Provider-hospital "fit" and patient outcomes: evidence from Massachusetts cardiac surgeons, 2002-2004.

Publisher: Blackwell Country of Publication: United States NLM ID: 0053006 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1475-6773 (Electronic) Linking ISSN: 00179124 NLM ISO Abbreviation: Health Serv Res Subsets: MEDLINE

Publication: Malden, MA : Blackwell
Original Publication: Chicago, Hospital Research and Educational Trust.

Cardiology Service, Hospital/*statistics & numerical data ; Coronary Artery Bypass/*statistics & numerical data ; Outcome and Process Assessment, Health Care/*statistics & numerical data; Aged ; Cardiology Service, Hospital/organization & administration ; Coronary Artery Bypass/adverse effects ; Female ; Guideline Adherence/statistics & numerical data ; Health Services Research ; Hospital Mortality ; Humans ; Intraoperative Period ; Male ; Massachusetts ; Middle Aged ; Postoperative Complications/epidemiology ; Practice Guidelines as Topic ; Quality of Health Care/organization & administration ; Quality of Health Care/statistics & numerical data ; Retrospective Studies ; Severity of Illness Index ; Time Factors

Objective: To examine whether the "fit" of a surgeon with hospital resources impacts cardiac surgery outcomes, separately from hospital or surgeon effects.
Data Sources: Retrospective secondary data from the Massachusetts Department of Public Health's Data Analysis Center, on all 12,983 adult isolated coronary artery bypass surgical admissions in state-regulated hospitals from 2002 through 2004. Clinically audited chart data was collected using Society of Thoracic Surgeons National Cardiac Surgery Database tools and cross-referenced with administrative discharge data in the Division of Health Care Finance and Policy. Mortality was followed up through 2007 via the state vital statistics registry.
Study Design: Analysis was at the patient level for those receiving isolated coronary artery bypass surgery (CABG). Sixteen outcomes included 30-day mortality, major morbidity, indicators of perioperative, and predischarge processes of care. Hierarchical crossed mixed models were used to estimate fixed covariate and random effects at hospital, surgeon, and hospital × surgeon level.
Principal Findings: Hospital volume was associated with significantly reduced intraoperative durations and significantly increased probability of aspirin, β-blocker, and lipid-lowering discharge medication use. The proportion of outcome variability due to unobserved hospital × surgeon interaction effects was small but meaningful for intraoperative practices, discharge destination, and medication use. For readmissions and mortality within 30 days or 1 year, unobserved patient and hospital factors drove almost all variability in outcomes.
Conclusions: Among Massachusetts patients receiving isolated CABG, consistent evidence was found that the hospital × surgeon combination independently impacted patient outcomes, beyond hospital or surgeon effects. Such distinct local interactions between a surgeon and hospital resources may play an important part in moderating quality improvement efforts, although residual patient-level factors generally contributed the most to outcome variability.
(© Health Research and Educational Trust.)

Erratum in: Health Serv Res. 2011 Apr;46(2):690.

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Date Created: 20100921 Date Completed: 20110208 Latest Revision: 20211020

20231215

PMC3034259

10.1111/j.1475-6773.2010.01169.x

20849555