Documentation of competency: Maintaining an outcomes database.

Abstract

Medical practice in the 21st century will include increased scrutiny of the competency of vascular surgeons measured in large part by treatment outcomes. At least part of the drive behind this is that the public demand for clinical competency of its doctors is greater than ever as the unassailable position of the "all-knowing physician" is (appropriately) vanishing. Two general types of variables need to be considered in the assessment of treatment outcomes: key outcome variables and key process variables. Key outcome variables are the critical results from a treatment plan, whereas key process variables affect these results. Ideal tracking methods do not exist in most hospital systems, and many variables are out of the control of the individual surgeon. Difficulties recording and reporting outcomes and determining competencies are numerous, but vascular surgeons must accept and overcome these difficulties. Standardized definitions for preoperative, surgical, and postoperative variables as well as treatment results must be decided before attempting to determine competency. Once the variables and definitions to define competency are determined, commercially available computer software can make the task of data recording and data output realistic. Eventually, systemwide "enterprise" solutions from computer companies will make this task even more uncomplicated.