title: Development and pilot study of an essential set of indicators for general surgery services.
abstract: BACKGROUND
  At present there is a lack of appropriate quality measures for benchmarking in general surgery units of Spanish National Health System. The aim of this study is to present the selection, development and pilot-testing of an initial set of surgical quality indicators for this purpose.
  
  
  METHODS
  A modified Delphi was performed with experts from the Spanish Surgeons Association in order to prioritize previously selected indicators. Then, a pilot study was carried out in a public hospital encompassing qualitative analysis of feasibility for prioritized indicators and an additional qualitative and quantitative three-rater reliability assessment for medical record-based indicators. Observed inter-rater agreement, prevalence adjusted and bias adjusted kappa and non-adjusted kappa were performed, using a systematic random sample (n=30) for each of these indicators.
  
  
  RESULTS
  Twelve out of 13 proposed indicators were feasible: 5 medical record-based indicators and 7 indicators based on administrative databases. From medical record-based indicators, 3 were reliable (observed agreement >95%, adjusted kappa index >0.6 or non-adjusted kappa index >0.6 for composites and its components) and 2 needed further refinement.
  
  
  CONCLUSIONS
  Currently, medical record-based indicators could be used for comparison purposes, whilst further research must be done for validation and risk-adjustment of outcome indicators from administrative databases. Compliance results in the adequacy of informed consent, diagnosis-to-treatment delay in colorectal cancer, and antibiotic prophylaxis show room for improvement in the pilot-tested hospital.
authors: Sección de Gestión de Calidad de la Asociación Española de Cirujanos, Servicio de Cirugía General, Hospital Morales Meseguer, Murcia, España; Departamento de Cirugía, Facultad de Medicina, Universidad de Murcia, Murcia, España.
authors: Victor
authors: V
authors: Soria-Aledo
authors: Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors: Daniel
authors: D
authors: Angel-Garcia
authors: Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México. Electronic address: ismael.martinez@insp.mx.
authors: Ismael
authors: I
authors: Martinez-Nicolas
authors: Sección de Gestión de Calidad de la Asociación Española de Cirujanos, Departamento de Cirugía, Corporación Sanitaria Parc Taulí, Sabadell, Barcelona, España.
authors: Pere
authors: P
authors: Rebasa Cladera
authors: Sección de Gestión de Calidad de la Asociación Española de Cirujanos, Servicio de Cirugía, Fundación Hospital de Calahorra, Calahorra, La Rioja, España.
authors: Roger
authors: R
authors: Cabezali Sanchez
authors: Hospital General Universitario Los Arcos del Mar Menor, Pozo Aledo, Murcia, España.
authors: Luis Francisco
authors: LF
authors: Pereira García
mesh_terms: D019985:Benchmarking; D013502:General Surgery / Q000592:standards*; D006801:Humans; D010865:Pilot Projects; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000592:standards*
keywords: Benchmarking; Cirugía general; General surgery; Health information systems; Indicadores de calidad de la atención de salud; Quality indicators; Servicio de cirugía en hospital; Sistemas de información en salud; Surgery department