Northwestern University Feinberg School of Medicine

Department of Surgery

SOQIC Initiatives

Illinois Surgical Quality Improvement Collaborative (ISQIC)            ISQIC logo

The Illinois Surgical Quality Improvement Collaborative (ISQIC) is a collaborative partnership of nearly 50 hospitals, the Illinois and Metropolitan Chicago Chapters of the American College of Surgeons, the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), Blue Cross Blue Shield of Illinois, and the Surgical Outcomes and Quality Improvement Center (SOQIC).

The mission of the collaborative is to improve the safety and quality of surgical care in Illinois. Hospitals are provided with detailed data regarding their performance compared to other Illinois hospitals, along with the tools to enact meaningful improvements in surgical care. Mentors, formal quality and process improvement training, and process improvement consultants are available to the hospitals as they work to implement solutions. Lessons learned at one hospital will be shared with all participating hospitals, so we can all learn from each other with a common goal of making care better and safer for the surgical patient in Illinois.

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Northwestern Medicine Quality Innovation Center

Northwestern Medicine Quality Innovation Center (QIC) improves care across the Northwestern Medicine health system by serving as a leader in developing innovative approaches at the intersection of quality and research, and serving as the incubator for these innovative initiatives. All SOQIC faculty also work within the NM QIC and focus a portion of their research agenda on improving care within our health system and studying the initiatives with rigorous externally funded and peer-reviewed research.

The three primary objectives of NM QIC are to

  1. Identify and diffuse best practices; tailoring them to fit local needs; and implementing them, as necessary, throughout the system
  2. Seek innovations internally and from other hospitals and outside the health care sector
  3. Market innovations to improve NM and physician reputation

The NM QIC portfolio currently includes many exciting initiatives including ongoing efforts to

  1. Evaluate national health policies to improve quality
  2. Examine and improved national hospital public quality ratings
  3. Launch and support clinically-focused, multidisciplinary learning collaboratives to advance the safety, effectiveness and efficiency of patient care to support health system clinical integration
  4. Develop an infrastructure to support implementation of Patient Reported Outcomes (PROs) and oversee implementation of PROs into service lines

Flexibility in Duty Hour Requirements for Surgical Trainees Trial – “the FIRST trial”

The FIRST trial is sponsored and jointly funded by the American Board of Surgery (ABS), the American College of Surgeons (ACS), and the Accreditation Council for Graduate Medical Education (ACGME).

The objective of the study is to determine whether the current restrictions on resident duty hours may be detrimental to patient care and resident training. This study seeks to determine if more flexible work hour requirements are associated with any difference in postoperative outcomes compared to current resident work hour requirements. This is being accomplished by using a prospective pragmatic cluster-randomized trial design where hospitals are randomized to flexible vs. current work schedule requirements. Participants for this study include all ACGME-approved surgical residency programs affiliated with hospitals that participate in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP).

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National Quality Measurement Policy Evaluations

Venous Thromboembolism (VTE): SOQIC faculty discovered that hospital VTE rates are driven by how often imaging tests are ordered looking for VTE – “the more you look, the more you find.” Thus, the measure actually makes vigilant hospitals appear to be poor performers. The results of this landmark study resulted in US News, UHC, ACS NSQIP, and several states dropping the VTE measure from public reporting programs.

PSI-90: Centers for Medicare & Medicaid began using the Agency for Healthcare Research and Quality (AHRQ) Patient Safety for Selected Indicators (PSI-90) as a core metric in 2 of its pay-for-performance programs: the Hospital-Acquired Condition (HAC) Reduction program and the Hospital Value-Based Purchasing (VBP) program. Researchers at SOQIC have demonstrated concerns with using PSI-90 and have lobbied CMS to drop this measure from pay-for-performance programs.

Hospital-Acquired Condition Reduction Program: CMS penalizes hospitals for high-rates of hospital acquired conditions, but SOQIC authors found that higher quality hospitals were the ones being penalized in the HAC program. Thus, considerable revisions are needed to ensure that hospitals are accurately penalized as fines frequently exceed $1,000,000.

Readmissions: CMS now penalizes hospitals with high readmission rates. SOQIC authors demonstrated why readmissions commonly occur after surgery and suggested opportunities for revising the CMS Readmission Reduction Program.