A new tool known as the HARM score may provide a low-cost solution for comparative quality assessment in colorectal surgery for patients with cancer and other conditions, say the developers of the formula.
The HARM score is based on HospitAl stay, Readmission, and Mortality rates, which are easily calculated from routine administrative data, explained Conor P. Delaney, MD, PhD, chief of the Division of Colorectal Surgery at University Hospitals Case Medical Center in Cleveland, Ohio, and colleagues in Annals of Surgery. The team created the tool in response to an increased demand for outcome measurement resulting from concerns about patient safety, quality, and health care costs.
Delaney’s group reviewed a national inpatient database for all colectomy discharges from 2010 to 2011, dividing the 81,662 cases evaluated into the categories of emergent (44%) and elective (56%). Each discharge received a score of 1 to 10 based on length of stay, vital status, and 30-day readmissions.
The mean HARM score was 3.04 for emergent cases and 2.6 for elective cases. To test validity, the HARM score was correlated to the complication rate:
• For emergent cases, mean complication rates were 30.3%, 41.9%, 49.3%, and 56.6% for hospitals with a HARM score of less than 2, 2 to 3, 3 to 4, and 4 or higher, respectively.
• For elective cases, mean complication rates were 15.2%, 18.2%, 24.0%, and 35.6% for hospitals with a HARM score of less than 2, 2 to 3, 3 to 4, and 4 or higher, respectively.
The results prompted Delaney and associates to deem the HARM score an easy, reliable, and valid tool for assessing quality in colorectal surgery that focuses on true outlier performance rather than process or clinical outcome metrics alone.