Abstract
<i>Objective</i>- To identify measures of surgeon performance that are valid, reliable, and capable of classifying the risk of surgeon performance. <i>Data Sources</i>- A surgical quality improvement program, dataset unique to selected hospitals and surgeons containing abstracted surgical case records. <i>Study Design</i>- Six criteria were employed to assess the validity of 24 candidate measures of surgeon performance: 1) the presence of a surgeon random intercept; 2) a surgeon signal that is greater than zero; 3) surgeon majority control; 4) reliability of the surgeon random intercept of at least 0.7; 5) the capacity to identify both low- and high-risk surgeons and 6) the presence of a learning/improvement effect. <i>Data collection/Extraction methods</i>- Surgical case review nurses abstracted cases for each surgeon using a structured sampling and abstraction methodology. <i>Principal findings</i>- Comparing outcomes requires risk adjustment and the use of the "true score" approach but is limited by case volume constraints and a confounding factor, i.e., the hospital, if used to judge surgeons' performance. Assessing surgeon performance requires a measure of the surgeon's effects on the consequences (postoperative occurrences) of surgical procedures, i.e., the surgeon-specific random intercept, which is a product of a multilevel risk adjustment model. <i>Conclusion</i>- Morbidities and mortality lack the characteristics necessary to be used as measures of surgeon performance. However, the process (task-time) measures LOS and OT both have high event rates, high reliability, and are capable of classifying surgeon risk.
Highlights
Surgeon performance measurements are potentially helpful for quality improvement [1], consumer decision support [2], and surgeon management [3, 4]
Comparing outcomes across surgeons differs from measuring surgeon performance
It is limited by the constraints of case volume and a confounding factor, i.e., the hospital, if used to judge surgeons' performance
Summary
Surgeon performance measurements are potentially helpful for quality improvement [1], consumer decision support [2], and surgeon management [3, 4]. Models of the surgeon role in modern multidisciplinary care include the "captain of the ship" and "member of the team" models [5, 6]. According to the "captain of the ship" model, the surgeon assumes responsibility for patient and intervention selection. In the "member of the team" model, decisions are made by the team. In a published statement regarding physician-led team-based surgical care, the American College of Surgeons (ACS) endorsed the team approach: "Optimal care is best provided by a coordinated multidisciplinary team recognizing each member's expertise. Coordinated surgical care provides the best outcomes, lowers costs, and increases patient satisfaction" (Statement on Physician-Led Team-Based Surgical Care) [7]
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