Dataset Information

Variation in Patient-reported Outcomes Across Hospitals Following Surgery.

ABSTRACT:

Background

Although there is growing interest in applying patient-reported outcomes (PROs) toward surgical quality, the extent to which PROs vary across hospitals following surgical procedures is unknown.

Objectives

We examined variation in PROs, specifically health-related quality of life (HRQOL), across hospitals performing bariatric surgery.

Research design

A retrospective cohort study.

Subjects

The Michigan Bariatric Surgery Collaborative is a statewide consortium of 39 hospitals performing laparoscopic gastric bypass, gastric banding, or sleeve gastrectomy (n=11,420 patients between 2008 and 2012).

Measures

We examined generic and disease-specific HRQOL measured by the Health and Activities Limitations Index (HALex) and Bariatric Quality of Life index (BQL) preoperatively and at 1 year. We measured the variation in postoperative HRQOL across hospitals, and the effect of risk and reliability adjustment on hospital ranking.

Results

In this cohort, HRQOL varied by 56% (HALex) and 37% (BQL) across hospitals. Patient factors accounted for 58% (HALex) to 71% (BQL) of the variation in HRQOL across hospitals. After risk and reliability adjustment, HRQOL varied by 18% (by HALex) and 14.5% (by BQL) across hospitals, and the proportion of patients who experienced a large improvement in HRQOL by HALex ranged from 33% to 69% and 67% to 92% by BQL. After adjusting for patient factors and reliability, these differences diminished to 55%-64% (HALex) and 79%-84% (BQL).

Conclusions

Patient factors explain a large proportion of hospital-level variation in PROs following bariatric surgery, underscoring the importance of risk adjustment. However, some variation in PROs across hospitals remains unexplained, suggesting PROs may represent a viable indicator of hospital performance.

SUBMITTER: Waljee JF

PROVIDER: S-EPMC9621341 | biostudies-literature | 2015 Nov

REPOSITORIES: biostudies-literature

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Publications

Variation in Patient-reported Outcomes Across Hospitals Following Surgery.

Waljee Jennifer F JF Ghaferi Amir A Finks Jonathan F JF Cassidy Ruth R Varban Oliver O Carlin Arthur A Carlozzi Noelle N Dimick Justin J

Medical care 20151101 11

<h4>Background</h4>Although there is growing interest in applying patient-reported outcomes (PROs) toward surgical quality, the extent to which PROs vary across hospitals following surgical procedures is unknown.<h4>Objectives</h4>We examined variation in PROs, specifically health-related quality of life (HRQOL), across hospitals performing bariatric surgery.<h4>Research design</h4>A retrospective cohort study.<h4>Subjects</h4>The Michigan Bariatric Surgery Collaborative is a statewide consortiu ...[more]

PMID: 26465124

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Project description:ImportancePatients should have an active role in decisions about pursuing or forgoing specific therapies in treatment de-escalation trials.ObjectiveTo evaluate longitudinal patient-reported outcomes (PROs) encompassing decisional comfort and health-related quality of life (HRQOL) among patients who elected to enroll in a clinical trial evaluating radiotherapy alone, without breast surgery, for invasive breast cancers with exceptional response to neoadjuvant systemic therapy (NST).Design, setting, and participantsProspective, single-group, phase 2 clinical trial at 7 US medical centers. Women aged 40 years or older with invasive cT1-2 N0-1 M0 triple-negative or human epidermal growth factor receptor 2 (ERBB2)-positive breast cancer with no pathologic evidence of residual disease following standard NST enrolled from March 6, 2017, to November 9, 2021. Validated PRO measures were administered at baseline and 6, 12, and 36 months post-radiotherapy. Data were analyzed from January to February 2023.InterventionsPRO measures included the Decision Regret Scale (DRS), Functional Assessment of Cancer Therapy-Lymphedema (FACT-B+4), and Breast Cancer Treatment Outcomes Scale (BCTOS).Main outcomes and measuresChanges in PRO measure scores and subscores over time.ResultsAmong 31 patients, the median (IQR) age was 61 (56-66) years, 26 (84%) were White, and 26 (84%) were non-Hispanic. A total of 15 (48%) had triple-negative disease and 16 (52%) had ERBB2-positive disease. Decisional comfort was high at baseline (median [IQR] DRS score 10 [0-25] on a 0-100 scale, with higher scores indicating higher decisional regret) and significantly increased over time (median [IQR] DRS score at 36 months, 0 [0-20]; P < .001). HRQOL was relatively high at baseline (median [IQR] FACT-B composite score 121 [111-134] on a 0-148 scale, with higher scores indicating higher HRQOL) and significantly increased over time (median [IQR] FACT-B score at 36 months, 128 [116-137]; P = .04). Perceived differences between the affected breast and contralateral breast were minimal at baseline (median [IQR] BCTOS score 1.05 [1.00-1.23] on a 1-4 scale, with higher scores indicating greater differences) and increased significantly over time (median [IQR] BCTOS score at 36 months, 1.36 [1.18-1.64]; P < .001). At 36 months postradiotherapy, the cosmetic subscore was 0.45 points higher than baseline (95% CI, 0.16-0.74; P = .001), whereas function, pain, and edema subscores were not significantly different than baseline.Conclusions and relevanceIn this nonrandomized phase 2 clinical trial, analysis of PROs demonstrated an overall positive experience for trial participants, with longitudinal improvements in decisional comfort and overall HRQOL over time and minimal lasting adverse effects of therapy.Trial registrationClinicalTrials.gov Identifier: NCT02945579.

Dataset Information

Variation in Patient-reported Outcomes Across Hospitals Following Surgery.

Background

Objectives

Research design

Subjects

Measures

Results

Conclusions

Publications

Variation in Patient-reported Outcomes Across Hospitals Following Surgery.

Similar Datasets

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