Demand for accurate information on surgical quality is at an all time high. Unfortunately, most existing measures of surgical quality are flawed. The candidate proposes to develop composite measures of surgical morbidity that overcome many of the limitations of existing approaches. The candidate, Dr. Justin B. Dimick is a general surgeon and health services researcher at the University of Michigan. This proposal will facilitate his development into an independent scientist focused on optimizing surgical quality measurement. He will supplement his previous research training with additional course work in advanced statistical methods and pursue a mentored research plan with real world applicability to the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP). The research plan has two specific aims:
Aim 1. To develop composite measures of performance based on surgical morbidity. Using ACS-NSQIP data, the candidate will develop empirically derived composite measures of surgical performance. These measures will combine all relevant information on hospital quality to generate procedure-specific estimates of """"""""true"""""""" morbidity that optimally filter out statistical noise. These measures will be validated by determining the extent to which they explain hospital level variation and forecast subsequent outcomes.
Aim 2. To establish the value of incorporating process of care variables into composite measures. The ACS-NSQIP has begun routinely collecting data on the process measures set forth in the Surgical Care Improvement Program (SCIP). Using this data, the candidate will determine whether the addition of processes of care to composite measures improves their ability to explain hospital level variation and forecast subsequent outcomes. Completion of the proposed research will move forward the science of quality measurement and facilitate the candidate's transition into an independent investigator. ? ? ?

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Clinical Investigator Award (CIA) (K08)
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Study Section
HSR Health Care Research Training SS (HCRT)
Program Officer
Anderson, Kay
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University of Michigan Ann Arbor
Schools of Medicine
Ann Arbor
United States
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Gonzalez, Andrew A; Cruz, Celeste G; Dev, Shantanu et al. (2016) Indication for Lower Extremity Revascularization and Hospital Profiling of Readmissions. Ann Vasc Surg 35:130-7
Gonzalez, Andrew A; Abdelsattar, Zaid M; Dimick, Justin B et al. (2015) Time-to-readmission and Mortality After High-risk Surgery. Ann Surg 262:53-9
Dimick, Justin B; Birkmeyer, Nancy J; Finks, Jonathan F et al. (2014) Composite measures for profiling hospitals on bariatric surgery performance. JAMA Surg 149:10-6
Gonzalez, Andrew A; Dimick, Justin B; Birkmeyer, John D et al. (2014) Understanding the volume-outcome effect in cardiovascular surgery: the role of failure to rescue. JAMA Surg 149:119-23
Krell, Robert W; Girotti, Micah E; Dimick, Justin B (2014) Extended length of stay after surgery: complications, inefficient practice, or sick patients? JAMA Surg 149:815-20
Shih, Terry; Nicholas, Lauren H; Thumma, Jyothi R et al. (2014) Does pay-for-performance improve surgical outcomes? An evaluation of phase 2 of the Premier Hospital Quality Incentive Demonstration. Ann Surg 259:677-81
Gonzalez, Andrew A; Girotti, Micah E; Shih, Terry et al. (2014) Reliability of hospital readmission rates in vascular surgery. J Vasc Surg 59:1638-43
Gonzalez, Andrew A; Shih, Terry; Dimick, Justin B et al. (2014) Using same-hospital readmission rates to estimate all-hospital readmission rates. J Am Coll Surg 219:656-63
Dimick, Justin B; Nicholas, Lauren H; Ryan, Andrew M et al. (2013) Bariatric surgery complications before vs after implementation of a national policy restricting coverage to centers of excellence. JAMA 309:792-9
Dimick, Justin B; Staiger, Douglas O; Hall, Bruce L et al. (2013) Composite measures for profiling hospitals on surgical morbidity. Ann Surg 257:67-72

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