“The Veterans Health Administration: NSQIP Program” (Ball, Weaver, Kiel; 2004) was a physician-driven comparison study initiated by senior surgeons between 1991 and 1997, in which mortality and morbidity rates were “risk adjusted and compared to observed-to-expected ratios”.
They studied data in order to determine the efficacy of surgical procedures from the pre-operative- through 30-day post-operative periods. This study was intended to improve the quality of care provided to patients throughout the Veterans Administration Medical Centers (VAMC) nationwide during the operative periods stated above by utilizing the National VA Surgical Risk Study (NVASRS).
The information technology (IT) system, VISTA, is an electronic medical record system developed by the VHA which uniformly connects the entire VAMC system and was utilized in the compilation of the necessary data. They intended to show that the quality of care provided for the patients was equal to the outcomes produced within the study and initiated solid evidenced-based practice (EVP) protocols to ensure improvement of outcomes.
Improvements were noted across the spectrum after the program was initiated. The 30-day mortality rate improved by 9.6%, the 30-day morbidity rate by 30% and length of stays decreased from 10.2 days to 5.1 days (a full 50% improvement). The VAMC sites with the greatest improvements also noted a significant improvement in patient satisfaction. Comparative Studies.
1) “Patient Safety. Validity of Selected AHRQ Patient Safety Indicators.
Based on VA National Surgical Quality Improvement Program Data” (2009) by Romano, Mull, Rivard et.al is a comparative study in which the NSQIP data at VAMC’s during fiscal year 2001 is merged with AHRQ Patient Safety Indicators (PSI). The purpose of this study is to determine the appropriate criterion for inclusion within the definitions given to the five PSI in order to appropriately and effectively study the 30-day morbidity and mortality rates as is applicable to private sector facilities.
By utilizing the VAMC’s data for determination of definition, the authors set out to utilize EVP effectively; thereby improving outcomes across the continuum of care nationwide. PSI software was utilized to evaluate the data extracted from the VAMC’s VISTA program and incorporate the ICD9 codes necessary in order to effectively compare VA and private sector data. Per the study “NSQIP events were generally defined more narrowly or precisely than PSI events, except for ‘‘postoperative wound dehiscence.’’ Our alternative PSI definitions improved the sensitivities of all five PSIs…”
2) “Surgical Outcomes for Patients Aged 80 and Older: Morbidity and Mortality from Major Noncardiac Surgery” by Hamel, Henderson, Khuri, and Daley (2005) was a prospective cohort study in which VA patients >/= 80 years of age were selected based on non-cardiac related surgeries from 1991 to 1998. The purpose of the study was to determine the efficacy of the use of the NSQIP program guidelines to the elderly population. Per the study, the “findings have a few important implications.
A substantial minority of patients aged 80 and older who have major noncardiac surgery die or suffer a postoperative complication, but the majority have good outcomes, and for many operations, mortality rates were low (>2%).” The data produced by this study is intended to provide patients, families and providers with important information necessary to determine whether a proposed surgery is beneficial when compared with the risks of mortality and morbidity. Implications for the Future of Case Conclusions.
These complimentary studies confirmed the need for review of risk-adjusted data in order to provide for the exceptional care demanded and required for surgical patients nationwide. They confirmed that the data collection modalities designed by the VA are applicable and feasible within the private sector as well.
It is imperative that facilities incorporate programs within their systems that are able to incorporate cost-effective, evidence-based and risk-adjusted data in order to design treatment modalities appropriate to the care of our aging population. Communication is crucial to the efficacy of all surgical procedures, and the implementation of EVP programs is necessary if quality improvements are to be successfully implemented.
References
Ball, M., Weaver, C. and Kiel, M. (2004). Healthcare Information Management Systems: Cases, Strategies and Solutions (3r ed.). New York: Springer-Verlag Hamel, M., Henderson, W., Khuri, S., & Daley, J. (2005). Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. Journal Of The American Geriatrics Society, 53(3), 424-429.
Retrieved from EBSCOhost. Romano, P., Mull, H., Rivard, P., Zhao, S., Henderson, W., Loveland, S., & … Rosen, A. (2009). Validity of selected AHRQ patient safety indicators based on VA National Surgical Quality Improvement Program data. Health Services Research, 44(1), 182-204. Retrieved from EBSCOhost. .