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Saito JM, Barnhart DC, Grant C, Brighton BK, Raval MV, Campbell BT, Kenney B, Jatana KR, Ellison JS, Cina RA, Allori AC, Uejima T, Roke D, Lam S, Johnson EK, Goretsky MJ, Byrd C, Iwaniuk M, Nayak R, Thompson VM, Cohen ME, Hall BL, Ko CY, Rangel SJ. The past, present and future of ACS NSQIP-Pediatric: Evolution from a quality registry to a comparative quality performance platform. Semin Pediatr Surg 2023; 32:151275. [PMID: 37075656 DOI: 10.1016/j.sempedsurg.2023.151275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Quality and process improvement (QI/PI) in children's surgical care require reliable data across the care continuum. Since 2012, the American College of Surgeons' (ACS) National Surgical Quality Improvement Program-Pediatric (NSQIP-Pediatric) has supported QI/PI by providing participating hospitals with risk-adjusted, comparative data regarding postoperative outcomes for multiple surgical specialties. To advance this goal over the past decade, iterative changes have been introduced to case inclusion and data collection, analysis and reporting. New datasets for specific procedures, such as appendectomy, spinal fusion for scoliosis, vesicoureteral reflux procedures, and tracheostomy in children less than 2 years old, have incorporated additional risk factors and outcomes to enhance the clinical relevance of data, and resource utilization to consider healthcare value. Recently, process measures for urgent surgical diagnoses and surgical antibiotic prophylaxis variables have been developed to promote timely and appropriate care. While a mature program, NSQIP-Pediatric remains dynamic and responsive to meet the needs of the surgical community. Future directions include introduction of variables and analyses to address patient-centered care and healthcare equity.
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Affiliation(s)
- Jacqueline M Saito
- Division of Pediatric Surgery, Washington University, St. Louis, MO, USA.
| | - Douglas C Barnhart
- Division of Pediatric Surgery, University of Utah, Salt Lake City, UT, USA
| | - Catherine Grant
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL, USA
| | - Brian K Brighton
- Division of Pediatric Orthopedic Surgery, Carolinas Medical Center, Wake Forest School of Medicine, Charlotte, NC, USA
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Brian Kenney
- Department of Pediatric Surgery, Nationwide Children's Hospital and Ohio State University, Columbus, OH, USA
| | - Kris R Jatana
- Department of Pediatric Otolaryngology, Nationwide Children's Hospital and Ohio State University, Columbus, OH, USA
| | - Jonathan S Ellison
- Division of Pediatric Urology, Department of Urology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Robert A Cina
- Division of Pediatric Surgery, Department of Surgery, Shawn Jenkins Children's Hospital, The Medical University of South Carolina, Charleston, SC, USA
| | - Alexander C Allori
- Division of Plastic, Maxillofacial and Oral Surgery, Department of Surgery and Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Tetsu Uejima
- Department of Pediatric Anesthesiology and Perioperative Medicine, Nemours Children's Hospital Delaware, Thomas Jefferson University, Philadelphia, USA
| | - Daniel Roke
- Department of Anesthesia & Critical Care Medicine, St. Louis University, St. Louis, MO, USA
| | - Sandi Lam
- Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emilie K Johnson
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael J Goretsky
- Division of Pediatric Surgery, Children's Hospital of the King's Daughters, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Claudia Byrd
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL, USA
| | - Marie Iwaniuk
- Independent Statistical Consultant, Phoenixville, PA, USA
| | - Raageswari Nayak
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL, USA
| | - Vanessa M Thompson
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL, USA
| | - Mark E Cohen
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL, USA
| | - Bruce L Hall
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL, USA; Department of Surgery, Washington University St. Louis School of Medicine and BJC Healthcare, St. Louis, MO, USA
| | - Clifford Y Ko
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL, USA
| | - Shawn J Rangel
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
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He K, Cramm SL, Rangel SJ. Defining high-quality care in pediatric surgery: Implications for performance measurement and prioritization of quality and process improvement efforts. Semin Pediatr Surg 2023; 32:151274. [PMID: 37088062 DOI: 10.1016/j.sempedsurg.2023.151274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Establishing a standardized and comprehensive framework for defining surgical quality is essential for meaningful performance measurement and process improvement efforts. The goal of this chapter is to provide a conceptual framework for defining surgical quality based on the perspectives of relevant stakeholders, and to identify infrastructure and care processes necessary for the delivery of high-quality surgical care. Central to this framework are the complementary approaches for quality assessment as outlined by the Institute of Medicine and Donabedian paradigms, and how these should be used together to develop a robust and granular taxonomy of quality constructs relevant to all surgical conditions. The utility of balancing and composite measures for quality assessment is also reviewed, as are practical considerations for identifying and prioritizing process improvement opportunities based on procedure volume and perioperative risk.
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Affiliation(s)
- Katherine He
- Department of Surgery, Boston Children's Hospital; Harvard Medical School, Boston, MA, United States
| | - Shannon L Cramm
- Department of Surgery, Boston Children's Hospital; Harvard Medical School, Boston, MA, United States
| | - Shawn J Rangel
- Department of Surgery, Boston Children's Hospital; Harvard Medical School, Boston, MA, United States.
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