title: Evaluation of the ProPublica Surgeon Scorecard "Adjusted Complication Rate" Measure Specifications.
abstract: The ProPublica Surgeon Scorecard is the first nationwide, multispecialty public reporting of individual surgeon outcomes. However, ProPublica's use of a previously undescribed outcome measure (composite of in-hospital mortality or 30-day related readmission) and inclusion of only inpatients have been questioned. Our objectives were to (1) determine the proportion of cases excluded by ProPublica's specifications, (2) assess the proportion of inpatient complications excluded from ProPublica's measure, and (3) examine the validity of ProPublica's outcome measure by comparing performance on the measure to well-established postoperative outcome measures.
  
  
  
  Using ACS-NSQIP data (2012-2014) for 8 ProPublica procedures and for All Operations, the proportion of cases meeting all ProPublica inclusion criteria was determined. We assessed the proportion of complications occurring inpatient, and thus not considered by ProPublica's measure. Finally, we compared risk-adjusted performance based on ProPublica's measure specifications to established ACS-NSQIP outcome measure performance (eg, death/serious morbidity, mortality).
  
  
  
  ProPublica's inclusion criteria resulted in elimination of 82% of all operations from assessment (range: 42% for total knee arthroplasty to 96% for laparoscopic cholecystectomy). For all ProPublica operations combined, 84% of complications occur during inpatient hospitalization (range: 61% for TURP to 88% for total hip arthroplasty), and are thus missed by the ProPublica measure. Hospital-level performance on the ProPublica measure correlated weakly with established complication measures, but correlated strongly with readmission (R = 0.834, P < 0.001).
  
  
  
  ProPublica's outcome measure specifications exclude 82% of cases, miss 84% of postoperative complications, and correlate poorly with well-established postoperative outcomes. Thus, the validity of the ProPublica Surgeon Scorecard is questionable.
authors.affiliation: *American College of Surgeons, Chicago, IL †Department of Surgery, Loyola University Medical Center, Maywood, IL ‡Department of Surgery, University of California Los Angeles, Los Angeles, CA §RAND Corporation, Boston, MA ¶Brigham and Women's Hospital, Harvard Medical School, Boston, MA ||Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL **Department of Surgery, Washington University in St. Louis, St. Louis, MO ††Center for Health Policy and the Olin Business School at Washington University in St. Louis, St. Louis, MO ‡‡John Cochran Veterans Affairs Medical Center, St. Louis, MO §§BJC Healthcare, St. Louis, MO.
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Ban
authors.forename: Mark E
authors.initials: ME
authors.lastname: Cohen
authors.forename: Clifford Y
authors.initials: CY
authors.lastname: Ko
authors.forename: Mark W
authors.initials: MW
authors.lastname: Friedberg
authors.forename: Jonah J
authors.initials: JJ
authors.lastname: Stulberg
authors.forename: Lynn
authors.initials: L
authors.lastname: Zhou
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Hall
authors.forename: David B
authors.initials: DB
authors.lastname: Hoyt
authors.forename: Karl Y
authors.initials: KY
authors.lastname: Bilimoria
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001178:Arthroplasty / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology*; D011468:Prostatectomy / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D058996:Quality Improvement; D015203:Reproducibility of Results; D013123:Spinal Fusion / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology