Improving Outcomes for Patients by Optimizing Surgical Performance

"My research career has focused on developing the science behind quality measurement and improvement in surgery. Without funding from AHRQ, I never would have gotten this work off the ground."

Measuring the performance of surgeons and coaching them to improve their techniques is no easy task, according to Justin Dimick, M.D., M.P.H., a surgeon, professor, and AHRQ grantee who has focused his research on improving the safety and quality of care for surgical patients.

A variety of factors -- including patient health, safety culture, surgical technique, and the skill of the surgeon -- contribute to patient outcomes, Dr. Dimick notes. With funding from AHRQ, he has developed new methods to better measure surgical performance, as well as innovative interventions using video analysis of surgeries to coach surgeons and help improve their individual performance.

Early in his career, Dr. Dimick, professor of surgery and health management and policy at the University of Michigan in Ann Arbor, recognized the limitations of existing surgical performance measures. In 2008, he received an AHRQ Mentored Clinical Scientist Development Award, which he used to develop a new composite measure of surgical performance based on combining multiple measures. This work required developing a careful understanding of the pros and cons of different measures and becoming an expert in using advanced statistical methods to determine which measures best predict outcomes, Dr. Dimick explains.

After Dr. Dimick used his techniques to measure surgical performance, it quickly became apparent that hospital and surgeon outcomes varied widely. Prior work in surgical quality improvement had focused on improving pre- and postoperative care, leaving the quality of the operation untouched. With funding from AHRQ in 2014, Dr. Dimick began investigating the effectiveness of video review as a tool to measure differences in surgical techniques and the relation of these differences to patient outcomes, with the ultimate goal of improving the quality of the operation itself.

The study followed 30 surgeons in Michigan performing nearly 7,000 sleeve gastrectomy procedures. It confirmed that the rate of complications varied based on the surgeon’s skill and adherence to optimal techniques. The December 2020 JAMA Surgery study also found that video review was effective in measuring variations in surgical technique and determining which variations in technique have a significant impact on patient outcomes.

Building on this work, Dr. Dimick’s current AHRQ grant will help him continue to investigate the effectiveness of coaching surgeons based on video reviews of their procedures. If validated, this technique could be expanded to improve patient surgical outcomes across a wide variety of procedures. This grant is scheduled to be completed in 2023.

Dr. Dimick shares AHRQ’s vision of improving healthcare quality. His expertise in surgical outcomes research and passion for improving surgical quality led to his appointment as the chair of the Department of Surgery at the University of Michigan Medical School in 2019. Among other organizations, Dr. Dimick is a member of the Society of Clinical Surgery, the American Surgical Association, the American Society of Clinical Investigation, and the National Academy of Medicine.

Principal Investigator: Justin Dimick, M.D., M.P.H.
Institution: University of Michigan
Grantee Since: 2008
Type of Grant: Various