title: Quality assessment in pancreatic surgery: what might tomorrow require?
abstract: BACKGROUND
  The Institute of Medicine (IOM) defines healthcare quality across six domains: safety, timeliness, effectiveness, patient centeredness, efficiency, and equitability. We asked experts in pancreatic surgery (PS) whether improved quality metrics are needed, and how they could align to contemporary IOM healthcare quality domains.
  
  
  METHODS
  We created and distributed a web-based survey to pancreatic surgeons. Respondents ranked 62 proposed PS quality metrics on level of importance (LoI) and aligned each metric to one or more IOM quality domains (multi-domain alignment (MDA)). LoI and MDA scores for a given quality metric were averaged together to render a total quality score (TQS) normalized to a 100-point scale.
  
  
  RESULTS
  One hundred six surgeons (21 %) completed the survey. Ninety percent of respondents indicated a definite or probable need for improved quality metrics in PS. Metrics related to mortality, to rates and severity of complications, and to access to multidisciplinary services had the highest TQS. Metrics related to patient satisfaction, costs, and patient demographics had the lowest TQS. The least represented IOM domains were equitability, efficiency, and patient-centeredness.
  
  
  CONCLUSIONS
  Experts in pancreatic surgery have significant consensus on 12 proposed metrics of quality that they view as both highly important and aligned with more than one IOM healthcare quality domain.
authors.affiliation: Harvard Medical School, Boston, MA, USA.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Kalish
authors.forename: Charles M
authors.initials: CM
authors.lastname: Vollmer
authors.forename: Tara S
authors.initials: TS
authors.lastname: Kent
authors.forename: William H
authors.initials: WH
authors.lastname: Nealon
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Tseng
authors.forename: Mark P
authors.initials: MP
authors.lastname: Callery
mesh_terms: D001291:Attitude of Health Personnel; D032921:Consensus; D004526:Efficiency; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D010180:Pancreatectomy / Q000592:standards*; D016577:Pancreaticoduodenectomy / Q000592:standards*; D061214:Patient Safety / Q000592:standards; D018802:Patient-Centered Care / Q000592:standards; D019990:Perioperative Care / Q000592:standards; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D013997:Time Factors; D014481:United States