Using Patient Outcomes to Inform Surgical Education

利用患者结果为外科教育提供信息

• 批准号: 9308803
• 负责人: Rachel Kelz
• 金额: $ 61.97万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-01 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9308803
• 关键词: Accounting; Adverse event; Affect; Algorithms; Blood Transfusion; Caring; Case Mixes; Cessation of life; Characteristics; Clinical; Code; Communities; Consultations; Credentialing; Custom; Data; Data Set; Development; Diagnostic tests; Education; Enrollment; Ensure; Equilibrium; Failure; Fellowship; Future; Goals; Healthcare; Hemorrhage; Hospitals; Hour; Knowledge; Medicare claim; Methodology; Methods; Modernization; Monitor; Nature; Operative Surgical Procedures; Oral; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Pattern; Performance; Phase; Policy Maker; Population; Postoperative Period; Procedures; Process; Program Development; Public Health; Quality of Care; Repeat Surgery; Research; Residencies; Residual state; Resources; Risk Factors; Role; Secure; Surgeon; Techniques; Technology; Testing; Thromboembolism; Time; Time Study; Training; United States; Variant; Venous; cohort; cost; economic outcome; environmental change; experience; health care delivery; improved; individual patient; medical specialties; novel; novel strategies; operation; public health relevance; skills; trend; virtual; wound

 DESCRIPTION (provided by applicant): An estimated 10 million patients undergo an operative procedure annually in the United States. Despite overall improvements in outcomes, over 120,000 people die following surgery each year in the US. Many more will suffer from adverse events. Nascent research suggests that a significant proportion of the variation in outcomes occurs at the level of the operative surgeons. Yet, recent changes in the nature of surgical care, increased scrutiny of surgical outcomes, and duty-hour reform have dramatically changed the surgical training process. Resultant concerns regarding the quality of the modern new surgeons are substantiated by the recent sharp increase in the oral board failure rate. To date, no one has been able to examine the quality of the modern new surgeons because they have only recently entered the workforce. Using the introduction of the duty-hour reform in 2003 as a landmark for the larger set of systematic changes, we aim to understand the effects of environmental changes on the quality of care provided by new surgeons and the public health implications of changes in the surgical field on the emerging surgical workforce. In this proposal, using a customized Medicare claims dataset including all new surgeons across 50 states, we will use a novel two-step matching process developed specifically for this study and a difference-in-difference (D-in-D) approach to examine the effects of training in the modern era on the new surgeon product. New surgeons will be classified as modern or traditional by the year in which they entered residency. Surgeon pairs will be constructed for the modern (AY 2009-2013), transitional and traditional (AY1999-2003) training eras. The first step of the "two- step" match pairs new and experienced surgeons by the surgical procedures they performed at the same hospital in the same time period. Step two matches individual patients inside each matched surgeon pair. Using this two-step matching approach, we can control for procedure, technical and patient characteristics such that the patients treated by new and experienced surgeons within hospitals will be virtually identical. The D-in-D approach using experienced surgeons as controls minimizes confounding associated with changes in the delivery of healthcare over time. Post-match regression will be used to control for residual confounders like fellowship status. Subset analysis will permit focused examination of specific clinical cohorts to provide transparently meaningful results. Moreover, we will derive time to proficiency curves across multiple specialties and within specific clinical cohorts. Aim 1 will examine clinical outcomes and Aim 2, economic outcomes. After completing the project, we will be able to 1) inform the ACGME and ABMS on gaps in new surgeon performance for subsequent education reform, 2) use the methodology developed for this proposal to monitor any future reform and 3) advise CMS (and other payors) and surgeons on strategies for focused professional development programs (e.g., surgical coaching or phased privileging or credentialing) to improve the quality of care delivered to surgical patients today and safeguard the care of surgical patients in the future.

 描述（由申请人提供）：估计美国每年有 1000 万患者接受手术。尽管结果总体有所改善，但美国每年仍有超过 120,000 人在手术后死亡。更多的人将遭受不良事件的影响。新兴研究表明，结果变化的很大一部分发生在手术外科医生的水平上。然而，最近手术护理性质的变化、对手术结果的更多审查以及值班时间改革极大地改变了手术培训过程。最近口腔板失败率的急剧上升证实了对现代新外科医生质量的担忧。迄今为止，没有人能够检验现代新外科医生的素质，因为他们最近才进入劳动力队伍。以 2003 年实行的工作时间改革作为更广泛的系统性变革的里程碑，我们旨在了解环境变化对新外科医生提供的护理质量的影响，以及外科领域的变化对新兴外科劳动力的公共卫生影响。在这个提案中， 使用包含 50 个州所有新外科医生的定制医疗保险索赔数据集，我们将使用专门为本研究开发的新型两步匹配流程和双重差分 (D-in-D) 方法来检查现代培训对新外科医生产品的影响。新外科医生将根据他们进入住院医师资格的年份被归类为现代或传统外科医生。外科医生对将针对现代（AY 2009-2013）、过渡和传统（AY1999-2003）培训时代而构建。 “两步”的第一步是将新外科医生和经验丰富的外科医生通过在同一时间段内同一家医院进行的外科手术进行配对。第二步匹配每个匹配的外科医生对中的个体患者。使用这种两步匹配方法，我们可以控制手术、技术和患者特征，以便医院内由新外科医生和经验丰富的外科医生治疗的患者几乎相同。 D-in-D 方法使用经验丰富的外科医生作为对照，最大限度地减少与医疗保健服务随时间变化相关的混淆。赛后回归将用于控制残留的混杂因素，例如奖学金状态。子集分析将允许对特定临床队列进行集中检查，以提供透明且有意义的结果。此外，我们将得出跨多个专业和特定临床队列的熟练时间曲线。目标 1 将检查临床结果，目标 2 将检查经济结果。项目完成后，我们将能够 1) 向 ACGME 和 ABMS 通报新外科医生在后续教育改革中表现的差距，2) 使用为此提案开发的方法来监测未来的任何改革，3) 就重点专业发展计划（例如手术指导或分阶段特权或认证）的策略向 CMS（和其他付款人）和外科医生提供建议，以提高当今为外科患者提供的护理质量并保障 未来手术患者的护理。