As health-care reforms progress, quality and risk assessment in the health-care system of the USA surface as critical issues. This review considers past, present and possible future changes in quality assessment along with formal programs of complication reduction and pay for performance (PFP) as related to surgery and vascular interventions. Strategies for quality improvement include aggregate and risk-adjusted outcome measurement, process compliance with the Surgical Complication Improvement Program, oversight and PFP, now policies of the Centers for Medicare and Medicaid Services (CMS). Advantages, disadvantages and unintended consequences of these policies are discussed. While ongoing system changes will influence vascular surgical practice, unique opportunities and obligations exist for vascular surgeons to contribute to quality assessment of their interventions, to evaluate long-term outcomes and to devise strategies for comprehensive cost-effective care for the conditions affecting patients with vascular disease.
HookerR.Mesopotamia: The Code of Hammurabi (translated by L.W king). WA: Washington State University. 1996. See http://www.wsu.edu/~dee/MESO/CODE.HTM (last checked 25 May 2010)
2.
DillerT. Louis XIV and his operation for fistula in ano. JAMA1926;87:2018–9
3.
ScottI. What are the most effective strategies for improving quality and safety of health care?Intern Med J (R Australas Coll Phys)2009;39:389–400
4.
LivingstonEH. Solutions for improving patient safety. JAMA2010;303:159–61
5.
AvelloneJS, BevenEG, HertzerNR, A regional specialty society as a model to monitor surgical care. JAMA1978;240:2177–80
6.
PlechaFR, AvelloneJC, BevenEG, DePalmaRG, HertzerNR. A computerized vascular registry: experience of the Cleveland Vascular Society. Surgery1979;86:826
7.
HoffmanM, AvelloneJC, PlechaFR, Operation for ruptured abdominal aortic aneurysms: a community-wide experience. Surgery1982;91:597–602
8.
StalloneRJ, BlaisdellFW, CafferataHT, LevinSM. Assessing morbidity and mortality from arterial embolectomy. Surgery1969;65:207–17
9.
GloviczkiP, BerganJJ, MenawatSS, Safety, feasibility and early efficacy of subfascial endoscopic surgery: a preliminary study report from the North American Registry. J Vasc Surg1997;25:94–105
10.
DePalmaRG. A treatment algorithm for venous ulcer. In: GloviczkiP, ed. Handbook of Venous Disorders. 3rd edn. London: Edward Arnold, 2009:545–50
11.
BerwickDM. The science of improvement. JAMA2008;299:1182–4
12.
KolodnerRM, ed. Computerizing Large Integrated Health Care Networks: The VA Success. New York: Springer-Verlag, 1997
13.
KhuriSF. Surgical systems. In: KolodnerRM, ed. Computerizing Large Integrated Health Care Networks: the VA Success. New York: Springer-Verlag, 1997: 240–52
14.
15.
HammermeisterKE, JohnsonR, MarshallG, GroverFL. Continuous assessment and improvement in the quality of care: a model from the Department of Veterans Affairs Cardiac Surgery. Ann Surg1994;219:281–90
16.
DePalmaRG. Surgical quality programs in the veterans health administration. Ann Surg2006;72:999–1004
17.
HallBL, HamiltonBH, RichardsK, Does surgical quality improve in the American College of Surgeons National Quality Improvement Program? An evaluation of all participating hospitals. Ann Surg2009;250:363–76
18.
Donebedian A. Evaluating the quality of medical care. Milbank Mem Fund1966;44:S166–206
19.
DimickJB, UpchurchGRJr. Measuring and improving the quality of care for abdominal aortic surgery. Circulation2008;117:2534–41
20.
FinkAS. Adjusted or unadjusted outcomes. Am J Surg2009;198:S28–S35
21.
ReasonJ. Understanding adverse events: human factors. Qual Health Care1995;4:80–9
22.
HutterMM, RowellKS, DevaneyLA, Identification of surgical complications and deaths: an assessment of the traditional surgical morbidity and mortality conference compared with the American College of Surgeons-National Surgical Quality Improvement Program. J Am Coll Surg2006;203:618–24
23.
ReasonJ. Safety in the operating theatre-Part 2: human error and organisational failure. Qual Safe Health Care2005;14:60–1
24.
SinghN, SidawyAN, DezeeK, The effects of the type of anesthesia on outcomes of lower extremity infrainguinal bypass. J Vasc Surg2006;44:964–8
25.
O'HareAM, SidawyAN, FeinglassJ, Influence of renal insufficiency on limb loss and mortality after initial lower extremity revascularization. J Vasc Surg2004;39:709–16
26.
O'KeefeSD, DavenportDL, MinionDJ, Blood transfusion is associated with increased morbidity and mortality after lower extremity revascularization. J Vasc Surg2010;51:616–21
GilesKA, HamdanAD, PomposelliFB, Body mass index: surgical site infections and mortality after lower extremity bypass from the National Surgical Quality Improvement Program 2005–2007. Ann Vasc Surg2010;24:48–56
29.
BushRL, DePalmaRG, ItaniKMF, Outcomes of care of abdominal aortic aneurysm in Veterans Administration Hospitals: results from the National Surgical Quality Improvement Program. Am J Surg2009:198:S41–8
30.
GilesKA, PomposelliFB, HamdanAD, Comparison of open and endovascular repair of ruptured aortic aneurysms from the ACS NSQIP 2005–2007. J Vasc Endovasc Ther2009;16:365–72
31.
AbediNN, DavenportDL, XenosE, Gender and 30-day outcome in patients undergoing endovascular aneurysm repair (EVAR): an analysis using ACS NSQIP data set. J Vasc Surg2009;50:486–91
32.
BushRL, JohnsonML, HedayatiN, Performance of endovascular aneurysm repair in high risk patients. J Vasc Surg2007;45:227–233
33.
HuaHT, CambriaRP, ChuangSK, Early outcomes of endovascular versus open abdominal aortic repair in the National Surgical Quality Improvement Program in the private sector. (NSQIP-NS). J Vasc Surg2005;41:382–9
34.
WooK, GargJ, HyeRJ, DilleyRB. Contemporary results of carotid endarterectomy for asymptomatic carotid stenosis. Stroke2010;41:975–9
A CBO Paper. Quality Initiative Undertaken by the Veterans Health Administration. Congress of the United States. Congressional Budget Office, 2009
37.
NeilyJ, MillsPD, EldridgeN, Incorrect surgical procedures within and outside of the operating room. Arch Surg2009;144:1028–34
38.
LongmanP. Best Care Anywhere: Why VA Care is Better than Yours. 2nd edn. Sausalito, CA: PoliPoint Press, LLC, 2010
39.
SwensonSJ, MeyerGS, NelsonED, Cottage industry to postindustrial care. The revolution in health care delivery. N Engl J Med2010;362:e12
40.
LeapeL, BerwickD, ClancyC, Transforming health care, a safety imperative. Qual Safe Health Care2009;18:424–8
41.
van KasterenME, MannienJ, OttA, Antibiotic prophylaxis and the risk of surgical site infections following total hip arthroplasty: timely administration is the most important factor. Clin Infect Dis2007;44:921–7
42.
HawnMT, ItaniKM, GrayS, Association of timely administration of antibiotics for major surgical procedures and surgical site infection. J Am Coll Surg2008;206:814–21
43.
Polk HC Jr. Keeping score and the application of known principles. Am J Surg2005;190:16–7
44.
StewartAH, EyersPS, EarnshawJJ. Prevention of infection in peripheral arterial reconstruction: a systematic review and meta-analysis. J Vasc Surg2007;46:148–55
45.
LachiewiczPF. Comparison of ACCP and AAOS Guidelines for VTE prophylaxis after total hip and total knee arthroplasty. Orthopedics2009;32(Suppl 12):74–8
46.
GroopmanJ. Warning about the ‘Best’ Medical practices. New York Rev Books2010;LVII:12–4
47.
KhuriSF, HendersonWG, DePalmaRG, MoscaC, Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg2005;242:326–43
48.
TannebaumSJ. Pay for performance in Medicare. Evidentiary irony and the politics of value. J Health Polit Policy Law2009;34:717–46
49.
HaywardA, KentDM. 6 EZ steps to improving your performance: (or How to Make P4P Pay 4U!). JAMA2008;300:255–6
50.
MilsteinA. Ending extra payments for ‘never events’––stronger incentives for patients' safety. N Engl J Med2009;360:2388–90
51.
DerGurahianJ. N.Y. Medicaid ups the ante. Modern Healthcare2008. See http://goliath.ecnext.com/coms2/gi_0199-8069936/N_Y_Medicaid_ups_the.html (last checked 10 February 2011)
52.
FryDE, PineM, JonesBL, MeimbaumRJ. Patient characteristics and occurrence of never events. Arch Surg2010;145:148–51
53.
de ToquevilleA. Democracy in America. Volume II, Book 4, Chapter 6. New York: AS Barnes & Co, 1851
54.
EpsteinAM. Pay for performance at the tipping point. N Engl J Med2007;356:515–7
55.
PetersonLA, WoodardLCD, UrechBA, Does pay for performance improve health care?Ann Intern Med2006;145:265–72
56.
StulbergJJ, DelaneyCP, NeuhauserDV, Adherence to surgical care improvement project measures and the association with postoperative infections. JAMA2010;303:2479–85
57.
LindenauerPK, RemusD, RomanS, Public reporting and pay for performance in hospital quality improvement. N Engl J Med2007;356:486–96
58.
OberlanderJ, MarmorT. The health care bill explained at last. New York Rev Books2010;LVII:61–3
