Bruinsma Floris F E, Nienhuijs Simon W, Liem Ronald S L, Greve Jan Willem M, Marang-van de Mheen Perla J
Maastricht University Medical Centre, Maastricht, Netherlands.
Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, Netherlands.
Obes Surg. 2025 Jul;35(7):2616-2625. doi: 10.1007/s11695-025-07898-2. Epub 2025 Jun 12.
Quality of metabolic bariatric surgery (MBS) care is often monitored by national registries using quality indicators (QIs), but data collection takes up considerable time and costs. QIs are mostly introduced merely based on expert opinion. Therefore, the study's aim was to systematically evaluate whether all QIs from the Dutch Audit for Treatment of Obesity (DATO) are still relevant and useful to initiate quality improvement initiatives.
Twenty-four QIs were evaluated using hospital data from 2022 to 2023. To test whether QIs measured the same quality of care aspect (parsimony and relevance), correlations of QI pairs were examined using Pearson correlation coefficients. Usefulness to identify improvement opportunities was considered limited when variance is ≤ 0.001 without any outliers identified, indicating that the QI could be retired. Actionability was assessed through line graphs of hospital performance over the years.
Eleven QIs were highly correlated to other QIs, particularly the follow-up and weight loss indicators at 2 and 4 years, and therefore lacked added value. The weight loss QIs showed minimal variance and were adjusted by increasing the threshold to achieving ≥ 25% total weight loss. Multiple QIs showed improving trends and thereby their actionability, most pronounced for postoperative complications. The final QI set measured three constructs with good validity: Cronbach's alpha values 0.53 (safety), 0.70 (treatment effectiveness), and 0.43 (follow-up process).
Through a systematic evaluation of the DATO QI set, a smaller set of 13 QIs was shown to capture the same relevant information to improve MBS care.
代谢性减肥手术（MBS）的护理质量通常由国家登记处使用质量指标（QIs）进行监测，但数据收集需要耗费大量时间和成本。质量指标大多仅基于专家意见引入。因此，本研究的目的是系统评估荷兰肥胖治疗审计（DATO）中的所有质量指标是否仍然相关且有助于启动质量改进计划。
使用2022年至2023年的医院数据对24个质量指标进行评估。为了测试质量指标是否衡量了相同的护理质量方面（简约性和相关性），使用Pearson相关系数检查质量指标对之间的相关性。当方差≤0.001且未识别出任何异常值时，认为识别改进机会的有用性有限，这表明该质量指标可以停用。通过多年来医院绩效的折线图评估可操作性。
11个质量指标与其他质量指标高度相关，特别是2年和4年的随访及体重减轻指标，因此缺乏附加值。体重减轻质量指标的方差最小，通过提高阈值以实现总体重减轻≥25%进行了调整。多个质量指标显示出改善趋势，从而具有可操作性，术后并发症最为明显。最终的质量指标集测量了三个具有良好效度的结构：Cronbach's alpha值分别为0.53（安全性）、0.70（治疗效果）和0.43（随访过程）。
通过对DATO质量指标集的系统评估，显示一组较小的13个质量指标能够获取相同的相关信息以改善MBS护理。
