1. American College of Surgeons

2.  Web-Based data collection program  Quality improvement tool  National Benchmarking  Surgical outcomes data What ACS NSQIP Is ______________________________

3. Current Participants ______________________________ Number of Participating Sites by State and Region (487) November 2012 CANADA 28 WEST 98 SOUTH 176 LEBANON 1 MIDWEST 87 NORTHEAST 95 5 9 55 1 3 4 9 4 1 9 3 9 3 8 18 2 24 5 15 10 66 3 11 10 15 29 9 8 11 2 15 13 1 7 ABU DHABI, UAE 1 11 25 1 2 2 1 2 2 2 LONDON, ENGLAND 1 1

4.  Clinically Rich Data  Web-Based Workstation  Private & Secure Data Encryption  On-line Training & Certification of SCR’s  Real-time reports access & Semi-annual reports  On-line Return of Investment (ROI) Calculator  Best Practices (Expert panel rated guidelines)  Improvement Case Studies  Pre-operative Surgical Risk Calculator  Participant Use File (PUF) Product Features _____________________________

5. Surgeon Champion (SC)  Program Mentor/Advocate Surgical Clinical Reviewer (SCR)  Data Collector  Honesty  Respect  Regarding SCR as a peer  Accessibility  Plan for personal growth  Develop chemistry  On-line/On-going training; CEU’s/CME’s & Certification - provided by the ACS Program Staffing ______________________________

6. Surgeon Champion Qualifications  Well Respected & Highly Regarded  Chief of Surgery or Chief Medical Officer  Program Mentor/Advocate  Must be trusted by peers and administration  Experience with Quality Improvement  Lead Quality Improvement Initiatives  Participate in Monthly SC Conference Calls

7. Surgical Clinical Reviewer Qualifications Preferred …  Bachelor’s Degree preferred  Clinical chart review and abstraction experience  Ability to build relationships & to articulate questions Recommended …  1 Year experience in surgery, medical records, or clinical research  Nursing Background  Quality improvement or patient safety knowledge and experience

8. Data Collection Data Collected  Demographics  Surgical Profile  Pre-operative Data (risk factors)  Intra-operative Data  Post operative Data (outcomes) ______________________________

9.  A randomized sampling system called the 8-day cycle  Process ensures that cases have an equal chance of being selected from each day of the week Sampling Methodology ______________________________ Data Collection

10. 30-Day Post-Op Follow Up Review Outcome /follow-up information can be obtained in a variety of ways:  Review of the patient’s medical record.  Screen for readmissions  Separate clinic or the private surgeon’s office -outpatient follow-up visits  Additional methods would be either a phone call placed directly to the patient or a follow-up letter can be mailed for the patient to respond to in writing

11. An Odds Ratio of 1 is like “par on a golf course” – the score that is expected It is a metric showing the risk-adjusted performance at a specific site compared to the average hospital  An Odds ratio 1 indicates an excess of adverse events  The odds is defined as the #events / #non-events i.e. 5/95=.053, is the odds for a hospital if there are 5 deaths among 100 patients  Our Odds Ratio is the risk-adjusted odds for an event at a site divided by the odds for an event at the average site  Our Odds Ratios are also adjusted so they are useful even for hospitals that provide very small samples Odds Ratios ______________________________ Risk Adjustment

12. Real-Time and Semiannual Reports  Real-time, continuously updated online reports  Programmed library of reports that can be filtered  Real-time data  Able to compare with all or like sites  Customizable Fields  Semiannual benchmarked report  Risk Adjusted  Distributed in the 1 st & 3 rd quarter of each year Reporting ______________________________

13. Real-Time Reports  Workflow Reports  Site-Level Reports  Database Statistics  Data Analysis Reporting ______________________________

14. Reporting ______________________________ Pre-Operative Risk Factor Summary

15. Reporting ______________________________ 30 Day Post-Op Summary

16. Reporting ______________________________ Mortality Patient Report

17. Reporting ______________________________ Post-Operative Occurrence Analysis

18. Semiannual Report Risk adjusted for hospital-to-hospital patient mix differences. Reporting ______________________________

19. Over 90 Risk Adjusted Outcomes  30-Day Mortality & Morbidity/ Serious Morbidity Odds Ratios in All Patients+  30-Day Morbidity/Serious Morbidity Odds Ratios in patients >65  Cardiac Occurrences  Pneumonia  Unplanned Intubation  Ventilator Dependence >48 hours  DVT/PE  Renal Failure  Urinary Tract Infection/UTI Odds Ratios  Surgical Site Infection/Deep & Organ Space Odds Ratios  Colorectal 30-Day Death or Serious Morbidity Odds Ratios Reporting ______________________________

20. Semiannual Report: Model Summary

21. Semiannual Report: Hospital-Specific Bar Plot

22. ACS NSQIP Improves Outcomes and Saves Money Return on Investment ______________________________

23. Does Surgical Quality Improve using the ACS NSQIP?  82% of ACS NSQIP hospitals had decreased surgical complications  66% of ACS NSQIP hospitals had decreased mortality  Each hospital is projected to avoid between 250-500 complications per year – on average Return on Investment ______________________________

24.  Beaumont Hospital saved $2.2 million and reduced average LOS by 6.5 days by reducing SSI. In 2009, the hospital estimates it prevented nearly 300 SSI’s.  Surrey Memorial Hospital reduced SSI’s over 4 years for savings of $2.54 million  Henry Ford Hospital reduced LOS for annual savings of $2 million Return on Investment ______________________________

25. ComplicationCost Per Case Averted EventsCost Savings Ventilator >48 hrs$ 27,654 X 17 = $ 470,118 UTI$ 12,828 X 12 = $ 153,936 Cardiac Arrest$ 15,079 X 4 = $ 60,316 Pneumonia$ 22,097 X 24 = $ 530,328 Unplanned Intubation$ 21,025 X 7 = $ 147,175 Deep SSI$ 20,012 X 15 = $ 300,180 Total $1,662,053 Return on Investment ______________________________ ROI Calculator

26. Non-Monetary Benefits …  Valid National benchmarking for surgical outcomes  Provides proactive, value-oriented surgical outcomes performance measurement  Improves local market position, i.e. publicly visible surgical quality improvement program  Optimizes cross-departmental partnerships and collaboration through shared knowledge  Helps build high performance surgical teams and employee retention, (i.e. nurses)  Offers CME’s for Surgeon Champions and CEU’s for SCR’s Return on Investment ______________________________

27.  Complete yet concise resource for health care providers and QI professionals  Evidence-based  Expert panel-rated  Framework to:  Prevent postsurgical complications  Prioritize/direct QI efforts aimed at reducing incidence/impact of postsurgical complications Best Practice Guidelines ______________________________

28. Selection of Data Choose Your Focus General & Vascular – sampling of the hospitals general & vascular surgical procedures abstracted Multi-Specialty – sampling of hospital surgical specialties abstracted ____________________________

29. The Options 1. ACS NSQIP Essentials 2. ACS NSQIP Measures 3. ACS NSQIP Small & Rural 4. ACS NSQIP Procedure Targeted _____________________________ Four Adult ACS NSQIP options

30. ACS NSQIP Essentials  General/Vascular = 1,680 general & vascular surgical cases submitted annually  Multispecialty = Abstract 20% of the total case volume from each specialty  1 FTE _____________________________

31. ACS NSQIP Measures  5 High Impact Measures: - UTI - Colorectal - SSI - Lower Extremity Bypass - Elderly  Minimal Data Collection = 840 cases collected annually  1/2 FTE _______________________________

32. ACS NSQIP Small & Rural  Small Hospital: performs less than 1,680 cases per year OR  Rural Hospital: ZIP code is defined within RUCA data codes  100% case collection across all specialties  1 FTE (or less depending upon case volume) _____________________________

33. ACS NSQIP Procedure Targeted  Larger hospitals targeting high-risk/high volume procedures  Hospital selects procedures  Selection may be CPT code-driven  Minimum of 1,680 cases per year: - 15 “Core” cases per 8-day cycle - 25 “Procedure Targeted” cases per 8-day cycle  Minimum 1 FTE (or more depending on volume) ______________________________

34. Pricing Essentials Procedure Targeted Small/Rural Measures Pediatric NSQIP Base Price$27,000$29,000$10,000 $15,000 $29,000 System or Collaborative Discount $3,500 N/A $3,500 Three - Year Contract Discount $1,500 N/A $1,500 Annual Fee $22,000$24,000$10,000 $15,000 $29,000 _____________________________

35. Recognition Meets MOC Part 4 - Evaluation of performance in practice through tools such as outcome measures and quality improvement programs, and the evaluation of behaviors such as communication and professionalism. _______________________________

36. Institute of Medicine named ACS NSQIP “the best in the nation” for measuring & reporting surgical quality and outcomes. Recognition _______________________________

37. Tresha Russell Business Development Representative tresharussell@facs.org 312-202-5441 _______________________________

38. Thank you _______________________________