New outcome measures in perioperative care
Abstract
Improvements in outcome measurement are needed to produce quality improvement in perioperative care. However, problems with the collection and use of outcome data persist in research and clinical practice. This is being addressed by several national programmes and initiatives to standardize and integrate outcome measurement.
The use of different outcome measures is changing and there has been a transition towards patient-focused measures. Traditional measures of quality in perioperative care include mortality, morbidity and resource utilization measures. Patient-focused measures include patient-reported outcome measures and measures of patient experience. Each of these has advantages and disadvantages in different situations.
The routine collection, analysis and dissemination of data relating to perioperative outcome is beneficial to patients, clinicians, hospitals, commissioners, regulators and researchers.
References
- 2014) Engaging Clinicians in Quality Improvement through National Clinical Audit. Report to the Healthcare Quality Improvement Partnership. www.hqip.org.uk/public/cms/253/625/19/373/Engaging-Clinicians-in-Quality-Improvement-Through-National-Clinical-Audit.pdf?realName=ctxnKi.pdf (
accessed 9 October 2017 ) Google Scholar ( - 2016) Standardizing endpoints in perioperative research. Can J Anaesth 63(2): 159–168. https://doi.org/https://doi.org/10.1007/s12630-015-0565-y Crossref, Medline, Google Scholar (
- 2007) Patient reported outcome measures (PROMs) in elective surgery: Report to the Department of Health. London School of Hygiene and Tropical Medicine, London Google Scholar (
- 2012) The National Adult Inpatient Survey conducted in the English National Health Service from 2002 to 2009: how have the data been used and what do we know as a result? BMC Health Serv Res 12(1): 71. https://doi.org/https://doi.org/10.1186/1472-6963-12-71 Crossref, Medline, Google Scholar (
- 2010) Getting the most out of PROMS. https://www.kingsfund.org.uk/sites/default/files/Getting-the-most-out-of-PROMs-Nancy-Devlin-John-Appleby-Kings-Fund-March-2010.pdf (
accessed 9 October 2017 ) Google Scholar ( - 2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2): 205–213. https://doi.org/https://doi.org/10.1097/01.sla.0000133083.54934.ae Crossref, Medline, Google Scholar (
EuroQol Group (1990) EuroQol—a new facility for the measurement of health related quality of life. Health Policy 16: 199–208. https://doi.org/https://doi.org/10.1016/0168-8510(90)90421-9 Crossref, Medline, Google Scholar- 1998) Evaluating patient-based outcome measures for use in clinical trials. Health Technol Assess 2(14): i-iv, 1–74. Medline, Google Scholar (
- 2012) The power of the National Surgical Quality Improvement Programachieving a zero pneumonia rate in general surgery patients. Perm J 16(1): 39–45. https://doi.org/https://doi.org/10.7812/TPP/11-127 Crossref, Medline, Google Scholar (
- 2009) Child and parent reported outcome measures: A scoping report focusing on feasibility for routine use in the NHS. Patient Reported Outcome Measurement Group, Oxford Google Scholar (
- 2015) The Outcomes and Experiences Questionnaire: development and validation. Patient Relat Outcome Meas 6: 179–189. https://doi.org/https://doi.org/10.2147/PROM.S82784. Crossref, Medline, Google Scholar (
- 2007) The Postoperative Morbidity Survey was validated and used to describe morbidity after major surgery. J Clin Epidemiol 60(9): 919–928. https://doi.org/https://doi.org/10.1016/j.jclinepi.2006.12.003 Crossref, Medline, Google Scholar (
- 2011) A systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesth Analg 112(6): 1392–1402. https://doi.org/https://doi.org/10.1213/ANE.0b013e3181eeaae5 Crossref, Medline, Google Scholar (
- 2011) Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res 20(10): 1727–1736. https://doi.org/https://doi.org/10.1007/s11136-011-9903-x Crossref, Medline, Google Scholar (
- 2006) Trends in hospital and surgeon volume and operative mortality for cancer surgery. Ann Surg Oncol 13(6): 851–858. https://doi.org/https://doi.org/10.1245/ASO.2006.07.021 Crossref, Medline, Google Scholar (
- 2005) Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg 242(3): 326–341. https://doi.org/https://doi.org/10.1097/01.sla.0000179621.33268.83. Crossref, Medline, Google Scholar (
- 2010) The impact of outcome reporting bias in randomised controlled trials on a cohort of systematic reviews. BMJ 340: c365. https://doi.org/https://doi.org/10.1136/bmj.c365 Crossref, Medline, Google Scholar (
- 2013) Post-hospital syndrome – an acquired, transient condition of generalized risk. N Engl J Med 368(2): 100–102. https://doi.org/https://doi.org/10.1056/NEJMp1212324 Crossref, Medline, Google Scholar (
- 2002) Quality of complication reporting in the surgical literature. Ann Surg 235(6): 803–813. https://doi.org/https://doi.org/10.1097/00000658-200206000-00007 Crossref, Medline, Google Scholar (
- 2015) Investigating the collection and assessment of patient-reported outcome data amongst unplanned surgical hospital admissions: a feasibility study’, Pilot and Feasibility Studies. BioMed Central 1(1): 16. https://doi.org/https://doi.org/10.1186/s40814-015-0011-5 Google Scholar (
- 2014) Survival after postoperative morbidity: a longitudinal observational cohort study. Br J Anaesth 113(6): 977–984. https://doi.org/https://doi.org/10.1093/bja/aeu224. Crossref, Medline, Google Scholar (
- 2000) Validity and reliability of a postoperative quality of recovery score: the QoR-40. Br J Anaesth 84(1): 11–15. https://doi.org/https://doi.org/10.1093/oxfordjournals.bja.a013366 Crossref, Medline, Google Scholar (
- 2016) Standardizing end points in perioperative trials: towards a core and extended outcome set. Br J Anaesth 116(5): 586–589. https://doi.org/https://doi.org/10.1093/bja/aew066 Crossref, Medline, Google Scholar (
- 2013) Pilot study of patient reported outcome measures (PROMs) in primary care. Report to the Department of Health. www.qoru.ac.uk/wp-content/uploads/2013/11/PROMs-Pilot-Report-June-2013.pdf (
accessed 9 October 2017 ) Google Scholar ( - 2015) Measurement of Disability-free Survival after Surgery. Anesthesiology 122(3): 524–536. https://doi.org/https://doi.org/10.1097/ALN.0000000000000586 Crossref, Medline, Google Scholar (
- 1992) Hospital and patient characteristics associated with death after surgery. A study of adverse occurrence and failure to rescue. Med Care 30(7): 615–629. https://doi.org/https://doi.org/10.1097/00005650-199207000-00004 Crossref, Medline, Google Scholar (
- 2013) Development and Psychometric Evaluation of a Postoperative Quality of Recovery Score. Anesthesiology 118(6): 1332–1340. https://doi.org/https://doi.org/10.1097/ALN.0b013e318289b84b Crossref, Medline, Google Scholar (
- 2016) A systematic review of patient-reported outcomes in randomized controlled trials of unplanned general surgery. World J Surg 40(2): 267–276. https://doi.org/https://doi.org/10.1007/s00268-015-3292-1 Crossref, Medline, Google Scholar (
- 2013) The long-term effects of postoperative complications. Curr Opin Crit Care 19(4): 364–368. https://doi.org/https://doi.org/10.1097/MCC.0b013e3283632f77 Crossref, Medline, Google Scholar (
- 2013) Variation in surgical-readmission rates and quality of hospital care. N Engl J Med 369(12): 1134–1142. https://doi.org/https://doi.org/10.1056/NEJMsa1303118 Crossref, Medline, Google Scholar (
- 2004) Outcome monitoring to facilitate clinical governance; experience from a national programme in the independent sector. J Public Health (Bangkok) 26(2): 187–192. https://doi.org/https://doi.org/10.1093/pubmed/fdh127 Crossref, Google Scholar (
- 2016) Patient reported outcome of adult perioperative anaesthesia in the United Kingdom: a cross-sectional observational study. Br J Anaesth 117(6): 758–766. https://doi.org/https://doi.org/10.1093/bja/aew381 Crossref, Medline, Google Scholar (
- 1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30(6): 473–483. https://doi.org/https://doi.org/10.1097/00005650-199206000-00002 Crossref, Medline, Google Scholar (
- 2008) An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 372(9633): 139–144. https://doi.org/https://doi.org/10.1016/S0140-6736(08)60878-8 Crossref, Medline, Google Scholar (
- 2014) Patient-reported outcome measures: an on-line system empowering patient choice. J Am Med Inform Assoc 21(4): 725–729. https://doi.org/https://doi.org/10.1136/amiajnl-2012-001183 Crossref, Medline, Google Scholar (