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手术质量改进计划（NSQIP）已经制定了可靠的30天死亡率和发病率的比较措施，导致质量的重大转变。然而，30天的结果只提供了一个有限的图片真正的手术效率。真正的手术效率应该是质量和成本的反映。本提案的目的是开发用于预测术后成本的模型，调整患者的病例组合，并开发结合结局（例如死亡率和发病率）、成本和分析这些措施的方法的联合收割机手术质量的措施。我们的方法是基于这样的假设，即成本代表了一个重要的独立评估的护理效率，并应结合临床质量的措施，以获得一个完整的图片的真正的护理效率。我们的长期目标是确定最有效的设施，最佳措施的手术结果和成本， 这些设施的这些过程可以在整个VA中进行模拟。我们建议对2007年至2009年间NSQIP、DSS和相关VA数据库中纳入的所有患者进行一项回顾性队列研究，其中包括7种常见手术。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前两年的记录和至少一年的随访。选择的七种外科手术代表了从疝气修复到冠状动脉旁路移植术的复杂性，以证明这些方法在一系列设施中的可行性和可靠性。

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.