Kamal Itani, MD, FACS, Chief of Surgery, Veterans Affairs Boston Healthcare System Professor Boston University; Faisal Bakaeen, MD, FACS, Professor Surgery Cleveland Clinic; William Gunnar, MD, FACS Director National Surgery Office.

A panel entitled “Risk-Adjusted Outcomes Assessment and Reporting” started with a presentation by Kamal Itani, MD entitled "Overview of VA NSQIP" in which he described the history of NSQIP/ VASQIP. Faisal Bakaeen, MD next presented "Using VASQIP and SQDUG as Research Tools" in which he explained how to use VASQIP data via SQDUG as a multi-institutional research data source. The session concluded with a talk by William Gunnar, MD, JD entitled “Future directions of risk adjustment and reporting within the VHA.” During this session we learned the importance of monitoring safety and quality. Studies were presented that reflected site team reliability in rating facilities in terms of high vs low outliers. We learned how to use this data to assess programs and introduce quality improvement plans. During this session, it was clear that patient access into clinics and the Operating room should be considered a significant component of patient quality and safety measures.

VHA statistics showed that inpatient mortality was reduced from 4.7% in 1998 to 2.2% in 2014 while our overall operative throughput has increased by 17%. Using current assessment processes, only 39% of total procedures are VASQIP eligible, 77% of VASQIP-eligible procedures undergo assessment (83% of complex and 67% of intermediate) and the majority of inpatient standard and Ambulatory Surgery Centers procedures are not assessed. The highest mortality was found in assessed complex procedures (1%). Any death in an ASC is rare and should be thoroughly examined. The NSO presented data indicating that the number and intensity of “Level of Concern” visits over the past couple of years has markedly declined. The presentation concluded with a question regarding the relevance of continuing the VHA Risk assessment program in its current model.

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