{"id":2626,"date":"2021-07-08T00:00:00","date_gmt":"2021-07-08T04:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/effect-of-a-health-system-payment-and-quality-improvement-programme-for-tonsillectomy-in-ontario-canada-an-interrupted-time-series-analysis\/"},"modified":"2023-11-15T09:34:31","modified_gmt":"2023-11-15T14:34:31","slug":"effect-of-a-health-system-payment-and-quality-improvement-programme-for-tonsillectomy-in-ontario-canada-an-interrupted-time-series-analysis","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/effect-of-a-health-system-payment-and-quality-improvement-programme-for-tonsillectomy-in-ontario-canada-an-interrupted-time-series-analysis\/","title":{"rendered":"Effect of a health system payment and quality improvement programme for tonsillectomy in Ontario, Canada: an interrupted time series analysis"},"content":{"rendered":"<p><strong>Background <\/strong>&#x2014; Tonsillectomy is among the most common and cumulatively expensive surgical procedures in children, with known variations in quality of care. However, evidence on health system interventions to improve quality of care is limited. The Quality-Based Procedures (QBP) programme in Ontario, Canada, introduced fixed episode hospital payment per tonsillectomy and disseminated a perioperative care pathway. We determined the association of this payment and quality improvement programme with tonsillectomy quality of care.<\/p>\n<p><strong>Methods <\/strong>&#x2014; Interrupted time series analysis of children undergoing elective tonsillectomy at community and children&apos;s hospitals in Ontario in the QBP period (1 April 2014 to 31 December 2018) and the pre-QBP period (1 January 2009 to 31 January 2014) using health administrative data. We compared the age-standardised and sex-standardised rates for all-cause tonsillectomy-related revisits within 30 days, opioid prescription fills within 30 days and index tonsillectomy inpatient admission.<\/p>\n<p><strong>Results <\/strong>&#x2014; 111 411 children underwent tonsillectomy: 51 967 in the QBP period and 59 444 in the pre-QBP period (annual median number of hospitals, 86 (range 77-93)). Following QBP programme implementation, revisit rates decreased for all-cause tonsillectomy-related revisits (0.48 to -0.18 revisits per 1000 tonsillectomies per month; difference -0.66 revisits per 1000 tonsillectomies per month (95% CI -0.97 to -0.34); p&lt;0.0001). Codeine prescription fill rate continued to decrease but at a slower rate (-4.81 to -0.11 prescriptions per 1000 tonsillectomies per month; difference 4.69 (95% CI 3.60 to 5.79) prescriptions per 1000 tonsillectomies per month; p&lt;0.0001). The index tonsillectomy inpatient admission rate decreased (1.12 to 0.23 admissions per 1000 tonsillectomies per month; difference -0.89 (95% CI -1.33 to -0.44) admissions per 1000 tonsillectomies per month; p&lt;0.0001).<\/p>\n<p><strong>Conclusions <\/strong>&#x2014; The payment and quality improvement programme was associated with several improvements in quality of care. These findings may inform jurisdictions planning health system interventions to improve quality of care for tonsillectomy and other paediatric procedures.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Background &#x2014; Tonsillectomy is among the most common and cumulatively expensive surgical procedures in children, with known variations in quality of care. However, evidence on health system interventions to improve quality of care is limited. The Quality-Based Procedures (QBP) programme in Ontario, Canada, introduced fixed episode hospital payment per tonsillectomy and disseminated a perioperative care [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[],"migration-helper-qa-sample-set":[],"class_list":["post-2626","journal_article","type-journal_article","status-publish","hentry"],"acf":{"citation":"Mahant S, Guan J, Zhang J, Gandhi S, Propst EJ, Guttmann A. <em>BMJ Qual Saf<\/em>. 2023; 32(9):526-35. Epub 2021 Jul 8.","source_url":"https:\/\/doi.org\/10.1136\/bmjqs-2021-013110","ices_scientist":[1238],"site":[6733],"research_program":[6740],"news_release":"","journal_article":"","atlas":"","research_report":"","infographic":"","video":"","downloads":null,"links":null,"sitecore_item_id":"1C793456-68E9-4BDE-8901-933B9650FF5A","sitecore_item_name":"Effect-of-a-health-system-payment-and-quality-improvement-programme-for-tonsillectomy-in-Ontario","sitecore_field_values":"{\n  \"Title\": \"Effect of a health system payment and quality improvement programme for tonsillectomy in Ontario, Canada: an interrupted time series analysis\",\n  \"Short title\": \"Effect of a health system payment and\",\n  \"Summary\": \"This study determined the association of hospital payments and quality improvement programme with tonsillectomy quality of care.\",\n  \"Citation\": \"<p>Mahant S, Guan J, Zhang J, Gandhi S, Propst EJ, Guttmann A. <em>BMJ Qual Saf<\/em>. 2021; Jul 8 [Epub ahead of print]. DOI: <a href=\"https:\/\/doi.org\/10.1136\/bmjqs-2021-013110\" title=\"opens external link\">https:\/\/doi.org\/10.1136\/bmjqs-2021-013110<\/a><\/p>\",\n  \"Abstract\": \"<p><strong>Background <\/strong>&mdash; Tonsillectomy is among the most common and cumulatively expensive surgical procedures in children, with known variations in quality of care. However, evidence on health system interventions to improve quality of care is limited. The Quality-Based Procedures (QBP) programme in Ontario, Canada, introduced fixed episode hospital payment per tonsillectomy and disseminated a perioperative care pathway. We determined the association of this payment and quality improvement programme with tonsillectomy quality of care.<\/p>n<p><strong>Methods <\/strong>&mdash; Interrupted time series analysis of children undergoing elective tonsillectomy at community and children's hospitals in Ontario in the QBP period (1 April 2014 to 31 December 2018) and the pre-QBP period (1 January 2009 to 31 January 2014) using health administrative data. We compared the age-standardised and sex-standardised rates for all-cause tonsillectomy-related revisits within 30 days, opioid prescription fills within 30 days and index tonsillectomy inpatient admission.<\/p>n<p><strong>Results <\/strong>&mdash; 111 411 children underwent tonsillectomy: 51 967 in the QBP period and 59 444 in the pre-QBP period (annual median number of hospitals, 86 (range 77-93)). Following QBP programme implementation, revisit rates decreased for all-cause tonsillectomy-related revisits (0.48 to -0.18 revisits per 1000 tonsillectomies per month; difference -0.66 revisits per 1000 tonsillectomies per month (95% CI -0.97 to -0.34); p&lt;0.0001). Codeine prescription fill rate continued to decrease but at a slower rate (-4.81 to -0.11 prescriptions per 1000 tonsillectomies per month; difference 4.69 (95% CI 3.60 to 5.79) prescriptions per 1000 tonsillectomies per month; p&lt;0.0001). The index tonsillectomy inpatient admission rate decreased (1.12 to 0.23 admissions per 1000 tonsillectomies per month; difference -0.89 (95% CI -1.33 to -0.44) admissions per 1000 tonsillectomies per month; p&lt;0.0001).<\/p>n<p><strong>Conclusions <\/strong>&mdash; The payment and quality improvement programme was associated with several improvements in quality of care. These findings may inform jurisdictions planning health system interventions to improve quality of care for tonsillectomy and other paediatric procedures.<\/p>\",\n  \"Research Programs\": \"{46DF28D2-EDE8-4DF2-8CC0-87CEF464E435}\",\n  \"ICES Locations\": \"{4FCAABBA-14A5-42E6-8F33-BC6C2F1D9908}\",\n  \"ICES Scientists\": \"{DF9D6D4F-1B33-4FB9-AD9B-576798163C2C}\",\n  \"Posted Date\": \"20210708T000000\",\n  \"Show on Publications Landing Page\": \"1\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2021\/July\/Effect-of-a-health-system-payment-and-quality-improvement-programme-for-tonsillectomy-in-Ontario"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Effect of a health system payment and quality improvement programme for tonsillectomy in Ontario, Canada: an interrupted time series analysis<\/title>\n<meta name=\"description\" content=\"Background &#x2014; Tonsillectomy is among the most common and cumulatively expensive surgical procedures in children, with known variations in quality of\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/effect-of-a-health-system-payment-and-quality-improvement-programme-for-tonsillectomy-in-ontario-canada-an-interrupted-time-series-analysis\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"ICES | Effect of a health system payment and quality improvement programme for tonsillectomy in Ontario, Canada: an interrupted time series analysis\" \/>\n<meta property=\"og:description\" content=\"Background &#x2014; Tonsillectomy is among the most common and cumulatively expensive surgical procedures in children, with known variations in quality of\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/effect-of-a-health-system-payment-and-quality-improvement-programme-for-tonsillectomy-in-ontario-canada-an-interrupted-time-series-analysis\/\" \/>\n<meta property=\"og:site_name\" content=\"ICES\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/ICESOntario\/\" \/>\n<meta property=\"article:modified_time\" content=\"2023-11-15T14:34:31+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.ices.on.ca\/wp-content\/uploads\/2024\/11\/ic-es-data-discovery-better-health-logo.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"675\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/publications\\\/journal-articles\\\/effect-of-a-health-system-payment-and-quality-improvement-programme-for-tonsillectomy-in-ontario-canada-an-interrupted-time-series-analysis\\\/\",\"url\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/publications\\\/journal-articles\\\/effect-of-a-health-system-payment-and-quality-improvement-programme-for-tonsillectomy-in-ontario-canada-an-interrupted-time-series-analysis\\\/\",\"name\":\"ICES | Effect of a health system payment and quality improvement programme for tonsillectomy in Ontario, Canada: an interrupted time series analysis\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/#website\"},\"datePublished\":\"2021-07-08T04:00:00+00:00\",\"dateModified\":\"2023-11-15T14:34:31+00:00\",\"description\":\"Background &#x2014; 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