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The National Anesthesia Clinical Outcomes Registry (NACOR)
The NACOR is a data ‘warehouse’ that will eventually capture the 25 million anesthetics (a very rough estimate) and millions of pain clinic procedures performed each year by anesthesiologists in the United States. Creation of the NACOR will require close collaboration between the AQI, individual providers, and the industry partners that link us together. Roles will be as follows:
- The AQI will define data and outcomes that the NACOR collects (with the assistance of various ASA Committees), will provide unifying definitions and templates, will contract with individual practices and hospitals to exchange data, and will be responsible for analyzing and reporting the data collected.
- Individual anesthesia practices, hospitals, and providers will provide data to NACOR in exchange for AQI verification of their participation in ABA, Joint Commission, and State and Federally mandated performance improvement efforts, and for benchmarking their practice and outcomes nationally.
- Vendors of anesthesia billing software and Anesthesia Information Management Systems will facilitate NACOR reporting through their work with individual practices. Vendors that can provide formatted data for contribution to NACOR will be endorsed and recommended by the AQI.
Data captured will fall into four categories:
- Practice demographics – describing the anesthesia group (age, training, certifications, subspecialties) and the environment (hospital size, inpatient/outpatient mix). This information will be collected once, and then periodically updated.
- Case specific data in several tiers: simple (e.g. CPT code, anesthesia type, provider code, patient age); moderate (e.g. duration of surgery, agents used); and complex (e.g. output from AIMS with vital signs, fluids, drug doses).
- Outcome data: Basic (e.g. intra-op cancellation, mortality, major morbidities) and extended (e.g. infections, prolonged length of stay, late events). The basis for recognized outcomes of interest will be the ASA Committee on Performance and Outcomes Measurement (CPOM) definitions. Information will come from Anesthesiology Department data or from linkage to surgical databases that capture long term patient outcome.
- Risk Adjustment data: ICD-9 diagnostic codes, pre-op medication use, defined comorbidities, hospital length of stay, etc. Much of this data will come from the hospital or healthcare facility’s systems.
NACOR will evolve over time under pressure of provider needs, experience and regulatory requirements. The definition of existing data elements will sharpen, and new elements will be introduced for business or research purposes.
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