Raising The Standard: MBSAQIP: The Evolution of 100 Years of Quality Programs

By Anthony T. Petrick, MD, FACS, FASMBS, and Dominick Gadaleta, MD, FACS, FASMBS

This column is dedicated to highlighting a broad range of quality issues in bariatric surgery.

Funding: No funding was provided for this article.

Disclosures: The authors report no conflicts of interest relevant to the content of this article.

Bariatric Times. 2018;15(8):8–9.

“A physician is obligated to consider more than a diseased organ, more even than the whole man – he must view the man in his world.” —Harvey Cushing

Most of our readers are familiar with the American Society for Metabolic and Bariatric Surgery (ASMBS) and American College of Surgeons (ACS) Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), which accredits over 800 bariatric surgery centers in North America; however, readers might be less familiar with the history of the ACS and its dedication to quality in surgery. This month, we provide an overview of ACS quality programs.

The ACS was founded in 1913. Cushing’s words prophesized the current evolution of ACS quality programs toward a continuum of care rather than focusing solely on a surgical procedure. The ACS Hospital Standards Committee was formed in 1951 and evolved into the current Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in 1987. The current pillar of the ACS Quality programs is the National Surgical Quality Improvement Program (NSQIP®) This validated, risk-adjusted, outcomes-based program measures the quality of surgical care across most surgical specialties. The program uses trained, nurse clinical reviewers for 30-day outcomes data collection. ACS NSQIP is not a standards-based accreditation program. It collects only a sampling of a hospital’s cases; however, data reports are both case mix and risk adjusted. Studies have shown that ACS NSQIP effectively improves the quality of surgical care while reducing complications and costs.[1,2] Surgeons and patients also have access to the ACS Surgical Risk Calculator, a current procedural terminology (CPT)-based tool provided by the ACS that calculates an estimate of surgical risk based on patient demographics (http://riskcalculator.Facs.org/RiskCalculator/).

The most recent ACS quality initiative is the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Surgical Care and Recovery (ISCR).[3] ISCR incorporates the preoperative principles (e.g., nutrition, glycemic control, medication management, smoking cessation) of Strong for Surgery, an ACS quality program adopted from the University of Washington in 2016. Participating ISCR hospitals use expertise from surgical, anesthesia, and nursing leaders in enhanced recovery to implement perioperative evidence-based pathways. The goal is to enroll at least 750 hospitals throughout the five-year contract. Care pathways have been launched for colorectal, orthopedic, and gynecologic surgery with bariatric and emergency general surgery planned in the next year.

The ACS began accrediting surgical programs in the United States in 1930 with the Commission on Cancer (CoC), which recognizes cancer care programs that are voluntarily accountable to CoC standards. Programs have access to reporting tools for benchmarking and patient outcomes. The ACS maintains a National Accreditation Program for Breast Centers (NAPBC), which is dedicated to quality improvement through voluntary, evidence-based standards, and also promotes quality in cancer care through the American Joint Committee on Cancer (AJCC) and The National Cancer Database (NCDB) in collaboration with the American Cancer Society. CoC-accredited cancer programs are required to review their data at least quarterly.[4]

The ACS began verifying trauma programs in 1987. The Trauma Quality Improvement Program (ACS TQIP®) has verified more than 775 centers across the United States. Participating TQIP centers enter data from all patients and receive risk-adjusted benchmarking that can be used to implement quality improvement.[5]

MBSAQIP represents a collaboration between the ACS and the ASMBS. Founded in 1983, ASMBS released accreditation standards for Bariatric Surgery Centers of Excellence (BSCOE) in 2004. In 2005, the ACS released their first Bariatric Surgery Center Network (ACS BSCN) accreditation standards, creating two separate but similar accrediting bodies for bariatric surgery. By 2006, both programs had developed data registries and major payers endorsed bariatric surgery at accredited centers.

MBSAQIP represents the most comprehensive ACS quality program with mandatory accreditation standards, data reporting, and quality improvement requirements. It was created in 2012 when the ACS signed a memorandum of understanding with the ASMBS to merge their programs. MBSAQIP standards were published in 2014 and updated in 2016.[6] The program is administered by the staff of the ACS with two sub-committees. The Accreditation and Standards Committee is currently developing version 3.0 of the standards. The Data and Quality Committee has now completed two national quality improvement projects—Decreasing Readmissions and Opportunities (DROP)[7] and Employing New Enhanced Recovery Goals for Bariatric Surgery (ENERGY).[8]

With over 100 years of experience in surgical quality, the ACS partnership with the ASMBS has created one of the most successful quality programs in American surgery. The adoption of accreditation standards has led to nearly a 10-fold decrease in bariatric surgical mortality, most markedly in higher-risk patients.[9,10]

References

1. Dimick, JB, Chen, SL, Taheri PA, et al. Hospital costs associated with surgical complications: a report from the private-sector National Surgical Quality Improvement Program. J Am Coll Surg. 2004;199(4):531–537.
2. Rowell KS, Turrentine FE, Hutter MM, Khuri SF, Henderson WG. Use of national surgical quality improvement program data as a catalyst for quality improvement. J Am Coll Surg. 2007;204(6):1293–1300.
3. American College of Surgeons. AHRQ Safety Program for Improving Surgical Care and Recovery. https://www.facs.org/quality-programs/iscr Accessed 7/27/18.
4. American College of Surgeons. Overview of cancer programs. https://www.facs.org/quality-programs/cancer/quality Accessed 7/27/18.
5. American College of Surgeons. Trauma. https://www.facs.org/qualityprograms/ trauma/tqip Accessed 7/27/18.
6. American College of Surgeons/ American Society for Metabolic and Bariatric Surgery. Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Standards Manual version 2.0: Resources for optimal care of the matabolic and bariatric surgery patient 2016. https://www.facs.org/~/media/files/quality%20programs/bariatric/mbsaqip%20standardsmanual.ashx Accessed 8/4/18.
7. Morton JM. The first metabolic and bariatric surgery accreditation and quality improvement program quality initiative: Decreasing readmissions through opportunities provided. Surg Obes Relat Dis. 2014;10(3):377–378.
8. Brethauer S. Building successful MBSAQIP collaboratives: lessons learned from experienced collaborative leaders. Presented at American College of Surgeons Quality and Safety Conference; 22 July 2018; Chicago, Illinois.
9. Flum DR, Salem L, Elrod JA, et al. Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures. JAMA. 2005;294:1903–1908.
10. Morton JM, Garg T, Nguyen N. Does hospital accreditation impact bariatric surgery safety? Ann Surg. 2014;260(3):504–508; discussion 508–509.

Tags: MBSAQIP, raising the standard

Category: Past Articles, Raising the Standard