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Evaluation Of Safety Grade, Magnet Recognition And Leapfrog Minimum Volume Standards Among Medicare Patients Undergoing Surgery
*Rittal Mehta, *Diamantis I Tsilimigras, *Kota Sahara, *Anghela Z Paredes, *Amika Moro, *Aslam Ejaz, *Mary Dillhoff, *Jordan Cloyd, *Allan Tsung, Timothy M Pawlik
The Ohio State University Wexner Medical Center, Columbus, OH

OBJECTIVE(S): The association of national quality designations with postoperative outcomes following complex surgery remains poorly defined. The aim of the current study was to assess the relationship between Leapfrog minimum volume standards, Hospital Safety Grades, and Magnet recognition with outcomes among patients undergoing rectal, lung, esophageal and pancreatic resection.
METHODS: The Standard Analytic Files (SAF) linked with Leapfrog Hospital Survey and Leapfrog Safety Scores Denominator Files were utilized to identify Medicare patients who underwent surgery between 2013-2016. Complications, 30-day mortality, as well as textbook outcome (TOO: no readmission, no mortality, no complication and no prolonged length-of-stay) were assessed relative to Leapfrog, Safety Grades and Magnet recognition using multivariable logistic regression.
RESULTS: Among 8,883 Medicare beneficiaries, 2,893 (32.5%) underwent surgery at hospitals with Magnet certification, 2,942 (33.1%) at Safety Grade A hospitals, and 2,272 (25.6%) at hospitals meeting Leapfrog volume standards. 24 (8.3%) hospitals met all three criteria, while 266 (91.7%) did not meet any quality designation. Leapfrog Safety Grade A (n=91, 31.4%) was the most commonly met criterion followed by Magnet recognition (n=68, 23.4%); Leapfrog minimum volume standards were achieved by 66 (22.8%) hospitals. Patients undergoing surgery at hospitals that met all three quality factors had lower odds of complications (OR 0.44, 95%CI 0.32 -0.60), as well as higher odds of experiencing TOO (OR 2.57, 95%CI 1.80 -3.68) (both p<0.05). While Magnet designation or Safety Grade A alone were not associated with TOO, combination of Safety Grade A (OR 1.47, 95% CI 1.24-1.73) or Magnet designation (OR 1.40, 95% CI 1.03-1.88) with Leapfrog volume standard compliance was associated with higher odds of TOO (both p<0.05).
CONCLUSIONS: Magnet status and Safety grade A designation should be considered secondary to Leapfrog procedural volume. Patients and payers should emphasize procedural volume rather than other secondary quality designations to achieve optimal outcomes for patients undergoing complex surgery.


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