NQUIRES Core Programs
Core Topics
Illinois Quality Collaboratives
Overview
- The Illinois Surgical Quality Improvement Collaborative (ISQIC) is comprised of over 50 hospitals in Illinois. ISQIC provides participating hospitals with a formal quality and process improvement training curriculum, surgeon mentors, and process improvement coaches as well as financial support for the implementation of QI initiatives. ISQIC hospitals work together to improve surgical quality and safety by sharing their experiences, best practices, successes, and failures. In addition, ISQIC hospitals report and receive comparative feedback on key process measures with the ability to view and compare empirical data about hospital performance and participate in the ISQIC initiatives. Hospitals are equipped to use their data to successfully implement quality improvement (QI) initiatives and improve care.
- The Illinois Cancer Collaborative (ILCC) is a first-of-its kind statewide cancer collaborative. Its mission is to convene a multidisciplinary learning collaborative of Illinois hospitals improving the safety and quality of care for cancer patients. The ILCC is an opportunity for Illinois hospitals to partner together to rapidly and efficiently address the unique challenges that we all face in providing safe and optimal cancer care to patients during and after the COVID-19 pandemic. The ILCC offers novel strategies to support effective QI in oncology: (1) guided implementation and mentoring of QI projects, (2) high-quality, Illinois-specific comparative data augmenting the NCDB, (3) cancer-specific QI resources and education, (4) statewide sharing of best practices.
Research Team
- Lead faculty: Karl Bilimoria, MD, MS; Michael McGee, MD; Anthony Yang, MD, MS
- Collaborating Faculty: Greg Auffenberg, MD, MS; Jeanette Chung, PhD; Julie Johnson, MSPH, PhD; Yue-Yung Hu, MD, MPH; Nisha Mohindra, MD; Ryan Merkow, MD, MS; David Odell, MD, MMSc; Mehul Raval, MD, MS; Sean Sachdev, MD; Jonah Stulberg, MD, PhD, MPH
- Fellows: Brian Brajcich, MD; Matt Chia, MD; Chelsea Fischer, MD; Hae Soo (Rachel) Joung, MD
- Staff: Brianna D’Orazio, MPH; Remi Love, MMPA; John Slocum, MPH; Nathan Monson, MS; Jenny Slota, BS
Funding Sources
- Statewide collaboratives are supported by Blue Cross Blue Shield of Illinois and the Agency for Healthcare Research and Quality (R01HS024516) and reflect a partnership with the American College of Surgeons. Additional funding for the ILCC comes from the Robert H. Lurie Comprehensive Cancer Center at Northwestern.
Selected High-Impact Publications
Surgical Education & Culture
Overview
Continuing on the success of the Flexibility in Duty Hour Requirement for Surgical Trainees (FIRST) trial, 2019 saw the launch of The Surgical Education Culture Optimization through targeted interventions based on National comparative Data (SECOND) trial.
This effort, a collaboration between Northwestern Medicine, the Accreditation Council for Graduate Medical Education (ACGME), the American College of Surgeons (ACS), the American Board of Surgery (ABS) and the Association of Program Directors in Surgery (APDS) is a prospective, 212-hospital pragmatic cluster randomized trial examining whether giving general surgery residency programs access to their performance data and an interactive toolkit of wellness interventions can improve residency program culture and resident wellness.
The SECOND Trial has enrolled 212 residency programs. For more information, please see http://thesecondtrial.org
Research Team
- Lead faculty: Karl Bilimoria, MD, MS and Yue-Yung Hu, MD, MPH
- Collaborating Faculty: Elaine Cheung, PhD; Julie Johnson, MSPH, PhD; Gaurava Agarwal, MD; David Hoyt, MD; Thomas Nasca, MD
- Fellows: Brian Brajcich, MD; Matt Chia, MD; Chelsea Fischer, MD; Rachel Joung, MD; Andrew Hu, MD; Debbie Li, MD; Meixi Ma, MD; Brian Nasca, MD; Arielle Thomas, MD
- Staff: Daniela Amórtegui, MA; Josh Eng, PhD; Nate Monson, MS; Sarah Plummer, BA; John Slocum, MPH; Tia Zhan, MS
Funding Sources
-
The SECOND Trial is a partnership among the following:
- Accreditation Council for Graduate Medical Education (ACGME)
- American College of Surgeons (ACS)
- American Board of Surgery (ABS)
- Association of Program Directors in Surgery (APDS)
- Society of Surgical Chairs (SSC)
- Association of American Medical Colleges (AAMC)
Selected High-Impact Publications
Hewitt DB, Ellis RJ, Hu YY, Cheung EOY, Moskowitz JT, BilimoriaKY. Evaluating the Impact of Multiple Burnout Definitions and Thresholds on Prevalence and Outcomes. JAMA Surgery 2020; in press.
Health Policy
Overview
Evaluating the impact of policy initiatives on healthcare quality measurement, improvement and delivery has been a focus area of NQUIRES, and this work has resulted in numerous changes in national quality measurement, pay-for-performance programs, and public hospital quality rating systems.
Research Team
- Lead faculty: Karl Bilimoria, MD, MS
- Collaborating Faculty: Jeanette Chung, PhD; Cynthia Barnard, MBA, PhD; Ryan Merkow, MD, MS
Funding Sources
- NQUIRES Health Policy efforts have been supported by the NIH, AHRQ, the American College of Surgeons, and Northwestern Medicine.
Selected High-Impact Publications
Peri-Operative Patient Safety & Surgical Safety
Overview
To identify opportunities to inform and improve the quality and delivery of surgical care, NQUIRES researchers have conducted hundreds of outcomes research studies and developed tools to help clinicians provide better care.
Research Team
- Lead faculty: Anthony Yang, MD, MS and Ryan Merkow, MD, MS
- Collaborating Faculty: Karl Bilimoria, MD, MS; Greg Auffenberg, MD, MS; Amy Halverson, MD; Yue-Yung Hu, MD, MPH; David Odell, MD, MMSc; Mehul Raval, MD, MS; Michael McGee, MD
- Staff: Brianna D’Orazio, MPH; Remi Love, MMPA; Jenny Slota, BS
Funding Sources
- NQUIRES Perioperative Patient Safety and Surgical Safety efforts have been supported by the NIH, AHRQ, BCBS-IL, and numerous other organizations and societies.
Selected High-Impact Publications
Using Surgical Video to Improve Surgical Technique
Overview
To date, most surgical quality improvement efforts have focused on preoperative and postoperative quality and safety with less work focusing on intraoperative care or surgical technique. Moreover, surgeons rarely receive feedback on their technical skills once done with training. Thus, we have developed multiple initiatives to leverage surgical video to improve surgeon technical skills. This is done through peer coaching, scoring and comments from peers, and group discussions. Video-based feedback for the improvement of surgical technique leverages video of surgical procedures to facilitate discussions and learning. This work is carried out in the NM health system and through the Illinois Surgical Quality Improvement Collaborative (ISQIC).
Research Team
- Lead faculty: Jonah Stulberg, MD, PhD, MPH; Karl Bilimoria, MD, MS;
- Collaborating Faculty: Greg Auffenberg, MD, MS; Heather Himelhoch, PhD, MPH; Vitaliy Poylin, MD
- Fellows: Bona Ko, MD, MPH; Andres Guerra, MD; Andrew Hu, MD; Brian Nasca, MD; Arielle Thomas, MD, MPH
- Staff: Neha Negrete MBA, MPH; Nathan Monson, MS; Egide Abahuje, MD, MPH
Funding Sources
- Video coaching efforts are supported by NQUIRES, ISQIC/BCBS-IL, and the NM Quality Innovation Center
Selected High-Impact Publications
Brajcich BC, Stulberg JJ, Palis BE, Chung JW, Huang R, Nelson H, Bilimoria KY. Association Between Surgical Technical Skill and Long-term Survival for Colon Cancer. JAMA Oncol. 2021;7(1):127–129. doi:10.1001/jamaoncol.2020.5462
Schlick CJR, Bilimoria KY, Stulberg JJ. Video-Based Feedback for the Improvement of Surgical Technique: A Platform for Remote Review and Improvement of Surgical Technique. JAMA Surg. Published online September 9, 2020.Pediatric Surgical Outcomes
Overview
The research team is dedicated to projects seeking to improve outcomes in children’s surgical care. The scope of their research extends from quality improvement and implementation science to advancement of clinical practice and standards of care. Our research has played a key role in the establishment of the American College of Surgeons National Surgical Quality Improvement Program –Pediatric (ACS-NSQIP-P) which is now in place at more than 150 hospitals.
Research Team
- Lead faculty: Mehul Raval, MD, MS
- Collaborating Faculty: Jane Holl, MD, MPH; Karl Bilimoria, MD; Julie Johnson, MSPH, PhD; Willemijn Schäfer, PhD
- Fellows: Martha Ingram, MD, MPH; Andrew Hu, MD; Salva Balbale, PhD
- Statistician: Yao Tian, PhD, MPH
- Staff: Erin Wymore, MS; Peter Graffy, MPH; Karen Miller, BS
Funding Sources
-
Efforts are supported by the following:
- Eunice Kennedy Shriver National Institute Of Child Health & Human Development of the National Institutes of Health (R01HD099344)
- Agency for Healthcare Research and Quality (R01HS024712)
- Digestive Health Foundation
- Crohn’s & Colitis Foundation
Selected High-Impact Publications
Vacek J, Davis T, Many BT, Close S, Blake S, Hu Y-Y, Holl JL, Johnson J, Strople J, Raval MV. A baseline assessment of enhanced recovery protocol implementation at pediatric surgery practices performing inflammatory bowel disease operations. Journal of Pediatric Surgery. Available online 27 June 2020.Northwestern Medicine Quality Innovation Center
Cancer Quality
Overview
The Northwestern Medicine Cancer Collaboratives are multidisciplinary groups of oncology care providers and quality leaders who seek to align and improve cancer care across the system. The collaboratives aim to equip hospitals and individual providers with skills to identify their local performance gaps in cancer care in a rigorous manner based on high-quality data, and then implement solutions to those problems using established process improvement methods. The collaboratives will ultimately measurably improve adherence to best practice guidelines, quality of care, and outcomes while reducing variation and costs arising from unsafe, inefficient, or inappropriate care.
Research Team
- Lead faculty
- Breast Cancer: Anthony Yang, MD, MS
- Colorectal Cancer: Ryan Merkow, MD, MS
- Lung Cancer: David Odell, MD, MMSc
- Collaborating Faculty: numerous faculty across departments, hospitals, and specialties
- Executive Sponsor: Karl Bilimoria, MD, MS
- Staff: Brianna D’Orazio, MPH; Remi Love, MMPA; John Slocum, MPH; Jenny Slota, BS
Funding Sources
This work has been funded by the NIH/NCI, AHRQ, American Cancer Society, NCCN, Northwestern Medicine, and the Lurie Cancer Center.Selected High-Impact Publications
Bilimoria KY, Bentrem DJ, Ko CY, Stewart AK, Winchester DP, Talamonti MS. National failure to operate on early stage pancreatic cancer. Ann Surg. 2007;246(2):173-80. PubMed PMID: 17667493; PubMed Central PMCID: PMC1933550.
Bilimoria KY, Bentrem DJ, Ko CY, Stewart AK, Winchester DP, Talamonti MS, Sturgeon C. Extent of surgery affects survival for papillary thyroid cancer. Ann Surg. 2007;246(3):375-84. PubMed PMID: WOS:000249174900004.
Bilimoria KY, Bentrem DJ, Stewart AK, Talamonti MS, Winchester DP, Russell TR, Ko CY. Lymph node evaluation as a colon cancer quality measure: a national hospital report card. J Natl Cancer Inst. 2008;100(18):1310-7. PubMed PMID: 18780863; PubMed Central PMCID: PMC2720724.
Bilimoria KY, Bentrem DJ, Lillemoe KD, Talamonti MS, Ko CY, Canc ACSP. Assessment of Pancreatic Cancer Care in the United States Based on Formally Developed Quality Indicators. J Natl Cancer I. 2009;101(12):848-59. PubMed PMID: WOS:000267225000007.
Bilimoria KY, Raval MV, Bentrem DJ, Wayne JD, Balch CM, Ko CY. National assessment of melanoma care using formally developed quality indicators. J Clin Oncol. 2009;27(32):5445-51. PubMed PMID: 19826131.
Bilimoria KY, Bentrem DJ, Talamonti MS, Stewart AK, Winchester DP, Ko CY. Risk-based selective referral for cancer surgery: a potential strategy to improve perioperative outcomes. Ann Surg. 2010;251(4):708-16. PubMed PMID: 19898231.
Merkow RP, Yang AD, Pavey E, Song MW, Chung JW, Bentrem DJ, Bilimoria KY. Comparison of Hospitals Affiliated With PPS-Exempt Cancer Centers, Other Hospitals Affiliated With NCI-Designated Cancer Centers, and Other Hospitals That Provide Cancer Care. JAMA Intern Med. 2019.
Odell DD, Feinglass J, Engelhardt K, Papastefan S, Meyerson SL, Bharat A, DeCamp MM, Bilimoria KY. Evaluation of adherence to the Commission on Cancer lung cancer quality measures. J Thorac Cardiovasc Surg. 2019;157(3):1219-1235.
Ellis RJ, Ho JW, Schlick CJR, Merkow RP, Bentrem DJ, Bilimoria KY, Yang AD. National Use of Chemotherapy in Initial Management of Stage I Pancreatic Cancer and Failure to Perform Subsequent Resection. Ann Surg Oncol. 2020;27(3):909-918.
Surgical Opioid Prescribing
Overview
Following surgery, surgeons frequently prescribe far more opioid pills than patients need to control their pain. These excess pills are too often consumed for non-medical indications or diverted to individuals other than the intended user. Furthermore, despite recent efforts to decrease the number of pills prescribed following surgery, patients continue to have a significant number of pills left over when their acute pain resolves.
Our portfolio of initiatives aims to reduce surgical overprescribing of opioids and develop appropriate tools for providers and families to address post-operative pain management. Using an implementation science approach, our efforts further seek to understand the effectiveness of these interventions to thus facilitate dissemination.
Research Team
- Lead faculty: Jonah Stulberg, MD, PhD, MPH; Julie Johnson, MSPH, PhD
- Collaborating Faculty: Karl Bilimoria, MD, MS; Willemijn Schäfer, PhD
- Staff: Brianna D’Orazio, MPH; Reiping Huang, PhD; Cassandra Iroz, MPH; John Slocum, MPH
Funding Sources
-
The following grants support our Opioid Reduction initiatives:
- System-Level Implementation to Reduce Excess Opioid Prescribing in Surgery – National Institute on Drug Abuse (R34DA044752)
- Preventing Opioid Misuse through Safe Opioid Use Agreements between Patients and Surgical Providers (PROMISE ME) – Agency for Healthcare Research and Quality (R18HS027331)
- Illinois Surgical Quality Improvement Collaborative (ISQIC) Opioid Reduction Initiative: Phase 2 – PaciraPharmaceuticals
- Understanding Opioid Use by Surgical Approach – Intuitive Foundation
- A Missing Piece of the Puzzle: Patient and Provider Perspectives on Opioid Use and Pain Management in Inflammatory Bowel Disease Care – Digestive Health Foundation