Senior Support Solutions, US

The National Surgical Quality Improvement Program ( NSQIP ) has demonstrated since 1991 that the systematic collection, analysis and feedback of risk-adjusted surgical data lead to improved patient outcomes. Since inception of the VA NSQIP in 1991 at 128 Veterans Affairs ( VA ) medical centers, the VA has experienced a 27% decrease in the 30-day postoperative mortality rate. Lengths of stay resulting from morbidities declined by 45% in that period. Same surgeons, just better systems. Private Sector A 1999 pilot study at three non-VA medical centers substantiated the risk-adjustment and predictive outcome models of the VA NSQIP, as well as its positive impact on the quality of surgical care. But something else was discovered during the pilot: whereas the VA hospitals shared a uniform and fully electronic IT infrastructure at its 128 medical centers, the systems in the private sector varied dramatically. Hospitals today are sitting on oceans of data. And these data, unfortunately, live in legacy systems commonly designed around a single purpose. The applications lack compatibility, so there's no integration or data sharing across the hospital. Information gets entered multiple times and often on paper. Items that should be stored as discrete variables get lumped together in a single field, eliminating any possibility for effective query and analysis. Moreover, these institutions are missing the fundamental structure and organization to support a data collection methodology like the NSQIP's. The principals of QCMetrix, with tens of years of combined experience at the VA and in the VA NSQIP, knew first-hand the system struggles experienced in these hospitals. They proposed to the VA's Private Sector Initiative to design and support a reliable, flexible and scalable informatics infrastructure. Their design would accommodate evolving program requirements and protocols and would work equally well in hospitals across a spectrum of information systems, procedures and cultures. In 2001, QCMetrix designed, proposed, and developed the Web-based platform for the VA's Private Sector Initiative. QCMetrix has refined and extended this platform for the American College of Surgeons ( ACS ) under a three-year AHRQ-funded grant. In August of 2004, at the expiration of the AHRQ grant, the ACS took on formal leadership of the Program in the private sector, and will steward the expansion of the ACS NSQIP nationally, powered by what is now the www.acsnsqip.org website. Over the past seven years, this site has been continually enhanced and recently, a new interface was added to automatically transfer data from hospital systems directly to the central Web server. Other productivity tools are under development to facilitate not only the mechanics of data collection, but also to support process management and decision-making. A Full Range of Services QCMetrix now serves over 300 private-sector medical centers, helping them get set up, trained and operational in the ACS NSQIP program. The number of medical centers is expected to increase steadily as the ACS commences its rollout in October, 2004. In addition to continuing to extend the informatics infrastructure for the ACS NSQIP, QCMetrix manages and monitors the data collection process, delivers online, continuously updated reports for immediate feedback, and delivers education and training to new Surgical Clinical Reviewers and other hospital staff. The company also provides consulting services to assist hospitals in surgical quality improvement.