Vha Nsqip Program Analysis

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Analysis: VHA’s NSQIP Program VHA’s NSQIP Program The VHA’s approach to the NSQIP program was to determine, through measurement strategies, the potential for complications and outcomes of the multitudes of surgical programs in their system. Risk adjusted outcomes were used to monitor and improve surgical components for their VA patients. They included information and data from 87,078 surgical cases related to 30-day mortality and morbidity rate outcomes. Comparative studies between all of their surgical sites were conducted resulting in benchmark standards using “risk adjusted models that were developed for general, vascular, orthopedic, urological, thoracic, cardiac and other surgery specialties. Cardiac surgery models were based on previous methods published” (Khuri et al., 1998) as well. Instituting a program based on pre-surgical risk factors they were able to determine those at risk for surgically related complications. Studies involving interventions with expected outcomes (O/E) and are considered particularly suitable for determining effectiveness of the subject studied. Computer based records were examined for workload data (volume) and for risk-adjusted data; the variables and outlier information that would eventually be used or set aside to ensure that consistent, error-free data was used for the most accurate results possible. “Logistic regression analysis was used to develop predictive models for surgical death and complications” (Khuri et al., 1998, p. 494). Cumulative data bases were used for electronic data transmission. Intercept terms and beta coefficients using pre-defined complications for surgical procedures were entered into the database. The program then calculated predicted probability of death or complications for each patient entered based on the pre-surgical risk factors. Confidence intervals were calculated which showed

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