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Progress on the Surgical Care Improvement Project (SCIP) Special Study: The Unique Role of a Surgeon Organization

Progress on the Surgical Care Improvement Project (SCIP) Special Study: The Unique Role of a Surgeon Organization and Quality Surgical Solutions Hiram C. Polk, Jr. MD, FACS John N. Lewis, MD, MPH Jan P. Van Vlack, RN February 2005

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Progress on the Surgical Care Improvement Project (SCIP) Special Study: The Unique Role of a Surgeon Organization

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  1. Progress on the Surgical Care Improvement Project(SCIP) Special Study:The Unique Role of aSurgeon Organization and Quality Surgical Solutions Hiram C. Polk, Jr. MD, FACS John N. Lewis, MD, MPH Jan P. Van Vlack, RN February 2005

  2. SCIP Special Study…From Surgical Infection Prevention (SIP) to SCIP Centers for Medicare & Medicaid Services (CMS) contract awarded to: • Kentucky Medicare Quality Improvement Organization (QIO) • Ohio Medicare QIO

  3. SCIP Special Study continued Subcontracts: • Kentucky Medicare QIO with Quality Surgical Solutions • Ohio Medicare QIO with Oklahoma Medicare QIO

  4. Quality Surgical Solutions (QSS) A surgeon organization whose mission is to improve quality and decrease costs of surgical care

  5. QSS–Added Value to SCIP • Surgical quality expertise • Surgical research and practice expertise • Practiced, accomplished leadership • Surgeon network • Hospital recruitment and commitment • Access to surgeon data on hospital case abstracted data

  6. Building Physician Consensus • Growing awareness of quality movement • Quality is more than the avoidance of error • Surgeons curiously excluded and/or non-participants in much work to date

  7. Scene Setting • To Err is Human*and Crossing the Quality Chasm** • Fundamental conflict with extreme risks and/or anxiety about professional liability issues • Relative success with SIP • Promise of reassertion of physician leadership * National Academy Press, Washington D.C. 2000 **National Academy Press , Washington D.C,.2001

  8. Kentucky–A Favorable Platform for Special Study • University of Kentucky Medical Center (UKMC) alpha test site for National Surgical Quality Improvement Program (NSQIP/VA) • Early quality initiatives at Norton Hospital • Quality Surgical Solutions • Health Care Excel of Kentucky

  9. What is QSS? • 66 surgical specialists • 15 hospitals • 12 cities • 2 health plans • 43 protocols/current procedural technology (CPT) codes • BETTER PRACTICES

  10. Specialties Representedin QSS • General surgery to include trauma, digestive, vascular, colorectal, oncology, endoscopy • Orthopedic, otolaryngologic, urologic, gynecologic surgery

  11. Fundamental Hypotheses • Better quality surgical care is associated with reduced direct and overall expenses • Physician–led initiatives work • Commitment to prove concepts and ethically reward its doctors • Only effective public role is that of patient advocate

  12. Record ofAchievement Locally • Confidentiality of data • Prompt spread of agreed upon goals • Surgeons more prone to emulate other surgeons

  13. Create an Environment of Transformational Change • Innovate, report, refine, publish • Quality Improvement Conference • Value of the “near miss” and the praise of heroes and heroines • Examine routine and/or outdated printed orders

  14. Personal Role–Generally Helpful • Accept secondary and tertiary referrals without pain • Longstanding commitment to surgical excellence • Trained (partly or fully) many of Kentucky’s surgical specialists • Halo effect of QSS and having discussed it with hundreds of surgeons and administrative leaders • Personalized letters seeking surgeon support for SCIP through their hospitals

  15. Which Six… and Why? A Lap GB D CABG/valve B Hysterectomy E CR resections C Major vascular F Total Knee/Hip ____________________________________ • Not limited to Medicare beneficiaries • Primarily large volume hospitals • Significant complications and death

  16. Recruitment for SCIP Pilot • Group meetings for potential hospital participants and often their surgical specialists • Follow-up meetings, letters, and telephone calls • Recognition of the impact of current data submissions with invisible or meaningless feedback

  17. Conference Calls • Interest groups for each procedure • Lewis, Garrison, Polk, Van Vlack, and 2-5 specialists for the procedure • Prolonged sessions • Physicians very knowledgeable of current literature • Immediate agreement on process measures and feedback

  18. Detailed Developmentof QSS Involvement • Laborious development of doctor report forms • Alpha test of forms • Surgeon-leader reports • Begin to match hospital and surgeon reports • Broad-based education–laboratory for student success (LSS), grand rounds, collaboratives

  19. An Overview • Hospital contributions - Multiple procedures and surgeons • Honest sampling • Detailed, accurate abstraction - Tremendous enthusiasm • Surgeon contributions - Pre- and postop data • Detailed outcomes • Documentation of patient education

  20. Unique Opportunity to Match Hospital and Physician Reporting • More complete outcomes • Validation of accuracy for both methods of reporting • Consolidate surgeon and hospital performance into homogenous profile of quality

  21. Patient Education • Far better done in surgical specialists’ offices–how to document and promulgate • How can we quantitate and then assess quality? • Discussion

  22. Atmosphere that Promotes Patient Safety • Near miss and specific praise for the hero or heroine • Value of the process that targets the very rare disaster • The analogy between a plane crash and a pulmonary embolus–prophylaxis of the latter carries both risks and costs

  23. “We have achieved our goals in reining in the professional liability dragon.” • Physicians must now take the lead in identifying and solving problems of patient safety. We are now more protected than ever and can be the patient advocate we all want to be. • Allow doctors to clearly identify methods that provide improved quality. June, 2004 G.E. McGee, M.D., FACS

  24. Peer-Reviewed Publications • Allen JW, DeSimone KJ. Valid peer review for surgeons working in small hospitals. Am J Surg 2002;184:16-18. • Allen JW, Hahm TX, Polk HC Jr. Surgeon-led initiatives cut costs and enhance the quality of endoscopic and laparoscopic procedures. J Soc Laparosc Surg 2003;7:243-247. • Galandiuk S, Rao MK, Heine MJ, et al. Mutual reporting of process and outcomes enhances quality outcomes for colon and rectal surgery. Surgery 2004; 136:833-841. [Presented at the Annual Meeting of the Central Surgical Association, March 2004]. • McCafferty MH, Polk HC Jr. Addition of “near-miss” cases enhances a quality improvement conference. Arch Surg 2004;139:216-217. • Shively EH, Heine MJ, Schell R, et al. Practicing surgeons lead in quality care, safety, and cost control. Ann Surg 2004;239:752-762 [Presented at the Annual Meeting of the Southern Surgical Association, 2003]. • Galandiuk S, Carter MB, Abby M, eds. When to Refer to a Surgeon. St. Louis, MO: Quality Medical Publishing, 2001.

  25. A multifaceted endeavor with the ultimate goal of significantly improving surgical care in the United States through the prevention of complications associated with surgery

  26. With a goal to reduce surgical complications and mortality 25% by 2010, the following estimated complications could be prevented annually for Medicare beneficiaries. 13,000 perioperative deaths 271,000 surgical complications Hunt and Bratzler

  27. The Elements of SCIP • The Partnership • The Program • The Pilot

  28. The SCIP Partnership A coalition of organizations interested in: • the improvement of surgical care through the reduction of post-operative complications • the development of performance measures and a data collection tool

  29. SCIP Partners • Agency for Healthcare Research and Quality (AHRQ) • American College of Surgeons (ACS) • American Hospital Association (AHA) • American Society of Anesthesiologists (ASA) • Association of periOperative Registered Nurses (AORN)

  30. SCIP Partners continued • Centers for Disease Control and Prevention (CDC) • Centers for Medicare & Medicaid Services (CMS) • Department of Veteran Affairs (VA) • Joint Commission on Accreditation of Healthcare Organizations (JCAHO) • Institute for Healthcare Improvement (IHI)

  31. The SCIP Program Technical elements, consisting of process measures (including specifications), outcome measures (including appropriate risk adjustment methods), and the “SPOT” database and electronic data collection tool

  32. The SCIP Pilot A Medicare demonstration pilot designed to assess the feasibility of engaging private sector hospitals to reduce the incidence of post-operative morbidity and mortality

  33. Where Do We GoFrom Here? Completion of pilot data collection Final reports Finalization of performance measures for 8th SoW National rollout

  34. For more information… Visit the National SCIP Web site http://www.medqic.org/scip Contact the Kentucky Medicare QIO kyscip@kyqio.sdps.org (800) 300-8190 Contact Quality Surgical Solutions http://www.qualitysurgical.com (502) 583-7579 This material was prepared by Health Care Excel of Kentucky, the Medicare Quality Improvement Organization (QIO) of the Commonwealth, under contract with the Centers for Medicare & Medicaid Services (CMS), a federal agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Pub #HCEKI 01-2005

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