Thursday, 01 August 2013 13:14

Day 2 ACS NSQIP Blog

Written by  doc roxas
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Day 2 ACS NSQIP Blog

The second day of the conference focused on more technical aspects of the NSQIP Data Base, specifically on data encoding, on-line reporting, as well as statistical issues such as modeling and interpretation of results. 

Once a hospital is accepted to be part of the NSQIP database, a Surgeon Champion (SC) and a Surgical Clinical Reviewer (SCR – usually a nurse with a masteral degree) are appointed within the hospital to lead the project. They are trained on how to use the database to both input data and evaluate reports. Then the data is transmitted on-line to the national office of the NSQIP in the ACS headquarters in Chicago, quarterly reports are generated and delivered back to the participating hospitals. These reports compare the standing of the hospital against national trends, particularly on key outcomes such as post-operative mortality and various complications, such as infections and cardiovascular events. If the hospital wants to improve on these outcomes, the SC then initiates a multidisciplinary and comprehensive quality improvement program. Success of the program will then be based on the succeeding quarterly reports generated by NSQIP. The data itself is very clinical, focusing on quality of care (rather than on administrative or financial outcomes). It is therefore quite valuable to clinicians and clinical researchers.

The NSQPI standardizes the surgery database across units and departments nationwide. It acquires data from preoperative work up, intraoperative processes and 30 day post-operative outcomes. It looks at such elements as glucose control, screening for methicillin-resistant staph aurus, bowel prep, antibiotic use, pneumonias, urinary tract infections, and deep venous thrombosis prophylaxis, among others.

Actual and dramatic improvements in outcomes using NSQIP were also presented. For instance, the NSQIP database allowed Ireland just this year to increase by 73% and 11%, its’ national reports on morbidity and mortality, respectively, from a previously poor data collections system. The Kaiser Permanente Health System saw a drop in its superficial surgical site infections from 20% to 4% by using NSQIP. In general, particularly for post-operative mortality, NSQIP hospitals improved faster than expected, as compared to non-NSQIP hospitals that were, in fairness to them, also improving but at a slower pace.

These discussions made me acutely aware of how surgical practice in America was rapidly changing towards value-driven healthcare - not the present “disconnected system of healthcare businesses”, which we still see in the Philippines. According to Warren Buffet: “Price is what you pay; value is what you get”. In the healthcare setting, value is directly proportional to quality, and inversely proportional to cost. Higher quality and lower cost equate to higher value of service. However, defining and measuring quality require concrete data that are both meaningful and trustworthy. And it is the NSQIP that provides surgeons and administrators with objective measurements of quality and outcomes, both for analysis and program development.

Having been involved in various capacities within national surgical societies such as the Philippine College of Surgeons, and the Philippine Society of Colorectal Surgeons, I can appreciate how technically advanced and comprehensive the NSQIP data system is, and how much funding as well as technical support from IT specialists, statisticians and researchers, it requires. My personal experiences with national projects such as clinical practice guidelines, or even specific researches within PGH, have been a continuous struggle against the lack of funding and quality. Frankly I don’t think a project like NSQIP, but locally produced and funded, is feasible nor sustainable in the country at the moment, whether by PCS, NIH, DOH or even Philhealth. 

Dr. Maher Abbas delivered the keynote address during the lunch symposium. Interestingly his topic was on the impact of the Titanic tragedy to the development of safety mechanisms for maritime navigation. He described how the Titanic tragedy was preventable, and how many warning flags and safety mechanisms were ignored. The aftermath witnessed intense public scrutiny and analysis of the prior events, and the establishment of safer maritime processes - similar, in many ways, to the whole surgical process, with the surgeon acting as the captain of the ship.

The other main theme for the day centered on professionalism and accountability. Successful and reliable teams required 3 pillars:
1. Vision/goals/core values; 
2. Leadership and authority; and 
3. A culture of safety and trust, not just physically but also psychologically.

Characteristics required from professionals:
- Competence
- Clear and effective communication
- Model respect
- Available
- Self-awareness
- Promote teamwork
- Submit to self and group regulation
- Practice full disclosure
- Protect those who speak up (with emphasis)

The fellowship dinner was held in a small Italian restaurant. I met my co-International Scholar who’s from China, Professor Ping Lan, also a colorectal surgeon. We sat beside 3 Research Fellows from the American College of Surgeons. It was quite interesting to hear that these research fellows were concomittantly taking masteral studies, even as they took 1 to 2 years off from their clinical residency training. Furthermore, they were using NSQIP as a database for their researches, usually on more public health issues such as quality of surgical care. These discussions pointed me to future possibilities for our own trainees in the Philippines.

The best event for the day was my meeting with Jim Wadzinski, Director of Operations of the ACS NSQIP. He, together with Dr. Clifford Ko, Director of the ACS Division of Research and Optimal Patient Care, were very keen on establishing a NSQIP pilot project in the Philippines, particularly since there was none yet in Southeast Asia. The fact that our own medical records are in English seemed to excite them even further. … And of course, their enthusiasm inspired me to strategize on how to best and most realistically promote the concept of NSQIP back home.

Read 5743 times Last modified on Thursday, 01 August 2013 13:19