# Refining the Quality Indicator Set from the Dutch Audit for Treatment of Obesity to Ensure Usefulness in Clinical Practice

## TL;DR

This study evaluates and refines a set of quality indicators for metabolic bariatric surgery to improve their usefulness in clinical practice.

## Contribution

A systematic evaluation and refinement of the Dutch quality indicators for obesity treatment to enhance their practicality and validity.

## Key findings

- Eleven quality indicators were found to be highly correlated and thus lacked added value.
- Adjusting weight loss thresholds improved the usefulness of certain indicators.
- The final set of 13 indicators captured three key constructs with acceptable validity.

## Abstract

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’s 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.

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 ≤ 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.

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 ≥ 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’s alpha values 0.53 (safety), 0.70 (treatment effectiveness), and 0.43 (follow-up process).

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.

The online version contains supplementary material available at 10.1007/s11695-025-07898-2.