Grant: Partnerships for Health System Improvement (PHSI)

Health Authorities in British Columbia are spending about $5 million per year for 24 BC hospitals to participate in the US National Surgical Quality Improvement Program (NSQIP), a surgery outcome measurement and reporting program. NSQIP has been shown in US hospitals to reduce very costly adverse outcomes, such as readmissions, extra procedures and longer stays. Participation is costly because NSQIP requires each site to have a full-time nurse as a Surgical Clinical Reviewer to do chart reviews for 1,680 patients per year, monitoring their adverse health events in the 30 days after leaving hospital by telephone follow-up, and doing data management and analysis. It is also costly because the data are sent to Chicago for statistical analysis using a proprietary NSQIP database for $10,000 to $30,000 per hospital. The BC Patient Safety and Quality Council and the Health Authorities would like to know why we must pay US analysts to compare Canadian with US hospitals' outcomes? Can we establish a Canadian version of NSQIP potentially serving all of Canada, that costs less per hospital than NSQIP, using Canadian databases and calibrated to Canadian patients? This study aims to assess the relative benefit and cost of surgery quality outcomes reporting (SQOR), to increase its spread, and to lower its cost, as a potential foundation for a Canadian SQOR program. The study will use administrative databases to measure savings from improved surgical outcomes due to 24 hospitals in BC participating in NSQIP. It will assess the validity and acceptability of hospital-specific SQOR 'report cards' and whether such 'SQOR-cards' can serve hospitals that do not participate in NSQIP. Finally, it will test several strategies for reducing the cost of chart review and telephone follow-up, relative to the cost of participating in NSQIP. The study will also assess how 'SQOR-cards' can help to develop a culture of quality improvement among surgical teams in smaller hospitals.