If you are an older person having a major operation, it is very likely that your hospital will receive a “report card” on their performance. These reports are designed to prompt hospitals to improve in areas where they perform poorly. That is the good news. The not-so-good news: Those “report cards” do not seem to be making things better for patients.
A new study published in JAMA by a team from the University of Michigan Medical School shows no difference in surgical safety between 263 hospitals taking part in a major national quality effort and 526 similar hospitals that were not involved. The study analyzed data from 1,226,000 seniors enrolled in Medicare who had one of 11 major operations at those hospitals over a 10-year time frame.
The initiative, called the American College of Surgeons National Surgical Quality Improvement Program, or ACS-NSQIP, has been in effect since the early 2000s. Trained nurses at participating hospitals carefully record data about every operation and send it to a secure central database. The ACS analyzes the data from all ACS-NSQIP hospitals and shares quality reports, allowing hospitals and doctors see how their overall performance measures up against others.
But this quality reporting, the authors find, is not enough to accelerate the pace of improvement in surgical safety – or cost savings. However, the report does not mean efforts should stop or are not worthwhile. It does point to the need for better efforts to ensure hospitals use the ACS-NSQIP data and work with other hospitals in their region to develop and share “best practices” that lead to improvements across hospitals. The ACS, and other large health care quality organizations such as the Michigan Surgical Quality Collaborative, have recently begun to emphasize the importance of collaboration.
“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,” said senior author Dr. Justin Dimick, the Henry King Ransom Associate Professor of Surgery in the University of Michigan Hospital System. “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,” added Dr. Dimick, who also holds a cross-appointment at the School of Public Health.
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