Background Like a measure of quality ambulatory surgery centers have begun reporting rates of hospital transfer at discharge. Results We studied 3 821 670 patients treated at 1 295 ambulatory surgery centers. At discharge the hospital transfer rate was 1.1/1 0 discharges (95% CI 1.1 Among patients discharged home the hospital-based acute care rate was 31.8/1 0 discharges (95% CI 31.6 Across ambulatory surgery centers there was little variation in adjusted hospital transfer rates (median=1.0/1 0 discharges [25th-75th percentile=1.0-2.0]) while substantial variation existed in adjusted hospital-based acute care rates (28.0/1 0 [21.0-39.0]). Conclusions Among adult patients undergoing ambulatory surgery center care hospital transfer at discharge is a rare event. In contrast the hospital-based acute care rate is nearly 30-fold higher INCB8761 (PF-4136309) varies across centers and may be a more meaningful measure for discriminating quality. Introduction Ambulatory surgery centers have become the preferred setting for providing low-risk medical and surgical procedures such as colonoscopy and glaucoma surgery in the United States.1 The proportion of all such procedures performed in this setting has increased 3-fold over the last two decades from 20% to 60% of all medical or surgical procedures.1-2 In parallel with ambulatory surgery center expansion there has been a growing focus on ensuring patients receive high-quality care in this setting.3-4 To this end the Center for Medicare and Medicaid Services (CMS) has adopted five measures of quality which ambulatory surgery centers were required to begin reporting to CMS as of October 2012 and on which reimbursement Rabbit polyclonal to PHC2. will be based beginning in 2014. These INCB8761 (PF-4136309) measures include patient burns patient falls prophylactic antibiotic timing wrong site surgery and hospital transfer at the time of discharge.5-7 The rate of hospital transfer at the time of discharge is intended to be a marker of complications resulting from care.7 However not all complications may be immediately evident and result in a hospital transfer. Treatment-related complications8-10 and symptoms11 may develop over the hours or days following discharge and require subsequent emergency department visits or hospital admissions INCB8761 (PF-4136309) termed hospital-based acute care.12-13 For example patients may present to the emergency department for perforation after colonoscopy; urinary retention subsequent to hemorrhoidectomy; or severe nausea following anesthesia.8-10 By not concurrently measuring these post-discharge events adverse outcomes related to treatment could be missed the resultant measure of ambulatory surgery center quality misrepresented and when linked to payment perverse incentives established to err on the side of a home discharge in lieu of hospital transfer. While prior studies suggest that hospital transfer rates are approximately 1 per 1 0 patients little is known about how frequently patients require hospital-based acute care after being discharge home.13-15 Similarly it is unknown if either rate varies substantially across centers to allow for meaningful discrimination between high and low performing centers. Therefore we conducted this study of ambulatory surgery centers in three geographically dispersed U.S. states to determine these rates; the most common diagnoses associated with these encounters; and whether they varied across centers. Because quality measures developed for the Medicare population are often adopted by other payers we also evaluated these outcomes in an all-payer setting and then specifically among those 65 years and INCB8761 (PF-4136309) older. By doing so findings from this study may help inform efforts aimed at measuring the quality of health care provided in ambulatory surgery centers across payers and provide an early evaluation of the proposed measure. Methods We used state-level administrative data from the Agency for Healthcare Research and Quality’s (AHRQ) Healthcare Cost and INCB8761 (PF-4136309) Utilization Project (HCUP).16 Specifically data were drawn from the 2008-2009 California (CA) INCB8761 (PF-4136309) Florida (FL) and Nebraska (NE) ambulatory surgery 17 inpatient 18 and emergency department19 databases. These states were selected for analysis.