Comparing national quality data
The next step to improving quality in bariatric surgery is to go beyond the case-by-case correction process by enabling surgeons and hospitals to view and compare quality statistics nationwide.
That is what the ASMBS is hoping to accomplish with its Bariatric Outcomes Longitudinal Database, its latest attempt to improve quality in bariatric surgery. In 2004 the ASMBS began accrediting bariatric surgery programs.
The society has accredited 458 programs to date, based on a number of requirements, such as performing at least 125 surgeries per year. Another 52 bariatric programs have applied for certification in the past six months.
When Rex Healthcare began its bariatric surgery pilot program in 2007, Moran had already decided he would eventually apply for ASMBS Center of Excellence certification. The weight-loss center became an established program in mid-2008 and received its COE designation in 2010.
"The COE designation was a top goal of the healthcare facility and our practice," Moran says. "COEs tend to perform higher volumes per year and have demonstrated better outcomes in comparison to lower volume, non-COE facilities. The COE was also becoming a requirement of many of the third-party payers in order to perform cases and receive reimbursement for services."
The ASMBS is now creating a quality composite measure through the BOLD database, which has data for 400,000 patients who have been followed over at least four years. The data will be predictive of center performance and allow each bariatric program to judge how it compares with its peers.
In 2012, the society will give programs actual targets for process improvements based on their BOLD scores.
"The way this whole field has evolved is to use composite measures, which are things you take signals of quality from a number of different places and combine them to make an overall measure you can use," Blackstone says.
Blackstone and the ASMBS are working with the University of Michigan bariatric surgery collaborative and the American College of Surgeons to improve BOLD.
"We’re combining all three quality programs to come up with a single standard for quality that we will use for all of our programs in the United States," she says. "What is really exciting about this project is that it’s taking the roots of what we’ve been doing and evolving us to the next level so that surgeons will get high-level, scientifically derived data to engage them in continuous quality improvement."