{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T19:19:26Z","timestamp":1757618366753,"version":"3.44.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T00:00:00Z","timestamp":1749686400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T00:00:00Z","timestamp":1749686400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["OBES SURG"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Quality of metabolic bariatric surgery (MBS) care is often monitored by national registries using quality indicators (QIs), but data collection takes up considerable time and costs. QIs are mostly introduced merely based on expert opinion. Therefore, the study\u2019s aim was to systematically evaluate whether all QIs from the Dutch Audit for Treatment of Obesity (DATO) are still relevant and useful to initiate quality improvement initiatives.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Twenty-four QIs were evaluated using hospital data from 2022 to 2023. To test whether QIs measured the same quality of care aspect (parsimony and relevance), correlations of QI pairs were examined using Pearson correlation coefficients. Usefulness to identify improvement opportunities was considered limited when variance is \u2264 0.001 without any outliers identified, indicating that the QI could be retired. Actionability was assessed through line graphs of hospital performance over the years.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Eleven QIs were highly correlated to other QIs, particularly the follow-up and weight loss indicators at 2 and 4 years, and therefore lacked added value. The weight loss QIs showed minimal variance and were adjusted by increasing the threshold to achieving \u2265 25% total weight loss. Multiple QIs showed improving trends and thereby their actionability, most pronounced for postoperative complications. The final QI set measured three constructs with good validity: Cronbach\u2019s alpha values 0.53 (safety), 0.70 (treatment effectiveness), and 0.43 (follow-up process).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Through a systematic evaluation of the DATO QI set, a smaller set of 13 QIs was shown to capture the same relevant information to improve MBS care.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s11695-025-07898-2","type":"journal-article","created":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T11:08:35Z","timestamp":1749726515000},"page":"2616-2625","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Refining the Quality Indicator Set from the Dutch Audit for Treatment of Obesity to Ensure Usefulness in Clinical Practice"],"prefix":"10.1007","volume":"35","author":[{"given":"Floris F.E.","family":"Bruinsma","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon W.","family":"Nienhuijs","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronald S.L.","family":"Liem","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan Willem M.","family":"Greve","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Perla J.","family":"Marang-van de Mheen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,6,12]]},"reference":[{"key":"7898_CR1","unstructured":"Busse R, Klazinga N, Panteli D,\u00a0et al. Improving healthcare quality in Europe - characteristics, effectiveness and implementation of different strategies. 53rd ed. Health Policy Series; 2019. p 1\u2013420."},{"key":"7898_CR2","unstructured":"Gliklich RE, Dreyer NA, Leavy MB. Quality improvement registries. 2014"},{"key":"7898_CR3","unstructured":"Government Department of Health A. Maximising the value of Australia\u2019s clinical quality outcomes data \u2013 a national strategy for clinical quality registries and virtual registries 2020\u20132030."},{"key":"7898_CR4","doi-asserted-by":"crossref","unstructured":"Baldewpersad Tewarie N, van Driel WJ, van Ham MAPC, et al. An overview of Clinical Quality Registries (CQRs) on gynecological oncology worldwide.\u00a0Eur J Surg Oncol. 2022;48(10):2094\u2013103.","DOI":"10.1016\/j.ejso.2022.06.020"},{"key":"7898_CR5","doi-asserted-by":"crossref","unstructured":"Beck N, Van Bommel AC, Eddes EH,\u00a0et al. The Dutch Institute for Clinical Auditing: achieving Codman\u2019s dream on a nationwide basis. Ann Surg. 2020;271(4):627\u201331.","DOI":"10.1097\/SLA.0000000000003665"},{"key":"7898_CR6","doi-asserted-by":"crossref","unstructured":"Dijs-Elsinga J, Otten W, Versluijs MM,\u00a0et al.\u00a0Choosing a hospital for surgery: the importance of information on quality of care. 2010;30(5):544\u201355.","DOI":"10.1177\/0272989X09357474"},{"key":"7898_CR7","unstructured":"Open data Medisch-specialistische zorg (MSZ) \/ Ziekenhuizen en Zelfstandige Behandelcentra | Zorginzicht. 2023."},{"key":"7898_CR8","unstructured":"S.W. Nienhuijs, R. Klaassen, F.F.E. Bruinsma, Clinical Audit Board DATO. DUTCH AUDIT FOR TREATMENT OF OBESITY (DATO) JAARVERSLAG 2023. 2024 Jul."},{"key":"7898_CR9","unstructured":"Brown W, Kow L, Anvari M, Ghaferi A, Morton J, Shikora S, et al. IFSO - 8th Global Registry Report. 2023."},{"issue":"4","key":"7898_CR10","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1016\/j.soard.2006.05.005","volume":"2","author":"MA Maggard","year":"2006","unstructured":"Maggard MA, McGory ML, Shekelle PG, Ko CY. Quality indicators in bariatric surgery: improving quality of care. Surgery for Obesity and Related Diseases. 2006;2(4):423\u20139.","journal-title":"Surgery for Obesity and Related Diseases."},{"key":"7898_CR11","doi-asserted-by":"crossref","unstructured":"Seyfried F, Buhr HJ, Klinger C, et al. Quality indicators for metabolic and bariatric surgery in Germany\u202f: evidence-based development of an indicator panel for the quality of results, indications and structure. Chirurg. 2018;89(1):4\u201316.","DOI":"10.1007\/s00104-017-0563-4"},{"key":"7898_CR12","doi-asserted-by":"crossref","unstructured":"Ahmed I, Ishtiaq S. Reliability and validity: importance in medical research. J Pak Med Assoc. 2021;71(10):2401\u20136.","DOI":"10.47391\/JPMA.06-861"},{"key":"7898_CR13","doi-asserted-by":"crossref","unstructured":"Hofstede SN, Ceyisakar IE, Lingsma HF,\u00a0et al. Ranking hospitals: do we gain reliability by using composite rather than individual indicators? BMJ Qual Saf. 2019;28(2):94\u2013102.","DOI":"10.1136\/bmjqs-2017-007669"},{"key":"7898_CR14","doi-asserted-by":"crossref","unstructured":"Fischer C, Lingsma HF, Marang-van De Mheen PJ,\u00a0et al.\u00a0Is the readmission rate a valid quality indicator? A review of the evidence. PLoS One. 2014;9(11).","DOI":"10.1371\/journal.pone.0112282"},{"key":"7898_CR15","doi-asserted-by":"crossref","unstructured":"Schang L, Blotenberg I, Boywitt D. What makes a good quality indicator set? A systematic review of criteria.\u00a0Int J Qual Health Care. 2021;33(3).","DOI":"10.1093\/intqhc\/mzab107"},{"key":"7898_CR16","doi-asserted-by":"crossref","unstructured":"Marang-Van De Mheen PJ, Vincent C. Measuring what matters: refining our approach to quality indicators. BMJ Qual Saf. 2023;32:305\u20138.","DOI":"10.1136\/bmjqs-2022-015221"},{"key":"7898_CR17","doi-asserted-by":"crossref","unstructured":"Poelemeijer YQM, Liem RSL, Nienhuijs SW. A Dutch nationwide bariatric quality registry: DATO. Obes Surg. 2018;28(6):1602\u201310.","DOI":"10.1007\/s11695-017-3062-2"},{"key":"7898_CR18","doi-asserted-by":"crossref","unstructured":"Xu D, Lewis T, Rurka M,\u00a0et al. Approach to systematically examine the usefulness of quality measures in practice: Minnesota\u2019s nursing home quality indicators and scoring approach. BMJ Qual Saf. 2023;32(6):319\u201329.","DOI":"10.1136\/bmjqs-2021-014384"},{"key":"7898_CR19","doi-asserted-by":"crossref","unstructured":"van der Werf LR, Voeten SC, van Loe CMM,\u00a0et al.\u00a0Data verification of nationwide clinical quality registries. BJS Open. 2019;3(6):857.","DOI":"10.1002\/bjs5.50209"},{"key":"7898_CR20","unstructured":"NVvH. Normendocument versie 9.1. 2023 Jun."},{"key":"7898_CR21","doi-asserted-by":"crossref","unstructured":"de Graaff MR, Hogenbirk RNM, Janssen YF, et al. Impact of the COVID-19 pandemic on surgical care in the Netherlands.\u00a0Br J Surg\u00a0[Internet]. 2022;109(12):1282\u201392.","DOI":"10.1093\/bjs\/znac301"},{"key":"7898_CR22","doi-asserted-by":"crossref","unstructured":"Alsaqaaby MS, le Roux CW. Weight loss to disrupt type 2 diabetes. Diabetol Int [Internet]. 2023;14(3):217\u201323.","DOI":"10.1007\/s13340-023-00626-0"},{"issue":"4","key":"7898_CR23","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1136\/qhc.11.4.390-a","volume":"11","author":"D Spiegelhalter","year":"2002","unstructured":"Spiegelhalter D. Funnel plots for institutional comparison. Qual Saf Health Care. 2002;11(4):390\u20131.","journal-title":"Qual Saf Health Care."},{"issue":"2","key":"7898_CR24","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1093\/geront\/35.2.172","volume":"35","author":"C Hawes","year":"1995","unstructured":"Hawes C, Morris JN, Phillips CD, Mor V, Fries BE, Nonemaker S. Reliability estimates for the minimum data set for nursing home resident assessment and care screening (MDS). Gerontologist. 1995;35(2):172\u20138.","journal-title":"Gerontologist"},{"key":"7898_CR25","doi-asserted-by":"crossref","unstructured":"Bruinsma FFE, Liem RSL, Nienhuijs SW, et al. Optimizing hospital performance evaluation in total weight loss outcomes after bariatric surgery: a retrospective analysis to guide further improvement in Dutch hospitals. Obes Surg. 2024;34(8):2820\u20137.","DOI":"10.1007\/s11695-024-07542-5"},{"key":"7898_CR26","doi-asserted-by":"crossref","unstructured":"Tu Y, Pan Y, Han J, et al. A total weight loss of 25% shows better predictivity in evaluating the efficiency of bariatric surgery. Int J Obes (Lond). 2021;45(2):396\u2013403.","DOI":"10.1038\/s41366-020-00690-5"},{"key":"7898_CR27","unstructured":"Welbourn R, Dixon J, Higa K, Kinsman R, Ottosson J, Ramos A, et al. The IFSO Global Registry Second IFSO Global Registry Report 2016."},{"key":"7898_CR28","unstructured":"Zegers M, Veenstra GL, Gerritsen G, et al. Perceived burden due to registrations for quality monitoring and improvement in hospitals: a mixed methods study. Int J Health Policy Manag. 2022;11(2):183\u201396."}],"container-title":["Obesity Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11695-025-07898-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11695-025-07898-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11695-025-07898-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,6]],"date-time":"2025-09-06T19:26:51Z","timestamp":1757186811000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11695-025-07898-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,12]]},"references-count":28,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["7898"],"URL":"https:\/\/doi.org\/10.1007\/s11695-025-07898-2","relation":{},"ISSN":["0960-8923","1708-0428"],"issn-type":[{"type":"print","value":"0960-8923"},{"type":"electronic","value":"1708-0428"}],"subject":[],"published":{"date-parts":[[2025,6,12]]},"assertion":[{"value":"3 January 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 January 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 April 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 June 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors have no conflicts of interest to declare and received no funding for performing the research.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}}]}}