Back to list of SPOTLIGHTS

VA Surgical Improvement Program Still Enhancing U.S. Health Care


Michael Kussman, MD
Under Secretary for
Health Veterans Health Administration

"NSQIP is an excellent example of how VA uses its size and organizational structure to drive improvements in health care that benefit the entire nation."

As the largest integrated health care system in the country, the Veterans Health Administration has substantial impact on the care of veterans and all Americans. A prime example of that is the National Surgical Quality Improvement Program (NSQIP), started by VA more than 15 years ago and now a growing force in private-sector health care as well.

VA created NSQIP in 1991 to provide a risk-adjusted model for assessing outcomes of major non-cardiac surgical cases across the health care system. This enabled VA to standardize review of surgical programs and take patients’ severity of illness into account in determining post-operative morbidity and mortality rates.

More importantly, NSQIP has helped VA to enhance patient care, because aggregating data by computer has made it easier to identify areas for improvement. Since the program began, post-operative mortality has declined from 3.2 percent to 1.7 percent. The percentage of morbidity in post-operative care was 18 percent in the early phase of the program, but now ranges between 9.3 and 10 percent each year.

A recent article in the on-line magazine Forbes.com cited NSQIP as on of the three waves of reform that have made VA health care a model system, noting that many non-VA hospitals now use it. Beginning in 2001, the American College of Surgeons worked with VA to expand NSQIP into the private sector. The Joint Commission on the Accreditation of Healthcare Organizations reported in April that 141 private hospitals in 37 states and Canada are enrolled in NSQIP.

VA believes it is our obligation to pursue innovation in health care and to share our experience and expertise with other providers. By doing so, we help ensure that veterans, and all Americans, receive the best health care available anywhere.