Invited commentary

Abstract

The authors are to be commended for a timely and unique study that compares the Vascular Quality Initiative (VQI) and National Surgical Quality Improvement Program (NSQIP) data sets in an identical patient cohort. It is widely accepted that risk adjustment is essential when reporting outcomes and assumed that the database used for this assessment accurately reflects patient co-morbidities and outcomes. The results of this study therefore are remarkable in that variables that are seemingly “black and white,” such as sex, ethnicity, prevalence of diabetes, or variables that should be extracted from the chart as a “number” (eg, American Society of Anesthesiologists class) showed more variability than might be expected. It is also disturbing that there is a lack of concordance in patient outcomes such as wound infection or change in renal function. Such discordance becomes concerning when patient outcomes are used as a factor for determining reimbursement, financial penalties, and/or rating the practitioner. It is feasible that a provider's outcomes could be in the acceptable range as monitored by one methodology yet be penalized by a payor using another methodology. The current study compared two databases, but many others are also being used such as data for the University Health Consortium, Society for Thoracic Surgery, disease-specific databases, and specialty-specific databases. Each database has inherent differences that are based on who collects or reports the information; the completeness of the medical record; definitions used for patient conditions, complications, or outcomes; the time frame for collection of data; and its intended purpose such as hospital related information, physician outcome, or disease-specific information. The authors have identified many of these issues as contributing to discordance between datasets. Because of associated costs, the number of programs in which institutions and practices participate will be limited. This naturally leads to questions regarding which database is more accurate or which database should be used to measure performance, specifically as it relates to payment. Studies such as this must be undertaken to address these questions. Physician and specialty society input is essential to guide the development and rational use of database information. It is also imperative that physicians understand the methodology and definitions that are used in any program that measures patient outcomes. The authors are to be commended for this study, and I look forward to future work by this group. Outcomes reported by the Vascular Quality Initiative and the National Surgical Quality Improvement Program are not comparableJournal of Vascular SurgeryVol. 60Issue 1PreviewThe Vascular Quality Initiative (VQI) and National Surgical Quality Improvement Program (NSQIP) have emerged as the primary vascular surgery quality measurement tools with the purpose of evaluating perioperative outcomes and assessing hospital and physician quality. VQI uses self-reporting to capture all index vascular procedures during the inpatient period. NSQIP employs nurse abstractors to capture a sample of procedures and covers 30-day events. We hypothesize that patients undergoing lower extremity bypass (LEB) will exhibit high concordance for preoperative variables and low concordance for postoperative variables between these data sets. Full-Text PDF Open Archive