Do cancer centers need to assess quality and outcomes? Introducing a customized ACS-NSQIP for oncology (Onc-NSQIP).

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 475-475 ◽  
Author(s):  
K. Y. Bilimoria ◽  
X. Wang ◽  
M. E. Cohen ◽  
B. L. Hall ◽  
K. Richards ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Regression Models ◽  
Operative Procedure ◽  
Surgical Oncology ◽  
The Other ◽  
Cancer Center ◽  
Cancer Centers ◽  
Acs Nsqip ◽  
Quality And Outcomes ◽  
Assess Quality

475 Background: To identify quality improvement opportunities, hospitals can use ACS NSQIP to compare their risk-adjusted performance to other hospitals. However, Cancer Centers have few opportunities to compare their outcomes to similar hospitals for oncologic operations. Our objective was to develop an oncology-specific version of ACS NSQIP (Onc-NSQIP) and determine whether it could be useful for Cancer Centers. Methods: From ACS-NSQIP (2006-2009), patients undergoing major colorectal (n=34,858; 221 hospitals) and pancreatic (n=7,667; 65 hospitals) as well as esophageal, gastric, and soft tissue operations for malignancy were identified. Risk-adjusted postoperative outcomes were assessed with regression models adjusting for demographics, comorbidities, and operative procedure. Relative rankings of NCI-designated Comprehensive Cancer Centers in ACS NSQIP among the other ACS NSQIP hospitals were compared. Results: Cancer Center outcomes varied widely for colorectal and pancreas. For overall colorectal morbidity, Cancer Centers were ranked in the top third (n=4), middle third (n=7), and bottom third (n=10). For colorectal 30-day mortality, Cancer Centers were ranked in the top (n=14), middle (n=3), and bottom third (n=4). For overall pancreatic morbidity, Cancer Centers were ranked in the top (n=5), middle (n=7), and bottom third (n=7). For pancreatic 30-day mortality, Cancer Centers were ranked in the top (n=5), middle (n=6), and bottom third (n=8). Similar results were observed for colorectal and pancreas for DVT/PE, SSI, reoperation, and length of stay. Onc-NSQIP models were comparable to standard ACS NSQIP models. At least some Cancer Centers were statistical outliers for most outcomes (P<0.05). Results were similar for other malignancies. Conclusions: Cancer Center outcomes varied as much as other ACS NSQIP hospitals, demonstrating need for quality assessment. Without standardized risk-adjusted outcomes comparisons, Cancer Centers cannot accurately assess their outcomes to identify quality improvement targets. ACS NSQIP's new platform allows customization so hospitals can compare surgical oncology-specific risk-adjusted processes and outcomes. No significant financial relationships to disclose.

Surgical oncology outcomes: The role of nurse practice environments

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6105-6105
Author(s):  
C. R. Friese ◽  
L. H. Aiken
Keyword(s):  
Logistic Regression ◽  
Patient Outcomes ◽  
Regression Models ◽  
Surgical Oncology ◽  
Cancer Center ◽  
Practice Environment ◽  
Failure To Rescue ◽  
Oncology Patient ◽  
Logistic Regression Models

6105 Background: Increased attention has focused on the role of hospital characteristics on cancer patient outcomes. We examined two cancer-specific credentials, as well registered nurse practice environments, on outcomes of care. Methods: Through secondary analysis of existing data from hospital claims, the tumor registry, and a statewide of survey of nurses (RNs), we studied 30-day mortality (D) and failure to rescue (death given a complication) (FTR) for surgical oncology patients treated in 164 Pennsylvania hospitals from 1998–1999 (N=24,618). We compared D and FTR rates by a hospital’s NCI cancer center designation, American College of Surgeon’s (ACoS) cancer program approval and categorized scores on the Practice Environment Scale of the Nursing Work Index (PES-NWI). The PES-NWI scales measure RN participation in hospital affairs, RN foundations for quality of care, nurse manager leadership/support, staffing/resource adequacy, and RN-physician relations. Multivariate logistic regression models examined predictors of D and FTR, controlling for 25 patient variables. Standard errors were corrected for patient clustering in hospitals. Results: NCI centers had lower D and FTR rates (p < .01). ACoS hospitals had lower D and FTR rates (ns). Hospitals with low scores on PES-NWI scales had the poorest outcomes (p < .01). In logistic regression models, significant predictors included unfavorable PES-NWI Scores for D (OR=1.32, 95% CI: 1.06–1.65) and FTR (OR=1.39, 95% CI:1.03–1.88), and NCI centers for D (OR=0.64, 95% CI: 0.50–0.83) and FTR (OR=0.67, 95% CI: 0.47–0.96). The NCI effect lost significance when environment was included. ACoS program effects were small (OR= 0.99, p = .90) for both outcomes. Conclusions: Favorable outcomes in NCI centers may be partly explained by practice environments. The practice environment of RNs significantly predicts surgical oncology patient outcomes, and should be a focus of quality improvement activities. No significant financial relationships to disclose.

Total Abdominal Colectomy Has a Similar Short-Term Outcome Profile Regardless of Indication: Data from the National Surgical Quality Improvement Program

2011 ◽  
Vol 77 (12) ◽  
pp. 1613-1618 ◽  
Author(s):  
Patricia C. Alves-Ferreira ◽  
Luiz Felipe De Campos-Lobato ◽  
Massarat Zutshi ◽  
Tracy Hull ◽  
Brooke Gurland
Keyword(s):  
Quality Improvement ◽  
Postoperative Complications ◽  
Chronic Constipation ◽  
The Other ◽  
Short Term ◽  
Improvement Program ◽  
Term Outcome ◽  
Total Abdominal Colectomy ◽  
Acs Nsqip ◽  
National Quality

The purpose of this study was to evaluate the 30-day postoperative complications rate in patients undergoing elective total abdominal colectomy (TAC) for chronic constipation, neoplastic disorders, and inflammatory bowel disease (IBD) using the American College of Surgeons National Quality Improvement Database (ACS-NSQIP). The 2007 ACS-NSQIP sample was used to identify the Current Procedural Terminology codes for TAC and International Classification of Diseases, 9th Revision codes for chronic constipation, neoplasia, and IBD. Preoperative and intraoperative variables and postoperative complications were compared among the three diagnosis groups. Wilcoxon rank sum and Fisher exact tests were used for analysis. P < 0.05 was considered significant. Seven hundred forty-four patients were identified; chronic constipation was found in 107 (14.4%) patients, neoplasia in 312 (42.3%), and IBD in 322 (43.3%). Patients with constipation were predominantly females (85.2%). The neoplastic group was older and had greater body mass index when compared with the other groups. Patients with IBD presented greater use of steroids, lower albumin and hematocrit levels, and higher morbidity probability. Constipated patients had more neurologic and renal complications when compared with the IBD group ( P = 0.01). None of the other categories of complications were statistically different among the diagnosis groups. With the exception of urinary tract infection being higher in the constipation patients compared with IBD (10 vs 4%, P = 0.03), there were no statistically significant differences among the other short-term specific complications. The 30-day complication rate after TAC is similar for chronic constipation, neoplasia, and IBD.

Agni - Key factor for Shodhananga Snehapana.

2017 ◽  
Vol 2 (1) ◽  
Author(s):  
Pavithra. S. ◽  
H. G. Gouda ◽  
Rajalakshmi M. G.
Keyword(s):  
Operative Procedure ◽  
The Other ◽  
Successful Outcome ◽  
Other Hand ◽  
Key Factor ◽  
Health And Disease

Agni is termed as Vaishwanara as it takes the person from Mruthyuloka to Swargaloka. It is an important factor and is equitant to Prana; is one among Dashaprana Ayatana. Agni in Shareera is present in different forms with different actions. It is the responsible factor for both health and disease; on the other hand the successful outcome of treatment is also dependant on Agni. Chikitsa (treatment) is the process of bestowing normalcy which is either brought by Shodhana (purificatory) or Shamana (palliative) Karma. Snehapana is a pre-operative procedure for Shodhana Chikitsa where in Sneha Dravya (medicated fat) is administered for attainment of Upasthita Dosha Avastha and further ease in elimination of the vitiated Doshas. Assessment of Dosha, Dushya, Vyadhi Avastha, Roga Bala, Rogi Bala, Agni, Koshta etc. factors are essential for the attainment of Chikitsa Phala. Assessment of Agni not only helps in understanding Vyadhi but also enables to plan the dosage of Sneha to be administered. Thus this paper is an attempt to throw light on the importance of Agni, assessment of Agni and Agni Bala prior to Shodhananga Snehapana.

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.

A Screening Attachment for an Amadas Peanut Combine1

1998 ◽  
Vol 25 (2) ◽  
pp. 110-114
Author(s):  
P. D. Blankenship ◽  
J. W. White ◽  
M. C. Lamb
Keyword(s):  
Quality Improvement ◽  
Research Laboratory ◽  
High Capacity ◽  
The Other ◽  
Market Values ◽  
Alternative Method ◽  
Cylindrical Screen ◽  
Foreign Materials

Abstract Some farmers mechanically screen farmer stock (FS) peanuts after combining to remove undesired materials for value and quality improvement. Screening is accomplished with low capacity, portable screens at the field after combining or with high capacity cleaners or screens at buying points. An alternative method for FS peanut screening has been developed cooperatively by Amadas Industries and USDA-ARS, National Peanut Research Laboratory utilizing an experimental combine screening attachment. The attachment is a hydraulically driven, rotating cylindrical screen (trommel) with an axis inclined less than 10° from horizontal during operation. Peanuts are screened with the trommel prior to entering the combine basket, and smaller, unwanted materials are returned to the soil. Thirty-eight lots of FS peanuts averaging 3.27 t/lot were combined throughout all U.S. peanut-producing regions to examine performance. Foreign materials for the screened lots averaged 2.15% less than the unscreened lots (P = 0.05). Hulls were 0.62% less in the screened lots (P = 0.05). None of the other grade factors or market values per hectare were significantly different for runner peanuts. Foreign materials for screened virginia peanuts were 2.44% less than in unscreened (P = 0.01). Loose shelled kernels were 0.44% higher (P = 0.05), hulls 0.67% lower (P = 0.10), and damage 0.56% higher in screened peanuts than in unscreened. None of the other grade factors or market values per hectare were significantly different for Virginia peanuts. Although most grade factors and values per hectare were not significantly different for screened and unscreened peanuts tested, foreign materials were reduced significantly providing needed quality improvement. Possible cleaning costs also could be reduced with the attachment.

scholarly journals Quality improvement in general practice: what do GPs and practice managers think? Results from a nationally representative survey of UK GPs and practice managers

2021 ◽  
Vol 10 (2) ◽  
pp. e001309
Author(s):  
Jennifer Gosling ◽  
Nicholas Mays ◽  
Bob Erens ◽  
David Reid ◽  
Josephine Exley
Keyword(s):  
General Practice ◽  
Quality Improvement ◽  
General Practitioners ◽  
Service Improvement ◽  
Protected Time ◽  
Routine Work ◽  
Professional Interest ◽  
Quality And Outcomes ◽  
Nationally Representative ◽  
The Uk

BackgroundThis paper presents the results of the first UK-wide survey of National Health Service (NHS) general practitioners (GPs) and practice managers (PMs) designed to explore the service improvement activities being undertaken in practices, and the factors that facilitated or obstructed that work. The research was prompted by growing policy and professional interest in the quality of general practice and its improvement. The analysis compares GP and PM involvement in, and experience of, quality improvement activities.MethodsThis was a mixed-method study comprising 26 semistructured interviews, a focus group and two surveys. The qualitative data supported the design of the surveys, which were sent to all 46 238 GPs on the Royal College of General Practitioners (RCGP) database and the PM at every practice across the UK (n=9153) in July 2017.ResultsResponses from 2377 GPs and 1424 PMs were received and were broadly representative of each group. Ninety-nine per cent reported having planned or undertaken improvement activities in the previous 12 months. The most frequent related to prescribing and access. Key facilitators of improvement included ‘good clinical leadership’. The two main barriers were ‘too many demands from external stakeholders’ and a lack of protected time. Audit and significant event audit were the most common improvement tools used, but respondents were interested in training on other quality improvement tools.ConclusionGPs and PMs are interested in improving service quality. As such, the new quality improvement domain in the Quality and Outcomes Framework used in the payment of practices is likely to be relatively easily accepted by GPs in England. However, if improving quality is to become routine work for practices, it will be important for the NHS in the four UK countries to work with practices to mitigate some of the barriers that they face, in particular the lack of protected time.

scholarly journals An innovative intervention to improve respectful maternity care in three Districts in Ethiopia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Birkety Mengistu ◽  
Haregeweyni Alemu ◽  
Munir Kassa ◽  
Meseret Zelalem ◽  
Mehiret Abate ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Maternity Care ◽  
Regression Coefficient ◽  
Interrupted Time Series ◽  
The Other ◽  
Respectful Maternity Care ◽  
Experience Of Care ◽  
National Initiative ◽  
Care Training

Abstract Background Mistreatment of women during facility-based childbirth is a major violation of human rights and often deters women from attending skilled birth. In Ethiopia, mistreatment occurs in up to 49.4% of mothers giving birth in health facilities. This study describes the development, implementation and results of interventions to improve respectful maternity care. As part of a national initiative to reduce maternal and perinatal mortality in Ethiopia, we developed respectful maternity care training module with three core components: testimonial videos developed from key themes identified by staff as experiences of mothers, skills-building sessions on communication and onsite coaching. Respectful maternity care training was conducted in February 2017 in three districts within three regions. Methods Facility level solutions applied to enhance the experience of care were documented. Safe Childbirth Checklist data measuring privacy and birth companion offered during labor and childbirth were collected over 27 months from 17 health centers and three hospitals. Interrupted time series and regression analysis were conducted to assess significance of improvement using secondary routinely collected programmatic data. Results Significant improvement in the percentage of births with two elements of respectful maternal care—privacy and birth companionship offered— was noted in one district (with short and long-term regression coefficient of 18 and 27% respectively), while in the other two districts, results were mixed. The short-term regression coefficient in one of the districts was 26% which was not sustained in the long-term while in the other district the long-term coefficient was 77%. Testimonial videos helped providers to see their care from their clients’ perspectives, while quality improvement training and coaching helped them reflect on potential root causes for this type of treatment and develop effective solutions. This includes organizing tour to the birthing ward and allowing cultural celebrations. Conclusion This study demonstrated effective way of improving respectful maternity care. Use of a multipronged approach, where the respectful maternity care intervention was embedded in quality improvement approach helped in enhancing respectful maternity care in a comprehensive manner.

scholarly journals Implementing Cancer Care in Rwanda: Capacity Building for Treatment and Scale-Up

2021 ◽  
Vol 13 (13) ◽  
pp. 7216
Author(s):  
Paul H. Park ◽  
Cyprien Shyirambere ◽  
Fred Kateera ◽  
Neil Gupta ◽  
Christian Rusangwa ◽  
...  
Keyword(s):  
Capacity Building ◽  
Scale Up ◽  
Implementation Strategies ◽  
Sub Saharan Africa ◽  
Essential Medicines ◽  
Cancer Center ◽  
Health Coverage ◽  
Cancer Centers ◽  
Implementation Approach ◽  
Single Cancer

Background: The majority of countries in sub-Saharan Africa are ill-prepared to address the rising burden of cancer. While some have been able to establish a single cancer referral center, few have been able to scale-up services nationally towards universal health coverage. The literature lacks a step-wise implementation approach for resource-limited countries to move beyond a single-facility implementation strategy and implement a national cancer strategy to expand effective coverage. Methods: We applied an implementation science framework, which describes a four-phase approach: Exploration, Preparation, Implementation, and Sustainment (EPIS). Through this framework, we describe Rwanda’s approach to establish not just a single cancer center, but a national cancer program. Results: By applying EPIS to Rwanda’s implementation approach, we analyzed and identified the implementation strategies and factors, which informed processes of each phase to establish foundational cancer delivery components, including trained staff, diagnostic technology, essential medicines, and medical informatics. These cancer delivery components allowed for the implementation of Rwanda’s first cancer center, while simultaneously serving as the nidus for capacity building of foundational components for future cancer centers. Conclusion: This “progressive scaling” approach ensured that initial investments in the country’s first cancer center was a step toward establishing future cancer centers in the country.

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