Measuring the quality of surgical care: structure, process, or outcomes?1

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Abstract
With widespread recognition that surgical outcomes vary by provider, 1 Khuri S.F. Daley J. Henderson W. et al. Risk adjustment of the postoperative mortality rate for the comparative assessment of the quality of surgical care results of the National Veterans Affairs Surgical Risk Study. J Am Coll Surg. 1997; 185 : 315-327 Abstract Full Text Full Text PDF PubMed Scopus (335) Google Scholar , 2 O’Connor G.T. Plume S.K. Olmstead E.M. et al. A regional prospective study of in-hospital mortality associated with coronary artery bypass grafting. JAMA. 1991; 266 : 803-809 Crossref PubMed Scopus (330) Google Scholar surgeons and hospitals are increasingly being asked to provide evidence of the quality of care that they deliver. Patients and their families are turning to the Internet and other sources to make better informed decisions about where and by whom to undergo surgery. Both public and private payers are looking to steer selected populations of surgical patients to high-quality providers—so-called value-based purchasing. 3 Galvin R. Milstein A. Large employers’ new strategies in health care. N Engl J Med. 2002; 347 : 939-942 Crossref PubMed Scopus (94) Google Scholar To meet these interests, policy makers, health services researchers, and a variety of related organizations have redoubled their efforts to develop and implement quality indicators germane to surgery.