John Birkmeyer

..In this context, we sought to describe the relative contribution of different procedures to overall morbidity, mortality, and excess length of stay in general surgery...

..Despite their obvious benefits for patients, the likely impact of these efforts on health care costs is uncertain. In this context, we examined relationships between hospital outcomes and expenditures in the US Medicare population...

..The current study was conducted to examine relations between hospital volume, process of care, and operative mortality in cancer surgery...

..The optimal strategy may depend on both the clinical context (e.g., which procedure) and political realities...

..Decisions about bundled payments would benefit from better information about how payments are currently distributed among providers of different perioperative services and how payments vary across hospitals...

..Although hospital procedure volume is clearly related to operative mortality with many cancer procedures, its effect on late survival is not well characterized...

..Population-based data can provide more realistic estimates of the risks and benefits of operations in this group...

..These data suggest that outcomes disparities could be reduced by strategies targeting earlier diagnosis and increasing adjuvant therapy use among African-American patients...

..Although the relation between hospital volume and surgical mortality is well established, for most procedures, the relative importance of the experience of the operating surgeon is uncertain...

..For some procedures, standards comprised of process of care or direct outcome measures would be more effective than those based on volume alone...

..CONCLUSION: Our model suggests that surgery would likely benefit a high proportion of medically treated GERD patients. Individual assessment of quality of life with GERD should be considered to aid clinical decision making...

..We sought to evaluate the importance of risk-adjustment for two cardiac surgery report cards in New York and Pennsylvania...

..The authors' purpose was to examine patterns and correlates of BCT for breast cancer in the elderly US population...

..The techniques used with laparoscopic gastric bypass (LGB) and their association with patient outcomes remain largely unexplored...

..We examined the hypothesis that the lower treatment rate for blacks is due to underreferral to medical and radiation oncologists...

..This study was performed to determine outcomes after transhiatal and transthoracic esophagectomy for patients undergoing resection nationwide...

..Although racial disparities in the quality of surgical care are well described, the impact of socioeconomic status on operative mortality is relatively unexplored...

..Despite growing calls for using lymph node counts as a hospital quality indicator, it has not been established that hospitals that obtain more lymph node have better outcomes...

..The National Quality Forum and other organizations recently endorsed a 12-node minimum as a measure of hospital quality...

..Outcomes of patients with acute myocardial infarction (AMI) and congestive heart failure (CHF) at specialty cardiac hospitals are uncertain...

..Investigators should be cognizant of this bias and exercise caution when interpreting these relationships when using SEER-Medicare data alone...

..However, the processes of care that mediate this effect are unknown. We sought to identify the processes that underlie the volume-outcome relationship for cystectomy...

..Although proponents argue that specialty cardiac hospitals provide high-quality cost-efficient care, strong financial incentives for physicians at these facilities could result in greater procedure utilization...

..75, P < .005). Cause-specific mortality can be reliably and systematically measured after cancer surgery. Understanding variation in cause-specific mortality can inform future quality improvement efforts...

..We examined associations between initial treatment intensity and subsequent outcomes...

..Mechanisms underlying such disparities have not been fully explored. We examined the role of hospital factors in racial differences in late mortality after surgery for breast or colon cancer...

..To determine whether high rates of compliance with perioperative processes of care used for public reporting and pay-for-performance are associated with lower rates of risk-adjusted mortality and high-risk surgical complications...

..We examined the implications of reliability adjustment on hospital mortality with surgery...

..9 per 1000 population; P < .01). The presence of an ASC is associated with higher utilization of common outpatient procedures in the elderly. Whether ASCs are meeting unmet clinical demand or spurring overutilization is not clear...

..In this regard, it was more effective than the individual measures. Such measures would be useful for helping patients and payers identify low-mortality hospitals for major surgery...

..We sought to guide these efforts by prioritizing orthopaedic procedures according to those that generate the greatest number of adverse events...

..To assess relationships between inferior vena cava (IVC) filter placement and complications within 30 days of gastric bypass surgery...

..To inform ongoing quality improvement initiatives, this study assessed the relative contribution of different procedures to overall morbidity, mortality, and excess length of stay in vascular surgery...

..We sought to determine whether these changes threaten the robustness of the risk adjustment of hospital quality comparisons...

..Rather than directly measuring outcomes, most programs rely on procedure volume. We sought to determine whether risk-adjusted outcomes or hospital volume were better at predicting future hospital morbidity with bariatric surgery...

..We sought to determine whether hospital variations in surgical mortality were due to differences in complication rates or failure to rescue rates (ie, case-fatality rates in patients with a complication)...

..Alternatively, black patients may receive a lower quality of care, which may explain this difference...

..Reducing rates of postoperative complications, the current focus of payers and regulators, may be one approach to reducing mortality. However, effective management of complications once they have occurred may be equally important...

..The purpose of the present study was to assess changing trends in the treatment of distal radial fractures in elderly patients in the United States...

..In this study, we sought to better understand the hospital characteristics that may explain failure to rescue...

..Still, there is variation across U.S. hospitals, with some hospitals experiencing much higher rates. These findings imply that there is potential for quality improvement to reduce costs while improving morbidity and mortality...

..To determine whether operative mortality rates at teaching hospitals in the United States are higher in July, the start of the academic year...

..The objective of this study was to test the hypothesis that surgical complications are associated with omission of chemotherapy for colorectal cancer...

..However, relations between resource availability and utilization are relatively unexplored in cancer care, including perioperative adjuvant therapy...

..In the current study, the authors assessed whether patients at NCI cancer centers compared with patients at control hospitals had lower mortality rates after major cancer surgery...

..Despite the growing popularity of bariatric surgery, there remain concerns about perioperative safety and variation in outcomes across hospitals...

..Whether these recent developments have had an impact on the use of antireflux surgery remains unknown...

..Although recent studies suggest that physician age is inversely related to clinical performance in primary care, relationships between surgeon age and patient outcomes have not been examined systematically...

..However, such regionalization policies might cause unreasonable travel burdens for surgical patients...

....

..Despite growing interest in evidence-based hospital referral for selected surgical procedures, there remains considerable debate about which measures should be used to identify high-quality providers...

..Statistical power can be improved by combining mortality data from multiple operations. We sought to determine whether this approach would still be useful in understanding performance with individual procedures...

..This work marks the first prospective, randomized evaluation of the LapMentor simulator, and provides evidence that LapMentor training may lead to improved operating room performance...

..Motivated by these concerns we evaluated how opening of an ambulatory surgery center impacts stone surgery use in a health care market and assessed the effect of its opening on the patient mix at nearby hospitals...

..Of a wide variety of methods for reducing postoperative nausea and vomiting, serotonin receptor antagonists appear the most effective and should be considered for routine prophylaxis...

..Relative to other major surgical procedures, gastric bypass for morbid obesity is associated with substantial gains in life expectancy. Long- term data from prospective studies are needed to confirm this finding...

..Although initiatives to regionalize cancer surgery are already under way, the relative importance of volume in cancer surgery is disputed...

..Further work is needed to understand the mechanisms underlying differences in performance across hospitals in cancer care...

..A recent analysis of coronary artery bypass grafting (CABG), however, suggests that volume-based referral initiatives should focus only on high-risk patients...

..This trend was largely associated with an increase in the use of gastric bypass procedures...

..When available, comorbidity information from prior hospitalizations may be more useful for risk adjustment...

..Although numerous studies suggest that there is an inverse relation between hospital volume of surgical procedures and surgical mortality, the relative importance of hospital volume in various surgical procedures is disputed...

..For this reason, we performed a meta-analysis of studies comparing open and laparoscopic ventral (including incisional) hernia repair...

..For these reasons, the primary argument for volume-based referral strategies should be improving quality, not reducing costs...

..Although mortality rates for some cardiovascular procedures seem to have declined, it is unclear whether other high-risk procedures are becoming safer over time...

..Although payers are leading the most visible of these efforts, it is unknown whether volume standards will also reduce resource use...

..We sought to determine if a hospital's performance in CABG is correlated to its performance in heart valve replacement...

..This study describes racial differences in postoperative mortality following 8 cardiovascular and cancer procedures and assesses possible explanations for these differences...

..Surgical mortality rates are increasingly used to measure hospital quality. It is not clear, however, how many hospitals have sufficient caseloads to reliably identify quality problems...

..Other regions had enough cases but too many hospitals performing them. Although consolidation of surgical services may be feasible in some settings, volume-based referral strategies are impractical for many U.S. regions...

..We sought to examine the effect of subspecialty training on operative mortality following lung resection...

..With increasing momentum from outside the profession of surgery, it is particularly important for surgeons to participate in making decisions regarding situations where volume may be an appropriate measure of quality...

..To learn how patients in Medicare, the US medical insurance programme that covers elderly patients, made decisions about where to undergo major surgery and how they would make future decisions...

..Surgeons with advanced training have lower mortality rates with some surgical procedures. The objective of the current study was to investigate the impact of thoracic surgery training on mortality rates of esophageal cancer resection...

..The effectiveness in improving survival of neoadjuvant chemoradiotherapy (NCRT) in patients undergoing surgery for esophageal carcinoma remains unclear...

..Further research is needed to determine the appropriate threshold for surgical treatment in patients with gastroesophageal reflux...

..We will develop and test a chart-based instrument for assessing cause of death in a pilot study at two hospitals in northern New England. ..

..g., historical mortality or volume alone). ..

..They will also acquire insights necessary to develop and evaluate interventions aimed at reducing racial disparities. ..

..We will develop and test a chart-based instrument for assessing cause of death in a pilot study at two hospitals in northern New England. ..

..The investigators will then estimate the change in mortality, by assuming that the patient will acquire the average predicted mortality for a similar patient at the larger volume hospital. ..

..We will then identify the resources and processes of care that account for differences in hospital outcomes, with the ultimate goal of identifying best practices and improving care in all settings. ..