Unwarranted Variation in the Quality of Care for Patients With Diseases of the Thoracic Aorta.pdf (3.86 MB)
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Unwarranted Variation in the Quality of Care for Patients With Diseases of the Thoracic Aorta

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journal contribution
posted on 06.10.2017, 15:39 by Alex Bottle, Giovanni Mariscalco, Matthew A. Shaw, Umberto Benedetto, Athanasios Saratzis, Silvia Mariani, Mohamad Bashir, Paul Aylin, David Jenkins, Aung Y. Oo, Gavin J. Murphy, UK Aortic Forum
BACKGROUND: Thoracic aortic disease has a high mortality. We sought to establish the contribution of unwarranted variation in care to regional differences in outcomes observed in patients with thoracic aortic disease in England. METHODS AND RESULTS: Data from the Hospital Episode Statistics (HES) and the National Adult Cardiac Surgery Audit (NACSA) were extracted. A parallel systematic review/meta-analysis through December 2015, and structure and process questionnaire of English cardiac surgery units were also accomplished. Treatment and mortality rates were investigated. A total of 24 548 adult patients in the HES study, 8058 in the NACSA study, and 103 543 from a total of 33 studies in the systematic review were obtained. Treatment rates for thoracic aortic disease within 6 months of index admission ranged from 7.6% to 31.5% between English counties. Risk-adjusted 6-month mortality in untreated patients ranged from 19.4% to 36.3%. Regional variation persisted after adjustment for disease or patient factors. Regional cardiac units with higher case volumes treated more-complex patients and had significantly lower risk-adjusted mortality relative to low-volume units. The results of the systematic review indicated that the delivery of care by multidisciplinary teams in high-volume units resulted in better outcomes. The observational analyses and the online survey indicated that this is not how services are configured in most units in England. CONCLUSIONS: Changes in the organization of services that address unwarranted variation in the provision of care for patients with thoracic aortic disease in England may result in more-equitable access to treatment and improved outcomes.

History

Citation

Journal of the American Heart Association, 2017, 6 (3)

Author affiliation

/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/School of Medicine/Department of Cardiovascular Sciences

Version

VoR (Version of Record)

Published in

Journal of the American Heart Association

Publisher

American Heart Association, Inc.

eissn

2047-9980

Acceptance date

07/02/2017

Copyright date

2017

Available date

06/10/2017

Publisher version

http://jaha.ahajournals.org/content/6/3/e004913

Language

en

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