1. From Process to Outcome Measures: How Can AQI Facilitate?
Richard P. Dutton, MD MBA
Executive Director

2. DATA!

3. Where are we now?

5. The
Challenge
The government wants to know that Ma and Pa are getting the healthcare they deserve … and that our taxes pay for.
11/18/2018

6. The AQI A non-profit 501(c)3 corporation
Vision: To become the primary source for quality improvement in the clinical practice of anesthesiology
Mission: To establish and maintain the National Anesthesia Clinical Outcomes Registry

7. Basic Principles The more you know, the better you do
Quality management data
= research data
= business data
Every patient encounter is a data point

8. NACOR: the National Anesthesia Clinical Outcomes Registry
Participation at the practice level
Every case, every day
All available data
Feedback via online reporting
Regulatory compliance
PQRS
OPPE, FPPE
The goal: Local Quality Improvement

9. NACOR – September, 2013
Practices under contract: 300 Facilities: 2,100 Providers: 21,000 Cases: 13,000,000 Outcomes: 2,000,000

10. Outcomes
Mortality: %
Major: %
Minor: %
11/18/2018

11. 11/18/2018

12. Anesthesia Measures Approved for public reporting: Antibiotic timing
Central line bundle
PACU normothermia
Smoking cessation
PONV prophylaxis
PACU and ICU hand-offs
Aspirin for stent patients
Registry participation
11/18/2018

13. Brown M&Ms

14. Where do we need to be?

15. The Perfect Quality Measure
A real outcome
Demonstrates variability
Easy to collect
Easy to risk adjust
Easy to report
Acceptable to the public (government)
Acceptable to the profession

16. Mortality
Easy to define Easy to count Should be a good way to define effectiveness … …right?

17. Anesthesia Mortality Estimates
Mortality in elective outpatient surgery:
7.8/million in ASCs (92/million in offices)
(Vila et al. Arch Surg 2003)
Mortality within 30 days of admission:
4/hundred at the Shock Trauma Center
(Dutton et al. J Trauma 2010)

18. Public Reporting

19. Too Rare to be Effective?
The average anesthesia provider might see 1 perioperative death per year …
… but …
Up to 4% of patients will die within 30 days of major surgery

20. Do We Contribute to Mortality?
Stress and inflammation
Fluid management
Ventilator strategy
Post-op analgesia
Antibiotics
DVT prophylaxis

21. Shared Accountability
Team-based measures of real outcomes
“Owned” in equal parts by surgery, anesthesia and nursing
Collected, reported and benchmarked at the facility level
Used by all for accreditation and regulation

22. The Rate of Successful Anesthesia
Denominator: All patients scheduled for surgery at 0600 on a given day Numerator: The number of those patients who complete the scheduled surgery without a serious adverse event

23. Serious Adverse Events
Mortality
Organ system failure
Respiratory
Cardiac
Renal
Neurologic injury
Cognitive
Peripheral
Wrong surgery
Cardiac or respiratory arrest
Anaphylaxis
Malignant hyperthermia
Difficult airway
Medication error

24. Serious Administrative Events
Unplanned admission
Unplanned ICU
Late case cancellation
Late start
Intra-op delay
Slow emergence
Delayed departure from PACU

25. Helping Anesthesia Professionals Improve Patient Care

26. Helping Anesthesia Professionals Improve Patient Care

27. PONV Countable, although definitions vary
Common, assessable at the provider level
Improvable
Empiric evidence
Scientific literature
But does it matter?
No durable harm, but …
Important to patient satisfaction
11/18/2018

28. Patient Satisfaction? Considered an important outcome measure
Required for facilities
CAHPS
S-CAHPS
CAHPS HOSD/ASC
Will be required for physicians
Limited data in anesthesiology

29. How do we get there?

30. At the Personal Level Find something meaningful to measure!
Insist on seeing the data
Follow trends over time
Share your data upwards
Look for peer group benchmarks

31. At the Practice Level
Measure those things that matter to your patients and facilities
Seek common definitions
Work with vendors
Work with registries
Share the data upwards
Seek external benchmarks

32. At the National Level
Learn – by looking – what anesthesiologists consider important
Encourage common definitions
AQI website:
Defcon
Aggregate data, learn what works
Advocate for the profession

33. www.aqihq.org r.dutton@asahq.org
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