Validity and feasibility of the american college of surgeons colectomy composite outcome quality measure.
Ann Surg
; 257(3): 483-9, 2013 Mar.
Article
em En
| MEDLINE
| ID: mdl-23299518
ABSTRACT
OBJECTIVE:
To develop a reliable, robust, parsimonious, risk-adjusted 30-day composite colectomy outcome measure.BACKGROUND:
A fundamental aspect in the pursuit of high-quality care is the development of valid and reliable performance measures in surgery. Colon resection is associated with appreciable morbidity and mortality and therefore is an ideal quality improvement target.METHODS:
From 2010 American College of Surgeons National Surgical Quality Improvement Program data, patients were identified who underwent colon resection for any indication. A composite outcome of death or any serious morbidity within 30 days of the index operation was established. A 6-predictor, parsimonious model was developed and compared with a more complex model with more variables. National caseload requirements were calculated on the basis of increasing reliability thresholds.RESULTS:
From 255 hospitals, 22,346 patients were accrued who underwent a colon resection in 2010, most commonly for neoplasm (46.7%). A mortality or serious morbidity event occurred in 4461 patients (20.0%). At the hospital level, the median composite event rate was 20.7% (interquartile range 15.8%-26.3%). The parsimonious model performed similarly to the full model (Akaike information criterion 19,411 vs 18,988), and hospital-level performance comparisons were highly correlated (R = 0.97). At a reliability threshold of 0.4, 56 annual colon resections would be required and achievable at an estimated 42% of US and 69% of American College of Surgeons National Surgical Quality Improvement Program hospitals. This 42% of US hospitals performed approximately 84% of all colon resections in the country in 2008.CONCLUSIONS:
It is feasible to design a measure with a composite outcome of death or serious morbidity after colon surgery that has a low burden for data collection, has substantial clinical importance, and has acceptable reliability.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Garantia da Qualidade dos Cuidados de Saúde
/
Avaliação de Resultados em Cuidados de Saúde
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Colectomia
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Hospitais
Tipo de estudo:
Etiology_studies
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Observational_studies
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Prognostic_studies
Limite:
Aged
/
Female
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Humans
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Male
/
Middle aged
País como assunto:
America do norte
Idioma:
En
Ano de publicação:
2013
Tipo de documento:
Article