Do Centers of Excellence excel in patient outcomes?: Evidence from U.S. Veterans Health Administration Centers for Epilepsy
Keywords:
Centers of Excellence, Outcomes Research, Healthcare Management, Focus in ActionAbstract
The Veterans Health Administration created in 2009 several Epilepsy Centers of Excellence (ECoE) for epilepsy treatment to improve health outcomes of veterans suffering undergoing treatment for epilepsy. Our outcomes study assesses the health quality at these ECoEs in comparison to non-ECoEs over a three year time period (2009 to 2011). Data from both ECoEs and Non-ECoEs were collected on a number of health outcome measures to empirically test if ECoEs led to better health outcomes than non-ECoEs. Findings show that ECoEs, compared to non-ECoEs, led to higher emergency room visits, higher hospitalizations, but lower drug prescriptions. However, ECoEs and non-ECoEs did not have statistically significant differences in adverse effects of medications. The study concludes with the findings, implications and limitations in ways that impact the prevailing perspectives on the concept of Centers of Excellence.
References
America’s SAP Users’ Group. (2006). Centers of excellence: Optimize your business and IT value. Retrieved from http://scn.sap.com/docs/DOC-4483
Begley, C., Basu, R., Lairson, D., Reynolds, T., Dubinsky, S., Newmark, M., & Hesdorffer, D. (2011). Socioeconomic status, health care use, and outcomes: Persistence of disparities over time. Epilepsia, 52(5), 957–964.
Birkmeyer JD, Stuel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. (2003). Surgeon volume and operative mortality in the United States. New England Journal of Medicine. 34(9), 2117–2127.
Brodie, M. J. (2001). Do we need any more new antiepileptic drugs? Epilepsy Research, 45(1-3), 3–6.
Bush, R. W. (2007). Reducing waste in US health care systems. Jama, 297(8), 871-874.
Campbell, M. J., & Swinscow, T. D. (2009). Statistics at square one (11th ed). Chichester: Wiley-Blackwell.
Campbell, S. M., Roland, M. O., & Buetow, S. A. (2000). Defining quality of care. Social Science and Medicine, 51(11), 1611-1625.
Centers for Disease Control and Prevention (2011). Targeting Epilepsy – Improving the lives of people with one of nation’s most common neurological conditions at a glance 2011.
CMS (2012). Centers for Medicare & Medicaid Services Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity—Facility Certification Requirement
Colvello, V., & Merkhofer, M. (1993). Risk assessment methods: Approaches for assessing health and environmental risks. New York, NY: Plenum Press.
Creswell, J. W. (2009). Educational research: Planning, conducting and evaluating quantitative and qualitative research (3rd ed). Columbus, OH: Merrill Prentice Hall.
Darkins, A., Ryan, P., Kobb, R., Foster, L., Edmonson, E., Wakefield, B., & Lancaster, A.E. (2008). Care coordination/home telehealth: The systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions. Telemedicine and e-Health, 14(10), 1118–-1126.
DeMaria, E. J., Pate, V., Warthen, M., & Winegar, D. A. (2010). Baseline data from American society for metabolic and bariatric surgery-designated bariatric surgery centers of excellence using the bariatric outcomes longitudinal database. Surgery for Obesity and Relate Disease, 6(4), 347-355.
Fay, M. P., & Proschan, M. A. (2010). Wilcoxon – Mann-Whitney or t test? On assumptions for hypothesis tests and multiple interpretations of decision rules. Statistics Surveys, 4, 1–39.
Fried, B. J., & Gaydos, L. M. (Eds.). (2002). World health systems: Challenges and perspectives. Chicago, IL: Health Administration Press.
George Mason University. (2010). Center of excellence in neuroergonomics, technology, and cognition (CENTEC) interim progress report.
Grol, R. P. T. M., Bosca, M. C., Hulscher, M. E. J., Eccles, M. P. & Wensing, M. (2007). Planning and studying Improvement in patient care: The use of theoretical perspectives. Milbank Quarterly, 85, 93-–138.
Gunderman, R.B. (2006). Achieving excellence in medical education. Springer London
Halpern, M., Rentz, A., & Murray, M. (2000). Cost of illness of epilepsy in the US: Comparison of patient-based and population-based estimates. Neuroepidemiology, 19(2), 87–99.
Holden, E. W., Grossman, E., Nguyen, H. T., Gunter, M. J., Grebosky, B., Von Worley, A., & Thurman, D. J. (2005). Developing a computer algorithm to identify epilepsy cases in managed care organizations. Disease Management, 8(1), 1–14.
Hyer, N. L., Wemmerlöv, U., & Morris Jr, J. A. (2009). Performance analysis of a focused hospital unit: The case of an integrated trauma center. Journal of Operations Management, 27(3), 203-219.
IOM (2012). England, M. J., Liverman, C. T., Schultz, A. M., & Strawbridge, L. M. (2012). Epilepsy across the spectrum: Promoting health and understanding.: A summary of the Institute of Medicine report. Epilepsy & Behavior, 25(2), 266-276.
Joosten T., Bongers, I., & Janssen, R. (2009). Application of lean thinking to health care: issues and observations. International Journal for Quality in Health Care, 21(5), 341–347.
Kaiser Foundation (2008). Health care costs and the 2008 election. Retrieved from http://www.kaiseredu.org
Kasun, K. K. (2010). Economic effectiveness of physician organizational models in a California integrated healthcare system. Retrieved from ProQuest dissertations and theses database.
Kelly, P., Rehman, R., Husain, A. (2013). Now that VHA has established Epilepsy Centers of Excellence, will the veterans come? US Medicine.
Khalil, T. M., Lefebvre, L. A., & Mason, R. M. (2001). Management of technology: The key to prosperity in the third millennium. Selected papers from the Ninth International Conference on Management of Technology. Oxford, England: Pergamon Press.
Kobau, R., Hatie, Z., Thurman, D. J., Zack, M. M., Henry, T. R., Schachter, S. C., & Price, P. H. (2008). Epilepsy surveillance among adults: 19 states, behavioral risk factor surveillance system, 2005. Morbidity and Mortality Weekly Report. 57(6), 32-48.
Koop, C. E., Pearson, C. E., & Schwarz, M. R. (2002). Critical issues in global health. San Francisco, CA: Jossey-Bass.
Kwan, P., & Brodie, M. J. (2001). Neuropsychological effects of epilepsy and antiepileptic drugs. The Lancet, 357(9251), 216–222.
Latts, L., & Singer, J. (2010). Centers of excellence. Archives of Surgery, 145(1), 106–107.
Lehman, J., & Suozzi, P. (2008). Founding integrative medicine centers of excellence: One strategy for chiropractic medicine to build higher cultural authority. The Journal of Chiropractic Education, 22(1), 29–33.
Levy, R. M. (2014). Centers of Excellence for Neuromodulation: A Critical Proposal. Neuromodulation: Technology at the Neural Interface, 17(1), 1-9.
Lingsma, H. (2010). Measuring quality of care (Unpublished doctoral dissertation). Proefschrift Erasmus Universiteit, Rotterdam.
Livingston, E. H. (2009). Bariatric surgery outcomes at designated centers of excellence vs. nondesignated programs. Archives of Surgery, 144(4), 319–325.
Lumley, T., Diehr, P., Emerson, S., & Chen, L. (2002). The importance of the normality assumption in large public health data sets. Annual Review of Public Health, 23, 151–69.
Manjunath, R., Paradis, P.E., Parise, H. Lafeuille, M.H., Bowers, B., Duh, M.S., Lefebvre, P., & Faught, E. (2012) Burden of uncontrolled epilepsy in patients requiring an emergency room visit or hospitalization. Neurology, 79(18), 1908-1916.
McClellan, M. (2011). Reforming payments to healthcare providers: The key to slowing health care cost growth while improving quality. Journal of Economic Perspectives, 25(2), 69–92.
McDermott, C. M., & Stock, G. N. (2011). Focus as emphasis: Conceptual and performance implications for hospitals. Journal of Operations Management, 29(6), 616-626.
National Association of Epilepsy Centers (NAEC). (1990). Recommended guidelines for diagnosis and treatment is specialized epilepsy centers. Epilepsia, 31(Supl 1), S1–S12.
National Hospital Ambulatory Medical Care Survey (2010). Emergency Department Summary Tables.
Nilsson, L., Farahmand, B. Y., Persson, P. G., Thiblin, I., & Tomson, T. (1999). Risk factors for sudden unexpected death in epilepsy in a case-control study. The Lancet, 353(9156), 888–893.
Nosek, L. (2004). Globalization’s costs to health care: How can we pay the bill? Nursing Administration Quarterly, 28(2), 116–121.
O’Malley, P. (2014). Technology Management in Complex Health Care Settings. Foundations of Clinical Nurse Specialist Practice, 331.
Pack, A. M. (2005). The impact of long-term antiepileptic drug use on bone health. Advanced Studies in Medicine, 5(6c), S567–571.
Pack, A. M., & Morrell, M. J. (2004). Epilepsy and bone health in adults. Epilepsy Behavior, 5(Suppl2), 524–529.
Palin, J. D., Goldstein, J. N., Moussally, J. S., Pelletier, A. J., Green, A. R., & Camargo, C. A. (2008). Seizure visits in US emergency departments: Epidemiology and potential disparities in care. International Journal of Emergency Medicine, 1(2), 97-105.
Pronovost, P. J. (2011). Navigating adaptive challenges in quality improvement. BMJ quality & safety, 20(7), 560-563.
Public Law 106-117 (1999). Veterans Millennium Health Care Benefits Act.
Public Law 110-387 (2008). Veterans Mental Health and Other Care Improvements Act.
Public Law 111-148 (2010). Patient Protection and Affordable Care Act.
Pugh, M., Berlowitz, D. R., Rao, J. K., Shapiro, G., Avetisya, R., Hanchate, A., & Kazis, L. E. (2011). The quality of care for adults with epilepsy: An initial glimpse using the QUIET measure. BioMed Central Health Services Research, 11(1). 39-48.
Pugh, M. J., Van Cott, A. C., Cramer, J. A., Knoefelm, J. E., Amuan, M. E., & Tabares, J. (2008). Treatment in Geriatric Epilepsy Research (TIGER) Team. Trends in antiepileptic drug prescribing for older patients with new-onset epilepsy: 2000–2004. Neurology, 70(22), 2171–2178.
Raymont, V., Salazar, A.M., Lipsky, R., Goldman, D. Tasick, G., & Grafman, J. (2010) Correlates of posttraumatic epilepsy 35 years following combat brain injury. Neurology, 75, 224–229.
Salinsky, M., Spencer, D., Boudreau, E., & Ferguson, F. (2011). Psychogenic non- epileptic seizures in US veterans. Neurology, 77(10), 945–950.
Shay, K., & Yoshikawa, T. T. (2010). Overview of VA healthcare for older veterans: Lessons learned and policy implications. Journal of the American Society on Aging, 34(2), 20–28.
Shortell, S. M., Rundall, T. G., & Hsu, J. (2007). Improving patient care by linking evidence-based medicine and evidence-based management. Jama, 298(6), 673-676.
So, E. L., Bainbridge, J., Buchhalter, J. R., Donalty, J., Donner, E. J., Finucane, A., & Sierzant, T. L. (2009). Report of the American Epilepsy Society and the Epilepsy Foundation Joint Task Force on sudden unexplained death in epilepsy. Epilepsia, 50(4), 917–922.
Sperling, M. R., Feldman, H., Kinman, J., Liporace, J. D., & O’Conner, M. J. (1999). Seizure control and mortality in epilepsy. Annals of Neurology, 46(1), 45–50.
Stephen, L. J., McLellan, A. R., Harrison, J. H., Shapiro, D., Dominiczak, M. H., Sills, G. J., & Brodie, M. J. (1999). Bone density and antiepileptic drugs: a case-controlled study. Seiszure, .8 (6), 339–-342.
Strzelczyk, A., Reese, J. P., Dodel, R., Hamer, H. M. (2008). Cost of epilepsy: A systematic review. PharmaCOEconomics, 26(6), 463–76.
Sugerman, D. T. (2013). Centers of Excellence. JAMA, 310(9), 994-994.
Weaver, B. (2004). Assumptions for t-test: Exact and Approximate Tests.
Wechsler, J. (2007). Healthcare measures to congressional agenda. Managed Healthcare Executive, 17(4), 12.
Weisbrod, B.A. (1991). The health care quadrilemma: An essay on technological technology change, insurance, quality of care and cost containment. Journal of Economic Literature, 29(2) 523-552.
Whittemore, R., & Meikus, G. D. (2008). Designing a research study. The Diabetes Educator, 34(2), 201–217.
Wonderling, D., Sawyer, L., Fenu, E., Lovibond, K., & Laramee, P. (2011). National Clinical Guideline Centre cost-effectiveness assessment for the National Institute for Health and Clinical Excellence. Annals of Internal Medicine, 154(22), 758–765.
World Health Organization. (2002). The world health report.
Wysolmerski, J. J., & Insogna, K. I. (2011). The parathyroid glands, hypercalcemia and hypocalcemia. In Goldman, L. & Schafer, A.L. (Eds.). Cecil Medicine (24th ed; chap 266). Philadelphia, PA: Saunders Elsevier.
Young, T., & McClean, S. (2008). A critical look at lean thinking in healthcare. Quality and Safety in Health Care, 17(5), 382–386.
