April 12, 2006
The Michael E. DeBakey Veterans Affairs Medical Center recently received notification from the National Veterans Affairs Surgical Quality Improvement Program Executive Committee that it has demonstrated consistently low observed-to-expected mortality rates in general surgery, all surgery, and all non-cardiac surgery six years in a row. The MEDVAMC is the only VA hospital with this record. Above, David H. Berger, M.D., Operative Care Line executive (right) performs surgery with (from left) Ronnie Blake, health technician, David Chafey, M.D., resident, and Kostas Votanopoulos, M.D., chief resident.
PHOTO BY: Mike Lane, MEDVAMC Media Section
HOUSTON – The Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC) recently received notification from the National Veterans Affairs Surgical Quality Improvement Program (NSQIP) Executive Committee that it has demonstrated consistently low observed-to-expected mortality rates in general surgery, all surgery, and all non-cardiac surgery six years in a row. The MEDVAMC is the only VA facility with this record.
“The entire surgical team, including surgeons, anesthesiologists, nurses, and our support staff, should be proud of their hard work in providing consistent, outstanding care to our veterans,” said David H. Berger, M.D., MEDVAMC Operative Care Line executive.
The Committee reviewed the accrual, workload, and outcome information on major surgery procedures performed at the MEDVAMC in fiscal years 2000 through 2005. The intent of the NSQIP is to provide reliable, valid data about comparative risk-adjusted outcomes of major surgery in the VA and to provide reliable data about workload and length of stay. The ultimate use of these data is to improve the quality of surgical care to all veterans.
Annually, the NSQIP Executive Committee carefully reviews the risk-adjusted observed/expected (O/E) mortality ratios in each VA hospital for all surgical operations combined and each surgical subspecialty. An O/E ratio statistically significantly above one indicates mortality is higher than what would be expected on the basis of the patient characteristics. An O/E ratio statistically significantly below one indicates that mortality is lower than what would be expected on the basis of the patient characteristics.
NSQIP is the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. The NSQIP incorporates 128 Veterans Affairs Medical Centers (VAMCs) and 14 sites from the private sector.
Prompted by the need to assess comparatively the quality of surgical care in VA hospitals, the Department of Veterans Affairs conducted the National VA Surgical Risk Study (NVASRS) between 1991-1993 in 44 VA medical centers. The study developed and validated models for risk adjustment of 30-day morbidity and 30-day mortality after major surgery in eight non-cardiac surgical specialties. Similar models were developed for cardiac surgery by the VA’s Continuous Improvement in Cardiac Surgery Program (CICSP).
Based on the results of the NVASRS and the CICSP, the VA established the NSQIP in 1994 in all the medical centers performing major surgery. A NSQIP nurse at each center oversees collection of data and electronic transmission for analysis at one of two data coordinating centers. Feedback to the providers and managers is aimed at achieving continuous quality improvement. It consists of (1) comparative, site-specific, and outcome-based annual reports; (2) periodic assessment of performance; (3) self-assessment tools; (4) structured site visits; and (5) dissemination of best practices. The NSQIP also provides an infrastructure for VA investigators to query the database and produce scientific presentations and publications.
"The Michael E. DeBakey Veterans Affairs Medical Center continues to stand out as a pre-eminent institution, providing the best of care to our nation's veterans," said Peter G. Traber, M.D., president and CEO of Baylor College of Medicine. "This important recognition is well-deserved for Dr. Berger as well as his team of surgeons, nurses, and staff. Baylor takes great pride in its partnership with the DeBakey VA." For more than 50 years, MEDVAMC staff has provided clinical training for health care professionals through affiliations with Baylor College of Medicine and 110 other educational and research institutions.
Since the inception of the NSQIP data collection process, the 30-day postoperative mortality after major surgery in the VA has decreased by 27 percent, and the 30-day morbidity by 45 percent. The future of the NSQIP lies in enhancing its capabilities by incorporating additional measures of outcome, structure, process, and cost, and in expanding it to the private sector.
In 2001, the private sector initiative was extended to 14 non-VA hospitals through a grant from the Agency for Healthcare Research and Quality. These activities have enabled for the first time a comparison of risk-adjusted postoperative outcomes between the VA and the private sector.
“I am very proud the Michael E. DeBakey Veterans Affairs Medical Center has achieved such an important objective,” said Thomas B. Horvath, M.D., F.R.A.C.P., MEDVAMC chief of staff. “Our surgical service staff and its practices are top-notch. I also want to mention the contributions the staff of our Anesthesiology Service has made toward the care and well being of our veterans. Their role in our Operative Care Line is critical in reducing mortality rates in our medical center. This acknowledgement for continuous surgical excellence is very much earned and deserved. I am pleased we serve as such a positive example for other hospitals both inside and outside the VA health care system.
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