To evaluate the strengths, limitations, and practical applications of structural, process-based, and outcome-oriented metrics in assessing the quality of surgical care.
Reviewed quality assessment frameworks based on the Donabedian model within surgical specialties.
Evaluated performance indicators including hospital procedural volume, clinical care process adherence, and risk-adjusted mortality and complication rates.
Structural characteristics, such as hospital procedural volume, serve as practical quality proxies but do not directly assess individual surgical proficiency.
Process measures evaluate adherence to evidence-based clinical guidelines but require verified links to meaningful clinical endpoints.
Outcome measures represent the definitive assessment of care quality but require adequate sample sizes and rigorous risk adjustment to account for patient case mix.
Abstract
Birkmeyer, John D. MD, FACS; Dimick, Justin B. MD; Birkmeyer, Nancy J.O. PhD Author Information