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Quality measures improve outcomes more than hospital volume alone
Date:5/20/2009

ers noted, and the study team sought to investigate whether some of the success factors of high volume centers or surgeons could be replicable at low volume centers. If so, then perhaps some of the risks associated with going to a low volume center could be mitigated, they said.

Findings showed patients have better outcomes when patient care teams strictly follow a routine of individual quality measures, independent of the volume of procedures performed. Those surgeons and hospitals that performed best on meeting every one of six quality measures had the best outcomes, regardless of their patient volume, the researchers found.

The research also showed that meeting quality measures seems to have an "all or nothing" effect. If a patient care team misses individual quality measures, positive post-operative outcomes decline precipitously. Study results suggested a strong association between the number of quality measures missed and death rates regardless of annual hospital volume for coronary artery bypass surgery, with mortality rates similar across all levels of hospital volume if no quality measures are missed.

The six quality measures were whether antimicrobials were used to prevent surgical site infection on the operative day, whether the antimicrobial was appropriate, whether serial compression devices were used to prevent venous thromboembolism on the operative day, and whether aspirin, beta-blockers, or statin lipid-lowering drugs were administered in the first two days after surgery.

The research team found that what made the biggest difference in mortality was whether any of the quality measures were missed. "It doesn't help if you got your aspirin but you didn't get your beta-blockers," said Auerbach. "You have to have everything on the list, or else a good explanation for why you did not."

Auerbach noted that the researchers assumed doctors in the study were administering medicines smartly; for example,
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Contact: Kirsten Michener
kmichener@pubaff.ucsf.edu
415-476-2557
University of California - San Francisco
Source:Eurekalert

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