Validation of Quality Measures for Hip Replacement. Abstract, Executive Summaryand Final Report

摘要

The principal aims of this project were to validate indicators of the quality ofelective total hip replacement (THR) and to develop a cumulative index of indicators of the quality of THR. A panel of clinical and quality improvement experts recommended potential indicators of the quality of THR. We validated these indicators empirically in a population-based sample of 5211 Medicare beneficiaries who had primary 171 randomly selected hospitals in three states. In univariate analyses, urban, private, and teaching hospitals, and hospitals with laminar airflow equipment in the operating room and dedicated orthopedic units had higher rates of dislocation or infection within 90 days of surgery. In multivariate analyses, these variables explained some of the influence of volume, while surgeon volume virtually eliminated the hospital volume effect. We created a cumulative index comprised of three of these indicators. Hospitals with none of these characteristics had adverse orthopedic event rates of 5.4%, while hospitals with all three had event rates of just 1.3% (p less than 0.0001). Our findings (which are still preliminary) suggest that hospital characteristics are associated with outcome, and have cumulative effect, but do not fully explain the strong influence upon outcome of hospital and surgeon case volume.