Evaluating the performance of amputee services at neighbouring hospitals: a risk adjusted performance analysis.
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Background: Despite advances in vascular surgery techniques, ageing populations and increasing rates of vascular disease and diabetes have contributed to relatively steady amputation rates. Older amputees have limited life expectancies and often require expensive rehabilitation interventions on top of vascular procedures. Services warrant scrutiny with view to reducing clinical practice variations, improving hospital performance and securing the best patient outcomes. Objective: This study employed a novel methodology to assess 12-month hospital performance associated with provision of lower-limb amputee services at three neighbouring hospitals. Design and Setting: Routinely collected data on individuals having an initial lower-limb amputation from July 2001 to June 2008 at three hospital networks in Adelaide, South Australia were analysed. Observed and expected lengths of stay and patient outcomes were generated, from which relative performance across hospitals were compared. Results: Following amputation we observed a short time-to-death (0.8 years, IQR 0.21-2.12) and 12-month mortality rate of 25% (unadjusted). Riskadjusted analyses indicated that one hospital with co-located vascular and rehabilitation services had greater performance with lower re-amputation rates and fewer deaths. However, length of stay at this hospital was longer than expected. Conclusion: The risk-adjusted performance analysis provided an approach which could inform further investigations around variation in hospital performance to inform best practice service delivery.
2018 The authors. The Journal of Aging Research and Clinical Practice is an Open Access Journal and adheres to the Budapest Open Access Initiative definition of Open Access, “…permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles…”.