The Minnesota Clinical Comparison and Assessment Program: a resource for clinical quality improvement programs

Project Overview: MCCAP is a voluntary, statewide initiative of more than 50 hospitals designed to improve patient outcomes by reducing variation among healthcare providers. Elective cholecystectomy, both open and laparoscopic, has been one area of focus.

Physicians are particularly interested in information about patient care that they do not routinely receive in a standardized format, such as the time required for patients to return to normal activities. Patients who did not meet guideline criteria but who were given prophylactic antibiotics prior to surgery experienced the same, minimal infection rate as patients who received no antibiotics prior to surgery. Participating hospitals are shifting their focus from looking at average occurrence rates (LOS, resource use by procedure) to identifying appropriate resource use. Although 82 percent of elective cholecystectomies met guideline requirements, 25 percent of all patients continue to experience their most distressing symptoms six months after surgery. Many physicians continue to use routine intraoperative cholangiography; however, MCCAP's guideline did a good job of differentiating patients who were more likely to benefit from the procedure from those who were not.