دورية أكاديمية
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What is the role of selection bias in quality comparisons between the Veterans Health Administration and community care? Example of elective hernia surgery.

التفاصيل البيبلوغرافية
العنوان: What is the role of selection bias in quality comparisons between the Veterans Health Administration and community care? Example of elective hernia surgery.
المؤلفون: Mull HJ; Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, USA.; Department of Surgery, Boston University School of Medicine, Boston, Massachusetts, USA., Kabdiyeva A; Partnered Evidence-based Policy Resource Center (PEPReC), Department of Veterans Affairs, Boston, Massachusetts, USA., Ndugga N; Partnered Evidence-based Policy Resource Center (PEPReC), Department of Veterans Affairs, Boston, Massachusetts, USA., Gordon SH; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA., Garrido MM; Partnered Evidence-based Policy Resource Center (PEPReC), Department of Veterans Affairs, Boston, Massachusetts, USA.; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA., Pizer SD; Partnered Evidence-based Policy Resource Center (PEPReC), Department of Veterans Affairs, Boston, Massachusetts, USA.; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA.
المصدر: Health services research [Health Serv Res] 2023 Jun; Vol. 58 (3), pp. 654-662. Date of Electronic Publication: 2022 Dec 25.
نوع المنشور: Journal Article; Research Support, U.S. Gov't, Non-P.H.S.
اللغة: English
بيانات الدورية: 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
أسماء مطبوعة: Publication: Malden, MA : Blackwell
Original Publication: Chicago, Hospital Research and Educational Trust.
مواضيع طبية MeSH: Veterans Health* , Veterans*, United States ; Humans ; United States Department of Veterans Affairs ; Selection Bias ; Elective Surgical Procedures ; Postoperative Complications/epidemiology
مستخلص: Objective: To investigate the relationship between community care (CC) treatment and a postoperative surgical complication in elective hernia surgery among Veterans using multiple approaches to control for potential selection bias.
Data Sources and Study Setting: Veterans Health Administration (VHA) data sources included Corporate Data Warehouse (VHA encounters and patient data), the Program Integrity Tool and Fee tables (CC encounters), the Planning Systems Support Group (geographic information), and the Paid file (VHA primary care providers).
Study Design: Prior works suggest patient outcomes are better in VHA than in CC settings; however, these studies may not have appropriately accounted for the selection of higher-risk cases into CC. We estimated (1) a naïve logistic regression model to calculate the effect of CC setting on the probability of a complication, controlling for facility fixed effects and patient and procedure characteristics, and (2) a 2-stage model using the hernia patient's primary care provider's 1-year prior CC referral rate as the instrument.
Data Collection: We identified patients residing ≤40 miles from a VHA surgical facility with elective VHA or CC hernia surgery from 2018 to 2019.
Principal Findings: Of 7991 hernia surgeries, 772 (9.7%) were in CC. The overall complication rate was 4.2%; 286/7219 (4.0%) among VHA surgeries versus 51/5772 (6.6%, p < 0.05) in CC. We observed a 2.8 percentage point increase in the probability of postoperative complication given CC surgery (95% confidence interval: 0.7, 4.8) in the naïve model. After accounting for the VHA provider's historical rate of CC referral, we no longer observed a relationship between surgery setting and risk of postoperative complication.
Conclusions: After accounting for the selection of higher-risk patients to CC settings, we found no difference in hernia surgery postoperative complications between CC and VHA. Future VHA and non-VHA comparisons should account for unobserved as well as observed differences in patients seen in each setting.
(Published 2022. This article is a U.S. Government work and is in the public domain in the USA.)
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معلومات مُعتمدة: PEC 16-001 United States VA VA
فهرسة مساهمة: Keywords: MISSION Act; Veteran Health Administration; fee-for-service care; instrumental variable; outpatient surgery; selection bias
تواريخ الأحداث: Date Created: 20221208 Date Completed: 20230504 Latest Revision: 20240603
رمز التحديث: 20240603
مُعرف محوري في PubMed: PMC10154155
DOI: 10.1111/1475-6773.14113
PMID: 36477645
قاعدة البيانات: MEDLINE
الوصف
تدمد:1475-6773
DOI:10.1111/1475-6773.14113