Better Surgical Quality Indicators for the Elderly

描述(由申请人提供)：老年患者在接受住院手术的患者中占越来越多的比例，他们的发病率和死亡率明显高于年轻患者。鉴于人们普遍认识到手术质量差异很大，向患者提供有关医院表现的信息的需求越来越大。不幸的是，大多数程序缺乏可靠的质量指标。在大多数手术中，手术量并不能可靠地预测个别医院的死亡率。流程措施是目前大多数绩效计划的薪酬基础，通常与次要成果有关。最后，直接结果指标(例如，经风险调整的死亡率)过于“嘈杂”，不能反映大多数医院的表现。出于这些原因，我们提出了一种新颖的、综合的质量测量方法，它通过特定的程序最佳地利用与医院死亡率相关的所有可用信息。我们的应用有两个具体目标：一是开发手术性能的综合衡量标准。使用国家医疗保险人口(1998-2001)的数据，我们将为10种常见或高风险住院手术的每一种制定综合绩效衡量标准。模型输入将包括来自不同质量领域的测量，包括结构变量(例如，程序量)、护理过程和患者结果(对于感兴趣的程序和相关手术)。模型输出将是医院和手术程序特定的“真实”死亡率的估计，它以最佳方式过滤统计噪声。评估综合指标对未来业绩的预测能力。考虑到患者希望如何使用它们，手术质量指标最好是通过历史测量是否预测未来的表现来判断。在这种情况下，我们将再次使用医疗保险数据来评估我们的综合指标(来自1998-2001年的数据)相对于个人质量指标(例如，历史死亡率或数量)预测2002-2003年医院死亡率的程度。

DESCRIPTION (provided by applicant): Elderly patients, who comprise a growing majority of patients undergoing inpatient surgery, experience markedly higher rates of morbidity and mortality than their younger counterparts. In light of widespread recognition that surgical quality varies widely, there is growing demand for providing patients with information about hospital performance. Unfortunately, reliable quality indicators are lacking for most procedures. Procedure volume does not reliably predict mortality of individual hospitals for most procedures. Process measures, the basis of most current pay for performance plans, generally relate to secondary outcomes. And, finally, direct outcome measures (e.g., risk-adjusted mortality) are too "noisy" to reflect performance at most hospitals. For these reasons, we propose a novel, integrative measure of quality that makes optimal use of all available information related to hospital mortality with a specific procedure. Our application has 2 specific aims: I. To develop integrative measures of surgical performance. Using data from the national Medicare population (1998-2001), we will develop integrative performance measures for each of 10 common or high-risk inpatient surgical procedures. Model inputs will include measures from different quality domains, including structural variables (e.g., procedure volume), process of care, and patient outcomes (both for the procedure of interest and related operations). Model outputs will be hospital- and procedure-specific estimates of "true" mortality that optimally filter out statistical noise. II. To assess how well integrative measures predict future performance. Given how patients hope to use them, surgical quality indicators are best judged by whether historical measures predict future performance. In this context, we will again use Medicare data to assess how well our integrative measures (from 1998-2001 data) predict hospital mortality rates in 2002-2003, relative to individual quality indicators (e.g., historical mortality or volume alone).