Procendi empowers patients to make smarter, evidence-based decisions in surgical care, optimizing outcomes, reducing costs, and accelerating the return to productive, healthy lives. Our approach is rooted in the principle that access to high-quality, outcomes-driven surgeon selection and seamless navigation can transform the often opaque world of healthcare into a more efficient and equitable journey.
To illuminate the science behind these innovations, we’ve curated a selection of peer-reviewed papers that substantiate key concepts—from the impact variability in surgeons and facilities on recovery rates to the economic benefits of transparency in medical care. Explore this collection to see how rigorous research aligns with our mission to build happier, healthier workplaces.
Key Papers on Variability in Surgical Quality Across the United States
Below is the updated curated list of peer-reviewed papers, now including direct URLs to PubMed, JAMA and AHRQ or publisher pages where available (e.g., full texts, abstracts, or PMC open access). These were sourced from academic databases like PubMed. (Some may require payment to read beyond the abstract.)
Title | Authors | Year | Journal | Key Findings on Variability | URL |
|---|---|---|---|---|---|
Geographic Variation in the Utilization of and Mortality After Emergency General Surgery Operations in the Northeastern and Southeastern United States | Becher RD, DeWane MP, et al. | 2020 | Journal of the American College of Surgeons | Wide geographic variations in emergency general surgery operation rates and mortality across six Northeastern and Southeastern states, emphasizing the need for targeted regional analyses to reduce disparities. | |
Variation in Surgical Outcomes Across Networks of the Highest-Rated US Hospitals | Ibrahim AM, Ghaferi AA, et al. | 2019 | JAMA Network Open | Surgical outcomes vary significantly even within networks of top-rated (US News Honor Roll) hospitals, with inconsistent performance between flagship and affiliated sites, suggesting a need for better network monitoring. | |
Trends in the Geospatial Distribution of Inpatient Adult Surgical Services across the United States | Diaz A, Ghaferi AA, et al. | 2019 | JAMA Surgery | Rural hospital closures led to increased geographic disparities, with nearly double the population living >60 minutes from major surgery-capable hospitals by 2015, highlighting access-related quality variations. | |
Variations in outcomes of emergency general surgery patients across hospitals: A call to establish emergency general surgery quality improvement program | Ogola GO, Crandall ML, et al. | 2018 | Surgery | Significant hospital-level variations in risk-adjusted outcomes for emergency general surgery, with thousands of excess deaths nationwide, advocating for a dedicated quality improvement program similar to NSQIP. | |
Quantifying Geographic Variation in Health Care Outcomes in the United States before and after Risk-Adjustment | Morden NE, Colla CH, et al. | 2017 | PLOS ONE | Large residual geographic variation in inpatient surgical mortality and safety outcomes persists after risk adjustment, across states, regions, counties, and hospitals, indicating systemic factors beyond patient mix. | |
Geographic variation in surgical outcomes and cost between the United States and Japan | Wakam E, Molina G, et al. | 2016 | Annals of Surgery | Lower outcome variability (e.g., mortality, complications) in the US compared to Japan, but higher costs; US variations are less pronounced in postoperative care but tied to inefficiencies. | |
Hospital and geographic variability in thirty-day all-cause mortality following colorectal cancer surgery | Parsons HM, Henderson WG, et al. | 2014 | Journal of the American College of Surgeons | Substantial variability in 30-day mortality post-colorectal surgery across hospitals and census tracts, influenced by socioeconomic factors, with similar magnitudes at both levels. | |
Patient satisfaction and quality of surgical care in US hospitals | Fenton JJ, Jerant A, et al. | 2014 | Annals of Surgery | High patient satisfaction correlates with better surgical quality and efficiency across US hospitals performing major procedures, with no trade-off between satisfaction and outcomes. | |
Understanding of regional variation in the use of surgery | Birkmeyer JD, Sharp SM, et al. | 2013 | New England Journal of Medicine | Regional surgery rates vary widely due to physician beliefs and patient preferences rather than illness burden, explaining “surgical signatures” and persistent geographic disparities. | |
Hospital and geographic variability in two colorectal cancer surgery outcomes: complications and mortality after complications | Parsons HM, Magliocco AM, et al. | 2013 | Journal of Rural Health | Unexplained variations in complications and post-complication mortality for colorectal cancer surgery across hospitals and geographic areas, linked to poverty rates and race. | |
Variation in esophagectomy outcomes in hospitals meeting Leapfrog volume outcome standards | Birkmeyer NJ, Dimick JB, et al. | 2011 | Surgery | Even among high-volume hospitals meeting Leapfrog standards, substantial outcome variability persists for esophagectomy, pointing to surgeon volume and process measures as key drivers. | |
Variability in reoperation rates at 182 hospitals: a potential target for quality improvement | Damle RM, Al-Temimi MH, et al. | 2010 | Journal of the American College of Surgeons | Considerable hospital variability in colorectal surgery reoperation rates, adjustable via NSQIP benchmarking, with factors like ASA class and wound contamination influencing risks. | |
Variation in hospital mortality associated with inpatient surgery | Ghaferi AA, Birkmeyer JD, Dimick JB | 2009 | New England Journal of Medicine | Hospital mortality after inpatient surgery varies widely, largely due to differences in managing complications (failure-to-rescue), not initial complication rates. | |
Geographic variation in rates of selected surgical procedures within Los Angeles County | Nallamothu BK, Rogers MA, et al. | 1995 | American Journal of Public Health | Ethnicity and socioeconomic status drive geographic variations in procedure rates (e.g., carotid endarterectomy, hysterectomy) within a single urban area like LA County. | |
Variations in the use of medical and surgical services by the Medicare population | Wennberg JE, Roos N, et al. | 1986 | New England Journal of Medicine | Large geographic differences in Medicare surgical service use across 13 US areas, with variations unrelated to health needs, signaling early evidence of supply-driven disparities. |
Key Papers on Outcomes Transparency in US Healthcare
Below is a curated list of peer-reviewed papers that examine outcomes transparency in the US healthcare system, focusing on public reporting of quality metrics, surgical and clinical outcomes, and its impacts on accountability, patient choice, and performance. These were identified from academic sources like PubMed, PMC, and journals via web searches.
Title | Authors | Year | Journal | Key Findings on Outcomes Transparency | URL |
|---|---|---|---|---|---|
Enhancing Healthcare Accountability for Administrators: Fostering Transparency for Patient Safety and Quality Enhancement | Al-Haqwi AI, Alshammari SA, et al. | 2024 | Cureus | Transparency in reporting clinical outcomes (e.g., mortality, complications) enables benchmarking against standards, incentivizes high performance, and builds trust, but requires accessible data to drive improvements in patient safety. | |
Price Transparency in United States’ Health Care: A Narrative Policy Review of the Current State and Way Forward | Bernstein DN, Crowe JR | 2024 | Inquiry | Price transparency could catalyze outcomes transparency, reducing disparities in surgical and procedural results by empowering informed choices, though implementation barriers limit widespread impact. | |
Fostering Transparency in Outcomes, Quality, Safety, and Costs: A Vital Direction for Health and Health Care | Pronovost PJ, Austin JM, Cassel CK, et al. | 2016 | NAM Perspectives (National Academy of Medicine) | Public reporting of outcomes (e.g., via STS registries, CDC infection measures) drives quality improvements in cardiac surgery and beyond, but needs oversight for integrity to maximize benefits. | |
The Role of Quality Transparency in Health Care: Challenges and Potential Solutions | Saghafian S, Hopp WJ | 2021 | NAM Perspectives (National Academy of Medicine) | Outcomes transparency improves sector efficiency when data is user-friendly and targeted, but requires policy incentives; evidence from Hospital Compare shows mixed consumer response without complementary reforms. | |
The impact of hospital price and quality transparency tools on healthcare spending: a systematic review | Yan J, Zhang Y, et al. | 2023 | Health Economics Review | Quality transparency tools reduce spending on procedures by 5-10% via informed choices, but effects vary by market; US hospital data shows stronger impacts on elective surgeries than emergencies. | |
Public reporting and transparency: a primer on public outcomes reporting | Romanelli JR, Fuchshuber PR, Stulberg JJ, et al. | 2019 | Surgical Endoscopy | Confusing rating systems hinder surgical outcomes transparency; specialty registries standardize metrics beyond 30-day mortality, improving relevance and feasibility for consumers seeking quality care. | |
Does transparency of quality metrics affect hospital care outcomes? A systematic review of the literature | Hefner JL, Al-Amin M, Huerta TR, et al. | 2020 | Advances in Health Care Management | Public release of outcomes data influences provider behavior and reduces complications in US hospitals, but inconsistent methodologies limit comparability; calls for unified metrics in surgical care. | |
Ensuring the integrity and transparency of public reports: How a possible oversight model could benefit healthcare | Austin J, Young G, Pronovost P | 2014 | American Journal of Accountable Care | Oversight models enhance trust in outcomes reporting (e.g., Hospital Compare), reducing variability in surgical mortality reporting; without integrity checks, transparency erodes consumer confidence. | |
State-of-the-art of hospital and physician/physician group public reports | Cronin C, Damberg C, Riedel A, France J | 2011 | Agency for Healthcare Research and Quality (AHRQ) Report | Early US public reporting initiatives show variable uptake for surgical outcomes, with successes in cardiac metrics but gaps in accessibility; recommends standardization for broader impact. |