Lack of Engagement in Surgical Quality Improvement Research Is Associated with Poorer Quality of Care

Vol. 221, No. 4S1, October 2015

Lack of Engagement in Surgical Quality Improvement Research Is Associated with Poorer Quality of Care Ben E Byrne, MB, BChir, Paul Aylin, Alex Bottle, PhD, Omar Faiz, Ara W Darzi, MB, BCh, FACS(Hon), Charles A Vincent, PhD Imperial College London, London, UK; St. Mark’s Hospital, London, UK; University of Oxford, Oxford, UK INTRODUCTION: Existing research suggests attendings who engage in national specialty-specific audits have better outcomes than those who do not. This study used public data to assess for differences between units that did or did not participate in a recent interview study. METHODS: Risk-adjusted length of stay after elective colonic surgery was determined for all English National Health Service hospitals between January 2011 and December 2012. Units with high or low outlying length of stay were selected for interview. Public data were collected for selected units, covering a range of structures, processes, and outcomes, including number of medical staff per bed; rate of incident reporting per 100 hospital admissions; health care-acquired infection rates; and patient and staff surveys. Participant and non-participant groups were compared using the independent samples Mann-Whitney U test. RESULTS: Fewer long length-of-stay units participated in interviews (10/10 units with short vs 5/12 units with long length of stay, p¼0.005). Of 56 items compared between participants and nonparticipants, 9 were significantly different at p<0.10. In each case, the difference suggested superior performance among participating hospitals, which had lower rates of Clostridium difficile infections; lower rates of cancellation of elective operations; fewer staff reporting workrelated stress; and higher patient survey ratings of doctors and nurses.

Scientific Forum Abstracts

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Healthcare Cost and Utilization Project State Inpatient Database, and from 2002 to 2011 in the Nationwide Inpatient Sample (NIS), were compared. Medicare patients were excluded. Pre-reform was defined as hospital discharge from 2002 through the second quarter of 2006 and post-reform from the third quarter of 2006 through 2012. Unadjusted categorical variables were compared by chi-square. Piecewise functions were used to test the effect of health care reform on the rate of emergent operations. RESULTS: Unadjusted rate of emergent colectomies was lower in MA after reform but did not change nationally over the same time period (Table). For emergent operations in MA, a piecewise model with an inflection point (peak) in the third quarter of 2006, coinciding with implementation of health care reform in MA, had a lower mean squared error than a linear model. In comparison, the US rate of emergent procedures demonstrated no change in pattern. NIS pre-MA reform (n¼91,152)

NIS post-MA reform (n¼137,594)

Variable

MA pre-reform (n¼2,284)

MA post-reform (n¼3,805)

Male

1,230 (53.9)

1,983 (52.1)

47,315 (51.7)

72,509 (52.7)

861 (37.7)

1,248(32.8)

35,189 (38.4)

48,814 (35.5)

1,028 (45.0)

1,926 (50.6)

40,667 (44.4)

65,989 (48.0)

395 (17.3)

631(16.6)

15,695 (17.1)

22,791 (16.6)

1,492 (65.3)

2,555 (67.2)

38,161 (41.7)

66,180 (48.1)

746 (35.7)

1,156 (30.4)

29,016 (31.7)

50,256 (36.5)

1,412 (61.8)

3,323(37.3)

55,166 (60.3)

82,345 (59.8)

Elikhauser Score 2

820 (35.9)

1,775 (46.7)

36,421 (39.7)

73,510 (53.4)

Emergent/ urgent

1,223 (53.6)

1,799 (47.3)

50,985 (55.7)

73,454 (53.4)

Age <45 y Age 45-49 y Age 60 y Non-Hispanic white Non-white Medicaid

Data are reported as n (%).

CONCLUSIONS: Failure to engage in quality improvement research may be a marker of poor performance. Future research should explore this lack of engagement and identify strategies for overcoming barriers to participation. Organizations with poor performance may benefit the most from quality improvement research. Massachusetts Health Care Reform and Trends in Emergent Colorectal Surgery Miriam Eskander, MD, Lindsay A Bliss, MD, MPH, Ellen P McCarthy, PhD, MPH, Susanna WL de Geus, Sing Chau Ng, James R Rodrigue, PhD, Jennifer F Tseng, MD, MPH, FACS Beth Israel Deaconess Medical Center, Boston, MA INTRODUCTION: Insurance affects access to therapeutic options, yet little is known about how health care reform might change the pattern of surgical admissions. We compared rates of emergent vs elective admissions for colectomy before and after reform in Massachusetts (MA). METHODS: Patients 18 to 64 years old with public or no insurance, who underwent emergent vs elective inpatient colectomy (via ICD-9 procedural code) from 2002 to 2012 in the MA

CONCLUSIONS: There was a unique and sustained decline in the rate of emergent colon resection among publically insured and uninsured patients after 2006 in MA, in contradistinction to the US national pattern, suggesting improved access to care associated with health insurance expansion. Minority-Serving Hospitals and Cancer Surgery Readmissions: A Reason for Concern Young K Hong, MD, Chaoyi Zheng, Russell C Langan, MD, Elizabeth M Hechenbleikner, MD, Erin C Hall, MD, MPH, Lynt B Johnson, MD, MBA, FACS, Nawar M Shara, PhD, Waddah B Al-Refaie, MB, BCh, FACS Medstar Georgetown University Hospital, Washington, DC INTRODUCTION: Minority-serving hospitals (MSH) are at risk for financial penalty for readmissions, especially given that the current Medicare Hospital Readmissions Reduction Program (HRRP) design does not account for social determinants. To date, little is known about readmission trends after major cancer surgery at MSH. To address this priority issue, we described and quantified