Elsevier

Advances in Surgery

Volume 44, Issue 1, September 2010, Pages 251-267
Advances in Surgery

Quality Improvement in Surgery: the American College of Surgeons National Surgical Quality Improvement Program Approach

https://doi.org/10.1016/j.yasu.2010.05.003Get rights and content

Section snippets

Surgical quality: meaning and assessment

The Donabedian model consists of 3 components for measuring the quality of health care: structure, process, and outcome. Structural measures evaluate the patient care resources afforded by a hospital. Process measures assess the treatments health care professionals provide, often in terms of compliance with recommended guidelines. Outcome measures quantify patients' health status and related parameters, such as morbidity, mortality, length of stay, and costs of care [1], [2], [3]. As patients,

The NSQIP: initiation in the Veterans Affairs health system and expansion to the private sector

After it was noticed that the rates of postoperative morbidity and mortality in the Veterans Affairs (VA) Health System were high, the Department of Veterans Affairs was mandated in 1985 (Public Law 99–166) by the United States Congress to periodically compare its risk-adjusted surgical outcomes to those of the private sector. At the time, no registries were available to provide risk-adjusted surgical outcomes for the VA or the private sector. Thus, the National VA Surgical Risk Study (NVASRS)

Vital lessons in surgical quality improvement: quality data, collaboratives, best practices guidelines and case studies, and surgeon champion conference calls

Although the foundation of the ACS NSQIP is its high-quality clinical data, simply providing feedback to hospitals on their risk-adjusted outcomes does not translate into quality improvement. Quality improvement professionals and health care providers must scrutinize their data, identify areas for improvement, implement quality improvement initiatives, and monitor the success of such endeavors. Such undertakings can be challenging, especially for institutions without significant quality

Health care finance and health policy reform

Prompted in part by a landmark Institute of Medicine report, government and private groups have developed programs to measure and improve health care quality [13], [32], [33], [34], [35], [36], [37]. Variation in health care quality has stimulated renewed interest in research to address the consumption and delivery of health care. This development is highlighted by the recent American Recovery and Reinvestment Act of 2009, which allocated a 1.1 billion down payment to support clinical outcomes,

Ongoing ACS NSQIP advances

With the ACS NSQIP in its sixth year, feedback from participating programs has led to a variety of ongoing modifications, some of which have already been described [50]. The heterogeneity of hospitals in the private sector has played a strong role in the changes being instituted. A brief summary of some of the more substantial changes follows.

Summary

The history and development of the NSQIP, from its inception in the Veterans Administration Health System to its implementation within the private sector sponsored by the ACS, documents the growth of a program that has substantially improved the quality of surgical care and has had a considerable influence on the culture of quality improvement in the profession. The success of the ACS NSQIP is the result of providing hospitals with rigorous, clinical data, networking opportunities, and

First page preview

First page preview
Click to open first page preview

References (55)

  • M.J. Englesbe et al.

    Who pays for biliary complications following liver transplant? A business case for quality improvement

    Am J Transplant

    (2006)
  • J.B. Dimick et al.

    Who pays for poor surgical quality? Building a business case for quality improvement

    J Am Coll Surg

    (2006)
  • J.D. Birkmeyer et al.

    Blueprint for a new American College of Surgeons: national surgical quality improvement program

    J Am Coll Surg

    (2008)
  • P.L. Schilling et al.

    Prioritizing quality improvement in general surgery

    J Am Coll Surg

    (2008)
  • M.E. Cohen et al.

    Development of an American College of Surgeons National Surgery Quality Improvement Program: morbidity and mortality risk calculator for colorectal surgery

    J Am Coll Surg

    (2009)
  • A. Donabedian

    The quality of care. How can it be assessed?

    JAMA

    (1988)
  • A. Donabedian

    Evaluating the quality of medical care

    Milbank Mem Fund Q

    (1966)
  • D.W. Bratzler et al.

    Performance measures for pneumonia: are they valuable, and are process measures adequate?

    Curr Opin Infect Dis

    (2007)
  • C.Y. Ko et al.

    Quality in surgery: current issues for the future

    World J Surg

    (2005)
  • S.F. Khuri et al.

    The National Veterans Administration Surgical Risk Study: risk adjustment for the comparative assessment of the quality of surgical care

    J Am Coll Surg

    (1995)
  • S.F. Khuri et al.

    The Department of Veterans Affairs' NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program

    Ann Surg

    (1998)
  • A.S. Fink et al.

    The National Surgical Quality Improvement Program in non-veterans administration hospitals: initial demonstration of feasibility

    Ann Surg

    (2002)
  • S.F. Khuri et al.

    Successful implementation of the Department of Veterans Affairs' National Surgical Quality Improvement Program in the private sector: the Patient Safety in Surgery study

    Ann Surg

    (2008)
  • B.L. Hall et al.

    Does surgical quality improve in the American College of Surgeons National Surgical Quality Improvement Program: an evaluation of all participating hospitals

    Ann Surg

    (2009)
  • U. Guller et al.

    Laparoscopic versus open appendectomy: outcomes comparison based on a large administrative database

    Ann Surg

    (2004)
  • C.P. Delaney et al.

    Clinical outcomes and resource utilization associated with laparoscopic and open colectomy using a large national database

    Ann Surg

    (2008)
  • Cited by (448)

    View all citing articles on Scopus

    Financial Disclosures: Dr Ingraham is supported by the Clinical Scholar in Residence Program at the American College of Surgeons. Dr Hall is supported by the Center for Health Policy, Washington University St Louis.

    View full text