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Comparative Effectiveness of Alternative Strategies for Monitoring Hospital Surgical Performance

监测医院手术表现的替代策略的比较有效性

基本信息

批准号：
10186540
负责人：
Nader Nabile Massarweh
金额：
--
依托单位：
MICHAEL E DEBAKEY VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-05-01 至 2021-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10186540
关键词：
Address Adverse event Awareness Blood Vessels Caring Chest Clinical Data Data Analyses Detection Disadvantaged Early Diagnosis Early identification Ensure Evaluation Event Exposure to Feedback Future Genitourinary system Goals Healthcare Hospitals Individual Industrialization Industry Infrastructure Inpatients Institution Measures Methodology Monitor Morbidity - disease rate Nature Operative Surgical Procedures Orthopedics Outcome Patients Perception Performance Perioperative Perioperative Care Postoperative Period Predictive Value Private Sector Process Production Quality Control Quality Indicator Quality of Care Repeat Surgery Reporting Resolution Risk Running Security Signal Transduction Specific qualifier value Statistical Computing Statistical Methods Structure Sum Techniques Time Variant Vertebral column Veterans Work base comparative comparative effectiveness comparative effectiveness analysis cost design effectiveness evaluation falls health care settings hospital performance improved mortality novel operation perioperative mortality programs prospective real time monitoring response surgery outcome surgical risk symposium

项目摘要

Abstract Important limitations associated with current approaches for monitoring the quality of surgical care include: (a) the retrospective and episodic (e.g.: quarterly, bi-annually, etc.) approach to feedback which creates a time lag between when performance is declining and when the hospital is made aware; (b) small clusters of clinically meaningful poor performance may go of undetected using current episodic analytic structures; (c) most healthcare entities are willing to accept average performance, but will respond if performance starts to fall below an acceptable threshold. As such, alternative approaches that could shorten the time lag for feedback, improve the detection of hospitals with potentially suboptimal perioperative care processes, or inspire hospitals to be more proactive in programmatic improvement could enhance current quality improvement efforts and have tangible benefits for VHA. The overall goal of this proposal is to generate comparative effectiveness data on novel, alternative approaches for monitoring VA hospital surgical performance relative to the current standard of episodic data analysis and feedback. The specific aims are to: (1) compare the CUSUM (a statistical process control methodology borrowed from industry) to the episodic Observed-to-Expected approach for evaluating surgical performance at VA hospitals; (2) evaluate a composite outcome of 30-day mortality, major morbidity, and reoperation as an indicator of declining institutional performance relative to 30-day mortality or overall morbidity alone. This work will involve a hospital-level, observational design using VA Surgical Quality Improvement Program (VASQIP) data for patients who underwent inpatient general, vascular, thoracic, genitourinary, orthopedic, spine, or neurosurgical operations between 2010 and 2016. Data will be used to conduct a comparative effectiveness analysis of these alternative QI strategies for monitoring VA hospital surgical performance relative to the current standard of episodic reporting of 30-day mortality or morbidity individually. This project is novel because it will be the first application of industrial quality control techniques to VASQIP, will provide important real-world comparative data on alternative approaches for evaluating hospital performance, and will evaluate such approaches within the context of the existing VASQIP framework and infrastructure to facilitate future prospective evaluation and eventual implementation. It is anticipated the analyses will demonstrate these alternative approaches could have significant value for hospitals' local quality improvement efforts. Incorporating additional approaches for monitoring surgical outcomes into VASQIP could have notable benefits for VHA and Veterans through earlier recognition of hospitals with potentially problematic perioperative care processes that are associated with suboptimal post- operative outcomes, decreased costs for correcting errant care processes, decreased rates of morbidity through the earlier identification and resolution of such errant processes, and the public perception that the VA remains a national leader in surgical quality. Given the VHA's current focus on ensuring quality care at all levels and in all care settings, it is feasible such alternative approaches could also influence existing quality improvement programs or new initiatives outside of surgery as well.

摘要与当前用于监测外科护理质量的方法相关的重要限制包括： (a)回顾性和偶发性（例如：每季度、每半年等）一种反馈方法，当性能下降时和当医院意识到时之间的滞后;（B）临床上的小集群使用当前的情景分析结构，可能无法发现有意义的不良业绩;（c）大多数医疗保健实体愿意接受平均绩效，但如果绩效开始下降，则会做出反应低于可接受的阈值。因此，可以缩短反馈时滞的替代方法，改善对可能存在不佳围手术期护理流程的医院的检测，或激励医院更积极主动地进行项目改进可以促进当前的质量改进努力并为VHA带来实实在在的好处。本提案的总体目标是，关于监测VA医院手术性能的新型替代方法的有效性数据，当前的情景数据分析和反馈标准。具体目的是：（1）比较（从工业界借用的统计过程控制方法）到偶发性的观测值与预期值之比评估VA医院手术性能的方法;（2）评估30天的复合结局死亡率、主要发病率和再次手术作为机构绩效下降的指标， 30-日死亡率或总发病率。这项工作将涉及医院级的观察设计，接受普通住院患者的VA手术质量改进计划（VASQIP）数据， 2010年至2016年期间进行的血管、胸部、泌尿生殖系统、骨科、脊柱或神经外科手术。数据将用于对这些用于监测VA的替代QI策略进行比较有效性分析相对于当前30天死亡率的间歇性报告标准的医院手术性能，或个别发病率。该项目是新颖的，因为它将是工业质量控制的第一个应用 VASQIP技术，将提供重要的现实世界的替代方法的比较数据，评估医院绩效，并将在现有VASQIP的背景下评估此类方法框架和基础设施，以促进未来的前瞻性评估和最终的实施。是预计分析将证明这些替代方法可能具有重大价值，医院的本地质量改进工作。为监测外科手术提供额外的方法结果纳入VASQIP可能有显着的好处VHA和退伍军人通过早期认识到，有潜在问题的围手术期护理过程的医院，手术结果，降低纠正错误护理过程的成本，通过早期识别和解决这些错误的过程，以及公众认为VA仍然存在手术质量的全国领先者鉴于VHA目前的重点是确保在各级和在所有护理环境中，这种替代方法也可能影响现有的质量改进，手术之外的新项目或新举措。

项目成果

期刊论文数量（11）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Surgical Quality Improvement: Working Toward Value or a Work in Progress?

DOI：
10.1016/j.jss.2018.09.086
发表时间：
2019-03-01
期刊：
JOURNAL OF SURGICAL RESEARCH
影响因子：
2.2
作者：
Yu, Justin;Massarweh, Nader N.
通讯作者：
Massarweh, Nader N.

Risk-Adjusted Cumulative Sum for Early Detection of Hospitals With Excess Perioperative Mortality.

用于及早发现围手术期死亡率过高的医院的风险调整累积金额。

DOI：
10.1001/jamasurg.2023.3673
发表时间：
2023
期刊：
JAMA surgery
影响因子：
16.9
作者：
Chen,ViviW;Chidi,AlexisP;Dong,Yongquan;Richardson,PeterA;Axelrod,DavidA;Petersen,LauraA;Massarweh,NaderN
通讯作者：
Massarweh,NaderN

Relationship Between Perioperative Outcomes Used for Profiling Hospital Noncardiac Surgical Quality.

用于分析医院非心脏手术质量的围手术期结果之间的关系。

DOI：
10.1016/j.jss.2021.02.004
发表时间：
2021
期刊：
The Journal of surgical research
影响因子：
0
作者：
Massarweh,NaderN;Chen,ViviW;Rosen,Tracey;Richardson,PeterA;Harris,AlexHS;Petersen,LauraA
通讯作者：
Petersen,LauraA

Translating Research Findings Into Practice-The Unfulfilled and Unclear Mission of Observational Data.

将研究成果转化为实践——观测数据未完成且不明确的使命。