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Defining Expanded Episode-Based Surgical Quality Measurement.

Nicole M Mott1,2, Trista M Benitez2,3, Daniel M Connochie2

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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.

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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.