Study Finds ‘Report Cards' Don't Affect Surgical Outcomes
By Christine Kern, contributing writer
New research examines the relationship between hospital quality ratings and surgical outcomes.
Researchers from the University of Michigan Medical School have published findings in JAMA demonstrating tracking quality had no impact on surgical safety. The study, Association of Hospital Participation in a Quality Reporting Program With Surgical Outcomes and Expenditures for Medicare Beneficiaries, set out to evaluate the association of participation in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) with outcomes and Medicare payments as compared with control hospitals that did not participate in the program.
As part of the ACS NSQIP initiative, a trained Surgical Clinical Reviewer at participating hospitals record preoperative to 30-day postoperative data about every operation carefully, and send it to a secure central database. The ACS crunches the data from all ACS-NSQIP hospitals and shares quality reports, allowing hospitals and doctors see how their overall performance stacks up against others.
The study authors assert, however quality reporting alone is not enough to accelerate the pace of improvement in surgical safety or cost savings. The research demonstrated that, “after accounting for patient factors and preexisting time trends toward improved outcomes, there were no statistically significant improvement in outcomes at 1, 2, or 3 years after (vs before) enrollment in ACS NSQOP.”
This has led the study authors to conclude enrollment in a national quality reporting program – the act of issuing quality “report cards” – had no associated correlation to improved outcomes or lower Medicare payments among surgical patients.
However, that does not mean that the review data is irrelevant. Hospitals need to better employ the ACS-NSQIP data and collaborate with other hospitals in their region to develop and share “best practices” that lead to improvements across hospitals. Collaboration has become a central emphasis of ACS, and organizations such as the Michigan Surgical Quality Collaborative.”
“Although ACS-NSQIP hospitals are improving over time, so are other non-participating hospitals,” says Dr. Nicholas Osborne, the study’s lead author and a vascular surgeon at the U-M 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.
“Knowing where you perform poorly is the important first step. But the next leap from measuring outcomes to improving outcomes is much more difficult.”
“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. 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,” explained senior author Dr. Justin Dimick.