Amy K Rosen1, Megan E Vanneman2, William J O'Brien1, Suzann Pershing3, Todd H Wagner4, Erin Beilstein-Wedel1, Jeanie Lo4, Qi Chen1, Glenn C Cockerham5, Michael Shwartz1. 1. Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts. 2. Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS), VA Salt Lake City Health Care System, Salt Lake City, Utah. 3. Department of Ophthalmology, VA Palo Alto Health Care System, Palo Alto, California. 4. Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California. 5. Department of Ophthalmology, Stanford University School of Medicine, Stanford, California.
Abstract
OBJECTIVES: To compare 90-day postoperative complication rates between Veterans receiving cataract surgery in VA vs Community Care (CC) during the first year of implementation of the Veterans Choice Act. DATA SOURCES: Fiscal Year (FY) 2015 VA and CC outpatient data from VA's Corporate Data Warehouse (CDW) 10/01/14-9/30/15). FY14 data were used to obtain baseline clinical information prior to surgery. STUDY DESIGN: Retrospective one-year study using secondary data to compare 90-day complication rates following cataract surgery (measured using National Quality Forum (NQF) criteria) in VA vs CC. NQF defines major complications from a specified list of Current Procedural Terminology (CPT) codes. We ran a series of logistic regression models to predict 90-day complication rates, adjusting for Veterans' sociodemographic characteristics, comorbidities, preoperative ocular conditions, eye risk group, and type of cataract surgery (classified as routine vs complex). DATA COLLECTION: We linked VA and CC users through patient identifiers obtained from the CDW files. Our sample included all enrolled Veterans who received outpatient cataract surgery either in the VA or through CC during FY15. Cataract surgeries were identified through CPT codes 66 984 (routine) and 66 982 (complex). PRINCIPAL FINDINGS: Of the 83,879 cataract surgeries performed in FY15, 31 percent occurred through CC. Undergoing complex surgery and having a high-risk eye (based on preoperative ocular conditions) were the strongest clinical predictors of 90-day postoperative complications. Overall, we found low complication rates, ranging from 1.1 percent in low-risk eyes to 3.6 percent in high-risk eyes. After adjustment for important confounders (eg, race, rurality, and preoperative ocular conditions), there were no statistically significant differences in 90-day complication rates between Veterans receiving cataract surgery in VA vs CC. CONCLUSIONS: As more Veterans seek care through CC, future studies should continue to monitor quality of care across the two care settings to help inform VA's "make vs buy decisions." Published 2020. This article is a U.S. Government work and is in the public domain in the USA.
OBJECTIVES: To compare 90-day postoperative complication rates between Veterans receiving cataract surgery in VA vs Community Care (CC) during the first year of implementation of the Veterans Choice Act. DATA SOURCES: Fiscal Year (FY) 2015 VA and CC outpatient data from VA's Corporate Data Warehouse (CDW) 10/01/14-9/30/15). FY14 data were used to obtain baseline clinical information prior to surgery. STUDY DESIGN: Retrospective one-year study using secondary data to compare 90-day complication rates following cataract surgery (measured using National Quality Forum (NQF) criteria) in VA vs CC. NQF defines major complications from a specified list of Current Procedural Terminology (CPT) codes. We ran a series of logistic regression models to predict 90-day complication rates, adjusting for Veterans' sociodemographic characteristics, comorbidities, preoperative ocular conditions, eye risk group, and type of cataract surgery (classified as routine vs complex). DATA COLLECTION: We linked VA and CC users through patient identifiers obtained from the CDW files. Our sample included all enrolled Veterans who received outpatientcataract surgery either in the VA or through CC during FY15. Cataract surgeries were identified through CPT codes 66 984 (routine) and 66 982 (complex). PRINCIPAL FINDINGS: Of the 83,879 cataract surgeries performed in FY15, 31 percent occurred through CC. Undergoing complex surgery and having a high-risk eye (based on preoperative ocular conditions) were the strongest clinical predictors of 90-day postoperative complications. Overall, we found low complication rates, ranging from 1.1 percent in low-risk eyes to 3.6 percent in high-risk eyes. After adjustment for important confounders (eg, race, rurality, and preoperative ocular conditions), there were no statistically significant differences in 90-day complication rates between Veterans receiving cataract surgery in VA vs CC. CONCLUSIONS: As more Veterans seek care through CC, future studies should continue to monitor quality of care across the two care settings to help inform VA's "make vs buy decisions." Published 2020. This article is a U.S. Government work and is in the public domain in the USA.
Entities:
Keywords:
community health services; postoperative complications; quality of health care; safety; veterans
Authors: Jessica L Zuchowski; Joya G Chrystal; Alison B Hamilton; Elizabeth W Patton; Laurie C Zephyrin; Elizabeth M Yano; Kristina M Cordasco Journal: Med Care Date: 2017-07 Impact factor: 2.983
Authors: Walid F Gellad; Francesca E Cunningham; Chester B Good; Joshua M Thorpe; Carolyn T Thorpe; Brandi Bair; KatieLynn Roman; Susan L Zickmund Journal: Med Care Date: 2017-07 Impact factor: 2.983
Authors: Robert J Campbell; Sherif R El-Defrawy; Sudeep S Gill; Marlo Whitehead; Erica de L P Campbell; Philip L Hooper; Chaim M Bell; Martin W Ten Hove Journal: JAMA Ophthalmol Date: 2019-01-01 Impact factor: 7.389
Authors: Abhishek R Payal; Luis A Gonzalez-Gonzalez; Xi Chen; Tulay Cakiner-Egilmez; Amy Chomsky; Elizabeth Baze; David Vollman; Mary G Lawrence; Mary K Daly Journal: J Cataract Refract Surg Date: 2016-03 Impact factor: 3.351
Authors: Amy K Rosen; Megan E Vanneman; William J O'Brien; Suzann Pershing; Todd H Wagner; Erin Beilstein-Wedel; Jeanie Lo; Qi Chen; Glenn C Cockerham; Michael Shwartz Journal: Health Serv Res Date: 2020-07-27 Impact factor: 3.402
Authors: Warren B P Pettey; Todd H Wagner; Amy K Rosen; Erin Beilstein-Wedel; Michael Shwartz; Megan E Vanneman Journal: Med Care Date: 2021-06-01 Impact factor: 3.178
Authors: Michelle A Mengeling; Kristin M Mattocks; Denise M Hynes; Megan E Vanneman; Kameron L Matthews; Amy K Rosen Journal: Med Care Date: 2021-06-01 Impact factor: 3.178
Authors: Nicholas J Giori; Erin E Beilstein-Wedel; Michael Shwartz; Alex H S Harris; Megan E Vanneman; Todd H Wagner; Amy K Rosen Journal: JAMA Netw Open Date: 2022-09-01