Data Collection and Reporting: Why and How

Data Collection and Reporting: Why and How

Disclosure Douglas C. Barnhart, MD MSPH FACS I do not have any relevant financial relationships with any commercial interest that pertains to the content of my presentation.

Rationale for Data Collection Requirements Improve the Children s Surgery Verification Program s understanding processes and outcomes of care and aid in development of new standards and benchmarks Performance improvement is an essential component of verification High impact quality improvement must be data driven NSQIP Pediatrics is the best risk adjusted data available Maturation of Children s Surgery Verification Program towards outcomes rather than processes will make this even more critical

Standards about Participation in Data Collection CD 7-1 Every verified children s surgical center must collect and analyze its surgical outcome data and contribute it to the national collaborative effort. For centers designated Level I or II this will be fulfilled by participation in the American College of Surgeons National Quality Improvement Program-Pediatric (NSQIP Pediatric). CD 7-2 Children s surgical centers at all levels (I, II, and III) and ambulatory surgical centers applying for verification must collect and report specific safety events detailed in the accompanying Children s Surgery Safety Report (Appendix 2)

Standards about Using Data Review data on a regular basis (institutionspecific and national aggregate) Use data to guide specific QI initiatives in a sustained fashion Engage in using electronic resources to capture data Demonstrate effectiveness of identifying safety events

Why does it have to be NSQIP Pediatrics? Lack of alternative risk adjusted data that crosses all surgical specialties Uniform definitions and data across all centers to support verification site visits and movement towards optimal outcomes Priorities of what is measured can be set be children s surgeons Take advantages of advancement in registry processes at the American College of Surgeons

NSQIP-Pediatrics Basics CPT based sampling based on 8 day cycle Multispecialty (all except cardiac, transplant, trauma and ophthalmology) Clinical data are collected by a trained data collector Outcomes assessed at 30 days after index surgery (inpatient or outpatient) Highly standardized and validated data definitions Advanced data analytics and hospital audits ensure data quality

History of the ACS NSQIP- Pediatrics 2007 ACS collaboration with American Pediatric Surgical Association 2008 Pilot Program 2009 Beta enrollment 2011 first Risk Adjusted report for the Pediatric program 2012 PEDS NSQIP and the first risk-adjusted report for participating ACS NSQIP Pediatric hospitals July 2016, Procedure Targeted Appendectomy in the SAR July 2017, Procedure Targeted Spinal Fusion and Ventricular Shunt in the SAR

NSQIP-Pediatrics Growth

Improving the Discrimination Ability and Value of NSQIP-Pediatrics Expand program to greater variety of centers (early adopter effect) Enrich the case mix for procedures with more complications Procedure specific risk factors and outcomes Process measure to assess value as well as quality Experiment with longer term outcomes

Procedure Specific Risk Factors and Outcomes Procedures selected by specialties based on morbidity burden (common procedures and frequent occurrences) More disease and procedure specific risk stratification Procedure specific outcomes Resource utilization as outcome Exploring extended follow-up options

Procedure-Specific Risk Factors and Outcomes General surgery- appendectomy Orthopedic-spinal fusion Neurosurgery- ventricular shunt ENT- Tracheostomy <2 years Plastics- Cleft lip and palate Urology- Ureteral reimplant

Using Your NSQIP Data-SAR Detailed semiannual report published by NSQIP statisticians 6 months of data analysis and report preparation Life insurance physical not a personal training plan

All Surgeries/All Patients

Models included in July 2016 SAR All surgeries/all patients Abdominal-pediatric Abdominal-neonate Sub-specialties (Morbidity and SSI) Orthopedics ENT Plastics Urology

Procedure Targeted Reports PICC utilization TPN utilization Postoperative US Postoperative CT Home IV antibiotics Home PO antibiotics

How to use your NSQIP data other than the SAR? Identify outlier status on specific outcomes of procedures using Post-operative Occurrence Summary Determine local morbidity burden by looking at local occurrences regardless of national norms Assess sensitivity of other identification methods (Does M&M conference identify all occurrences?) Report occurrences to divisions for possible process variance

Children s Surgery Safety Report- Appendix 2 Required of all levels of centers Serious safety events which should always prompt local PIPS review Anesthetic events are major component Intentional overlap with other safety efforts such as Wake Up Safe Definitions drawn from overlapping efforts when possible Must and Should elements

Completing the Children s Surgery Safety Report Method to identify events will be locally determined but must be reliable Pilot program solutions Inclusion in the electronic anesthetic record Standardized post-anesthetic note completed by CRNA Extraction from existing data sources

Site Reviewer Evaluation of Children s Surgery Safety Report Completion of report as component of PRQ Explanation of event identification method and local assessment of reliability Plans for improvement in case identification Evidence of PI review of individual events Pattern of events to suggest particular area of concern

Process Measures- Assessing your system using infrequent events Prompted by need to verify availability and performance of services as part of CSVP site visit Use response to infrequent emergent events to test the ability of the system to respond Descriptive statistics sufficient to prompt PI Center difference from median Single outlier event

Process Measures: Pilot Data points: Time to critical study Time to operation Pilot program diseases Testicular torsion Ovarian torsion Post-tonsillectomy hemorrhage Button battery ingestion Malrotation with volvulus Challenge: Case identification not CPT based

Conclusions Data driven PI central to CSVP NSQIP-Pediatrics fundamental component for Level 1 and 2 centers NSQIP-Pediatrics data should be used before first Semiannual Report (SAR) Children s Surgery Safety Report required of all centers Significant overlap of CSSR with other efforts Mechanism for event identification is locally determined