As the result of a congressional mandate, the Veterans Health Administration (VA) undertook an initiative called the National VA Surgical Risk study. The purpose of this study was to collect information on its surgical patients to determine outcome data, adjusted for patient risk factors. In 1994, the VA started its National Surgical Quality Improvement Program (VASQIP). These efforts were one of the earliest well-done nationwide systems to study and improve outcomes in surgery adjusted for patient risk. Between 1991 and 2006, the VA hospitals observed a decrease of mortality of 47% and a decrease of morbidity of 43% of their patients in the first 30 days after an operation.