SDS outcomes for all? Database makes it so
July 1, 1998
SDS outcomes for all? Database makes it so
Centers file info on nine most common procedures
Does same-day surgery benefit patients? Virtually any surgery center now can prove it does with a new outcomes project that encompasses nine common same-day surgery procedures - the most comprehensive, patient- focused database yet developed for the field.
The American Association of Ambulatory Surgery Centers in Chicago (AAASC) also is making its mark by being among the first to use the Internet to collect data from around the country, a technology that allows for rapid feedback, says Stephen E. Zimberg, MD, MSHA. An obstetrician/gynecologist, Zimberg is secretary of AAASC and vice president of the Lakeview Medical Center in Suffolk, VA.
Procedure-specific data available
Centers may send data on procedures (see list, p. 92), or they may submit data on all procedures at their facility and receive reports that are not procedure-specific. The project is conducted in partnership with the Williamson Institute for Health Studies of the Virginia Commonwealth University/Medical College of Virginia in Richmond. It's free but available to association members only. (For information on joining the association, see source box, p. 92.)
"This was designed for the sites, not for the individual physician," says Zimberg. "We want [managers at] the sites to be able to say, 'I've got great patient quality, and I can prove it.'"
Proving your quality is valuable in negotiating managed care contracts. In the future, however, it may become a business imperative, Zimberg says.
The Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, and the Accreditation Association for Ambulatory Health Care in Skokie, IL, plan to add requirements for performance assessment that would apply to ambulatory surgery centers. (For details, see story, p. 93.) Meanwhile, centers can use the data to create their own quality improvement projects.
"What we're interested in as a whole is good patient data," Zimberg says. "We want the sites to know how well they're doing. We're looking at best practices and trying to disseminate that over the Internet."
The AAASC project began modestly, with a handful of centers collecting measures on knee arthroscopy and pelvic laparoscopy. It soon grew to include hernia repair and cataract surgery. Pfizer pharmaceutical of New York City funded the project, which requires only basic equipment: a personal computer with a Windows 95 operating system, a 28.8 kbps telephone modem, an Internet service, and the FileMaker Pro Version 3 database management software.
"We started off [collecting] just the basic indicators for the procedures that everybody needed," Zimberg says.
The 10 indicators include perioperative complications, longer-than-expected recovery time, and pain relief. (For a complete list of the indicators, see p. 93.)
Collecting data no chore, staff say
Collecting and reporting the data haven't been a problem for Lakeview Medical Center in Suffolk, VA, one of the first to join the outcomes project, says Deena Cordero, operating room office manager. Surgery center staff fill out a Medical Abstract Form to collect clinical information, and nurses use a Patient Telephone Interview Form to ask a set of questions during the follow-up phone call. (For a sample copy of charts, see insert.) The center's receptionist logs the information on-line, which automatically enters it into the project database. At other centers, staff may enter the survey information directly into the computer.
The standardization of the follow-up call allows centers to learn immediately how their patients overall are faring after discharge, notes Louis F. Rossiter, PhD, co-principal investigator for the project at the Williamson Institute. "When you're finished, you can [determine] the percentage that are most satisfied, the percentage that had pain, and you can analyze all that data," he says. "In the old system, all you had was a bunch of random notes on a chart sitting on a shelf."
Changes address pain control
The post-op survey helped nurses focus on issues of pain control, says Penny Jones, RN, coordinator of the ambulatory surgery center. For example, the survey asks patients if they are using comfort measures other than pain medication. That led to improved post-op teaching about comfort measures as well as pain assessment, she says.
While centers receive comparative reports on-line, the project's World Wide Web site also is a vehicle for training, education, and networking. It's a natural evolution for the Williamson Institute, which has been teaching courses on-line for the past 10 years, says Rossiter, who also is a professor of health economics.
As the AAASC project evolves, it will include an auditing function to ensure the integrity of the reported data, he says. For example, the project may verify that centers are reporting data on all cases within the procedure codes they have chosen for participation.
The project also will refine its methods of case mix adjustment to account for differences among patients - for example, by adjusting for different CPT codes within a set of procedure codes. Currently, the database is adjusted for age, co-morbidity, and time in surgery.
Eventually, the project could become a network for clinical trials for drugs and devices, Rossiter says.
"That would mean that if a pharmaceutical company wanted to try a new drug, each of these sites would be signed up as clinical investigators. The physicians would agree to use the drug and report the results back to our system. Each ASC would receive compensation for its participation."
But the primary motivation will continue to be quality improvement, he says. "This provides an opportunity for the industry to show the value of ambulatory surgery," he says.
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