The complementary value of trained abstractors and surgeons in the more accurate assessment of surgical quality.

The authors acquired valid clinical data representative of patients who choose to undergo elective operations. Their results indicate that complementary data recorded by paid, trained abstractors and from the specialist surgeon and his/her office staff on hospital events add major evaluative components to those derived from administrative data sets. The cost of these extra reports is reasonable, and they provide a more complete review of the entire episode of care, extending to the return to normal activities.

Process and outcome measures in specialty surgery: early steps in defining quality.

This study is currently under way in Kentucky, Ohio, and Oklahoma. So far, thousands of cases have been reported to HCE by participating Kentucky hospitals, and hundreds of cases reported to QSS by its surgeons. Many standards of practice quality are being accepted and followed.

Attitudes of surgical specialists toward venous thromboembolism prophylaxis in surgical patients.

Venous thromboembolism (VTE) and pulmonary embolism are serious and potentially life-threatening complications in surgical patients; however, the risk can effectively be lessened using appropriate pharmaceutical and mechanical prophylaxis. Due to the variability in opinions and indications for VTE prophylaxis, proposed guidelines for VTE prophylaxis stratified according to patient- and procedure-oriented risk factors were widely circulated. We investigated to what extent these guidelines were accepted by 147 university and community-based surgeons in mid-America and how the recommendations for prophylaxis compared with recent past surgical practice performed on 5285 patients in Kentucky in 2004.

Opportunities for improved performance in surgical specialty practice.

Objective: To identify opportunities for improvement in quality performance profile while maintaining better clinical outcomes.

Methods: A prospective study of 5285 surgical specialty procedures including hip and knee replacement, cholecystectomy, hysterectomy, nonaccess vascular and cardiac procedures, and colorectal resections in 16 Kentucky hospitals was undertaken. The following observations were made after univariate and stepwise logistic regression analysis, from the Surgical Care Improvement Project.

Expanded surgical time out: a key to real-time data collection and quality improvement.

Unlabelled: Some of the concepts contained here have been discussed and incorporated in another publication, but the data are entirely unique to this manuscript. (See: Transforming the Surgical "Time-Out" Into a Comprehensive "Preparatory Pause." Backster A, Teo A, Swift M, MD, Polk HC Jr, MD, FACS, Harken AH, MD, FACS.

Differences and similarities between rural and urban operations.

Background: The importance of rural operations is magnified by super-specialization, uneven geographic distribution, and special educational needs. Definition of practice patterns and quality measures are needed.

Methods: A statewide network of 60 operative specialists studied costs, quality, and outcomes in 17,319 patients undergoing 46 different specialty operations between 1998 and 2003, comparing 9,544 rural to 7,775 urban patients.

Limitation of a single clinical data source for measuring physicians' performance on quality indicators.

Objectives: To determine the extent to which relying on only one source of data leads to incomplete assessment of pneumococcal polysaccharide vaccine (PPV) or mammography.

Design: Cross-sectional survey.

Setting: An urban Midwestern academic medical center in 1998/99.

A practical method of linking data from Medicare claims and a comprehensive electronic medical records system.

Background: Linking administrative and clinical databases provides opportunities for richer studies to improve healthcare, but linkage may require sophisticated algorithms. Linking US Medicare data with large databases used for everyday clinical practice is seldom described in detail in medical literature.

Objectives: Test a deterministic method of linking data from a local electronic medical records system to Medicare data, and report specific details of the algorithm used as well as lessons learned from the linkage process.

The use of ACE inhibitors in the treatment of heart failure in Kentucky Medicare beneficiaries: a quality improvement project.

Heart failure (HF) is a highly prevalent and frequently fatal condition. During 1998, 10,815 Medicare beneficiaries in Kentucky were diagnosed as having HF; 14,777 beneficiaries were hospitalized for the condition, and 696 Medicare beneficiaries died with HF as the primary diagnosis. Proper diagnosis and subsequent treatment with angiotensin converting enzyme (ACE) inhibitors improve functional status, quality of life, and survival among HF patients.