ACS-NSQIP National Meeting July 22, 2012 Breakout Session 5: Bariatric Data Collector Updated Agenda: 1. Overview of the Bariatric Data Collection Program. Past, present and future. Matt Hutter 2. Data Collector Updates: Lisa Scholl Updates to workstation. CMS definition format. Introduction to FAQ Database. 3. Important Issues for High Quality Data Matt Hutter 4. Q&A
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ACS-NSQIP National Meeting July 22, 2012
Breakout Session 5: Bariatric Data CollectorUpdated Agenda:
1. Overview of the Bariatric Data Collection Program.Past, present and future. Matt Hutter
2. Data Collector Updates: Lisa SchollUpdates to workstation. CMS definition format. Introduction to FAQ Database.
3. Important Issues for High Quality Data Matt Hutter
4. Q&A
Matthew M. Hutter, MD, MPH
Director, Codman Centerfor Clinical Effectiveness in Surgery
Massachusetts General HospitalACS-NSQIP National Meeting July 22, 2012
Data Collection Program
Breakout Session 5: Bariatric Data Collector
Disclosures
None.
• I am NOT an employee of, nor am I paid by, the American College of Surgeons.
Data Collection Program
Overview Why collect data?
Data Collection Program Design How the data are collected Variables and definitions.
Unification of Programs. Transition to Outcomes Based Accreditation.
Why Collect Data?
To assess quality and effectiveness▪ in order to drive Continuous Quality Improvement
and ▪ to verify that centers are performing well.
If we do not do it, others will…and they cannot do it as well !!
Data Collection Program
Data Registry
Data Registry Overview
The Key is to obtainHigh Quality Data
that is ▪ objective▪ based on standardized definitions▪ reliable▪ risk-adjusted
and ▪ captures clinical effectivenessthat we and our patients care about.
MBSAQIP Data Collection System▪ 100% of cases.
▪ Data collected by trained surgical clinical reviewers.
▪ Does NOT require a center to have NSQIP (but it was designed to integrate with the NSQIP).
▪ Bariatric specific data points:• Leaks, strictures, internal
hernias etc.• Risk-adjusted.• Weight.• Weight related illnesses.
▪ Long term follow-up.30 days, 6 months, one-year……..Annually… Forever?
▪ Developed for quality improvement and quality assessment. (Not specifically for research.)
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Bariatric Surgical Clinical Reviewer (BSCRs) at each site.
▪ Data collectors are not involved directly in patient care (third party). (NOT surgeons, fellows, nurses, medical assistants etc.
NOT someone who is charting on that patient.)
▪ Does not have to be a nurse.
▪ Can be a preexisting person at your site.
▪ Required resource – compensation can be requested from administration (as opposed to additional work for the surgeons/staff).
▪ All cases are to be collected% or # of FTEs depends on volume.
▪ Trained centrally – online. Ongoing assessment, training and conference calls.
Data Collectors
Data points and data definitions• Data points have discreet definitions, and
are derived from objective information.
• NSQIP data points and data definitions used as the framework.
• NIH Longitudinal Assessment of Bariatric Surgery (LABS) provided additional bariatric specific data points.
• Ali- Wolfe classification considered, and dichotomized to yes/no.
• Expert opinion and experience with institutional data bases used to complete the system.
▪ Multiple revisions and re-revisions with in person meetings and conference calls.
ACS BSCN Data Collection System
• Data points and data definitions
• SAGES Bariatric Committee and • SAGES Outcomes Committee had input and vetted data points and definitions.
Data points andData Definitions
Interventions determine an occurrence, not just definitions:
e.g. An anastomotic leak:• Objective data:
» Re-operation.» Percutaneous Drain placement.» Primary drain left in for 30 days.
• “Suspected reason”»“Anastomotic /Staple line leak”
Anastomotic/Staple Line Leak: Answer “Yes” if a leak of endoluminal contents through an anastomosis/staple line occurred. This could include air, fluid, GI contents, or contrast material. The presence of an infection/abscess thought to be related to an anastomosis/staple line, even if it cannot be definitively identified as visualized during an operation, or by contrast extravasation would also be considered an anastomotic/staple line leak.
Process Measures▪ Provocative Leak Test.▪ Level of Assistant.▪ Approach: NOTES, Single incision, Robotic,
Laparoscopic, Hand assist, Open….And conversions
▪ Sleeve Gastrectomy:▪ Distance from Pylorus▪ Staple line: ▪ Reinforcement