Quality Measurement and Improvement in General Surgery

摘要

Increasing emphasis is being placed on health care quality measurement and improvement in the US. Within general surgery, several sophisticated quality-measurement and outcomes systems have been developed. These include the National Surgical Quality Improvement Program, the use of selective referral and centers of excellence, the Surgical Care Improvement Project, and the World Health Organization Surgical Safety Checklist. This article reviews each of these quality-improvement initiatives, highlights their relative contributions, and discusses future directions of quality improvement within general surgery. Measuring and improving the quality of health care is an increasingly important goal in American medicine. Patients and their families request information on outcomes, payers require health care systems to address variations in quality of care, and credentialing agencies demand evidence that hospitals meet performance standards. Within general surgery, the American Board of Surgery has implemented new standards for maintenance of certification, requiring surgeons to monitor their own performance.1 The Joint Commission also tracks key indicators of surgical safety and monitors surgeon-specific performance as part of its credentialing process.2 Payers in both the public and private sectors are rapidly implementing centers of excellence and pay-for-performance programs, further driving the need to systematically track and improve the quality of surgical care.3 The importance of measuring and improving surgical quality is well established, but it is unclear how best to accomplish these objectives. Time-consuming review of medical records, the tardiness of retrospective quality measures, and the accuracy and fairness of public report cards are frequently cited shortcomings of current methods.4 However, surgeons and national surgical organizations, such as the American College of Surgeons (ACS), are developing more precise and timely methods of measuring surgical quality, with the goal of ultimately improving outcomes. This article discusses current initiatives in quality measurement and improvement within general surgery and highlights future directions within the field of surgical outcomes.