Racial and ethnic health inequity remains a significant social burden in the United States, and exists across nearly every sector of care. With more than 50 million inpatient and 53 million outpatient surgical cases performed in the United States each year, surgical quality is an important national priority, yet the quality of surgical care received is not equitable across all racial and ethnic groups. Given the known differences in quality for minority patients, data driven campaigns to improve quality of care for minority patients have been initiated across a variety of fields, however no focused campaigns have been carried out for surgery. A barrier to progress has been a lack of standardized quality indicators and metrics used to consistently measure surgical disparities and access to surgical care. The National Institutes of Health (NIH) and American College of Surgeons (ACS) has identified improvement and exploration of new and existing surgical quality metrics as one of the most important solutions to eradicate surgical disparities. The National Quality Forum (NQF), based on years of evidence-based quality improvement research, has developed criteria to evaluate which quality metrics are effective for detecting disparities, a term they coined ?Disparities-Sensitive Metrics? (DSM). Currently, no DSMs exist which address surgical access, quality, or outcomes. This proposal aims to address this gap by determining a suite of robust surgical DSMs that can be used to measure surgical quality across the continuum of surgical care (access to care, pre-operative, peri-operative, intra-operative, post-operative, and post-discharge). We will convene an expert advisory panel (EAP) to participate in a formal modified Delphi approach to develop a conceptual framework for identifying the highest risk of disparities in access and the continuum of surgical care. The EAP will adapt the NQF DSM criteria for use with surgical metrics. We will then conduct a targeted environmental scan and systematic review of all surgical quality metrics, and the EAP will rate a preliminary set of metrics on disparities sensitivity using the adapted NQF DSM criteria. Using current data from large datasets available at the ACS, we will benchmark hospitals on surgical disparities using the candidate DSMs. A final Delphi round will determine a definitive suite of quality metrics most appropriate for measuring surgical disparities and access. Identifying robust surgical disparities metrics will enable determination of the true extent of surgical quality disparities and allow for the monitoring of the progress of reduction of disparities. As the largest organization of surgeons in the world, the ACS is in a unique position to heavily promote or mandate collection of these metrics, and lay the foundation for eradicating disparities in surgical care in the United States.

Public Health Relevance

Surgical disparities are a significant contributor to disparate health outcomes across minority populations, with inequitable quality of care a major driver of poor outcomes. One way to reduce surgical disparities is through targeted quality improvement interventions, which rely on quality indicators that span the care continuum and are sensitive to detecting disparities. Using a modified Delphi approach, this proposal aims to determine a suite of robust surgical disparities-sensitive measures across the continuum of care that can be used to develop targeted interventions aimed at eradicating disparities and improving outcomes.

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Research Project (R01)
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Special Emphasis Panel (ZRG1)
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Hailu, Benyam
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American College of Surgeons
United States
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