Solving the Value Equation: Assessing Surgeon Performance Using Risk-Adjusted Quality-Cost Diagrams and Surgical Outcomes

2016 ◽  
Vol 32 (5) ◽  
pp. 532-540 ◽  
Author(s):  
William S. Knechtle ◽  
Sebastian D. Perez ◽  
Mehul V. Raval ◽  
Patrick S. Sullivan ◽  
Yazan M. Duwayri ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Risk Adjustment ◽  
Complication Rates ◽  
Single Institution ◽  
Improvement Program ◽  
Quality Cost ◽  
Surgical Quality ◽  
Accounting Data ◽  
Hospital Cost Accounting ◽  
Surgeon Performance

Quality-cost diagrams have been used previously to assess interventions and their cost-effectiveness. This study explores the use of risk-adjusted quality-cost diagrams to compare the value provided by surgeons by presenting cost and outcomes simultaneously. Colectomy cases from a single institution captured in the National Surgical Quality Improvement Program database were linked to hospital cost-accounting data to determine costs per encounter. Risk adjustment models were developed and observed average cost and complication rates per surgeon were compared to expected cost and complication rates using the diagrams. Surgeons were surveyed to determine if the diagrams could provide information that would result in practice adjustment. Of 55 surgeons surveyed on the utility of the diagrams, 92% of respondents believed the diagrams were useful. The diagrams seemed intuitive to interpret, and making risk-adjusted comparisons accounted for patient differences in the evaluation.

Economic impact of the use of the National Surgical Quality Improvement Program

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Alvine Fansi ◽  
Angela Ly ◽  
Julie Mayrand ◽  
Maggy Wassef ◽  
Aldanie Rho ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Cost Analysis ◽  
Economic Impact ◽  
Quality Improvement Program ◽  
Economic Evaluations ◽  
Complication Rates ◽  
Improvement Program ◽  
Surgical Quality ◽  
Acs Nsqip ◽  
The Cost

Objectives The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) is a validated, risk-adjusted database for improving the quality and security of surgical care. ACS NSQIP can help participating hospitals target areas that need improvement. The aim of this study was to systematically review the literature analyzing the economic impact of using NSQIP. This paper also provides an estimation of annual cost savings following the implementation of NSQIP and quality improvement (QI) activities in two hospitals in Quebec. Methods In June 2018, we searched in seven databases, including PubMed, Embase, and NHSEED for economic evaluations based on NSQIP data. Contextual NSQIP databases from two hospitals were collected and analyzed. A cost analysis was conducted from the hospital care perspective, comparing complication costs before and after 1 year of the implementation of NSQIP and QI activities. The number and the cost of complications are measured. Costs are presented in 2018 Canadian dollars. Results Out of 1,612 studies, 11 were selected. The level of overall evidence was judged to be of moderate to high quality. In general, data showed that, following the implementation of NSQIP and QI activities, a significant decrease in complications and associated costs was observed, which improved with time. In the cost analysis of contextual data, the reduction in complication costs outweighed the cost of implementing NSQIP. However, this cost analysis did not take into account the costs of QI activities. Conclusions NSQIP improves complication rates and associated costs when QI activities are implemented.

Short-term Complication Rates Following Anterior Urethroplasty: An Analysis of National Surgical Quality Improvement Program Data

Urology ◽  
2018 ◽  
Vol 111 ◽  
pp. 197-202 ◽  
Author(s):  
John M. Lacy ◽  
Ramiro J. Madden-Fuentes ◽  
Adam Dugan ◽  
Andrew C. Peterson ◽  
Shubham Gupta
Keyword(s):  
Quality Improvement ◽  
Quality Improvement Program ◽  
Complication Rates ◽  
Short Term ◽  
Improvement Program ◽  
Surgical Quality ◽  
Program Data

scholarly journals Impact of resident involvement in neurosurgery: an analysis of 8748 patients from the 2011 American College of Surgeons National Surgical Quality Improvement Program database

2015 ◽  
Vol 122 (4) ◽  
pp. 962-970 ◽  
Author(s):  
Seokchun Lim ◽  
Andrew T. Parsa ◽  
Bobby D. Kim ◽  
Joshua M. Rosenow ◽  
John Y. S. Kim
Keyword(s):  
Quality Improvement ◽  
Postoperative Complications ◽  
Operating Room ◽  
Quality Improvement Program ◽  
Independent Effect ◽  
Complication Rates ◽  
Improvement Program ◽  
Surgical Quality ◽  
Resident Involvement ◽  
American College Of Surgeons

OBJECT This study evaluates the impact of resident presence in the operating room on postoperative outcomes in neurosurgery. METHODS The authors retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and identified all cases treated in a neurosurgery service in 2011. Propensity scoring analysis and multiple logistic regression models were used to reduce patient bias and to assess independent effect of resident involvement. RESULTS Of the 8748 neurosurgery cases identified, residents were present in 4529 cases. Residents were more likely to be involved in complex procedures with longer operative duration. The multivariate analysis found that resident involvement was not a statistically significant factor for overall complications (OR 1.116, 95% CI 0.961–1.297), surgical complications (OR 1.132, 95% CI 0.825–1.554), medical complications (OR 1.146, 95% CI 0.979–1.343), reoperation (OR 1.250, 95% CI 0.984–1.589), mortality (OR 1.164, 95% CI 0.780–1.737), or unplanned readmission (OR 1.148, 95% CI 0.946–1.393). CONCLUSIONS In this multicenter study, the authors demonstrated that resident involvement in the operating room was not a significant factor for postoperative complications in neurosurgery service. This analysis also showed that much of the observed difference in postoperative complication rates was attributable to other confounding factors. This is a quality indicator for resident trainees and current medical education. Maintaining high standards in postgraduate training is imperative in enhancing patient care and reducing postoperative complications.

scholarly journals Quality Improvement–Focused Departmental Grand Rounds Reports: A Strategy to Engage General Surgery Residents

2016 ◽  
Vol 8 (2) ◽  
pp. 232-236 ◽  
Author(s):  
Jonathan S. Abelson ◽  
Katrina B. Mitchell ◽  
Cheguevera Afaneh ◽  
Barrie S. Rich ◽  
Theresa J. Frey ◽  
...  
Keyword(s):  
New York ◽  
Quality Improvement ◽  
Surgical Site Infections ◽  
Data Sources ◽  
Complication Rates ◽  
Improvement Program ◽  
Surgical Quality ◽  
Surgical Trainees ◽  
Tract Infections ◽  
Grand Rounds

ABSTRACT  Many institutions are seeking ways to enhance their surgical trainees' quality improvement (QI) skills.Background  To educate trainees about the importance of lifelong performance improvement, chief residents at New York Presbyterian Hospital–Weill Cornell Medicine are members of a multidisciplinary QI team tasked with improving surgical outcomes. We describe the process and the results of this effort.Objective  Our analysis used 2 data sources to assess complication rates: the National Surgical Quality Improvement Program (NSQIP) and ECOMP, our own internal complication database. Chief residents met with a multidisciplinary QI team to review complication rates from both data sources. Chief residents performed a case-by-case analysis of complications and a literature search in areas requiring improvement. Based on this information, chief residents met with the multidisciplinary team to select interventions for implementation, and delivered QI-focused grand rounds summarizing the QI process and new interventions.Methods  Since 2009, chief residents have presented 16 QI-focused grand rounds. Urinary tract infections (UTIs) and surgical site infections (SSIs) were the most frequently discussed. Interventions to improve UTIs and SSIs were introduced to the department of surgery through these reports in 2011 and 2012. During this time we saw improvement in outcomes as measured by NSQIP odds ratio.Results  Departmental grand rounds are a suitable forum to review NSQIP data and our internal, resident-collected data as a means to engage chief residents in QI improvement, and can serve as a model for other institutions to engage surgery residents in QI projects.Conclusions

scholarly journals Acute Complications in Total Wrist Arthroplasty: A National Surgical Quality Improvement Program Review

2019 ◽  
Vol 09 (02) ◽  
pp. 124-128 ◽  
Author(s):  
Michael D. Eckhoff ◽  
Julia M. Bader ◽  
Leon J. Nesti ◽  
John C. Dunn
Keyword(s):  
Quality Improvement ◽  
Postoperative Period ◽  
Quality Improvement Program ◽  
Complication Rates ◽  
Safe Procedure ◽  
Improvement Program ◽  
Level Of Evidence ◽  
Surgical Quality ◽  
Total Wrist Arthroplasty ◽  
Wrist Arthroplasty

Abstract Background The study sought to assess the patient-based variables, surgical risk factors, and postoperative conditions associated with readmission after total wrist arthroplasty (TWA). Materials and Methods All patients undergoing TWA were identified from the National Surgical Quality Improvement Program dataset from 2005 to 2016. Patient demographics, medical comorbidities, surgical characteristics, and outcomes were examined to isolate predictors for readmission within 30 days postoperatively. Results A total of 57 patients were identified to have undergone TWA. The average patients were 62.3 (13.8) years old, female (57.7%), and most were treated in the outpatient setting (67.3%). Comorbid conditions included smoking (17.3%), diabetes (15.4%), and chronic steroid therapy (15.4%). No complications were identified in the 30-day postoperative period. There was a trend for increasing utilization of TWA over the years included. Conclusion TWA is a safe procedure with low complication rates in the acute postoperative period. Increasing utilization is likely a result of improved outcomes and cost-effectiveness of TWA. Level of Evidence This is a Level II, prognostic study.

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