Key Studies

Summaries and Links to Peer-Reviewed Studies

FSCI: Built on a Strong Foundation of Quality Improvement

FSCI is based on the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), which is well-documented to have helped hundreds of hospitals achieve improvements in the quality of care and cost savings. Clinical studies show that ACS NSQIP provides highly reliable, robust data that helps hospitals improve risk-adjusted outcomes, and FSCI was developed using the same approach. Following are recent studies that support the effectiveness of ACS NSQIP:

REDUCES COMPLICATIONS

Does Surgical Quality Improve in the American College of Surgeons National Surgical Quality Improvement Program: An Evaluation of All Participating Hospitals

B.L. Hall, et al., Annals of Surgery, September 2009

This study evaluated 118 hospitals that began participating in ACS NSQIP between 2005 and 2007, and found that participating hospitals each prevented 250-500 complications annually. The researchers concluded that hospitals of all types – large and small, urban and rural, teaching and non-teaching – improved their quality of care, and that hospitals that were poorer performers when they joined ACS NSQIP, achieved the greatest quality improvement.
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IMPROVES OUTCOMES

Successful Implementation of the Department of Veterans Affairs’ National Surgical Quality Improvement Program in the Private Sector: The Patient Safety in Surgery Study

S.F. Khuri, et al., Annals of Surgery, August 2008

The U.S. Department of Veterans Affairs’ (VA) National Surgical Quality Improvement Program (NSQIP) has been associated with significant reductions in postoperative morbidity and mortality. Researchers sought to determine if NSQIP methods and risk models were applicable to private sector hospitals. This study evaluated patients undergoing general or vascular surgical procedures in 128 VA medical centers and 14 private sector hospitals between 2001 and 2004. Researchers found that the implementation of ACS NSQIP in private sector hospitals was associated with a reduction in morbidity, including statistically significant reductions in overall postoperative morbidity, surgical site infections, and renal complications.
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USES HIGHLY EFFECTIVE TRAINING AND AUDIT PROCEDURES

Toward Robust Information: Data Quality and Inter-Rater Reliability in the American College of Surgeons National Surgical Quality Improvement Program

M. Shiloach, et al., Journal of the American College of Surgeons, January 2010

Data used for evaluating quality of medical care must be highly reliable to ensure valid quality assessment and benchmarking. The program infrastructure of ACS NSQIP facilitates collection of highly reliable clinical data. This study evaluated data quality and inter-rater reliability in ACS NSQIP for 2005 through 2008. Researchers determined that the training and audit procedures for hospitals participating in ACS NSQIP are highly effective. Audit results show that data have been reliable since the program’s inception and that reliability has improved every year.
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USES ROBUST CLINICAL DATA

Comparison of Risk-Adjustment Methodologies in Surgical Quality Improvement

S.M. Steinberg, et al., Surgery, October 2008

This study compared ACS NSQIP’s risk-adjusted clinical, 30-day outcomes database with the administrative data collected in the University HealthSystem Consortium (UHC) program. The researchers’ institution recognized a large disparity between their UHC and ACS NSQIP risk-adjusted mortality rates and conducted the study in order to discover the cause of that disparity. The researchers found that ACS NSQIP uncovered 26 percent more complications than the UHC program. For example, the ACS NSQIP database showed that 11 percent of patients experienced a surgical site infection, compared with only one percent of patients in the UHC database.
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INCLUDES VALIDATED MEASUREMENTS

Validating Risk-Adjusted Surgical Outcomes: Site Visit Assessment of Process and Structure

J. Daley, et al., Journal of the American College of Surgeons, October 1997

This early study was conducted to assess the validity of risk-adjusted surgical morbidity and mortality rates as measures of quality of care, by assessing the process and structure of care in surgical services with higher-than-expected and lower-than-expected risk-adjusted 30-day mortality and morbidity rates. Using a site visit methodology, researchers confirmed an association between the risk-adjusted adverse outcomes of surgical mortality and postoperative morbidity in surgical services at 20 Veterans Affairs Medical Centers.
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SAVES LIVES AND MONEY

Who Pays for Poor Surgical Quality? Building a Business Case for Quality Improvement

J.B. Dimick, et al., Journal of the American College of Surgeons, June 2006

The purpose of this study was to determine whether hospitals or payers incur a larger burden of increased hospital costs associated with complications. Researchers merged clinical data for 1,008 surgical patients from ACS NSQIP to the internal cost-accounting database of a large university hospital to determine the marginal costs of surgical complications from the perspective of both hospitals (changes in profit and profit margin) and payers (increase in reimbursement paid to the hospital). Researchers found hospitals and payers both suffer financial consequences from poor-quality health care, but the greater burden falls on payers. For patients without complications, the average reimbursement was $14,266, exceeding the hospital’s costs of $10,978 and yielding a hospital profit of $3,288, a 23.0 percent profit margin. For patients with complications, however, the average reimbursement was $21,911, exceeding the hospital’s costs of $21,156 and yielding a far smaller profit of $755, or a 3.4 percent profit margin.
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