Quality and performance indicators in an academic department of head and neck surgery.

OBJECTIVE: to create a method for assessing physician performance and care outcomes that are adjusted for procedure acuity and patient comorbidity. DESIGN: between 2004 and 2008 surgical procedures performed by 10 surgeons were stratified into high-acuity procedures (HAPs) and low-acuity procedures (LAPs). Risk adjustment was made for comorbid conditions examined singly or in groups of 2 or more. SETTING: a tertiary care medical center. PATIENTS: a total of 2618 surgical patients. MAIN OUTCOME MEASURES: performance measures included length of stay; return to operating room within 7 days of surgery; and the occurrence of mortality, hospital readmission, transfusion, and wound infection within 30 days of surgery. RESULTS: the transfusion rate was 2.7% and 40.6% for LAPs and HAPs, respectively. Wound infection rates were 1.4% for LAPs vs 14.1% for HAPs, while 30-day mortality rate was 0.3% and 1.6% for LAPs and HAPs, respectively. The mean (SD) hospital stay for LAPs was 2.1 (3.6) vs 10.5 (7.0) days for HAPs. Negative performance factors were significantly higher for patients who underwent HAPs and had comorbid conditions. Differences among surgeons significantly affect the incidence of negative performance indicators. Factors affecting performance measures were procedure acuity, the surgeon, and comorbidity, in order of decreasing significance. Surgeons were ranked low, middle, and high based on negative performance indicators. CONCLUSIONS: performance measures following oncologic procedures were significantly affected by comorbid conditions and by procedure acuity. Although the latter most strongly affects quality and performance indicators, both should weigh heavily in physician comparisons. The incidence of negative performance indicators was also influenced by the individual surgeon. These data may serve as a tool to evaluate and improve physician performance and outcomes and to develop risk-adjusted benchmarks. Ultimately, reimbursement may be tied to quantifiable measures of physician and institutional performance.

Designing multi-ethnic stroke studies: the Brain Attack Surveillance in Corpus Christi (BASIC) project.

The Brain Attack Surveillance in Corpus Christi (BASIC) project is a population-based stroke study comparing Mexican Americans and non-Hispanic whites. Extensive effort is made to detect all patients regardless of ethnicity and ensure equal participation in the interview among both groups. We describe here the study's design and process evaluation with a focus on reducing bias in case ascertainment and participation. During the first 28 months of the project, 11,829 subjects were screened. Availability of neuroimaging did not differ by ethnicity (P=0.22), nor did confidence in the validated diagnosis of stroke (P=0.10). Participation rate in the interview also did not differ by ethnicity (P=0.92). There was excellent agreement of ethnic classification between chart abstraction and self-report (kappa=0.94, P<0.001). We conclude that multi-ethnic stroke comparison studies are feasible. Utilizing epidemiologic principles to design, recruit and analyze data are critical. Process evaluation to examine for sources of bias is important to study conduct.