With the role of anesthesia becoming ever more crucial to hospital treatments around the globe, ensuring the quality of the anesthetic treatment itself becomes an issue that all healthcare providers must consider in their practices. The Anesthesia Quality Institute (AQI) plays a large role in that capacity, as it manages the National Anesthesia Clinical Outcomes Registry (NACOR), which monitors anesthesia providers that have registered with the AQI, and provides feedback for improvement based on quality gaps that have been identified through performance results and other types of qualitative and quantitative data.
The NACOR is a registered Qualified Clinical Data Registry (QCDR), a designation given from the Centers for Medicaid and Medicare Services (CMS) that indicates that the database relies on a certain reporting mechanism to submit quality reports from qualified healthcare professionals. In 2008, the American Society of Anesthesiologists (ASA) funded the AQI to begin development of the NACOR, to address the lack of a national perspective and the lack of information on procedures that required anesthetics. The AQI began operations in 2009, and the NACOR was then approved and recognized as a QCDR database in 2014, where it was the first anesthesia registry to receive this recognition from CMS.
The NACOR presents a unique solution to the lack of comprehensive information on anesthesiology. The design of the registry itself was aimed to be adaptable for the evolution of healthcare with the development of technology. While most traditional registries for medical records rely on written reports from professionals in the field, NACOR solely collects data electronically, with information directly from anesthesia providers and other healthcare facilities to its database. This information requires a minimum of at least 20 fields of quality measurements, however, the most comprehensive files in NACOR include thousands of data points—including the patient’s vital signs, medication doses, and procedure notes.
The growth of the NACOR and its diversity in reporting anesthesia groups has been rapid. As of 2014, NACOR represented 2534 facilities, ranging from pain clinics to university hospitals and surgery centers. Approximately 317 different anesthesia groups managed these 2534 facilities, 268 of which provided descriptive information on their practices through the NACOR survey. The NACOR provides for a higher level of communication between the AQI, the individual practices, and those involved in the information technology of anesthesia. With the constant flow of information, the AQI can perform a number of tasks, including contracting “with individual practices and hospitals to exchange data” (1). Similarly, the individual practices can use this reported data to “meet various local, state, and federal regulatory requirements”, as well as increase the overall level of quality of their treatments based on the quality measures structured (1).
The NACOR now contains over 16 million records that provide critical information to healthcare providers all over the nation, including information on various types of procedures from different types of facilities. The AQI now hopes to develop a new model for the NACOR that provides a more universal reporting of data, with even more integration of electronic data and expert designed quality metrics. However, the data that is currently provided still serves as a way for anesthesia providers and facilities to identify and fill any quality gaps in their treatments, providing for a more streamlined and patient care oriented experience.
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