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American College 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. Number of Participating Sites by State and Region (487). CANADA 28.

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American College of Surgeons

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  1. AmericanCollege of Surgeons

  2. What ACS NSQIP Is ______________________________ • Web-Based data collection program • Quality improvement tool • National Benchmarking • Surgical outcomes data

  3. 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

  4. 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 _____________________________

  5. 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

  6. 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

  7. 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

  8. Data Collection Data Collected ______________________________ • Demographics • Surgical Profile • Pre-operative Data (risk factors) • Intra-operative Data • Post operative Data (outcomes)

  9. 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

  10. 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

  11. 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

  12. 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 ______________________________

  13. Real-Time Reports Workflow Reports Site-Level Reports Database Statistics Data Analysis Reporting ______________________________

  14. Reporting ______________________________ Pre-Operative Risk Factor Summary

  15. Reporting ______________________________ 30 Day Post-Op Summary

  16. Reporting ______________________________ Mortality Patient Report

  17. Reporting ______________________________ Post-Operative Occurrence Analysis

  18. Semiannual Report Reporting ______________________________ Risk adjusted for hospital-to-hospital patient mix differences.

  19. 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 ______________________________

  20. Semiannual Report: Model Summary

  21. Semiannual Report: Hospital-Specific Bar Plot

  22. Return on Investment ______________________________ ACS NSQIP Improves Outcomes and Saves Money

  23. 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

  24. 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 ______________________________

  25. Return on Investment ______________________________ ROI Calculator

  26. 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 ______________________________

  27. 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 ______________________________

  28. 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

  29. The Options _____________________________ Four Adult ACS NSQIP options ACS NSQIP Essentials ACS NSQIP Measures ACS NSQIP Small & Rural ACS NSQIP Procedure Targeted

  30. 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 _____________________________

  31. ACS NSQIP Measures 5 High Impact Measures: - UTI - Colorectal - SSI - Lower Extremity Bypass - Elderly Minimal Data Collection = 840 cases collected annually 1/2 FTE _______________________________

  32. 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) _____________________________

  33. 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) ______________________________

  34. Pricing _____________________________

  35. 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.

  36. Recognition _______________________________ Institute of Medicine named ACS NSQIP “the best in the nation” for measuring & reporting surgical quality and outcomes.

  37. Tresha Russell Business Development Representative tresharussell@facs.org 312-202-5441 _______________________________

  38. Thank you _______________________________

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