What is the American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP®)?
ACS NSQIP is a nationally validated, risk-adjusted, outcomes-based approach to measure and improve the quality of surgical care. It employs a prospective, peer-controlled, validated database to quantify 30-day, risk-adjusted surgical outcomes, which provide a valid comparison of outcomes among all hospitals in the program. Currently, about 700 hospitals use the ACS NSQIP tools, analyses, reports and support to make informed decisions about improving the quality of their care. Peer-reviewed studies have shown that ACS NSQIP is effective in improving the quality of surgical care while also reducing complications and costs.
How can hospitals benefit from implementing ACS NSQIP?
Participating hospitals benefit from access to powerful tools and a proven process to assess and improve their surgical quality; by sharing what they have learned with other participants; and by building on the lessons learned. They also have a significant opportunity to reduce costs and improve profit margins by reducing complications.
How is ACS NSQIP different from other quality improvement programs?
The data. Most quality improvement efforts are based on claims data from billing files. Among many shortcomings, claims data does not enable researchers to adjust for patient risk factors or to determine if a patient experienced a related complication after leaving the hospital (when half of all such complications typically occur).
In contrast, ACS NSQIP uses risk-adjusted data gathered from medical charts by clinically trained personnel and includes an assessment of the patient’s condition 30 days after a surgical procedure. This information enables each hospital to make a valid comparison of its outcomes with those of other hospitals and, as a result, determine where it needs to make improvements.
How does ACS NSQIP help participating hospitals implement these improvements?
ACS NSQIP provides participating hospitals with resources, such as Best Practice Guidelines developed by leading surgeons and experts, evidence-based primers on relevant topics and Case Studies that illustrate how other hospitals achieve quality improvement.
ACS NSQIP also provides intensive training and follow-up support for Surgical Clinical Reviewers (SCRs) as well as monthly conference calls and a national conference for both the SCRs and Surgeon Champions. Further, ACS NSQIP offers hospitals and clinicians the necessary tools, reports, analysis and support to collect data and implement quality improvement initiatives:
- Benchmarking via hospital-specific reports and comparative state and national data
- Periodic reports and collaborative meetings to review and interpret data, including performance information to guide surgical decision making and identify areas for improvement that will provide the greatest return and highest impact
- Access to best practices tools, including evidence-based guidelines and Case Studies developed by leading U.S. surgeons
- Reporting software developed by a CMS-approved vendor with complete and ongoing training in how to use it
- Site audits to ensure data reliability
How much does it cost to take part in ACS NSQIP?
There is an annual fee of between $10,000 to $29,000 for sites participating in ACS NSQIP. This fee covers all program management and administration, training of the site’s Surgical Clinical Reviewer (SCR), on-site audits according to the ACS NSQIP audit policy, and ongoing technical support. Additionally, the fee includes the use of online web tools for data submission, access to site-specific reports and tools, and semiannual program reports, that provide risk-adjusted benchmarking against other hospitals. Data automation and software programs to support the SCR and continuing education credits for SCRs who successfully complete the online training are also included. All annual fees must be paid prior to beginning participation in the program.
How long before we start to see meaningful data for our site?
Because ACS NSQIP captures data prospectively, it takes most sites approximately six to 12 months to capture enough data to begin to be able to make meaningful comparisons to other sites and to have a statistically significant OR ratio. Factors such as how many SCRs the site has and the presence/absence of data automation will also affect the volume and subsequent speed from which a site will have enough data to draw any conclusions.
What steps does ACS NSQIP take to ensure that data samples are randomly selected, complete and reliable?
All ACS NSQIP adult and pediatric participation options use an ACS-validated, systematic sampling protocol. Hospitals with larger volumes collect a certain number of cases during this cycle. Those with lower volumes will collect all surgical cases, so a sampling system is not required.
How does ACS NSQIP fit with other quality efforts a hospital may be involved with?
Most hospitals participate in multiple quality improvement programs, including checklists, bundles and various process measures. ACS NSQIP is different in that if focuses on outcomes, an approach which has been shown to be more effective, and which is synergistic to other quality efforts. As a surgical registry that allows hospitals to discover where their complications rates are statistically below those of their peers, ACS NSQIP offers a proven way to measure a hospital’s progress in improving outcomes in a given area. ACS NSQIP can also help hospitals measure how well current surgical quality improvement efforts are working and may indicate previously unrecognized areas for improvement.
Collecting data for multiple registries can create a burden for hospitals since many of the data definitions are not standardized between registries. ACS NSQIP understands this is a widespread concern. That’s why ACS is working with CMS to develop national outcomes-based measures, and working with the CDC’s National Healthcare Safety Network (NHSN) program, a government-required hospital surveillance system, to harmonize variable definitions with the CDC’s. While a hospital using ACS NSQIP must invest monetary and staffing resources to participate, many hospitals are able to recoup their costs in a short time through the cost savings from reduced complications, especially after the first year. Hospitals also find that improved outcomes on ACS NSQIP can help drive improved results on required and publicly reported measures, such as those for readmissions and infections.
