The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) started in the Veterans Affairs (VA) health care system when the US Congress mandated that the VA improve the surgical care provided at its facilities. To those charged with this task, it was evident that not all VA hospitals provided care to the same mix of patient acuity. To be able to fairly compare hospitals, they developed and validated statistical methods to risk-adjust outcomes, based on preoperative risk factors. By 1991, this program became operational in the VA system. As data were gathered on the performance of individual hospitals, this information was then confidentially reported to the individual VA hospitals in hopes that they would use it to improve quality. In 2001, the ACS received a grant to assess whether this program could be used in the non-VA facilities with a test of voluntary pilot hospitals. This proved to be feasible, and in 2004, the program was expanded to include any private and public (non-VA) hospital. As of June 2016, 767 hospitals now participate in ACS-NSQIP.
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