Quality of British and American Nationwide Quality of Care and Patient Safety Benchmarking Programs : Case Neurosurgery

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dc.contributor.author Reponen, Elina
dc.contributor.author Tuominen, Hanna
dc.contributor.author Korja, Miikka
dc.date.accessioned 2020-01-09T06:57:01Z
dc.date.available 2020-01-09T06:57:01Z
dc.date.issued 2019-10
dc.identifier.citation Reponen , E , Tuominen , H & Korja , M 2019 , ' Quality of British and American Nationwide Quality of Care and Patient Safety Benchmarking Programs : Case Neurosurgery ' , Neurosurgery (Baltimore) , vol. 85 , no. 4 , pp. 500-507 . https://doi.org/10.1093/neuros/nyy380
dc.identifier.other PURE: 129738952
dc.identifier.other PURE UUID: 5013440b-15e6-4cd2-9288-c930398e0af8
dc.identifier.other WOS: 000491255600008
dc.identifier.other ORCID: /0000-0002-4463-6954/work/67135334
dc.identifier.uri http://hdl.handle.net/10138/309142
dc.description.abstract BACKGROUND: Multiple nationwide outcome registries are utilized for quality benchmarking between institutions and individual surgeons. OBJECTIVE: To evaluate whether nationwide quality of care programs in the United Kingdom and United States can measure differences in neurosurgical quality. METHODS: This prospective observational study comprised 418 consecutive adult patients undergoing elective craniotomy at Helsinki University Hospital between December 7, 2011 and December 31, 2012.We recorded outcome event rates and categorized them according to British Neurosurgical National Audit Programme (NNAP), American National Surgical Quality Improvement Program (NSQIP), and American National Neurosurgery Quality and Outcomes Database (N(2)QOD) to assess the applicability of these programs for quality benchmarking and estimated sample sizes required for reliable quality comparisons. RESULTS: The rate of in-hospital major and minor morbidity was 18.7% and 38.0%, respectively, and 30-d mortality rate was 2.4%. The NSQIP criteria identified 96.2% of major but only 38.4% of minor complications. N(2)QOD performed better, but almost one-fourth (23.2%) of all patients with adverse outcomes, mostly minor, went unnoticed. For NNAP, a sample size of over 4200 patients per surgeon is required to detect a 50.0% increase in mortality rates between surgeons. The sample size required for reliable comparisons between the rates of complications exceeds 600 patients per center per year. CONCLUSION: The implemented benchmarking programs in the United Kingdom and United States fail to identify a considerable number of complications in a high-volume center. Health care policy makers should be cautious as outcome comparisons between most centers and individual surgeons are questionable if based on the programs. en
dc.format.extent 8
dc.language.iso eng
dc.relation.ispartof Neurosurgery (Baltimore)
dc.rights unspecified
dc.rights.uri info:eu-repo/semantics/openAccess
dc.subject Quality of care
dc.subject Patient safety
dc.subject Benchmarking
dc.subject UNRUPTURED INTRACRANIAL ANEURYSM
dc.subject SURGICAL SITE INFECTION
dc.subject HOSPITAL PARTICIPATION
dc.subject OPERATIVE DURATION
dc.subject PATIENTS VALIDITY
dc.subject RISK-FACTORS
dc.subject CRANIOTOMY
dc.subject OUTCOMES
dc.subject TUMOR
dc.subject MORTALITY
dc.subject 3112 Neurosciences
dc.subject 3124 Neurology and psychiatry
dc.subject 3126 Surgery, anesthesiology, intensive care, radiology
dc.title Quality of British and American Nationwide Quality of Care and Patient Safety Benchmarking Programs : Case Neurosurgery en
dc.type Article
dc.contributor.organization HUS Perioperative, Intensive Care and Pain Medicine
dc.contributor.organization Anestesiologian yksikkö
dc.contributor.organization University of Helsinki
dc.contributor.organization Department of Diagnostics and Therapeutics
dc.contributor.organization Clinicum
dc.contributor.organization HUS Neurocenter
dc.contributor.organization Neurokirurgian yksikkö
dc.description.reviewstatus Peer reviewed
dc.relation.doi https://doi.org/10.1093/neuros/nyy380
dc.relation.issn 0148-396X
dc.rights.accesslevel openAccess
dc.type.version publishedVersion

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