Students aren’t the only ones receiving report cards.
Many hospitals earn grades, too. But according to a study by University researchers, surgical safety remains constant across similar hospitals, whether or not the hospital received report cards.
The study’s authors considered the 263 hospitals evaluated by the American College of Surgeons’ National Surgical Quality Improvement Program report card. The group found that the hospitals participating in the evaluation program not experience improvement over time compared to hospitals not receiving report cards.
The study’s lead author, Nicholas Osborne, a vascular surgeon at the University of Michigan Health System’s Cardiovascular Center, said he was interested in finding whether or not there was a benefit to participating in a program such as ACS-NSQIP.
“What you can take from the study is that hospital quality has gone up across the board during the time period that we looked at,” Osborne said. “All hospitals improved but that improvement wasn’t more so in hospitals that are in NSQIP.”
NSQIP was developed by the Department of Veterans Affairs during the 1990s to evaluate surgical practice in VA hospitals. Private hospitals eventually expressed interest in adopting the program, which in 1999 was piloted at several private institutions, including the University.
The study’s authors said the lack of relative improvement could be due to the failure of institution’s to use the report cards to change surgical procedures.
“This is a good example of why we need to look at the data,” Osborne said. “I think the future of quality improvement will be affected by this study because it encourages hospitals to participate in not only a data report, but to participate in a quality collaborative.”
Public hospitals in the state of Michigan previously participated in both ACS-NSQIP and a regional collaborative called the Michigan Surgical Quality Collaborative. In 2012, the state pulled out of ACS-NSQIP, and hospitals its hospitals now only participate in MSQC.
Unlike ACS-NSQIP, MSQC brings together surgeons to analyze the report cards and brainstorm strategies for improving hospital care.
Justin Dimick, chief of the UMHS division of minimally invasive surgery and senior author of the study, said the MSQC allows Michigan hospitals to excel beyond those using ACS-NSQIP, making it one of the safest states to have surgery.
“Michigan does a really nice job at analysis and issuing report cards,” Dimick said. “Without a tutor, or lesson plan, you can’t get improvement. Michigan does things differently through a collaboratively quality improvement program, where we do measure outcomes. We then build on top of that a structure where the surgeons meet four times a year to help implement them locally.”
Andrew Ryan, associate professor in the School of Public Health and co-author of the study, said designing and implementing interventions is most important in the process of improving surgical quality. He added that this study can motivate hospitals to actually implement measures based on their report cards.
“The fact that it didn’t achieve its objective means to me that we need to keep searching and come up with new ways to measure important patient outcomes,” Ryan said. “We can’t be complacent about thinking that we’ve solved our quality problems, and that we have the answers. We have seen decline in adverse events, so improvement is happening, but the question is how do we design and implement interventions that are going to improve quality of care?”