Surgical Volume Matters: Helping Patients Pick Hospitals

Dartmouth College, Hanover NH

Investigators

Linked publications & trials

Abstract

DESCRIPTION: (Adapted from the application) Context: It is well documented that for many high-risk operations, there is a strong association between procedure-specific hospital volume and mortality. The Center for Medicare and Medicaid Services (CMS) is considering a large-scale effort to disseminate hospital volume information to beneficiaries in the hope that patients will select to have surgery at high volume centers. Before moving forward with their plan, CMS needs to learn: what information should be communicated, how it should be presented, and whether having such information would influence how patients make choices. Objectives: To learn how Medicare patients currently choose hospitals for surgery. We plan a national telephone survey of Medicare beneficiaries who recently underwent surgery to find out how they chose their hospital. We will assess whether hospital volume influenced their choice, how involved they were in the decision process, and what resources they used to find out about hospitals. To determine how to inform Medicare beneficiaries about volume and surgical risk. We plan to develop and field test educational formats for presentation of surgical volume information. These materials will provide an overview of the volume-outcome association as well as give hospital-specific volume data. Methods: Hospital selection survey. Building on our ongoing survey as a first draft, we will work with survey research consultants to develop a telephone interview through cognitive interviews and pilot testing with Medicare patients who recently underwent surgery. The final version will be administered to a random national sample of Medicare beneficiaries who recently had 1 of 14 high-risk operations with volume-outcome associations of varying strength. Development/field testing of educational materials: We will draft formats for presenting volume-outcomes data to patients with input from content experts in education, epidemiology, and cognitive psychology. We will perform semi-structured in-person interviews with Medicare beneficiaries to ensure that materials are understood and to see how subjects respond to alternative formats (Are some formats more effective than others?, Would patients use volume if they had to select a hospital? And if so, how). Significance: At the conclusion of the project, we will have a template for presenting information about surgical volume that patients can understand. In addition, we will gain insight into whether and how patients might use such data (e.g., how great a reduction in mortality would prompt patients to move to higher volume hospitals). This information will be essential to consider when deciding which operations to focus on for dissemination of information about volume and surgical risk.