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Comparing cataract surgery complication rates in veterans receiving VA and community care.
Rosen, Amy K; Vanneman, Megan E; O'Brien, William J; Pershing, Suzann; Wagner, Todd H; Beilstein-Wedel, Erin; Lo, Jeanie; Chen, Qi; Cockerham, Glenn C; Shwartz, Michael.
Afiliación
  • Rosen AK; Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts.
  • Vanneman ME; Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS), VA Salt Lake City Health Care System, Salt Lake City, Utah.
  • O'Brien WJ; Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts.
  • Pershing S; Department of Ophthalmology, VA Palo Alto Health Care System, Palo Alto, California.
  • Wagner TH; Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California.
  • Beilstein-Wedel E; Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts.
  • Lo J; Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California.
  • Chen Q; Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts.
  • Cockerham GC; Department of Ophthalmology, Stanford University School of Medicine, Stanford, California.
  • Shwartz M; Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts.
Health Serv Res ; 55(5): 690-700, 2020 10.
Article en En | MEDLINE | ID: mdl-32715468
OBJECTIVES: To compare 90-day postoperative complication rates between Veterans receiving cataract surgery in VA vs Community Care (CC) during the first year of implementation of the Veterans Choice Act. DATA SOURCES: Fiscal Year (FY) 2015 VA and CC outpatient data from VA's Corporate Data Warehouse (CDW) 10/01/14-9/30/15). FY14 data were used to obtain baseline clinical information prior to surgery. STUDY DESIGN: Retrospective one-year study using secondary data to compare 90-day complication rates following cataract surgery (measured using National Quality Forum (NQF) criteria) in VA vs CC. NQF defines major complications from a specified list of Current Procedural Terminology (CPT) codes. We ran a series of logistic regression models to predict 90-day complication rates, adjusting for Veterans' sociodemographic characteristics, comorbidities, preoperative ocular conditions, eye risk group, and type of cataract surgery (classified as routine vs complex). DATA COLLECTION: We linked VA and CC users through patient identifiers obtained from the CDW files. Our sample included all enrolled Veterans who received outpatient cataract surgery either in the VA or through CC during FY15. Cataract surgeries were identified through CPT codes 66 984 (routine) and 66 982 (complex). PRINCIPAL FINDINGS: Of the 83,879 cataract surgeries performed in FY15, 31 percent occurred through CC. Undergoing complex surgery and having a high-risk eye (based on preoperative ocular conditions) were the strongest clinical predictors of 90-day postoperative complications. Overall, we found low complication rates, ranging from 1.1 percent in low-risk eyes to 3.6 percent in high-risk eyes. After adjustment for important confounders (eg, race, rurality, and preoperative ocular conditions), there were no statistically significant differences in 90-day complication rates between Veterans receiving cataract surgery in VA vs CC. CONCLUSIONS: As more Veterans seek care through CC, future studies should continue to monitor quality of care across the two care settings to help inform VA's "make vs buy decisions."
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Veteranos / Extracción de Catarata / United States Department of Veterans Affairs Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Health Serv Res Año: 2020 Tipo del documento: Article

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Veteranos / Extracción de Catarata / United States Department of Veterans Affairs Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Health Serv Res Año: 2020 Tipo del documento: Article