slide1 l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Dedicated to improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethica PowerPoint Presentation
Download Presentation
Dedicated to improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethica

Loading in 2 Seconds...

play fullscreen
1 / 47

Dedicated to improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethica - PowerPoint PPT Presentation


  • 262 Views
  • Uploaded on

American College of Surgeons. Dedicated to improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethical practice environment. What NSQIP Is. ______________________________. Web-Based data collection software Quality improvement tool

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Dedicated to improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethica' - paul2


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

American College of Surgeons

Dedicated to improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethical practice environment

slide2

What NSQIP Is

______________________________

  • Web-Based data collection software
  • Quality improvement tool
  • Risk-adjusted, outcomes-baseddata
  • Clinically Validated data
  • Benchmarking
current participants
Current Participants

Number of Participating Sites by State and Region (273)

CANADA 4

October 31,2010

3

MIDWEST 78

4

3

8

6

20

1

5

1

22

2

4

34

6

2

9

2

5

5

2

13

6

NORTHEAST

2

33

3

67

10

4

2

8

10

1

1

ABU DHABI 1

3

4

WEST 57

2

LEBANON 1

6

SOUTH 65

1

2

______________________________

10

slide4
Clinically Rich Data

Web-Based Workstation

Private & Secure Data Encryption

Semi Annual Reports & Other Real-Time Reports

Online Return of Investment (ROI) Calculator

Best Practices (Expert panel rated guidelines)

Case Studies

Online Risk Calculator

Participant Use File (PUF)

Product Features

_____________________________

slide5

Program Staffing

______________________________

  • Surgeon Champion (SC)
    • Program Mentor/Advocate
    • Lead Quality Improvement Initiatives
    • Participate in Monthly SC Conference Calls
  • Surgical Clinical Reviewer (SCR)
    • Collect Data
    • Online/On-going training; CEU’s & Certification - provided by the

ACS

data collection
Data Collection

______________________________

  • Demographics
  • Surgical Profile
  • Pre-operative Data (risk factors)
  • Intra-operative Data
  • Post operative Data (outcomes)
slide7

Data Collection

______________________________

Case Selection

  • Sampling of all operations requiring
    • General anesthesia
    • Spinal anesthesia
    • Epidural anesthesia
  • Inpatient and Outpatient Surgical Procedures
    • excluding trauma and transplant
slide8
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

clinical vs administrative data clinical data tends to tell us more
Clinical vs. Administrative Data Clinical Data tends to tell us more…

Data Collection

______________________________

slide10
O/E ratio = par on a golf course –

the score that is expected

An O/E ratio is a mathematical construct accurately showing the risk-adjusted outcome for a specific site

‘O’ represents the total number of observed postoperative events (deaths or complications)

‘ E’ represents the number of expected events based on the preoperative risk and other factors in a given patient population

An O/E ratio < 1 means that the site is performing better than expected, while a ratio > 1 indicates an excess of adverse events

Risk Adjustment

______________________________

Observed vs. Expected O/E Ratios

slide11

01

01

04

04

08

08

12

12

16

16

Rank by

unadjusted

Mortality

Observed

Only

Rank by

risk-adjusted

Mortality

Observed/Expected

20

20

24

24

28

28

32

32

36

36

40

40

44

44

Risk Adjustment

______________________________

O/E ratios show that risk adjustment has a profound effect in determining the true performance of a medical center

A

B

B

A

Changes in Medical Center Rank (O/E Ratio) After Risk Adjustment For 30-Day Mortality

data needs to be believed validation with audits
Data Needs to be Believed:Validation with Audits

Audits

______________________________

Shiloach JACS 2009

real time and semiannual reports
Real-Time and Semiannual Reports

Real-time, continuously updated benchmarked online reports

Pre-programmed library of reports

Real-time data

Not risk adjusted

Able to benchmark with all or like sites

Semiannual benchmarked report

Risk Adjusted

Available 1st and 3rd quarters

Reporting

______________________________

real time reports
Real-Time Reports

Workflow Reports

Site-Level Reports

Database Statistics

Data Analysis

ACS Reports

Reporting

______________________________

slide15

Reporting

______________________________

how are our outcomes ssi pneumonia uti
How are our outcomes? SSI? Pneumonia? UTI?

Reporting

______________________________

slide17

Reporting

______________________________

How are our outcomes? SSI? Pneumonia? UTI?

slide18

Reporting

______________________________

How are our outcomes? SSI? Pneumonia? UTI?

slide19

Reporting

______________________________

Further drilling down on the data

real time analyses i e mortality in colectomy cases with or without uti
Real Time Analysesi.e,Mortality in Colectomy cases with or without UTI

Reporting

______________________________

semiannual report
Semiannual Report

Reporting

______________________________

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

over 40 risk adjusted outcomes
Over 40 Risk Adjusted Outcomes

30-Day Mortality & Morbidity/ Serious Morbidity O/E Ratios in All Patients

30-Day Morbidity/Serious Morbidity O/E Ratios in patients >65

Cardiac Occurrences

Pneumonia

Unplanned Intubation

Ventilator Dependence >48 hours

DVT/PE

Renal Failure

Urinary Tract Infection/UTI O/E Ratios

Surgical Site Infection/Deep & Organ Space O/E Ratios

Colorectal 30-Day Death or Serious Morbidity O/E Ratios

Reporting

______________________________

slide23

Reporting

Interpretation of Results

______________________________

Observed to Expected (O/E) Ratio

Represents the hospital’s outcomes compared to the other ACS NSQIP hospitals, adjusted for inter-hospital differences in patients’ characteristics, comorbidities, and preoperative laboratory values

LOW OUTLIER: If the upper bound of the O/E confidence interval is <1.0, the hospital’s outcomes are statistically better than expected. Thus, the hospital’s outcomes are “Exemplary.”

AS EXPECTED

HIGH OUTLIER: If the lower bound of the O/E ratio is >1.0, the hospital’s outcomes are statistically worse than expected. Thus, the hospital’s outcomes “Need Improvement.”

ACS NSQIP Hospital ID Number

slide24

Return on Investment

______________________________

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 NSQIP hospitals had decreased surgical complications
  • 66% of NSQIP hospitals had decreased mortality
  • Each hospital is projected to avoid between 250-500 complications per year – on average
slide26

Return on Investment

______________________________

  • Example …
    • If 250 complications are avoided
    • And each complication costs $10,000
    • The potential savings is $2,500,000
slide27
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

______________________________

slide28
Henry Ford Hospital reduced their length of stay by an average of 1.54 days after reviewing data from all patients who underwent a general, vascular, or colorectal procedure translating into an annual savings of $2 million.

Surrey Memorial Hospital avoided an estimated $380,000in costs over a four-monthperiod through initiatives to reduce the number of urinary tract infections.

Return on Investment

______________________________

slide29

Return on Investment

______________________________

ROI Calculator

slide30
Non-Monetary Benefits …

Valid National benchmarking for surgical outcomes

Provides proactive, value-oriented performance measurement before it’s dictated by outside agents

Improves local market position through publicly visible improvement programs

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

______________________________

slide31
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

______________________________

best practice case studies
Best Practice Case Studies

Kaiser Sunnyside Medical Center used NSQIP data to optimize glucose and temperature control in the operating room

Advocate Good Samaritan Hospital used NSQIP data to improve postoperative Renal Outcomes

______________________________

  • Scripps Green Hospital used NSQIP data to reduce surgical site infection rates in vascular surgery
  • Morristown Memorial Hospital used NSQIP data to prevent surgical site infections
the options
The Options

_____________________________

Four Adult NSQIP options

NSQIP Classic

NSQIP Essentials

NSQIP Small &Rural

NSQIP Procedure Targeted

regardless of which option all hospitals will receive
Regardless of Which Option, All Hospitals Will Receive:

The Options

_____________________________

  • Semi Annual Reports
  • Real Time Online Reports (including new SPCs)
  • National Benchmarking
  • NSQIP Best Practices/Guidelines
  • NSQIP Improvement Case Studies
  • Additional Items (e.g. Risk Calculator, Public Use File)
for all options the rigor and validity of acs nsqip is unchanged
For All Options, the Rigor and Validity of ACS NSQIP is Unchanged

The Options

_____________________________

  • Risk Adjustment
  • 30 Day Post Surgical Outcomes
  • Clinical Data
  • SCR Training
  • SCR Certification
nsqip classic
NSQIP Classic

General/Vascular = 1,680 cases per year,

8-day sampling cycle

Multispecialty = 20% total case volume by specialty, 8-day sampling cycle

1 FTE

_____________________________

nsqip essentials
NSQIP Essentials

General/Vascular = 1,680 cases per year,

8-day sampling cycle

Multispecialty = 20% total case volume by specialty, 8-day sampling cycle

1 FTE

_____________________________

nsqip small rural
NSQIP Small & Rural

Small Hospital: < 1,680 cases per year

OR

Rural Hospital: ZIP code is defined within RUCA data codes

100% collection of cases across all specialties

Collection of core variables for QI purposes

1 FTE (or less depending upon case volume)

_____________________________

nsqip procedure targeted
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)

_____________________________

nsqip procedure targeted40
NSQIP Procedure Targeted

_____________________________

Nine Subspecialties

  • General Surgery
  • Vascular
  • Gynecologic
  • Urologic
  • Plastic & Reconstructive Surgery
  • Otolaryngology
  • Orthopedic Surgery
  • Neurosurgery
  • Thoracic Surgery
nsqip procedure targeted41
NSQIP Procedure Targeted

_____________________________

30+ Procedures

Pancreatectomy▪ Colectomy ▪ Ventral Hernia Repair ▪ Bariatric ▪ Proctectomy ▪ Hepatectomy ▪ Tyroidectomy ▪ Esophagectomy ▪ Appendectomy ▪ Cartoid Endarterectomy ▪ Cartoid Artery Stenting ▪ Open AAA Repair ▪ EVAR ▪ Open Aortoiliac Bypass ▪ Endo Aortoiliac Repair ▪ Lower Extremity Open Bypass ▪ Lower Extremity Repair Endovascular ▪ Hysterectomy ▪ Myomectomy ▪ Reconstructive Procedures ▪ TURP ▪ Bladder Suspension ▪ Radial Prostatectomy ▪ Radical Nephrectomy ▪ Radical Cystectomy ▪ Muscle/Myocutaneous Flap ▪ Reduction Mammoplasty ▪ Breast Reconstruction ▪ Abdominoplasty ▪ Thyroidectomy ▪ Total Hip Arthroplasty ▪ Total Knee Arthroplasty ▪ Spine Surgery ▪ Hip Fracture ▪ Brain Tumor Procedure ▪Spine Procedure ▪ Lung Resection

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.

slide44

Recognition

_______________________________

Institute of Medicine named NSQIP

“the best in the nation”

for measuring & reporting surgical quality and outcomes.

summary
Summary

Risk adjusted Data

Clinically Robust Data

Validated Data

Best Practices Tools, Guidelines, and Case Studies

Proven! (improve quality AND decrease costs)

_______________________________

slide46
Tresha Russell

Business Development Representative

tresharussell@facs.org

312-202-5441

_______________________________

slide47
Thank you

_______________________________