title: The HARM score for gastrointestinal surgery: Application and validation of a novel, reliable and simple tool to measure surgical quality and outcomes.
abstract: BACKGROUND
  The HospitAl length of stay, Readmissions and Mortality (HARM) score is a simple, inexpensive quality tool, linked directly to patient outcomes. We assess the HARM score for measuring surgical quality across multiple surgical populations.
  
  
  METHODS
  Upper gastrointestinal, hepatobiliary, and colorectal surgery cases between 2005 and 2009 were identified from the Healthcare Cost and Utilization Project California State Inpatient Database. Composite and individual HARM scores were calculated from length of stay, 30-day readmission and mortality, correlated to complication rates for each hospital and stratified by operative type.
  
  
  RESULTS
  71,419 admissions were analyzed. Higher HARM scores correlated with higher complication rates for all cases after risk adjustment and stratification by operation type, elective or emergent status.
  
  
  CONCLUSIONS
  The HARM score is a simple and valid quality measurement for upper gastrointestinal, hepatobiliary and colorectal surgery. The HARM score could facilitate benchmarking to improve patient outcomes and resource utilization, and may facilitate outcome improvement.
authors.affiliation: Department of Surgery, Division of Colorectal Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
authors.forename: Benjamin P
authors.initials: BP
authors.lastname: Crawshaw
authors.affiliation: Department of Surgery, Division of Colorectal Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Keller
authors.affiliation: Department of Surgery, Division of Colorectal Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
authors.forename: Justin T
authors.initials: JT
authors.lastname: Brady
authors.affiliation: Department of Surgery, Division of Colorectal Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
authors.forename: Knut M
authors.initials: KM
authors.lastname: Augestad
authors.affiliation: Department of Epidemiology and Biostatistics, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, 44106-4945, USA.
authors.forename: Nicholas K
authors.initials: NK
authors.lastname: Schiltz
authors.affiliation: Department of Epidemiology and Biostatistics, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, 44106-4945, USA.
authors.forename: Siran M
authors.initials: SM
authors.lastname: Koroukian
authors.affiliation: Department of Epidemiology and Biostatistics, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, 44106-4945, USA.
authors.forename: Suparna M
authors.initials: SM
authors.lastname: Navale
authors.affiliation: Department of Surgery, Division of Colorectal Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Steele
authors.affiliation: Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. Electronic address: delanec@ccf.org.
authors.forename: Conor P
authors.initials: CP
authors.lastname: Delaney
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D002140:California / Q000453:epidemiology; D013505:Digestive System Surgical Procedures / Q000401:mortality; D017558:Elective Surgical Procedures; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D010359:Patient Readmission; D011183:Postoperative Complications; D011787:Quality of Health Care; D015203:Reproducibility of Results; D012189:Retrospective Studies
keywords: Colorectal; Hepatobiliary; Outcomes