Private Performance Feedback Report for Pediatric Adenotonsillectomy

 描述（由申请人提供）：适当激励外科医生通过以较低成本提供更高质量的护理来提高效率，可以显著提高美国医疗保健服务的价值。在该提案中，对执行小儿腺样体扁桃体切除术（T&A）的外科医生的私人绩效反馈报告进行了测试，作为提高外科医生和系统绩效的非经济激励。本报告包括术后结局、围手术期处理措施和费用。Intermountain医疗保健系统内的一个试点项目，为这一奖项做准备，为外科医生提供了一份初步报告，允许每位外科医生将他或她的数据与医院和系统的平均值进行比较。腺样体切除术（T&A）是美国儿童最常见的大手术。然而，该手术的结局和成本仍存在显著的地理、医院和外科医生差异。Intermountain Healthcare拥有一个独特的企业数据仓库（EDW），其中包含管理、财务（包括成本和费用）和临床数据。成本来自医院的成本会计程序标准成本主程序。这是一个基于交易的微观成本计算系统，根据服务日期确定和汇总患者活动、医院服务和产品的可变和固定成本组成部分。我们之前的研究已经证明了Intermountain Healthcare系统中每位外科医生的T&A成本的变化，并发现成本较高的外科医生不一定能获得更好的结果，这表明外科医生的效率和表现存在差异。已向外科医生介绍了针对执行儿科T&A的外科医生的试点私人绩效反馈报告。该报告包括平均患者满意度评分，遵守类固醇和抗生素给药国家指南的频率，术后并发症的频率以及每例患者的平均护理费用。该应用程序将使用中断的时间序列分析来确定向外科医生提供的季度报告在改善结局和/或降低成本方面的有效性。将使用研究组进行定性分析，以便从外科医生的角度更好地了解本报告的有效性。该应用程序的最终目标是评估私人绩效反馈报告的有效性，该报告包含结果、临床流程措施以及提高儿科T&A的外科医生和系统效率的成本。这项研究将帮助我们更好地了解如何，为什么，以及在什么条件下，私人报告提高外科医生的表现。将这种方法应用于其他常见的儿科手术条件可以改善美国的健康结果并降低成本。

 DESCRIPTION (provided by applicant): Appropriately incentivizing surgeons to increase efficiency by delivering higher quality care at a lower cost could significantly improve the value of healthcare delivery in the United States. In this proposal, a private performance feedback report for surgeons performing pediatric adenotonsillectomy (T&A) is tested as a non- financial incentive to improve surgeon and system performance. This report includes postoperative outcomes, perioperative process measures, and costs. A pilot program within the Intermountain Healthcare system, in preparation for this award, has provided surgeons with an initial report allowing each surgeon to compare his or her data to hospital and system averages. Adenotonsillectomy (T&A) is the most common major operation performed in children in the US. However, there remains significant geographic, hospital, and surgeon variation in outcomes and costs for this procedure. Intermountain Healthcare maintains a unique Enterprise Data Warehouse (EDW) that contains administrative, financial (including both costs and charges), and clinical data. Costs are derived from the Standard Cost Master, the hospital's cost-accounting program. This is a transaction-based micro-costing system that identifies and aggregates the variable- and fixed-cost components of patient activities, hospital services, and products according to the date of service. Our previous research has demonstrated variation in T&A costs per surgeon across the Intermountain Healthcare system and found that surgeons with higher costs did not necessarily achieve better outcomes, suggesting that variation in surgeon efficiency and performance exist. A pilot private performance feedback report for surgeons performing pediatric T&A has been introduced to surgeons. This report includes average patient satisfaction scores, frequency of adherence to national guidelines for steroid and antibiotic administration, frequency of postoperative complications, and the mean cost of care per case. This application will use an interrupted time-series analysis to determine the efficacy of quarterly reports given to surgeons in improving outcomes and/or reducing costs. Qualitative analysis using study groups will be performed to better understand from a surgeon's perspective the effectiveness of this report. The ultimate goal of this application is to evaluate the efficacy of a private performance feedback report containing outcomes, clinical process measures, and costs in improving surgeon and system efficiency for pediatric T&A. This study will help us better understand how, why, and under what conditions private reporting improves surgeon performance. Applying this approach to other common pediatric surgical conditions can improve health outcomes and reduce costs across the United States.