Video Analysis for Ensuring Safer Diffusion of New Procedures

描述（由申请人提供）：视频分析确保新手术更安全的传播新的外科手术不断被引入实践。即使新方法在随机临床试验中被证明是安全有效的，它们在不同实践环境中的推广也往往不是最佳的。这些创新所隐含的对新技术的掌握程度参差不齐，可能会导致提供者之间的结果和有效性存在很大差异。确定最佳技术并传播这些技术的战略将有明显的好处，但实际的、可扩展的战略一直难以捉摸。视频分析是否可以用于这一目的还没有被探讨。在这个提案中，我们将以我们最近发表在NEJM上的工作为基础，该工作使用视频分析来评估手术技能。利用之前在密歇根减肥手术合作中心（MBSC）的工作，我们将研究最近由医疗保险和医疗补助服务中心（CMS）批准的袖式胃切除术。我们有以下具体目的：目的1：使用手术视频分析来检查手术技术的变化。我们将收集密歇根所有进行袖式胃切除术的外科医生的视频。使用标准化的工具，我们将让同行审稿人评估彼此的技术。同行评审工具包括与短期和长期结果相关的技术方面。目标2。目的探讨手术技术与患者预后的关系。我们将把视频分析技术的这些细节与来自MBSC临床注册的患者结果数据联系起来。在调整了所有潜在的混杂因素后，我们将评估手术技术与短期安全性结果和长期有效性结果之间的关系。目标3。实施最佳技术实践并评估对患者预后的影响。我们将使用MBSC平台设计并实施阶梯式楔形随机试验干预措施。干预将包括一份最佳做法的清单，展示最佳做法的视频，以及具有这些技术专长的外科医生的指导课程。这项工作最直接的影响将是密歇根州和其他地区接受袖式胃切除术的患者。然而，使用视频分析来了解和传播最佳技术实践将是更广泛地提高手术和医疗程序质量的有力工具。

DESCRIPTION (provided by applicant): Video Analysis for Ensuring Safer Diffusion of New Procedures New surgical procedures are introduced continuously into practice. Even when new procedures are proven safe and effective in randomized clinical trials, their diffusion into divers practice settings is often suboptimal. The uneven mastery of new techniques implied by these innovations may contribute to wide variations in outcomes and effectiveness across providers. Strategies for identifying best techniques and disseminating them would have clear benefits, but practical, scalable strategies have been elusive. Whether video analysis can be used for this purpose has not been explored. In this proposal, we will build on our recent work, published in NEJM, which uses vide analysis to assess surgical skill. Leveraging this prior work in the Michigan Bariatric Surgery Collaborative (MBSC), we will study sleeve gastrectomy, which was recently approved by the Center for Medicare and Medicaid Services (CMS). We have the following Specific Aims: Aim 1: To use surgical video analysis to examine variations in surgical technique. We will collect videos from all Michigan surgeons who perform sleeve gastrectomy. Using a standardized instrument, we will have peer reviewers assess each other's technique. The peer review instrument includes aspects of technique that relate to both short-term and long-term outcomes. Aim 2. To examine the relationship between surgical technique and patient outcomes. We will link these details on technique from video analysis to patient outcome data from the MBSC clinical registry. After adjusting for all potential confounders, we will assess the relationship between surgical technique and short-term safety outcomes and long-term effectiveness outcomes. Aim 3. To implement best technical practices and evaluate the impact on patient outcomes. . We will design and implement an intervention in a stepped wedge cluster randomized trial using the MBSC platform. The intervention will include a checklist of best practices, videos demonstrating the best practices, and coaching sessions by surgeons with expertise in these techniques. The most immediate impact of this work will be for patients undergoing sleeve gastrectomy in Michigan and beyond. However, the use of video analysis to understand and disseminate best technical practices will be a powerful tool for improving the quality of surgery and medical procedures more broadly.