Department of Surgery, University of California, San Diego, La Jolla, CA.
The Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA.
Ann Surg. 2022 Jan 1;275(1):196-202. doi: 10.1097/SLA.0000000000003894.
Develop quality indicators that measure access to and the quality of primary PC delivered to seriously ill surgical patients.
PC for seriously ill surgical patients, including aligning treatments with patients' goals and managing symptoms, is associated with improved patient-oriented outcomes and decreased healthcare utilization. However, efforts to integrate PC alongside restorative surgical care are limited by a lack of surgical quality indicators to evaluate primary PC delivery.
We developed a set of 27 preliminary indicators that measured palliative processes of care across the surgical episode, including goals of care, decision-making, symptom assessment, and issues related to palliative surgery. Then using the RAND-UCLA Appropriateness method, a 12-member expert advisory panel rated the validity (primary outcome) and feasibility of each indicator twice: (1) remotely and (2) after an in-person moderated discussion.
After 2 rounds of rating, 24 indicators were rated as valid, covering the preoperative evaluation (9 indicators), immediate preoperative readiness (2 indicators), intraoperative (1 indicator), postoperative (8 indicators), and end of life (4 indicators) phases of surgical care.
This set of quality indicators provides a comprehensive set of process measures that possess the potential to measure high quality PC for seriously ill surgical patients throughout the surgical episode.
制定衡量严重疾病手术患者初级 PC 获得情况和质量的质量指标。
为严重疾病手术患者提供 PC，包括使治疗与患者的目标一致并管理症状，与改善以患者为导向的结果和减少医疗保健利用有关。然而，由于缺乏评估初级 PC 提供情况的手术质量指标，将 PC 与恢复性手术护理相结合的努力受到限制。
我们制定了一套 27 个初步指标，用于衡量手术期间的姑息护理过程，包括护理目标、决策、症状评估以及与姑息手术相关的问题。然后，使用 RAND-UCLA 适宜性方法，一个由 12 名成员组成的专家咨询小组对每个指标的有效性（主要结果）和可行性进行了两次评估：（1）远程评估和（2）在现场讨论后评估。
经过两轮评分，24 个指标被评为有效，涵盖了术前评估（9 个指标）、术前即刻准备（2 个指标）、术中（1 个指标）、术后（8 个指标）和生命末期（4 个指标）手术护理阶段。
这套质量指标提供了一套全面的流程措施，有可能在整个手术过程中衡量严重疾病手术患者的高质量 PC。
