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How to Measure Outcomes in Surgery

  • Chapter
Abdominal Wall Surgery

Abstract

Traditional paradigms about surgeons are to be abandoned. The surgeon’s role is evolving and, consequently, even the framework of surgery is changing.

From the patient’s point of view this is a dramatic modification, because there is a movement from the evaluation of the “surgical act” itself to the evaluation of its outcome, which is the multidimensional effect produced by the surgical act.

Nevertheless, the objective evaluation of outcomes is not a simple process, because many factors have to be considered.

We examined factors affecting the outcomes of surgery, considering some available indicators to be used in the evaluation process, and citing some of the most important experiences, to provide some evaluation toolboxes that have been developed worldwide to professionals and institutions.

A particular focus is dedicated to the Italian situation.

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References

  1. Ballard DJ. Indicatori per il miglioramento della qualità dell’assistenza clinica in un sistema sanitario integrato. QA. 2004;15(4):231–44.

    Google Scholar 

  2. Baraghini G, Trevisani B, Roli L. Le ISO 9000 in Sanità/la Vision. In: Per governare bisogni e richieste. Milano: Franco Angeli; 2001.

    Google Scholar 

  3. Reeve BB, Wyrwich KW, Wu AW, et al. ISOQOL recommends minimum standards for patient-reported outcome measures used in patient-centered outcomes and comparative effectiveness research. Qual Life Res. 2013;22:1889.

    PubMed  Google Scholar 

  4. Curtis LH, Phelps CE, McDermott MP, et al. The value of patient-reported health status in predicting short-term outcomes after coronary artery bypass graft surgery. Med Care. 2002;40(11):1090–100.

    PubMed  Google Scholar 

  5. Greenhalgh J. The applications of PROs in clinical practice: what are they, do they work, and why? Qual Life Res. 2009;18:115. https://doi.org/10.1007/s11136-008-9430-6.

    Article  PubMed  Google Scholar 

  6. Black N. Patient reported outcome measures could help transform healthcare. BMJ. 2013;346:f167.

    PubMed  Google Scholar 

  7. Agency for Health Care Policy and Research. Using clinical practice guidelines to evaluate quality of care. 1. Issues. Rockville, MD: US Department of Health and Human Services, Public Health Services; 1995. (AHCPR publication No 95-0045.)

    Google Scholar 

  8. Arcà M, Fusco D, Barone AP, Perucci CA. Introduzione ai metodi di risk adjustment nella valutazione comparativa degli esiti. Epidemiol. Prev. 2006;30(4 Suppl):1–48.

    Google Scholar 

  9. Freeman T. Using performance indicators to improve health care quality in the public sector: a review of the literature. Health Serv Manag Res. 2002;15:126–37.

    Google Scholar 

  10. Grilli R, Ballini L. L’implementazione delle linee-guida: valore e limiti della ricerca sull’efficacia delle diverse strategie per orientare i comportamenti professionali. In: Liberati A, editor. La medicina basata sulle prove di efficacia. Roma: Il Pensiero Scientifico; 2004.

    Google Scholar 

  11. Gubb J. Have targets done more harm than good in the English NHS? Yes. BMJ. 2009;338:a3130.

    PubMed  Google Scholar 

  12. Canadian Council on Health Services Accreditation. A guide to the development and use of performance indicators. Ottawa: CCHSA; 1996.

    Google Scholar 

  13. Marshall MN. Accountability and quality improvement: the role of report cards. Qual Health Care. 2001;10:67–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Oliver A, Brown LD. Incentivizing professionals and patients: a consideration in the context of the United Kingdom and the United States. J Health Polit Policy Law. 2011;36:59–87.

    PubMed  Google Scholar 

  15. Piano Sanitario Nazionale 1994-1996 (D.P.R.1/3/94), par. 8.

    Google Scholar 

  16. Raleigh VS, Foot C. Getting the measure of quality. Opportunities and challenges. London: The King’s Fund; 2010.

    Google Scholar 

  17. ACHS Care Evaluation Program. Internal medicine indicators. Sydney: The Royal Australian College of Physicians, ACHS; 1997.

    Google Scholar 

  18. Kazandjiian VA, Matthes N, Thomas T. Errors: can indicators measures the magnitude? J Eval Clin Prat. 2001;7:252–60.

    Google Scholar 

  19. Liva C. Le iniziative dell’Agenzia per i Servizi sanitari Regionali sugli indicatori di performance. Relazione tenuta al Convegno Internazionale “Introdurre gli indicatori di performance clinica nel sistema sanitario nazionale”, Ferrara 20–22 novembre 2003. http://www.assr.it.

  20. Morosini P, Palumbo G. Indicatori per l’accreditamento professionale e il benchmarking. In: Liva C, Di Stanislao F, editors. Accreditamento dei servizi sanitari in Italia. Torino: Centro Scientifico Editore; 1998.

    Google Scholar 

  21. Murray CJL, Salomon JA, Mathers CD, Lopez AD, editors. Summary Measures of Population Health: concepts, ethics, measurements and applications. Geneva: World Health Organization; 2002. http://www.who.int/health-systems-performance/docs.

  22. The good indicators guide: Understanding how to use and choose indicators. Copyright © 2008 NHS Institute of Innovation and Improvement. http://www.apho.org.uk/resource/item.aspx?RID=44584.

  23. Mediobanca. Indicatori per il controllo dell’efficienza e dell’economicità della spesa nel S.S.N. Milano: Mediobanca; 1993.

    Google Scholar 

  24. Solberg LI, Mosser G, McDonald S. The three faces of performance measurement: improvement, accountability and research. Jt Comm J Qual Improv. 1997;23:135–47.

    CAS  PubMed  Google Scholar 

  25. Tommassini C, Turco L, Faraoni T, Mannacci A, Cecchi A, Nerattini M, Filomena A, Veneri F. IL progetto indicatori del presidio ospedaliero del Mugello – ASL 10 di Firenze. Relazione tenuta al Convegno Introduzione agli indicatori di performance clinica nel sistema sanitario, Ferrara 21–22 novembre 2003.

    Google Scholar 

  26. Donabedian A. The quality of healthcare assistance, vol. 1. Florence: NIS; 1990.

    Google Scholar 

  27. Scagliarini M, Apreda M, Wienand U, Valpiani G. Monitoring operating room turnaround time: a retrospective analysis. Int J Health Care Qual Assur. 2016;29(3):351–9.

    PubMed  Google Scholar 

  28. Morosini P, Perraro F. Enciclopedia del Miglioramento Continuo di Qualità in Sanità. 2nd ed. Torino: Centro Scientifico Editore; 2001.

    Google Scholar 

  29. Morosini P, Palumbo G, editors. Variabilità nei servizi sanitari in Italia. Centro Scientifico Editore: Torino; 2004.

    Google Scholar 

  30. Berwick DM. Continuous improvement as an ideal in health care. N Engl J Med. 1989;320:53.

    CAS  PubMed  Google Scholar 

  31. Berwick DM. A primer on leading the improvement of systems. BMJ. 1996;312:619–22.

    CAS  PubMed  PubMed Central  Google Scholar 

  32. Scheiderer KJ. The Maryland Quality Indicator Project: searching for opportunities for improvement. Top Health Inf Manage. 1995;15(4):26–30.

    CAS  PubMed  Google Scholar 

  33. Inpatient Quality Indicators Technical Specifications - Version 5.0, March 2015. https://www.qualityindicators.ahrq.gov/Modules/IQI_TechSpec.aspx.

  34. The Joint Commission Performance Measurement. https://www.jointcommission.org/performance_measurement.aspx.

  35. Hospital Wide Medical Indicators—Australian Council on Healthcare Standards (ACHS) Care Evaluation Program. https://www.achs.org.au/programs-services/clinical-indicator-program/.

  36. JCAHO. Managing performance measurement data in health care. Oakbrook Terrace, IL: Joint Commission; 2000.

    Google Scholar 

  37. Health Maintenance Organizations (HMO). http://www.pni.dk.

  38. NHS Clinical Performance Indicators. https://www.gov.uk/government/publications/performance-management-of-nhs-a-e-services-using-theclinical-quality-indicators.

  39. Ministero della Salute - DIPARTIMENTO DELLA PROGRAMMAZIONE E DELL’ORDINAMENTODEL SERVIZIO SANITARIO NAZIONALE DIREZIONE GENERALE DELLA PROGRAMMAZIONE SANITARIA Ufficio III ex DG.PROG. Manuale di formazione per il governo clinico: monitoraggio delle performance cliniche (2012). http://www.salute.gov.it/imgs/C_17_pubblicazioni_1984_allegato.pdf.

  40. Fusco D, Barone AP, Sorge C, D’Ovidio M, Stafoggia M, Lallo A, Davoli M, Perucci CA. P.Re.Val.E.: outcome research program for the evaluation of health care quality in Lazio, Italy. BMC Health Serv Res. 12:25.

    Google Scholar 

  41. EuroQol Office Marten Meesweg 107 3068 AV Rotterdam, The Netherlands. https://euroqol.org.

  42. RAND 1776 Main Street Santa Monica, CA 90401-3208. https://www.rand.org/healthcare/surveys_tools/mos/36-item-short-form.html.

  43. Lattuada L, Burba I. Quali cautele sono consigliabili nell’interpretazione delle informazioni prodotte dagli indicatori? QA. 2004;15(4):277–85.

    Google Scholar 

Suggested Readings

  • ACHS Care Evaluation Program. Hospital-wide medical indicators, version 6. Sydney: Australian Council on Healthcare Standards (ACHS); 1998.

    Google Scholar 

  • AHRQ (Agency for Healthcare Research and Quality). CONQUEST overview: a computerised needs-oriented quality measurement evaluation system. Rockville, MD: CONQUEST; 1999. http://www.ahcpr.gov/qual/conquest.htm.

  • Altman DG, Machin D, Bryant TN, Gardner MJ. Statistics with confidence. 2nd ed. London: BMJ Publishing Group; 2000.

    Google Scholar 

  • Atherton PJ, Sloan JA. Rising importance of patient-reported outcomes. Lancet Oncol. 2006;7:883–4.

    PubMed  Google Scholar 

  • Baker R, Fraser RC. Development of review criteria: linking guidelines and assessment of quality. BMJ. 1995;311:370–3.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Barbieri P, La Pietra L, Liva C. La qualità delle attività ospedaliere. Salute e Territorio. 2004a;144:186–92.

    Google Scholar 

  • Barbieri P, Duca G, Liva C, La Pietra L. Gli indicatori di qualità per la valutazione dell’attività ospedaliera. Alcuni problemi metodologici. QA. 2004b;15(4):245–59.

    Google Scholar 

  • Barletta C, Trotta MC, Gregori M, Barletta P, De Simone M. Efficacia degli indicatori in medicina di urgenza: strumento per migliorare la qualità della cure, indurre il cambiamento ed acquisire consapevolezza. Relazione al Convegno Internazionale “Introdurre gli indicatori di performance clinica nel sistema sanitario nazionale”. Ferrara 20–22 novembre 2003.

    Google Scholar 

  • Bellini P, Braga M, Rebba V, Rodella S, Vendrami E, editors. Indicatori per il monitoraggio e la valutazione dell’attività sanitaria. Atti del seminario organizzato dalla Commissione per la garanzia dell’informazione statistica, Roma, giugno 2002 (scaricabile dal sito https://www.palazzochigi.it/Presidenza/statistica/attitiva/rapporti).

  • Berti E, Grilli R. Practice guidelines and clinical governance: do the means match with the end? A quality appraisal of local practice guidelines. Clin Govern Int J. 2003;8(4):312–7.

    Google Scholar 

  • Birnbaum D. Mandatory public reporting. Clin Govern Int J. 2008;13(2):142–6.

    Google Scholar 

  • Browne J, Jamieson L, Lewsey J, van der Meulen J, Black N, Caims J, Lamping D, Smith, CL, Horrocks J. Patient reported outcome measures (PROMs) in elective surgery. Report to the Department of Health. 2007.

    Google Scholar 

  • Campbell SM, Reeves D, Kontopantelis E, Sibbald B, Roland M. Effects of pay for performance on the quality of primary care in England. N Engl J Med. 2009;361:368–78.

    CAS  PubMed  Google Scholar 

  • Canadian Council on Health Services Accreditation. AIM achieving improved measurement accreditation. Ottawa: CCHSA; 2002.

    Google Scholar 

  • Checkland K, Marshall M, Harrison S. Re-thinking accountability: trust versus confidence in medical practice. Qual Saf Health Care. 2004;13:130–5.

    CAS  PubMed  Google Scholar 

  • Cook DJ, Manning DM, Holland DE, et al. Patient engagement and reported outcomes in surgical recovery: effectiveness of an e-health platform. J Am Coll Surg. 2013;217(4):648–55.

    PubMed  Google Scholar 

  • Department of Health. NHS Performance Indicators: national figures 2002. London; 2003. vari documenti visibili nel sito in http://www.doh.gov.uk/nhsperformanceindicators

  • DH, Department of Health. Guidance on the routine collection of Patient Reported Outcome Measures (PROMs). 2008/9; NHS Operating Framework and 2009/10 Guidance on the Standard NHS Contract for Acute Services.

    Google Scholar 

  • Feldman-Stewart D, Brundage MD. A conceptual framework for patient–provider communication: a tool in the PRO research tool box. Qual Life Res. 2009;18:109.

    CAS  PubMed  Google Scholar 

  • Frazzica RG, Giambelluca SE, Perraro F, Morosini P, Arnone R, Centineo G, Pinco M, Testaquadra S, Vancheri O. Miglioramento Continuo della Qualità negli ospedali in Sicilia. QA. 2002;13(3):142–53.

    Google Scholar 

  • Goddard M, Jacobs DC. Using composite indicators to measure performance in health care. In: Smith PC, Mossialos E, Papanicolas I, Leatherman S, editors. Performance measurement for health system improvement. Experiences, challenges and prospects. Cambridge: Cambridge University Press; 2009. p. 339–68.

    Google Scholar 

  • Gray M, Jani A. Promoting triple value healthcare in countries with universal healthcare. Healthc Pap. 2016;15(3):42–8.

    PubMed  Google Scholar 

  • Health Services Research Group University of Newcastle. Trends in quality of care. Clinical indicators. Sydney: ACHS (Australian Council on Healthcare Standards); 2002. p. 1998–2000.

    Google Scholar 

  • Institute of Medicine. To err is human: building a safer health system. Washington, DC: National Academic Press; 1999.

    Google Scholar 

  • Institute of Medicine. The quality chasm: a new health system for the 21st century. Washington, DC: National Academic Press; 2001.

    Google Scholar 

  • Institute of Medicine. Priority areas for national action: transforming health care quality. Washington, DC: Institute of Medicine; 2003.

    Google Scholar 

  • Jackson S. Il modello EFQM in sanità: guida ad una applicazione di successo. Torino: Centro Scientifico Editore; 2003.

    Google Scholar 

  • James S, Daubert JC, Werf FV. Commentary: use of registries to investigate the past and develop the future. BMJ. 2011;342:d2826.

    PubMed  Google Scholar 

  • JCAHO. The measurement mandate. Oakbrook Terrace, IL: Joint Commission; 1993.

    Google Scholar 

  • JCAHO. A guide to establishing programs for assessing outcomes in clinical settings. Oakbrook Terrace, IL: Joint Commission; 1994.

    Google Scholar 

  • JCAHO. National library of healthcare indicators. Oakbrook Terrace, IL: Joint Commission; 1997.

    Google Scholar 

  • Kazandjiian VA, Matthes N, Wicker KG. Are performance indicators generic? The international experience of the Quality Indicators Project. J Eval Clin Prat. 2003;9:265–76.

    Google Scholar 

  • Le Grand J. The other invisible hand. Delivering public services through choice and competition. Princeton, NJ: Princeton University Press; 2007.

    Google Scholar 

  • Macleod D, Clarke N. Engaging for success: enhancing performance through employee engagement. London: Department for Business, Innovation and Skills; 2009.

    Google Scholar 

  • Mannion R, Davies HTO. Payment for performance in health care. BMJ. 2008;336:306–8.

    PubMed  PubMed Central  Google Scholar 

  • Mathers CD, Sadana R, Salomon JA, Murray CJ, Lopez AD. Healthy life expectancy in 191 countries, 1999. Lancet. 2001;357:1685–91.

    CAS  PubMed  Google Scholar 

  • Mays N. Use of targets to improve health system performance: English NHS experience and implications for New Zealand. Working Paper 06/06. In: New Zealand Treasury; 2006.

    Google Scholar 

  • McGlynn EA, Ash SM, Adams J, Keesey J, Hicks J, DeCristofaro A. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348:2635–45.

    PubMed  Google Scholar 

  • Montaguti U. Per raggiungere l’ appropriatezza degli interventi serve una metodologia di gestione dei quadri clinici. Quaderni de Il Sole 35 Ore Sanità. 2003;3(5):7–12.

    Google Scholar 

  • Morosini P. Nuove tendenze dell’accreditamento alla luce del sistema dell’accreditamento australiano. QA. 1992;2:13–22.

    Google Scholar 

  • Morosini P. Griglie di valutazione in sanità. Torino: Centro Scientifico Editore; 2000.

    Google Scholar 

  • NCQA (National Committee for Quality Assurance). 2001. HEDIS 2001. Vol. 2: Technical specifications; Vol. 3: Specifications for Survey Measures; Vol. 5: HEDIS compliance audit; Washington 2000L Street NW, NCQA. http://www.ncqa.org.

  • NQMC (National Quality Measures Clearinghouse). 2003. http://www.qualitymeasures.ahrq.gov/resources.

  • Ovretveit J. What are the best strategies for ensuring quality in hospitals? Copenhagen: WHO Regional Office for Europe; 2003.

    Google Scholar 

  • Piergentili P, Focarile F. Indicatori sanitari per la qualità dell’assistenza sul territorio. Una guida pratica. QA. 2004;15(4):2676.

    Google Scholar 

  • Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001;33(5):337–43.

    CAS  PubMed  Google Scholar 

  • Rodella S, editor. Numero monografico: Indicatori di qualità dei servizi socio-sanitari. Salute e Territorio. 2004;144:138–200.

    Google Scholar 

  • Rodella S, Maistrello M. Rassegna di esperienze internazionali. Salute e Territorio. 2004;144:140–56.

    Google Scholar 

  • Shekelle PG, Lim YW, Mattke S, Damberg C. Does public release of performance results improve quality of care? London: The Health Foundation; 2008.

    Google Scholar 

  • Shore DA. The trust crisis in health care. Causes, consequences, and cures. Oxford: Oxford University Press; 2007.

    Google Scholar 

  • Smith PC. Performance measurement in health care: history, challenges and prospects. Public Money Manag. 2005;2005:213–20.

    Google Scholar 

  • Snyder CF, Aaronson NK. Use of patient-reported outcomes in clinical practice. Lancet. 2009;374(9687):369–70.

    PubMed  Google Scholar 

  • Spurgeon P, Mazelan PM, Barwell F. Medical engagement: a crucial underpinning to organizational performance. Health Serv Manag Res. 2011;24:114–20.

    Google Scholar 

  • Sussex J. Paying for better outcomes - the English way. J Health Serv Res Policy. 2009;14:131–2.

    PubMed  Google Scholar 

  • The Health Foundation. Are clinicians engaged in quality improvement? A review of the literature on healthcare professionals’ views on quality improvement initiatives. London, The Health Foundation. 2011.

    Google Scholar 

  • UNI (ente nazionale italiano di unificazione). Norma UNI EN ISO 9004:2001: sistemi di gestione per la qualità e linee guida per il miglioramento delle prestazioni. UNI, Via Battistotti Sassi 11b, 20133 Milano; 2000.

    Google Scholar 

  • Veillard J, Champagne F, Klazinga N, Kazandijan V, Arah OA, Guisset A-L. A performance assessment framework for hospital: the WHO regional office for Europe PATH project. Int J Qual Health Care. 2005;17(6):487–96.

    CAS  PubMed  Google Scholar 

  • Wachter RM, Pronovost PJ. Balancing “no blame” with accountability in patient safety. N Engl J Med. 2009;361:1401–6.

    CAS  PubMed  Google Scholar 

  • WHO Regional Office for Europe. Measuring hospital performance to improve quality of care in Europe: a need for clarifying concepts and defining the main dimensions. 2003. http://www.euro.who.int/Document.

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Pernazza, G., Pernazza, E. (2019). How to Measure Outcomes in Surgery. In: Greco, D.P., Borgonovi, E. (eds) Abdominal Wall Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-02426-0_15

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