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A National Comparison of Laparoscopic versus Open Colectomy Using NSQIP

A National Comparison of Laparoscopic versus Open Colectomy Using NSQIP. Anthony J Senagore M.D, M.S., M.B.A. VP/CAO, Spectrum Health Professor of Surgery, Michigan State University Grand Rapids, MI. Anxiety About Health Care ($$).

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A National Comparison of Laparoscopic versus Open Colectomy Using NSQIP

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  1. A National Comparison of Laparoscopic versus Open Colectomy Using NSQIP Anthony J Senagore M.D, M.S., M.B.A. VP/CAO, Spectrum Health Professor of Surgery, Michigan State University Grand Rapids, MI

  2. Anxiety About Health Care ($$) • Employers: premiums growing at 2-3x wages; affecting profits and competitiveness • Consumers: higher out-of-pocket costs keeping real wage growth down; fear of losing insurance; lack of information for confident decisions • Insurers: pressure from employer customers to control rising costs • Doctors and Hospitals: Medicare reimbursement rates; administrative challenges of data collection, performance measurement and reporting

  3. Defining Value • Risk Adjusted Comparison • Outcomes defined • Resource Consumption • Transparency of Reporting • Hospital/Physician Comparison • Informed Consent

  4. Complex Interactions:Quality • Hospital Systems • Diagnostic Equipment/access • Staffing • OR equipment • Operative Technique • Postoperative Care • Preoperative Evaluation/Optimization • Enhanced Recovery Protocols • Post-Discharge care plans

  5. Hospital Issues Beds Personnel OR’s Diagnostic equipment Doctor Issues # admissions/ LOS Complications Case volume/mix Duration of Surgery Equipment used Tests ordered Readmissions Sources of Surgical Cost

  6. Potential Administrative Data Sources • CMS • National Inpatient Census • Premier • ACS-NSQIP • Surgical Risk Formulae

  7. What is NSQIP • 30 day observational database • Trained and audited nurse evaluators • 121 sites in the US (academic and community hospitals)

  8. NSQIP Model vs Others

  9. NSQIP Lap v Open Kennedy et al. Ann Surg 2009;249: 596–601

  10. NSQIP Lap v Open Kennedy et al. Ann Surg 2009;249: 596–601

  11. NSQIP Lap v Open Kennedy et al. Ann Surg 2009;249: 596–601

  12. NSQIP Lap v Open Kennedy et al. Ann Surg 2009;249: 596–601

  13. NSQIP Lap v Open Kennedy et al. Ann Surg 2009;249: 596–601

  14. NSQIP Lap v Open: Outcomes Senagore et al. DCR 2009 52: 183-6

  15. NSQIP Lap v Open: ? cohorts Senagore et al. DCR 2009 52: 183-6

  16. Departmental length of stay 1991-1999 1999 3-6/2000 n LOS n LOS n LOS DRG 148 study team 1784 9.5 185 8.6 62 5.7 * other CR teams 6459 9.8 824 8.8 162 10.1 Laparoscopic 24 3.2 * DRG 149 study team 742 6.4 69 5.2 44 3.5 † other CR teams 2256 6.4 327 5.1 111 4.5 Laparoscopic 18 2.5 * DRG 148 & 149 study team 2526 8.6 254 7.7 106 4.7 § other CR teams 8715 8.9 1151 7.7 273 7.7 Laparoscopic 42 2.9 * * p<0.0001; † p=0.002; §p<0.001, Student’s t test Delaney, Fazio, Senagore et al, Br J Surg, 2001

  17. The Future ??

  18. Conclusion • Belief in a system approach • Align stakeholder incentives • Understanding Cost/Quality Impacts • Report OUR Value Proposition

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