© The Author 2006. Published by Oxford University Press.
ARTICLE |
Development of Quality Indicators for Patients Undergoing Colorectal Cancer Surgery
Affiliations of authors: Center for Surgical Outcomes and Quality, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA (MLM, CYK); Departments of Medicine (PGS) and Surgery (CYK), VA Greater Los Angeles Healthcare System, Los Angeles, CA
Correspondence to: Marcia L. McGory, MD, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave., 72-215 Center for Health Sciences, Box 956904, Los Angeles, CA 90095-6904 (e-mail: mmcgory{at}mednet.ucla.edu).
Background: Colorectal cancer is the second most common cancer type among new cancer diagnoses in the United States. Attention to the quality of surgical care for colorectal cancer is of particular importance given the increasing numbers of colorectal cancer resections performed in the aging population. A National Cancer Institute–sponsored consensus panel produced guidelines for colorectal cancer surgery in 2000. We have updated and extended that work by using a formal process to identify and rate quality indicators as valid for care during the preoperative, intraoperative, and postoperative periods. Methods: Using a modification of the RAND/UCLA Appropriateness Methodology, we carried out structured interviews with leaders in the field of colorectal cancer surgery and systematic reviews of the literature to identify candidate quality indicators addressing perioperative care for patients undergoing surgery for colorectal cancer. A panel of 14 colorectal surgeons, general surgeons, and surgical oncologists then evaluated and formally rated the indicators using the modified Delphi method to identify valid indicators. Results: A total of 142 candidate indicators were identified in six broad domains: privileging (which addresses surgical credentials), preoperative evaluation, patient–provider discussions, medication use, intraoperative care, and postoperative management. The expert panel rated 92 indicators as valid. These indicators address all domains of perioperative care for patients undergoing surgery for colorectal cancer. Conclusions: The RAND/UCLA Appropriateness Methodology can be used to identify and rate indicators of high-quality perioperative care for patients undergoing surgery for colorectal cancer. The indicators can be used as quality performance measures and for quality-improvement programs.
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