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JAMA Dec 2023The effects of private equity acquisitions of US hospitals on the clinical quality of inpatient care and patient outcomes remain largely unknown. (Comparative Study)
Comparative Study
IMPORTANCE
The effects of private equity acquisitions of US hospitals on the clinical quality of inpatient care and patient outcomes remain largely unknown.
OBJECTIVE
To examine changes in hospital-acquired adverse events and hospitalization outcomes associated with private equity acquisitions of US hospitals.
DESIGN, SETTING, AND PARTICIPANTS
Data from 100% Medicare Part A claims for 662 095 hospitalizations at 51 private equity-acquired hospitals were compared with data for 4 160 720 hospitalizations at 259 matched control hospitals (not acquired by private equity) for hospital stays between 2009 and 2019. An event study, difference-in-differences design was used to assess hospitalizations from 3 years before to 3 years after private equity acquisition using a linear model that was adjusted for patient and hospital attributes.
MAIN OUTCOMES AND MEASURES
Hospital-acquired adverse events (synonymous with hospital-acquired conditions; the individual conditions were defined by the US Centers for Medicare & Medicaid Services as falls, infections, and other adverse events), patient mix, and hospitalization outcomes (including mortality, discharge disposition, length of stay, and readmissions).
RESULTS
Hospital-acquired adverse events (or conditions) were observed within 10 091 hospitalizations. After private equity acquisition, Medicare beneficiaries admitted to private equity hospitals experienced a 25.4% increase in hospital-acquired conditions compared with those treated at control hospitals (4.6 [95% CI, 2.0-7.2] additional hospital-acquired conditions per 10 000 hospitalizations, P = .004). This increase in hospital-acquired conditions was driven by a 27.3% increase in falls (P = .02) and a 37.7% increase in central line-associated bloodstream infections (P = .04) at private equity hospitals, despite placing 16.2% fewer central lines. Surgical site infections doubled from 10.8 to 21.6 per 10 000 hospitalizations at private equity hospitals despite an 8.1% reduction in surgical volume; meanwhile, such infections decreased at control hospitals, though statistical precision of the between-group comparison was limited by the smaller sample size of surgical hospitalizations. Compared with Medicare beneficiaries treated at control hospitals, those treated at private equity hospitals were modestly younger, less likely to be dually eligible for Medicare and Medicaid, and more often transferred to other acute care hospitals after shorter lengths of stay. In-hospital mortality (n = 162 652 in the population or 3.4% on average) decreased slightly at private equity hospitals compared with the control hospitals; there was no differential change in mortality by 30 days after hospital discharge.
CONCLUSIONS AND RELEVANCE
Private equity acquisition was associated with increased hospital-acquired adverse events, including falls and central line-associated bloodstream infections, along with a larger but less statistically precise increase in surgical site infections. Shifts in patient mix toward younger and fewer dually eligible beneficiaries admitted and increased transfers to other hospitals may explain the small decrease in in-hospital mortality at private equity hospitals relative to the control hospitals, which was no longer evident 30 days after discharge. These findings heighten concerns about the implications of private equity on health care delivery.
Topics: Aged; Humans; Hospitals, Private; Iatrogenic Disease; Medicare; Sepsis; Surgical Wound Infection; United States; Outcome Assessment, Health Care; Quality of Health Care; Hospitalization; Medicare Part A
PubMed: 38147093
DOI: 10.1001/jama.2023.23147 -
Expert Review of Pharmacoeconomics &... Jun 2024
Topics: Economics, Pharmaceutical; Humans; Outcome Assessment, Health Care; Periodicals as Topic; Journal Impact Factor
PubMed: 38591254
DOI: 10.1080/14737167.2024.2339945 -
Neurosurgery Clinics of North America Oct 2023Outcome assessment in adult spinal deformity has evolved from radiographic analysis of curve correction to patient-centered perception of health-related quality-of-life.... (Review)
Review
Outcome assessment in adult spinal deformity has evolved from radiographic analysis of curve correction to patient-centered perception of health-related quality-of-life. Oswestry Disability Index and the Scoliosis Research Society-22 Patient Questionnaire are the predominantly used patient-reported outcome (PRO) measurements for deformity surgery. Correction of sagittal alignment correlates with improved PRO. Functional outcomes and accelerometer measurements represent newer methods of measuring outcomes but have not yet been widely adopted or validated. Further adoption of a minimum set of core outcome domains will help facilitate international comparisons and benchmarking, and ultimately enhance value-based healthcare.
Topics: Adult; Humans; Neurosurgical Procedures; Outcome Assessment, Health Care; Quality of Life; Scoliosis
PubMed: 37718115
DOI: 10.1016/j.nec.2023.06.013 -
The Lancet. Healthy Longevity Jul 2023Comprehensive geriatric assessment is the core toolkit of geriatric medicine. Awareness of and engagement in comprehensive geriatric assessment are crucial competences... (Review)
Review
Comprehensive geriatric assessment is the core toolkit of geriatric medicine. Awareness of and engagement in comprehensive geriatric assessment are crucial competences for all professionals caring for older people living with frailty. The fundamental tenet of comprehensive geriatric assessment is person centredness, which means orienting problem evaluation and intervention plans around an individual's specific biopsychosocial situation to maximise their function and participation. Person-centred outcomes are frequently neglected from measurements of health-care delivery, service improvement, and research. Instead, systems tend to measure outcomes of the health-care service (ie, resource use) or a person's destination following a health-care process. The absence of person-centred outcome measures risks the delivery of health care that seeks to achieve, and is benchmarked against, outcomes that are not best for the patient. We must, therefore, ensure that the outcomes that matter to older people are being measured.
Topics: Humans; Aged; Delivery of Health Care; Geriatrics; Outcome Assessment, Health Care
PubMed: 37336229
DOI: 10.1016/S2666-7568(23)00084-3 -
Journal of Neurosurgery Dec 2023The Quality Outcomes Database (QOD) was established in 2012 by the NeuroPoint Alliance, a nonprofit organization supported by the American Association of Neurological...
OBJECTIVE
The Quality Outcomes Database (QOD) was established in 2012 by the NeuroPoint Alliance, a nonprofit organization supported by the American Association of Neurological Surgeons. Currently, the QOD has launched six different modules to cover a broad spectrum of neurosurgical practice-namely lumbar spine surgery, cervical spine surgery, brain tumor, stereotactic radiosurgery (SRS), functional neurosurgery for Parkinson's disease, and cerebrovascular surgery. This investigation aims to summarize research efforts and evidence yielded through QOD research endeavors.
METHODS
The authors identified all publications from January 1, 2012, to February 18, 2023, that were produced by using data collected prospectively in a QOD module without a prespecified research purpose in the context of quality surveillance and improvement. Citations were compiled and presented along with comprehensive documentation of the main study objective and take-home message.
RESULTS
A total of 94 studies have been produced through QOD efforts during the past decade. QOD-derived literature has been predominantly dedicated to spinal surgical outcomes, with 59 and 22 studies focusing on lumbar and cervical spine surgery, respectively, and 6 studies focusing on both. More specifically, the QOD Study Group-a research collaborative between 16 high-enrolling sites-has yielded 24 studies on lumbar grade 1 spondylolisthesis and 13 studies on cervical spondylotic myelopathy, using two focused data sets with high data accuracy and long-term follow-up. The more recent neuro-oncological QOD efforts, i.e., the Tumor QOD and the SRS Quality Registry, have contributed 5 studies, providing insights into the real-world neuro-oncological practice and the role of patient-reported outcomes.
CONCLUSIONS
Prospective quality registries are an important resource for observational research, yielding clinical evidence to guide decision-making across neurosurgical subspecialties. Future directions of the QOD efforts include the development of research efforts within the neuro-oncological registries and the American Spine Registry-which has now replaced the inactive spinal modules of the QOD-and the focused research on high-grade lumbar spondylolisthesis and cervical radiculopathy.
Topics: Humans; Spondylolisthesis; Prospective Studies; Registries; Outcome Assessment, Health Care; Neurosurgical Procedures; Lumbar Vertebrae; Treatment Outcome
PubMed: 37209070
DOI: 10.3171/2023.3.JNS222601 -
Clinical Journal of the American... Mar 2024Peritoneal dialysis (PD) enables people to have a home-based therapy, permitting greater autonomy for individuals along with enhanced treatment satisfaction compared... (Review)
Review
Peritoneal dialysis (PD) enables people to have a home-based therapy, permitting greater autonomy for individuals along with enhanced treatment satisfaction compared with in-center dialysis care. The burden of treatment on PD, however, remains considerable and underpins the need for person-centered care. This reflects the need to address the patient as a person with needs and preferences beyond just the medical perspective. Shared decision making is central to the recent International Society for Peritoneal Dialysis recommendations for prescribing PD, balancing the potential benefits of PD on patient well-being with the burden associated with treatment. This review considers the role of high-quality goal-directed prescribing, incremental dialysis, and remote patient monitoring in reducing the burden of dialysis, including an approach to implementing incremental PD. Although patient-related outcomes are important in assessing the response to treatment and, particularly life participation, the corollary of dialysis burden, there are no clear routes to the clinical implementation of patient-related outcome measures. Delivering person-centered care is dependent on treating people both as individuals and as equal partners in their care.
Topics: Humans; Peritoneal Dialysis; Renal Dialysis; Outcome Assessment, Health Care; Patients
PubMed: 37611155
DOI: 10.2215/CJN.0000000000000281 -
Sleep Medicine Reviews Dec 2023Youth is a vulnerable developmental period associated with an increased preference for eveningness and risk for developing psychopathology. Growing evidence suggests a... (Meta-Analysis)
Meta-Analysis Review
Youth is a vulnerable developmental period associated with an increased preference for eveningness and risk for developing psychopathology. Growing evidence suggests a link between eveningness and poorer mental health outcomes, but the findings in the current literature are inconsistent, and a comprehensive synthesis of evidence in this area remains lacking. This meta-analysis aimed to 1) synthesise the existing evidence on the association between circadian preference and mental health outcomes in youths and 2) explore potential sleep-related factors that may moderate the relationship between circadian preference and mental health outcomes. A systematic search of five electronic databases resulted in 81 observational studies included in the review. Eveningness was found to be significantly associated with general mental health (r = 0.20), mood-related disturbances (r = 0.17), and anxiety problems (r = 0.13). The qualitative review also identified that eveningness was associated with greater risks for psychotic symptoms and maladaptive eating behaviours. These findings highlighted the need to consider circadian preference in the clinical management of youth mental health problems. Further research is needed to examine the efficacy of a circadian-focused intervention in the context of youth mental health.
Topics: Humans; Adolescent; Sleep; Psychotic Disorders; Anxiety Disorders; Mood Disorders; Outcome Assessment, Health Care; Circadian Rhythm; Surveys and Questionnaires
PubMed: 37793219
DOI: 10.1016/j.smrv.2023.101851 -
Brain : a Journal of Neurology Dec 2023The capacity and power of data from cohorts, registries and randomized trials to provide answers to contemporary clinical questions in neurology has increased... (Review)
Review
The capacity and power of data from cohorts, registries and randomized trials to provide answers to contemporary clinical questions in neurology has increased considerably over the past two decades. Novel sophisticated statistical methods are enabling us to harness these data to guide treatment decisions, but their complexity is making appraisal of clinical evidence increasingly demanding. In this review, we discuss several methodological aspects of contemporary research of treatment effectiveness in observational data in neurology, aimed at academic neurologists and analysts specializing in outcomes research. The review discusses specifics of the sources of observational data and their key features. It focuses on the limitations of observational data and study design, as well as statistical approaches aimed to overcome these limitations. Among the examples of leading clinical themes typically studied with analyses of observational data, the review discusses methodological approaches to comparative treatment effectiveness, development of diagnostic criteria and definitions of clinical outcomes. Finally, this review provides a brief summary of key points that will help clinical audience critically evaluate design and analytical aspects of studies of disease outcomes using observational data.
Topics: Humans; Treatment Outcome; Outcome Assessment, Health Care; Registries; Research Design; Neurology
PubMed: 37587541
DOI: 10.1093/brain/awad278 -
Haemophilia : the Official Journal of... Apr 2024Advances in haemophilia treatment have resulted in a near-normal life expectancy, lower burden of bleeding and treatment, and improved quality of life in high-income...
INTRODUCTION
Advances in haemophilia treatment have resulted in a near-normal life expectancy, lower burden of bleeding and treatment, and improved quality of life in high-income countries. Bleeding rate is approaching zero and novel parameters should be evaluated to assess the efficacy of treatment not only from the clinical point of view by using new methodologies (e.g. joint health assessment), but also from the patient's perspective (e.g. pain, quality of life, treatment satisfaction).
METHODS AND RESULTS
This approach should be aimed at combining objective clinical methodologies and patient-reported outcomes (PROs). However, some instruments used for assessing PROs are still suboptimal and not properly validated. Recent evidence suggests that these tools can take advantage from a more personalized designed approach and could be effectively improved and serve to facilitate the patient's self-evaluation. For other congenital bleeding disorders (BDs), a set of patient-relevant outcomes has been also defined that overlap substantially those of haemophilia, including bleeding, side effects and complications, and PROs, such as pain, physical functioning, impact on daily life including school and work and mental health. There is a growing focus on addressing women-specific outcomes in BDs, reflecting an increased awareness of the unique challenges faced by women in this context. However, the development of tailored tools is imperative to further advance the progress in managing women with BDs, ensuring more accurate monitoring and personalized care.
CONCLUSIONS
How incorporating these outcome measures in the process of approval of novel treatments for these disorders by regulatory authorities remains to be established.
Topics: Humans; Female; Quality of Life; Hemophilia A; Outcome Assessment, Health Care; Treatment Outcome; Pain
PubMed: 38504408
DOI: 10.1111/hae.14990 -
JAMA Network Open Aug 2023The ideal hospitalist workload and optimal way to measure it are not well understood.
IMPORTANCE
The ideal hospitalist workload and optimal way to measure it are not well understood.
OBJECTIVE
To obtain expert consensus on the salient measures of hospitalist workload.
DESIGN, SETTING, AND PARTICIPANTS
This qualitative study used a 3-round Delphi technique between April 5 and July 13, 2022, involving national experts within and external to the field. Experts included hospitalist clinicians, leaders, and administrators, as well as researchers with expertise in human factors engineering and cognitive load theory.
MAIN OUTCOMES AND MEASURES
Three rounds of surveys were conducted, during which participants provided input on the salient measures of hospitalist workload across various domains. In the first round, free-text data collected from the surveys were analyzed using a directed qualitative content approach. In the second and third rounds, participants rated each measure's relevance on a Likert scale, and consensus was evaluated using the IQR. Percentage agreement was also calculated.
RESULTS
Seventeen individuals from 14 organizations, encompassing clinicians, leaders, administrators, and researchers, participated in 3 rounds of surveys. In round 1, participants provided 135 unique qualitative comments across 10 domains, with 192 unique measures identified. Of the 192 measures presented in the second round, 6 (3%) were considered highly relevant, and 25 (13%) were considered moderately relevant. In round 3, 161 measures not meeting consensus were evaluated, with 25 (16%) considered highly relevant and 95 (59%) considered moderately relevant. Examples of measures considered highly relevant included a patient complexity score and outcome measures such as savings from hospital days avoided and clinician turnover.
CONCLUSIONS AND RELEVANCE
In this qualitative study measuring hospitalist workload, multiple measures, including those quantifying work demands and the association of those demands with outcomes, were considered relevant for measuring and understanding workloads. The findings suggest that relying on traditional measures, such as productivity-related measures and financial measures, may offer an incomplete understanding of workloads and their association with key outcomes. By embracing a broader range of measures, organizations may be able to better capture the complexity and nuances of hospitalist work demands and their outcomes on clinicians, patients, and organizations.
Topics: Humans; Workload; Hospitalists; Outcome Assessment, Health Care; Consensus; Delphi Technique
PubMed: 37561462
DOI: 10.1001/jamanetworkopen.2023.28165