Assessing Hospital Surgical Quality.

Objective: Develop a new hospital surgery report card for use in performance improvement. Background: When evaluating quality, a surgical program is aided by benchmark comparisons with outcomes achieved at other hospitals. To be credible, benchmarking should be based on the same surgical procedures and patient risk, despite there being many types of patients and procedures. Methods: Using Medicare patients undergoing general, orthopedic, or vascular surgery, each patient in a hospital is closely matched to 10 control patients from typical hospitals and to 10 control patients from well-resourced hospitals throughout the United States. Patients were matched on 200 characteristics, including procedure, comorbidities, socio-demographics, and the presence of multimorbidity. Hospitals were graded based on the differences in outcomes between matched sets of patients. As an illustration, we examine the 20 highest volume hospitals in Pennsylvania and provide detailed report cards on 2 example hospitals. Results: The hospitals studied differed in quality and grades, with better outcomes than matched controls for Hospital A and significantly worse outcomes than controls for Hospital B, depending on the type of surgery and patient. For the 20 largest hospitals in Pennsylvania, 5 had significantly elevated mortality, and 2 had significantly lower mortality than matched controls. Conclusions: Surgical programs benefit from knowing how their outcomes compare with those of other hospitals, both their overall outcomes and their outcomes for subsets of patients, such as patients with or without multimorbidity. Detailed reports based on matching can help identify meaningful deficiencies and strengths in programs concerning specific surgeries and patient types.