1. Solving the Value Equation: Assessing Surgeon Performance Using Risk-Adjusted Quality-Cost Diagrams and Surgical Outcomes
- Author
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Felix G. Fernandez, Yazan Duwayri, William Knechtle, Mehul V. Raval, Patrick S. Sullivan, Joe Sharma, Sebastian D. Perez, and John F. Sweeney
- Subjects
Adult ,Male ,Quality Assurance, Health Care ,Cost-Benefit Analysis ,medicine.medical_treatment ,Psychological intervention ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,Humans ,Medicine ,Operations management ,030212 general & internal medicine ,Single institution ,Colectomy ,health care economics and organizations ,Average cost ,Quality of Health Care ,Risk adjusted ,Surgeons ,Models, Statistical ,business.industry ,Health Policy ,technology, industry, and agriculture ,Middle Aged ,Risk adjustment ,Treatment Outcome ,Surgical Procedures, Operative ,030220 oncology & carcinogenesis ,Female ,Risk Adjustment ,lipids (amino acids, peptides, and proteins) ,business ,Value (mathematics) ,Quality costs - Abstract
Quality-cost diagrams have been used previously to assess interventions and their cost-effectiveness. This study explores the use of risk-adjusted quality-cost diagrams to compare the value provided by surgeons by presenting cost and outcomes simultaneously. Colectomy cases from a single institution captured in the National Surgical Quality Improvement Program database were linked to hospital cost-accounting data to determine costs per encounter. Risk adjustment models were developed and observed average cost and complication rates per surgeon were compared to expected cost and complication rates using the diagrams. Surgeons were surveyed to determine if the diagrams could provide information that would result in practice adjustment. Of 55 surgeons surveyed on the utility of the diagrams, 92% of respondents believed the diagrams were useful. The diagrams seemed intuitive to interpret, and making risk-adjusted comparisons accounted for patient differences in the evaluation.
- Published
- 2016