Measuring the quality of medical interventions

A guest contribution by Prof. Dr Pierre-Alain Clavien

Without standardized, clinically relevant, and universal measurement points, the assessment of surgical interventions remains unclear and inconsistent. This makes it difficult to improve the quality of surgery and to inform professionals and patients about the expected consequences of a medical intervention. This issue was addressed from different perspectives - by experts, patients and other stakeholders - at the Outcome4Medicine conference in Zurich in June 2022. The recommendations developed there have now been published in Nature Medicine. 

Patients should be able to make informed decisions
The recommendations relate to the measurement, interpretation and communication of outcomes after medical interventions. For example, to ensure that outcomes can be compared after interventions, standardized observation times must be defined and, if possible, all complications must be recorded using the Comprehensive Complication Index (CCI®). The jury suggests five fixed time points: before the disease, during the disease, symptoms before the intervention, results in the early postoperative phase, in the medium term and in the long term. Further, the independent international panel recommends that symptoms and experiences reported by patients should also be recorded using standardized questionnaires. Outcomes of medical interventions should be compared not only within but also between medical institutions. Another focus is on improving patients' health literacy; patients should be able to make informed decisions for or against certain medical interventions. 

Finally, the jury makes recommendations on how to deal with adverse outcomes and advocates a constructive, transparent and respectful approach so that patients are supported in the best possible way and professionals can learn from adverse outcomes. "This interdisciplinary, international collaboration lays an important foundation for reliably measuring quality after medical interventions and improving care", says Pierre-Alain Clavien. "Hopefully, this will help reduce the large burden of disease and the high cost of postoperative complications", adds Milo Puhan.

The conference was supported by the Swiss Medical Network.

More information: Anja Domenghino, Carmen Walbert, Dominique Lisa Birrer, Milo A. Puhan, Pierre-Alain Clavien, The Outcome4Medicine consensus group & panel members. Consensus recommendations on how to assess the quality of surgical interventions. Nature Medicine 2023, read the full article here.