Outcomes reported by the vascular quality initiative and the national surgical quality improvement program are not comparable Invited commentary

摘要

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.