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Development and Validation of a Novel Literature-Based Method to Identify Disparity-Sensitive Surgical Quality Metrics.
de Jager E, Levine AA, Sidey-Gibbons CJ, Udyavar NR, Liu C, Lamaina M, Maggard Gibbons MA, Ko CY, Burstin HR, Haider AH, Hoyt DB, Schoenfeld AJ, Weissman JS, Britt LD. Development and Validation of a Novel Literature-Based Method to Identify Disparity-Sensitive Surgical Quality Metrics. Journal of the American College of Surgeons. 2023 Sep 13.
Disparities in surgical care impede the delivery of uniformly high-quality care. Metrics that quantify disparities in care can help identify areas for needed intervention. A literature based disparity sensitivity scoring (DSS) system for surgical care was adapted by the MEASUR (Metrics for Equitable Access and care in SURgery) 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.
534 surgical metrics were scored by MEASUR co-investigators using DSS criteria and subsequently rated by the EAP. All scores were converted to a nine-point scale. Agreement between the new measurement technique (DSS) and an established subjective technique ('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%).
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'. By comparison, 94.4% of the two subjective EAP ratings were inside the limits of agreement (LOA = 0.7 points).
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.