NSQIP Overview: Now and the Future

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NSQIP Overview Now and the Future

• Clifford Ko, MD, MS, MSHS, FACS
• Director, Division of Research and Optimal
  Patient Care
• Director of NSQIP
• American College of Surgeons

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Mission of Division of Research and Optimal
Patient Care

• The mission of the ACS Division of Research and
  Optimal Patient Care is to improve the quality of
  surgical care by enabling all surgeons to apply
  the best scientific evidence available in all
  aspects of their daily practice with respect,
  compassion, and dignity for all patients.

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Division of Research and Optimal Patient Care

• Continuous Quality Improvement
• National Surgical Quality Improvement Program
  (NSQIP)
• Bariatric Accreditation (Database)
• Guidelines Program (Evidence base)
• Commission on Cancer (NCDB)
• Committee on Trauma (NTDB)

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Achieving Optimal Patient Care
Surgical Care in our community
(Feedback Education Site Visits)

Outcomes (NSQIP, Cancer database, Trauma
database, Accreditation)
Best Practices QI

• (Evidence,
• Literature,
• Experience)

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ACS NSQIP

• Where we are now

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Project Priorities and Target Completion Dates
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Multispecialty

• Gen Surg, Vasc, Urology, Neurosurgery,
  Orthopedics, ENT, Plastic, Thoracic, Cardiac, and
  Gynecological surgery (10)
• In order to remain in alignment with the CMS SCIP
  requirements, the committee decided to include
  cardiac cases
• Launched Feb. 2007
• Sites interested in switching can contact ACS
  NSQIP

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Bariatrics

• ACS Bariatric Accreditation Program
• Bariatric module developed
• NSQIP sites continue to capture their current
  sample of Bariatric cases using the 8-day cycle
• Additional Data Points and Long-term follow up
  will be entered into the ACS NSQIP database
• non-SCNR can enter the additional data.
• Pilot target July 2007

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Surgical Care Improvement Project

• The ACS NSQIP has been working closely with CMS
  to create an ACS NSQIP SCIP Module
• Allow sites to meet SCIP reporting requirements
  and collect data all in one place.
• CMS/Joint Commission have approved the ACS NSQIP
  sampling methodology
• Final software testing nearly complete
• Target launch date is set for July/August 2007

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Public Use File

• A Participant Use File (PUF) will be made
  available to participating ACS NSQIP hospitals.
• HIPAA compliant and
• Compliant with BA agreements.
• Data Use Agreement will be used.
• PUF will be available shortly.
• Sites always have 24/7 access to their data and
  benchmark reports

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Statistical Modeling

• Need to assess and optimize statistical modeling
  as NSQIP grows, expands, and matures.

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Pediatric Pilot

• Collaborative effort with APSA
• Stand alone module (separate fee).
• Neonate
• General Pediatrics
• Trauma
• Data points and definitions
• Prototype (APSA Conference) May 2007
• Pilot the module in November 2007
• Tentative date for public rollout - Fall 2008

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Gynecology Pilot

• Collaboration between the SGO and ACS
• Add a limited number of variables
• Data and definitions being finalized
• Pilot in 5-6 sites
• Pilot set for Fall 2007

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ACS NSQIP CMS Demonstration Project

• To develop a public reporting system
• Dr. Frank Opelka has developed a white paper on
  the project
• Exploratory meetings with potential sites
• Awaiting specs from CMS

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Recognitions

• Joint Commission now provides merit badges on
  their Quality Check website for hospitals that
  participate in the ACS NSQIP.

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Recognitions

• American Board of Surgery
• Maintenance Of Certification (MOC)

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Four Components of MOCTo assess physician
competencies on a continual basis

• Professional Standing
• Lifelong Learning and Self-Assessment
• Cognitive Expertise
• Evaluation of Performance in Practice

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Four Components of MOC 4. Evaluation of
Performance in Practice

• ABS Requirement
• Participation in a national, regional or local
  surgical outcomes database or quality assessment
  process.

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Four Components of MOC 4. Evaluation of
Performance in Practice

• ABS Requirement
• Participation in a national, regional or local
  surgical outcomes database or quality assessment
  process.
• NSQIP participation counts for your surgeons

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Consortium Groups

• MSQC Michigan Initiative BC/BS
• Oregon, Tennessee, New York, UK
• Other Payor Groups Interested
• Hospital Groups

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Project Priorities and Target Completion Dates
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Summary of NSQIP Now

• Successful PSS Grant (AHRQ) and implementation of
  NSQIP into private sector.
• Multispecialty (10 total specialties)
• Additional modules (bariatric)
• Piloting new modules (pediatric surg)
• Participant Use File
• SCIP Performance Measures
• Demonstration project
• Collaboratives/Consortium Groups
• Recognitions (Joint Commission, MOC)

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Creating Quality Improvement

• Define the issue and create the sense of urgency
• Vertical buy-in / understanding / ownership to
  Improvement (administrators, managers, front line
  providers)
• Pull the working team together (make up is
  important with ownership and accountability)
• For broader issues take the time necessary (e.g.
  RPIW 5 day vs. Kai Zen 1-2 day)
• Collect initial (starting) data
• Have everyone on the team examine the process
  together.
• Develop the change vision and strategy stay
  focused.
• Immediate change (with ad hoc personnel if
  necessary)
• Iterative dont wait for perfection. Fail
  forward fast (PDSA)
• Produce short term wins
• Dont let up, dont be too satisfied
• Create the culture for iterative improvementit
  can exist.

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Future Vision for NSQIP

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Future Vision for NSQIP
1. Measurement Variable Selection and Modeling
(Surg level pilot)

• Issues in Health Care
• Regulation (hospital, surgeon)
• Costs and Value
• Demonstration of quality
• Quality improvement
• Transparency

2. Best Practices, Education, Site Visits
3. Partnerships (Payers, Government, etc)
4. Research and Discovery
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• Iterative

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Achieving Optimal Patient Care
Surgical Care in our community
(Feedback Education Site Visits)

Outcomes (NSQIP, Cancer database, Trauma
database, Accreditation)
Best Practices QI

• (Evidence,
• Literature,
• Experience)

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Where We Stand
Industries by Size, Productivity, and Efficiency
Low
Airlines
Hotels
Tobacco
Quality (error rate)
Computers
U.S. Postal Service
Food Services
Auto Manufacturing

Health Services
High
Low
High
Source Advisory Board Company, 2005
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Where We Stand
Industries by Size, Productivity, and Efficiency
NSQIP
Low
Airlines
Hotels
Tobacco
Quality (error rate)
Computers
U.S. Postal Service
Food Services
Auto Manufacturing

Health Services
High
Low
High
Source Advisory Board Company, 2005
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• Thank You

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NSQIP Overview Now and the Future

• Clifford Ko, MD, MS, MSHS, FACS
• Director, Division of Research and Optimal
  Patient Care
• Director of NSQIP
• American College of Surgeons