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Surgeon-Specific Performance Reports in General Surgery: An Observational Study of Initial Implementation and Adoption - 20/09/13

Doi : 10.1016/j.jamcollsurg.2013.04.040 
Stephanie G. Yi, MD, MS , Nelda P. Wray, MD, MPH, Stephen L. Jones, MD, MSHI, Barbara L. Bass, MD, FACS, Jeanne Nishioka, RN, MSN, Sarah Brann, BS, Carol M. Ashton, MD, MPH
Department of Surgery, The Methodist Hospital, Houston, TX 

Correspondence address: Stephanie G Yi, MD, MS, The Methodist Hospital, Department of Surgery, 6550 Fannin St, SM 1661, Houston, TX 77030.

Abstract

Background

As national quality initiatives are increasing requirements for individual physician data, our department of surgery initiated a surgeon-specific reporting (SSR) program to assess the value of personal knowledge on individual performance quality. We sought to evaluate the use of SSR as a tool to enable surgeons to assess and improve their clinical performance, and to identify barriers to use of their reports.

Study Design

Qualitative research design involving semistructured interviews of surgeons who received performance reports derived from National Surgical Quality Improvement Program (NSQIP), Surgical Care Improvement Project (SCIP), and the Centers for Medicare and Medicaid Services (CMS) core measures and hospital administrative data. Transcripts were analyzed by the constant comparative method.

Results

Twenty-four of 39 surgeons (61.5%) who received their SSRs agreed to be interviewed and 23 were interviewed. About half (11 of 23) demonstrated comprehension of the data validity, accuracy, or complexity. Of these, 6 took steps to validate data or improve performance. Most respondents believed SSR would lead to performance improvement through knowledge of personal outcomes and peer comparison; however, they perceived SSR had limitations, such as small sample size and potential coding errors, and could lead to unintended consequences, such as inaccurate interpretation by others and surgeons' aversion to selecting high-risk patients. Respondents also suggested logistical improvements to reporting methods, such as report format and definitions of metrics.

Conclusions

Surgeon-specific reporting has the potential to empower surgeons to improve their practice; however, more surgeons need efficient guidelines to understand the metrics. Our findings can be used to guide development of more SSR programs. Whether SSR programs lead to improvements in surgical outcomes is a matter for future research.

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Abbreviations and Acronyms : ACS, CABG, CMS, NSQIP, PAR, SCIP, SSR


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© 2013  Pubblicato da Elsevier Masson SAS.
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Vol 217 - N° 4

P. 636 - ottobre 2013 Ritorno al numero
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