A joint evaluation of surgery-related outcomes and costs across VAMCs

对 VAMC 的手术相关结果和成本进行联合评估

• 批准号: 8278804
• 负责人: XIAO-HUA A. ZHOU
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-01 至 2015-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8278804
• 关键词: Caring; Case Mixes; Clinical; Cohort Studies; Commit; Databases; Development; Economic Inflation; Evaluation; Goals; Growth; Health Care Costs; Health Care Reform; Health Services Research; Healthcare; Healthcare Systems; Hernia; Joints; Masks; Measures; Methods; Modeling; Morbidity - disease rate; Operative Surgical Procedures; Outcome; Outcome Measure; Patients; Performance; Process; Property; Quality of Care; Records; Reporting; Risk; Sampling; Statistical Methods; Statutes and Laws; Structure; Surgical Models; United States Dept. of Health and Human Services; Variant; Veterans; Wages; administrative database; base; comparative; cost; follow-up; health administration; health care quality; improved; mortality; programs; repaired; software development

DESCRIPTION (provided by applicant): The Veterans Health Administration National Surgical Quality Improvement Program (NSQIP) has developed reliable comparative measures of 30-day mortality and morbidity for surgical procedures that have led to significant transformations in quality. However, 30-day outcomes provide only a limited picture of true surgical efficiency. True surgical efficiency should be a reflection of both quality and cost. The objective of this proposal is to develop models for predicting post-surgery costs, adjusting for patient's case-mix, and to develop measures of surgical quality that combine both outcomes (e.g. mortality and morbidity), costs, and methods for analyzing those measures. Our approach is based on the hypothesis that costs represent an important independent assessment of efficiency of care, and should combined with clinical quality measures to gain a complete picture of true efficiency of care. Our long-term goal is to identify the most efficient facilities with optimal measures of both surgical outcomes and cost, so that these processes at these facilities can be emulated throughout the VA. We propose a retrospective cohort study of all patients included in the NSQIP, DSS and relevant VA databases with seven common surgical procedures between 2007 and 2009. A comprehensive database that includes all records will be developed, which will include two years of records prior to date of the surgical procedure and at least one year of follow-up. The seven surgical procedures were selected to represent a mix of complexities ranging from hernia repair to CABG to demonstrate the feasibility and reliability of the methods across a range of facilities.

描述（由申请人提供）： 退伍军人卫生管理局国家手术质量改善计划（NSQIP）已开发出可靠的比较度量，以实现30天死亡率和发病率的外科手术程序，这导致了质量的重大转变。但是，30天的结果仅提供了有限的真实手术效率的情况。真正的手术效率应该反映出质量和成本。该提案的目的是开发用于预测手术后成本，调整患者病例混合的模型，并开发相结合两种结果（例如死亡率和发病率），成本和分析这些度量的方法的手术质量的度量。我们的方法基于以下假设：成本代表了对护理效率的重要独立评估，并应与临床质量指标相结合，以获取真正的护理效率的完整情况。我们的长期目标是通过手术结果和成本来确定最有效的设施，因此 可以在整个VA中模仿这些设施的这些过程。我们建议对NSQIP，DSS和相关VA数据库中的所有患者进行回顾性队列研究，并在2007年至2009年之间使用七个常见的手术程序。一个全面的数据库，其中包括所有记录，其中包括所有记录，其中将包括在手术程序日期之前的两年记录和至少一年的随访。选择了七个手术程序，以代表从疝气修复到CABG的复杂性的混合，以证明各种设施的方法的可行性和可靠性。