C. R. Sheils1,2, A. R. Dahlke1, A. Yang1, K. Bilimoria1 1Northwestern University,Department Of Surgery,Chicago, IL, USA 2University Of Rochester,School Of Medicine,Rochester, NY, USA
Introduction: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) is a well-recognized program for surgical quality measurement. Given the widespread use of ACS NSQIP in research and recent calls for it to become a platform for national public reporting and pay-for-performance initiatives, it is important to understand which types of hospitals elect to participate in the program. Our objective was to compare the characteristics of ACS NSQIP-participating hospitals to non-participating hospitals in the United States.
Methods: Using the 2013 American Hospital Association data on hospital characteristics, hospitals participating in ACS NSQIP were compared to non-participating hospitals. The 2013 Healthcare Cost Report Information System (HCRIS) dataset was used to calculate hospital operating margin as a measure of financial health. The CMS 2013 Inpatient Prospective Payment System (IPPS) Final Rule Impact File was used to abstract the Medicare and Medicaid Services Value Based Purchasing (VBP) and Disproportionate Share adjustment scores, which were used as proxies for hospital quality and patient population, respectively.
Results: Of 3,872 total U.S. general medical and surgical hospitals, 475 (12.3%) participated in ACS NSQIP. ACS NSQIP hospitals performed 29.0% of operations in the U.S, with a slightly greater share of inpatient operations (32.4%) and a smaller share of outpatient operations (27.1%). Compared to non-participating hospitals, ACS NSQIP hospitals had a higher mean annual inpatient surgical case volume (6,426 vs 1,874; p<0.001), a larger number of hospital beds (420 vs 167; p<0.001), were more often academic affiliates (35.2% vs 4.1%; p<0.001), were more often accredited by JCAHO and CoC (p<0.001), and had higher mean operating margins (p<0.05). ACS NSQIP hospitals were less likely to be designated as critical access hospitals (p<0.001). No significant differences in VBP or Disproportionate Share adjustment scores were found. States with the highest percentage of hospitals participating in ACS NSQIP were states with established surgical quality improvement collaboratives (Figure 1).
Conclusion: Hospitals that participate in ACS NSQIP represent 12% of all U.S. hospitals performing inpatient surgery, yet they perform nearly 30% of all surgeries done in the U.S. ACS NSQIP disproportionately includes larger, accredited, and academic-affiliated hospitals with more financial resources. These findings should be taken into account in research studies using ACS NSQIP, and more importantly, indicate that additional efforts are needed to address barriers to enrollment in order to facilitate participation in surgical quality improvement programs by all hospitals.
