Using Video Analysis to Improve Outcomes of Laparoscopic Colectomy

视频分析在提高腹腔镜结肠切除术疗效中的应用 摘要： 新的外科手术不断地被引入实践。即使新的程序 在随机临床试验中被证明是安全有效的，它们在不同的实践环境中的传播通常是 次优加快手术学习曲线的策略将有明显的好处，但实际上， 可扩展的方法一直难以实现。视频分析可能有助于填补这一空白。有几个重要的 在这一新出现的业绩改进领域，存在着一些尚未回答的问题。首先，目前尚不清楚手术是否 技术（如何完成案例的细节）或技能（案例完成得有多好）是更好的驱动力 腹腔镜结肠切除术的结果。第二，虽然有新的证据表明， 指导变化（即，有些教练比其他人更好），这是否会转化为不同的临床 教练的结果是未知的。第三，外科医生改善应对的技术途径， 教练是完全未开发的。我们有机会利用现有的外科医生 密歇根州外科质量协作（MSQC）中的关系和登记数据，以实现这一点 程序.基于我们在腹腔镜减肥手术中使用视频分析的初步数据，我们建议 具体目标：目标1。检查外科医生视频评级与患者 结果。在调整患者风险因素的所有潜在差异后，我们将评估 外科医生技术（他们如何做手术）和外科医生技能（他们如何做手术）之间的关系 结果（例如，死亡率并发症再手术目标2.实施基于视频的辅导 干预和评估对结果的影响。我们将设计和实施一个教练干预， 使用MSQC平台进行的阶梯式楔形分组随机试验。我们将评估 使用来自MSQC临床登记研究的详细结局对患者结局进行干预。目标3.到 评估指导效果与患者结局之间的关系。我们将录音， 记录所有辅导对话。根据这些数据，我们将评估对话的质量 使用一个经过验证的工具，对教练的有效性进行评分（从1到5，跨越四个领域）。 我们还将对教练谈话和离职面谈进行定性评估，以探索 外科医生改善的途径（即，他们会做出什么样的改变）以及障碍和 推动者们更广泛地采用。这项研究将产生直接和直接的影响。密歇根州的病人 除此之外，这项研究将加速腹腔镜结肠手术最佳技术实践的实施。 手术并改善其结果。使用视频分析和基于视频的辅导， 传播最佳技术实践将是提高手术和医疗质量的有力工具。 程序更广泛。

Using Video Analysis to Improve Outcomes of Laparoscopic Colectomy Abstract: New surgical procedures are continuously introduced into practice. Even when new procedures are proven safe and effective in randomized clinical trials, their diffusion into diverse practice settings is often suboptimal. Strategies for accelerating the surgical learning curve would have clear benefits, but practical, scalable approaches have been elusive. Video analysis may help fill this void. There several important unanswered questions in this emerging area of performance improvement. First, it is unclear whether surgical technique (the details of how the case is done) or skill (how well the case was done) is the driver of better outcomes for laparoscopic colectomy. Second, although there is emerging evidence that the effectiveness of coaching varies (i.e., some coaches are better than others), whether this translates into differential clinical outcomes of coachees is unknown. Third, the technical pathways by which surgeons improve in response to coaching are entirely unexplored. We have the unique opportunity to leverage the existing surgeon relationships and registry data in the Michigan Surgical Quality Collaborative (MSQC) to implement this program. Building on our preliminary data using video analysis in laparoscopic bariatric surgery, we propose the following Specific Aims: Aim 1. To examine the relationship between surgeon video ratings and patient outcomes. After adjusting for all potential differences in patient risk factors, we will assess the relationship between surgeon technique (how they do operation) and surgeon skill (how well they do operation) on patient outcomes (e.g., mortality, complications, reoperations. Aim 2. To implement a video-based coaching intervention and evaluate the impact on outcomes. We will design and implement a coaching intervention in a stepped wedge cluster randomized trial using the MSQC platform. We will evaluate the impact of the intervention on patient outcomes using the detailed outcomes from the MSQC clinical registry. Aim 3. To evaluate the relationship between coaching effectiveness and patient outcomes. We will audio record and transcribe all coaching conversations. Based on these data, we will evaluate the quality of the conversation using a validated instrument that scores coaching effectiveness (from a scale of 1 to 5, across four domains). We will also conduct a qualitative evaluation of coaching conversations and exit interviews to explore the pathways by which surgeons improve (i.e., what changes do they make) and also what the barriers and facilitators are to broader adoption. This study will have immediate and direct impact. For patients in Michigan and beyond, this study will accelerate the implementation of best technical practices for laparoscopic colon surgery and improve their outcomes. The use of video analysis and video-based coaching to understand and disseminate best technical practices will be a powerful tool for improving the quality of surgery and medical procedures more broadly.