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- W1983306003 abstract "Introduction: Risk-adjusted morbidity rates are widely used as surgical quality indicators for vascular surgery. However, since many hospitals have low caseloads, morbidity rates can be unreliable. We evaluated whether a novel approach for creating composite quality measures can improve the reliability of hospital morbidity reporting. Methods: Using data from ACS-NSQIP, we studied all patients undergoing major general and vascular surgery in 2008. for lower extremity bypass surgery, we created a composite measure by combining quality indicators from several distinct domains of quality: morbidity, reoperation, length of stay, and hospital morbidity with other potentially related procedures. We empirically weighted each measure and filtered out measurement noise using multilevel modeling. Hospitals were then ranked based upon the composite and placed in quintiles (1- to 5-stars). to validate this approach, we assessed how well composite measures from 2008 forecasted risk-adjusted morbidity in the next year (2009) compared to the traditional approach of using risk-adjusted morbidity alone. Results: Composite measures were better at discriminating differences in the future risk of serious complications compared to the traditional approach. Hospitals rated as 1-star and 5-star had a 58% difference in future risk-adjusted morbidity (13.4% vs 8.2%) using the composite measure, compared to only a 36% difference (11.8% vs 10.0%) for the traditional NSQIP approach. the composite measure also explained a higher proportion of hospital-level variation in serious complication rates compared to the traditional NSQIP approach. Conclusions: Empirically-derived composite measures are more reliable measures of hospital morbidity for lower extremity vascular surgery than traditional approaches. These measures could be used to improve the accuracy of quality measurement programs such as ACS-NSQIP." @default.
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- W1983306003 date "2012-02-01" @default.
- W1983306003 modified "2023-09-26" @default.
- W1983306003 title "Composite Measures for Assessing Hospital Quality With Lower Extremity Bypass Surgery" @default.
- W1983306003 doi "https://doi.org/10.1016/j.jss.2011.11.312" @default.
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