PDF(Pubmed)
Abstract：
To assess risk-adjusted outcomes and participant perceptions following a statewide coaching program for bariatric surgeons.
Coaching has emerged as a new approach for improving individual surgeon performance, but lacks evidence linking to clinical outcomes.
This program took place between October 2015 and February 2018 in the Michigan Bariatric Surgery Collaborative. Surgeons were categorized as coach, participant, or nonparticipant for an interrupted time series analysis. Multilevel logistic regression models included patient characteristics, time trends, and number of sessions. Risk-adjusted overall and surgical complication rates are reported, as are within-group relative risk ratios and 95% confidence intervals. We also compared operative times and report risk differences and 95% confidence intervals. Iterative thematic analysis of semi-structured interviews examined participant and coach perceptions of the program.
The coaching program was viewed favorably by most surgeons and many participants described numerous technical and nontechnical practice changes. The program was not associated with significant change in risk-adjusted complications with relative risks for coaches, participants, and nonparticipants of 0.99 (0.62-1.37), 0.91 (0.64-1.17), and 1.15 (0.83-1.47), respectively. Operative times did improve for participants, but not coaches or nonparticipants, with risk differences of -14.0 (-22.3, -5.7), -1.0 (-4.5, 2.4), and -2.6 (-6.9, 1.7). Future coaching programmatic design should consider dose-complexity matching, hierarchical leveling, and optimizing video review.
This statewide surgical coaching program was perceived as valuable and surgeons reported numerous practice changes. Operative times improved, but there was no significant improvement in risk-adjusted outcomes.
Coaching has emerged as a new approach for improving individual surgeon performance, but lacks evidence linking to clinical outcomes.
This program took place between October 2015 and February 2018 in the Michigan Bariatric Surgery Collaborative. Surgeons were categorized as coach, participant, or nonparticipant for an interrupted time series analysis. Multilevel logistic regression models included patient characteristics, time trends, and number of sessions. Risk-adjusted overall and surgical complication rates are reported, as are within-group relative risk ratios and 95% confidence intervals. We also compared operative times and report risk differences and 95% confidence intervals. Iterative thematic analysis of semi-structured interviews examined participant and coach perceptions of the program.
The coaching program was viewed favorably by most surgeons and many participants described numerous technical and nontechnical practice changes. The program was not associated with significant change in risk-adjusted complications with relative risks for coaches, participants, and nonparticipants of 0.99 (0.62-1.37), 0.91 (0.64-1.17), and 1.15 (0.83-1.47), respectively. Operative times did improve for participants, but not coaches or nonparticipants, with risk differences of -14.0 (-22.3, -5.7), -1.0 (-4.5, 2.4), and -2.6 (-6.9, 1.7). Future coaching programmatic design should consider dose-complexity matching, hierarchical leveling, and optimizing video review.
This statewide surgical coaching program was perceived as valuable and surgeons reported numerous practice changes. Operative times improved, but there was no significant improvement in risk-adjusted outcomes.
摘要：
在全州范围的减肥外科医生指导计划之后，评估风险调整后的结果和参与者的看法。
教练已经成为提高个人外科医生表现的新方法，但缺乏与临床结果相关的证据.
该计划于2015年10月至2018年2月在密歇根州减肥手术合作中进行。外科医生被归类为教练，参与者,或非参与者进行中断的时间序列分析。多水平逻辑回归模型包括患者特征，时间趋势,和会话的数量。报告了风险调整后的总体和手术并发症发生率，以及组内相对风险比和95%置信区间.我们还比较了手术时间，并报告了风险差异和95％置信区间。半结构化访谈的迭代主题分析检查了参与者和教练对该计划的看法。
大多数外科医生都对该指导计划表示赞赏，许多参与者描述了许多技术和非技术实践的变化。该计划与教练相对风险的风险调整后并发症的显着变化无关，参与者,和0.99（0.62-1.37）的非参与者，0.91（0.64-1.17），和1.15（0.83-1.47），分别。参与者的手术时间确实有所改善，但不是教练或非参与者，风险差异为-14.0(-22.3，-5.7)，-1.0（-4.5，2.4），和-2.6（-6.9，1.7）。未来的教练程序设计应考虑剂量-复杂性匹配，分层调平,和优化视频审查。
这项全州范围的手术指导计划被认为是有价值的，外科医生报告了许多实践变化。手术时间改善，但风险校正结局无显著改善.
教练已经成为提高个人外科医生表现的新方法，但缺乏与临床结果相关的证据.
该计划于2015年10月至2018年2月在密歇根州减肥手术合作中进行。外科医生被归类为教练，参与者,或非参与者进行中断的时间序列分析。多水平逻辑回归模型包括患者特征，时间趋势,和会话的数量。报告了风险调整后的总体和手术并发症发生率，以及组内相对风险比和95%置信区间.我们还比较了手术时间，并报告了风险差异和95％置信区间。半结构化访谈的迭代主题分析检查了参与者和教练对该计划的看法。
大多数外科医生都对该指导计划表示赞赏，许多参与者描述了许多技术和非技术实践的变化。该计划与教练相对风险的风险调整后并发症的显着变化无关，参与者,和0.99（0.62-1.37）的非参与者，0.91（0.64-1.17），和1.15（0.83-1.47），分别。参与者的手术时间确实有所改善，但不是教练或非参与者，风险差异为-14.0(-22.3，-5.7)，-1.0（-4.5，2.4），和-2.6（-6.9，1.7）。未来的教练程序设计应考虑剂量-复杂性匹配，分层调平,和优化视频审查。
这项全州范围的手术指导计划被认为是有价值的，外科医生报告了许多实践变化。手术时间改善，但风险校正结局无显著改善.
