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

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)为外科手术开发了30天死亡率和发病率的可靠比较指标，这些手术导致了质量上的重大转变。然而，30天的结果仅提供了真实手术效率的有限图景。真正的手术效率应该是质量和成本的反映。这项建议的目标是开发预测术后成本的模型，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)、成本和分析这些指标的方法的手术质量指标。我们的方法是基于这样一种假设，即成本代表着对护理效率的重要独立评估，并应与临床质量测量相结合，以获得真实护理效率的完整图景。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采取最佳措施，因此 这些设施的这些流程可以在退伍军人管理局内仿效。我们建议对NSQIP、DSS和相关退伍军人数据库中的所有患者进行一项回顾性队列研究，其中包括2007至2009年间的七种常见外科手术。将开发一个包括所有记录的综合数据库，其中将包括手术日期前两年的记录和至少一年的后续行动。这七种手术程序被选为代表从疝气修补到冠状动脉搭桥术的复杂组合，以证明这些方法在一系列设施中的可行性和可靠性。

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.