title: Performance measurement in surgery through the National Quality Forum.
abstract: BACKGROUND
  Performance measurement has become central to surgical practice. We systematically reviewed all endorsed performance measures from the National Quality Forum, the national clearing house for performance measures in health care, to identify measures relevant to surgical practice and describe measure stewardship, measure types, and identify gaps in measurement.
  
  
  METHODS
  Performance measures current to June 2014 were categorized by denominator statement as either assessing surgical practice in specific or as part of a mixed medical and surgical population. Measures were further classified by surgical specialty, Donabedian measure type, patients, disease and events targeted, reporting eligibility, and measure stewards.
  
  
  RESULTS
  Of 637 measures, 123 measures assessed surgical performance in specific and 123 assessed surgical performance in aggregate. Physician societies (51 of 123, 41.5%) were more common than government agencies (32 of 123, 26.0%) among measure stewards for surgical measures, in particular, the Society for Thoracic Surgery (n = 32). Outcomes measures rather than process measures were common among surgical measures (62 of 123, 50.4%) compared with aggregate medical/surgical measures (46 of 123, 37.4%). Among outcomes measures, death alone was the most commonly specified outcome (24 of 62, 38.7%). Only 1 surgical measure addressed patient-centered care and only 1 measure addressed hospital readmission. We found 7 current surgical measures eligible for value-based purchasing.
  
  
  CONCLUSIONS
  Surgical society stewards and outcomes measure types, particularly for cardiac surgery, were well represented in the National Quality Forum. Measures addressing patient-centered outcomes and the value of surgical decision-making were not well represented and may be suitable targets for measure innovation.
authors.affiliation: Department of Anesthesiology, Division of Respiratory and Critical Care Medicine, Mayo Clinic, Rochester, MN; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA. Electronic address: hyder.joseph@mayo.edu.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Hyder
authors.affiliation: Department of Surgery Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Roy
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA; Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: Elliot
authors.initials: E
authors.lastname: Wakeam
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA; Department of Surgery, Brigham and Women's Hospital, Boston, MA.
authors.forename: Roland
authors.initials: R
authors.lastname: Hernandez
authors.affiliation: Department of Urology, Yale Medical School, New Haven, CT.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kim
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA; Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA; Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Bader
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN; Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Cima
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA; Department of Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: Louis L
authors.initials: LL
authors.lastname: Nguyen
mesh_terms: D006801:Humans; D010043:Outcome and Process Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D010358:Patient Participation; D018802:Patient-Centered Care / Q000592:standards; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012955:Societies, Medical; D013043:Specialties, Surgical / Q000592:standards*; D013514:Surgical Procedures, Operative / Q000592:standards*; D014481:United States