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Surrounded by quality metrics: what do surgeons think of ACS-NSQIP?
Heather B Neuman1, Fabrizio Michelassi, James W Turner
1Department of Surgery, Weill Medical College of Cornell University, New York, NY, USA. neumanh@mskcc.org
Surgery
|December 17, 2008
Summary
Surgeons support the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) for institutional quality improvement but express skepticism regarding individual outcome reporting and public data use. Continued education is vital for surgeon engagement in quality metrics.
Area of Science:
- Surgical Quality Improvement
- Health Services Research
- Medical Informatics
Background:
- Surgeon confidence in quality assessment tools is crucial for effective quality improvement initiatives.
- The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) is a unique, surgeon-developed, risk-adjusted system for assessing surgical outcomes.
Purpose of the Study:
- To evaluate surgeons' awareness and attitudes towards the ACS NSQIP.
- To understand surgeon perceptions of ACS NSQIP's utility in quality improvement and outcome assessment.
Main Methods:
- A 33-item survey with established content validity and test-retest reliability was administered to 108 surgeons across three institutions.
- Data were analyzed using summary statistics and subgroup analyses (Fisher's exact test) to explore variations in responses based on practice experience and institutional ACS NSQIP exposure.
Main Results:
- Surgeons demonstrated familiarity with ACS NSQIP structure (e.g., prospective data collection, observed/expected ratios) but misidentified specific data points.
- While a majority believed ACS NSQIP improves care quality and identifies improvement areas, confidence waned regarding individual outcome reporting (46%) and public data availability (45%).
- Surgeons with longer institutional experience using ACS NSQIP showed more reservations about data applications.
Conclusions:
- Surgeons generally accept ACS NSQIP for institutional quality assessment but harbor skepticism about measuring individual outcomes and public reporting.
- Perceptions of ACS NSQIP's utility are influenced by the duration of institutional experience, with longer exposure correlating with increased cynicism.
- Ongoing education and assessment of surgeon perceptions are essential to maintain active engagement in defining and utilizing quality of care metrics.
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