Nationwide Outcomes Measurement in XXXX Surgery: Improving Quality and Reducing Costs.

@entity1 @entity353 @entity14
BACKGROUND: Recent literature suggests that focus in health care should shift from reducing costs to improving quality; where quality of health care improves, @entity353 will follow. Our primary aim was to investigate whether improving the quality of surgical @entity14 care, by using a national quality improvement initiative, leads to a reduction of hospital costs. STUDY DESIGN: This was a retrospective analysis of clinical and financial outcomes after @entity14 surgery in 29 Dutch hospitals (9,913 @entity1 ). Detailed clinical data were obtained from the 2010 to 2012 population-based Dutch Surgical Colorectal Audit. @entity1 -level costs were measured uniformly in all participating hospitals and based on time-driven, activity-based costing. Odds ratios (OR) and relative differences (RD) were risk adjusted for hospitals and differences in @entity1 characteristics. RESULTS: Over 3 consecutive years, severe complications and mortality declined by 20% (risk-adjusted OR 0.739, 95% CI 0.653 to 0.836, p < 0.001), and 29% (risk-adjusted OR 0.757, 95% CI 0.571 to 1.003, p  = 0.05), respectively. Simultaneously, costs during primary admission decreased 9% (risk-adjusted RD  -7%, 95% CI  -10% to  -5%, p  <  0.001) without an increase in costs within the first 90 days after discharge (RD  -2%, 95% CI  -10% to 6%, p  =  0.65). An inverse relationship (at hospital level) between severe complication rate and hospital costs was identified (R  = 0.64). Hospitals with increasing severe complication rates (between 2010 and 2012) were associated with increasing costs; hospitals with declining severe complication rates were associated with @entity353 . CONCLUSIONS: This report presents evidence for simultaneous quality improvement and @entity353 . Participation in a nationwide quality improvement initiative with continuous quality measurement and benchmarked feedback reveals opportunities for targeted improvements, bringing the medical field forward in improving value of health care delivery. The focus of health care should shift to improving quality, which will catalyze costs savings as well.
