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Stuart CM, Henderson WG, Bronsert MR, Thompson KP, Meguid RA. The association between participation in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and postoperative outcomes: A comprehensive analysis of 7,474,298 patients. Surgery 2024; 176:841-848. [PMID: 38862278 DOI: 10.1016/j.surg.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/08/2024] [Accepted: 05/12/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Prior publications about the association between participation in the American College of Surgeons National Surgical Quality Improvement Program and improved postoperative outcomes have reported mixed results. We aimed to perform a comprehensive analysis of preoperative characteristics and unadjusted and risk-adjusted postoperative complication rates over time in the American College of Surgeons National Surgical Quality Improvement Program dataset. METHODS We used the American College of Surgeons National Surgical Quality Improvement Program database, 2005 to 2018, to analyze preoperative patient characteristics and unadjusted and risk-adjusted rates of adverse postoperative outcomes by year. Expected events were calculated using multiple logistic regression, with each complication as the dependent variable and the 28 non-laboratory preoperative American College of Surgeons National Surgical Quality Improvement Program variables as the independent variables. Annual observed-to-expected ratios for each outcome were used to risk-adjust outcomes over time. RESULTS The analytic cohort included 7,474,298 operations across 9 surgical specialties. Both the preoperative patient risk and the unadjusted rate of postoperative complications decreased over time. While the observed-to-expected ratio for mortality remained around 1, the observed-to-expected ratios for the other outcomes decreased over time from 2005 to 2018, except for the following cardiac complications: overall morbidity 1.11 (95% confidence interval: 1.10-1.13) to 0.97 (0.96-0.98); pulmonary 1.18 (1.15-1.21) to 0.91 (0.89-0.92); infection 1.19 (1.16-1.21) to 1.01 (1.00-1.01); urinary tract infection 1.29 (1.23-1.34) to 0.87 (0.86-0.89); venous thromboembolism 1.10 (1.03-1.16) to 0.92 (0.90-0.94) ; cardiac 0.76 (0.70-0.81) to 1.04 (1.01-1.07); renal 1.14 (1.08-1.21) to 0.96 (0.93-0.99); stroke 1.12 (1.00-1.25) to 0.98 (0.94-1.03); and bleeding 1.35 (1.33-1.36) to 0.80 (0.79-0.81). CONCLUSION Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program have experienced a decrease in risk-adjusted postoperative surgical complications over time in all areas except for mortality and cardiac complications.
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Affiliation(s)
- Christina M Stuart
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO. https://twitter.com/CMStuart_MD
| | - William G Henderson
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Michael R Bronsert
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
| | - Katherine P Thompson
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Robert A Meguid
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO.
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Willmington C, Belardi P, Murante AM, Vainieri M. The contribution of benchmarking to quality improvement in healthcare. A systematic literature review. BMC Health Serv Res 2022; 22:139. [PMID: 35109824 PMCID: PMC8812166 DOI: 10.1186/s12913-022-07467-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/03/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Benchmarking has been recognised as a valuable method to help identify strengths and weaknesses at all levels of the healthcare system. Despite a growing interest in the practice and study of benchmarking, its contribution to quality of care have not been well elucidated. As such, we conducted a systematic literature review with the aim of synthesizing the evidence regarding the relationship between benchmarking and quality improvement. We also sought to provide evidence on the associated strategies that can be used to further stimulate quality improvement. METHODS We searched three databases (PubMed, Web of Science and Scopus) for articles studying the impact of benchmarking on quality of care (processes and outcomes). Following assessment of the articles for inclusion, we conducted data analysis, quality assessment and critical synthesis according to the PRISMA guidelines for systematic literature review. RESULTS A total of 17 articles were identified. All studies reported a positive association between the use of benchmarking and quality improvement in terms of processes (N = 10), outcomes (N = 13) or both (N = 7). In the majority of studies (N = 12), at least one intervention, complementary to benchmarking, was undertaken to stimulate quality improvement. The interventions ranged from meetings between participants to quality improvement plans and financial incentives. A combination of multiple interventions was present in over half of the studies (N = 10). CONCLUSIONS The results generated from this review suggest that the practice of benchmarking in healthcare is a growing field, and more research is needed to better understand its effects on quality improvement. Furthermore, our findings indicate that benchmarking may stimulate quality improvement, and that interventions, complementary to benchmarking, seem to reinforce this improvement. Although this study points towards the benefit of combining performance measurement with interventions in terms of quality, future research should further analyse the impact of these interventions individually.
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Affiliation(s)
- Claire Willmington
- Institute of Management and Department EMbeDS, Sant'Anna School of Advanced Studies, Pisa, Piazza Martiri della Libertà, 33, Pisa, Italy
| | - Paolo Belardi
- Institute of Management and Department EMbeDS, Sant'Anna School of Advanced Studies, Pisa, Piazza Martiri della Libertà, 33, Pisa, Italy.
| | - Anna Maria Murante
- Institute of Management and Department EMbeDS, Sant'Anna School of Advanced Studies, Pisa, Piazza Martiri della Libertà, 33, Pisa, Italy
| | - Milena Vainieri
- Institute of Management and Department EMbeDS, Sant'Anna School of Advanced Studies, Pisa, Piazza Martiri della Libertà, 33, Pisa, Italy
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Beesoon S, Sydora BC, Thanh NX, Chakravorty D, Robert J, Wasylak T, White J, Brindle ME. Does the Introduction of American College of Surgeons NSQIP Improve Outcomes? A Systematic Review of the Academic Literature. J Am Coll Surg 2020; 231:721-739.e8. [DOI: 10.1016/j.jamcollsurg.2020.08.773] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/26/2020] [Accepted: 08/26/2020] [Indexed: 12/14/2022]
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Learn PA, Mullen MJ, Saldinger PF, Kreishman P, Cordts PR, Ko CY, Knudson MM, Elster EA. A Collaborative To Evaluate And Improve The Quality Of Surgical Care Delivered By The Military Health System. Health Aff (Millwood) 2020; 38:1313-1320. [PMID: 31381406 DOI: 10.1377/hlthaff.2019.00286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In an effort to improve surgical quality and reduce clinical variability, the Military Health System (MHS) expanded its participation in the National Surgical Quality Improvement Program to all military hospitals beginning in 2015. This expansion and a partnership with the American College of Surgeons laid the foundation for a surgical quality collaborative in the MHS. We review the history of the program in the MHS and the activities that have contributed to developing the collaborative. We also report promising trends in surgical outcomes at hospitals that were already participating in the program in 2014, when a critical MHS review identified areas for improvement in surgical care. We conclude with a discussion of possible lessons for other health systems and challenges ahead for the MHS, now that full enrollment in the program has been completed.
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Affiliation(s)
- Peter A Learn
- Peter A. Learn ( ) is associate chair of surgery for quality and patient outcomes, Department of Surgery, at the Uniformed Services University of the Health Sciences (USUHS), in Bethesda, Maryland
| | - Mollie J Mullen
- Mollie J. Mullen is cochair of the Department of Defense National Surgical Quality Improvement Program Steering Panel, Directorate of Surgical Services, at the Naval Medical Center in San Diego, California
| | - Pierre F Saldinger
- Pierre F. Saldinger is chair of the Department of Surgery at NewYork-Presbyterian Hospital in Queens, New York, and a professor of clinical surgery at Weill Cornell Medicine, in New York City
| | - Peter Kreishman
- Peter Kreishman is surgeon champion in the Department of Surgery, Madigan Army Medical Center, in Tacoma, Washington
| | - Paul R Cordts
- Paul R. Cordts is deputy assistant director for medical affairs at the Defense Health Agency, in Falls Church, Virginia
| | - Clifford Y Ko
- Clifford Y. Ko is a professor of surgery in the Department of Surgery, University of California Los Angeles Health System. He also serves as director of the Division of Research and Optimal Patient Care at the American College of Surgeons
| | - M Margaret Knudson
- M. Margaret Knudson is a professor of surgery in the Department of Surgery, University of California San Francisco Health System
| | - Eric A Elster
- Eric A. Elster is chair of the Department of Surgery at USUHS
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Multicenter Observational Study Examining the Implementation of Enhanced Recovery Within the Virginia Surgical Quality Collaborative in Patients Undergoing Elective Colectomy. J Am Coll Surg 2019; 229:374-382.e3. [DOI: 10.1016/j.jamcollsurg.2019.04.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/26/2019] [Accepted: 04/26/2019] [Indexed: 01/03/2023]
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The return of investment of hospital-based surgical quality improvement programs in reducing surgical site infection at a Canadian tertiary-care hospital. Infect Control Hosp Epidemiol 2018; 40:125-132. [DOI: 10.1017/ice.2018.294] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveWe performed a return-on-investment analysis comparing the investment in surgical site infection (SSI) prevention programs in a hospital setting to the savings from averted SSI cases.DesignA retrospective case costing study using aggregated patient data to determine the incidence and costs of SSI infection in surgical departments over time. We calculated return on investment to the hospital and conducted several sensitivity and scenario analyses.SettingData were compiled for the Ottawa Hospital (TOH), a Canadian tertiary-care teaching institution.PatientsWe used aggregated records for all hospital patients who underwent surgical procedures between April 2010 and January 2015.InterventionWe estimated the potential cost savings of the hospital’s surgical quality improvement program, namely the Surgeons National Surgical Quality Improvement Program (NSQIP) and the Comprehensive Unit-based Safety Program (CUSP).ResultsFrom 2010 to 2016, TOH invested C$826,882 (US$624,384) in surgical quality improvement programs targeting SSI incidence and accrued C$1,885,110 (US$1,423,460) in cumulative savings from averted SSI cases, generating a return of $2.28 (US$3.02) per dollar invested (95% confidence interval [CI], −0.67 to 7.37). The study findings are sensitive to the estimated cost to the hospital per SSI case and the rate reduction attributable to the prevention program.ConclusionsThe NSQIP and CUSP have produced a positive return on investment at TOH; however, the result rests on several assumptions. This positive return on investment is expected to continue if the hospital can continue to reduce SSI incidence at least 0.25% annually without new investments. Findings from this study highlight the need for continuous program evaluation of the quality improvement initiatives.
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Mikhail JN, Nemeth LS, Mueller M, Pope C, NeSmith EG. The Social Determinants of Trauma: A Trauma Disparities Scoping Review and Framework. J Trauma Nurs 2018; 25:266-281. [DOI: 10.1097/jtn.0000000000000388] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Jackson T, Schramm D, Moloo H, Fairclough L, Maeda A, Beath T, Nathens A. Accelerating surgical quality improvement in Ontario through a regional collaborative: a quality-improvement study. CMAJ Open 2018; 6:E353-E359. [PMID: 30154219 PMCID: PMC6182121 DOI: 10.9778/cmajo.20170166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) collaborative in Ontario, the Ontario Surgical Quality Improvement Network (ON-SQIN), was launched in January 2015. We describe its approaches to support surgical quality improvement and examine its early impact on member hospitals. METHODS All Ontario hospitals that participated in the ON-SQIN and NSQIP were included in this quality-improvement study. The primary intervention was the introduction of the ON-SQIN, and the secondary interventions included a community of practice and access to quality-improvement resources and tools. Outcome measures included the level of quality-improvement capacity, collaborative-wide aggregate data on postoperative complications, and self-reported rates of surgical site and urinary tract infections. RESULTS Eighteen hospitals that enrolled in the ON-SQIN in 2015 reported an increase in their capacity for quality improvement after 18 months. Analysis of the collaborative-wide aggregate data in a 6-month period (14 748 surgical cases) revealed a substantial reduction of acute renal failure (relative risk 0.48, 95% confidence interval 0.25-0.95) and urinary tract infection (relative risk 0.77, 95% confidence interval 0.61-0.97). Most hospitals that targeted prevention of surgical site infection and urinary tract infection reported reduction of these occurrences during a 1-year period. INTERPRETATION The ON-SQIN supported the uptake of the NSQIP in Ontario hospitals and promoted targeted surgical quality-improvement initiatives, resulting in increased quality-improvement capacity and development of the community of practice. Furthermore, our early experience suggests that improvements in surgical care are being realized.
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Affiliation(s)
- Timothy Jackson
- Department of Surgery (Jackson), University of Toronto; Division of General Surgery (Jackson), Toronto Western Hospital, University Health Network, Toronto, Ont.; Department of Otolaryngology - Head and Neck Surgery (Schramm), The Ottawa Hospital; Department of Epidemiology and Community Medicine (Schramm) and Division of General Surgery (Moloo), Faculty of Medicine, University of Ottawa; Division of General Surgery (Moloo), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; Health Quality Ontario (Fairclough, Beath); Division of General Surgery (Maeda), Toronto Western Hospital, University Health Network; Sunnybrook Health Sciences Centre (Nathens); Institute for Clinical Evaluative Sciences (Nathens), Toronto, Ont.
| | - David Schramm
- Department of Surgery (Jackson), University of Toronto; Division of General Surgery (Jackson), Toronto Western Hospital, University Health Network, Toronto, Ont.; Department of Otolaryngology - Head and Neck Surgery (Schramm), The Ottawa Hospital; Department of Epidemiology and Community Medicine (Schramm) and Division of General Surgery (Moloo), Faculty of Medicine, University of Ottawa; Division of General Surgery (Moloo), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; Health Quality Ontario (Fairclough, Beath); Division of General Surgery (Maeda), Toronto Western Hospital, University Health Network; Sunnybrook Health Sciences Centre (Nathens); Institute for Clinical Evaluative Sciences (Nathens), Toronto, Ont
| | - Husein Moloo
- Department of Surgery (Jackson), University of Toronto; Division of General Surgery (Jackson), Toronto Western Hospital, University Health Network, Toronto, Ont.; Department of Otolaryngology - Head and Neck Surgery (Schramm), The Ottawa Hospital; Department of Epidemiology and Community Medicine (Schramm) and Division of General Surgery (Moloo), Faculty of Medicine, University of Ottawa; Division of General Surgery (Moloo), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; Health Quality Ontario (Fairclough, Beath); Division of General Surgery (Maeda), Toronto Western Hospital, University Health Network; Sunnybrook Health Sciences Centre (Nathens); Institute for Clinical Evaluative Sciences (Nathens), Toronto, Ont
| | - Lee Fairclough
- Department of Surgery (Jackson), University of Toronto; Division of General Surgery (Jackson), Toronto Western Hospital, University Health Network, Toronto, Ont.; Department of Otolaryngology - Head and Neck Surgery (Schramm), The Ottawa Hospital; Department of Epidemiology and Community Medicine (Schramm) and Division of General Surgery (Moloo), Faculty of Medicine, University of Ottawa; Division of General Surgery (Moloo), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; Health Quality Ontario (Fairclough, Beath); Division of General Surgery (Maeda), Toronto Western Hospital, University Health Network; Sunnybrook Health Sciences Centre (Nathens); Institute for Clinical Evaluative Sciences (Nathens), Toronto, Ont
| | - Azusa Maeda
- Department of Surgery (Jackson), University of Toronto; Division of General Surgery (Jackson), Toronto Western Hospital, University Health Network, Toronto, Ont.; Department of Otolaryngology - Head and Neck Surgery (Schramm), The Ottawa Hospital; Department of Epidemiology and Community Medicine (Schramm) and Division of General Surgery (Moloo), Faculty of Medicine, University of Ottawa; Division of General Surgery (Moloo), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; Health Quality Ontario (Fairclough, Beath); Division of General Surgery (Maeda), Toronto Western Hospital, University Health Network; Sunnybrook Health Sciences Centre (Nathens); Institute for Clinical Evaluative Sciences (Nathens), Toronto, Ont
| | - Tricia Beath
- Department of Surgery (Jackson), University of Toronto; Division of General Surgery (Jackson), Toronto Western Hospital, University Health Network, Toronto, Ont.; Department of Otolaryngology - Head and Neck Surgery (Schramm), The Ottawa Hospital; Department of Epidemiology and Community Medicine (Schramm) and Division of General Surgery (Moloo), Faculty of Medicine, University of Ottawa; Division of General Surgery (Moloo), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; Health Quality Ontario (Fairclough, Beath); Division of General Surgery (Maeda), Toronto Western Hospital, University Health Network; Sunnybrook Health Sciences Centre (Nathens); Institute for Clinical Evaluative Sciences (Nathens), Toronto, Ont
| | - Avery Nathens
- Department of Surgery (Jackson), University of Toronto; Division of General Surgery (Jackson), Toronto Western Hospital, University Health Network, Toronto, Ont.; Department of Otolaryngology - Head and Neck Surgery (Schramm), The Ottawa Hospital; Department of Epidemiology and Community Medicine (Schramm) and Division of General Surgery (Moloo), Faculty of Medicine, University of Ottawa; Division of General Surgery (Moloo), Department of Surgery, The Ottawa Hospital, Ottawa, Ont.; Health Quality Ontario (Fairclough, Beath); Division of General Surgery (Maeda), Toronto Western Hospital, University Health Network; Sunnybrook Health Sciences Centre (Nathens); Institute for Clinical Evaluative Sciences (Nathens), Toronto, Ont
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Kantor O, Talamonti MS, Pitt HA, Vollmer CM, Riall TS, Hall BL, Wang CH, Baker MS. Using the NSQIP Pancreatic Demonstration Project to Derive a Modified Fistula Risk Score for Preoperative Risk Stratification in Patients Undergoing Pancreaticoduodenectomy. J Am Coll Surg 2017; 224:816-825. [DOI: 10.1016/j.jamcollsurg.2017.01.054] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/03/2017] [Accepted: 01/04/2017] [Indexed: 02/08/2023]
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National Surgical Quality Improvement Program integration with Morbidity and Mortality conference is essential to success in the march to zero. Am J Surg 2016; 212:623-628. [PMID: 27596798 DOI: 10.1016/j.amjsurg.2016.06.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/26/2016] [Accepted: 06/23/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Morbidity and Mortality conference (M&M) and the National Surgical Quality Improvement Program (NSQIP) are systems to improve surgical care. We evaluated the commonality of adverse events (AEs) and the change in AE rates after integration. METHODS A single institution's NSQIP and M&M registries were analyzed to determine commonality of AE reported. Causal determinant groups were then created to categorize and standardize AE. Incidence of AE and patient commonality identified by these systems was evaluated over 2 years. RESULTS The 68 common patients identified in 2012 represented 27% of NSQIP and 43% of M&M patients. Common AE reported by M&M and NSQIP decreased from 16.9% (2013) to 9.6% (2014). Causality code analysis demonstrated significant differences in proportion of issues addressed within each (P < .0001). CONCLUSIONS Despite standardized coding, M&M focus differed from NSQIP. Low commonality affirms NSQIP as a critical adjunct to voluntary reporting. Combining both may help eliminate preventable AEs.
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Tepas JJ, Kerwin AJ, de Villa J, Ra JH, Nussbaum MS. Restating Surgical Risk: From Patient to Population. J Am Coll Surg 2016; 222:505-12. [PMID: 26809748 DOI: 10.1016/j.jamcollsurg.2015.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 12/14/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent federal legislation driving transition from fee-for-service to alternative methods of payment makes risk recognition essential for determination of appropriate payment systems. Because negotiations will include bundled population cohorts, we compared risk and results of an urban safety net teaching hospital's surgical population with state and national cohorts. STUDY DESIGN Deidentified summary data for 2013 and 2014 were analyzed to compare the safety net teaching hospital with a statewide collaborative and a national cohort from similar academic centers. Incidence of preoperative risk factors were compared, identifying those that were >50% higher than both state and national experiences. These were compared for change in incidence between years. Outcomes were evaluated by 30-day mortality, readmissions, return to operating room, length of stay, and adverse events incidence. RESULTS For both years, incidence of smoking, ventilator dependence, and CHF within 30 days was >50% higher than in the state and national cohorts. In 2014, septic shock was added to this, along with increased diabetes (14.3% to 19.8%), CHF (1.9% to 2.8%), and hypertension (39.9% to 52.5%). Despite these changes, 30-day mortality, return to operating room, length of stay, and readmissions were within ±5% of state and national results. Unplanned intubation, ventilation longer than 48 hours, and acute renal failure were 10th decile outliers. Median and interquartile range for length of stay were similar for all 3 populations across both years. CONCLUSIONS The incidence of comorbid conditions defines greater risk in this safety net teaching hospital population. Increased smoking-related pathology reflects local population disease burden, and increased ventilator support defines additional cost for this care. As disease-, procedure-, or population-based payment alternatives evolve, risk recognition, reduction, and resolution will be essential for determination of cost-efficient, optimal, surgical outcomes.
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Affiliation(s)
- Joseph J Tepas
- Department of Surgery, University of Florida College of Medicine, Jacksonville, FL.
| | - Andrew James Kerwin
- Department of Surgery, University of Florida College of Medicine, Jacksonville, FL
| | - Jhun de Villa
- Department of Surgery, University of Florida College of Medicine, Jacksonville, FL
| | - Jin Hee Ra
- Department of Surgery, University of Florida College of Medicine, Jacksonville, FL
| | - Michael S Nussbaum
- Department of Surgery, University of Florida College of Medicine, Jacksonville, FL
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Abstract
Collaborative quality improvement has demonstrated success in improving quality and reducing health care costs in several state-based examples. Professional societies and payers are keen on identifying the most effective strategies to improve the safety and efficiency of surgical care. This review highlights the development and features of collaborative quality improvement programs, their advantages and examples of successful collaborations for several surgical conditions, and their potential application for surgeons caring for patients with upper extremity trauma and disability.
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Affiliation(s)
- Jennifer F Waljee
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical Center, University of Michigan Health System, 1500 East Medical Center Drive, 2131 Taubman Center, Ann Arbor, MI 48109, USA.
| | - Nancy J O Birkmeyer
- Michigan Bariatric Surgery Collaborative, Center for Healthcare Outcomes and Policy, North Campus Research Complex, 2800 Plymouth Road, B016, Ann Arbor, MI 48109, USA; Department of Surgery, University of Michigan Medical Center, 1500 East Medial Center Drive, Ann Arbor, MI 48109, USA
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