Development and Pilot Study of an Essential Set of Indicators for General Surgery Services

Abstract Introduction At present there is a lack of appropriate quality measures for benchmarking in general surgery units of Spanish National Health System. The aim of this study is to present the selection, development and pilot-testing of an initial set of surgical quality indicators for this pur...

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Bibliographic Details
Published in:Cirugia española (English ed.) 2016-11, Vol.94 (9), p.502-510
Main Authors: Soria-Aledo, Victor, Angel-Garcia, Daniel, Martinez-Nicolas, Ismael, Rebasa Cladera, Pere, Cabezali Sanchez, Roger, Pereira García, Luis Francisco
Format: Article
Language:English
Subjects:
Benchmarking
Cirugía general
General surgery
Health information systems
Indicadores de calidad de la atención de salud
Quality indicators
Servicio de cirugía en hospital
Sistemas de información en salud
Surgery
Surgery department
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Summary:Abstract Introduction At present there is a lack of appropriate quality measures for benchmarking in general surgery units of Spanish National Health System. The aim of this study is to present the selection, development and pilot-testing of an initial set of surgical quality indicators for this purpose. Methods A modified Delphi was performed with experts from the Spanish Surgeons Association in order to prioritize previously selected indicators. Then, a pilot study was carried out in a public hospital encompassing qualitative analysis of feasibility for prioritized indicators and an additional qualitative and quantitative three-rater reliability assessment for medical record-based indicators. Observed inter-rater agreement, prevalence adjusted and bias adjusted kappa and non-adjusted kappa were performed, using a systematic random sample (n=30) for each of these indicators. Results Twelve out of 13 proposed indicators were feasible: 5 medical record-based indicators and 7 indicators based on administrative databases. From medical record-based indicators, 3 were reliable (observed agreement >95%, adjusted kappa index >0.6 or non-adjusted kappa index >0.6 for composites and its components) and 2 needed further refinement. Conclusions Currently, medical record-based indicators could be used for comparison purposes, whilst further research must be done for validation and risk-adjustment of outcome indicators from administrative databases. Compliance results in the adequacy of informed consent, diagnosis-to-treatment delay in colorectal cancer, and antibiotic prophylaxis show room for improvement in the pilot-tested hospital.
ISSN:2173-5077
2173-5077
DOI:10.1016/j.cireng.2016.11.005