Kimon Bekelis1,2,3, Symeon Missios4, Todd A MacKenzie3,5,6. 1. a Department of Neurosurgery , Thomas Jefferson University Hospital , Philadelphia , PA , USA. 2. b Department of Neurosurgery, The Dartmouth Institute for Health Policy and Clinical Practice , Lebanon , NH , USA. 3. c Department of Neurosurgery, Geisel School of Medicine at Dartmouth , Hanover , NH , USA. 4. d Center for Neuro and Spine , Akron General Hospital-Clevel and Clinic , Akron , OH , USA. 5. e Department of Medicine , Dartmouth-Hitchcock Medical Center , Lebanon , NH , USA. 6. f Department of Community and Family Medicine , Dartmouth-Hitchcock Medical Center , Lebanon , NH , USA.
Abstract
PURPOSE: The quality of physicians practicing in hospitals recognized for nursing excellence by the American Nurses Credentialing Center has not been studied before. We investigated whether Magnet hospital recognition is associated with higher quality of physicians performing neurosurgical procedures. MATERIALS AND METHODS: We performed a cohort study of patients undergoing neurosurgical procedures from 2009-2013, who were registered in the New York Statewide Planning and Research Cooperative System (SPARCS) database. Propensity score adjusted multivariable regression models were used to adjust for known confounders, with mixed effects methods to control for clustering at the facility level. An instrumental variable analysis was used to control for unmeasured confounding and simulate the effect of a randomized trial. RESULTS: During the study period, 185,277 patients underwent neurosurgical procedures, and met the inclusion criteria. Of these, 66,607 (35.6%) were hospitalized in Magnet hospitals, and 118,670 (64.4%) in non-Magnet institutions. Instrumental variable analysis demonstrated that undergoing neurosurgical operations in Magnet hospitals was associated with a 13.6% higher chance of being treated by a physician with superior performance in terms of mortality (95% CI, 13.2% to 14.1%), and a 4.3% higher chance of being treated by a physician with superior performance in terms of length-of-stay (LOS) (95% CI, 3.8% to 4.7%) in comparison to non-Magnet institutions. The same associations were present in propensity score adjusted mixed effects models. CONCLUSIONS: Using a comprehensive all-payer cohort of neurosurgical patients in New York State we identified an association of Magnet hospital recognition with superior physician performance.
PURPOSE: The quality of physicians practicing in hospitals recognized for nursing excellence by the American Nurses Credentialing Center has not been studied before. We investigated whether Magnet hospital recognition is associated with higher quality of physicians performing neurosurgical procedures. MATERIALS AND METHODS: We performed a cohort study of patients undergoing neurosurgical procedures from 2009-2013, who were registered in the New York Statewide Planning and Research Cooperative System (SPARCS) database. Propensity score adjusted multivariable regression models were used to adjust for known confounders, with mixed effects methods to control for clustering at the facility level. An instrumental variable analysis was used to control for unmeasured confounding and simulate the effect of a randomized trial. RESULTS: During the study period, 185,277 patients underwent neurosurgical procedures, and met the inclusion criteria. Of these, 66,607 (35.6%) were hospitalized in Magnet hospitals, and 118,670 (64.4%) in non-Magnet institutions. Instrumental variable analysis demonstrated that undergoing neurosurgical operations in Magnet hospitals was associated with a 13.6% higher chance of being treated by a physician with superior performance in terms of mortality (95% CI, 13.2% to 14.1%), and a 4.3% higher chance of being treated by a physician with superior performance in terms of length-of-stay (LOS) (95% CI, 3.8% to 4.7%) in comparison to non-Magnet institutions. The same associations were present in propensity score adjusted mixed effects models. CONCLUSIONS: Using a comprehensive all-payer cohort of neurosurgical patients in New York State we identified an association of Magnet hospital recognition with superior physician performance.
Entities:
Keywords:
Neurosurgery; SPARCS; center of excellence; magnet recognition; physician quality; public reporting
Authors: Ann Kutney-Lee; Amy Witkoski Stimpfel; Douglas M Sloane; Jeannie P Cimiotti; Lisa W Quinn; Linda H Aiken Journal: Med Care Date: 2015-06 Impact factor: 2.983
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