Composite measures for profiling hospitals on surgical morbidity

Area of Science:

• Surgical Quality Improvement
• Health Services Research
• Medical Informatics

Background:

• Risk-adjusted morbidity is a common surgical quality indicator but may lack reliability for hospital assessment.
• There is a need for improved methods to accurately rank hospital quality in surgery.
• A novel composite measure is proposed to enhance the reliability of hospital morbidity rankings.

Purpose of the Study:

• To assess the value of a novel composite measure for improving the reliability of hospital morbidity rankings.
• To compare the predictive performance of the composite measure against the standard approach.
• To determine if the composite measure better reflects true hospital quality.

Main Methods:

• Utilized data from the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) for four procedures (2008-2009).
• Developed a composite measure combining morbidity, reoperation, length of stay, and related procedures, empirically weighted and reliability-adjusted.
• Validated the approach by comparing the composite measure's ability to predict 2009 morbidity from 2008 data against the standard ACS-NSQIP method.

Main Results:

• Composite measures explained a higher proportion of hospital-level variation in morbidity across all four procedures compared to the standard approach.
• For ventral hernia repair, the composite approach showed a significant difference in morbidity rates between the top and bottom 20% of hospitals (OR 2.65 vs. 1.30).
• The composite measure demonstrated superior predictive ability for future performance, particularly for ventral hernia repair.

Conclusions:

• Composite measures provide a more accurate reflection of hospital quality than simple risk-adjusted morbidity rates.
• The ACS-NSQIP context can benefit from composite measures for better hospital self-assessment and identification of exemplary institutions.
• This approach enhances the ability to identify truly high-quality hospitals for benchmarking and quality improvement initiatives.