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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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William Thomas Cecil, Independent Consultant, Knoxville, Tennessee, the United States
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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.
Multilevel Mixed-Effects Modeling, Risk Adjustment for Clinical Outcomes, Reliability, Validity
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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 © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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