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Defining Expanded Episode-Based Surgical Quality Measurement
Nicole M Mott1,2, Trista M Benitez2,3, Daniel M Connochie2
1National Clinician Scholars Program, University of Michigan, Ann Arbor.
JAMA Network Open
|April 10, 2026
Summary
This study developed a surgical episode quality model covering preoperative, intraoperative, and postoperative care. The model aims to improve surgical quality across the entire patient journey for common procedures.
Area of Science:
- Health Services Research
- Surgical Quality Improvement
- Perioperative Medicine
Background:
- Current surgical quality assessment often focuses narrowly on postoperative outcomes.
- This approach overlooks critical aspects of care throughout the entire perioperative continuum.
- The Veterans Health Administration (VA) can leverage a surgical episode framework for broader quality measurement.
Purpose of the Study:
- To create an innovative surgical episode quality measurement model.
- The model encompasses preoperative, perioperative, and postoperative phases.
- It is designed for common elective surgeries and applicable to VA and private sectors.
Main Methods:
- Modified Delphi panels with multidisciplinary experts from VA and private sectors.
- Environmental scan to identify existing and new quality measures (April 2023-August 2024).
- RAND-UCLA Appropriateness Method used for rating measures via 2-step Likert scales (October-December 2024).
Main Results:
- 31 panelists participated; 594 measures/recommendations were identified.
- 61 measures were presented, and 40 were included in the final models (15 for CTR, 8 for IHR, 17 for TKA).
- Included measures emphasized preoperative evaluation, intraoperative practices, and postoperative complication minimization.
Conclusions:
- This study offers a roadmap for assessing and enhancing surgical quality across the full perioperative continuum.
- The developed model includes preoperative, perioperative, and postoperative care phases.
- Future research will operationalize the model to evaluate quality variations in VA and VA-Community Care settings.
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