1. BC’S LOCAL RISK-ADJUSTED MODEL JANUARY 2012

2. Background Most BC sites joined NSQIP in mid 2011 1 st NSQIP risk-adjusted semi-annual report – Mar 2012 2 nd NSQIP risk-adjusted semi-annual report – July 2012 3 rd NSQIP risk-adjusted semi-annual report – Mar 2013 Data analysis using non-risk-adjusted data - SPC chart - customized reports from workstation

3. Background NSQIP’s Semi-annual report limitations and challenges SMH’s attempt in replicating NSQIP’s SAR Jonathan Berkowitz, BSc, MSc, PhD Sauder School of Business, University of British Columbia

4. BC NSQIP Timeline and Important Dates Jan 2012 Doug’s Challenge: Identify 3 areas for improvement Feb 2012 Data Analysis Workshop with Kathy Rowell (Feb 8, 2012) Mar 2012 NSQIP’s SAR Release (Jul 2010-Jun 2011 Data) July 2012 NSQIP Annual Conference in Salt Lake City NSQIP’s SAR Release (Jan- Jun 2011 Data) Nov 2012 Site Update

5. * Includes General and Vascular Surgery Cases Observed Rate: 2.20% Pred. Obs. Rate: 2.48% Expected Rate: 2.75% Odds Ratio: 0.84 Status: Non-Outlier PLAN: Overall Mortality

6. PLAN: Establish a local risk-adjusted model using BC data

7. Advantages Identify local predictors Timely reports - release of BC’s hierarchical odds-ratio report will be ~3 months ahead of NSQIP’s SAR The current program is scheduled to end on Mar 2013. Using NSQIP data alone, sites will receive 2 SAR from NSQIP. Participating sites in the BC Collaborative accelerated plan will receive 5 risk-adjusted reports. Provides valid statistical advice and certified accelerated process that meets statistical requirements in comparing sites in BC A consistent provincial reporting template will be used to foster dialogue between sites, to identify and share best practices leading to improved outcomes.

8. BC NSQIP Timeline and Important Dates Jan 2012 Doug’s Challenge: Identify 3 areas for improvement Feb 2012 Data Analysis Workshop with Kathy Rowell (Feb 8, 2012) Mar 2012 NSQIP’s SAR Release (Jul 2010-Jun 2011 Data) May 2012 1 st BC Local Risk- Adjusted Report (Jan- Dec 2011 Data) Jul 2012 NSQIP Annual Conference in Salt Lake City NSQIP’s SAR Release (Jan-Jun 2011 Data) Oct 2012 2 nd BC Local Risk-Adjusted Report (Jul 2011-Jun 2012 Data) Nov 2012 Update PROPOSED TIMELINE:

9. Expectations Timely submission of data -Data transmission to NSQIP workstation and data cleaning for all 2011 cases done by April 29, 2012 -Submit de-identified data download to BCPSQC by May 1 st, 2012 VOLUNTARY

10. Jonathan Berkowitz, BSc, MSc, PhD Sauder School of Business, University of British Columbia

11. Data, data, data! I cannot make bricks without clay! - Sherlock Holmes

12. SPC Charts

13. Q&A

14. Data Analysis Workshop February 8, 2012 8:30am-4:00pm Delta Airport Hotel Richmond, BC Highlights: 1.Finding QI opportunities in your NSQIP data 2.Communicating NSQIP Data 3.Promoting ideas, identifying project advocates and securing resources

15. Learning Objectives: Improved understanding about the NSQIP dataset, including: Why specific data is captured (intent and purpose of data). Using non risk‐adjusted [and adjusted data] to identify QI opportunities. Techniques to “ask the right questions” when working with the data.

16. Learning Objectives: Improved skills to: Identify project advocates. Identify required and available resources. Improved critical thinking and analytical skills: To search for previously un ‑ seen patterns and trends. To identify the potential causes behind patterns and trends. To discover connections and stories in the data not previously considered.

17. Learning Objectives: Improved communication and data presentation skills: To tell stories with data correctly, clearly and compellingly in reports with tables and graphs and an increased awareness of the power of dashboards To communicate information “at a glance.” Understand of the importance of NSQIP non risk‐adjusted data Concepts of how to communicate non risk‐‐adjusted data.

18. Q&A