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Impact of Hospital Affiliation With a Flagship Hospital System on Surgical Outcomes.
Ramadan, Omar I; Rosenbaum, Paul R; Reiter, Joseph G; Jain, Siddharth; Hill, Alexander S; Hashemi, Sean; Kelz, Rachel R; Fleisher, Lee A; Silber, Jeffrey H.
Afiliação
  • Ramadan OI; Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Rosenbaum PR; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
  • Reiter JG; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
  • Jain S; Department of Statistics and Data Science, The Wharton School, University of Pennsylvania, Philadelphia, PA.
  • Hill AS; Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA.
  • Hashemi S; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
  • Kelz RR; Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA.
  • Fleisher LA; Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA.
  • Silber JH; Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA.
Ann Surg ; 279(4): 631-639, 2024 Apr 01.
Article em En | MEDLINE | ID: mdl-38456279
ABSTRACT

OBJECTIVE:

To compare general surgery outcomes at flagship systems, flagship hospitals, and flagship hospital affiliates versus matched controls. SUMMARY BACKGROUND DATA It is unknown whether flagship hospitals perform better than flagship hospital affiliates for surgical patients.

METHODS:

Using Medicare claims for 2018 to 2019, we matched patients undergoing inpatient general surgery in flagship system hospitals to controls who underwent the same procedure at hospitals outside the system but within the same region. We defined a "flagship hospital" within each region as the major teaching hospital with the highest patient volume that is also part of a hospital system; its system was labeled a "flagship system." We performed 4 main comparisons patients treated at any flagship system hospital versus hospitals outside the flagship system; flagship hospitals versus hospitals outside the flagship system; flagship hospital affiliates versus hospitals outside the flagship system; and flagship hospitals versus affiliate hospitals. Our primary outcome was 30-day mortality.

RESULTS:

We formed 32,228 closely matched pairs across 35 regions. Patients at flagship system hospitals (32,228 pairs) had lower 30-day mortality than matched control patients [3.79% vs. 4.36%, difference=-0.57% (-0.86%, -0.28%), P<0.001]. Similarly, patients at flagship hospitals (15,571/32,228 pairs) had lower mortality than control patients. However, patients at flagship hospital affiliates (16,657/32,228 pairs) had similar mortality to matched controls. Flagship hospitals had lower mortality than affiliate hospitals [difference-in-differences=-1.05% (-1.62%, -0.47%), P<0.001].

CONCLUSIONS:

Patients treated at flagship hospitals had significantly lower mortality rates than those treated at flagship hospital affiliates. Hence, flagship system affiliation does not alone imply better surgical outcomes.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Medicare / Hospitais de Ensino Limite: Aged / Humans País/Região como assunto: America do norte Idioma: En Revista: Ann Surg Ano de publicação: 2024 Tipo de documento: Article País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Medicare / Hospitais de Ensino Limite: Aged / Humans País/Região como assunto: America do norte Idioma: En Revista: Ann Surg Ano de publicação: 2024 Tipo de documento: Article País de publicação: Estados Unidos