Excellence in Bariatrics

This article appears in the February 2012 issue of HealthLeaders magazine.

While widely regarded as the best medical weapon to combat obesity and a lucrative venture for providers, bariatric surgery is still in its infancy in terms of quality measures.

To date, more than 109,000 procedures, costing about $26,000 a piece, are performed each year, but surgeons have had no easy way of comparing their quality metrics to those of their peers, making it difficult to identify and improve any unfavorable nationwide trends.

Now, the American Society for Metabolic and Bariatric Surgery is trying to change that by creating a national database of quality measures so that all bariatric surgeons in the United States can see where they fall.

Key quality measures
The most important quality measurements are structure, process, and outcome, says Robin Blackstone, MD, president of the ASMBS and medical director of the Scottsdale (AZ) Healthcare Bariatric Center.

Structural elements, such as volume, have traditionally been a measurement used as a quality indicator, but Blackstone says it’s actually a proxy because it doesn’t give real quality data.

"In procedures with high mortality rates and major complication rates, it’s very useful to use volume, but over the last seven or eight years, the whole issue of using volume has come into question as people have evolved more to use a composite outcome measure," she says.

Measuring process elements, such as giving patients medication to prevent blood clots prior to surgery, is critical, but it is also difficult to discern the impact it has on the quality of care because the data isn’t clear which elements of process are most important yet, Blackstone says.

For now, using risk-adjusted and reliability-adjusted composite measures is the most effective quality metric.