# Outcomes in Patients with Multimorbidity at Ambulatory Surgical Centers

> **NIH AHRQ R01** · CHILDREN'S HOSP OF PHILADELPHIA · 2020 · $398,765

## Abstract

Abstract
The growth in procedure volume at Ambulatory Surgical Centers (ASCs) has coincided with the growth in
surgery performed on the elderly and on more vulnerable patients with multimorbidity (MM). This proposal aims
to examine outcomes of patients with multimorbidity who were treated either at an ASC or at a hospital setting,
including hospital outpatient (HOPD) and inpatient settings, in order to provide guidance as to where MM
patients should receive their care. Understanding the answer to this question will greatly inform policy aimed at
protecting patients with MM, and provide guidance to patients and their surgeons about what characteristics of
the operative setting and the patient are important for ensuring better outcomes. Because the decision to
operate on a patient with MM must weigh the increased operative risks in the MM population, and because the
choice of operative setting (ASC versus hospital) is critical to this calculation, we will present specific
approaches to studying this setting question, we aim to closely define patient characteristics through the use of
multivariate matching. AIM 1 will define the pattern of surgery performed at ASCs, hospital outpatient (HOPD)
and inpatient locations in elderly patients with and without MM using the new Virtual Research Data Center at
CMS, allowing us to examine the entire country's data from 2008 to 2017. Using our new approach to defining
MM for general surgery and orthopedic surgery, and exploring ophthalmologic and diagnostic procedures, we
will be able to describe differences in setting (including by the characteristics of ASCs, hospitals, and
physicians) for patients undergoing surgery, with and without MM, between ASC and hospital settings. AIM 2
will examine differences in outcomes across initial ASC and initial HOPD settings for MM cases through the
use of multivariate matching. Hypothesis 2.1 will explore differences in outcomes for matched MM patients
between ASC and HOPD settings. Hypothesis 2.2 will explore differences in outcomes between matched MM
and non-MM patients by specified ASC settings (exploring differential outcomes in MM patients by the
characteristics of the ASC, using ownership, volume, location in relation to hospitals, anesthesia staffing,
physician characteristics, and "alignment" of ASC case-mix to the individual index case). Hypothesis 2.3 will
examine outcome differences between specific MM patient subgroups at the ASC versus HOPD setting. AIM 3
will examine differences in outcomes across ASC and HOPD settings for the non-MM cases using hypotheses
parallel to AIM 2. Through this research, we aim to identify procedures and types of MM patients that should
be encouraged to or discouraged from having surgery in specific settings in order to improve expected
outcomes for this especially vulnerable population. Furthermore, using a similar analytic approach, we will also
learn about differential outcomes across settings in the non-MM population. In the end,...

## Key facts

- **NIH application ID:** 9944543
- **Project number:** 5R01HS026897-02
- **Recipient organization:** CHILDREN'S HOSP OF PHILADELPHIA
- **Principal Investigator:** Lee A. Fleisher
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $398,765
- **Award type:** 5
- **Project period:** 2019-07-01 → 2022-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9944543

## Citation

> US National Institutes of Health, RePORTER application 9944543, Outcomes in Patients with Multimorbidity at Ambulatory Surgical Centers (5R01HS026897-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9944543. Licensed CC0.

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