Developing Disparities-Sensitive Surgical Quality Metrics Across the Continuum of Care

项目总结/摘要 种族和民族健康不平等仍然是美国的一个重大社会负担， 几乎每个护理部门。超过5000万住院病人和5300万门诊手术病例 在美国每年进行的手术中，手术质量是一个重要的国家优先事项， 在所有种族和族裔群体中，获得的外科护理并不公平。鉴于已知的差异， 为了提高少数民族患者的护理质量， 在多个领域发起了这一运动，但没有针对外科手术开展有针对性的运动。的屏障 缺乏标准化的质量指标和衡量标准， 手术差异和获得手术护理的机会。美国国立卫生研究院（NIH）和美国大学 美国外科医生协会（ACS）已经确定了新的和现有的手术质量指标的改进和探索， 消除手术差异的最重要的解决方案之一。国家质量论坛（NQF） 在多年的循证质量改进研究中，已经制定了标准来评估哪些质量 度量对于检测差异是有效的，他们创造了一个术语“差异敏感的差异”（DSM）。 目前，没有DSM涉及手术入路、质量或结局。该提案旨在解决 通过确定一套强大的手术DSM来弥补这一差距，这些DSM可用于衡量手术质量， 手术护理的连续性（获得护理、术前、围手术期、术中、术后， 出院后）。我们将召集一个专家咨询小组（EAP）参加正式的修改后的德尔菲 制定一个概念框架，以确定在获得服务方面存在差距的最大风险， 手术护理的连续性。EAP将调整NQF DSM标准，以便与手术指标一起使用。然后我们将 对所有手术质量指标进行有针对性的环境扫描和系统审查，EAP将 使用所述经调适的NQF DSM准则对关于视差敏感性的初步度量集进行评级。使用当前 从ACS提供的大型数据集的数据，我们将基准医院的手术差异使用 候选DSM。最后一轮德尔菲将确定一套最适合于 测量手术差异和手术机会。确定稳健的手术差异指标将使 确定手术质量差异的真实程度，并允许监测 缩小差距。作为世界上最大的外科医生组织，ACS处于独特的地位， 大力促进或授权收集这些指标，并为消除 外科护理在美国。

Project Summary/Abstract Racial and ethnic health inequity remains a significant social burden in the United States, and exists across nearly every sector of care. With more than 50 million inpatient and 53 million outpatient surgical cases performed in the United States each year, surgical quality is an important national priority, yet the quality of surgical care received is not equitable across all racial and ethnic groups. Given the known differences in quality for minority patients, data driven campaigns to improve quality of care for minority patients have been initiated across a variety of fields, however no focused campaigns have been carried out for surgery. A barrier to progress has been a lack of standardized quality indicators and metrics used to consistently measure surgical disparities and access to surgical care. The National Institutes of Health (NIH) and American College of Surgeons (ACS) has identified improvement and exploration of new and existing surgical quality metrics as one of the most important solutions to eradicate surgical disparities. The National Quality Forum (NQF), based on years of evidence-based quality improvement research, has developed criteria to evaluate which quality metrics are effective for detecting disparities, a term they coined “Disparities-Sensitive Metrics” (DSM). Currently, no DSMs exist which address surgical access, quality, or outcomes. This proposal aims to address this gap by determining a suite of robust surgical DSMs that can be used to measure surgical quality across the continuum of surgical care (access to care, pre-operative, peri-operative, intra-operative, post-operative, and post-discharge). We will convene an expert advisory panel (EAP) to participate in a formal modified Delphi approach to develop a conceptual framework for identifying the highest risk of disparities in access and the continuum of surgical care. The EAP will adapt the NQF DSM criteria for use with surgical metrics. We will then conduct a targeted environmental scan and systematic review of all surgical quality metrics, and the EAP will rate a preliminary set of metrics on disparities sensitivity using the adapted NQF DSM criteria. Using current data from large datasets available at the ACS, we will benchmark hospitals on surgical disparities using the candidate DSMs. A final Delphi round will determine a definitive suite of quality metrics most appropriate for measuring surgical disparities and access. Identifying robust surgical disparities metrics will enable determination of the true extent of surgical quality disparities and allow for the monitoring of the progress of reduction of disparities. As the largest organization of surgeons in the world, the ACS is in a unique position to heavily promote or mandate collection of these metrics, and lay the foundation for eradicating disparities in surgical care in the United States.