How do they mea­sure up?

Pro­gram gauges surgery ser­vices at ru­ral hos­pi­tals

Modern Healthcare - - SPECIAL REPORT - Mau­reen Mckin­ney

For re­source-strapped ru­ral hos­pi­tals, mea­sur­ing sur­gi­cal qual­ity is crit­i­cal not only for spurring im­prove­ment ef­forts but also for retaining lo­cal pa­tient pop­u­la­tions. “Ru­ral hos­pi­tals some­times get a bad rap,” says Dr. Clif­ford Ko, di­rec­tor of the Amer­i­can Col­lege of Sur­geons’ di­vi­sion of re­search and op­ti­mal pa­tient care, and the di­rec­tor of its Na­tional Sur­gi­cal Qual­ity Im­prove­ment Pro­gram, known as ACS NSQIP. “Pa­tients might feel like they need to travel to the big city for surgery, so it’s ad­van­ta­geous for ru­ral hos­pi­tals to show that they’re do­ing a great job.”

Cre­ated in 2004, the ACS NSQIP pro­vides risk-ad­justed out­comes data to par­tic­i­pat­ing hos­pi­tals, based on re­views of post­op­er­a­tive in­for­ma­tion in pa­tient charts. The pro­gram fo­cuses on mea­sur­ing rates of com­pli­ca­tions such as sur­gi­cal-site in­fec­tions and uri­nary-tract in­fec­tions, as well as 30-day mor­tal­ity, Ko says.

A lit­tle more than a year ago, mo­ti­vated by feed­back from providers, the ACS added a spe­cial mod­ule to the pro­gram, cus­tom­ized for the needs of small and ru­ral hos­pi­tals.

“It takes into ac­count the types of cases that are usu­ally done in these hos­pi­tals as well as the re­sources that a typ­i­cal ru­ral fa­cil­ity will or will not have,” Ko says.

The ru­ral ver­sion of the pro­gram re­quires fewer cases and uses a smaller set of vari­ables. The cus­tom­ized mod­ule also comes with a hefty price re­duc­tion that Ko says makes it more fea­si­ble for such providers. While the price tag for the ACS NSQIP’S clas­sic pro­gram is roughly $30,000, the ru­ral pro­gram costs about $10,000.

And while par­tic­i­pants in the reg­u­lar pro­gram are re­quired to have a full-time sur­gi­cal clin­i­cal re­viewer, ru­ral and smaller fa­cil­i­ties can des­ig­nate a part-time em­ployee to as­sess the data, he adds. The ru­ral pro­gram also gives sur­geons op­por­tu­ni­ties to net­work with one an­other and to combat pro­fes­sional iso­la­tion.

“They not only have bench­mark data but they have ac­cess to five peo­ple they can call if they, for in­stance, want to see how an­other hospi­tal in a sim­i­lar set­ting fixed their UTI rate,” he says.

Ru­ral fa­cil­i­ties need to par­tic­i­pate in qual­ity-im­prove­ment projects and be able to reach and main­tain the same qual­ity tar­gets as their large ur­ban peers, ar­gues Dr. Howard Mccol­lis­ter, chief of surgery at Cuyuna Re­gional Med­i­cal Cen­ter, a 25-bed crit­i­cal-ac­cess hospi­tal in Crosby, Minn., a town of less than 2,400.

“You can’t say ru­ral out­comes are not as good so we’ll make al­lowances,” Mccol­lis­ter says. “You have to be will­ing to hold your own feet to the fire. The Univer­sity of Min­nesota is two hours away. We’d bet­ter be able to do a colon re­sec­tion as well as them and, if not, I should send my pa­tients there in­stead.”

De­spite its ru­ral set­ting, Cuyuna Re­gional has built a well-known surgery depart­ment. Mccol­lis­ter says that cred­i­bil­ity is bol­stered by trans­parency about pa­tient out­comes.

Us­ing the ACS NSQIP, the hospi­tal has con­firmed high lev­els of per­for­mance in many sur­gi­cal ar­eas and has also ad­dressed prob­lems as they arose, he says. For ex­am­ple, when it be­came ap­par­ent that Cuyuna Re­gional had higher-than-av­er­age rates of UTIS, the hospi­tal traced the in­fec­tions to fre­quent use of Fo­ley catheters. Af­ter im­ple­ment­ing new guide­lines and train­ing nurses in ev­i­dence-based prac­tices, the hospi­tal’s UTI rate fell to well be­low the na­tional norm within 18 months.

“It’s in­sid­i­ously easy to ra­tio­nal­ize your com­pli­ca­tions,” Mccol­lis­ter says. “Things slip your mind and the im­pres­sion you have of the work that you do is not al­ways right. Out­comes mea­sures are ex­tremely im­por­tant

stand.”<< so we know where we

CUYUNA RE­GIONAL MED­I­CAL CEN­TER

The sur­gi­cal depart­ment at Cuyuna Re­gional has bol­stered its rep­u­ta­tion based on trans­parency with out­comes.

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