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

在整个护理过程中制定差异敏感的手术质量指标

• 批准号: 9381163
• 负责人: L. D. Britt
• 金额: $ 85.33万
• 依托单位: AMERICAN COLLEGE OF SURGEONS
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9381163
• 关键词: Accreditation; Address; American College of Surgeons; Benchmarking; Cardiovascular Diseases; Caring; Chronic Disease; Coin; Collection; Consensus; Continuity of Patient Care; Data; Data Set; Databases; Development; Ensure; Ethnic group; Foundations; Goals; Health; Health Services Accessibility; Hispanics; Hospitals; Inpatients; Intervention; Malignant Neoplasms; Measurement; Measures; Medical; Metabolic; Minority; Monitor; Operative Surgical Procedures; Outcome; Outpatients; Patients; Performance; Perioperative; Phase; Population; Positioning Attribute; Postoperative Period; Preoperative Care; Procedures; Psyche structure; Quality Indicator; Quality of Care; Race; Research; Savings; Scanning; Standardization; Surgeon; Time; Trauma; United States; United States National Institutes of Health; bariatric surgery; base; cancer care; disparity reduction; evidence base; follow-up; health care disparity; high risk; improved; improved outcome; mortality; programs; racial and ethnic; satisfaction; social; systematic review

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.

项目概要/摘要 种族和族裔健康不平等仍然是美国的一个重大社会负担，并且存在于各个国家 几乎所有护理部门。住院病人数超过5000万例，门诊手术例数超过5300万例 每年在美国进行的手术质量是国家的一个重要优先事项，但手术质量 所有种族和族裔群体所接受的手术护理并不公平。鉴于已知的差异 少数族裔患者的质量，数据驱动的活动旨在提高少数族裔患者的护理质量 各个领域都发起了这项活动，但尚未针对手术开展有针对性的活动。一个障碍 缺乏用于一致衡量的标准化质量指标和衡量标准是取得进展的原因 手术差异和获得手术护理的机会。美国国立卫生研究院 (NIH) 和美国学院 外科医生协会 (ACS) 已确定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解决方案之一。国家质量论坛（NQF） 根据多年的循证质量改进研究，制定了评估哪些质量的标准 指标对于检测差异非常有效，他们创造了这个术语“差异敏感指标”（DSM）。 目前，尚不存在解决手术途径、质量或结果的 DSM。该提案旨在解决 通过确定一套强大的手术 DSM 来弥补差距，这些 DSM 可用于衡量各个领域的手术质量 手术护理的连续性（获得护理、术前、围手术期、术中、术后、 和出院后）。我们将召集专家顾问小组（EAP）参与正式修改Delphi 制定一个概念框架的方法，以识别获取和获取方面差异的最大风险 手术护理的连续性。 EAP 将调整 NQF DSM 标准以与手术指标一起使用。我们随后将 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 使用改编后的 NQF DSM 标准对一组关于差异敏感性的初步指标进行评级。使用电流 数据来自 ACS 提供的大型数据集，我们将使用以下方法对医院的手术差异进行基准测试 候选 DSM。最后一轮德尔福将确定一套最适合的最终质量指标 测量手术差异和通路。确定稳健的手术差异指标将有助于 确定手术质量差异的真实程度，并监控手术进展 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： 大力促进或强制收集这些指标，并为消除差异奠定基础 美国的外科护理。