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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

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.

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

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

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。