Quality Improvement in Surgery: the American College of Surgeons National Surgical Quality Improvement Program Approach
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
References (55)
- et al.
Measuring the quality of surgical care: structure, process, or outcomes?
J Am Coll Surg
(2004) - et al.
Risk adjustment of the postoperative mortality rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study
J Am Coll Surg
(1997) - et al.
Risk adjustment of the postoperative morbidity rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study
J Am Coll Surg
(1997) - et al.
Validating risk-adjusted surgical outcomes: site visit assessment of process and structure. National VA Surgical Risk Study
J Am Coll Surg
(1997) The NSQIP: a new frontier in surgery
Surgery
(2005)- et al.
The patient safety in surgery study: background, study design, and patient populations
J Am Coll Surg
(2007) - et al.
Toward robust information: data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program
J Am Coll Surg
(2010) - et al.
Identifying patient preoperative risk factors and postoperative adverse events in administrative databases: results from the Department of Veterans Affairs National Surgical Quality Improvement Program
J Am Coll Surg
(2002) Quality improvement is local
J Am Coll Surg
(2009)- et al.
Hospital costs associated with surgical complications: a report from the private-sector National Surgical Quality Improvement Program
J Am Coll Surg
(2004)
Who pays for biliary complications following liver transplant? A business case for quality improvement
Am J Transplant
Who pays for poor surgical quality? Building a business case for quality improvement
J Am Coll Surg
Blueprint for a new American College of Surgeons: national surgical quality improvement program
J Am Coll Surg
Prioritizing quality improvement in general surgery
J Am Coll Surg
Development of an American College of Surgeons National Surgery Quality Improvement Program: morbidity and mortality risk calculator for colorectal surgery
J Am Coll Surg
The quality of care. How can it be assessed?
JAMA
Evaluating the quality of medical care
Milbank Mem Fund Q
Performance measures for pneumonia: are they valuable, and are process measures adequate?
Curr Opin Infect Dis
Quality in surgery: current issues for the future
World J Surg
The National Veterans Administration Surgical Risk Study: risk adjustment for the comparative assessment of the quality of surgical care
J Am Coll Surg
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
The National Surgical Quality Improvement Program in non-veterans administration hospitals: initial demonstration of feasibility
Ann Surg
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
Does surgical quality improve in the American College of Surgeons National Surgical Quality Improvement Program: an evaluation of all participating hospitals
Ann Surg
Laparoscopic versus open appendectomy: outcomes comparison based on a large administrative database
Ann Surg
Clinical outcomes and resource utilization associated with laparoscopic and open colectomy using a large national database
Ann Surg
Cited by (448)
Role of pre-operative counseling with NSQIP surgical risk calculator in the surgical patients
2024, Surgery Open ScienceEffect of conditions being present at time of surgery (PATOS) on outcomes in liver surgery
2024, American Journal of SurgeryContinuous monitoring of adverse effects improves surgical outcomes
2024, Cirugia EspanolaEffect of Present at Time of Surgery (PATOS) on Outcomes in Pancreatic Surgery
2023, Journal of Gastrointestinal Surgery
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.