title: Solving the Value Equation: Assessing Surgeon Performance Using Risk-Adjusted Quality-Cost Diagrams and Surgical Outcomes.
abstract: Quality-cost diagrams have been used previously to assess interventions and their cost-effectiveness. This study explores the use of risk-adjusted quality-cost diagrams to compare the value provided by surgeons by presenting cost and outcomes simultaneously. Colectomy cases from a single institution captured in the National Surgical Quality Improvement Program database were linked to hospital cost-accounting data to determine costs per encounter. Risk adjustment models were developed and observed average cost and complication rates per surgeon were compared to expected cost and complication rates using the diagrams. Surgeons were surveyed to determine if the diagrams could provide information that would result in practice adjustment. Of 55 surgeons surveyed on the utility of the diagrams, 92% of respondents believed the diagrams were useful. The diagrams seemed intuitive to interpret, and making risk-adjusted comparisons accounted for patient differences in the evaluation.
authors.affiliation: 1 Emory University School of Medicine, Atlanta, GA.
authors.forename: William S
authors.initials: WS
authors.lastname: Knechtle
authors.affiliation: 1 Emory University School of Medicine, Atlanta, GA.
authors.forename: Sebastian D
authors.initials: SD
authors.lastname: Perez
authors.affiliation: 1 Emory University School of Medicine, Atlanta, GA.
authors.forename: Mehul V
authors.initials: MV
authors.lastname: Raval
authors.affiliation: 1 Emory University School of Medicine, Atlanta, GA.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Sullivan
authors.affiliation: 1 Emory University School of Medicine, Atlanta, GA.
authors.forename: Yazan M
authors.initials: YM
authors.lastname: Duwayri
authors.affiliation: 1 Emory University School of Medicine, Atlanta, GA.
authors.forename: Felix
authors.initials: F
authors.lastname: Fernandez
authors.affiliation: 1 Emory University School of Medicine, Atlanta, GA.
authors.forename: Joe
authors.initials: J
authors.lastname: Sharma
authors.affiliation: 1 Emory University School of Medicine, Atlanta, GA.
authors.forename: John F
authors.initials: JF
authors.lastname: Sweeney
mesh_terms: D000328:Adult; D003082:Colectomy / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011785:Quality Assurance, Health Care / Q000191:economics / Q000379:methods*; D011787:Quality of Health Care / Q000191:economics / Q000706:statistics & numerical data; D020379:Risk Adjustment; D066231:Surgeons / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D013514:Surgical Procedures, Operative / Q000191:economics / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: cost-effectiveness planes; evaluation; provider; quality-cost diagrams