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Open heart surgery in public and private practice
1Catalan Agency for Health Technology Assessment (Agència d'Avaluació de Tecnología Medica), Catalan Health Service, Barcelona, Spain.
Insights
Public and private hospitals in Catalonia showed differences in open heart surgery patient risk and outcomes. After adjusting for patient complexity, surgical mortality rates were similar between public and private providers.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Public Health Policy
Background:
- Public and private hospitals offer open heart surgery services in Catalonia, Spain.
- Patient case mix, procedures, and surgical mortality may differ between these providers.
- Understanding these differences is crucial for evaluating healthcare quality and equity.
Purpose of the Study:
- To compare open heart surgery services in public versus private hospitals in Catalonia.
- To analyze differences in patient case mix, surgical procedures, and mortality rates.
- To determine if provider type influences surgical outcomes after adjusting for patient risk.
Main Methods:
- Prospective data collection on 1287 adult open heart surgery procedures over 6.5 months in 1994.
- Inclusion of sociodemographic, clinical, and procedural variables.
- Utilized a predictive model to adjust for surgical mortality risk and case mix differences.
Main Results:
- Significant differences observed in patient demographics, clinical history, and procedures between public and private centers.
- Higher-risk patients were more likely to be treated in public centers.
- Crude surgical mortality rates varied, but after adjusting for case mix, the difference between public and private providers was not statistically significant (OR 1.68; 95% CI 0.94-3.0).
Conclusions:
- Crude mortality rates differ between public and private providers, with higher surgical risk in public centers.
- Adjusting for surgical risk significantly reduced and eliminated statistically significant differences in mortality between provider types.
- Socioeconomic factors, like educational level, may influence patient selection and contribute to observed differences in surgical risk and performance.
Objectives:
To compare open heart surgery services provided by public and private hospitals in Catalonia (Spain) according to case mix, procedures undergone and surgical mortality.
Methods:
Data on all adult patients undergoing open heart surgery procedures were collected prospectively in a sample of public and privately owned centres for a 6.5-month period in 1994. Sociodemographic, clinical and procedural variables were collected. A predictive model stratifying patients according to their surgical mortality risk was used to adjust for differences in case mix between providers.
Results:
Included were 1287 open heart surgery procedures. Public and private patients differed significantly in terms of gender, clinical history (e.g. hypertension, pulmonary disease, recent infarction) and procedural variables (e.g. reoperation, type of intervention). There were also statistically significant differences related to educational level, with better educated patients more likely to be treated in private centres. Crude surgical mortality rates differed between providers, although public centres operated on higher-risk patients. After adjusting for differences in case mix, the association between the type of provider and surgical mortality was not statistically significant (odds ratio 1.68; 95% CI from 0.94 to 3.0).
Conclusions:
Although crude mortality rates differ between public and private providers, there is a significant trend towards higher surgical risk in public centres. After adjusting for surgical risk, differences between types of provider decreased and were no longer statistically significant. The importance of other social and health-related factors, such as educational level, may explain differences between providers in their patients' surgical risk and in their performance in open heart surgery.