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Quality Measures in Breast Reconstruction: A Systematic Review
Rahim N Nazerali1, Micaela A Finnegan, Vasu Divi
1From the *Department of Surgery-Plastic and Reconstructive Surgery, †Department of Otolaryngology, and ‡Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA.
Quality measures for breast reconstruction surgery are shifting towards value-based care. Current measures overemphasize processes, with few specific to breast reconstruction, highlighting a need for more outcome and structure-focused quality development.
Area of Science:
- Health Services Research
- Surgical Quality Improvement
- Health Economics
Background:
- Transition to value-based healthcare payment models emphasizes quality over quantity of care.
- Centers for Medicare and Medicaid Services and private payers are linking financial incentives to quality measure adherence.
- Understanding current quality measures for breast reconstruction is crucial for future development.
Purpose of the Study:
- To identify existing quality measures for breast reconstruction surgery.
- To understand gaps in current quality measures to inform future development.
- To evaluate breast reconstruction surgery within value-based payment models.
Main Methods:
- Systematic review of quality measure databases, clinical practice guidelines, and literature.
- Categorization of identified measures into structure, process, or outcome domains (Donabedian model).
Main Results:
- Identified 27 applicable quality measures for breast reconstruction.
- 5 candidate measures specific to breast reconstruction (3 process, 2 outcome).
- 22 general surgical quality measures (17 process, 5 outcome); no structural measures identified.
Conclusions:
- Current quality measures for breast reconstruction are heavily weighted towards process measures.
- Limited number of specific candidate measures for breast reconstruction exist.
- Future development should focus on underrepresented domains (structure, outcome) and candidate measure stewardship.
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