title: Relationship of processes and structures of care in general surgery to postoperative outcomes: a descriptive analysis.
abstract: BACKGROUND
  The systematic collection of quantitative data on structures and processes from surgical services participating in the National Surgical Quality Improvement Program (NSQIP) has not been a focus to date. Efficient collection of useful measures of structures and processes may improve understanding of surgical outcomes and strategies for improving the quality of surgical care, as NSQIP continues to expand. The purpose of this article was to describe results of a quantitative survey designed to measure surgical care structures and processes within NSQIP sites.
  
  
  METHODS
  A cross-sectional survey was mailed to 123 Department of Veteran Affairs (VA) and 14 private sector sites participating in the Agency for Healthcare Research and Quality (AHRQ)-funded Patient Safety in Surgery (PSS) Study. The survey included questions about organizational structures and processes of preoperative, intraoperative, and postoperative general surgical care services. For this study, we included only data from 90 VA sites that returned a survey (73% response rate). We used descriptive statistics and examined the bivariate association of structures and processes items or scales with risk-adjusted observed-to-expected (O/E) ratios of surgical morbidity and mortality.
  
  
  RESULTS
  Examination of frequency or means and standard deviations of items and scales revealed substantial variation in the structures and processes of surgical care services in participating VA sites, with correlation analyses demonstrating that, of 35 process and structure variables, there was a statistically significant relationship with the hospital's observed-to-expected ratio for 14 variables for morbidity, but only 4 variables for mortality.
  
  
  CONCLUSIONS
  This descriptive analysis provides support for the potential importance of measuring organizational structures and processes of care in addition to risk-adjusted morbidity and mortality.
authors.affiliation: Colorado Health Outcomes Program, Aurora, CO 80045-0508, USA. debbi.main@uchsc.edu
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Main
authors.forename: William G
authors.initials: WG
authors.lastname: Henderson
authors.forename: Katherine
authors.initials: K
authors.lastname: Pratte
authors.forename: Tia A
authors.initials: TA
authors.lastname: Cavender
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Schifftner
authors.forename: Anne
authors.initials: A
authors.lastname: Kinney
authors.forename: Tamara
authors.initials: T
authors.lastname: Stoner
authors.forename: John F
authors.initials: JF
authors.lastname: Steiner
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Fink
authors.forename: Shukri F
authors.initials: SF
authors.lastname: Khuri
mesh_terms: D003430:Cross-Sectional Studies; D003625:Data Collection; D006787:Hospitals, Veterans; D006801:Humans; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D017149:Private Sector; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care; D012449:Safety; D013514:Surgical Procedures, Operative / Q000401:mortality / Q000592:standards; D016896:Treatment Outcome; D014481:United States