title: Lung resection outcomes and costs in Washington State: a case for regional quality improvement.
abstract: BACKGROUND
  A regional quality improvement effort does not exist for thoracic surgery in the United States. To initiate the development of one, we sought to describe temporal trends and hospital-level variability in associated outcomes and costs of pulmonary resection in Washington (WA) State.
  
  
  METHODS
  A cohort study (2000-2011) was conducted of operated-on lung cancer patients. The WA State discharge database was used to describe outcomes and costs for operations performed at all nonfederal hospitals within the state.
  
  
  RESULTS
  Over 12 years, 8,457 lung cancer patients underwent pulmonary resection across 49 hospitals. Inpatient deaths decreased over time (adjusted p-trend=0.023) but prolonged length of stay did not (adjusted p-trend=0.880). Inflation-adjusted hospital costs increased over time (adjusted p-trend<0.001). Among 24 hospitals performing at least 1 resection per year, 5 hospitals were statistical outliers in rates of death (4 lower and 1 higher than the state average), and 13 were outliers with respect to prolonged length of stay (7 higher and 6 lower than the state average) and costs (5 higher and 8 lower than the state average). When evaluated for rates of death and costs, there were hospitals with fewer deaths/lower costs, fewer deaths/higher costs, more deaths/lower costs, and more deaths/higher costs.
  
  
  CONCLUSIONS
  Variability in outcomes and costs over time and across hospitals suggest opportunities to improve the quality and value of thoracic surgery in WA State. Examples from cardiac surgery suggest that a regional quality improvement collaborative is an effective way to meaningfully and rapidly act upon these opportunities.
authors.affiliation: Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington; Surgical Outcomes Research Center, University of Washington, Seattle, Washington. Electronic address: ffarjah@uw.edu.
authors.forename: Farhood
authors.initials: F
authors.lastname: Farjah
authors.affiliation: Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington.
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Varghese
authors.affiliation: Providence Physician Group Cardiac and Thoracic Surgery, Everett, Washington.
authors.forename: Kimberley
authors.initials: K
authors.lastname: Costas
authors.affiliation: Franciscan Health System, Catholic Health Initiatives, Tacoma, Washington.
authors.forename: Bahirathan
authors.initials: B
authors.lastname: Krishnadasan
authors.affiliation: Thoracic Surgery Division, Swedish Cancer Institute, Seattle, Washington.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Farivar
authors.affiliation: Virginia Mason Medical Center, Seattle, Washington.
authors.forename: Michal
authors.initials: M
authors.lastname: Hubka
authors.affiliation: Thoracic Surgery Division, Swedish Cancer Institute, Seattle, Washington.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Louie
authors.affiliation: Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington.
authors.forename: Leah M
authors.initials: LM
authors.lastname: Backhus
authors.affiliation: Franciscan Health System, Catholic Health Initiatives, Tacoma, Washington.
authors.forename: Nyen
authors.initials: N
authors.lastname: Chong
authors.affiliation: Thoracic Surgery Division, Swedish Cancer Institute, Seattle, Washington.
authors.forename: Jed
authors.initials: J
authors.lastname: Gorden
authors.affiliation: Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Cheng
authors.affiliation: Surgical Outcomes Research Center, University of Washington, Seattle, Washington.
authors.forename: Hao
authors.initials: H
authors.lastname: He
authors.affiliation: Surgical Outcomes Research Center, University of Washington, Seattle, Washington.
authors.forename: David R
authors.initials: DR
authors.lastname: Flum
authors.affiliation: Virginia Mason Medical Center, Seattle, Washington.
authors.forename: Donald
authors.initials: D
authors.lastname: Low
authors.affiliation: Thoracic Surgery Division, Swedish Cancer Institute, Seattle, Washington.
authors.forename: Ralph
authors.initials: R
authors.lastname: Aye
authors.affiliation: Thoracic Surgery Division, Swedish Cancer Institute, Seattle, Washington.
authors.forename: Eric
authors.initials: E
authors.lastname: Vallières
authors.affiliation: Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Mulligan
authors.affiliation: Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington.
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Wood
mesh_terms: D015331:Cohort Studies; D016208:Databases, Factual; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008175:Lung Neoplasms / Q000191:economics / Q000401:mortality / Q000601:surgery*; D017063:Outcome Assessment, Health Care / Q000191:economics*; D010351:Patient Discharge / Q000191:economics; D011013:Pneumonectomy / Q000191:economics* / Q000379:methods / Q000401:mortality; D058996:Quality Improvement / Q000639:trends*; D012189:Retrospective Studies; D014861:Washington / Q000453:epidemiology