Understanding the Semiannual Report (SAR),Site Summary Reports, and Model Drill Down

Transcription

1 Understanding the Semiannual Report (SAR),Site Summary Reports, and Model Drill Down Kristopher Huffman, MS Division of Research and Optimal Patient Care American College of Surgeons July 22 nd, 2017

2 Disclosures I have nothing to disclose

3 Continuous Quality Improvement Site Summary Report SAR Case Occurrences Report Case Details Report

4 Site Summary

5 Site Summary How would these patients have fared if their surgeries were performed at a different hospital? Average Hospital

6 The Average Hospital The Average Hospital = All NSQIP hospitals combined Site 2 Site 1 Site 3 Site 4 Site 5 Site 680

7 Site Summary How would these patients have fared if their surgeries were performed at a different hospital? Average Hospital What percent of GV cases would have experienced Renal Failure if their surgeries were performed at the average hospital? 0.54%

8 Site Summary Expected Rate = the event rate we would expect IF your hospital s cases were performed at the average hospital Patient Characteristics Procedure Information MODEL Expected Rate

9 Site Summary Observed Rate = 1.32% CRUDE Estimate of the Hospital s True Event Rate Adjust for Risk Reliability Adjust for Adjustment Noise Pred Obs. Rate = 1.05% Our Best Estimate of the Hospital s True Event Rate

10 Site Summary Hospital Quality Metric Rate Ratio Hospital s Event Rate Pred Obs. Rate = = = Average Hospital s Event Rate Expected Rate = 1.94 Odds Ratio Rate Ratio

11 Rate Ratio Hospital s Event Rate Average Hospital s Event Rate = 2 Hospital s Event Rate = 2 * Average Hospital s Event Rate The hospital s event rate is two times greater than the average hospital s event rate

12 Site Summary The odds rate of renal failure at this hospital are two times greater than the odds rate of renal failure at the average hospital Odds Rates (when rates are low) Renal failure is twice as likely at this hospital when compared to the average hospital

13 Site Summary Report Performance Assessment

14 Model Drill Down 509 Models 182 Essentials 327 Procedure-Targeted Don t need to (AND YOU SHOULDN T) go one-by-one through each of these models There is a structure to these models Use this structure to tell a story

15 Model Drill Down Global Models All Cases GV General Procedure-Specific Models Ortho Hip Fracture

16 Model Drill Down Unplanned Intubation All Cases 34 Procedure Targets GV Subspecialties Colorectal General Vascular General Procedure - Targeted Vascular Procedure-Targeted Other Procedure-Targeted (Gyne, Neuro, Urology, Ortho, Plastics, Thoracic)

17 Model Drill Down Procedure Count All Cases 2569 GV General 1676 Vascular 513 Subspecialties 380 Cardiac 1 Gynecology 0 Neurosurgery 0 Orthopedic 1 Otolaryngology 0 Plastic 0 Thoracic 378 Urology 0 Procedure-Targeted General Vascular Thoracic

18 Model Drill Down

19 Model Drill Down All Cases X What cases are driving this?

20 Model Drill Down All Cases General GV Vascular?? Subspecialties?

21 Model Drill Down

22 Model Drill Down Ventilator > 48 Hours Model Needs Improvement GV No General No Vascular Yes We can still dig deeper All Cases GV General Vascular X Subspecialties Are other procedures contributing to the hospital s poor performance with respect to Ventilator > 48 Hours?

23 Model Drill Down = 3.52% = 2.54% 28% Reduction By Targeting One Procedure

24 Model Drill Down Ventilator > 48 Hours All Cases GV General Vascular X Targeted VASC AAA X Subspecialties Are other procedures contributing to the hospital s poor performance with respect to Ventilator > 48 Hours?

25 Model Drill Down Procedure Count All Cases 2569 GV General 1676 Vascular 513 Subspecialties 380 Cardiac 1 Gynecology 0 Neurosurgery 0 Orthopedic 1 Otolaryngology 0 Plastic 0 Thoracic 378 Urology 0 Procedure-Targeted General Vascular Thoracic

26 Model Drill Down

27 Model Drill Down Ventilator > 48 Hours All Cases GV General Vascular X Targeted VASC AAA X Subspecialties Thoracic X

28 Heat map for outcome SSI All Cases 10 th Decile (Worst) Essentials General/Vascular General Colorectal Vascular SS Gynecology SS Neurosurgery SS Urology SS Orthopedic SS Plastics SS Cardiac 6 th Decile 5 th Decile PT Distal pancreatectomy Whipple pancreatectomy Proctectomy VHR Bariatric Hepatectomy Thyroidectomy Esophagectomy Appendectomy Colectomy CEA CAS AAA EVAR Aortoiliac open Aortoiliac endo Lower extremity open Lower extremity endo Hyst/Myom Gyne reconstruction Spine Brain TURP Prostatectomy Nephrectomy Cystectomy TKA THA Flap Breast reduction Abdominoplasty Lung resection 1 st Decile (Best)

29 Case Occurrences Report

30 Case Occurrences Report Model Procedure Type SAR Period View cases for selected model

31 Case Occurrences Report

32 Excel File Case Details Report Over 200 columns - Demographics - Preoperative Patient Risk Factors - Operative Characteristics - Lab Values - Postoperative Outcomes

33 Case Details Report

34 Case Details Report High Risk Patient Identify risk factors Plan accordingly to reduce the risk of a postoperative occurrence

35 Case Details Report Low Risk Patient Why did this happen? A) Unknown (Pure chance) B) Risk Factor the model didn t account for C) Unknown Risk Factor D) Hospital Error

36 Conclusion SAR Site Summary Report Identify areas for QI Case Occurrences Report Identify cases with occurrences Case Details Report Data Drill Down for QI