Use of Data from Surgical Registries to Improve Outcomes
Data from surgical registries may serve multiple purposes including the assessment of outcomes, the improvement of quality of healthcare, and the enhancement of patient safety. The increasing sophistication and analytic capabilities of clinical registries and databases contribute considerably in all of these domains due to their use of accurate, credible, risk adjusted, and concurrent clinical data which is acquired for these specific purposes and not simply for generating financial claims for reimbursement. In order to perform meaningful multi-institutional analyses of outcomes, any database must incorporate the following seven essential elements: (1) Use of a common language and nomenclature, (2) Use of a database with an established uniform core dataset for collection of information, (3) Incorporation of a mechanism of evaluating case complexity, (4) Availability of a mechanism to assure and verify the completeness and accuracy of the data collected, (5) Collaboration between medical and surgical subspecialties, (6) Standardization of protocols for lifelong follow-up, and (7) Incorporation of strategies for quality assessment and quality improvement.
For optimal use, clinical registries should be able to link and collaborate with other clinical and administrative datasets and should be able to follow patients along the continuum of care in order to facilitate longitudinal assessment of outcomes, comparative effectiveness research, and quality improvement. Finally, datasets must be able to measure risk-adjusted outcomes and discriminate quality at the level of hospitals, surgical teams, and individual surgeons; such measurement and discrimination will identify high-performing and low-performing groups and therefore facilitate quality improvement and enhance patient safety. Two surgical databases, The National Surgical Quality Improvement Program® (ACS NSQIP®) and The Society of Thoracic Surgeons National Database, have established sophisticated and effective methods for analysis of outcomes and assessment of quality. Both of these two databases are platforms for multiple quality measures endorsed by The National Quality Forum (NQF). Some of these NQF endorsed quality measures are multi-domain composite performance metrics that combine the outcome domains of mortality and morbidity and thereby recognize that survival is only one of many measures of the quality of care.
Surgical registries are valuable tools to improve the outcomes of our patients and advance the art and science of outcomes analysis, quality improvement, and patient safety. As public reporting of surgical outcomes evolves, surgical registries will also be important platforms for transparency. Thoughtful graphical depiction of data will support and enhance all of these efforts. In the final analyses, surgical registries should allow surgical teams to provide better care for our patients.
KeywordsOutcomes analysis Quality improvement Patient safety Surgical registry Surgical database
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