Web proxy 5 20 16 general hospital
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N Engl J Med ; June 2, DOI: It remains unknown whether referral Web proxy 5 20 16 general hospital for high-risk surgery have changed as a result and how operative mortality has been affected. Full Text of Background We used national Medicare data to study patients undergoing one of eight different cancer and cardiovascular operations from through Web proxy 5 20 16 general hospital For each procedure, we examined trends in hospital volume and market concentration, defined as the proportion of Medicare patients undergoing surgery in the top decile of hospitals by volume per year.
We used regression-based techniques to assess the effects of volume and market concentration on mortality over time, adjusting for case mix. Full Text of Methods Median hospital volumes of four cancer resections lung, esophagus, pancreas, and bladder and of repair of abdominal aortic aneurysm AAA rose substantially. Depending on the procedure, higher hospital volumes were attributable to an increasing number of cases nationwide, an increasing market concentration, or both.
Hospital volumes rose slightly for aortic-valve replacement but fell for coronary-artery bypass grafting and carotid endarterectomy. Full Text of Results Operative mortality with high-risk surgery fell substantially during the previous decade. Although increased market concentration and hospital volume have contributed to declining mortality with some high-risk cancer operations, declines in mortality with other procedures are largely attributable to other factors.
Funded by the National Institute on Aging. Full Text of Discussion Fueled by a growing number of studies reporting inverse relationships between hospital volume and surgical mortality, there was considerable interest in the United States during the previous decade in concentrating selected operations in high-volume hospitals. The Web proxy 5 20 16 general hospital Group, a consortium of large corporations and public agencies that purchase health care, has been among the most prominent advocates of volume-based referral.
Init established minimum volume standards for several surgical procedures as part of a broader, value-based purchasing initiative. There are still many barriers to regionalization, including patient preferences for local care, 6 financial incentives for smaller hospitals to retain surgical cases, 7,8 and lack of access to high-volume centers in some regions. Although hospital volume of a few high-risk cancer procedures e. We also examined concurrent trends in operative mortality rates associated with these procedures and the extent to which decreases in mortality could be associated with a concentration of surgical care in high-volume hospitals.
We based this study on national Medicare Provider Analysis and Review MEDPAR files, which contain all hospital discharge abstracts for fee-for-service, acute care hospitalizations for Medicare recipients. Using appropriate procedure codes from the International Classification of Diseases, Ninth Revision ICD-911 we identified all patients from 65 to 99 years of age who underwent one of the following eight cancer and cardiovascular operations from through esophagectomy, pancreatectomy, lung resection, cystectomy, repair of abdominal aortic aneurysm AAAcoronary-artery bypass grafting CABGcarotid endarterectomy, and aortic-valve replacement for a full list of ICD-9 codes, see the Supplementary Appendixavailable with the full text of this article at NEJM.
Six of these procedures have been targeted for volume-based referral by the Leapfrog Group. To quantify market concentration, we determined the proportion of Medicare patients undergoing one of the eight procedures in the top decile and top quintile of hospitals by volume for each year. Operative mortality, determined from the Medicare eligibility file, was defined as death before discharge or within 30 days after the operation. In creating cohorts for analysis of operative mortality, we used several limitations to enhance the homogeneity of our study cohorts and Web proxy 5 20 16 general hospital confounding due to changes in case mix over time.
Special Article. Trends in Hospital Volume and Operative Mortality for High-Risk Surgery. Jonathan F. Finks, M.D., Nicholas H. Osborne, M.D., and John D. Birkmeyer. Research Risk of cancer in first seven years after metal-on-metal hip replacement compared with other bearings and general population: linkage study between the. ReadyTalk delivers audio and web conferencing services that inspire collaboration and enable the Future of Work for today’s increasingly digital and mobile workforce. The high level of diabetes among Aboriginal and Torres Strait Islander people reflects a broad range of contributing factors [13, 14]. Addressing these factors should.