Process of Care Partly Explains the Variation in Mortality Between Hospitals After Peripheral Vascular Surgery

• Published in: European journal of vascular and endovascular surgery 2010-08, Vol.40 (2), p.147-154
• Main Authors: Hoeks, S.E, Scholte op Reimer, W.J.M, Lingsma, H.F, van Gestel, Y, van Urk, H, Bax, J.J, Simoons, M.L, Poldermans, D
• Format: Article
• Language: English
• Subjects: Aged; Aortic Aneurysm, Abdominal - surgery; Blood Vessel Prosthesis Implantation - mortality; Comorbidity; Endarterectomy, Carotid - mortality; Female; Hospital Mortality; Humans; Logistic Models; Middle Aged; Netherlands; Performance measures; Peripheral arterial disease; Process Assessment (Health Care); Quality Indicators, Health Care; Quality of care; Quality of Health Care; Risk Assessment; Surgery; Vascular Diseases - epidemiology; Vascular Diseases - surgery; Vascular surgery; Vascular Surgical Procedures - mortality; Vascular Surgical Procedures - standards
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2010.04.005

Abstract Objectives The aim of this study is to investigate whether variation in mortality at hospital level reflects differences in quality of care of peripheral vascular surgery patients. Design Observational study. Materials In 11 hospitals in the Netherlands, 711 consecutive vascular surgery patients were enrolled. Methods Multilevel logistic regression models were used to relate patient characteristics, structure and process of care to mortality at 1 year. The models were constructed by consecutively adding age, sex and Lee index, then remaining risk factors, followed by structural measures for quality of care and finally, selected process of care parameters. Results Total 1-year mortality was 11%, ranging from 6% to 26% in different hospitals. Large differences in patient characteristics and quality indicators were observed between hospitals (e.g., age > 70 years: 28–58%; beta-blocker therapy: 39–87%). Adjusted analyses showed that a large part of variation in mortality was explained by age, sex and the Lee index (Akaike’s information criterion (AIC) = 59, p < 0.001). Another substantial part of the variation was explained by process of care (AIC = 5, p = 0.001). Conclusions Differences between hospitals exist in patient characteristics, structure of care, process of care and mortality. Even after adjusting for the patient population at risk, a substantial part of the variation in mortality can be explained by differences in process measures of quality of care.