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.

抽象的当前监测手术护理质量的方法相关的重要局限性包括： (a) 回顾性和偶发性（例如：每季度、每半年等）反馈方式可以创造时间绩效下降与医院意识到之间的滞后； (b) 临床小群使用当前的情景分析结构可能无法检测到有意义的不良表现； (c) 大多数医疗保健实体愿意接受平均绩效，但如果绩效开始下降，他们会做出反应低于可接受的阈值。因此，可以缩短反馈时间滞后的替代方法，改善对围手术期护理流程可能不理想的医院的发现，或启发医院更加积极主动地进行计划改进可以提高当前的质量改进努力并为 VHA 带来实实在在的好处。该提案的总体目标是产生比较监测 VA 医院手术表现的新颖替代方法的有效性数据情景数据分析和反馈的当前标准。具体目标是：（1）比较CUSUM （从工业界借用的统计过程控制方法）到情景观察到预期评估 VA 医院手术表现的方法； (2)评估30天的综合结果死亡率、主要发病率和再手术作为机构绩效相对于仅 30 天死亡率或总体发病率。这项工作将涉及医院级别的观察性设计，使用 VA 手术质量改进计划 (VASQIP) 数据，适用于接受住院普通科、 2010 年至 2016 年间血管、胸部、泌尿生殖、骨科、脊柱或神经外科手术。数据将用于对这些监测 VA 的替代 QI 策略进行比较有效性分析相对于当前 30 天死亡率偶发报告标准的医院手术表现或单独发病。该项目很新颖，因为它将是工业质量控制的首次应用 VASQIP 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，以促进未来的前瞻性评估和最终实施。这是预计分析将证明这些替代方法可能具有重大价值医院当地的质量改进工作。纳入额外的手术监测方法通过尽早认识到 VASQIP 的结果，可以为 VHA 和退伍军人带来显着的好处围手术期护理流程可能存在问题的医院与次优的术后护理流程相关手术结果、纠正错误护理过程的成本降低、发病率降低及早识别和解决此类错误流程，以及公众认为 VA 仍然存在手术质量全国领先。鉴于 VHA 目前的重点是确保各级和各个领域的优质护理在所有护理机构中，这种替代方法也可能影响现有的质量改进是可行的手术之外的计划或新举措也是如此。

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.

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

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

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。