Table 1 Overview of ISQ-R study aims and methods

1 Evaluate contribution of patient, procedure, postoperative and systems factors following major surgery (with minimum 2-day stay) to develop and validate a readmission risk prediction model.

Classify reasons for readmissions and related processes of care.

Acquire and merge retrospective data from the VA Surgical Quality Improvement Program for all assessed surgeries between October 1, 2007 and September 30, 2014

Investigate predictors of 30-day unplanned readmission following surgery using logistic regression

Develop a risk prediction tool for 30-day unplanned readmission following surgery

Determine readmission reason categories from primary ICD9 diagnosis codes

Report findings to National Surgery Office Advisory Board

2 Assess potential patient factors not currently collected by VASQIP for association with readmission

Develop and pilot a prospective survey to assess patient psychosocial factors at discharge

Recruit 800 surgical patients from four (4) VA sites distributed across the nation

Administer prospective survey prior to discharge and follow patients for 30 days post-discharge to assess readmission

Assess the association between psychosocial factors not currently assessed in administrative data and 30-day unplanned readmission in the prospective cohort

Further explore predictors of 30-day unplanned readmission following surgery using psychosocial factors

3 Rank reasons for readmission based on Aim 1 and Aim 2 and assess for potential preventability and appropriateness for classification as a measure of surgical quality.

Develop Delphi process form using readmission reasons defined in Aim 1

Convene Delphi panel participants

Rank readmission reasons as (1) potentially preventable and (2) appropriate measures of surgical quality

Report findings to National Surgery Office Advisory Board