John Browne|Liz Jamieson|Jim Lewsey|Jan van der Meulen|Lynn P. Copley|Nick Black
Case-mix &amp; patients' reports of outcome in Independent Sector Treatment Centres: Comparison with NHS providers
London School of Hygiene & Tropical Medicine|Royal College of Surgeons of England|London School of Hygiene & Tropical Medicine|Royal College of Surgeons of England|Royal College of Surgeons of England|London School of Hygiene & Tropical Medicine
abstract background considerable concern expressed outcomes achieved independent sector treatment centres istcs introduced england since 2003 aim compare casemix patients reported outcomes surgery istcs nhs providers methods prospective cohort study 769 patients treated six istcs 1895 treated 20 nhs providers acute hospitals treatment centres england 200607 participants underwent one three day surgery procedures inguinal hernia repair varicose vein surgery cataract extraction hip knee replacement change patientreported health status health related quality life measured using diseasespecific generic eq5d instrument assessed either 3months day surgery 6months hipknee surgery addition patientreported postoperative complications overall assessment success surgery collected outcome measures adjusted using multivariable regression patient characteristics disease severity duration symptoms age sex socioeconomic status general health previous similar surgery comorbidity results postoperative response rates varied procedure 7388 similar treated istcs nhs facilities patients treated istcs healthier less likely comorbidity undergoing cataract surgery joint replacement primary condition less severe undergoing hernia repair joint replacement less likely similar surgery adjustment made preoperative characteristics patients undergoing cataract surgery hip replacement istcs achieved slightly greater improvement functional status quality life treated nhs facilities opposite true patients undergoing hernia repair significant differences found two procedures patients treated istcs less likely report postoperative problems treated nhs facilities cataract surgery adjusted odds ratio 035 95 ci 017070 hernia repair 042 028063 knee replacement 044 028069 patients described result operation excellent good good regardless treated conclusion casemix patients treated istcs differs nhs providers line intention contracts caution needed interpreting observation patients treated istcs reported slightly better outcomes istcs participated casemix adjustment might insufficient patients reports might biased likely satisfied way treated