Alex H S Harris, Kristen Davis-Lopez, Eric Schmidt, Kenneth Nieser, Nader N Massarweh
Objective: Healthcare quality measures have a central role in monitoring and incentivizing the quality of surgical care. Payors and other stakeholders rely on consensus-based entities (CBEs) for the rigorous, independent evaluation and endorsement of quality measures. The aim of this study is to catalog current CBE-endorsed, surgery-related quality measures and to assess measure characteristics, gaps, and redundancies to inform prioritization of measure development efforts.
Methods: The National Quality Forum Quality Positioning System and Battelle Partnership for Quality Measurement were reviewed to identify CBE-endorsed quality measures related to perioperative care. Identified measures were characterized in terms of their type (eg, structure, process and outcome), quality domain (eg, effectiveness and efficiency), focus (eg, complications, cost and improvement in functioning), and perioperative specialty (eg, general surgery and anesthesia).
Results: A total of 172 perioperative measures were identified, of which 79 were currently CBE-endorsed and 93 were previously endorsed. Among currently endorsed measures, 43 (54%) were clinical outcomes measures (eg, mortality and/or complications, readmissions), 8 (10%) were patient-reported outcomes measures, 20 (26%) were process measures, 4 (5%) were cost measures, and 4 (5%) were measures of structure. Measures specific to cardiothoracic (n = 40) and orthopedic (n = 11) surgery were the most common while 12 measures were relevant to multiple specialties.
Conclusions: Despite the large number of surgery-related quality measures, most are concentrated on a small sample of quality domains for a few surgical specialties. Fewer measures are focused on patient-reported outcomes or experiences, low-value care (eg, unnecessary testing or imaging), healthcare structures, or processes that may lead to better outcomes.
