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Composite measures predicted bariatric surgery performance better than other methods
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Composite measures interpreted a greater number of hospital-level variations regarding serious complication rates associated with laparoscopic gastric bypass surgery compared with other measures, according to a recent report in JAMA Surgery. In particular, composite measures explained 89% of the variation compared with 28% for risk-adjusted complication rates alone.
“This study provides preliminary data that empirically weighted composite outcomes measures may be better than existing alternatives for selective referral and outcomes feedback programs,” Justin B. Dimick, MD, of the Michigan Bariatric Surgery Collaborative at the University of Michigan, and colleagues wrote.
Justin B. Dimick
The composite measures appeared to better predict future performance compared with individual measures, researchers added.
Researchers used the Michigan Bariatric Surgery Collaborative, a payer-funded quality improvement program, to investigate hospital volume, risk-adjusted complications, risk- and reliability-adjusted complications and the composite measure from the prior year.
They found that when ranked on the composite measure, one-star hospitals demonstrated a twofold complication rate (4.6% vs. 2.4%; OR=2; 95% CI, 1.1-3.5) compared with three-star hospitals, according to data.
Varying results regarding serious complication rates between one- and three-star hospitals were considered to be minor when hospitals were ranked based on serious complications (4% vs. 2.7%; OR=1.6; 95% CI, 0.8-2.9) and hospital volume (3.3% vs. 3.2%; OR=0.85; 95% CI, 0.4-1.7), according to data.
“The method used in this article provides an alternative approach. Rather than making the assumption that all hospitals have average performance, we use a flexible approach that incorporates information on hospital and surgeon characteristics, including hospital volume,” researchers wrote.
Disclosure: Dimick reports serving as a consultant and having equity interest in ArborMetrix Inc.
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