Surgical Quality Enhanced By Electronics Records Data Interview with:
Jamie Anderson MD MPH
Department of Surgery
University of California, San Diego

Medical Research: What is the background for this study? What are the main findings?

Dr. Anderson: Risk adjustment is an important component of outcomes and quality analysis in surgical healthcare. To compare two hospitals fairly, you must take into account the “risk profile” of their patients. For example, a hospital operating on predominately very sick patients with multiple co-morbidities would be expected to have different outcomes to a hospital operating on relatively healthier patients with fewer co-morbidities. Somewhat counter-intuitively, it is possible that a hospital with a 10% mortality rate may be better than a hospital with 5% mortality rate when you adjust for the risk of the patient population.

Currently, the “gold standard” database to evaluate surgical outcomes is the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), which includes a number of variables on each patient to perform risk adjustment. However, collecting these variables is costly and time consuming. There is also concern that risk adjusted benchmarking systems can be “gamed” because they include data elements that require subjective interpretation by hospital personnel.

With the widespread adoption of electronic health records, the aim of this study was to determine whether a number of objective data elements already used for patient care could perform as well as a traditional, full risk adjustment model that includes other provider-assessed and provider-recorded data elements.

We tested this hypothesis with an analysis of the NSQIP database from 2005-2010, comparing models that adjusted for all 66 pre-operative risk variables captured by NSQIP to models that only included 25 objective variables. These results suggest that rigorous risk adjusted surgical quality assessment can be performed relying solely on objective variables already captured in electronic health records.

Medical Research: What should clinicians and patients take away from your report?

Dr. Anderson: By leveraging data that are already regularly collected for patient care, this approach is a more efficient use of data already collected for patient care. While we are still several steps away from putting these findings into practice, we are hopeful that this research will open the door to expand risk-adjusted quality improvement studies to all hospitals, especially those in rural or underserved areas that don’t have the resources to devote solely to examining their outcomes.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Anderson: The next step will be putting these findings into practice. This requires developing new ways to easily use electronic health records for quality purposes. Electronic health records are designed to assist with medical communication and billing, but it is not always easy to use this information to evaluate quality and outcomes.

Furthermore, the private sector has a plethora of databases that could be linked to patient data in innovative ways, from tracking purchasing patterns of healthy food or over-the-counter medicines to using global positioning system (GPS) technology (now embedded in many personal handheld devices) to record patient exercise regimens or identify geographical disease “hot spots.” In our data-driven environment in which technology will continue to become an integral part of our daily lives, the possibilities are endless. In the future, it is not inconceivable that we will be able to perform retrospective analyses of complex databases with the same rigor as prospective trials. Hiring additional personnel for the sole purpose of data collection may become outdated in the era of “big data.” However, with these advances, we must continue to be diligent about protecting patient information.



Last Updated on June 10, 2015 by Marie Benz MD FAAD