Transcript ACS NSQIP - UNYSQI

American College of Surgeons
What ACS NSQIP Is
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 Web-Based data collection program
 Quality improvement tool
 National Benchmarking
 Surgical outcomes data
Current
Participants
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Number of Participating Sites by State and Region (487)
CANADA 28
November 2012
5
MIDWEST 87
13
4
9
2
15
112
9
1
8
1
29
15
3
4
2
18
3
55
15
9
2
25
10
5
1
3
LONDON, ENGLAND 1
11
3
ABU DHABI , UAE 1
66
SOUTH 176
1
7
NORTHEAST
95
11
24
2
WEST 98
9 2
1
1
9
2
10
10
8
LEBANON 1
Product
Features
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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)
Program
Staffing
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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
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Well Respected & Highly Regarded
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Chief of Surgery or Chief Medical Officer
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Program Mentor/Advocate
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Must be trusted by peers and administration
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Experience with Quality Improvement
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Lead Quality Improvement Initiatives
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Participate in Monthly SC Conference Calls
Surgical Clinical Reviewer Qualifications
Preferred …
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Bachelor’s Degree preferred
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Clinical chart review and
abstraction experience
Ability to build relationships
& to articulate questions
Recommended …
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1 Year experience in surgery,
medical records, or clinical
research
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Nursing Background
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Quality improvement or patient
safety knowledge and
experience
Data
Collection
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Data Collected
 Demographics
 Surgical Profile
 Pre-operative Data (risk factors)
 Intra-operative Data
 Post operative Data (outcomes)
Data
Collection
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Sampling Methodology
 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
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
Risk
Adjustment
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Odds Ratios
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
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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
Reporting
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Real-Time and Semiannual Reports
 Real-time, continuously updated online reports
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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
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Real-Time Reports
 Workflow Reports
 Site-Level Reports
 Database Statistics
 Data Analysis
Reporting
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Pre-Operative Risk Factor Summary
Reporting
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30 Day Post-Op Summary
Reporting
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Mortality Patient Report
Reporting
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Post-Operative Occurrence Analysis
Reporting
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Semiannual Report
Risk adjusted for hospital-to-hospital patient mix differences.
Reporting
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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
Semiannual Report:
Model Summary
Semiannual Report:
Hospital-Specific Bar Plot
Return on Investment
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ACS NSQIP Improves Outcomes and
Saves Money
Return on Investment
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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
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 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
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ROI Calculator
Complication
Cost Per
Case
Averted Events
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
Cost
Savings
$1,662,053
Return on Investment
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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
Best
Practice Guidelines
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 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
Selection
of
Data
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Choose Your Focus
• General & Vascular – sampling of
the hospitals general & vascular
surgical procedures abstracted
• Multi-Specialty – sampling of hospital
surgical specialties abstracted
The
Options
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Four Adult ACS NSQIP options
1.
2.
3.
4.
ACS NSQIP Essentials
ACS NSQIP Measures
ACS NSQIP Small & Rural
ACS NSQIP Procedure Targeted
ACS NSQIP Essentials
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General/Vascular = 1,680 general & vascular
surgical cases submitted annually
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Multispecialty = Abstract 20% of the total case
volume from each specialty
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1 FTE
ACS NSQIP Measures
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5 High Impact Measures:
- UTI
- SSI
- Elderly
- Colorectal
- Lower Extremity Bypass
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Minimal Data Collection = 840 cases
collected annually
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1/2 FTE
ACS NSQIP Small & Rural
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Small Hospital: performs less than 1,680 cases
per year
OR
Rural Hospital: ZIP code is defined within
RUCA data codes
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100% case collection across all specialties
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1 FTE (or less depending upon case volume)
ACS
NSQIP Procedure Targeted
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Larger hospitals targeting high-risk/high volume
procedures
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Hospital selects procedures
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Selection may be CPT code-driven
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Minimum of 1,680 cases per year:
- 15 “Core” cases per 8-day cycle
- 25 “Procedure Targeted” cases per 8-day cycle
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Minimum 1 FTE (or more depending on volume)
Pricing
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Essentials
Procedure
Targeted
Small/Rural
$10,000
Measures
$15,000
Pediatric
NSQIP
Base Price
$27,000
$29,000
System or
Collaborative
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
$29,000
Recognition
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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.
Recognition
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Institute of Medicine named ACS NSQIP
“the best in the nation”
for measuring & reporting surgical quality and
outcomes.
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Tresha Russell
Business Development
Representative
[email protected]
312-202-5441
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Thank you