Case Analysis: VHS’s NSQIP Program
Informatics and Applied Systems in Healthcare
Case Analysis: VHS’s NSQIP Program
VHA’s Approach to its NSQUP Program
The Veterans Health Administration (VHA) adopted the National Surgical Quality Improvement Program (NSQIP). This program is a physician-driven comparison study initiated by senior surgeons between 1991 and 1997, in which mortality and morbidity rates were “risk adjusted and compared to observed-to-expected ratios” (Ball, Weaver, & Kiel, 2004, p. 277). They studied data in order to determine the efficacy of surgical procedures from the pre-operative- through 30-day post-operative periods. This study was intended to improve the quality of care provided to patients throughout the Veterans Administration Medical Centers (VAMC) nationwide during the operative periods stated above by utilizing the National VA Surgical Risk Study (NVASRS).
The VHA’s NSQIP includes chief of surgery in VHA from each medical center, prepared annual report comparing local outcomes with those of other VA hospitals performance of all VA hospitals combined. The information technology (IT) system, VISTA, is an electronic medical record system developed by the VHA, which uniformly connects the entire VAMC system and was utilized in the compilation of the necessary data (Ball, Weaver, & Kiel, 2004). Benchmark Standards Established
The NSQIP was created by the VHA to extend the methods and reporting developed in the National VA Surgical Risk Study (NVASRS). Their aim was to develop and validate risk-adjustment models to predict surgical outcome, and for comparative assessment of the quality of surgical care across multiple facilities. The NSQIP program was implemented to provide reliable, valid and comparative information about surgical outcomes across over a hundred VAMC’s that perform major surgery (Best, Khuri, & Phelan, 2002). Risk-adjustment models for 30-day mortality and morbidity rates were developed for all non-cardiac surgery and for various sub-specialties.
The ability of these models to detect variations in the quality of surgical care was demonstrated in a validation study. Separate models were developed for risk adjustment of the 30-day mortality rate of cardiac surgery, based on a previously published methodology. The NVASRS provided the VHA with a validated tool with which the quality of surgery could potentially be monitored, compared, and improved in all of the VAMCs performing surgery (Best, Khuri, & Phelan, 2002). Therefore, based on the results of the NVASRS, NSQIP was established in 1994. It was the first structure that provided a way to continuously monitoring and enhances the quality of surgical care in the VHA. NSQIP reports that since 1994 the 30-day mortality and morbidity rate for major surgery have fallen 9% to 30% respectively (Best, Khuri, & Phelan, 2002). Computer-Based Records Used for Measurements
The information technology (IT) system, VISTA, is an electronic medical record (EMR) system developed by the VHA to connect the entire VAMC system. It was used to compile all of the data necessary for research. This has permitted the NSQIP to gain access to a consistent surgical scheduling module and operating room log in every VAMC. This allows them to identify all procedures performed throughout the country and to create and use a dedicated risk-assessment and outcome module into which all the surgical nurse reviewers enter the same data everywhere (Best, Khuri, & Phelan, 2002). A total of 88 permanent full-time-equivalent positions have been assigned for trained surgical clinical nurse reviewers (SCNRs) at the VAMCs participating in the program (Best, Khuri, & Phelan, 2002). The SCNRs worked closely with the chief of surgery at each VAMC to ensure the accurate collection and timely transmission of the data. Risk adjustment data are entered by the SCNR into a special risk-assessment software module, which is...
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