Surgeons are skeptical about how surgeon-specific quality outcomes should be measured and reported
Research Activities, July 2009, No. 347
Surgeons endorse surgical quality improvement programs at the institutional level. However, they remain skeptical about how surgeon-specific quality outcomes should be measured and reported, suggests a new study. For example, they fear that the risk-adjustment methods used in measuring outcomes are not reliable enough to avoid penalizing surgeons who perform high-risk procedures that often have poorer outcomes. Researchers evaluated surgeons' awareness and attitudes about the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP). This risk-adjusted measure of surgical patient outcomes is now used in more than 180 private sector hospitals. It is also being considered to direct future pay-for-performance programs sponsored by the Centers for Medicare & Medicaid Services.
The study surveyed 108 surgeons, including residents and highly experienced clinicians. Overall, the study found that surgeons recognized the importance and acceptance of quality initiatives, such as the ACS-NSQIP. They were also aware of the key principles behind the NSQIP, including its prospective data collection and risk-adjustment methods. The participating surgeons viewed the ACS-NSQIP data as being more reliable compared with other quality improvement initiatives. However, they did not believe that the unique risk-adjustment aspect of the program was reliable enough to prevent surgeons who perform high-risk procedures from being penalized. There was also uncertainty as to whether or not these data should be reported to the public, including patients and payers, or used in marketing campaigns.
Most surveyed surgeons believed that surgical outcomes were not the sole measure of surgical quality and that surgeon-specific outcomes should not be used within a hospital to direct patient referrals. Finally, most surgeons considered that the data were not accurate enough to guide pay-for-performance programs. The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00066). See "Surrounded by quality metrics: What do surgeons think of ACS-NSQIP?" by Heather B. Neuman, M.D., M.S., Fabrizio Michelassi, M.D., F.A.C.S., James W. Turner, M.D., F.A.C.S., and Barbara Lee Bass, M.D., F.A.C.S., in the January 2009 Surgery 145, pp. 27-33.