Two studies released at the recent American College of Surgeons National Surgical Quality Improvement Program (NSQIP) conference show that data collected by the organization appears to be better than other sources of data for improving quality of care for surgical patients.
The first study, yet to be published as more than a conference abstract, came out of Inova Health System in Virginia, and looked at NSQIP data and administrative data used for billing. They looked at information from 157 readmissions at Inova Fairfax Hospital that had undergone general, endovascular, or colorectal surgery during 2013, and were readmitted within 30 days of their surgical procedures.
According to the study, their records were reviewed by three surgeons to determine the cause for their readmissions. They found the most common reasons were surgical site infections and intestinal obstruction.
The researchers, led by Amber Trickey, MSc, PhD, a surgery epidemiologist and biostatistician at Inova, then looked at the accuracy of administrative claims and the NSQIP data as compared to what the surgeons determined was the cause for those readmissions. The study found that there was a 71% agreement rate when using NSQIP data, but just 61% using administrative information. Trickey and her team also determined that about 60% of the readmissions were possibly preventable.
The authors noted in their work that one reason for the difference in the data might be a lack of specificity in the diagnosis codes in administrative data, compared to NSQIP data, which has very specific codes that can identify primary causes for readmission, and are standardized in ways that administrative data are not.
Next up, Trickey says she and her team will look further into those top two reasons for readmission — infection and obstruction — and see if there is anything they can learn that will help improve patient care further.
The second study presented at the conference used data from the National Inpatient Sample (NIS), the largest U.S. administrative database — which includes information on Medicare, Medicaid, the uninsured, and privately insured patients discharged from about 1,000 hospitals around the country — and compared it to NSQIP data on 11 major surgeries, including coronary artery bypass grafting, aortic valve replacement, and appendectomy. The other surgeries were abdominal aortic aneurysm repair, carotid endarterectomy, laparoscopic cholecystectomy, total and partial colectomy, esophagectomy, sleeve gastrectomy, pancreatectomy, and ventral hernia repair.1
The researchers, from UC San Diego, UC Davis, and Massachusetts General Hospital, looked at something called the c-statistic, a measure of model discrimination where a value of 1 indicates that the model is perfect in discrimination between cases that experienced and did not experience the adverse event, and a value of 0.5 indicates that discrimination is at the level of chance.1
When the researchers compared the c-statistic for complications and mortality models built from the two data sets, they found that they were consistently higher (closer to one) for ACS NSQIP data, compared with the NIS data. Unadjusted complication rates were higher in hospitals in the NIS for seven of the 11 surgeries, but unadjusted mortality rates in every procedure were lower in NSQIP hospitals. The authors concluded that those at the NSQIP hospitals seem to have lower inpatient mortality.1
For more information contact: http://www.acsnsqipconference.org/
• Amber Trickey, MSc, PhD, Surgery Epidemiologist and Biostatistician, Advanced Surgical Technology and Education Center, Inova Fairfax Hospital, Falls Church, VA. Email: [email protected]
• Anna Weiss, MD, Department of Surgery, University of California, San Diego. Email: [email protected].
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Weiss A, Anderson JE, Chang DC. Comparing the National Surgical Quality Improvement Program With the Nationwide Inpatient Sample Database. JAMA Surg. Published online June 10, 2015. doi:10.1001/jamasurg.2015.0962
