Chuck Bednar for redOrbit.com – Your Universe Online
A program designed to give hospitals report cards on the quality of their overall performance is doing little to improve the quality of surgery at medical centers, according to research published online Tuesday in the Journal of the American Medical Center (JAMA).
The report cards, which are part of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) initiative, are designed to let hospitals known which areas of their day-to-day operations need to be improved. However, in the new study, experts from the University of Michigan said that they have done little to make things better for patients.
The study found no difference in surgical safety among 263 hospitals participating in the ACS-NSQIP program and 526 similar hospitals that were not involved. Data from over 1.2 million seniors who were enrolled in Medicare and who had one of 11 major operations at those centers over the past decade were analyzed during the course of the study.
Even as adults, we apparently still don’t like report cards
Preparation of those report cards involves careful analysis of every operation conducted at the hospitals. That information is then sent to a secure central database, where it is then reviewed by the ACS and shared with medical centers and doctors so they can see how their performance compares to other hospitals and surgeons.
However, the authors of the new study found that this quality reporting alone has not been adequate to speed-up the pace of improvement in surgical safety, nor has it helped lower the cost of such procedures. While they insist they are not suggesting that the report card initiative should be halted, they believe that the data needs to be put to better use.
“Although ACS-NSQIP hospitals are improving over time, so are other non-participating hospitals,” said lead author Dr. Nicholas Osborne, a vascular surgeon at the UM Health System’s Frankel Cardiovascular Center. “Our study suggests that the ACS-NSQIP is a good start, but that reporting data back to hospitals is not enough. The ‘drilling down’ that is needed to improve quality using these reports is better suited for regional collaboratives.”
Dr. Osborne explained that this analysis is the first to use a control group of hospitals in order to gauge the impact of participation in the ACS-NSQIP program, and that each participating center was matched with two control facilities. Patients treated at both types of hospitals were generally similar, though the ACS-NSQIP hospitals were larger and performed operations.
Eleven different types of operations were analyzed: esophagectomy, pancreatic resection, colon resection, gastrectomy, liver resection, ventral hernia repair, cholecystectomy, appendectomy, abdominal aortic aneurysm repair, lower extremity bypass, and carotid endarterectomy.
Ok, but…why isn’t this system working??
The lack of benefit from participating in the report card program could be due to several different factors, the researchers said. The hospitals may not have used the information to improve care; they may lack the infrastructure needed to develop effective improvement strategies; or their efforts may not have had an impact on the four items evaluated by the study.
“Knowing where you perform poorly is the important first step, but the next leap from measuring outcomes to improving outcomes is much more difficult,” Dr. Osborne said.
“Better approaches for engaging surgeons, better systems for supporting them in change efforts, and better tools for helping them re-engineer care are clearly needed,” added senior author Justin Dimick. “Future national and regional quality improvement initiatives must be aimed at not only providing feedback to participants, but also providing an infrastructure for implementing change.”
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