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Individual Surgeon's Contribution to Value.

Florence E Turrentine1, Min-Woong Sohn1, Margaret C Tracci1

  • 11 University of Virginia, Charlottesville, VA.

American Journal of Medical Quality : the Official Journal of the American College of Medical Quality
|June 12, 2018
PubMed
Summary
This summary is machine-generated.

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Surgeon value, defined as quality divided by cost, improved for mortality but not morbidity over time. This metric can help surgeons identify performance improvement areas.

Area of Science:

  • Health Services Research
  • Surgical Quality Improvement
  • Health Economics

Background:

  • Estimating surgeon-level value in healthcare is an underexplored area.
  • Value-based healthcare models necessitate understanding provider-specific performance.
  • Linking quality outcomes with costs is crucial for comprehensive value assessment.

Purpose of the Study:

  • To estimate surgeon-level value by analyzing quality (mortality/morbidity) against costs.
  • To determine trends in surgeon value over time using historical data.
  • To assess the utility of value metrics for surgeon performance evaluation.

Main Methods:

  • Utilized American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data (2005-2013).
  • Linked surgical quality data with institutional total costs.
Keywords:
quality/costsurgeon valuesurgical outcomesvalue

Related Experiment Videos

  • Employed 3-level random effects logistic regression models to predict 30-day postoperative mortality or morbidity.
  • Defined value as risk-adjusted quality (mortality/morbidity) divided by risk-adjusted costs.

    • Main Results:

    • Risk-adjusted costs demonstrated a downward trend over the study period.
    • Mortality value significantly increased by 3.27 points annually (P < .001) on a 100-point scale.
    • Morbidity value showed no significant change over time.
    • For surgeons with ≥5 years of data, mortality value improved for all but one individual.
    • Increasing complication rates from 2008 negatively impacted morbidity value.

    Conclusions:

    • Surgeon-level mortality value shows an improving trend, suggesting enhanced efficiency in reducing deaths relative to costs.
    • Morbidity value has stagnated, potentially due to rising complication rates, indicating a need for focused quality improvement efforts.
    • Value metrics, integrating both quality and cost, offer a more nuanced view of surgeon performance than quality metrics alone.
    • This approach can guide surgeons in identifying specific areas for performance enhancement.