The National Surgical Quality Improvement Program in Non-Veterans Administration Hospitals: Initial Demonstration of Feasibility

A system that reliably identifies and reports adverse events is one prerequisite for process improvement in healthcare. Since its inception in 1994, the National Surgical Quality Improvement Program (NSQIP) has filled such a need within the VA healthcare system. 1–9 Using data adjusted for patient preoperative risk, this validated, outcome-based program compares the performance of all VA hospitals performing major surgery and compares these hospitals by the ratio of observed to expected (O/E) adverse events. These results are provided to each hospital and used to identify areas of substandard performance and potential excessive adverse events. The NSQIP has garnered the acceptance of VA surgeons and healthcare managers and has provided annual outcome reports that have contributed to improving the standard of surgical care. Since 1991, unadjusted 30-day mortality and morbidity rates for major noncardiac surgery within the VA have decreased from 3.2% and 17.4% to 2.3% and 9.9%, respectively. 7 Feedback and performance comparisons such as that offered by the NSQIP are uniquely effective in changing physicians’ behavior. 10–14 Despite this evidence, with the exception of specific clinical programs such as cardiac surgery, 15–20 the non-VA healthcare sector currently does not possess a standard method for comprehensive surgical outcomes assessment and comparative institutional risk-adjusted performance feedback. Given this critical void, we undertook a pilot study to assess the applicability of the NSQIP models and methodology within non-VA hospitals.