Background: Despite the importance of shared decision-making (SDM) in surgical care, evaluating it from the patient's perspective is not a performance measure (PM). We aimed (1) to determine whether levels of SDM could be distinguished among hospitals and surgeons, and (2) to understand implementation feasibility by estimating minimum response numbers per hospital and surgeon to maintain acceptable levels of statistical reliability.

Study design: Two patient-reported SDM measures were administered during the ACS NSQIP Patient-Reported Outcome Measures Demonstration Project between 2020-2023: the CollaboRATE measure and the 9-item Shared-Decision Making Questionnaire (SDM-Q-9). 24 candidate PMs were constructed to evaluate hospital- and surgeon-level performance. Mixed models estimated statistical reliability for each PM and projected minimum sample sizes required to achieve reliabilities of at least 0.70 and 0.40. Effects of risk adjustment, nonresponse bias, and ambulatory procedure classification were explored.

Results: Among hospitals, the highest median reliability was achieved with CollaboRATE after correcting for nonresponse bias and among the subgroup of ambulatory procedures at 0.81 (IQR 0.72-0.85) and 0.81 (0.73-0.85), respectively. Projected minimum sample sizes required to achieve acceptable reliability were the lowest at 235 and 192 responses per hospital, respectively. Among surgeons, the highest median reliability was also achieved with CollaboRATE after correcting for nonresponse bias and among the subgroup of ambulatory procedures at 0.49 (0.41-0.61) and 0.47 (0.39-0.59), respectively. Projected minimum sizes were lowest at 46 and 46 responses per surgeon, respectively.

Conclusion: While both CollaboRATE and SDM-Q-9 could distinguish patient-centered care quality, CollaboRATE identified performance differences with higher statistical reliability than the SDM-Q-9. With few responses required per surgeon, implementing CollaboRATE as a surgeon-specific PM is realistic and feasible to distinguish patient-centered SDM practices.

Keywords: Patient-centered care; patient-reported outcomes; performance measure; quality measure; shared decision making.

Copyright © 2025 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

背景: 尽管共享决策（SDM）在手术护理中的重要性不言而喻，但从患者的角度评估它却不是一项绩效指标（PM）。我们的目标是：(1) 确定医院和外科医生之间的SDM水平是否可以区分；(2) 通过估计每家医院和每位外科医生所需的最低响应数量以维持统计可靠性来理解实施可行性。

研究设计: 在2020-2023年间，ACS NSQIP患者报告结果测量示范项目中施用了两项患者的SDM评估措施：CollaboRATE量表和9项共享决策问卷（SDM-Q-9）。构建了24个候选PM来评价医院和外科医生层面的表现。混合模型估计每个PM的统计可靠性，并预测达到至少0.70和0.40可靠性的最小样本规模。探索了风险调整、无响应偏差以及门诊手术分类的影响。

结果: 在医院层面，经过对无响应偏差进行校正后，CollaboRATE实现了最高的中位可靠性，在一个子组的门诊手术中分别为0.81（四分位间距 0.72-0.85）和0.81（0.73-0.85）。为实现可接受的可靠性所需的最低样本规模在医院层面分别达到了235和192个响应。在外科医生层面上，经过无响应偏差校正后CollaboRATE实现了最高的中位可靠性，在门诊手术子组分别为0.49（0.41-0.61）和0.47（0.39-0.59）。为实现可接受的可靠性所需的最低样本规模在外科医生层面分别达到了46个响应。

结论: 尽管CollaboRATE和SDM-Q-9都可以区分以患者为中心的护理质量，但CollaboRATE在统计可靠性的基础上比SDM-Q-9更能识别出性能差异。鉴于每位外科医生所需响应较少，实施CollaboRATE作为专门针对外科医生的PM是现实且可行的。

关键词: 以患者为中心的护理；患者报告结果；绩效指标；质量测量；共享决策。