MedicalResearch.com Interview with:
Hillary J. Mull, PhD, MPP
Center for Healthcare Organization and Implementation Research
Veterans Affairs (VA) Boston Healthcare System
Department of Surgery, Boston University School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Little is known about outpatient procedures that can be considered invasive but are not conducted in a surgical operating room. These procedures are largely neglected by quality or patient safety surveillance programs, yet they are increasingly performed as technology improves and the U.S. population gets older.
We assessed the rate of invasive procedures across five specialties, urology, podiatry, cardiology, interventional radiology and gastroenterology in the Veterans Health Administration between fiscal years 2012 and 2015. Our analysis included examining the rates of post procedure emergency department visits and hospitalizations within 14 days and the key patient, procedure or facility characteristics associated with these outcomes. We found varying rates of post procedure ED visits and hospitalizations across the specialties with podiatry accounting for a high volume of invasive outpatient care but the lowest rate of postoperative utilization (1.8%); in contrast, few of the procedures were in interventional radiology, but the postoperative utilization rate was the highest at 4.7%. In a series of logistic regression models predicting post procedure healthcare utilization for each specialty, we observed significantly higher odds of post procedural outcomes for African American patients compared to white patients.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: Invasive outpatient procedures are commonly performed and between 2-5% of cases are associated with post-procedure ED visits or hospitalizations. This finding challenges the perceived safety of invasive outpatient procedures. Furthermore, we observed racial disparities that should be further explored.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Post procedure utilization is a useful metric, but we do not know how many of the ED visits and hospitalizations reflect true patient safety problems associated with the invasive outpatient procedure. Future work should examine these procedures with chart review to better understand the rate and type of adverse events and identify opportunities for quality improvement, particularly among minority race patients. This study uses data from the VA and it is important to also examine data from private sector healthcare providers.
The opinions expressed are those of the author and not necessarily the views of the U.S. Department of Veterans Affairs.
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Mull HJ, Gellad ZF, Gupta RT, et al. Factors Associated With Emergency Department Visits and Hospital Admissions After Invasive Outpatient Procedures in the Veterans Health Administration. JAMA Surg. Published online May 02, 2018. doi:10.1001/jamasurg.2018.0874
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