title: The HARM score: a novel, easy measure to evaluate quality and outcomes in colorectal surgery.
abstract: OBJECTIVE
  To develop a measurement tool based on HospitAl stay, Readmission, and Mortality rates (HARM) score, which is easily calculated from routine administrative data. Secondary goals were to validate the HARM score on a national inpatient sample.
  
  
  BACKGROUND
  Concerns about patient safety, quality, and health care costs have increased demand for outcome measurement. Performance metrics such as Surgical Care Improvement Project and National Surgical Quality Improvement Program have been described, but they require significant personnel and expenses to maintain.
  
  
  METHODS
  A national inpatient database was reviewed for all colectomy discharges from 2010 to 2011. Cases were stratified into emergent and elective. For each discharge, a 1 to 10 score was calculated on the basis of length of stay, vital status, and 30-day readmissions. The HARM score was correlated to the complication rate to test validity, and bootstrapping was used to test reliability.
  
  
  RESULTS
  A total of 81,622 colectomy discharges were evaluated: 44% emergent and 56% elective. The mean HARM score was 3.04 (SD = 0.57) for emergent and 2.64 (SD = 0.65) for elective cases. For hospitals with a HARM score of less than 2, 2 to 3, 3 to 4, and 4+, the mean complication rates were 30.3%, 41.9%, 49.3%, and 56.6% (emergent) and 15.2%, 18.2%, 24.0%, and 35.6% (elective), respectively. Pearson correlation coefficients for the mean score and the complication rate were 0.45 (P < 0.01) for elective and emergent cases. Bootstrapping correlation demonstrated reliability for emergent and elective cases.
  
  
  CONCLUSIONS
  The HARM score is easy, reliable, and valid for assessing quality in colorectal surgery. It may provide a low-cost solution for comparative quality assessment in surgery focused on true outlier performance rather than process or clinical outcome metrics alone.
authors.affiliation: *Division of Colorectal Surgery, Department of Surgery, University Hospitals-Case Medical Center, Cleveland, OH †Biostatistics, Healthcare Economics & Outcomes Research, Mansfield, MA ‡Division of Colorectal Surgery, Department of Surgery, Keck School of Medicine of The University of Southern California, Los Angeles.
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Keller
authors.forename: Hung-Lun
authors.initials: HL
authors.lastname: Chien
authors.forename: Lobat
authors.initials: L
authors.lastname: Hashemi
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Senagore
authors.forename: Conor P
authors.initials: CP
authors.lastname: Delaney
mesh_terms: D003082:Colectomy / Q000592:standards*; D003107:Colorectal Surgery / Q000592:standards*; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care / Q000379:methods*; D058996:Quality Improvement; D015203:Reproducibility of Results; D012189:Retrospective Studies