An Executive Summary of the Physician s Report Card: Another Benefit of ACS NSQIP

Transcription

1 An Executive Summary of the Physician s Report Card: Another Benefit of ACS NSQIP Vijay K Maker MD, FACS, FRCS(c) Chairman, Department of Surgery, Executive Program Director, University of Illinois at Chicago, Metro Residency in General Surgery Margaret Wasserman BSN, RN Senior Analyst and ACS NSQIP Clinical Reviewer

2 Advocate Illinois Masonic Medical Center No disclosures or conflicts

3 A 408-bed teaching hospital, ranked as one of the best hospitals in the Chicago metropolitan area by U.S. News & World Report. Over 12,000 surgical procedures per year Training 200 residents and 500 medical students each year One of Advocate s three major teaching hospitals all active ACS NSQIP members and participants in the QITI Collaborative and part of general surgery residency programs in Chicago One of only four Level I Trauma Centers in Chicago, caring for 40,000 emergency visits annually and treating nearly 1,200 trauma patients a year

4 Hypothesis A simplified single-score report card can translate complex surgeonspecific data.

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6 Advantages of a Single-score Report Card It s a single number It can be easily translated and compared It can be validated Like golf, the lower the score, the better the score

7 Materials & Methods: Risk Index Formula How many cases with this # of RISK FACTORS? Multiplied by Total Sum divided by 6 (Numerator) Surgeon s total # of cases (Denominator) RISK INDEX (sum) Yellow-shaded = you complete Green-shaded = formula completes

8 Risk Index Formula How many cases with this # of RISK FACTORS? Multiplied by Total Sum divided by 6 (Numerator) Surgeon s total # of cases (Denominator) RISK INDEX Yellow-shaded = you complete Green-shaded = formula completes

9 Outcome Measures Cases with zero Cases with 1 Cases with 2 Cases with 3 Cases with 4 Cases with 5 Materials & Methods: Outcome Index Formula Occurrence Based Risk adjusted (x) # of Occurrences (y) Yellow-shaded = you complete Green-shaded = formula completes (x)(y) = numerator (sum) Total cases(z) = denominator SCORE = (x)(y)/ (z)

10 Outcome Measures Cases with zero Cases with 1 Cases with 2 Cases with 3 Cases with 4 Cases with 5 Materials & Methods: Outcome Index Formula Occurrence Based Risk adjusted (x) # of Occurrences (y) Yellow-shaded = you complete Green-shaded = formula completes (x)(y) = numerator Total cases(z) = denominator SCORE = (x)(y)/ (z)

11 Materials & Methods: Outcome Index Formula Specifics based Outcome Measures Risk adjusted (x) # of Occurrences (y) (x)(y) = numerator Total cases(z) = denominator SCORE = (x)(y)/ (z) Superficial SSI 1 Deep SSI 2 Organ space SSI 3 Wound Dehiscence 4 DVT 3 PE 4 Expire within 30 days 5 (sum) Yellow-shaded = you complete Green-shaded = formula completes

12 Materials & Methods: Outcome Index Formula Specifics based Outcome Measures Risk adjusted (x) # of Occurrences (y) (x)(y) = numerator Superficial SSI Deep SSI Organ space SSI Wound Dehiscence DVT PE Expire within 30 days Total cases(z) = denominator SCORE = (x)(y)/ (z) Yellow-shaded = you complete Green-shaded = formula completes

13 Final Step Outcome Index Score (numerator) (Occurrence based or Specifics based) Risk Index Score (denominator) Maker-Wasserman Score Yellow-shaded = you complete Green-shaded = formula completes

14 Final Step Occurrence based Outcome Index Score (numerator) (Occurrence based or Specifics based) 0.07 Risk Index Score (denominator) 0.34 Maker-Wasserman Score 0.21 Yellow-shaded = you complete Green-shaded = formula completes

15 Conclusion Maker-Wasserman Score Surgeon O

16 Conclusion Maker-Wasserman Score Surgeon O NSQIP equivalent hospital database 21