The American College of Surgeons’ (ACS) National Surgical
Quality Improvement Program (NSQIP)
What is it? The ACS NSQIP is a surgical quality improvement program that monitors a variety of data and
outcomes across surgical specialties, including pre-, intra-, and post- (30 days after surgery) factors and outcomes.
How long has it been in existence? The program was pilot tested in 2001 and fully implemented by the ACS in
2005. Since that time, it has undergone continuous updates and expansions.
Where it is located? The ACS NSQIP is primarily based in the United States; 526 hospitals participate, with
international representation from Canada, Lebanon, the United Kingdom, Saudi Arabia, the United Arab Emirates,
the Philippines, and Australia.
Who oversees the Registry? The ACS NSQIP is managed by ACS.
How does it work? Data are entered by trained Surgical Clinical Reviewers (SCRs) at hospitals into an online data
collection portal; these data are used to clinically risk adjust performance assessments.
Why is it used? It is used to: 1) improve patients’ health outcomes by measuring surgical outcomes and
establishing risk-adjusted models for comparison, and 2) aid in hospital quality improvement and research
initiatives.
What are its accomplishments? The ACS NSQIP is used by member hospitals to: measure and monitor
surgical outcomes, often resulting in positive changes in outcomes, including complications prevention; improve
patient care by reducing associated mortality and morbidity through prevention activities; achieve cost savings,
the majority of which comes from lowering the rate of complications; and, improve decision-making for
member-hospitals by providing reliable data on which members can run quality improvement analyses.
Introduction to the American College of
Surgeons
for participating hospitals. One study showed that for each year a
large hospital participates in ACS NSQIP and conducts internal
quality improvement activities, 250-500 surgical complications
could be prevented.2 At present, nine of the top ten U.S. News
and World Reports hospitals use ACS NSQIP to improve surgical
quality.3,4
The ACS hosts the ACS NSQIP – a quality improvement (QI)
program that monitors patient data and outcomes. These include
before surgery demographics (e.g., age and gender) and patient
health characteristics (e.g., a history of prior heart conditions),
characteristics of the surgery (e.g., difficulty), during-surgery
variables related to the patient’s course or events (e.g., how much
blood was transfused), and 30-day-after surgery outcomes (e.g.,
infections, pneumonia, death) across certain surgical specialties
Purpose of the ACS NSQIP
Founded in 1913, the ACS is a scientific and educational association of surgeons that was initiated to improve the quality of care
for patients through the implementation of surgical education and
practice standards.1
The ACS NSQIP is a quality improvement program used by member hospitals to:
• Measure the quality of surgical outcomes to improve overall
patient care;
• Compare the quality of surgical outcomes against a national
standard; and
• Identify critical quality improvement opportunities.
2 | The American College of Surgeons’ National Surgical Quality Improvement Program
History and Development of the ACS NSQIP
The current program was modeled after a U.S. Department of
Veterans Affairs (VA) pilot initiative that was established in 1994
to evaluate surgical quality and identify areas for improvement
within VA hospitals.
In 2001, the Agency for Healthcare Research and Quality
(AHRQ) provided funding for the ACS to deploy a pilot program
(based on the VA experience) to evaluate surgical quality within
12 private sector hospitals. This program, which ran from 2001 to
2004, leveraged the methodology applied in the VA initiative. The
program was well received, and in 2005 the ACS began enrolling
additional private sector hospitals.
With input from experts in the field, the ACS has continued
to shape and expand the program, now referred to as the “ACS
NSQIP”.5
Information (Data) Included in the ACS NSQIP
The ACS NSQIP currently collects a range of data on patient
characteristics and 30-day outcomes, including morbidities (or
complications), such as surgical site infections (SSI) and pneumonia, as well as mortality and other items such as readmission
rates. All outcomes are tracked from before surgery through 30
days after surgery to capture the full patient experiences, including complications. In addition to these core data, the ACS NSQIP
collects additional performance information in sub-specialties,
such as gastrointestinal surgery, orthopedic surgery, pediatric
surgery and others.6
Data are collected by highly trained SCRs who are employed by
the hospital and trained entirely by the ACS. SCRs enter data
directly into a secure, web-based platform at each hospital site.
Every eight days, SCRs identify a sample of eligible patient cases
based on information found in medical charts that is then entered
into the data collection platform and subsequently analyzed. The
ACS NSQIP evaluations are then risk-adjusted (i.e., accounting
for differences in patient factors that might raise or lower their
risk of adverse surgical outcomes, such as age or weight) and
case mix-adjusted (i.e., accounting for the complexity of different
procedures). These adjustments help ensure accurate comparisons
across hospital sites.7,8 Importantly, all data fields are associated
with rigorous definitions and criteria, helping ensure the “quality”
of the data points themselves.
The ACS provides SCRs with continuing education and training
as well as continuous support to ensure capture of high quality
data. SCRs must also pass periodic examinations. Data quality
checks, such as audits of a data samples found in patient medical
records and those entered into the ACS NSQIP, are built into the
platform and conducted regularly by the ACS.
Participation Options
All participating hospitals report to the ACS NSQIP on a general
set of defined data.9 In 2010, the ACS NSQIP established a set of
expanded participation options, which are designed to collect a
variety of data fields depending on hospitals’ needs; in particular,
these expanded options help satisfy the requirements of the increasingly diverse membership base of large health systems as well
as small rural critical access sites.10 Options include:
• Small and Rural: for hospitals with fewer than 1,680 eligible
surgical cases per year;
• Essential: for hospitals with a minimum of 1,680 eligible surgical cases per year;
• Procedure-targeted: for specialty hospitals with a focus on high
volume, high-risk procedures;
• Measures Option: for hospitals focused on a specific set of
outcomes; and
• Pediatric: for hospitals focused on child and pediatric care.11
If a hospital chooses an expanded option, it must report both the
general and expanded set of data. In turn, the hospital receives
multiple risk-adjusted reports that can be used to inform care
improvements.12
Management and Governance
The ACS NSQIP operates under the ACS’s Division of Research
and Optimal Patient Care. The ACS NSQIP Advisory Committee
advises ACS leadership on topics such as hospital recruitment,
policy considerations, and opportunities for quality improvement
within the program. The Advisory Committee also provides input
to the ACS Quality Committee on the current state of and outlook
for the ACS NSQIP. The ACS NSQIP also receives guidance from
ACS policy and advocacy experts. The SCR Advisory Council,
a group of highly motivated and expert SCRs from a sample of
hospital sites, regularly advises the ACS on data collection issues
faced by participating hospitals.
In recent years, the ACS NSQIP Advisory Committee chartered
the Expansion Work Group Committee, whose charge is to promote the ACS NSQIP’s value to non-participating hospitals and
recruit additional members.13
Funding
The ACS NSQIP is supported by the ACS, a not-for-profit organization, and by member hospitals’ annual fees. These fees range
from $10,000 to $29,000, depending on the membership option
and the cost to cover the program’s management and administration, training for SCRs, on-site audits, the installation of the ACS
NSQIP platform, and ongoing technical support.14
Noteworthy Attributes
Robust Data and Methodology
Numerous studies detail the successes of the ACS NSQIP and
justify its long-standing reputation for data quality and reliability.
For example, its data are highly robust and less prone to misclassification or underreporting of outcomes than administrative data.15
One study compared data found in a clinical database with those
in the ACS NSQIP and found that the ACS NSQIP was better at
predicting outcomes, including death, for higher-risk patients.16
3 | The American College of Surgeons’ National Surgical Quality Improvement Program
This success is due in large part to the ACS NSQIP’s extensive
efforts to ensure data quality, accuracy, and relevance to the needs
of its hospitals. Further, the program has developed statistical
methodologies used for analyses, such as risk adjustment.17
The ACS NSQIP’s risk-adjustment process allows for data to be
nationally benchmarked so that members can compare results to
similar patients and hospitals.18,19,20
Highly Effective Training and Auditing Services
Members regularly cite that the training for SCRs and data
auditing services provided by the ACS NSQIP are beneficial to
their internal efforts. Once a hospital becomes a member, the ACS
NSQIP Clinical Support Team leads an initial training for the
designated SCR. This initial training session lasts approximately
four weeks, during which time the ACS provides thorough review
of data entered in the platform for the first 80-100 patient cases
by the new SCR. At the end of the training, the SCR completes
a test to ensure full understanding of the program and the data
entry process.21 Additionally, SCRs receive ongoing support from
the ACS NSQIP nurse coordinators, who periodically test staff to
ensure comprehensive understanding of the program and hold
weekly conference calls to discuss issues encountered in data collection, data analyses, and quality improvement activities.22
The ACS NSQIP nurse coordinators also conduct follow-up
site visits with SCRs approximately six months after the initial
training session to review processes, provide continuing education programs, and perform an inter-rater reliability audit, where
two or more SCRs code an identical set of patients which are then
analyzed for similarities and differences.23
Interrater Reliability Study
From 2005 through 2008, the interrater reliability was carefully
tracked for all ACS NSQIP auditing services. Analyses showed
that overall disagreement rates fell from 3.15 percent in 2005 to
1.56 percent in 2008. Furthermore, the audit results have shown
that data are reliable.24
Access to Learning Collaboratives
Another benefit of the program is access to learning collaboratives, or groups of member hospitals where participants learn
from one another and share best practices for quality improvement. These collaboratives are often organized around geographic
location (e.g., Tennessee Surgical Quality Collaborative), specific procedures of interest (e.g., pancreatic surgery), or hospital
characteristics (e.g., small and rural hospitals). Collaboratives
host regular conference calls, educational webinars, and in-person networking events.25 Many hospitals note that access to these
groups adds value to their participation in the overall program.26
See Spotlight: The Tennessee Surgical Quality Collaborative.
Products and End Users
Hospitals can access data and reports in a variety of formats. Data
are largely used for internal quality improvement, research, and
multi-hospital collaboration activities that focus on improvement
in surgical outcomes.
The ACS NSQIP outputs include:
• Semiannual reports (SAR) are site-specific reports prepared
for hospital administrators and surgical staff that compare
risk-adjusted surgical outcomes data to other hospitals. Though
titled semi-annual, these reports are provided quarterly.
º Individual site summary reports and presentation slides
are also provided as supplements to each SAR and provide
hospital-specific data.
• July annual report includes information on “best practices”
and outcomes for all member hospitals. The report is a compilation of the feedback provided by hospital sites that have
significantly improved their performance or sustained excellent
performance over time as well as data collected from site visits
by the ACS NSQIP staff.27 It is delivered to sites as part of the
July SAR.
• Online reports are available in real-time and include both
risk-adjusted and non-risk adjusted, hospital-specific data in
addition to data comparisons of hospital-specific data and
national averages. These reports are tailored to the different
hospital participation options or subsets of patients or time
frames.28
• Raw datasets are also available for download from the platform
at any time. Hospitals can use data to draft additional reports
on an as needed basis.29
•The Online Calculator for Surgical Complication Risk was
developed and released in September 2013. The calculator
allows users to enter information (i.e., 22 before surgery and
risk factors such as age, weight, and other medical indicators)
to predict possible patient outcomes prior to surgeries, such as
risk of death and risk of common complications. The calculator
can also estimate a patient’s length of hospital stay. This tool is
mainly used by providers during patient consultations.30
• Monthly newsletter includes best practices and updates from
all hospital sites. It is distributed to sites via email.
• Case studies are shared across hospitals participating in the
ACS NSQIP via the program website and newsletter.31
• Scientific papers (e.g., peer-reviewed literature) and presentations provide information to the larger clinical and research
communities.
• Annual meeting serves as an opportunity for hospital leaders,
clinicians, and SCRs to convene and network with each other.
The meeting includes presentations on national outcomes,
specific hospital case studies and updates on the ACS NSQIP’s
ongoing work.32 The most recent meeting included representation from more than 500 hospitals and had more than 1,000
attendees.33
4 | The American College of Surgeons’ National Surgical Quality Improvement Program
Data users and the ACS NSQIP stakeholders include:
1. Hospitals use quarterly reports, real-time online reports, and
datasets to conduct quality improvement activities.
2. Providers participate in quality improvement activities and
use datasets for targeted decision making. Providers can also
use the online risk calculator during patient consultations.34
3. Researchers and academic hospitals use datasets to conduct
research on surgical outcomes. To date, more than 600 articles
have been published in the peer-reviewed literature using the
ACS NSQIP data.35 Many note that the rich and robust data
provided by the ACS NSQIP allows for studies to investigate
complicated hypotheses.36
4. Patients have access to publicly reported outcomes data
through Hospital Compare, a website that allows users to compare hospital ratings and performance.37
5. Policymakers and national quality organizations use the
ACS NSQIP to inform quality reporting efforts, such as:
a. Ongoing professional practice evaluation requirements from
the Joint Commission, a national nonprofit accreditation
and certification organization.38
b.The 2014 surgical quality measure implemented by the
Centers for Medicare and Medicaid Services (CMS) that
requires all general surgery to be accounted for in a clinical
data registry.39
c. Participation in National Quality Forum (NQF), a nonprofit that endorses consensus standards for performance
measures. NQF endorses several measures found in the
ACS NSQIP, addressing issues such as specific surgical site
infections, elderly surgical outcomes, colectomy outcomes,
lower-extremity vascular bypass outcomes, and urinary
tract infection outcomes.40,41,42,43,44
d.Participation in National Healthcare Safety Network
(NHSN).The ACS and the Centers for Disease Control and
Prevention have collaborated to develop jointly-endorsed
the ACS NSQIP measures of infection for knee surgery and
hysterectomy, which are included in the current conduct
of the NHSN, the most widely used health care-associated
infection tracking system in the United States.
Contributions of ACS NSQIP
The ACS NSQIP has generated significant value for numerous
users, but some contributions are noted across all stakeholder
groups:
• Improves Surgical Outcomes and Reduces Complications:
Quality improvement activities leverage the ACS NSQIP data
to pinpoint areas of opportunity. Two notable examples: 1) reducing the rate of SSI at the Surrey Memorial Hospital in Vancouver, British Columbia, an initiative that saved the hospital
roughly $2.5 million over a two-year period,47 and 2) reducing
length of patient stay by an average of 1.54 days in Henry Ford
Hospital in Detroit, Michigan.48 To achieve these improvements, the two hospitals utilized the ACS NSQIP reports (e.g.,
best practices documents, SAR report) and analyses to implement quality improvement programs.
• Reduces Overall Morbidity: A study investigating the implementation of the ACS NSQIP in private hospitals found that
site participation was associated with a reduction in overall
morbidity following major and general vascular surgery over
three years. Specifically, surgical site infections and renal
complications were reduced.49 The observed fall in morbidity
rates is thought to be the result of data being made available to
providers; the feedback loops can catalyze outcomes improvement activities in hospital sites.50
• Generates Better Quality Measures: There is an increasing
demand for outcomes-based measures for hospitals. The ACS
NSQIP provides data through its risk-adjusted outcomes measures, which are of value to both sites and entities such as the
National Quality Forum, which can endorse measures developed from high quality ACS NSQIP data.51
• Saves Money and Provides Return on Investment: Costs associated with patient complications are burdensome to hospitals
and patients, and this is increasingly the case given health
reform’s bundled and capitated payment initiatives. One study
found that a major surgical complication generates an average
of $11,626 in extra costs per site. Another study concluded
that adverse surgical events raise the median cost of hospitalization for major surgical procedures by up to five-fold. The
ACS NSQIP, by identifying areas of concern within hospitals
and providing resources for improvement activities, has been
shown to reduce complications. It is estimated that preventing just 15 or fewer complications per year per hospital could
provide enough savings to cover the full cost of the ACS NSQIP
participation.52
Spotlight: The Tennessee Surgical Quality Collaborative
The Tennessee Surgical Quality Collaborative (TSQC), a working partnership of 22 regional the ACS NSQIP hospitals, has successfully reduced
surgical complications, resulting in a total savings of $2.2 million per 10,000 cases from 2009 to 2010.45 Documented successes include improvements in superficial surgical site infection (18.9 percent reduction) and acute renal failure rates (25.1 percent reduction). These two accomplishments resulted in at least $8 million in savings in the same time period.46 To learn from each other, the TSQC meets in person in conjunction with
other the ACS events and participates in monthly calls with SCRs and the ACS’s Leadership Committee.47 Participating hospitals note that these
activities are extremely helpful and lead to achievement of their internal quality improvement goals.
5 | The American College of Surgeons’ National Surgical Quality Improvement Program
Cost Snapshot
Many hospitals note that participating in the ACS NSQIP produces significant cost savings, which are yielded from quality improvement activities:53
• Average potential cost saved per hospital per year: $2,906,500-$5,813,000
• Average cost per complication: $11,626
• Potential yearly savings if half of the roughly 4,500 U.S. hospitals participated in the ACS NSQIP (roughly the size of the U.S. private market):
$7-$13 billion54
• Estimated total savings over a decade if half of the roughly 4,500 U.S. hospitals participated in the ACS NSQIP: $130-$260 billion55
Future Opportunities
The ACS is committed to enhancing the ACS NSQIP by:
1. Expanding the number of participating hospitals;
2. Continuing to refine data collection processes and statistical
methodologies;
3. Investigating cost and utilization in hospitals; and
4. Collaborating with national quality improvement initiatives.
Expanding Hospital Participation
To encourage new participants and enhance program participation efficiency overall, the ACS NSQIP plans to provide individualized technical assistance and tailored member options in the
coming years, such as the ability to report on transplant data; ear,
nose and throat specialty data; cancer outcomes; and additional
pediatric data assessments.56
Refining Data Collection Processes and Statistical
Methodologies
The ACS NSQIP is adding surgery sub-specialties to its data collection process, which will allow for greater reporting of surgical
outcomes. Refinements in data collection, such as the ability of
electronic health records to automatically populate basic patient
demographics in the ACS NSQIP portal, will reduce data collection burden (i.e., time spent by SCRs) on hospital sites.57,58 Doing
so will also cut costs for those participating in the ACS NSQIP
since sustaining SCRs as full-time hospital employees often costs
$65,000-$100,000 per year.59
Investigating Hospital Cost and Utilization
The ACS NSQIP is considering integrating cost and utilization
data into the collection process. On the immediate horizon is the
addition of Medicare payment data to the ACS NSQIP’s core dataset measures. Then, the ACS NSQIP will consider the inclusion
of utilization data into the program (e.g., the number of scans
performed before an appendectomy at each hospital site).60
Collaborating with National Quality Improvement
Initiatives
Following the success of the Comprehensive Unit-Based Safety
Program (CUSP) – a five-step program designed to improve the
culture in hospital surgical units via education, awareness and
access to resources and intervention toolkits, the ACS NSQIP and
Johns Hopkins University have partnered to develop a program
that also seeks to improve surgical outcomes and prevent complications.61
CUSP began in 2001 at Johns Hopkins University as an effort to
improve safety in intensive care units. Surgical CUSP, implemented
at Johns Hopkins Hospital, initially focused on improving colectomy outcomes and preventing SSIs. Early findings from the program found that the overall rate of surgical infections fell from 27
percent to 18 percent.62 Funded through AHRQ, Johns Hopkins,
in partnership with the ACS NSQIP has enrolled hospitals in the
Surgical Unit-Based Safety Program (SUSP), which is essentially
the CUSP program adapted to the perioperative area. The goal of
SUSP is to reduce SSIs and surgical harm through the implementation of technical and adaptive changes. Both the ACS NSQIP and
non-ACS NSQIP hospitals are participating through 2015.63
Citations
The American College of Surgeons National Surgical Quality
Improvement Program, About ACS, available at: http://site.
acsnsqip.org/about-acs/. Accessed July 30, 2014.
1
Hall, B. et al. “Does Surgical Quality Improve in the American
College of Surgeons National Surgical Quality Improvement
Program.” Annals of Surgery, Vol. 250(3); 363-376, September
2009.
2
The American College of Surgeons National Surgical Quality
Improvement Program, Participants, available at: http://site.
acsnsqip.org/participants/. Accessed on July 30, 2014.
3
U.S. News & World Report, Best Hospitals 2014-2015: Overview
and Honor Roll, available at: http://health.usnews.com/healthnews/best-hospitals/articles/2014/07/15/best-hospitals-201415-overview-and-honor-roll. Accessed on July 30, 2014.
4
5
The American College of Surgeons National Surgical Quality
Improvement Program, NSQIP History, available at: http://site.
acsnsqip.org/program-specifics/nsqip-history/. Accessed on
June 25, 2014.
Key informant interview, Summer 2014.
6
The American College of Surgeons National Surgical Quality
Improvement Program, Common Ground for Health Care: ACS
NSQIP Increases Quality, Reduces Costs, available at: http://site.
acsnsqip.org/wp-content/uploads/2012/02/ACS-Policy1.pdf.
Accessed on July 31, 2014.
7
6 | The American College of Surgeons’ National Surgical Quality Improvement Program
8
9
Cohen, M. et al. “Optimizing ACS NSQIP Modeling for Evaluation of Surgical Quality and Risk: Patient Risk Adjustment,
Procedure Mix Adjustment, Shrinkage Adjustment, and Surgical Focus.” Journal of the American College of Surgeons, Vol.
217:336-346. August 2013.
Key informant interview, Summer 2014.
The American College of Surgeons National Surgical Quality Improvement Program, ACS NSQIP: Participation Options, available at: http://site.acsnsqip.org/wp-content/
uploads/2012/11/NSQIP-Participation-Options-10.12.pdf.
Accessed on June 25, 2014.
10
Key informant interview, Summer 2014.
11
ACS NSQIP, ACS NSQIP: Participation Options, available
at: http://site.acsnsqip.org/wp-content/uploads/2012/11/
NSQIP-Participation-Options-10.12.pdf. Accessed on June 25,
2014.
12
The American College of Surgeons National Surgical Quality
Improvement Program, ACS NSQIP Leadership, available at:
http://site.acsnsqip.org/program-specifics/acs-nsqip-leadership/. Accessed on June 25, 2014.
13
The American College of Surgeons National Surgical Quality
Improvement Program, FAQ, available at: http://site.acsnsqip.
org/join-now/faq/. Accessed July 30, 2014.
14
Davenport D., Holsapple C., and Conigliaro J. “Assessing
Surgical Quality Using Administrative and Clinical Data Sets:
A Direct Comparison of the University Health System Consortium Clinical Database and the National Surgical Quality
Improvement Program Data Set.” American Journal of Medical
Quality, Vol. 24(5):395-402, September-October 2009.
15
Ibid.
16
Cohen, M. et al. “Optimizing ACS NSQIP Modeling for Evaluation of Surgical Quality and Risk: Patient Risk Adjustment,
Procedure Mix Adjustment, Shrinkage Adjustment, and Surgical Focus.” Journal of the American College of Surgeons, Vol.
217:336-346, August 2013.
17
Shiloach, M., et al. “Toward Robust Information: Data Quality
and Inter-Rater Reliability in the American College of Surgeons
National Surgical Quality Improvement Program.” Journal of
the American College of Surgeons, Vol. 210(1):6-16, January
2010.
18
Cohen, M. et al. “Optimizing ACS NSQIP Modeling for Evaluation of Surgical Quality and Risk: Patient Risk Adjustment,
Procedure Mix Adjustment, Shrinkage Adjustment, and Surgical Focus.” Journal of the American College of Surgeons, Vol.
217:336-346, August 2013.
19
The American College of Surgeons National Surgical Quality
Improvement Program, Data Collection, Analysis and Reporting,
available at: http://site.acsnsqip.org/program-specifics/data-collection-analysis-and-reporting/. Accessed on June 25, 2014.
20
Key informant interview, Summer 2014.
21
The American College of Surgeons National Surgical Quality
Improvement Program, SCR Training and Resources, available at: http://site.acsnsqip.org/program-specifics/scr-training-and-resources/. Accessed on June 25, 2014.
22
Ibid.
23
Shiloach, M., et al. “Toward Robust Information: Data Quality
and Inter-Rater Reliability in the American College of Surgeons
National Surgical Quality Improvement Program.” Journal of
the American College of Surgeons, Vol. 210(1):6-16, January
2010.
24
The American College of Surgeons National Surgical Quality
Improvement Program, Collaboratives, available at: http://site.
acsnsqip.org/participants/collaboratives/. Accessed July 30, 2014.
25
Key Informant Interview, Summer 2014.
26
The American College of Surgeons National Surgical Quality
Improvement Program, Data Collection Analysis and Reporting,
available at: http://site.acsnsqip.org/program-specifics/data-collection-analysis-and-reporting/. Accessed July 30, 2014.
27
Ibid.
28
Ibid.
29
Heltz, D. “Online Calculator Predicts Risk of Surgical Complications.” Released September 4, 2013. Yahoo! Health, available at: http://site.acsnsqip.org/news/online-calculator-predicts-risk-of-surgical-complications/. Accessed July 30, 2014.
30
The American College of Surgeons National Surgical Quality
Improvement Program, Case Studies, available at: http://site.
acsnsqip.org/about/case-studies/. Accessed July 30, 2014.
31
The American College of Surgeons National Surgical Quality
Improvement Program, 2014 ACS NSQIP National Conference,
available at: http://www.acsnsqipconference.org/?page_id=17.
Accessed July 30, 2014.
32
Key Informant Interview, Summer 2014.
33
Heltz, D. “Online Calculator Predicts Risk of Surgical Complications.” Released September 4, 2013. Yahoo! Health, available at: http://site.acsnsqip.org/news/online-calculator-predicts-risk-of-surgical-complications/. Accessed July 30, 2014.
34
Key Informant Interview, Summer 2014.
35
Zollo R., et al. “Blood Transfusion in the perioperative period.”
Best Practices & Research Clinical Anesthesiology, Vol. 26(4):
475-84, December 2010.
36
Centers for Medicare and Medicaid Services, What is Hospital
Compare, available at: www.medicare.gov/hospitalcompare/
About/What-Is-HOS.html. Accessed July 30, 2014.
37
The Joint Commission, About The Joint Commission, available
at: http://www.jointcommission.org/about_us/about_the_joint_
commission_main.aspx. Accessed July 30, 2014.
38
The American College of Surgeons National Surgical Quality
Improvement Program, ACS NSQIP Benefits, available at: http://
site.acsnsqip.org/about/acs-nsqip-benefits/. Accessed July 30,
2014.
39
7 | The American College of Surgeons’ National Surgical Quality Improvement Program
National Quality Forum, About Us, available at: http://www.
qualityforum.org/story/About_Us.aspx. Accessed July 30, 2014.
40
National Quality Forum, American College of Surgeons – Centers
for Disease Control and Prevention (ACS-CDC) Harmonized
Procedure Specific Surgical Site Infection (SSI) Outcome Measure,
available at: http://www.qualityforum.org/QPS/0753. Accessed
July 30, 2014.
41
National Quality Forum, Risk Adjusted Case Mix Adjusted
Elderly Surgery Outcomes Measure, available at: http://www.
qualityforum.org/QPS/0697. Accessed July 30, 2014.
42
National Quality Forum, Risk Adjusted Colon Surgery Outcome
Measure, available at: http://www.qualityforum.org/QPS/0706.
Accessed July 30, 2014.
43
National Quality Forum, Risk Adjusted Urinary Tract Infection
Outcome Measure After Surgery, available at: http://www.qualityforum.org/QPS/0751. Accessed July 30, 2014.
44
Key informant interview, Summer 2014.
45
Guillamondegui, O. et al. “Using the National Quality Improvement Program and the Tennessee Surgical Quality Collaborative to Improve Surgical Outcomes.” Journal of the American
College of Surgery, Vol. 214(4):709-14, April 2012.
46
Ingraham A., et al. “Quality Improvement in Surgery: The
American College of Surgeons National Surgical Quality
Improvement Program Approach.” Advances in Surgery, Vol.
44:251-267. October 2010.
47
Ibid.
48
Khuri S., Henderson W., Daley J., et al. “Successful Implementation of the Department of Veterans Affairs’ National Surgical
Quality Improvement Program in the Private Sector: The Patient Safety in Surgery Study.” Annals of Surgery, Vol. 248:329336, August 2008.
Key informant interview, Summer 2014.
56
Ibid.
57
Cohen, M. et al. “Optimizing ACS NSQIP Modeling for Evaluation of Surgical Quality and Risk: Patient Risk Adjustment,
Procedure Mix Adjustment, Shrinkage Adjustment, and Surgical Focus.” Journal of the American College of Surgeons, Vol.
217:336-346, August 2013.
58
Key informant interview, Summer 2014.
59
Ibid.
60
Johns Hopkins Medicine, The Comprehensive Unit-based Safety
Program (CUSP), available at: http://www.hopkinsmedicine.org/
innovation_quality_patient_care/areas_expertise/improve_patient_safety/cusp/. Accessed July 30, 2014.
61
The American College of Surgeons National Surgical Quality
Improvement Program, New Surgical Patient Safety Program
Reduces Surgical Site Infections by One-Third in Patients Who
Undergo Colorectal Operations, available at: http://site.acsnsqip.
org/news/new-surgical-patient-safety-program-reduces-surgical-site-infections-by-one-third-in-patients-who-undergo-colorectal-operations/. Accessed July 30, 2014.
62
The American College of Surgeons National Surgical Quality Improvement Program, ACS NSQIP Partners with Johns
Hopkins and Dr. Peter Provonost to Develop Surgical CUSP
Program, available at: http://site.acsnsqip.org/wp-content/uploads/2012/11/NSQIP-CUSP-Program-10.12.pdf. Accessed July
30, 2014.
63
49
Ibid.
50
The American College of Surgeons National Surgical Quality
Improvement Program, Key Studies, available at: http://site.
acsnsqip.org/program-specifics/key-studies/. Accessed July 30,
2014.
51
The American College of Surgeons National Surgical Quality
Improvement Program, Business Case, available at: http://site.
acsnsqip.org/about/business-case/.
52
The American College of Surgeons National Surgical Quality
Improvement Program, Options and Pricing, available at: http://
site.acsnsqip.org/wp-content/uploads/2012/11/NSQIP-OptionsPricing-Sheet-10.12.pdf.
53
About the Authors
Jessica Winkler, M.P.H., is a senior associate at AcademyHealth.
She may be reached at jessica.winkler@academyhealth.org.
Emily Moore is a student at University of Michigan School of Public
Health. She was formerly a research assistant at AcademyHealth.
Acknowledgements
Sponsorship for this project was provided by The Kaiser
Permanente Institute for Health Policy. We thank our partners
at The Pew Charitable Trusts and all those interviewed for their
contributions to these resources. A special thank you to Clifford
Ko, Bruce Hall, Elizabeth Wick, and Laurent Glance for their
review and assistance.
Ibid.
54
The American College of Surgeons National Surgical Quality
Improvement Program, Common Ground for Health Care: ACS
NSQIP Increases Quality, Reduces Costs, available at: http://site.
acsnsqip.org/wp-content/uploads/2012/02/ACS-Policy1.pdf.
Accessed on July 31, 2014.
55
This document represents a synthesis of information generated by a series of key informant interviews. Any views expressed are those of the interviewees.