Performance Measurement for Surgery at National Level in China

Performance assessment is the first step to improve the quality of surgery. To date, no studies have systematically evaluated the surgical performance measures in China. This study aims to investigate the performance measures in surgical care at national level in China, with the objective of identifying existing gaps and potential opportunities in performance measurement of surgical care.

We summarized and evaluated surgery related performance measures from five officially published performance evaluation indicator systems in China, and compared with those endorsed by National Quality Forum (NQF), the clearing house for all federal performance measures in the United States. The evaluation and comparison include: (1) the process of measure development; (2) the characteristics of the measures, including stewards, Donabedian frames, risk adjustment, and so on; (3) the keywords of the measures using word cloud analysis.

A total of 85 measures relevant to surgery were included in the analysis. Among them, the majority was outcome measures, which was similar to NQF measures (76.47% vs. 70.27%, p = 0.9875). The development of surgical performance measures in China was primarily led by the government, but lacked a third-party evaluation mechanism. Further, compared with NQF, the performance measures were more generic and limited in specialty association engagement, risk adjustment, and payment linkage.

While China has made significant progress in the performance measures in surgery, the opportunities for improvement remain in this area, including the involvement of special societies, the establishment of an evaluation mechanism, and the implementation of risk adjustment for measures.