Clinical Outcomes and Measures in Perioperative Care

Key Points

• To improve perioperative care and safety, relevant clinical outcomes and appropriate measures must be defined.

• The National Quality Forum (NQF) proposed that ideal clinical measures are:

  • Evidence-based and highlight a “performance gap.”

  • Demonstrative of reliability and validity.

  • Feasible to collect without undue burden (routinely generated during care delivery; available in electronic medical record).

  • “Usable”—the measure should be able to be used for both accountability, such as for public reporting, and performance improvement.

• Despite many clinical outcome measures developed and used in the perioperative space, success has been variable regarding application, practical reliability, clinical meaningfulness, and overall sustained effectiveness in improving outcomes.

• Lessons learned include the need for consistent and appropriate risk adjustment and the importance of data source, case ascertainment, and collection methods.

• Coordination among experts, patient-centered goals, and thoughtful selection of clinical outcomes to measure will ultimately lead to improved patient care.