Quality indicators in bariatric surgery: improving quality of care.
OBJECTIVE
Bariatric surgery is one of the most common complex intraabdominal operations, and there are reports of variations in outcome among providers. There is a need to standardize the processes of care in this specialty, and, as an attempt to do so, quality indicators were developed.


METHODS
Candidate indicators, covering preoperative to follow-up care (5 domains), were developed based on evidence in the literature. Indicators were formally rated as valid by use of the RAND/UCLA Validity and Appropriateness method, which quantitatively assesses the expert judgment of a group using a 9-point scale (1 = not valid; 9 = definitely valid). Fourteen individuals participated in the expert panel, including bariatric surgeons and obesity experts. The method is iterative with 2 rounds of ratings and a group discussion. Indicators with a median rating > or =7 were valid. This method has been shown to have content, construct, and predictive validity.


RESULTS
Of 63 candidate indicators, 51 were rated as valid measures of good quality of care covering the spectrum of perioperative care for bariatric surgery. Of the 51 indicators rated as valid (> or =7), all had sufficient "agreement" scores among panelists. Indicators included structural measures (e.g., procedural volume requirements) as well as processes of care (e.g., receipt of preoperative antibiotics, use of clinical pathway).


CONCLUSIONS
This is the first formal attempt at development of quality indicators for bariatric surgery. Adherence to the indicators should equate with better quality of care, and their implementation will allow for quantitative assessment of quality of care.
Maggard
Melinda A
MA
Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA, USA. mmaggard@mednet.ucla.edu
McGory
Marcia L
ML
Shekelle
Paul G
PG
Ko
Clifford Y
CY
D000328:Adult; D050110:Bariatric Surgery / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D011184:Postoperative Period; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care / Q000639:trends*; D013997:Time Factors; D016896:Treatment Outcome