Letters First, as noted in our Methods and Limitation sections, practices and protocols to replicate the outcomes of their Petrick et al correctly point out that we were only able to best performers. evaluate a subset of accredited centers within our data set. Andrew M. Ibrahim, MD, MSc If anything, a more inclusive assessment—including more Justin B. Dimick, MD, MPH accredited centers—would likely demonstrate more varia- tion, not less. Because all 12 states in our study consistently Author Affiliations: Department of Surgery, University of Michigan, Ann Arbor demonstrated variation within themselves, we believe our (Ibrahim, Dimick); Center for Healthcare Outcomes and Policy, University of findings to be robust and would replicate if more states were Michigan, Ann Arbor (Ibrahim, Dimick); Surgical Innovation Editor, JAMA assessed. Surgery (Dimick). The second point raised by Petrick et al concerns the geo- Corresponding Author: Andrew M. Ibrahim, MD, MSc, Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, 2800 graphic proximity of high-performing and low-performing cen- Plymouth Ave, Bldg 10-G016, Ann Arbor, MI 48109-2800 (firstname.lastname@example.org). ters. They overstate our position in misquoting the article as Published Online: January 3, 2018. doi:10.1001/jamasurg.2017.4590 declaring, “lower-quality centers were almost uniformly lo- Conflict of Interest Disclosures: None reported. cated near higher-quality centers.” In fact, the actual article 1. Ibrahim AM, Ghaferi AA, Thumma JR, Dimick JB. Variation in outcomes at reads, a “large proportion of lower-performing centers were bariatric surgery centers of excellence. JAMA Surg. 2017;152(7):629-636. often located in the same hospital service area as higher- 2. Ibrahim AM, Hughes TG, Thumma JR, Dimick JB. Association of hospital performing centers.” We believe this assessment to be con- critical access status with surgical outcomes and expenditures among Medicare sistent with our data. beneficiaries. JAMA. 2016;315(19):2095-2103. Third, concerns about the codes used to define complica- 3. Ibrahim AM, Ghaferi AA, Thumma JR, Dimick JB. Hospital quality and tions and perform risk adjustment are addressed in the origi- Medicare expenditures for bariatric surgery in the United States. Ann Surg. 2017;266(1):105-110. nal article and follow conventions applied in several previ- 2,3 ous studies. The additional point that accredited centers treat CORRECTION patients with higher body mass index seems moot here, as all centers in our study were accredited and presumably all carry Error in Table 2: In the Original Investigation titled “Analysis of Survival After Ini- this same additional risk factor. tiation of Continuous Renal Replacement Therapy in a Surgical Intensive Care Unit,” published online June 21, 2017, and in the October print issue, there was an error Finally, we are in agreement on the potential of regional in Table 2. In the “Use of vasopressors during CRRT” row, the first 2 columns of the collaboratives to drive quality improvement. In the era of “Yes” row should read “45” and “28 (62.2).” This article was corrected online. rapid mergers and consolidations forming new hospital 1. Tatum JM, Barmparas G, Ko A, et al. Analysis of survival after initiation of networks with shared incentives, neighboring centers continuous renal replacement therapy in a surgical intensive care unit. JAMA Surg. may find themselves more aligned than ever to adopt best 2017;152(10):938-943. 192 JAMA Surgery February 2018 Volume 153, Number 2 (Reprinted) jamasurgery.com © 2017 American Medical Association. All rights reserved.
JAMA Surgery – American Medical Association
Published: Feb 13, 2018
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