title: Unwarranted Variation in the Quality of Care for Patients With Diseases of the Thoracic Aorta.
abstract: BACKGROUND
  Thoracic aortic disease has a high mortality. We sought to establish the contribution of unwarranted variation in care to regional differences in outcomes observed in patients with thoracic aortic disease in England.
  
  
  RESULTS
  Data from the Hospital Episode Statistics (HES) and the National Adult Cardiac Surgery Audit (NACSA) were extracted. A parallel systematic review/meta-analysis through December 2015, and structure and process questionnaire of English cardiac surgery units were also accomplished. Treatment and mortality rates were investigated. A total of 24 548 adult patients in the HES study, 8058 in the NACSA study, and 103 543 from a total of 33 studies in the systematic review were obtained. Treatment rates for thoracic aortic disease within 6 months of index admission ranged from 7.6% to 31.5% between English counties. Risk-adjusted 6-month mortality in untreated patients ranged from 19.4% to 36.3%. Regional variation persisted after adjustment for disease or patient factors. Regional cardiac units with higher case volumes treated more-complex patients and had significantly lower risk-adjusted mortality relative to low-volume units. The results of the systematic review indicated that the delivery of care by multidisciplinary teams in high-volume units resulted in better outcomes. The observational analyses and the online survey indicated that this is not how services are configured in most units in England.
  
  
  CONCLUSIONS
  Changes in the organization of services that address unwarranted variation in the provision of care for patients with thoracic aortic disease in England may result in more-equitable access to treatment and improved outcomes.
authors.affiliation: Dr Foster Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College, London, United Kingdom.
authors.forename: Alex
authors.initials: A
authors.lastname: Bottle
authors.affiliation: Leicester Cardiovascular Biomedical Research Unit & Department of Cardiovascular Sciences, Glenfield Hospital, University of Leicester, United Kingdom gm247@le.ac.uk.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mariscalco
authors.affiliation: Information Department, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Shaw
authors.affiliation: School of Clinical Sciences, Bristol Heart Institute, University of Bristol, United Kingdom.
authors.forename: Umberto
authors.initials: U
authors.lastname: Benedetto
authors.affiliation: Leicester Cardiovascular Biomedical Research Unit & Department of Cardiovascular Sciences, Glenfield Hospital, University of Leicester, United Kingdom.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Saratzis
authors.affiliation: Leicester Cardiovascular Biomedical Research Unit & Department of Cardiovascular Sciences, Glenfield Hospital, University of Leicester, United Kingdom.
authors.forename: Silvia
authors.initials: S
authors.lastname: Mariani
authors.affiliation: Department of Health Economics, University of Liverpool, United Kingdom.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Bashir
authors.affiliation: Dr Foster Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College, London, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Aylin
authors.affiliation: Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Jenkins
authors.affiliation: Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
authors.forename: Aung Y
authors.initials: AY
authors.lastname: Oo
authors.affiliation: Leicester Cardiovascular Biomedical Research Unit & Department of Cardiovascular Sciences, Glenfield Hospital, University of Leicester, United Kingdom.
authors.forename: Gavin J
authors.initials: GJ
authors.lastname: Murphy
mesh_terms: D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery*; D006348:Cardiac Surgical Procedures; D004739:England / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D011183:Postoperative Complications / Q000453:epidemiology*; D058996:Quality Improvement; D011787:Quality of Health Care; D015996:Survival Rate / Q000639:trends
keywords: aortic disease; aortic dissection; cardiac surgery; quality of care