Participation in Hospital Quality Reporting Program Did Not Improve Outcomes

Nicholas Osborne, M.D., M.S
Vascular Surgery Fellow
University of Michigan, Ann Arbor What is the background for this study?

Dr. Osborne: The American College of Surgeons launched the National Surgical Quality Improvement Program (ACS-NSQIP) in the early 2000s. This program collects and reports surgical outcomes to participating hospitals. One retrospective study of participating hospitals in the ACS-NSQIP reported improvements in risk-adjusted outcomes with participation. This study, however, did not compare ACS-NSQIP hospitals to control hospitals. The purpose of our study was to compare ACS-NSQIP to similar non-participating hospitals over time and determine whether participation in the ACS-NSQIP was associated with improved outcomes. What are the main findings?

Dr. Osborne: When comparing hospitals participating in a national quality reporting program (ACS-NSQIP) to similar hospitals, there is no appreciable improvement in outcomes (mortality, morbidity, readmissions or cost)  outside of pre-existing trends across all hospitals. In other words, Hospitals nationwide were improving over this same time period and ACS-NSQIP hospitals did not improve above and beyond these existing trends. What should clinicians and patients take away from your report?

Dr. Osborne: Our study failed to show any improvements n outcomes with participation in the ACS-NSQIP. We caution, however, that this study should not be interpreted as a reason to stop participating in the ACS-NSQIP or other national quality improvement programs. The ACS-NSQIP is a very necessary first step in improving hospital and surgical quality, but simply feeding back outcomes to hospitals does not lead to improved care. More recent efforts by the ACS-NSQIP and other quality collaboratives have been focused on providing a platform for improvement, including:

  1. Regional collaboratives which can serve as a platform for benchmarking, and quality improvement projects across hospitals
  2. Disease –specific collaboratives to allow surgeons and hospitals to focus on disease specific outcomes and quality improvement projects that may not be appreciable on a larger scale
  3. Creating incentives for quality improvement (pay for performance/pay-for-participation programs, non-payment for adverse events and value-based purchasing) What recommendations do you have for future research as a result of this study?

Dr. Osborne: This study demonstrates that quality improvement is difficult and that simply measuring and reporting outcomes to hospitals is not sufficient to improve outcomes. Instead, we must now focus on expanding our efforts to enable hospitals to improve. As the ACS-NSQIP continues to evolve and other quality initiatives continue, we must continue to assess their impact in a non-biased and scientifically rigorous manner.


Association of Hospital Participation in a Quality Reporting Program With Surgical Outcomes and Expenditures for Medicare Beneficiaries

Nicholas H. Osborne MD, MS, Lauren H. Nicholas PhD, Andrew M. Ryan PhD, Jyothi R. Thumma MPH, Justin B. Dimick MD, MPH

JAMA. 2015;313(5):496-504. doi:10.1001/jama.2015.25

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Nicholas Osborne, M.D., M.S, Vascular Surgery Fellow, & University of Michigan, Ann Arbor (2015). Participation in Hospital Quality Reporting Program Did Not Improve Outcomes

Last Updated on February 3, 2015 by Marie Benz MD FAAD