Quality varies wildly among affiliates linked with US News top hospitals, JAMA study finds

By | March 14, 2019

Dive Brief:

  • Choosing to have surgery at a facility affiliated with a highly rated U.S. hospital doesn’t guarantee the same quality experience, a new study in JAMA Surgery finds.
  • In an analysis of hospitals affiliated with U.S. News & World Report Honor Roll hospitals, surgical outcomes varied widely both within and across networks.
  • Moreover, Honor Roll hospitals didn’t always outperform network affiliates. While they had lower failure to rescue rates (13.3% versus 15.1%), their complication rates were actually higher (22.1% vs 18%).

Dive Insight:

Ben Harder, chief of health analysis at U.S. News, noted on Twitter that the study’s findings were not surprising. “That variation is why we evaluate discrete hospitals, not hospital system brands,” he said.

The researchers analyzed data from Medicare beneficiaries who underwent colectomy, coronary artery bypass graft or hip replacement at 87 hospitals belonging to one of 16 networks affiliated with Honor Roll hospitals to see how they differed in risk-adjusted outcomes. 

For failure to rescue, variations in outcomes within networks ranged from as little as 1.1-fold for failure to as high as 4.9-fold. Across all networks, complication rates varied by 1.1-fold to 4.3-fold. 

The findings have implications for patients, but also for large hospital systems looking to expand services at more of their facilities. 

“The wide variation in outcomes suggests that multihospital networks are not realizing the potential to leverage their combined resources to optimize these services across the entire clinical delivery system,” the authors write.

They note that while networks often take advantage of economies of scale and administrative efficiencies to reduce costs and waste, opportunities to impact quality of care are often overlooked. 

Monitoring for variations within networks could help change that. For  example, systems could centralize care at specified referral centers for rare conditions, high-risk patients or volume-sensitive procedures. They also could enhance quality at affiliates by exporting best practices from high-performing hospitals.

“Networks choosing to expand services across more affiliated hospitals can use coordinated peer-to-peer collaborative improvement plans in which hospitals learn from the experience of the Honor Roll hospital or other centers with the best outcomes,” the authors say. “In this context, the practices of high-performing affiliates, such as training staff to recognize and appropriately manage complications, are teachable or exportable to the entire network.”

They also call for increased transparency around the quality at all network-affiliated hospitals.  

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