Measuring Up: Associations between SCIP measures and Surgical Outcomes

描述(由申请人提供)： 对退伍军人医疗保健的预期影响：目前，VHA是唯一一个收集外科护理改进计划(SCIP)绩效衡量数据及其目标结果的系统。这项研究将评估外科护理绩效评估的现状，并将指导未来外科护理质量评估的改进，并最终做出更知情的决策，以防止不利的手术结果。这不仅将改善手术护理，而且最终可能导致VHA与不良后果相关的成本降低。项目背景：SCIP是一个旨在改善外科护理的全国性合作项目，始于2005年。VHA是该项目的34个合作伙伴之一，并于2005年开始通过外部同行审查计划(EPRP)跟踪SCIP的业绩。SCIP的目标是到2010年将手术并发症减少25%。虽然这些措施旨在减少手术并发症，但它们也被用作医生奖励薪酬和医院质量衡量的标准。很少有研究，包括我们自己的研究，显示了单独的SCIP绩效指标与它们旨在防止的不良手术结果之间的关联，这使得它们是否应该被用作手术或医院质量的指标尚不清楚。我们之前的研究考察了2006年可用的单一SCIP衡量标准，提供了绩效和结果的快照。目前，退伍军人管理局跟踪的SCIP主题模块有三个：1)感染(6项措施)，2)静脉血栓栓子(2项措施)，以及3)心脏预防(1项措施)。我们建议检查过程措施与它们所针对的不良手术结果之间的关联。这将提供一个更复杂、更全面的VHA外科护理绩效衡量现状的评估。项目目标：本项目的目标是：1)在患者、医院和系统层面确定与遵守SCIP绩效相关的因素。2)从患者和机构两个层面考察SCIP绩效指标与不良手术结果之间的关系。3)分析自2005年SCIP计划开始以来外科并发症和SCIP依从性的趋势。项目方法：我们提出了一项关于退伍军人事务部外部同行评审计划SCIP模块中所有选择性手术的队列研究，并在VASQIP中提供了2005-2009年的相应信息。单变量统计将用于描述总体，而二元统计将用于确定未调整的关联。将为每个患者构建每个主题的遵守程度的综合衡量标准。多变量Logistic回归将被用来检验SCIP措施作为不良手术结果的预测因子，并使用广义估计方程来解释设施内的聚集。

DESCRIPTION (provided by applicant): Anticipated Impacts on Veteran's Healthcare: Currently, VHA is the only system where data on Surgical Care Improvement Program (SCIP) performance measures are collected with their targeted outcomes. This study will assess the current state of surgical care performance measurement and will guide future refinements in surgical care quality assessment, and ultimately more informed decision making for preventing adverse surgical outcomes. This will not only improve surgical care, but can eventually lead to reduction in cost to VHA related to adverse outcomes. Project Background: SCIP, a national collaborative to improve surgical care, began in 2005. VHA is one of 34 partners in the project and began tracking SCIP performance through the External Peer Review Program (EPRP) in 2005. The goal of SCIP is to reduce surgical complications by 25% by 2010. While these measures are intended to reduce surgical complications, they are also used as criteria for physician incentive pay as well as hospital quality measurement. Few studies, including our own, have shown associations between individual SCIP performance measures and the adverse surgical outcomes they are intended to prevent, making it unclear as to whether they should be used as the measures of surgical or hospital quality. Our previous study examined the single SCIP measure available in 2006, providing a snapshot of performance and outcomes. There are currently three SCIP topics modules tracked by VA: 1) Infection (6 measures), 2) Venous Thromboembolus (2 measures), and 3) Cardiac Prevention (1 measure). We propose examining the association between the process measures with the adverse surgical outcomes they target. This will provide a more complex, comprehensive assessment of the current state of surgical care performance measurement in VHA. Project Objectives: The objectives of this project are: 1)To determine the factors associated with adherence to SCIP performance at the patient, hospital and system level. 2)To examine the association between SCIP performance measures and adverse surgical outcomes on both a patient and facility level. 3)To analyze trends in surgical complications and SCIP adherence since the inception of the SCIP program in 2005. Project Methods: We propose a cohort study of all elective surgeries accrued in the VA External Peer Review Program SCIP module, with corresponding information in VASQIP from 2005- 2009. Univariate statistics will be used to describe the population, while bivariate statistics will be used to determine unadjusted associations. Composite measures of adherence for each topic will be constructed for each patient. Multivariable logistic regression will be used to examine SCIP measures as predictors of adverse surgical outcomes, with generalized estimating equations to account for clustering within facilities.