Comparative Effectiveness of Alternative Strategies for Monitoring Hospital Surgical Performance

监测医院手术表现的替代策略的比较有效性

基本信息

批准号：
10186540
负责人：
Nader Nabile Massarweh
金额：
--
依托单位：
MICHAEL E DEBAKEY VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-05-01 至 2021-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10186540
关键词：
Address Adverse event Awareness Blood Vessels Caring Chest Clinical Data Data Analyses Detection Disadvantaged Early Diagnosis Early identification Ensure Evaluation Event Exposure to Feedback Future Genitourinary system Goals Healthcare Hospitals Individual Industrialization Industry Infrastructure Inpatients Institution Measures Methodology Monitor Morbidity - disease rate Nature Operative Surgical Procedures Orthopedics Outcome Patients Perception Performance Perioperative Perioperative Care Postoperative Period Predictive Value Private Sector Process Production Quality Control Quality Indicator Quality of Care Repeat Surgery Reporting Resolution Risk Running Security Signal Transduction Specific qualifier value Statistical Computing Statistical Methods Structure Sum Techniques Time Variant Vertebral column Veterans Work base comparative comparative effectiveness comparative effectiveness analysis cost design effectiveness evaluation falls health care settings hospital performance improved mortality novel operation perioperative mortality programs prospective real time monitoring response surgery outcome surgical risk symposium

项目摘要

Abstract Important limitations associated with current approaches for monitoring the quality of surgical care include: (a) the retrospective and episodic (e.g.: quarterly, bi-annually, etc.) approach to feedback which creates a time lag between when performance is declining and when the hospital is made aware; (b) small clusters of clinically meaningful poor performance may go of undetected using current episodic analytic structures; (c) most healthcare entities are willing to accept average performance, but will respond if performance starts to fall below an acceptable threshold. As such, alternative approaches that could shorten the time lag for feedback, improve the detection of hospitals with potentially suboptimal perioperative care processes, or inspire hospitals to be more proactive in programmatic improvement could enhance current quality improvement efforts and have tangible benefits for VHA. The overall goal of this proposal is to generate comparative effectiveness data on novel, alternative approaches for monitoring VA hospital surgical performance relative to the current standard of episodic data analysis and feedback. The specific aims are to: (1) compare the CUSUM (a statistical process control methodology borrowed from industry) to the episodic Observed-to-Expected approach for evaluating surgical performance at VA hospitals; (2) evaluate a composite outcome of 30-day mortality, major morbidity, and reoperation as an indicator of declining institutional performance relative to 30-day mortality or overall morbidity alone. This work will involve a hospital-level, observational design using VA Surgical Quality Improvement Program (VASQIP) data for patients who underwent inpatient general, vascular, thoracic, genitourinary, orthopedic, spine, or neurosurgical operations between 2010 and 2016. Data will be used to conduct a comparative effectiveness analysis of these alternative QI strategies for monitoring VA hospital surgical performance relative to the current standard of episodic reporting of 30-day mortality or morbidity individually. This project is novel because it will be the first application of industrial quality control techniques to VASQIP, will provide important real-world comparative data on alternative approaches for evaluating hospital performance, and will evaluate such approaches within the context of the existing VASQIP framework and infrastructure to facilitate future prospective evaluation and eventual implementation. It is anticipated the analyses will demonstrate these alternative approaches could have significant value for hospitals' local quality improvement efforts. Incorporating additional approaches for monitoring surgical outcomes into VASQIP could have notable benefits for VHA and Veterans through earlier recognition of hospitals with potentially problematic perioperative care processes that are associated with suboptimal post- operative outcomes, decreased costs for correcting errant care processes, decreased rates of morbidity through the earlier identification and resolution of such errant processes, and the public perception that the VA remains a national leader in surgical quality. Given the VHA's current focus on ensuring quality care at all levels and in all care settings, it is feasible such alternative approaches could also influence existing quality improvement programs or new initiatives outside of surgery as well.

抽象的与目前监测手术护理质量有关的方法相关的重要限制包括：（a）回顾性和情节（例如：每季度，一年一度等）反馈的方法，这会产生时间何时绩效下降和医院意识到何时滞后；（b）临床上的小簇有意义的不良性能可能会使用当前的情节分析结构未被发现。（c）大多数医疗保健实体愿意接受平均表现，但是如果绩效开始下降，将会做出回应低于可接受的阈值。因此，可以缩短反馈时间滞后时间的替代方法，通过潜在的围手术期护理过程来改善医院的检测，或激发医院在程序化改进方面更加主动可以提高当前质量的改善努力并为VHA带来切实的好处。该提案的总体目标是产生比较相对于监测VA医院手术表现的新颖，替代方法的有效性数据当前的情节数据分析和反馈标准。具体目的是：（1）比较爵士（一种从行业借入的统计过程控制方法）到观察到的情节评估VA医院手术表现的方法；（2）评估30天的综合结果死亡率，主要发病率和重新手术是相对于机构绩效下降的指标仅30天死亡率或整体发病率。这项工作将涉及使用医院级别的观察设计 VA外科质量改进计划（VASQIP）数据，用于接受住院通用的患者 2010年至2016年之间的血管，胸腔，泌尿生殖器，骨科，脊柱或神经外科手术。将用于对这些替代的QI策略进行比较有效性分析，以监视VA 医院手术表现相对于当前的30天死亡率的情节报告标准或分别发病。该项目是新颖的，因为它将是工业质量控制的第一个应用 vasqip的技术将为替代方法提供重要的现实世界比较数据评估医院的绩效，并将在现有VASQIP的背景下评估此类方法框架和基础设施，以促进未来的预期评估和最终实施。这是预期分析将证明这些替代方法可能具有重要的价值医院的当地质量改进工作。结合手术的其他方法通过早期认识到VHA和退伍军人的VASQIP的成果可能会为VHA和退伍军人带来明显的好处具有与次优的围手术期护理过程的医院手术成果，降低了纠正错误护理过程的成本，发病率降低此类错误过程的较早识别和解决方案，以及公众对VA仍然存在的看法手术质量的国家领导者。鉴于VHA目前的重点是确保各个级别的优质护理在所有护理环境中，这种替代方法也可能影响现有的质量改善手术外的计划或新举措。

项目成果

期刊论文数量（11）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Surgical Quality Improvement: Working Toward Value or a Work in Progress?

DOI：
10.1016/j.jss.2018.09.086
发表时间：
2019-03-01
期刊：
JOURNAL OF SURGICAL RESEARCH
影响因子：
2.2
作者：
Yu, Justin;Massarweh, Nader N.
通讯作者：
Massarweh, Nader N.

Relationship Between Perioperative Outcomes Used for Profiling Hospital Noncardiac Surgical Quality.

用于分析医院非心脏手术质量的围手术期结果之间的关系。

DOI：
10.1016/j.jss.2021.02.004
发表时间：
2021
期刊：
The Journal of surgical research
影响因子：
0
作者：
Massarweh,NaderN;Chen,ViviW;Rosen,Tracey;Richardson,PeterA;Harris,AlexHS;Petersen,LauraA
通讯作者：
Petersen,LauraA

Risk-Adjusted Cumulative Sum for Early Detection of Hospitals With Excess Perioperative Mortality.

用于及早发现围手术期死亡率过高的医院的风险调整累积金额。

DOI：
10.1001/jamasurg.2023.3673
发表时间：
2023
期刊：
JAMA surgery
影响因子：
16.9
作者：
Chen,ViviW;Chidi,AlexisP;Dong,Yongquan;Richardson,PeterA;Axelrod,DavidA;Petersen,LauraA;Massarweh,NaderN
通讯作者：
Massarweh,NaderN

Opportunities to Improve the Capacity to Rescue: Intraoperative and Perioperative Tools.

提高救援能力的机会：术中和围手术期工具。