title: Variation in Patient-reported Outcomes Across Hospitals Following Surgery.
abstract: BACKGROUND
  Although there is growing interest in applying patient-reported outcomes (PROs) toward surgical quality, the extent to which PROs vary across hospitals following surgical procedures is unknown.
  
  
  OBJECTIVE
  We examined variation in PROs, specifically health-related quality of life (HRQOL), across hospitals performing bariatric surgery.
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  The Michigan Bariatric Surgery Collaborative is a statewide consortium of 39 hospitals performing laparoscopic gastric bypass, gastric banding, or sleeve gastrectomy (n=11,420 patients between 2008 and 2012).
  
  
  METHODS
  We examined generic and disease-specific HRQOL measured by the Health and Activities Limitations Index (HALex) and Bariatric Quality of Life index (BQL) preoperatively and at 1 year. We measured the variation in postoperative HRQOL across hospitals, and the effect of risk and reliability adjustment on hospital ranking.
  
  
  RESULTS
  In this cohort, HRQOL varied by 56% (HALex) and 37% (BQL) across hospitals. Patient factors accounted for 58% (HALex) to 71% (BQL) of the variation in HRQOL across hospitals. After risk and reliability adjustment, HRQOL varied by 18% (by HALex) and 14.5% (by BQL) across hospitals, and the proportion of patients who experienced a large improvement in HRQOL by HALex ranged from 33% to 69% and 67% to 92% by BQL. After adjusting for patient factors and reliability, these differences diminished to 55%-64% (HALex) and 79%-84% (BQL).
  
  
  CONCLUSIONS
  Patient factors explain a large proportion of hospital-level variation in PROs following bariatric surgery, underscoring the importance of risk adjustment. However, some variation in PROs across hospitals remains unexplained, suggesting PROs may represent a viable indicator of hospital performance.
authors.affiliation: *Department of Surgery, Center for Health Outcomes and Policy †Michigan Bariatric Surgery Collaborative, Center for Health Outcomes and Policy, University of Michigan, Ann Arbor ‡Department of Surgery, Division of General Surgery, Henry Ford Health System, Wayne State University School of Medicine, Detroit §Department of Physical Medicine & Rehabilitation, Center for Clinical Outcomes Development and Application, University of Michigan, Ann Arbor, MI.
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Waljee
authors.forename: Amir
authors.initials: A
authors.lastname: Ghaferi
authors.forename: Jonathan F
authors.initials: JF
authors.lastname: Finks
authors.forename: Ruth
authors.initials: R
authors.lastname: Cassidy
authors.forename: Oliver
authors.initials: O
authors.lastname: Varban
authors.forename: Arthur
authors.initials: A
authors.lastname: Carlin
authors.forename: Noelle
authors.initials: N
authors.lastname: Carlozzi
authors.forename: Justin
authors.initials: J
authors.lastname: Dimick
mesh_terms: D050110:Bariatric Surgery / Q000523:psychology* / Q000706:statistics & numerical data; D015331:Cohort Studies; D005163:Factor Analysis, Statistical; D006801:Humans; D008824:Michigan; D009767:Obesity, Morbid / Q000601:surgery; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome