1932

Abstract

Surgeons are increasingly under pressure to measure and improve their quality. While there is broad consensus that we ought to track surgical quality, there is far less agreement about which metrics matter most. This article reviews the important statistical concepts of case mix and chance as they apply to understanding the observed wide variation in surgical quality. We then discuss the benefits and drawbacks of current measurement strategies through the framework of structure, process, and outcomes approaches. Finally, we describe emerging new metrics, such as video evaluation and network optimization, that are likely to take on an increasingly important role in the future of measuring surgical quality.

Loading

Article metrics loading...

/content/journals/10.1146/annurev-med-060116-022805
2018-01-29
2024-06-13
Loading full text...

Full text loading...

/deliver/fulltext/med/69/1/annurev-med-060116-022805.html?itemId=/content/journals/10.1146/annurev-med-060116-022805&mimeType=html&fmt=ahah

Literature Cited

  1. Hannan EL, Kilburn H Jr., O'Donnell JF. 1.  et al. 1990. Adult open heart surgery in New York State. An analysis of risk factors and hospital mortality rates. JAMA 264:212768–74 [Google Scholar]
  2. Birkmeyer JD, Siewers AE, Finlayson EV. 2.  et al. 2002. Hospital volume and surgical mortality in the United States. N. Engl. J. Med. 346:151128–37 [Google Scholar]
  3. Ghaferi AA, Birkmeyer JD, Dimick JB. 3.  2009. Variation in hospital mortality associated with inpatient surgery. N. Engl. J. Med. 361:141368–75 [Google Scholar]
  4. Finks JF, Osborne NH, Birkmeyer JD. 4.  2011. Trends in hospital volume and operative mortality for high-risk surgery. N. Engl. J. Med. 364:222128–37 [Google Scholar]
  5. Birkmeyer JD, Stukel TA, Siewers AE. 5.  et al. 2003. Surgeon volume and operative mortality in the United States. N. Engl. J. Med. 349:222117–27 [Google Scholar]
  6. Birkmeyer NJ, Birkmeyer JD. 6.  2006. Strategies for improving surgical quality—Should payers reward excellence or effort?. N. Engl. J. Med. 354:8864–70 [Google Scholar]
  7. Dimick JB, Welch HG. 7.  2008. The zero mortality paradox in surgery. J. Am. Coll. Surg. 206:113–16 [Google Scholar]
  8. Dimick JB, Welch HG, Birkmeyer JD. 8.  2004. Surgical mortality as an indicator of hospital quality: the problem with small sample size. JAMA 292:7847–51 [Google Scholar]
  9. Ibrahim AM, Regenbogen SE, Thumma JR, Dimick JB. 9.  2017. Emergency surgery for Medicare beneficiaries admitted to critical access hospitals. Ann. Surg. In press [Google Scholar]
  10. Dimick JB, Osborne NH, Hall BL. 10.  et al. 2010. Risk adjustment for comparing hospital quality with surgery: How many variables are needed?. J. Am. Coll. Surg. 210:4503–8 [Google Scholar]
  11. Donabedian A. 11.  1966. Evaluating the quality of medical care. Milbank Mem. Fund Q. 44:3166–206 (Suppl.) [Google Scholar]
  12. Donabedian A. 12.  1988. The quality of care. How can it be assessed?. JAMA 260:121743–48 [Google Scholar]
  13. Morche J, Mathes T, Pieper D. 13.  2016. Relationship between surgeon volume and outcomes: a systematic review of systematic reviews. Syst. Rev. 5:204 [Google Scholar]
  14. Haynes AB, Weiser TG, Berry WR. 14.  et al. 2009. A surgical safety checklist to reduce morbidity and mortality in a global population. N. Engl. J. Med. 360:5491–99 [Google Scholar]
  15. Urbach DR, Govindarajan A, Saskin R. 15.  et al. 2014. Introduction of surgical safety checklists in Ontario. Canada N. Engl. J. Med. 370:111029–38 [Google Scholar]
  16. Stulberg JJ, Pavey ES, Cohen ME. 16.  et al. 2017. Effect of flexible duty hour policies on length of stay for complex intra-abdominal operations: a Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial analysis. J. Am. Coll. Surg. 224:2143–48 [Google Scholar]
  17. 17. Medicare.gov. 2015. Linking quality to payment. https://www.medicare.gov/hospitalcompare/linking-quality-to-payment.html?AspxAutoDetectCookieSupport=1. Accessed Nov. 30, 2015
  18. Dimick JB, Ghaferi AA, Osborne NH. 18.  et al. 2012. Reliability adjustment for reporting hospital outcomes with surgery. Ann. Surg. 255:4703–7 [Google Scholar]
  19. Ibrahim AM, Ghaferi AA, Thumma JR, Dimick JB. 19.  2017. Variation in outcomes at bariatric surgery centers of excellence. JAMA Surg 152:7629–36 [Google Scholar]
  20. Ibrahim AM, Hughes TG, Thumma JR, Dimick JB. 20.  2016. Association of hospital critical access status with surgical outcomes and expenditures among Medicare beneficiaries. JAMA 315:192095–103 [Google Scholar]
  21. Birkmeyer JD, Finks JF, O'Reilly A. 21.  et al. 2013. Surgical skill and complication rates after bariatric surgery. N. Engl. J. Med. 369:151434–42 [Google Scholar]
  22. Greenberg CC, Dombrowski J, Dimick JB. 22.  2015. Video-based surgical coaching: an emerging approach to performance improvement. JAMA Surg 151:3282–83 [Google Scholar]
  23. Greenberg CC, Ghousseini HN, Pavuluri Quamme SR. 23.  et al. 2015. Surgical coaching for individual performance improvement. Ann. Surg. 261:132–34 [Google Scholar]
  24. Bilimoria KY, Cella D, Butt Z. 24.  2014. Current challenges in using patient-reported outcomes for surgical care and performance measurement: Everybody wants to hear from the patient, but are we ready to listen?. JAMA Surg 149:6505–6 [Google Scholar]
  25. 25. ProPublica. 2015. Surgeon scorecard. https://projects.propublica.org/surgeons. Accessed Nov. 30, 2015
  26. Jaffe TA, Hasday SJ, Dimick JB. 26.  2016. Power outage—inadequate surgeon performance measures leave patients in the dark. JAMA Surg 151:7599–600 [Google Scholar]
  27. Habuchi T, Terachi T, Mimata H. 27.  et al. 2012. Evaluation of 2,590 urological laparoscopic surgeries undertaken by urological surgeons accredited by an endoscopic surgical skill qualification system in urological laparoscopy in Japan. Surg. Endosc. 26:61656–63 [Google Scholar]
  28. Tanigawa N, Lee SW, Kimura T. 28.  et al. 2011. The Endoscopic Surgical Skill Qualification System for gastric surgery in Japan. Asian J. Endosc. Surg. 4:3112–15 [Google Scholar]
  29. Dimick JB, Varban OA. 29.  2015. Surgical video analysis: an emerging tool for improving surgeon performance. BMJ Qual. Saf. 24:8490–91 [Google Scholar]
  30. 30. Centers for Medicare and Medicaid Services. 2017. Readmissions Reduction Program (HRRP). https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program.html. Accessed Mar. 20, 2017
  31. Berenson RA, Paulus RA, Kalman NS. 31.  2012. Medicare's readmissions-reduction program—a positive alternative. N. Engl. J. Med. 366:151364–66 [Google Scholar]
  32. Dafny L. 32.  2014. Hospital industry consolidation—still more to come?. N. Engl. J. Med. 370:3198–99 [Google Scholar]
  33. Frakt AB. 33.  2015. Hospital consolidation isn't the key to lowering costs and raising quality. JAMA 313:4345 [Google Scholar]
  34. Harder B, Comarow A. 34.  2016. An updated honor roll. US News World Rep. Second Opinion blog. http://health.usnews.com/health-news/blogs/second-opinion/articles/2016-04-20/an-updated-honor-roll. Accessed May 28, 2017 [Google Scholar]
  35. Tsai TC, Jha AK. 35.  2014. Hospital consolidation, competition, and quality: Is bigger necessarily better?. JAMA 312:129–30 [Google Scholar]
  36. Chhabra KR, Dimick JB. 36.  2015. Hospital networks and value-based payment: fertile ground for regionalizing high-risk surgery. JAMA 314:131335–36 [Google Scholar]
  37. Urbach DR. 37.  2015. Pledging to eliminate low-volume surgery. N. Engl. J. Med. 373:151388–90 [Google Scholar]
  38. Ibrahim AM, Dimick JB. 38.  2017. Redesigning the delivery of specialty care within newly formed hospital networks. N. Engl. J. Med. Catalyst. Mar. 30. http://catalyst.nejm.org/redesigning-specialty-care-delivery
  39. Berwick DM. 39.  2015. Measuring surgical outcomes for improvement: Was Codman wrong?. JAMA 313:5469–70 [Google Scholar]
  40. Etzioni DA, Wasif N, Dueck AC. 40.  et al. 2015. Association of hospital participation in a surgical outcomes monitoring program with inpatient complications and mortality. JAMA 313:5505–11 [Google Scholar]
  41. Osborne NH, Nicholas LH, Ryan AM. 41.  et al. 2015. Association of hospital participation in a quality reporting program with surgical outcomes and expenditures for Medicare beneficiaries. JAMA 313:5496–504 [Google Scholar]
/content/journals/10.1146/annurev-med-060116-022805
Loading
/content/journals/10.1146/annurev-med-060116-022805
Loading

Data & Media loading...

  • Article Type: Review Article
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error