Illinois Surgical Quality Improvement Collaborative
The Illinois Surgical Quality Improvement Collaborative 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, Blue Cross Blue Shield of Illinois and 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 with 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.
Northwestern Medicine Quality Innovation Center
Northwestern Medicine Quality Innovation Center (NM 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 the incubator for these innovative initiatives. All SOQIC faculty also work within 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:
- Identify and diffuse best practices; tailoring them to fit local needs; and implementing them, as necessary, throughout the system
- Seek innovations internally and from other hospitals and outside the healthcare sector
- Market innovations to improve NM and physician reputation
The NM QIC portfolio currently includes many exciting initiatives, including ongoing efforts to:
- Evaluate national health policies to improve quality
- Examine and improved national hospital public quality ratings
- Launch and support clinically-focused, multidisciplinary learning collaboratives to advance the safety, effectiveness and efficiency of patient care to support health system clinical integration
- 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
Flexibility in Duty Hour Requirements for Surgical Trainees Trial (the FIRST trial) is sponsored and jointly funded by the American Board of Surgery, the American College of Surgeons 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.
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 U.S. News, UHC, ACS NSQIP, and several states dropping the VTE measure from public reporting programs.
Centers for Medicare & Medicaid Services (CMS) began using the Agency for Healthcare Research and Quality Patient Safety for Selected Indicators (PSI-90) as a core metric in two of its pay-for-performance programs: the Hospital-Acquired Condition Reduction program and the Hospital Value-Based Purchasing program. Scientists 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.
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.