Development and Validation of a Novel Literature-Based Method to Identify Disparity-Sensitive Surgical Quality Metrics

BACKGROUND

Disparity in surgical care impedes the delivery of uniformly high-quality care. Metrics that quantify disparity in care can help identify areas for needed intervention. A literature-based Disparity-Sensitive Score (DSS) system for surgical care was adapted by the Metrics for Equitable Access and Care in Surgery (MEASUR) group. The alignment between the MEASUR DSS and Delphi ratings of an expert advisory panel (EAP) regarding the disparity sensitivity of surgical quality metrics was assessed.

STUDY DESIGN

Using DSS criteria MEASUR co-investigators scored 534 surgical metrics which were subsequently rated by the EAP. All scores were converted to a 9-point scale. Agreement between the new measurement technique (ie DSS) and an established subjective technique (ie importance and validity ratings) were assessed using the Bland-Altman method, adjusting for the linear relationship between the paired difference and the paired average. The limit of agreement (LOA) was set at 1.96 SD (95%).

RESULTS

The percentage of DSS scores inside the LOA was 96.8% (LOA, 0.02 points) for the importance rating and 94.6% (LOA, 1.5 points) for the validity rating. In comparison, 94.4% of the 2 subjective EAP ratings were inside the LOA (0.7 points).

CONCLUSIONS

Applying the MEASUR DSS criteria using available literature allowed for identification of disparity-sensitive surgical metrics. The results suggest that this literature-based method of selecting quality metrics may be comparable to more complex consensus-based Delphi methods. In fields with robust literature, literature-based composite scores may be used to select quality metrics rather than assembling consensus panels.

Disparity-Sensitive Measures in Surgical Care: A Delphi Panel Consensus

BACKGROUND

In the US, disparities in surgical care impede the delivery of uniformly high-quality care to all patients. There is a lack of disparity-sensitive measures related to surgical care. The American College of Surgeons Metrics for Equitable Access and Care in Surgery group, through research and expert consensus, aimed to identify disparity-sensitive measures in surgical care.

STUDY DESIGN

An environmental scan, systematic literature review, and subspecialty society surveys were conducted to identify potential disparity-sensitive surgical measures. A modified Delphi process was conducted where panelists rated measures on both importance and validity. In addition, a novel literature-based disparity-sensitive scoring process was used.

RESULTS

We identified 841 potential disparity-sensitive surgical measures. From these, our Delphi and literature-based approaches yielded a consensus list of 125 candidate disparity-sensitive measures. These measures were rated as both valid and important and were supported by the existing literature.

CONCLUSION

There are profound disparities in surgical care within the US healthcare system. A multidisciplinary Delphi panel identified 125 potential disparity-sensitive surgical measures that could be used to track health disparities, evaluate the impact of focused interventions, and reduce healthcare inequity.

Childhood obesity elevates blood pressure and total cholesterol independent of physical activity

OBJECTIVE

To compare the habitual physical activity, blood pressure, total cholesterol levels of obese and non-obese matched children.

SUBJECTS

546 obese children (BMI and sum of skinfolds > or = 90% tile) were matched for gender, race, age, and height (within 2 cm) with non-obese controls for a total sample of 1092 children.

MEASUREMENTS

Systolic (BPsys) and diastolic (BPdia) blood pressure by mercury sphygmomanometer, total cholesterol by reflectance photometry, and physical activity by questionnaire.

RESULTS

Mean comparisons indicated the obese children, regardless of gender, had higher BPsys (108 +/- 11 vs 104 +/- 10 mm Hg, P = 0.0001), BPdia (70 +/- 9 vs 68 +/- 8 mm Hg, P = 0.002), and greater total cholesterol levels (4.47 +/- 0.80 vs 4.11 +/- 0.75 mmol/L, P = 0.0001) than the non-obese subjects. Self-reported physical activity scores were not significantly different when comparing the obese and non-obese children. Correlations between self-reported activity and cholesterol or blood pressure were all very low and not significant (r < or = 0.06).

CONCLUSION

These results suggest that childhood obesity is associated with higher blood pressures and greater circulating cholesterol levels independent of physical activity levels.