Using Patient Outcomes to Inform Surgical Education

利用患者结果为外科教育提供信息

• 批准号: 9308803
• 负责人: Rachel Kelz
• 金额: $ 61.97万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-01 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9308803
• 关键词: Accounting; Adverse event; Affect; Algorithms; Blood Transfusion; Caring; Case Mixes; Cessation of life; Characteristics; Clinical; Code; Communities; Consultations; Credentialing; Custom; Data; Data Set; Development; Diagnostic tests; Education; Enrollment; Ensure; Equilibrium; Failure; Fellowship; Future; Goals; Healthcare; Hemorrhage; Hospitals; Hour; Knowledge; Medicare claim; Methodology; Methods; Modernization; Monitor; Nature; Operative Surgical Procedures; Oral; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Pattern; Performance; Phase; Policy Maker; Population; Postoperative Period; Procedures; Process; Program Development; Public Health; Quality of Care; Repeat Surgery; Research; Residencies; Residual state; Resources; Risk Factors; Role; Secure; Surgeon; Techniques; Technology; Testing; Thromboembolism; Time; Time Study; Training; United States; Variant; Venous; cohort; cost; economic outcome; environmental change; experience; health care delivery; improved; individual patient; medical specialties; novel; novel strategies; operation; public health relevance; skills; trend; virtual; wound

 DESCRIPTION (provided by applicant): An estimated 10 million patients undergo an operative procedure annually in the United States. Despite overall improvements in outcomes, over 120,000 people die following surgery each year in the US. Many more will suffer from adverse events. Nascent research suggests that a significant proportion of the variation in outcomes occurs at the level of the operative surgeons. Yet, recent changes in the nature of surgical care, increased scrutiny of surgical outcomes, and duty-hour reform have dramatically changed the surgical training process. Resultant concerns regarding the quality of the modern new surgeons are substantiated by the recent sharp increase in the oral board failure rate. To date, no one has been able to examine the quality of the modern new surgeons because they have only recently entered the workforce. Using the introduction of the duty-hour reform in 2003 as a landmark for the larger set of systematic changes, we aim to understand the effects of environmental changes on the quality of care provided by new surgeons and the public health implications of changes in the surgical field on the emerging surgical workforce. In this proposal, using a customized Medicare claims dataset including all new surgeons across 50 states, we will use a novel two-step matching process developed specifically for this study and a difference-in-difference (D-in-D) approach to examine the effects of training in the modern era on the new surgeon product. New surgeons will be classified as modern or traditional by the year in which they entered residency. Surgeon pairs will be constructed for the modern (AY 2009-2013), transitional and traditional (AY1999-2003) training eras. The first step of the "two- step" match pairs new and experienced surgeons by the surgical procedures they performed at the same hospital in the same time period. Step two matches individual patients inside each matched surgeon pair. Using this two-step matching approach, we can control for procedure, technical and patient characteristics such that the patients treated by new and experienced surgeons within hospitals will be virtually identical. The D-in-D approach using experienced surgeons as controls minimizes confounding associated with changes in the delivery of healthcare over time. Post-match regression will be used to control for residual confounders like fellowship status. Subset analysis will permit focused examination of specific clinical cohorts to provide transparently meaningful results. Moreover, we will derive time to proficiency curves across multiple specialties and within specific clinical cohorts. Aim 1 will examine clinical outcomes and Aim 2, economic outcomes. After completing the project, we will be able to 1) inform the ACGME and ABMS on gaps in new surgeon performance for subsequent education reform, 2) use the methodology developed for this proposal to monitor any future reform and 3) advise CMS (and other payors) and surgeons on strategies for focused professional development programs (e.g., surgical coaching or phased privileging or credentialing) to improve the quality of care delivered to surgical patients today and safeguard the care of surgical patients in the future.

 描述（由适用提供）：每年在美国的操作程序下，估计有1000万患者。尽管结局的总体改善，但在美国，每年的手术后有超过12万人死亡。更多的人将遭受不利事件的困扰。新生的研究表明，结局的差异很大一部分发生在手术外科医生的水平上。然而，最近对手术护理性质的变化，对手术结果的审查增加以及值班小时的改革发生了巨大变化。由于口头董事会失败率的急剧提高，人们对现代新外科医生的质量的担忧得到了证实。迄今为止，没有人能够检查现代新外科医生的质量，因为他们直到最近才进入劳动力。我们利用2003年的税后改革作为对系统变化的更大变化的地标，我们旨在了解环境变化对新外科医生提供的护理质量的影响以及外科手术领域变化对新兴手术劳动力的影响。在此提案中， 使用定制的Medicare索赔数据集，包括50个州的所有新外科医生，我们将使用专门针对本研究开发的新型两步匹配过程以及一种差异差异（D-IN-D）方法来检查现代时代培训对新外科医生产品的影响。到他们进入海拔的一年，新外科医生将被归类为现代或传统。外科医生将为现代（AY 2009-2013），过渡和传统（AY1999-2003）培训时代建造外科医生。 “两步”比赛的第一步对他们在同一时期在同一医院进行的外科手术进行了新的和经验丰富的外科医生。第二步与每个匹配的外科医生对中的单个患者匹配。使用这种两步匹配的方法，我们可以控制手术，技术和患者特征，以便医院中新的和经验丰富的外科医生治疗的患者实际上是相同的。使用经验丰富的外科医生控制的D-IN-D方法可以最大程度地减少与随着时间的推移提供的医疗保健交付的变化相关的混淆。匹配后回归将用于控制诸如奖学金状态之类的残留混杂因素。子集分析将允许重点检查特定的临床队列，以提供透明有意义的结果。此外，我们将为多个专业和特定的临床队列中的熟练度曲线提供时间。 AIM 1将检查临床结果并AIM 2，经济成果。 After completing the project, we will be able to 1) inform the ACGME and ABMS on gaps in new surgeon performance for subsequent education reform, 2) use the methodology developed for this proposal to monitor any future reform and 3) advise CMS (and other payors) and surgeons on strategies for focused professional development programs (e.g., surgical coaching or phased privilege or credentialing) to improve the quality of care delivered to surgical patients today and safeguard将来手术患者的护理。