# Comparative Effectiveness of Alternative Strategies for Monitoring Hospital Surgical Performance

> **NIH VA I01** · MICHAEL E DEBAKEY VA MEDICAL CENTER · 2020 · —

## Abstract

Abstract
Important limitations associated with current approaches for monitoring the quality of surgical care include:
(a) the retrospective and episodic (e.g.: quarterly, bi-annually, etc.) approach to feedback which creates a time
lag between when performance is declining and when the hospital is made aware; (b) small clusters of clinically
meaningful poor performance may go of undetected using current episodic analytic structures; (c) most
healthcare entities are willing to accept average performance, but will respond if performance starts to fall
below an acceptable threshold. As such, alternative approaches that could shorten the time lag for feedback,
improve the detection of hospitals with potentially suboptimal perioperative care processes, or inspire
hospitals to be more proactive in programmatic improvement could enhance current quality improvement
efforts and have tangible benefits for VHA. The overall goal of this proposal is to generate comparative
effectiveness data on novel, alternative approaches for monitoring VA hospital surgical performance relative to
the current standard of episodic data analysis and feedback. The specific aims are to: (1) compare the CUSUM
(a statistical process control methodology borrowed from industry) to the episodic Observed-to-Expected
approach for evaluating surgical performance at VA hospitals; (2) evaluate a composite outcome of 30-day
mortality, major morbidity, and reoperation as an indicator of declining institutional performance relative to
30-day mortality or overall morbidity alone. This work will involve a hospital-level, observational design using
VA Surgical Quality Improvement Program (VASQIP) data for patients who underwent inpatient general,
vascular, thoracic, genitourinary, orthopedic, spine, or neurosurgical operations between 2010 and 2016. Data
will be used to conduct a comparative effectiveness analysis of these alternative QI strategies for monitoring VA
hospital surgical performance relative to the current standard of episodic reporting of 30-day mortality or
morbidity individually. This project is novel because it will be the first application of industrial quality control
techniques to VASQIP, will provide important real-world comparative data on alternative approaches for
evaluating hospital performance, and will evaluate such approaches within the context of the existing VASQIP
framework and infrastructure to facilitate future prospective evaluation and eventual implementation. It is
anticipated the analyses will demonstrate these alternative approaches could have significant value for
hospitals' local quality improvement efforts. Incorporating additional approaches for monitoring surgical
outcomes into VASQIP could have notable benefits for VHA and Veterans through earlier recognition of
hospitals with potentially problematic perioperative care processes that are associated with suboptimal post-
operative outcomes, decreased costs for correcting errant care processes, decrea...

## Key facts

- **NIH application ID:** 9692259
- **Project number:** 5I01HX002447-02
- **Recipient organization:** MICHAEL E DEBAKEY VA MEDICAL CENTER
- **Principal Investigator:** Nader Nabile Massarweh
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-05-01 → 2021-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9692259

## Citation

> US National Institutes of Health, RePORTER application 9692259, Comparative Effectiveness of Alternative Strategies for Monitoring Hospital Surgical Performance (5I01HX002447-02). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/9692259. Licensed CC0.

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