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. 2015 Nov;53(11):960-6.
doi: 10.1097/MLR.0000000000000425.

Variation in Patient-reported Outcomes Across Hospitals Following Surgery

Jennifer F Waljee  1 , Amir Ghaferi, Jonathan F Finks, Ruth Cassidy, Oliver Varban, Arthur Carlin, Noelle Carlozzi, Justin Dimick
Affiliations

Variation in Patient-reported Outcomes Across Hospitals Following Surgery

Jennifer F Waljee et al. Med Care. 2015 Nov.

Abstract

Background: Although there is growing interest in applying patient-reported outcomes (PROs) toward surgical quality, the extent to which PROs vary across hospitals following surgical procedures is unknown.

Objectives: We examined variation in PROs, specifically health-related quality of life (HRQOL), across hospitals performing bariatric surgery.

Research design: A retrospective cohort study.

Subjects: The Michigan Bariatric Surgery Collaborative is a statewide consortium of 39 hospitals performing laparoscopic gastric bypass, gastric banding, or sleeve gastrectomy (n=11,420 patients between 2008 and 2012).

Measures: We examined generic and disease-specific HRQOL measured by the Health and Activities Limitations Index (HALex) and Bariatric Quality of Life index (BQL) preoperatively and at 1 year. We measured the variation in postoperative HRQOL across hospitals, and the effect of risk and reliability adjustment on hospital ranking.

Results: In this cohort, HRQOL varied by 56% (HALex) and 37% (BQL) across hospitals. Patient factors accounted for 58% (HALex) to 71% (BQL) of the variation in HRQOL across hospitals. After risk and reliability adjustment, HRQOL varied by 18% (by HALex) and 14.5% (by BQL) across hospitals, and the proportion of patients who experienced a large improvement in HRQOL by HALex ranged from 33% to 69% and 67% to 92% by BQL. After adjusting for patient factors and reliability, these differences diminished to 55%-64% (HALex) and 79%-84% (BQL).

Conclusions: Patient factors explain a large proportion of hospital-level variation in PROs following bariatric surgery, underscoring the importance of risk adjustment. However, some variation in PROs across hospitals remains unexplained, suggesting PROs may represent a viable indicator of hospital performance.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1.
FIGURE 1.
Unadjusted hospital ranking by proportion of patients who experienced a large improvement in HRQOL following bariatric surgery at 1 year as measured by HALex score at 1 year following bariatric surgery. HALex indicates Health and Activities Limitations Index; HRQOL, and health-related quality of life.
FIGURE 2.
FIGURE 2.
Hospital ranking by proportion of patients who experienced a large improvement in HRQOL following bariatric surgery at 1 year as measured by HALex score at 1 year following bariatric surgery, adjusted for patient risk factors and reliability. HALex indicates Health and Activities Limitations Index; HRQOL, and health-related quality of life.
FIGURE 3.
FIGURE 3.
Unadjusted hospital ranking by proportion of patients who experienced a large improvement in HRQOL following bariatric surgery at 1 year as measured by BQL score at 1 year following bariatric surgery. BQL indicates Bariatric Quality of Life index; HRQOL, and health-related quality of life.
FIGURE 4.
FIGURE 4.
Hospital ranking by proportion of patients who experienced a large improvement in HRQOL following bariatric surgery at 1 year as measured by BQL score at 1 year following bariatric surgery, adjusted for patient risk factors and reliability. BQL indicates Bariatric Quality of Life index; HRQOL, and health-related quality of life.
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