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American College of Surgeons. What ACS NSQIP Is. ______________________________. Web-Based data collection program Quality improvement tool National Benchmarking Surgical outcomes data. Current Participants. Number of Participating Sites by State and Region (487). CANADA 28. - PowerPoint PPT Presentation
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American College of Surgeons
Web-Based data collection program Quality improvement tool National Benchmarking Surgical outcomes data
What ACS NSQIP Is ______________________________
Current Participants______________________________Number of Participating Sites by State and Region (487)
November 2012CANADA 28
WEST 98
SOUTH 176
LEBANON 1
MIDWEST 87
NORTHEAST95
5
9
55
1
3
4
9
4
1
9
3
9
3
8
18
2
24
5
15
10 10
66
3
11
10
15
29
9
8
11
2
15
13
1
7
ABU DHABI , UAE 1
11
25
1
2
2
1
2
22
LONDON, ENGLAND 1
1
Clinically Rich Data Web-Based Workstation Private & Secure Data Encryption On-line Training & Certification of SCR’s Real-time reports access & Semi-annual reports On-line Return of Investment (ROI) Calculator Best Practices (Expert panel rated guidelines) Improvement Case Studies Pre-operative Surgical Risk Calculator Participant Use File (PUF)
Product Features_____________________________
Surgeon Champion (SC) Program Mentor/Advocate
Surgical Clinical Reviewer (SCR) Data Collector
Honesty Respect Regarding SCR as a peer Accessibility Plan for personal growth Develop chemistry On-line/On-going training; CEU’s/CME’s & Certification - provided by the ACS
Program Staffing______________________________
Surgeon Champion Qualifications
Well Respected & Highly Regarded
Chief of Surgery or Chief Medical Officer
Program Mentor/Advocate
Must be trusted by peers and administration
Experience with Quality Improvement
Lead Quality Improvement Initiatives
Participate in Monthly SC Conference Calls
Surgical Clinical Reviewer QualificationsPreferred … Bachelor’s Degree preferred
Clinical chart review and abstraction experience
Ability to build relationships & to articulate questions
Recommended … 1 Year experience in surgery,
medical records, or clinical research
Nursing Background
Quality improvement or patient safety knowledge and experience
Data Collection
Data Collected
Demographics Surgical Profile Pre-operative Data (risk factors) Intra-operative Data Post operative Data (outcomes)
______________________________
A randomized sampling system called the 8-day cycle
Process ensures that cases have an equal chance of being selected from each day of the week
Sampling Methodology
______________________________ Data Collection
30-Day Post-Op Follow Up ReviewOutcome /follow-up information can be obtained in a variety of
ways: Review of the patient’s medical record. Screen for readmissions Separate clinic or the private surgeon’s office -outpatient follow-up
visits Additional methods would be either a phone call placed directly to
the patient or a follow-up letter can be mailed for the patient to respond to in writing
An Odds Ratio of 1 is like “par on a golf course” – the score that is expected It is a metric showing the risk-adjusted performance at a specific site
compared to the average hospital
An Odds ratio < 1 means that the site is performing better than expected, while a ratio > 1 indicates an excess of adverse events
The odds is defined as the #events / #non-events i.e. 5/95=.053, is the odds for a hospital if there are 5 deaths among 100
patients
Our Odds Ratio is the risk-adjusted odds for an event at a site divided by the odds for an event at the average site
Our Odds Ratios are also adjusted so they are useful even for hospitals that provide very small samples
Odds Ratios
______________________________ Risk Adjustment
Real-Time and Semiannual Reports Real-time, continuously updated online
reports Programmed library of reports that can be filtered Real-time data Able to compare with all or like sites Customizable Fields
Semiannual benchmarked report Risk Adjusted Distributed in the 1st & 3rd quarter of each year
Reporting______________________________
Real-Time Reports
Workflow Reports
Site-Level Reports
Database Statistics
Data Analysis
Reporting______________________________
Reporting______________________________ Pre-Operative Risk Factor Summary
Reporting______________________________ 30 Day Post-Op Summary
Reporting______________________________ Mortality Patient Report
Reporting______________________________ Post-Operative Occurrence Analysis
Semiannual Report
Risk adjusted for hospital-to-hospital patient mix differences.Risk adjusted for hospital-to-hospital patient mix differences.
Reporting______________________________
Over 90 Risk Adjusted Outcomes 30-Day Mortality & Morbidity/ Serious Morbidity Odds Ratios
in All Patients+ 30-Day Morbidity/Serious Morbidity Odds Ratios in patients
>65 Cardiac Occurrences Pneumonia Unplanned Intubation Ventilator Dependence >48 hours DVT/PE Renal Failure Urinary Tract Infection/UTI Odds Ratios Surgical Site Infection/Deep & Organ Space Odds Ratios Colorectal 30-Day Death or Serious Morbidity Odds Ratios
Reporting______________________________
Semiannual Report: Model Summary
Semiannual Report: Hospital-Specific Bar Plot
ACS NSQIP Improves Outcomes and Saves Money
Return on Investment______________________________
Does Surgical Quality Improve using the ACS NSQIP?
82% of ACS NSQIP hospitals had decreased surgical complications
66% of ACS NSQIP hospitals had decreased mortality
Each hospital is projected to avoid between 250-500 complications per year – on average
Return on Investment______________________________
Beaumont Hospital saved $2.2 million and reduced average LOS by 6.5 days by reducing SSI. In 2009, the hospital estimates it prevented nearly 300 SSI’s.
Surrey Memorial Hospital reduced SSI’s over 4 years for savings of $2.54 million
Henry Ford Hospital reduced LOS for annual savings of $2 million
Return on Investment______________________________
Complication Cost Per Case
Averted Events
Cost Savings
Ventilator >48 hrs
$ 27,654 X 17=
$ 470,118
UTI $ 12,828 X 12=
$ 153,936
Cardiac Arrest $ 15,079 X 4=
$ 60,316
Pneumonia $ 22,097 X 24=
$ 530,328
Unplanned Intubation
$ 21,025 X 7=
$ 147,175
Deep SSI $ 20,012 X 15=
$ 300,180
Total $1,662,053
Return on Investment______________________________ ROI Calculator
Non-Monetary Benefits … Valid National benchmarking for surgical outcomes
Provides proactive, value-oriented surgical outcomes performance measurement
Improves local market position, i.e. publicly visible surgical quality improvement program
Optimizes cross-departmental partnerships and collaboration through shared knowledge
Helps build high performance surgical teams and employee retention, (i.e. nurses)
Offers CME’s for Surgeon Champions and CEU’s for SCR’s
Return on Investment______________________________
Complete yet concise resource for health care providers and QI professionals
Evidence-based Expert panel-rated Framework to:
Prevent postsurgical complications
Prioritize/direct QI efforts aimed at reducing incidence/impact of postsurgical complications
Best Practice Guidelines______________________________
Selection of Data
Choose Your Focus
• General & Vascular – sampling of the hospitals general & vascular surgical procedures abstracted
• Multi-Specialty – sampling of hospital surgical specialties abstracted
____________________________
The Options
1. ACS NSQIP Essentials
2. ACS NSQIP Measures
3. ACS NSQIP Small & Rural
4. ACS NSQIP Procedure Targeted
_____________________________
Four Adult ACS NSQIP options
ACS NSQIP Essentials General/Vascular = 1,680 general & vascular
surgical cases submitted annually
Multispecialty = Abstract 20% of the total case volume from each specialty
1 FTE
_____________________________
ACS NSQIP Measures 5 High Impact Measures:
- UTI - Colorectal - SSI - Lower Extremity Bypass - Elderly
Minimal Data Collection = 840 cases collected annually
1/2 FTE
_______________________________
ACS NSQIP Small & Rural
Small Hospital: performs less than 1,680 cases per year
OR Rural Hospital: ZIP code is defined within
RUCA data codes
100% case collection across all specialties
1 FTE (or less depending upon case volume)
_____________________________
ACS NSQIP Procedure Targeted Larger hospitals targeting high-risk/high volume
procedures
Hospital selects procedures
Selection may be CPT code-driven
Minimum of 1,680 cases per year:
- 15 “Core” cases per 8-day cycle
- 25 “Procedure Targeted” cases per 8-day cycle
Minimum 1 FTE (or more depending on volume)
______________________________
Pricing
EssentialsProcedure Targeted
Small/Rural Measures Pediatric
NSQIP
Base Price $27,000 $29,000 $10,000 $15,000 $29,000
System orCollaborative Discount $3,500
$3, 500 N/A N/A
$3,500
Three - Year Contract Discount $1,500
$1,500 N/A N/A
$1,500
Annual Fee $22,000 $24,000 $10,000 $15,000 $29,000
_____________________________
Recognition
Meets MOC Part 4 - Evaluation of performance in practice through tools such as outcome measures and quality improvement programs, and the evaluation of behaviors such as communication and professionalism.
_______________________________
Institute of Medicine named ACS NSQIP “the best in the nation”
for measuring & reporting surgical quality and outcomes.
Recognition_______________________________
Thank you
_______________________________
