Houston Methodist Research Institute, Houston, TX; University of Houston College of Pharmacy, Houston, TX.
Houston Methodist Research Institute, Houston, TX.
J Am Coll Surg. 2016 Feb;222(2):113-21. doi: 10.1016/j.jamcollsurg.2015.10.017. Epub 2015 Nov 21.
Methods to assess a surgeon's individual performance based on clinically meaningful outcomes have not been fully developed, due to small numbers of adverse outcomes and wide variation in case volumes. The Achievable Benchmark of Care (ABC) method addresses these issues by identifying benchmark-setting surgeons with high levels of performance and greater case volumes. This method was used to help surgeons compare their surgical practice to that of their peers by using merged National Surgical Quality Improvement Program (NSQIP) and Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data to generate surgeon-specific reports.
A retrospective cohort study at a single institution's department of surgery was conducted involving 107 surgeons (8,660 cases) over 5.5 years. Stratification of more than 32,000 CPT codes into 16 CPT clusters served as the risk adjustment. Thirty-day outcomes of interest included surgical site infection (SSI), acute kidney injury (AKI), and mortality. Performance characteristics of the ABC method were explored by examining how many surgeons were identified as benchmark-setters in view of volume and outcome rates within CPT clusters.
For the data captured, most surgeons performed cases spanning a median of 5 CPT clusters (range 1 to 15 clusters), with a median of 26 cases (range 1 to 776 cases) and a median of 2.8 years (range 0 to 5.5 years). The highest volume surgeon for that CPT cluster set the benchmark for 6 of 16 CPT clusters for SSIs, 8 of 16 CPT clusters for AKIs, and 9 of 16 CPT clusters for mortality.
The ABC method appears to be a sound and useful approach to identifying benchmark-setting surgeons within a single institution. Such surgeons may be able to help their peers improve their performance.
由于不良结果数量较少且病例量变化较大，因此尚未完全开发出基于有临床意义的结果来评估外科医生个体绩效的方法。通过确定具有高水平绩效和更多病例量的基准设定外科医生，可实现可实现的护理基准（ABC）方法解决了这些问题。该方法通过使用合并的国家手术质量改进计划（NSQIP）和代谢和减重手术认证和质量改进计划（MBSAQIP）数据生成特定于外科医生的报告，帮助外科医生将其手术实践与同行进行比较。
对一个机构的外科部门进行了一项回顾性队列研究，涉及 107 名外科医生（8660 例），研究时间为 5.5 年。将 32000 多个 CPT 代码分层为 16 个 CPT 集群，作为风险调整。感兴趣的 30 天结果包括手术部位感染（SSI）、急性肾损伤（AKI）和死亡率。通过检查在 CPT 集群内的体积和结果率方面有多少外科医生被确定为基准设定者，探讨了 ABC 方法的性能特征。
对于捕获的数据，大多数外科医生执行的病例中位数跨越了 5 个 CPT 集群（范围为 1 至 15 个集群），中位数为 26 例（范围为 1 至 776 例），中位数为 2.8 年（范围为 0 至 5.5 年）。对于该 CPT 集群集，最高容量的外科医生为 6 个 CPT 集群设定了 SSI 的基准，为 16 个 CPT 集群设定了 AKI 的基准，为 16 个 CPT 集群设定了死亡率的基准。
ABC 方法似乎是一种可靠且有用的方法，可以在单个机构内确定基准设定的外科医生。这样的外科医生可能能够帮助他们的同行提高绩效。
