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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.

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American college of surgeons

AmericanCollege of Surgeons


American college of surgeons

What ACS NSQIP Is

______________________________

  • Web-Based data collection program

  • Quality improvement tool

  • National Benchmarking

  • Surgical outcomes data


Current participants

Current Participants

Number of Participating Sites by State and Region (487)

CANADA 28

November 2012

5

MIDWEST 87

13

4

9

2

9

1

8

15

1

29

11

15

8

3

15

4

10

9

18

10

NORTHEAST

3

55

9

95

10

9

5

11

24

3

11

2

WEST 98

3

ABU DHABI , UAE 1

66

LEBANON 1

SOUTH 176

1

7

______________________________

2

2

2

1

1

2

2

1

LONDON, ENGLAND 1

25


American college of surgeons

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

_____________________________


American college of surgeons

Program Staffing

______________________________

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


  • Surgeon champion qualifications

    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 qualifications

    Preferred …

    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

    Surgical Clinical Reviewer Qualifications


    Data collection

    Data Collection

    Data Collected

    ______________________________

    • Demographics

    • Surgical Profile

    • Pre-operative Data (risk factors)

    • Intra-operative Data

    • Post operative Data (outcomes)


    American college of surgeons

    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

    Data Collection

    ______________________________

    Sampling Methodology


    30 day post op follow up review

    30-Day Post-Op Follow Up Review

    Outcome /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


    American college of surgeons

    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

    Risk Adjustment

    ______________________________

    Odds Ratios


    Real time and semiannual reports

    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

    Real-Time Reports

    Workflow Reports

    Site-Level Reports

    Database Statistics

    Data Analysis

    Reporting

    ______________________________


    American college of surgeons

    Reporting

    ______________________________

    Pre-Operative Risk Factor Summary


    American college of surgeons

    Reporting

    ______________________________

    30 Day Post-Op Summary


    American college of surgeons

    Reporting

    ______________________________

    Mortality Patient Report


    American college of surgeons

    Reporting

    ______________________________

    Post-Operative Occurrence Analysis


    Semiannual report

    Semiannual Report

    Reporting

    ______________________________

    Risk adjusted for hospital-to-hospital patient mix differences.


    Over 90 risk adjusted outcomes

    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: Model Summary


    Semiannual report hospital specific bar plot

    Semiannual Report: Hospital-Specific Bar Plot


    American college of surgeons

    Return on Investment

    ______________________________

    ACS NSQIP Improves Outcomes and Saves Money


    Does surgical quality improve using the acs nsqip

    Does Surgical Quality Improve using the ACS NSQIP?

    Return on Investment

    ______________________________

    • 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


    American college of surgeons

    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 Hospitalreduced LOS for annual savings of $2 million

    Return on Investment

    ______________________________


    American college of surgeons

    Return on Investment

    ______________________________

    ROI Calculator


    American college of surgeons

    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

    ______________________________


    American college of surgeons

    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

    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

    The Options

    _____________________________

    Four Adult ACS NSQIP options

    ACS NSQIP Essentials

    ACS NSQIP Measures

    ACS NSQIP Small & Rural

    ACS NSQIP Procedure Targeted


    Acs nsqip essentials

    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

    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

    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

    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

    Pricing

    _____________________________


    Recognition

    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.


    American college of surgeons

    Recognition

    _______________________________

    Institute of Medicine named ACS NSQIP

    “the best in the nation”

    for measuring & reporting surgical quality and outcomes.


    American college of surgeons

    Tresha Russell

    Business Development Representative

    [email protected]

    312-202-5441

    _______________________________


    American college of surgeons

    Thank you

    _______________________________


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