outcome measure to profile outpatient facilities by estimating risk-standardized rates of unplanned hospital visits within 7 days of colonoscopy. METHODS: We used a 20% sample of 2010 Medicare outpatient colonoscopy claims (331,880 colonoscopies performed at 8140 facilities) from patients ≥65 years or older, and developed a patient-level logistic regression model to estimate the risk of unplanned hospital visits (ie, emergency department visits, observation stays, and inpatient admissions) within 7 days of colonoscopy. We then used the patient-level risk model variables and hierarchical logistic regression to estimate facility rates of risk-standardized unplanned hospital visits using data from the Healthcare Cost and Utilization Project (325,811 colonoscopies at 992 facilities), from 4 states containing 100% of colonoscopies per facility. RESULTS: Outpatient colonoscopies were followed by 5412 unplanned hospital visits within 7 days (16.3/1000 colonoscopies). Hemorrhage, abdominal pain, and perforation were the most common causes of unplanned hospital visits. Fifteen variables were independently associated with unplanned hospital visits (c = 0.67). A history of fluid and electrolyte imbalance (odds ratio [OR] = 1.43; 95% confidence interval [CI]: 1.29-1.58), psychiatric disorders (OR = 1.34; 95% CI: 1.22-1.46), and, in the absence of prior arrhythmia, increasing age past 65 years (aged >85 years vs 65-69 years: OR = 1.87; 95% CI: 1.54-2.28) were most strongly associated. The facility risk-standardized unplanned hospital visits calculated using Healthcare Cost and Utilization Project data showed significant variation (median 12.3/1000; 5th-95th percentile, 10.5-14.6/1000). Median risk-standardized unplanned hospital visits were comparable between ambulatory surgery centers and hospital outpatient departments (each was 10.2/1000), and ranged from 16.1/1000 in the Northeast to 17.2/1000 in the Midwest. CONCLUSIONS: We calculated a risk-adjusted measure of outpatient colonoscopy quality, which shows important variation in quality among outpatient facilities. This measure can make transparent the extent to which patients require follow-up hospital care, help inform patient choices, and assist in quality-improvement efforts.
BACKGROUND & AIMS: Colonoscopy is a common procedure, yet little is known about variations in colonoscopy quality among outpatient facilities. We developed an outcome measure to profile outpatient facilities by estimating risk-standardized rates of unplanned hospital visits within 7 days of colonoscopy. METHODS: We used a 20% sample of 2010 Medicare outpatient colonoscopy claims (331,880 colonoscopies performed at 8140 facilities) from patients ≥65 years or older, and developed a patient-level logistic regression model to estimate the risk of unplanned hospital visits (ie, emergency department visits, observation stays, and inpatient admissions) within 7 days of colonoscopy. We then used the patient-level risk model variables and hierarchical logistic regression to estimate facility rates of risk-standardized unplanned hospital visits using data from the Healthcare Cost and Utilization Project (325,811 colonoscopies at 992 facilities), from 4 states containing 100% of colonoscopies per facility. RESULTS:Outpatient colonoscopies were followed by 5412 unplanned hospital visits within 7 days (16.3/1000 colonoscopies). Hemorrhage, abdominal pain, and perforation were the most common causes of unplanned hospital visits. Fifteen variables were independently associated with unplanned hospital visits (c = 0.67). A history of fluid and electrolyte imbalance (odds ratio [OR] = 1.43; 95% confidence interval [CI]: 1.29-1.58), psychiatric disorders (OR = 1.34; 95% CI: 1.22-1.46), and, in the absence of prior arrhythmia, increasing age past 65 years (aged >85 years vs 65-69 years: OR = 1.87; 95% CI: 1.54-2.28) were most strongly associated. The facility risk-standardized unplanned hospital visits calculated using Healthcare Cost and Utilization Project data showed significant variation (median 12.3/1000; 5th-95th percentile, 10.5-14.6/1000). Median risk-standardized unplanned hospital visits were comparable between ambulatory surgery centers and hospital outpatient departments (each was 10.2/1000), and ranged from 16.1/1000 in the Northeast to 17.2/1000 in the Midwest. CONCLUSIONS: We calculated a risk-adjusted measure of outpatient colonoscopy quality, which shows important variation in quality among outpatient facilities. This measure can make transparent the extent to which patients require follow-up hospital care, help inform patient choices, and assist in quality-improvement efforts.
Authors: Mary Dillon; Louisa Flander; Daniel D Buchanan; Finlay A Macrae; Jon D Emery; Ingrid M Winship; Alex Boussioutas; Graham G Giles; John L Hopper; Mark A Jenkins; Driss Ait Ouakrim Journal: PLoS Med Date: 2018-08-16 Impact factor: 11.069
Authors: Alan Lobo; Rafael Torrejon Torres; Mark McAlindon; Simon Panter; Catherine Leonard; Nancy van Lent; Rhodri Saunders Journal: Int J Qual Health Care Date: 2020-06-17 Impact factor: 2.038