title: Identification of consensus-based quality end points for colorectal surgery.
abstract: BACKGROUND
  Process and outcome measures for quality assessment of colorectal surgical care are poorly defined.
  
  
  OBJECTIVE
  The aim of this study was to develop candidate end points for use in surgeon-specific registries designed for case reporting and quality improvement program development.
  
  
  METHODS
  The study design was based on modified Delphi-based development of consensus quality end points.
  
  
  METHODS
  This study was undertaken by the American Society of Colon and Rectal Surgeons Executive Council, Quality Committee, and by the ColoRectal Education System Template Committee, American Board of Colon and Rectal Surgery.
  
  
  METHODS
  No patients were included in this study.
  
  
  METHODS
  Six areas of colorectal surgery were defined by members of the American Society of Colon and Rectal Surgeons' Executive Council and the American Board of Colon and Rectal Surgery to cover areas of importance for colorectal surgeons. These included colectomy, rectal cancer, hemorrhoidectomy, anal fistula and abscess, colonoscopy, and rectal prolapse. Relevant American Society of Colon and Rectal Surgeons' committee members through a series of 4 panel discussions identified important demographic, process, and outcome measures in each of these 6 areas that might be suitable for the American College of Surgeons case log. Panel size was sequentially expanded from 8 members to 28 members to include all active committee members. Panelists contributed additional process and outcome measures for inclusion during each discussion. Modified Delphi methodology was used to generate consensus, and, after each panel discussion, members rated the relative importance of each end point from 1 (least important) to 4 (most important).
  
  
  METHODS
  The mean rating for each process and outcome measure after each round was recorded with the use of standardized definitions for relevant variables.
  
  
  RESULTS
  Eighty-nine process and outcome measures were compiled and rated. Mean scores following the final round ranged from a low of 1.3 (anal fistula/abscess, preoperative imaging) to a high of 4.0 (colectomy-anastomotic leak).
  
  
  CONCLUSIONS
  The limitations of this study involved the use of consensus, small study size, and the fact that no end points were excluded.
  
  
  CONCLUSIONS
  With the use of modified Delphi methodology, a consensus-derived ranked list of 89 process and outcome measures was developed in 6 key areas of colorectal surgery. These data provide a framework for development of guideline standards for case-reporting program development initiatives for colon and rectal surgery.
authors.affiliation: University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Manwaring
authors.forename: Clifford Y
authors.initials: CY
authors.lastname: Ko
authors.forename: James W
authors.initials: JW
authors.lastname: Fleshman
authors.forename: David E
authors.initials: DE
authors.lastname: Beck
authors.forename: David J
authors.initials: DJ
authors.lastname: Schoetz
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Senagore
authors.forename: Rocco
authors.initials: R
authors.lastname: Ricciardi
authors.forename: Larissa K
authors.initials: LK
authors.lastname: Temple
authors.forename: Arden M
authors.initials: AM
authors.lastname: Morris
authors.forename: Conor P
authors.initials: CP
authors.lastname: Delaney
mesh_terms: D003106:Colon / Q000601:surgery*; D032921:Consensus; D003697:Delphi Technique; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000592:standards; D023381:Endpoint Determination; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D012007:Rectum / Q000601:surgery*