Engaging Patients and Hospitals to Expand Public Reporting in Surgery

描述(申请人提供)：公开报告医院绩效数据的两个主要目标是帮助患者选择高质量的医院，并鼓励医院改善其护理质量。然而，公共报道在实现这些目标方面并不是特别有效，外科手术中的公共报道也很少。自2001年以来，美国外科医师学会国家外科质量改进计划(ACS NSQIP)已根据临床数据为参与计划的医院提供了24项手术结果的风险调整基准报告。这些医院的临床医生还可以使用外科风险计算器，根据患者的风险因素和合并症来估计他们的并发症发生率。这些数据都没有公开报道。2012年，ACSNSQIP将在医疗保险和医疗补助服务中心(CMS)医院比较网站上启动一个试点项目，公开报告国家质量论坛认可的手术结果衡量标准。然而，CMS医院比较网站不会提供患者特定的信息，也不是按照以患者为中心的原则开发的。这项研究建议通过以下方式利用ACS-CMS试点项目：(1)采用现有的ACS NSQIP手术风险计算器开发名为“MyHospital”的特定于患者和以患者为中心的医院比较工具，该工具将允许患者通过输入个人人口统计数据、合并症、手术适应症/类型、可接受的旅行距离和医疗保险信息来比较在多家医院进行手术的风险；(2)让外科患者比较MyHospital和CMS-NSQIP医院，通过认知访谈和调查比较公共报告，以评估参与者的可用性、理解力、满意度和选择最高质量医院的能力；以及(3)评估CMS-NSQIP医院比较公共报告试点项目的效果，方法是在基线和两年试点项目时间线上比较参与医院(病例)和非参与医院(对照)，以检查结果和医院质量改进文化的差异。这项研究具有非常重要的意义和创新性，因为它将开发第一个以患者为中心的手术结果公共报告医院比较工具，并将评估第一个全国手术结果公共报告的效果。我的医院可以显著提高单个患者选择最高质量的医院进行手术的能力，从而立即影响数百万美国外科患者的护理质量。此外，公开报告手术结果可能会导致非参与的医院参与，可能会诱使所有医院扩大其公开报告的指标，并最终可能提高美国提供的手术护理的质量。 可以提供所需的证据，鼓励在整个手术过程中广泛公开报道。总体而言，评审员以“极好的”热情推荐了这份申请供进一步审议。

DESCRIPTION (provided by applicant): Two key goals of public reporting of hospital performance data are to help patients' select high-quality hospitals and to encourage hospitals to improve their quality of care. However, public reporting has not been particularly effective in achieving these goals, and public reporting in surgery has been infrequent. Since 2001, the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) has provided participating hospitals with risk-adjusted benchmark reports for 24 surgical outcomes based on clinical data. Clinicians at these hospitals also have access to a Surgical Risk Calculator to estimate complication rates for individual patients based on their risk factors and comorbidities. None of these data are publicly reported. In 2012, ACS NSQIP will be launching a pilot project for public reporting of National Quality Forum-endorsed surgical outcomes measures on the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website. However, the CMS Hospital Compare website will not provide patient-specific information nor is it being developed using patient-centered principles. This study proposes to take advantage of the ACS-CMS pilot project by (1) adapting the existing ACS NSQIP Surgical Risk Calculator to develop a patient-specific and patient-centered hospital comparison tool called "myHospital" which will allow a patient to compare the risks of surgery at multiple hospitals, based on the individual patient's risk factors by entering individual demographics, comorbidities, surgical indication/type, acceptable travel distance, and health insurance information; (2) engaging surgical patients to compare myHospital with the CMS-NSQIP Hospital Compare public reporting through cognitive interviews and surveys to assess participant usability, comprehension, satisfaction, and ability to select the highest quality hospital; and (3) assessing the effect of the CMS-NSQIP Hospital Compare public reporting pilot project by comparing participating hospitals (cases) to non-participating hospitals (controls) at baseline and over the two-year pilot project timeline to examine differences in outcomes and hospital quality improvement culture. This research is highly significant and innovative because it will develop the first patient-centered public reporting hospital comparison tool for surgical outcomes and will assess the effect of the first national public reporting of surgical outcomes. myHospital could significantly improve an individual patient's ability to select the highest qualit hospital for their surgery, thus affecting the quality of care for millions of U.S. surgical patiens immediately. In addition, public reporting of surgical outcomes could potentially cause non-participating hospitals to participate, could entice all hospitals to expand their publicly reporte metrics, and could ultimately improve the quality of surgical care delivered in the U.S. This study could provide the evidence needed to encourage widespread public reporting throughout all of surgery. Overall, the reviewers recommended this application for further consideration with an "Excellent" level of enthusiasm.