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Benchmarking clinical practice in surgery: looking beyond traditional mortality rates

dc.contributor.authorCastro, Ricardo A. S.
dc.contributor.authorOliveira, Pedro N.
dc.contributor.authorPortela, Maria
dc.contributor.authorCamanho, Ana S.
dc.contributor.authorQueiroz e Melo, João
dc.date.accessioned2014-06-06T09:30:30Z
dc.date.available2014-06-06T09:30:30Z
dc.date.issued2015
dc.description.abstractThis paper proposes two new measures to assess performance of surgical practice based on observed mortality: reliability, measured as the area under the ROC curve and a living score, the sum of individual risk among surviving patients, divided by the total number of patients. A Monte Carlo simulation of surgeons' practice was used for conceptual validation and an analysis of a real-world hospital department was used for managerial validation. We modelled surgical practice as a bivariate distribution function of risk and final state. We sampled 250 distributions, varying the maximum risk each surgeon faced, the distribution of risk among dead patients, the mortality rate and the number of surgeries performed yearly. We applied the measures developed to a Portuguese cardiothoracic department. We found that the joint use of the reliability and living score measures overcomes the limitations of risk adjustedmortality rates, as it enables a different valuation of deaths, according to their risk levels. Reliability favours surgeons with casualties, predominantly, in high values of risk and penalizes surgeons with deaths in relatively low levels of risk. The living score is positively influenced by the maximum risk for which a surgeon yields surviving patients. These measures enable a deeper understanding of surgical practice and, as risk adjusted mortality rates, they rely only on mortality and risk scores data. The case study revealed that the performance of the department analysed could be improved with enhanced policies of risk management, involving the assignment of surgeries based on surgeon's reliability and living score.por
dc.description.versioninfo:eu-repo/semantics/publishedVersion
dc.identifier.citationCASTRO, Ricardo A. S.; OLIVEIRA, Pedro N.; PORTELA, Maria; CAMANHO, A.S.; QUEIROZ E MELO, João - Benchmarking clinical practice in surgery: looking beyond traditional mortality rates. Health Care Management Science. ISSN 1572-9389. Vol. 18, n.º 4 (2015), p. 431–443por
dc.identifier.doi10.1007/s10729-014-9266-2
dc.identifier.eid84947487598
dc.identifier.eissn1572-9389
dc.identifier.issn1386-9620
dc.identifier.urihttp://hdl.handle.net/10400.14/14512
dc.identifier.wos000365175800003
dc.language.isoengpor
dc.peerreviewedyespor
dc.publisherSpringerpor
dc.subjectQuality measurementpor
dc.subjectPatient outcomespor
dc.subjectSimulation and modellingpor
dc.subjectROC curvespor
dc.titleBenchmarking clinical practice in surgery: looking beyond traditional mortality ratespor
dc.typejournal article
dspace.entity.typePublication
oaire.awardURIinfo:eu-repo/grantAgreement/FCT/SFRH/SFRH%2FBD%2F76634%2F2011/PT
oaire.awardURIinfo:eu-repo/grantAgreement/FCT/3599-PPCDT/PTDC%2FEGE-GES%2F112232%2F2009/PT
oaire.citation.endPage443
oaire.citation.issue4
oaire.citation.startPage431
oaire.citation.titleHealth Care Management Science
oaire.citation.volume18
oaire.fundingStreamSFRH
oaire.fundingStream3599-PPCDT
person.familyNameOliveira
person.familyNameSilva
person.familyNameCamanho
person.givenNamePedro
person.givenNameMaria
person.givenNameAna
person.identifierR-000-F2N
person.identifier.ciencia-id6C11-D7C8-DD95
person.identifier.ciencia-idD012-79F9-34BC
person.identifier.ciencia-id0612-BE1E-35AB
person.identifier.orcid0000-0002-2470-0795
person.identifier.orcid0000-0002-3525-2393
person.identifier.orcid0000-0001-7683-5889
person.identifier.scopus-author-id7102098106
person.identifier.scopus-author-id55663172600
person.identifier.scopus-author-id7801312656
project.funder.identifierhttp://doi.org/10.13039/501100001871
project.funder.identifierhttp://doi.org/10.13039/501100001871
project.funder.nameFundação para a Ciência e a Tecnologia
project.funder.nameFundação para a Ciência e a Tecnologia
rcaap.rightsrestrictedAccesspor
rcaap.typearticlepor
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