Evaluating quality, cost-effective health care

Vascular database predicated on hospital discharge abstracts

W. H. Edwards, J. A. Morris, J. M. Jenkins, S. M. Bass, E. J. MacKenzie

    Research output: Contribution to journalArticle

    44 Citations (Scopus)

    Abstract

    This population-based study examines all carotid endarterectomies (CE) performed by all surgeons in a single state over a 10-year period. The methodology is designed to determine morbidity rate, mortality rate, cost, and length of stay, as well as to understand the effect of pre-existing chronic disease, physician, and hospital volume on these outcome variables. The data source consisted of hospital discharge abstract data uniformly collected on all admissions (N = 5.9 million) to acute care hospitals in the state. In the decade 1979 to 1988, 11,199 patients underwent CE. Mortality rate from CE was 2.1%, and the postoperative stroke rate was 3.7% over this period. High physician volume decreased the mortality rate (p < 0.05) and stroke rate (p < 0.01) by 50% and significantly (p < 0.001) reduced hospital cost and length of stay independent of patient complexity. Examination of cost data, adjusted for inflation, showed a decrease in mean cost for CE over the decade. Thus physicians are providing better care for less hospital dollars. Both patient and payor outcome is improved by concentrating CE patients in the hands of high-volume surgeons. Although the data suggests this trend is already evolving, the pace of this evolution can be expected to increase as payors recognize that regionalization of this procedure lowers costs.

    Original languageEnglish (US)
    Pages (from-to)433-439
    Number of pages7
    JournalAnnals of Surgery
    Volume213
    Issue number5
    DOIs
    StatePublished - Jan 1 1991

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    Carotid Endarterectomy
    Health Care Costs
    Blood Vessels
    Databases
    Costs and Cost Analysis
    Physicians
    Mortality
    Length of Stay
    Stroke
    Chronic Disease Hospitals
    Preexisting Condition Coverage
    State Hospitals
    Hospital Costs
    Information Storage and Retrieval
    Economic Inflation
    Morbidity
    Population
    Surgeons

    All Science Journal Classification (ASJC) codes

    • Surgery

    Cite this

    Evaluating quality, cost-effective health care : Vascular database predicated on hospital discharge abstracts. / Edwards, W. H.; Morris, J. A.; Jenkins, J. M.; Bass, S. M.; MacKenzie, E. J.

    In: Annals of Surgery, Vol. 213, No. 5, 01.01.1991, p. 433-439.

    Research output: Contribution to journalArticle

    Edwards, W. H. ; Morris, J. A. ; Jenkins, J. M. ; Bass, S. M. ; MacKenzie, E. J. / Evaluating quality, cost-effective health care : Vascular database predicated on hospital discharge abstracts. In: Annals of Surgery. 1991 ; Vol. 213, No. 5. pp. 433-439.
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