Higher mortality rates were seen in patients receiving complex medical surgeries in affiliates against the establishments with the highest level they share their mark with, a new check t search.
It was more likely to die within 90 days compared with those in hospital with an exclusive surgery (NO 1.40, 95% CI 1.23-1.59,) t P<0.001) they named Daniel J. Bovefa, MD, of Yale Medical School in New Haven, Connecticut, and colleagues.
"Not surprisingly, this is because smaller hospitals are smaller, more likely to teach hospitals, and produce complex medical procedures with fewer frequency (lower measure) compared to hospitals. T at a high level " Open Network Open. "Thus far, including hospital features in revised models of revitalization (but never excluding) differences in the 90-day death."
The risk of death within 90 days was highest for patients receiving gastrectomy in a linked hospital (OR 2.04, 95% CI 1.41-2.95, t P<0.001), continued by:
- Pancreaticoduodenectomy (OR 1.59, 95% CI 1.12-2.24, P<0.009)
- Esophagectomy (NO 1.48, 95% CI 0.98-2.22, P<0.06)
- Lobectomy (NO 1.34, 95% CI 1.03-1.74, t P<0.03)
- Collaboration (NO 1.32, 95% CI 1.12-1.56, P= 0.001)
For the safety of enumeration, 79.6% of prestigious hospitals made the national average and only 34.7% of their attached hospitals.
Previous studies suggest that patients are likely to have a significant impact on hospital affinity status, the authors explained. One survey study indicated that respondents would prefer to opt for complex respite care in a US hospital carrying a link to a high level cancer center. Another study found that half felt that hospitals were high quality and their close associates providing similar care and that they were the same.
“Nearly a third of respondents willing to travel an hour for advanced in-patient hospital treatment changed their level of choice for a smaller local hospital if they connected to t top-level hospital, "they wrote." As a result, there is a concern that some US public could share the trade as a mark of equal care.
To examine the cross-departmental analysis, the Beea group examined the results of 29,228 Medicare patients who underwent surgery for cancers of the colon, the eophagus, lungs, pancreas, and the stomach from 2013 to 2016 at senior hospitals. cancer, how it was rated at U.S News and World Report, as well as the hospitals in their network. The authors explained that up to one-third of the complicated surgeries for Medicare recipients were made by the highest-rise cancer hospitals and their associates in 2016.
In an annexed report, Lesly A. Dossett, MD, MPH, from the University of Michigan, wrote in Ann Arbor, “in general, there is no network connection to their theoretical capacity for better quality in patients who have receive surgery. "
However, she warned that the investigation had only examined slim slice of cancer care, and noted that the results do not apply to less complex operations for breast cancer of the breast, protest, skin, or skin cancer. thyroid. She also noted a number of important constraints in the inspection. Researchers did not change for other types of cancer treatment such as chemistry and radiation, nor did they change for the treatment of "obscene final cancer, or screening, surveillance and live care," she said.
“In addition, it appears that it is not possible or feasible for every patient in the geographical area of the brand to be handled at that center,” Dossett wrote. The first step is to understand what patients are being treated as less well than at care and could receive high quality care at the smaller joint. ” t
Epic Sciences' non-financial support Toolkit outside current study. One co-author announced funding from the Medicare & Medicaid Services Centers relating to the development of hospital ratings and performance measures. # 39; publish another relationship author with Medtronic and Roche / Genentech.
Dossett declared that there were no competing interests.
2019-04-12T17: 45: 00-0400