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BACKGROUND/RATIONALE:
The VA health care system continues to devote significant effort and resources toward improving operational quality and economic efficiency, such as the National Surgical Quality Improvement Program (NSQIP). However, there has been relatively little research examining the economic effects of these quality initiatives. As health care costs continue to climb, creating a "business case for quality" is a critical component of sustained quality improvement and has been identified as one of the major potential mechanisms through which many of the quality and safety goals identified by the Institute of Medicine.
OBJECTIVE(S):
The main goal of this project is to examine the relationship between surgical quality improvement and treatment costs. There are two aims: (1) identify the main determinants of surgical quality in the VA system, including organizational-level determinants; and (2) measure the costs of surgical complications in the VA system.
METHODS:
Both aims rely on the NSQIP, which was created in 1994 by the VA as a national, validated, outcomes-based, risk-adjusted program for the measurement and enhancement of surgical care. All VA medical centers performing major surgery participate in NSQIP (n = 123). Data is collected for approximately 60,000 to 90,000 surgical procedures per year, or roughly 500 to 750 procedures per VAMC per year. We will create files for all years from CY2000 through CY2007. For Aim #1, we will create measures of surgical quality based on surgery data from the NSQIP, following the methodologies of other NSQIP researchers. We will replicate those models with the unique addition of organizational determinants of quality, including measures of organizational culture and quality improvement environment captured on the National VA Quality Improvement Survey (NQIS) and the VA All-Employee Survey (AES). For Aim #2, we will follow the basic methodology of Dimick et al. (2004), who calculated hospital costs associated with postoperative complications. We will exapnd on Dimisck's work by including data from 123 sites and by estimating econometric cost functions explaining the determinants of variation in surgical costs and the incremental costs associated with surgical complications.
FINDINGS/RESULTS:
No results to report at this time.
IMPACT:
Identifying the determinants and costs of surgical complications provides a critical element in the economic evaluation of the surgical process improvement initiatives. It is often argued that the cost savings associated with surgical process improvement more than offsets the costs of implementing improvement initiatives. However, there is comparatively little direct evidence to support the conjecture that quality improvement unambiguously "pays for itself." By combining some of the richest VA databases on costs and surgical complications and applying rigorous statistical models, we will be able to estimate the potential incremental cost savings associated with improvement in the quality of surgical outcomes.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems
DRE:
Quality of Care, Resource Use and Cost
Keywords:
Cost effectiveness, Utilization patterns
MeSH Terms:
none
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