A joint evaluation of surgery-related outcomes and costs across VAMCs

对 VAMC 的手术相关结果和成本进行联合评估

• 批准号: 8597955
• 负责人: XIAO-HUA A. ZHOU
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-01 至 2015-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8597955
• 关键词: Caring; Case Mixes; Clinical; Cohort Studies; Commit; Databases; Development; Economic Inflation; Evaluation; Goals; Growth; Health Care Costs; Health Care Reform; Health Services Research; Healthcare; Healthcare Systems; Hernia; Joints; Masks; Measures; Methods; Modeling; Morbidity - disease rate; Operative Surgical Procedures; Outcome; Outcome Measure; Patients; Performance; Process; Property; Quality of Care; Records; Reporting; Risk; Sampling; Statistical Methods; Statutes and Laws; Structure; Surgical Models; United States Dept. of Health and Human Services; Variant; Veterans; Wages; administrative database; base; comparative; cost; follow-up; health administration; health care quality; improved; mortality; programs; repaired; software development

DESCRIPTION (provided by applicant): The Veterans Health Administration National Surgical Quality Improvement Program (NSQIP) has developed reliable comparative measures of 30-day mortality and morbidity for surgical procedures that have led to significant transformations in quality. However, 30-day outcomes provide only a limited picture of true surgical efficiency. True surgical efficiency should be a reflection of both quality and cost. The objective of this proposal is to develop models for predicting post-surgery costs, adjusting for patient's case-mix, and to develop measures of surgical quality that combine both outcomes (e.g. mortality and morbidity), costs, and methods for analyzing those measures. Our approach is based on the hypothesis that costs represent an important independent assessment of efficiency of care, and should combined with clinical quality measures to gain a complete picture of true efficiency of care. Our long-term goal is to identify the most efficient facilities with optimal measures of both surgical outcomes and cost, so that these processes at these facilities can be emulated throughout the VA. We propose a retrospective cohort study of all patients included in the NSQIP, DSS and relevant VA databases with seven common surgical procedures between 2007 and 2009. A comprehensive database that includes all records will be developed, which will include two years of records prior to date of the surgical procedure and at least one year of follow-up. The seven surgical procedures were selected to represent a mix of complexities ranging from hernia repair to CABG to demonstrate the feasibility and reliability of the methods across a range of facilities.

描述（由申请人提供）： 退伍军人健康管理局国家外科质量改进计划 (NSQIP) 制定了可靠的外科手术 30 天死亡率和发病率比较措施，导致质量发生重大转变。然而，30 天的结果只能有限地反映真实的手术效率。真正的手术效率应该反映质量和成本。该提案的目的是开发预测术后费用的模型，根据患者的病例组合进行调整，并开发结合结果（例如死亡率和发病率）、成本和分析这些措施的方法的手术质量衡量标准。我们的方法基于这样的假设：成本代表了对护理效率的重要独立评估，并且应与临床质量措施相结合，以获得护理真实效率的完整情况。我们的长期目标是确定最有效的设施，并对手术结果和成本进行最佳衡量，因此 这些设施中的这些流程可以在整个退伍军人事务部进行模拟。我们建议对 NSQIP、DSS 和相关 VA 数据库中包含的所有患者进行一项回顾性队列研究，这些患者在 2007 年至 2009 年间进行了七种常见的外科手术。将开发一个包含所有记录的综合数据库，其中将包括外科手术日期之前两年的记录和至少一年的随访记录。选择的七种手术程序代表了从疝气修复到冠状动脉搭桥术（CABG）的复杂性，以证明这些方法在一系列设施中的可行性和可靠性。