Changes in Surgical Outcomes in a Statewide Quality Improvement Collaborative with Introduction of Simultaneous,...

Area of Science:

• Healthcare Quality Improvement
• Surgical Outcomes Research
• Patient Safety

Background:

• Surgical Quality Improvement Collaboratives (QICs) are designed to enhance patient outcomes.
• The effectiveness of a simultaneously implemented, comprehensive QIC program at formation is not well-established.
• Existing QICs have often formed organically over time.

Purpose of the Study:

• To evaluate the impact of a comprehensive quality improvement program implemented simultaneously across hospitals at the formation of a QIC.
• To determine if the Illinois Surgical Quality Improvement Collaborative (ISQIC) improved patient outcomes.
• To compare surgical outcomes in ISQIC hospitals versus a control group.

Main Methods:

• A cohort of 180,582 patients undergoing surgery at 48 ISQIC hospitals was analyzed.
• Risk-adjusted rates of postoperative morbidity and mortality were compared from baseline to year 3.
• Difference-in-differences analyses compared ISQIC hospitals with control hospitals from the NSQIP Participant Use File (PUF).

Main Results:

• ISQIC participation was associated with a significantly greater reduction in death or serious morbidity (OR 0.94, p=0.01) compared to PUF hospitals.
• Risk-adjusted rates of death or serious morbidity decreased by 25.0% in ISQIC hospitals and 7.8% in PUF hospitals by year 3.
• While other complication rates also decreased in both groups, the difference-in-differences did not reach statistical significance.

Conclusions:

• Participation in the ISQIC was linked to a significant improvement in reducing death or serious morbidity.
• The study highlights the potential effectiveness of QICs in improving surgical patient outcomes.
• Both ISQIC and control hospitals saw reductions in complications, but ISQIC showed superior results for major adverse events.