(Press-News.org) ANN ARBOR, Mich. – Michigan hospitals reduced surgical complications by nearly 10 percent at a time when the rest of the nation saw no change in complication rates, according to a new study out next week in the Archives of Surgery.
Complications dropped at hospitals participating in what's called the Michigan Surgical Quality Collaborative, a group of 16 hospitals led by the University of Michigan Health System that agreed to pool data and share information about what keeps patients safe.
The fewer patients suffering ventilator associated pneumonias alone, among the 300,000 surgical patients studied, could save $13 million a year.
The backdrop of President Obama's vision for health care reform is improving quality and reducing costs, two ideas that seem to conflict. But the collaborative strategy could quicken the pace of reaching those goals.
"The collaboration of hospitals in terms of identifying and disseminating information about best practices is actually a much more effective way of improving quality than just relying on each hospital alone to come up with what they think is a way to improve quality," says study author Darrell A. Campbell Jr., M.D., professor of surgery and chief medical officer at the University of Michigan Health System.
"In other words, sharing ideas is important and it's effective," he says.
The backbone of the partnership is support by Blue Cross Blue Shield of Michigan and its Blue Care Network which pays hospitals to participate and covers the cost of the technology needed to evaluate the data.
Hospitals agree to share information, but individual hospital results are not reported to BCBS. It's an arrangement that inspires collaboration beyond competition, Campbell says.
"The approach we've tried is called 'pay for participation,' rather than 'pay for performance,' " he says. "'Pay for participation' means that a hospital receives money from Blue Cross Blue Shield simply for participating, it doesn't depend on the results that they get.
"We think this fosters a less competitive atmosphere," Campbell says. "They're willing to share their best ideas and that's what makes the collaborative work."
The study examined general and vascular surgeries, those scheduled and ones done in emergency, performed between 2005 and 2007. The greatest improvements were seen in reducing blood infections, septic shock, prolonged ventilator use and cardiac arrest. Death rates remained the same.
Still, "surgical complications are very expensive," Campbell says. "Once something bad happens following surgery, it takes a lot of resources for the patient to recover."
A preventable surgical complication can add weeks to a hospital stay and thousands in added costs. For example, contracting pneumonia from prolonged ventilator use following a surgical procedure can add $50,000 to a hospital bill.
Given the high cost of surgical complications, authors estimate that it would take only a 1.8 percent reduction in complications a year for three years to offset the cost of supporting the pay for participation program.
"If this system was adopted nationally, not just in Michigan, I think you would find a greatly accelerated pace of surgical quality improvement," Campbell says.
Inspired by the Michigan group, surgeons in Tennessee and upper New York have launched collaboratives. Similar ones are in the works in Pennsylvania, Virginia and Illinois.
###
Additional authors: Michael J. Englesbe, M.D., U-M Department of Surgery; James J. Kubus, M.S., U-M Department of Surgery, Laurel R.S. Phillips, R.N., M.S.N., U-M Department of Surgery; Charles J. Shanley, M.D., William Beaumont Hospital; Vic Velanovich, M.D., Henry Ford Health System; Larry R. Lloyd, M.D., St. John Hospital Medical Center; Max C. Hutton, M.D., Allegiance Health; Wallace A. Arneson, M.D., St. Joseph Mercy Health System; Thomas L. Simmer, M.D., Blue Cross Blue Shield of Michigan; and David A. Share, M.D., M.P.H., U-M Department of Family Medicine.
Reference: "Accelerating the pace of surgical quality improvement: The power of hospital collaboration," Archives of Surgery, Oct. 18, 2010.
Funding: Blue Cross Blue Shield of Michigan, Blue Care Network, and Englesbe's work was supported by the American Surgical Association Foundation.
Resources
Michigan Surgical Quality Collaborative
https://www.msqc.org/Public/index.aspx
U-M Department of Surgery
http://surgery.med.umich.edu/portal/
Written by Shantell M. Kirkendoll
Bethesda, Maryland (October 14, 2010) – Many of the world's preeminent gastroenterologists will gather for the American College of Gastroenterology's (ACG) 75th Annual Scientific Meeting at the Henry B. Gonzalez Convention Center in San Antonio, Texas starting Monday October 18, 2010, to review the latest scientific advances in gastrointestinal research, treatment of digestive diseases and clinical practice management.
Innovative technologies for the diagnosis and treatment of digestive diseases; insights into digestive health conditions, their causes and how they impact ...
ROCHESTER, Minn. -- A group of Mayo Clinic (http://www.mayoclinic.org/about/) researchers conducted the first controlled trial of swallowed fluticasone nasal spray (also known as Flonase) on people with the allergic esophageal condition called eosinophilic esophagitis (http://www.mayoclinic.org/eosinophilic-esophagitis/). Research showed that the aerosolized swallowed allergy drug helped treat the cause of the throat condition, but symptoms lingered. The researchers' findings were presented today at the Annual Scientific Meeting of the American College of Gastroenterology ...
Breast cancers can be divided into different subtypes based on several criteria, including whether or not they express the protein to which the female hormone estrogen binds; that is, the estrogen receptor (ER). Patients with ER-negative breast tumors have a worse outlook than those with ER-positive breast tumors. However, even among ER-negative breast tumors, those characterized as basal-like are the most aggressive and difficult to treat. New therapeutic targets for this subtype of breast cancer are urgently needed. Now, a team of researchers, led by Stefan Ambs, at the ...
EDITOR'S PICK: The protein NOS2 isn't good for ER-negative breast cancer patients
Breast cancers can be divided into different subtypes based on several criteria, including whether or not they express the protein to which the female hormone estrogen binds; that is, the estrogen receptor (ER). Patients with ER-negative breast tumors have a worse outlook than those with ER-positive breast tumors. However, even among ER-negative breast tumors, those characterized as basal-like are the most aggressive and difficult to treat. New therapeutic targets for this subtype of breast ...
Information available on a government Web site designed to help patients choose high-quality hospitals does not appear to help Medicare beneficiaries identify facilities with better outcomes for high-risk surgeries, according to a report in the October issue of Archives of Surgery, one of the JAMA/Archives journals.
In an effort to reduce variations in surgical quality, the Centers for Medicare and Medicaid Services (CMS) now requires hospitals to report data from the national Surgical Care Improvement Project involving measures taken to prevent infection and blood clots, ...
Individuals with co-occurring psychiatric illnesses, especially anxiety and depression, appear to have an increased risk of death within 30 days of surgery, according to a report in the October issue of Archives of Surgery, one of the JAMA/Archives journals.
Psychiatric illnesses occur along with physical complaints in an estimated 5 percent to 40 percent of hospitalized patients, according to background information in the article. Having a psychiatric condition is independently associated with an increased risk of illness and death. Previous studies of these conditions ...
A survey of patients undergoing skin cancer screening shows that women were more likely to seek screening because of a skin lesion, a family history of skin cancer, or concern about sun exposure, whereas men age 50 and older, a group at highest risk for melanoma, may only seek screenings after a previous skin cancer diagnosis, according to a report in the October issue of Archives of Dermatology, one of the JAMA/Archives journals.
In 2008, more than 62,000 Americans were diagnosed with the skin cancer melanoma and almost 8,500 died from the disease, according to background ...
Patients with basal cell nevus syndrome, which predisposes them to develop non-melanoma skin cancers, appear to be at increased risk for vitamin D deficiency if they take steps to protect themselves from sunlight, according to a report in the October issue of Archives of Dermatology, one of the JAMA/Archives journals.
"Vitamin D deficiency has been associated with an increased risk of autoimmune disease, fractures, cancer, cardiovascular disease and all-cause mortality," the authors write as background information in the article. "There is increasing concern that sun ...
A simple, eight-item pre-operative questionnaire could help identify patients at risk for complications following surgery, according to a report in the October issue of Archives of Otolaryngology–Head & Neck Surgery, one of the JAMA/Archives journals. Individuals prone to the obstructive sleep apnea syndrome as determined by the questionnaire appear to have an increased risk of heart, lung and other complications following elective surgery.
Obstructive sleep apnea, a disorder in which individuals periodically stop breathing during sleep, occurs in approximately 5 percent ...
High fat diets cause a dramatic immune system overreaction to sepsis, a condition of systemic bacterial infection. An experimental study in mice, published in the open access journal BMC Physiology, has shown that a diet high in saturated fat, sugars and cholesterol greatly exaggerates the inflammatory response to sepsis.
Chantal Rivera, PhD Associate Professor of Molecular and Cellular Physiology at Louisiana State University Health Sciences Center-Shreveport, said that "Mortality due to sepsis in morbidly obese subjects is estimated to be 7 times more prevalent compared ...
