Does Surgical Quality Improve in the American College of Surgeons National Surgical Quality Improvement Program

• DOI: 10.1097/sla.0b013e3181b4148f
• Publication Date: 2009-08-28T07:12:51Z
• Authors: Bruce L. Hall; Barton H. Hamilton; Karen Richards; Karl Y. Bilimoria; Mark E. Cohen; Clifford Y. Ko
• Keywords: Quality Assurance, Health Care; Hospitals, Veterans; 16. Peace & justice; United States; 3. Good health; United States Department of Veterans Affairs; 03 medical and health sciences; Logistic Models; Treatment Outcome; 0302 clinical medicine; Humans; Risk Adjustment; Longitudinal Studies; Surgery Department, Hospital; Societies, Medical

The National Surgical Quality Improvement Program (NSQIP) has demonstrated quality improvement in the VA and pilot study of 14 academic institutions. objective was to show that American College Surgeons (ACS)-NSQIP helps all enrolled hospitals.ACS-NSQIP data used evaluate hospitals longitudinally over 3 years (2005-2007). defined as reduction risk-adjusted "Observed/Expected" (O/E) ratios between periods with risk adjustment held constant. Multivariable logistic regression-based performed included indicators for procedure groups. Additionally, morbidity counts were modeled using a negative binomial model, estimate number avoided complications.Multiple perspectives reflected time. In analysis 118 (2006-2007), 66% improved mortality (mean O/E improvement: 0.174; P < 0.05) 82% adjusted complication rates 0.114; 0.05). Correlations starting (0.834 mortality, 0.652 morbidity), well relative risk, revealed initially worse-performing had more likelihood improvement. Nonetheless, well-performing also improved. Modeling counts, 183 (2007), ~9598 potential complications: ~52/hospital. Due sampling this may represent only 1 5 1of 10 true total. aggregate performance across types (academic/community, urban/rural). Changes patient time important contributions effect.ACS-NSQIP indicates surgical outcomes improve participating private sector. is both poor- facilities. NSQIP appear be avoiding substantial numbers complications- improving care, reducing costs. merit further study.