Measuring Up: Associations between SCIP measures and Surgical Outcomes

衡量标准：SCIP 措施与手术结果之间的关联

• 批准号: 8087895
• 负责人: Mary Hawn
• 金额: --
• 依托单位: BIRMINGHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-02-01 至 2012-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8087895
• 关键词: Accounting; Adherence; Admission activity; Antibiotics; Cardiac; Caring; Case Mixes; Cohort Studies; Comorbidity; Complex; Decision Making; Deep Vein Thrombosis; Equation; Event; Future; Goals; Healthcare; Hospitals; Incentives; Individual; Infection; Information Systems; Lead; Logistic Regressions; Measurement; Measures; Methods; Myocardial Infarction; Operative Surgical Procedures; Outcome; Outcome Measure; Patients; Peer Review; Performance; Physicians; Population; Postoperative Period; Prevention; Procedures; Process; Process Measure; Pulmonary Embolism; Quality of Care; Site; Structure; Surgical complication; System; Time; Venous; Veterans; adverse outcome; cost; health administration; hospital patient care; improved; prevent; programs; prophylactic; statistics; trend

DESCRIPTION (provided by applicant): Anticipated Impacts on Veteran's Healthcare: Currently, VHA is the only system where data on Surgical Care Improvement Program (SCIP) performance measures are collected with their targeted outcomes. This study will assess the current state of surgical care performance measurement and will guide future refinements in surgical care quality assessment, and ultimately more informed decision making for preventing adverse surgical outcomes. This will not only improve surgical care, but can eventually lead to reduction in cost to VHA related to adverse outcomes. Project Background: SCIP, a national collaborative to improve surgical care, began in 2005. VHA is one of 34 partners in the project and began tracking SCIP performance through the External Peer Review Program (EPRP) in 2005. The goal of SCIP is to reduce surgical complications by 25% by 2010. While these measures are intended to reduce surgical complications, they are also used as criteria for physician incentive pay as well as hospital quality measurement. Few studies, including our own, have shown associations between individual SCIP performance measures and the adverse surgical outcomes they are intended to prevent, making it unclear as to whether they should be used as the measures of surgical or hospital quality. Our previous study examined the single SCIP measure available in 2006, providing a snapshot of performance and outcomes. There are currently three SCIP topics modules tracked by VA: 1) Infection (6 measures), 2) Venous Thromboembolus (2 measures), and 3) Cardiac Prevention (1 measure). We propose examining the association between the process measures with the adverse surgical outcomes they target. This will provide a more complex, comprehensive assessment of the current state of surgical care performance measurement in VHA. Project Objectives: The objectives of this project are: 1)To determine the factors associated with adherence to SCIP performance at the patient, hospital and system level. 2)To examine the association between SCIP performance measures and adverse surgical outcomes on both a patient and facility level. 3)To analyze trends in surgical complications and SCIP adherence since the inception of the SCIP program in 2005. Project Methods: We propose a cohort study of all elective surgeries accrued in the VA External Peer Review Program SCIP module, with corresponding information in VASQIP from 2005- 2009. Univariate statistics will be used to describe the population, while bivariate statistics will be used to determine unadjusted associations. Composite measures of adherence for each topic will be constructed for each patient. Multivariable logistic regression will be used to examine SCIP measures as predictors of adverse surgical outcomes, with generalized estimating equations to account for clustering within facilities.

描述（由申请人提供）： 对退伍军人医疗保健的预期影响：目前，VHA是唯一一个以其目标成果收集手术护理改进计划（SCIP）绩效指标数据的系统。这项研究将评估当前的手术护理绩效测量状态，并指导手术护理质量评估中的未来细化，并最终为防止不良外科手术结果做出更明智的决策。这不仅可以改善手术护理，而且最终可能导致与不良结果相关的VHA成本降低。 Project Background: SCIP, a national collaborative to improve surgical care, began in 2005. VHA is one of 34 partners in the project and began tracking SCIP performance through the External Peer Review Program (EPRP) in 2005. The goal of SCIP is to reduce surgical complications by 25% by 2010. While these measures are intended to reduce surgical complications, they are also used as criteria for physician incentive pay as well as hospital quality measurement.很少有研究（包括我们自己的研究）表明，个人SCIP绩效指标与他们旨在预防的不良外科结果之间的关联，因此尚不清楚它们是否应被用作手术或医院质量的措施。我们先前的研究检查了2006年可用的单一SCIP措施，提供了绩效和结果的快照。当前有三个SCIP主题模块由VA跟踪：1）感染（6个测量值），2）静脉血栓栓塞（2个测量）和3）心脏预防（1个度量）。我们建议研究过程测量与它们针对的不良外科结果之间的关联。这将对VHA中手术护理绩效的当前状态提供更复杂，更全面的评估。项目目标：该项目的目标是：1）确定与遵守患者，医院和系统级别遵守SCIP性能相关的因素。 2）检查患者和设施水平上SCIP绩效指标与不良外科结果之间的关联。 3）分析自2005年SCIP计划以来的手术并发症和SCIP依从性的趋势。项目方法：我们提出了一项对VA外部同行评审计划SCIP模块中所有选修手术的同类研究，并在2005年至2009年间使用了统计的人群。协会。每个患者的依从性综合措施都将为每个患者构建。多变量逻辑回归将用于检查SCIP度量作为不良外科结果的预测指标，并具有广义估算方程式以说明设施内的聚类。