Het volume van chirurgische ingrepen en de impact ervan op ... - KCE

More documents

Recommendations

Info

40 Volume Outcome KCE reports 113 Only the “classical” hospitalisation stays coupled and validated by the Technical Cell were withheld (no long stay, no one day). All stays fulfilling one of these criteria were included in the primary selection of stays, resulting in a very wide list. This list was afterwards refined in the definition stage. 4.2.2 Definition of procedure The second step was to define all procedures. To that end, the following descriptive tables were performed, in order to refine the primary selection of data from the previous step: • details of reasons for inclusion in primary selection • investigate reasons for differences between inclusion for ICD-9-CM procedure and inclusion for NIHDI procedure (cross tables) • details of principal and secondary diagnoses • details of major diagnostic categories (MDC) • details of APR-DRGs. As an example, the primary selection of the procedures “carotid endarterectomy (CEA) and carotid stenting (CAS)” was too elaborate (more than 10 000 stays) because it contained all stays with ICD-9-CM procedure code or NIHDI codes, whatever the indication for the procedure. The definition of the procedure selected the stays based on a combination of the principal diagnoses and the selected procedure, and resulted in the inclusion of approximately 3 300 stays. In addition, some exclusion criteria were applied uniformly across procedures: • Cancer surgery procedures: o Exclude all stays that do not belong to the APR-DRG of interest: Oesophageal cancer surgery: APR-DRG 220 Major stomach, oesophageal and duodenal procedures Peripancreatic cancer surgery: APR-DRG 220 and APR- DRG 260 Pancreas, Liver and Shunt procedures Colon cancer surgery: APR-DRG 221 major small and large bowel procedures Breast cancer surgery APR-DRG 362 mastectomy procedures and APR-DRG 363 breast procedures except mastectomy Lung cancer surgery APR-DRG 120 major respiratory procedures. • Cardiovascular procedures: o Exclude all stays for congenital anomaly. Congenital anomalies are coded with ICD-9-CM diagnosis codes 740-759. o Exclude all stays that do not belong to the MDC of the analyzed procedure, i.e. MDC 01 “Diseases and disorders of the nervous system” for CEA/CAS and MDC 05 “Circulatory system” for the other cardiovascular procedures. • Orthopaedic procedures: o Exclude all stays that do not belong to MDC 08 “Diseases and disorders of the musculoskeletal system”. After the definition of each condition or procedure, external data sources were searched for validation of the number of stays. The numbers of procedures were compared, and differences investigated.
KCE Reports 113 Volume Outcome 41 4.2.3 Definition of volume The HOSPITAL volume is the number of stays selected in the definition of the procedure. The SURGEON volume is the number of stays selected in the definition of the procedure, where the Performer identifier variable (from the MFD) is available in the database. When the same surgeon operates in different hospitals, the surgeon volume is computed across all hospitals (and not the volume in each particular hospital). If international cut off for volume of centres or surgeon was identified in the literature, these cut off were used in order to facilitate comparison of results. If not cut of volume could be identified, then tertiles (dividing the hospitals in three group of the same size) were used in cardiology and in orthopaedics. In oncology, cut off volume were chosen in order to differentiate the providers (low versus versus medium versus high volume), keeping sufficient number of observations in each group. The analyses were not intended to determine thresholds but were primarily designed to validate the existence of volume-outcome correlations. Consequently, this precludes making recommendations about specific minimal provider volume thresholds to achieve optimal results. 4.2.4 Definition of outcome 4.2.4.1 Outcome measures These are the outcome measures which were obtained from the following databases: 1. In-hospital mortality: retrieved from MCD data. 2. Approximate 30-day mortality and 2-year mortality: retrieved from IMA database. 3. Readmission rate: retrieved from MCD data. For patients with an index admission in 2004, i.e. who were hospitalized in 2004 to undergo one of the investigated surgical procedures, we disposed of the readmissions until the end of 2005. This information applied to readmissions in both the same hospital as in other hospitals as the index admission. It has to be acknowledged that whether the patient is readmitted or not depends on the decision of the physician and is therefore a less reliable outcome to assess the quality of care. 4. Complication rate during index admission or readmission: retrieved from the MCD. Table 2.1 (page 16) illustrates which outcomes are analyzed for the different procedures. 4.2.4.2 Quality problems of outcome measures 1. As explained in Chapter 2 (see page 15), the approximate 30-day mortality is only an approximation. This means that this outcome measure covers a postoperative window of at least 1 day and at most 60 days. 2. When we compared the (in-hospital) mortality encoded in MCD data with the one registered in IMA data, it was noticed that some patients were encoded as deceased in the MCD data while the IMA data said the contrary. On the whole of the databases, which counted more than 280 000 patients, we counted 1.9% of patients who were deceased in the MCD data 2004 but alive in the IMA data 2004. In these cases, short term mortality was based on the worst case (death in MCD or in IMA database) and long term mortality was based on IMA data only. The rationale behind this decision is that IMA data, which are provided by the Belgian sickness funds, are probably substantially more reliable when the mortality date is concerned. If a patient is encoded as deceased by the sickness funds this means that he no longer benefits any reimbursement of his healthcare costs. An erroneous mortality
Page 1 and 2:
Het volume van chirurgische ingrepe
Page 3 and 4:
Het volume van chirurgische ingrepe
Page 5 and 6: KCE reports 113A Volume - Uitkomst
Page 17 and 18: KCE Reports 113 Volume Outcome 1 Sc
Page 19 and 20: KCE Reports 113 Volume Outcome 3 6.
Page 21 and 22: KCE Reports 113 Volume Outcome 5 Ab
Page 23 and 24: KCE Reports 113 Volume Outcome 7 2
Page 25 and 26: KCE Reports 113 Volume Outcome 9 5.
Page 27 and 28: KCE Reports 113 Volume Outcome 11 O
Page 29 and 30: KCE Reports 113 Volume Outcome 13 F
Page 31 and 32: KCE Reports 113 Volume Outcome 15 T
Page 33 and 34: KCE Reports 113 Volume Outcome 17 P
Page 49 and 50: KCE Reports 113 Volume Outcome 33 H
Page 55: KCE Reports 113 Volume Outcome 39 4
Page 73 and 74: KCE Reports 113 Volume Outcome 57 R
Page 77 and 78: KCE Reports 113 Volume Outcome 61 C
Page 79 and 80: KCE Reports 113 Volume Outcome 63 A
Page 93 and 94: KCE Reports 113 Volume Outcome 77 D
Page 107 and 108:
KCE Reports 113 Volume Outcome 91 F
Page 109 and 110:
KCE Reports 113 Volume Outcome 93 R
Page 111 and 112:
KCE Reports 113 Volume Outcome 95 T
Page 113 and 114:
KCE Reports 113 Volume Outcome 97 V
Page 115 and 116:
KCE Reports 113 Volume Outcome 99 5
Page 117 and 118:
KCE Reports 113 Volume Outcome 101
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
Page 183 and 184:
Page 185 and 186:
Page 187 and 188:
Page 189 and 190:
Page 191 and 192:
Page 193 and 194:
Page 195 and 196:
Page 197 and 198:
Page 199 and 200:
Page 201 and 202:
Page 203 and 204:
Page 205 and 206:
Page 207 and 208:
Page 209 and 210:
Page 211 and 212:
Page 213 and 214:
Page 215 and 216:
Page 217 and 218:
Page 219 and 220:
Page 221 and 222:
Page 223 and 224:
Page 225 and 226:
Page 227 and 228:
Page 229 and 230:
Page 231 and 232:
Page 233 and 234:
Page 235 and 236:
Page 237 and 238:
Page 239 and 240:
Page 241 and 242:
Page 243 and 244:
Page 245 and 246:
Page 247 and 248:
Page 249 and 250:
Page 251 and 252:
Page 253 and 254:
This page is left intentionally bla
Page 255 and 256:
KCE reports 1. Effectiviteit en kos
Page 257 and 258:
73. Financiering van het zorgprogra
show all

Het volume van chirurgische ingrepen en de impact ervan op ... - KCE

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?