The VHA's NSQIP includes the following components:
• An annual report prepared for the chief of surgery of each medical center, comparing local outcomes with those of other (anonymous) VA hospitals and to the performance of all VA hospitals combined. • An annual performance evaluation by an executive committee that communicates praise or concerns about high- and low-performing centers. • The provision of self-assessment tools for use by local centers to improve care. • Structured site visits by a team of experts, when requested by local centers, to evaluate potential problems and give advice regarding care and performance. • Identification and dissemination of good practices associated with better outcomes.
2. How were benchmark standards established?
In 1993, the Veterans Health Administration (VHA) conducted the National VA Surgical Risk Study (NVASRS), with the aim of developing and validating risk-adjustment models for the prediction of surgical outcome and the comparative assessment of the quality of surgical care among multiple facilities. On the basis of data from 87,078 major surgical procedures, 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 132 of the VAMCs performing surgery. Hence, based on the results of the NVASRS, the National VA Surgical Quality Improvement Program (NSQIP) was established in January 1994; it provided, for the first time, a reporting and managerial...