This study addresses the question for cholecystectomy patients of whether there is an association among manifesting better health outcomes and the quantity of hospital resources consumed when the appropriateness of this surgery is also considered. 10 043 cholecystectomies performed by 218 surgeons in 43 Pennsylvanian hospitals are analysed using data from an administrative data set. Performance measures are adjusted for admission severity of illness and other patient variables. The results demonstrate a statistically significant positive association between adjusted hospital total charges and adjusted morbidity controlling for whether specified clinical criteria are met that validate the need for a cholecystectomy. This study illustrates a systems quality paradigm wherein performance is examined in terms of health outcomes, appropriateness and resource expenditures, as well as the relationships among these three dimensions.
Get full access to this article
View all access options for this article.
References
1.
AllenH. M.DarlingH.McNeillD. N.BastienF. (1994). ‘The employee health care value survey: round one’. Health Affairs, 13 (4): 25–41.
2.
American Hospital Association (1990). Guide to the Health Care Field. Chicago: Americal Hospital Association.
3.
American Hospital Association (1991). Directory of Health Care Coalitions in the United States. Chicago: Americal Hospital Association.
4.
ArndtM.BradburyR. C. (1995). ‘Admission severity of illness and resource utilization: comaring Medicaid and privately insured patients.’ Hospital and Health Services Administration, 40 (2): 211–226.
5.
BerwickD. M. (1989). ‘Continuous improvement as an ideal in health care.’ New England Journal of Medicine, 320 (1): 53–56.
6.
BradburyR. C. (1977). ‘Policymaking and the planning process.’ American Journal of Health Planning, 1 (4): 37–43.
7.
BradburyR. C. (1987). ‘A community approach to health care competition.’ Inquiry, 24 (3): 253–265.
8.
BradburyR. C.StearnsF. E.SteenP. M. (1991a). ‘Interhospital variations in admission severity-adjusted hospital mortality and morbidity.’ Health Services Research, 26 (4): 407–424.
9.
BradburyR. C.GolecJ. H.StearnsF. E. (1991b). ‘Comparing hospital length of stay in independent practice association HMOs and traditional insurance programs.’ Inquiry, 28 (1): 87–93.
10.
BradburyR. C.GolecJ. H.SteenP. M. (1994). ‘Relating hospital health outcomes and resource expenditures.’ Inquiry, 31 (1): 56–65.
11.
BradburyR. C.GolecJ. H.SteenP. M. (1995). ‘Occurrence of validating clinical findings in the hospital record for appendectomy, cholecystectomy and intervertebral disc excision patients: comparisons among hospitals and among surgeons.’ Health Services Management Research, 8 (4): 1–12.
12.
BrewsterA. C.KarlinB. G.HydeL. A.BradburyR. C.ChaeY. M. (1985). ‘MEDISGRPS: a clinically based approach to classifying hospital patients at admission.’ Inquiry, 22 (4): 377–387.
13.
Commonwealth of Pennsylvania (1990). Hospital Effectiveness Report, Technical Notes. Harrisburg: Pennsylvania Health Care Cost Containment Commission.
EnthovenA. C. (1993). ‘The history and principles of managed competition.’ Health Affairs, 12 (suppl): 24–48.
16.
EscarceJ. J.ChenW.SchwartzJ. S. (1995). ‘Falling cholecystectomy thresholds since the introduction of laparoscopic cholecystectomy.’ JAMA, 273 (20): 1581–1585.
17.
FitzpatrickG.NeutraR.GilbertJ. P. (1977). ‘Cost-effectiveness of cholecystectomy for silent gallstones.’ In: BunkerJ. P.BarnesB. A.MostellerF. (eds), Costs, Risks and Benefits of Surgery. New York: Oxford University Press, pp. 246–261.
18.
FlemingS. T. (1984). ‘The relationship between the cost and quality of hospital care: a review of the literature.’ Medical Care Review, 47 (4): 487–502.
19.
FlemingS. T. (1991). ‘The relationship between quality and cost: pure and simple?’ Inquiry, 28 (1): 29–38.
20.
FraserG. M.PilpelD.HollisS.KosecoffJ.BrookR. H. (1993). ‘Indications for cholecystectomy: the results of a consensus panel approach.’ Quality Assurance in Health Care, 5 (1): 75–85.
21.
GracieW. A.RansohoffD. F. (1982). ‘The natural history of silent gallstones.’ New England Journal of Medicine, 307 (13): 798–800.
22.
GriffithJ. R.SahneyV. K.MohrR. A. (1995). Reengineering Health Care, Building on CQI. Ann Arbor: Health Administration Press.
23.
IezzoniL. I.AshA. S.MoskowitzM. A. (1987). MEDISGROUPS: A Clinical and Analytic Assessment. Boston: Health Policy Research Consortium, Boston University Medical Center.
24.
IezzoniL. I.MoskowitzM. A. (1988). ‘A clinical assessment of MedisGroups.’ JAMA, 260 (21): 3159–3163.
25.
Joint Commission on Accreditation of Healthcare Organizations (1991). An Introduction to Quality Improvement in Health Care. Joint Commission on Accreditation of Healthcare: Illinois.
26.
JohnsonK. L. (1993). ‘Health care coalitions: an emerging force for change.’ Hospital and Health Services Administration, 38 (4): 557–571.
27.
LeapeL. L. (1989). ‘Unnecessary surgery.’ Health Services Research, 24 (3): 351–407.
28.
McLaughlinC. G.ZellersW. K.BrownL. D. (1989). ‘Health care coalitions: characteristics, activities, and prospects.’ Inquiry, 26 (1): 72–83.
29.
MediQual Systems, Inc (1991). MedisGroups Procedure Monitoring Report Module — User Documentation. MediQual Systems Inc: Westborough, MA.
30.
National Committee for Quality Assurance (1993). Healthplan Employer Data and Information Set and User's Manual, Version 2.0. National Committee for Quality Assurance: Washington.
31.
NIH Consensus Development Panel on Gallstones and Laparoscopic Cholecystectomy (1993). ‘Gallstones and laparoscopic cholecystectomy.’ JAMA, 269 (8): 1018–1024.
32.
PaulyM. V. (1994). ‘The Clinton plan: what happened to the tough choices?’ Health Affairs, 13 (1): 147–160.
33.
RansohoffD. F. (1995). ‘Why are cholecystectomy rates increasing?’ JAMA, 273 (20): 1621–1622.
34.
RansohoffD. F.GracieW. A.WolfensonL. B.NeuhauserD. (1983). ‘Prophylactic cholecystectomy or expectant management of silent gallstones.’ Annals of Internal Medicine, 99 (2): 199–203.
35.
ScottW. R.FloodA. B. (1984). ‘Cost and quality of hospital care: a review of the literature.’ Medical Care Review, 41 (3): 213–261.
36.
SolomonD. H.BrookR. H.FinkA.ParkR. E.KeeseyJ. (1986). Indications for Selected Medical and Surgical Procedures — A Literature Review and Ratings of Appropriateness: Colecystectomy. Santa Monica: RAND Corporation.
37.
SteenP. M.BrewsterA. C.BradburyR. C. (1993). ‘Predicted Probabilities of Hospital Death as a Measure of Admission Severity of Illness.’ Inquiry, 30 (2): 128–141.
38.
ThomasJ. W.AshcraftM. L. F. (1989). ‘Measuring Severity of Illness: A Comparison of Interrater Reliability.’ Inquiry, 26 (4): 483–492.
39.
WareJ. H.MostellerF.IngelfingerJ. A. (1986). ‘P values.’ In: BailarJ.C.MostellerF. (eds) Medical Uses of Statistics. Waltham, MA: NEJM Books.
40.
WennbergJ. E. (1984). ‘Dealing with medical practice variations: a proposal for action.’ Health Affairs, 3 (2): 6–32.
41.
White House Domestic Policy Council (1993). The President's Health Security Plan. New York: Times Books.
42.
ZelmanW. A. (1994). ‘The rationale behind the Clinton Health Care Reform Plan.’ Health Affairs, 13 (1): 9–29.
