Objective Assessment of Quality Measurement and Improvement

Abstract

Accurate quality measurement that allows for and results in improvement is essential to colon and rectal surgery. Currently, no consensus exists as to which variables are most important in measuring outcomes. Debate continues concerning the “best” variables to measure from a structural, process, and outcomes standpoint. Although American College of Surgeons National Surgical Quality Improvement Program provides an opportunity for outcomes measurement in general and vascular surgery, there is no specific quality improvement tool available for colon and rectal surgery. However, there is growing literature testing the validity of candidate variables to be used in such a data collection system. This article evaluates the current objective assessment measurements used for quality improvement in colon and rectal surgery.

Keywords

quality improvement - quality measure - colorectal - outcomes - processes

• References

• 1 Birkmeyer JD, Dimick JB, Birkmeyer NJ. Measuring the quality of surgical care: structure, process, or outcomes?. J Am Coll Surg 2004; 198 (4) 626-632
• 2 Billingsley KG, Morris AM, Dominitz JA , et al. Surgeon and hospital characteristics as predictors of major adverse outcomes following colon cancer surgery: understanding the volume-outcome relationship. Arch Surg 2007; 142 (1) 23-31 , discussion 32
• 3 Porter GA, Soskolne CL, Yakimets WW, Newman SC. Surgeon-related factors and outcome in rectal cancer. Ann Surg 1998; 227 (2) 157-167
• 4 Paulson EC, Mitra N, Sonnad S , et al. National Cancer Institute designation predicts improved outcomes in colorectal cancer surgery. Ann Surg 2008; 248 (4) 675-686
• 5 Birkmeyer NJ, Goodney PP, Stukel TA, Hillner BE, Birkmeyer JD. Do cancer centers designated by the National Cancer Institute have better surgical outcomes?. Cancer 2005; 103 (3) 435-441
• 6 Bratzler DW. The surgical infection prevention and surgical care improvement projects: promises and pitfalls. Am Surg 2006; 72 (11) 1010-1016 , discussion 1021–1030, 1133–1148
• 7 Bratzler DW, Houck PM. Anti-microbial prophylaxis for surgery: an advisory statement from the national surgical infection prevention project. Am J Surg 2005; 189 (4) 395-404
• 8 Surgical Care Improvement Project (8/15/2012). Retrieved 1/30/14, from http://www.jointcommission.org/surgical-care-improvement-project/
• 9 Ingraham AM, Cohen ME, Bilimoria KY , et al. Association of surgical care improvement project infection-related process measure compliance with risk-adjusted outcomes: implications for quality measurement. J Am Coll Surg 2010; 211 (6) 705-714
• 10 Participant Use Data File (n.d.). Retrieved 1/30/14, from http://site.acsnsqip.org/participant-use-data-file/
• 11 Pastor C, Artinyan A, Varma MG, Kim E, Gibbs L, Garcia-Aguilar J. An increase in compliance with the Surgical Care Improvement Project measures does not prevent surgical site infection in colorectal surgery. Dis Colon Rectum 2010; 53 (1) 24-30
• 12 Wick EC, Hobson DB, Bennett JL , et al. Implementation of a surgical Comprehensive Unit-Based Safety Program to reduce surgical site infections. J Am Coll Surg 2012; 215 (2) 193-200
• 13 Arriaga AF, Lancaster RT, Berry WR , et al. The better colectomy project: association of evidence-based best-practice adherence rates to outcomes in colorectal surgery. Ann Surg 2009; 250 (4) 507-513
• 14 Khuri SF, Henderson WG, Daley J , et al; Principal Investigators of the Patient Safety in Surgery Study. Successful implementation of the department of veterans affairs' national surgical quality improvement program in the private sector: the patient safety in surgery study. Ann Surg 2008; 248 (2) 329-336
• 15 Khuri SF, Daley J, Henderson W , et al. Risk adjustment of the postoperative mortality rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. J Am Coll Surg 1997; 185 (4) 315-327
• 16 Daley J, Khuri SF, Henderson W , et al. Risk adjustment of the postoperative morbidity rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. J Am Coll Surg 1997; 185 (4) 328-340
• 17 Corrigan JM, Eden J, Smith BM. Leadership by Example: Coordinating Government Roles in Improving Health Care Quality. 1st ed. Washington DC: National Academy Press; 2002
• 18 Hall BL, Hamilton BH, Richards K, Bilimoria KY, Cohen ME, Ko CY. Does surgical quality improve in the American College of Surgeons National Surgical Quality Improvement Program: an evaluation of all participating hospitals. Ann Surg 2009; 250 (3) 363-376
• 19 McCloskey CA, Wilson MA, Hughes SJ, Eid GM. Laparoscopic colorectal surgery is safe in the high-risk patient: a NSQIP risk-adjusted analysis. Surgery 2007; 142 (4) 594-597 , discussion e1–e2
• 20 Cohen ME, Ko CY, Bilimoria KY , et al. Optimizing ACS NSQIP modeling for evaluation of surgical quality and risk: patient risk adjustment, procedure mix adjustment, shrinkage adjustment, and surgical focus. J Am Coll Surg 2013; 217 (2) 336 , e1
• 21 ACS NSQIP: How it works (n.d.). ACS NSQIP. Retrieved 1/30/14, from site.acsnsqip.org/wp-content/uploads/2012/02/Technical Paper1.pdf
• 22 Kwon S, Florence M, Grigas P , et al; SCOAP Collaborative, Writing Group for the SCOAP Collaborative. Creating a learning healthcare system in surgery: Washington State's Surgical Care and Outcomes Assessment Program (SCOAP) at 5 years. Surgery 2012; 151 (2) 146-152
• 23 Kwon S, Morris A, Billingham R , et al; Surgical Care and Outcomes Assessment Program (SCOAP) Collaborative. Routine leak testing in colorectal surgery in the Surgical Care and Outcomes Assessment Program. Arch Surg 2012; 147 (4) 345-351
• 24 Procedure Targeted (n.d.). ACS NSQIP. Retrieved 1/30/14, from http://site.acsnsqip.org/program-specifics/program-options/procedure-targeted-program
• 25 McGory ML, Shekelle PG, Ko CY. Development of quality indicators for patients undergoing colorectal cancer surgery. J Natl Cancer Inst 2006; 98 (22) 1623-1633
• 26 Manwaring ML, Ko CY, Fleshman Jr JW , et al. Identification of consensus-based quality end points for colorectal surgery. Dis Colon Rectum 2012; 55 (3) 294-301
• 27 Cook A, Hyman N. Quality assessment and improvement in colon and rectal surgery. Dis Colon Rectum 2004; 47 (12) 2195-2201
• 28 Prytherch DR, Whiteley MS, Higgins B, Weaver PC, Prout WG, Powell SJ. POSSUM and Portsmouth POSSUM for predicting mortality. Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity. Br J Surg 1998; 85 (9) 1217-1220
• 29 Tekkis PP, Prytherch DR, Kocher HM , et al. Development of a dedicated risk-adjustment scoring system for colorectal surgery (colorectal POSSUM). Br J Surg 2004; 91 (9) 1174-1182
• 30 Cohen ME, Bilimoria KY, Ko CY, Hall BL. Development of an American College of Surgeons National Surgery Quality Improvement Program: morbidity and mortality risk calculator for colorectal surgery. J Am Coll Surg 2009; 208 (6) 1009-1016
• 31 Gagliardi AR, Simunovic M, Langer B, Stern H, Brown AD. Development of quality indicators for colorectal cancer surgery, using a 3-step modified Delphi approach. Can J Surg 2005; 48 (6) 441-452
• 32 Vergara-Fernandez O, Swallow CJ, Victor JC , et al. Assessing outcomes following surgery for colorectal cancer using quality of care indicators. Can J Surg 2010; 53 (4) 232-240
• 33 Morris AM, Baldwin LM, Matthews B , et al. Reoperation as a quality indicator in colorectal surgery: a population-based analysis. Ann Surg 2007; 245 (1) 73-79
• 34 Cohen ME, Bilimoria KY, Ko CY, Richards K, Hall BL. Variability in length of stay after colorectal surgery: assessment of 182 hospitals in the national surgical quality improvement program. Ann Surg 2009; 250 (6) 901-907
• 35 Jensen CC, Prasad LM, Abcarian H. Cost-effectiveness of laparoscopic vs open resection for colon and rectal cancer. Dis Colon Rectum 2012; 55 (10) 1017-1023