Original CommunicationHow best to measure surgical quality? comparison of the Agency for Healthcare Research and Quality Patient Safety Indicators (AHRQ-PSI) and the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) postoperative adverse events at a single institution
Section snippets
Data sources
All data used in this study originated from patients operated at the Mayo Clinic, Rochester (MCR) between April 2006 and June 2009. MCR is a tertiary care academic medical center in the upper Midwest of the United States. The annual operative volume averages 53,000 cases. This study was approved by the Institutional Review Board.
ACS-NSQIP is based on manual review of medical records using strict adverse event definitions. Clinical documentation is reviewed by a trained nurse abstractor for
Results
Overall, 564 (7.4%) patients had an ACS-NSQIP adverse event identified during the hospitalization, with an additional 384 (5.0%) patients with an ACS-NSQIP event after discharge. An AHRQ-PSI was identified in 268 (3.5%) patients. As shown in Fig 1, only 159 patients had inpatient events identified by both methodologies.
The screening performance of AHRQ-PSI for clinical adverse events is displayed in Table II. The number of events flagged by both methods ranged from 8 for renal failure to 39 for
Discussion
The assessment and reporting of quality medical outcomes has become a key component of health care improvement and efforts in cost reduction. Nevertheless, the best methodology for evaluating institutional surgical outcomes remains unclear. We performed a comparative analysis using the ACS-NSQIP general and vascular surgical patient database (N = 7606) and the AHRQ-PSI algorithms from a single institution. Overall, the AHRQ-PSI was not very sensitive for detecting important clinical adverse
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