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

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From Surgical Infection Prevention (SIP) to SCIP ... Arch Surg 2004;139:216-217. ... St. Louis, MO: Quality Medical Publishing, 2001. HCEKI 01-2005 ... – PowerPoint PPT presentation

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Title: Progress on the Surgical Care Improvement Project SCIP Special Study: The Unique Role of a Surgeon O


1
Progress on the Surgical Care Improvement
Project(SCIP) Special StudyThe Unique Role of
aSurgeon Organization
  • Quality Surgical Solutions
  • and

Hiram C. Polk, Jr. MD, FACS John N. Lewis, MD,
MPH Jan P. Van Vlack, RN February 2005
2
SCIP Special StudyFrom 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
QSSAdded 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
KentuckyA 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
  • Physicianled 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 RoleGenerally Helpful
  • Accept secondary and tertiary referrals without
    pain
  • Longstanding commitment to surgical excellence
  • Trained (partly or fully) many of Kentuckys
    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 educationlaboratory 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
    officeshow 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
    embolusprophylaxis 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
    200218416-18.
  • 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 20037243-247.
  • Galandiuk S, Rao MK, Heine MJ, et al. Mutual
    reporting of process and outcomes enhances
    quality outcomes for colon and rectal surgery.
    Surgery 2004 136833-841. 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 2004139216-217.
  • Shively EH, Heine MJ, Schell R, et al.
    Practicing surgeons lead in quality care, safety,
    and cost control. Ann Surg 2004239752-762
    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_at_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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