Comparative effectiveness of real-time and episodic hospital surgical performance evaluation

实时与间歇式医院手术绩效评估的效果比较

• 批准号: 9370221
• 负责人: Nader Nabile Massarweh
• 金额: $ 4.99万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-01 至 2018-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9370221
• 关键词: Comparative; effectiveness; real; time; episodic

Project Summary/Abstract Contemporary surgical quality improvement (QI) programs provide hospitals with episodic feedback. There are two main limitations associated with this approach. The first is the time required for data abstraction, analysis, and subsequent feedback creating a built-in time lag between when a hospital is having a decrement in performance and when the hospital receives this information. The second is the inability of current episodic analytic methods to explicitly account for the impact of time as variable (i.e.: the occurrence of a cluster of events in a short period of time). Episodic data put hospitals' local QI teams at a disadvantage because their response to declining performance must be reactive rather than proactive. Furthermore, patients treated in the interval between when performance is declining and when this decrement is appreciated are potentially at risk for exposure to suboptimal perioperative care processes. The cumulative sum (CUSUM) is an industrial statistical process control method traditionally used for monitoring the quality of a production process and for ensuring that process is operating efficiently, effectively, and at full potential. The CUSUM is well-suited for ascertaining variation over time for rare outcomes, is resilient to multiple statistical testing, and explicitly accounts for the impact of time as a variable. It has been used for health care evaluation and shown to provide early, meaningful, performance-based feedback. The objective of this proposal is to compare the effectiveness of a risk-adjusted, time-to- event CUSUM for the early detection of hospitals with outlier performance in terms of 30-day morbidity and mortality relative to the standard of episodic observed-to-expected (O-E) methodology used by the VA Surgical Quality Improvement Program (VASQIP) and the American College of Surgeons National Surgical Quality Improvement Program. Using national VASQIP data, we intend to: 1.) evaluate whether the CUSUM identifies similar outlier hospitals relative to the O-E approach and to compare differences in timing for outlier identification; 2.) estimate the number of at risk surgical procedures and post-operative patient days using CUSUM compared to O-E hospital performance evaluation. The data from this proposal will inform a future prospective evaluation of the CUSUM within the VA's existing surgical QI framework and infrastructure with the ultimate goal being eventual integration of CUSUM into VASQIP reporting. Providing hospitals with more timely data would benefit local QI efforts and could shift the paradigm away from a reactive response to episodic data to a proactive approach based on a more real-time evaluation of performance. Identifying opportunities to correct errant care processes when performance is declining rather than when it has already reached an unacceptable level could decrease the number of surgical patients at risk for unintended outcomes, decrease the costs associated with correcting errant care processes and treating potentially preventable morbidity, and make surgical care safer.

项目摘要/摘要 当代手术质量改进（QI）计划为医院提供了情节反馈。有两个主要 与这种方法相关的限制。首先是数据抽象，分析和随后所需的时间 反馈在医院的绩效下降和医院何时在医院降低之间产生内置时间滞后 接收此信息。第二个是当前的情节分析方法明确说明 时间作为变量的影响（即：在短时间内发生一系列事件的发生）。情节数据 医院当地的QI团队处于不利地位，因为他们对绩效下降的反应必须是反应性的，而不是 积极主动的。此外，在绩效下降和这种降低何时进行的间隔中治疗的患者 受到的理解可能有可能暴露于次要的围手术期护理过程的风险。累积总和 （Cusum）是一种工业统计过程控制方法，用于监视生产的质量 过程并确保该过程有效，有效且具有全部潜力。 Cusum非常适合 为了确定稀有结果的随着时间的变化，对多次统计测试有弹性，并明确说明 时间作为变量的影响。它已用于医疗保健评估，并证明可以提供早期，有意义的， 基于绩效的反馈。该提案的目的是比较经过风险调整的，时间为时间的有效性 在30天的发病率和死亡率方面，早期发现具有较高表现的医院的事件cusum 相对于VA手术质量使用的观察到的（O-E）方法的情节标准 改进计划（VASQIP）和美国外科医生国家外科手术质量改进 程序。使用国家VASQIP数据，我们打算：1。）评估Cusum是否识别类似的离群值 医院相对于O-E方法，并比较异常识别的时间差异； 2.）估计 与O-E医院相比 绩效评估。该提案的数据将为未来对库苏姆的预期评估提供信息 VA现有的手术QI框架和基础设施，最终目标是最终集成 进入VASQIP报告。为医院提供更及时的数据将使当地的QI努力受益，并可能改变 从对情节数据的反应响应到基于对实时评估的主动方法的范式 表现。确定在绩效下降而不是何时纠正错误护理过程的机会 已经达到不可接受的水平可能会减少出现意外结局风险的外科手术患者的数量， 降低与纠正错误的护理过程相关的成本并处理潜在的可预防发病率，并 使手术护理更安全。