An Economic Evaluation of the National Surgical Quality Improvement Program (NSQIP) in Alberta, Canada.

OBJECTIVE: The aim of this study was to analyze the health care costs and savings associated with quality improvement (QI) interventions initiated and implemented utilizing NSQIP. BACKGROUND: Five acute care facilities of Alberta Health Services (AHS) adopted NSQIP in 2015 for a pilot project. METHODS: The cost-savings of NSQIP were estimated from the start of NSQIP to the end of 2017 under an AHS perspective using this formula: Gross cost-savings = N * (p1 - p2) * unit cost, where N was the number of surgical patients after the intervention, p1 was the probability of event occurrence (within 30 days of surgery) before the intervention, p2 was the probability of event occurrence after the intervention, and unit cost is health care cost per event. To calculate the net cost-savings, we deducted the costs of NSQIP and its interventions from the gross cost-savings. RESULTS: The QI initiatives initiated by NSQIP to reduce surgical events had significant impacts clinically and economically. The gross cost-savings of NSQIP were estimated at $11.4 million. Subtracting the costs of NSQIP and its interventions ($2.6 million) from the gross cost-savings, the net cost-savings were $8.8 million. The return on investment ratio was 4.3, meaning that every $1.00 invested in NSQIP would bring $4.30 in returns. The sensitivity analysis showed the probability for NSQIP to be cost-saving was 95%. CONCLUSION: QI interventions initiated and implemented utilizing NSQIP appear to be effective and cost-saving for AHS. These cost-savings would be even larger if NSQIP was prolonged in the pilot sites and/or expanded to other sites across the province.

Predicting Enrollment in Multidisciplinary Clinical Care for Pediatric Weight Management.

OBJECTIVES: To characterize the children who were referred, determine the proportion of referred children who enrolled, and examine factors associated with enrollment in multidisciplinary clinical care for pediatric weight management. STUDY DESIGN: This cross-sectional study included the population of children (2-17 years of age; body mass index of ≥85th percentile) referred to 1 of 3 hospital-based multidisciplinary weight management clinics in Alberta, Canada, from April 2013 to April 2016. Referral and enrollment data were obtained from Alberta Health Services databases. Bivariate and multivariable logistic regression models were used to determine the independent and combined effects of predictors of enrollment. RESULTS: Of the 2014 children (51.8% male; mean body mass index z-score: 3.42 ± 0.03) referred to multidisciplinary clinical care, 757 (37.6%) enrolled in care. Most referred children had severe obesity and were referred by physicians. Several factors independently predicted enrollment; however, in our most parsimonious multivariable model, only the time gap (OR, 0.94; 95% CI, 0.88-0.99; P = .03) between the attendance date of the orientation session and the booking date of initial appointment predicted enrollment for all children. Body mass index z-score (OR, 0.81; 95% CI, 0.67-0.98; P = .03) and time gap (OR, 0.92; 95% CI, 0.85-0.99; P = .02) predicted enrollment in children with severe obesity exclusively. CONCLUSIONS: Fewer than 40% of referred children enrolled in multidisciplinary clinical care. Reducing the duration of enrollment and providing additional support for treatment initiation to children with severe obesity may enhance treatment uptake for pediatric weight management.