Two key goals of public reporting of hospital performance data are to help patients'select high-quality hospitals and to encourage hospitals to improve their quality of care. However, public reporting has not been particularly effective in achieving these goals, and public reporting in surgery has been infrequent. Since 2001, the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) has provided participating hospitals with risk-adjusted benchmark reports for 24 surgical outcomes based on clinical data. Clinicians at these hospitals also have access to a Surgical Risk Calculator to estimate complication rates for individual patients based on their risk factors and comorbidities. None of these data are publicly reported. In 2012, ACS NSQIP will be launching a pilot project for public reporting of National Quality Forum-endorsed surgical outcomes measures on the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website. However, the CMS Hospital Compare website will not provide patient-specific information nor is it being developed using patient-centered principles. This study proposes to take advantage of the ACS-CMS pilot project by (1) adapting the existing ACS NSQIP Surgical Risk Calculator to develop a patient-specific and patient-centered hospital comparison tool called "myHospital" which will allow a patient to compare the risks of surgery at multiple hospitals, based on the individual patient's risk factors by entering individual demographics, comorbidities, surgical indication/type, acceptable travel distance, and health insurance information;(2) engaging surgical patients to compare myHospital with the CMS-NSQIP Hospital Compare public reporting through cognitive interviews and surveys to assess participant usability, comprehension, satisfaction, and ability to select the highest quality hospital;and (3) assessing the effect of the CMS-NSQIP Hospital Compare public reporting pilot project by comparing participating hospitals (cases) to non-participating hospitals (controls) at baseline and over the two-year pilot project timeline to examine differences in outcomes and hospital quality improvement culture. This research is highly significant and innovative because it will develop the first patient-centered public reporting hospital comparison tool for surgical outcomes and will assess the effect of the first national public reporting of surgical outcomes. myHospital could significantly improve an individual patient's ability to select the highest qualit hospital for their surgery, thus affecting the quality of care for millions of U.S. surgical patiens immediately. In addition, public reporting of surgical outcomes could potentially cause non-participating hospitals to participate, could entice all hospitals to expand their publicly reporte metrics, and could ultimately improve the quality of surgical care delivered in the U.S. This study could provide the evidence needed to encourage widespread public reporting throughout all of surgery. Overall, the reviewers recommended this application for further consideration with an "Excellent" level of enthusiasm.
Current hospital public reporting initiatives are not patient-specific, and the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) can be leveraged to develop a patient-specific and patient-centered hospital comparison tool called myHospital which allows patients to compare the risks of surgery at multiple hospitals based on the individual patient's risk factors. An upcoming Centers for Medicare and Medicaid Services (CMS) collaboration with ACS NSQIP to publicly report surgical outcomes provides a unique, natural experiment to assess the effect of public reporting. Public reporting and myHospital, in particular, could potentially entice all hospitals to participae in public reporting and to increase transparency by expanding their publicly reported metrics. This study should also improve an individual patient's ability to select the highest quality hospitl for their surgery, thus immediately affecting the quality of care for millions of surgical patientsin the U.S.
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