Video Analysis for Ensuring Safer Diffusion of New Procedures

描述（由申请人提供）：视频分析，以确保更安全的新程序的扩散新的外科手术不断引入实践。即使新的程序被证明是安全和有效的随机临床试验，他们的扩散到潜水实践设置往往是次优。这些创新所隐含的对新技术的掌握程度参差不齐，可能会导致提供者之间的结果和有效性存在很大差异。确定最佳技术并加以传播的战略将有明显的好处，但实际的、可扩展的战略一直难以捉摸。视频分析是否可用于此目的尚未探讨。在这项提案中，我们将建立在我们最近发表在NEJM上的工作基础上，该工作使用视频分析来评估手术技巧。利用密歇根州减肥手术协作（MBSC）的先前工作，我们将研究袖状胃切除术，该手术最近获得了医疗保险和医疗补助服务中心（CMS）的批准。我们有以下具体目标：目标1：使用手术视频分析来检查手术技术的变化。我们将收集所有密歇根州外科医生进行袖状胃切除术的视频。使用标准化的工具，我们将让同行评审员评估彼此的技术。同行审查工具包括与短期和长期成果有关的技术方面。目标二。检查手术技术与患者结局之间的关系。我们将从视频分析中将这些技术细节与来自MBSC临床注册的患者结局数据联系起来。在调整所有潜在混杂因素后，我们将评估手术技术与短期安全性结局和长期有效性结局之间的关系。目标3。实施最佳技术实践并评估对患者结局的影响。.我们将使用MBSC平台设计并实施一项阶梯式楔形分组随机试验中的干预措施。干预措施将包括最佳实践清单，演示最佳实践的视频，以及具有这些技术专业知识的外科医生的辅导课程。这项工作最直接的影响将是在密歇根州及其他地区接受袖状胃切除术的患者。然而，使用视频分析来理解和传播最佳技术实践将是更广泛地提高手术和医疗程序质量的有力工具。

DESCRIPTION (provided by applicant): Video Analysis for Ensuring Safer Diffusion of New Procedures New surgical procedures are introduced continuously into practice. Even when new procedures are proven safe and effective in randomized clinical trials, their diffusion into divers practice settings is often suboptimal. The uneven mastery of new techniques implied by these innovations may contribute to wide variations in outcomes and effectiveness across providers. Strategies for identifying best techniques and disseminating them would have clear benefits, but practical, scalable strategies have been elusive. Whether video analysis can be used for this purpose has not been explored. In this proposal, we will build on our recent work, published in NEJM, which uses vide analysis to assess surgical skill. Leveraging this prior work in the Michigan Bariatric Surgery Collaborative (MBSC), we will study sleeve gastrectomy, which was recently approved by the Center for Medicare and Medicaid Services (CMS). We have the following Specific Aims: Aim 1: To use surgical video analysis to examine variations in surgical technique. We will collect videos from all Michigan surgeons who perform sleeve gastrectomy. Using a standardized instrument, we will have peer reviewers assess each other's technique. The peer review instrument includes aspects of technique that relate to both short-term and long-term outcomes. Aim 2. To examine the relationship between surgical technique and patient outcomes. We will link these details on technique from video analysis to patient outcome data from the MBSC clinical registry. After adjusting for all potential confounders, we will assess the relationship between surgical technique and short-term safety outcomes and long-term effectiveness outcomes. Aim 3. To implement best technical practices and evaluate the impact on patient outcomes. . We will design and implement an intervention in a stepped wedge cluster randomized trial using the MBSC platform. The intervention will include a checklist of best practices, videos demonstrating the best practices, and coaching sessions by surgeons with expertise in these techniques. The most immediate impact of this work will be for patients undergoing sleeve gastrectomy in Michigan and beyond. However, the use of video analysis to understand and disseminate best technical practices will be a powerful tool for improving the quality of surgery and medical procedures more broadly.