Using Video Analysis to Improve Outcomes of Laparoscopic Colectomy

应用视频分析改善腹腔镜结肠切除术的疗效 摘要： 新的外科手术程序不断地被引入实践中。即使在新的程序 在随机临床试验中被证明是安全和有效的，它们在不同的实践环境中的扩散通常是 不太理想。加快外科手术学习曲线的策略将有明显的好处，但实用， 可扩展的方法一直难以捉摸。视频分析可能有助于填补这一空白。有几个重要的 在这一新出现的业绩改进领域，还有一些悬而未决的问题。首先，目前还不清楚外科手术是否 技术(如何完成案件的细节)或技能(案件完成得有多好)是更好的驱动因素 腹腔镜结肠切除术的结果。第二，尽管有越来越多的证据表明， 教练的训练各不相同(即，有些教练比其他教练更好)，这是否会转化为不同的临床 被辅导者的结果是未知的。第三，外科医生改进应对疾病的技术途径 教练是完全未被开发的。我们有独一无二的机会利用现有的外科医生 密歇根外科质量合作(MSQC)中的关系和注册数据来实现这一点 程序。基于我们在腹腔镜减肥手术中使用视频分析的初步数据，我们建议 具体目标如下：目标1.检查外科医生的视频收视率与患者之间的关系 结果。在调整了患者风险因素中的所有潜在差异后，我们将评估这种关系 在外科医生技能(他们如何做手术)和外科医生技能(他们做手术有多好)之间 结果(如死亡率、并发症、再手术)。目标2.实施基于视频的辅导 干预措施并评估对结果的影响。我们将设计并实施一项教练干预 采用MSQC平台进行阶梯式楔形整群随机试验。我们会评估该计划的影响。 使用MSQC临床注册的详细结果对患者结果进行干预。目标3.至 评估指导效果与患者预后之间的关系。我们将录制音频并 记录所有教练的对话。根据这些数据，我们将评估对话的质量 使用经过验证的工具对教练效率进行评分(从1分到5分，涉及四个领域)。 我们还将对教练谈话和离职访谈进行定性评估，以探索 外科医生改进的途径(即，他们做出了哪些改变)，以及障碍和 促进者将被更广泛地采用。这项研究将产生直接和直接的影响。对于密歇根州的患者来说 此外，这项研究将加速实施腹腔镜结肠检查的最佳技术实践 手术和改善他们的结果。使用视频分析和基于视频的指导来理解和 传播最佳技术实践将是提高手术和医疗质量的有力工具 更广泛的程序。

Using Video Analysis to Improve Outcomes of Laparoscopic Colectomy Abstract: New surgical procedures are continuously introduced into practice. Even when new procedures are proven safe and effective in randomized clinical trials, their diffusion into diverse practice settings is often suboptimal. Strategies for accelerating the surgical learning curve would have clear benefits, but practical, scalable approaches have been elusive. Video analysis may help fill this void. There several important unanswered questions in this emerging area of performance improvement. First, it is unclear whether surgical technique (the details of how the case is done) or skill (how well the case was done) is the driver of better outcomes for laparoscopic colectomy. Second, although there is emerging evidence that the effectiveness of coaching varies (i.e., some coaches are better than others), whether this translates into differential clinical outcomes of coachees is unknown. Third, the technical pathways by which surgeons improve in response to coaching are entirely unexplored. We have the unique opportunity to leverage the existing surgeon relationships and registry data in the Michigan Surgical Quality Collaborative (MSQC) to implement this program. Building on our preliminary data using video analysis in laparoscopic bariatric surgery, we propose the following Specific Aims: Aim 1. To examine the relationship between surgeon video ratings and patient outcomes. After adjusting for all potential differences in patient risk factors, we will assess the relationship between surgeon technique (how they do operation) and surgeon skill (how well they do operation) on patient outcomes (e.g., mortality, complications, reoperations. Aim 2. To implement a video-based coaching intervention and evaluate the impact on outcomes. We will design and implement a coaching intervention in a stepped wedge cluster randomized trial using the MSQC platform. We will evaluate the impact of the intervention on patient outcomes using the detailed outcomes from the MSQC clinical registry. Aim 3. To evaluate the relationship between coaching effectiveness and patient outcomes. We will audio record and transcribe all coaching conversations. Based on these data, we will evaluate the quality of the conversation using a validated instrument that scores coaching effectiveness (from a scale of 1 to 5, across four domains). We will also conduct a qualitative evaluation of coaching conversations and exit interviews to explore the pathways by which surgeons improve (i.e., what changes do they make) and also what the barriers and facilitators are to broader adoption. This study will have immediate and direct impact. For patients in Michigan and beyond, this study will accelerate the implementation of best technical practices for laparoscopic colon surgery and improve their outcomes. The use of video analysis and video-based coaching to understand and disseminate best technical practices will be a powerful tool for improving the quality of surgery and medical procedures more broadly.