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Selection of Reliable and Valid Surgeon Performance Measures
American Journal of Management Science and Engineering
Volume 5, Issue 5, September 2020, Pages: 62-69
Received: Oct. 26, 2020; Accepted: Nov. 3, 2020; Published: Nov. 11, 2020
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Author
William Thomas Cecil, Independent Consultant, Knoxville, Tennessee, the United States
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Abstract
Objective- To identify measures of surgeon performance that are valid, reliable, and capable of classifying the risk of surgeon performance. Data Sources- A surgical quality improvement program, dataset unique to selected hospitals and surgeons containing abstracted surgical case records. Study Design- 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. Data collection/Extraction methods- Surgical case review nurses abstracted cases for each surgeon using a structured sampling and abstraction methodology. Principal findings- 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. Conclusion- 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.
Keywords
Multilevel Mixed-Effects Modeling, Risk Adjustment for Clinical Outcomes, Reliability, Validity
To cite this article
William Thomas Cecil, Selection of Reliable and Valid Surgeon Performance Measures, American Journal of Management Science and Engineering. Vol. 5, No. 5, 2020, pp. 62-69. doi: 10.11648/j.ajmse.20200505.12
Copyright
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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