Composite Measures of Surgical Performance

描述(由申请者提供)：对手术质量的准确信息的需求一直很高。不幸的是，大多数现有的手术质量衡量标准都存在缺陷。候选人建议开发外科发病率的综合测量方法，以克服现有方法的许多局限性。候选人贾斯汀·B·迪米克博士是密歇根大学的一名普通外科医生和卫生服务研究员。这项建议将有助于他发展成为一名专注于优化手术质量测量的独立科学家。除了之前的研究培训，他还将在高级统计方法方面进行额外的课程工作，并寻求一项具有现实世界适用性的指导性研究计划，以适用于美国外科医生学会-国家外科质量改进计划(ACS-NSQIP)。该研究计划有两个具体目标：目标1。开发基于外科发病率的综合绩效衡量标准。使用ACS-NSQIP数据，候选人将开发出手术性能的经验性综合测量方法。这些措施将结合所有关于医院质量的相关信息，以产生特定于程序的“真实”发病率估计，从而以最佳方式过滤统计噪音。这些措施将通过确定它们解释医院水平差异和预测后续结果的程度来验证。目的2.确定将护理过程变量纳入综合措施的价值。ACS-NSQIP已经开始例行收集外科护理改进计划(SCIP)中规定的过程措施的数据。使用这些数据，候选人将确定在综合措施中增加护理过程是否提高了他们解释医院水平差异和预测后续结果的能力。拟议研究的完成将推动质量测量科学的发展，并促进候选人向独立调查员的转变。

DESCRIPTION (provided by applicant): Demand for accurate information on surgical quality is at an all time high. Unfortunately, most existing measures of surgical quality are flawed. The candidate proposes to develop composite measures of surgical morbidity that overcome many of the limitations of existing approaches. The candidate, Dr. Justin B. Dimick is a general surgeon and health services researcher at the University of Michigan. This proposal will facilitate his development into an independent scientist focused on optimizing surgical quality measurement. He will supplement his previous research training with additional course work in advanced statistical methods and pursue a mentored research plan with real world applicability to the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP). The research plan has two specific aims: Aim 1. To develop composite measures of performance based on surgical morbidity. Using ACS-NSQIP data, the candidate will develop empirically derived composite measures of surgical performance. These measures will combine all relevant information on hospital quality to generate procedure-specific estimates of "true" morbidity that optimally filter out statistical noise. These measures will be validated by determining the extent to which they explain hospital level variation and forecast subsequent outcomes. Aim 2. To establish the value of incorporating process of care variables into composite measures. The ACS-NSQIP has begun routinely collecting data on the process measures set forth in the Surgical Care Improvement Program (SCIP). Using this data, the candidate will determine whether the addition of processes of care to composite measures improves their ability to explain hospital level variation and forecast subsequent outcomes. Completion of the proposed research will move forward the science of quality measurement and facilitate the candidate's transition into an independent investigator.