NQUIRES Initiatives

The Illinois Surgical Quality Improvement Collaborative is a collaborative partnership of nearly 50 hospitals, the Illinois and Metropolitan Chicago Chapters of the American College of Surgeons, the American College of Surgeons National Surgical Quality Improvement Program, Blue Cross Blue Shield of Illinois and NQUIRES.

The mission of the collaborative is to improve the safety and quality of surgical care in Illinois. Hospitals are provided with detailed data regarding their performance compared with other Illinois hospitals, along with the tools to enact meaningful improvements in surgical care. Mentors, formal quality and process improvement training and process improvement consultants are available to the hospitals as they work to implement solutions. Lessons learned at one hospital will be shared with all participating hospitals, so we can all learn from each other with a common goal of making care better and safer for the surgical patient in Illinois.

Northwestern Medicine Quality Innovation Center (NM QIC) improves care across the Northwestern Medicine health system by serving as a leader in developing innovative approaches at the intersection of quality and research and the incubator for these innovative initiatives. All NQUIRES faculty also work within NM QIC and focus a portion of their research agenda on improving care within our health system and studying the initiatives with rigorous externally funded and peer-reviewed research.

The three primary objectives of NM QIC are to:

• Identify and diffuse best practices; tailoring them to fit local needs; and implementing them, as necessary, throughout the system
• Seek innovations internally and from other hospitals and outside the healthcare sector
• Market innovations to improve NM and physician reputation

The NM QIC portfolio currently includes many exciting initiatives, including ongoing efforts to:

• Evaluate national health policies to improve quality
• Examine and improved national hospital public quality ratings
• Launch and support clinically-focused, multidisciplinary learning collaboratives to advance the safety, effectiveness and efficiency of patient care to support health system clinical integration
• Develop an infrastructure to support implementation of Patient Reported Outcomes (PROs) and oversee implementation of PROs into service lines

Flexibility in Duty Hour Requirements for Surgical Trainees Trial (the FIRST trial) is sponsored and jointly funded by the American Board of Surgery, the American College of Surgeons and the Accreditation Council for Graduate Medical Education (ACGME).

The objective of the study is to determine whether the current restrictions on resident duty hours may be detrimental to patient care and resident training. This study seeks to determine if more flexible work hour requirements are associated with any difference in postoperative outcomes compared to current resident work hour requirements. This is being accomplished by using a prospective pragmatic cluster-randomized trial design where hospitals are randomized to flexible vs. current work schedule requirements. Participants for this study include all ACGME-approved surgical residency programs affiliated with hospitals that participate in the American College of Surgeons National Surgical Quality Improvement Program.

Continuing on the success of the Flexibility in Duty Hour Requirement for Surgical Trainees (FIRST) trial, 2019 saw the launch of The Surgical Education Culture Optimization through targeted interventions based on National comparative Data (SECOND) trial.  This effort, a collaboration between Northwestern Medicine, the Accreditation Council for Graduate Medical Education (ACGME), the American College of Surgeons (ACS), the American Board of Surgery (ABS) and the Association of Program Directors in Surgery (APDS) is a prospective, pragmatic cluster randomized trial examining whether giving general surgery residency programs access to their performance data and a toolkit can improve residency program culture and resident wellness.  The SECOND Trial has enrolled and randomized 215 programs and is providing a range of wellness interventions through an interactive toolkit.  For more information, please see http://thesecondtrial.org/

Led by Dr. Mehul Raval, the ENhancing Recovery in CHildren Undergoing Surgery (ENRICH-US) study aims to evaluate implementation and clinical outcomes following Enhanced Recovery Protocol (ERP) initiation for children undergoing gastrointestinal surgery in 18 US hospitals. It is a prospective, pragmatic study using a stepped-wedge, cluster, randomized controlled trial design to evaluate the effectiveness of ERPs including patient reported outcomes while assessing implementation fidelity, sustainability, and site-specific adaptations.  For more information, please see http://www.enrich-us.org/

The ILCC is a statewide initiative in partnership with the American College of Surgeons (ACS) Commission on Cancer.  ILCC is a first-of-its-kind cancer collaborative in Illinois, providing a platform to improve the quality of cancer care through (1) guided implementation and mentoring of QI projects, (2) high-quality, Illinois-specific comparative data augmenting the NCDB, (3) oncology-specific Quality Improvement resources and education, (4) statewide sharing of best practices, and (5) numerous additional learning collaborative approaches to improve adherence to cancer management guidelines in Illinois.

Directed by NQUIRES faculty Drs. Gregory Auffenberg and Jonah Stulberg, this project is a way for surgeons to earn Continuing Medical Education (CME) credits while providing feedback for other surgeons to improve their technical skill.  The VISTA website was built to provide a way for practicing surgeons to give and receive operative feedback in order to maintain and improve surgical skills while earning CME credits.  For more information, please see www.vistavideos.org

NQUIRES faculty have previously combined patient reported outcomes (PRO) tools and imaging review through telehealth strategies to develop the Patient-Centered Remote Telehealth User-Reported caNcer Surveillance (ReTURNS) program for patients with lung cancer.  Experience with ReTURNS supports the concept that cancer care can safely and effectively be delivered without requiring the patient to physically come to the hospital building or outpatient clinics. While initially conceived as a means of providing more patient-centered care (i.e., patient convenience), this experience uniquely positions NQUIRES to respond to the challenges in cancer care resulting from the COVID-19 pandemic by minimizing patient exposure to the healthcare system.  Importantly, limiting the need for these patients to return for in-person clinic visits will decrease the potential for exposure to both patients and our healthcare workers.  Moreover, patients with symptoms potentially consistent with COVID-19 could be identified with this telehealth approach and rerouted before any in-person visits.

Venous Thromboembolism (VTE)

NQUIRES faculty discovered that hospital VTE rates are driven by how often imaging tests are ordered looking for VTE ("the more you look, the more you find"). Thus, the measure actually makes vigilant hospitals appear to be poor performers. The results of this landmark study resulted in U.S. News, UHC, ACS NSQIP, and several states dropping the VTE measure from public reporting programs.

PSI-90

Centers for Medicare & Medicaid Services (CMS) began using the Agency for Healthcare Research and Quality Patient Safety for Selected Indicators (PSI-90) as a core metric in two of its pay-for-performance programs: the Hospital-Acquired Condition Reduction program and the Hospital Value-Based Purchasing program. Scientists at SOQIC have demonstrated concerns with using PSI-90 and have lobbied CMS to drop this measure from pay-for-performance programs.

Hospital-Acquired Condition Reduction Program

CMS penalizes hospitals for high rates of hospital acquired conditions, but SOQIC authors found that higher quality hospitals were the ones being penalized in the HAC program. Thus, considerable revisions are needed to ensure that hospitals are accurately penalized as fines frequently exceed $1,000,000.

Readmissions

CMS now penalizes hospitals with high readmission rates. NQUIRES authors demonstrated why readmissions commonly occur after surgery and suggested opportunities for revising the CMS Readmission Reduction Program.

The proposed CONSORT program brings together the extensive oncologic expertise at Northwestern University’s Feinberg School of Medicine and the RHLCCC to create a multidisciplinary, two-year research training program consisting of (1) a Health Services and Outcomes Research (HSOR) Track and (2) a Basic and Translational Science (BTS) Research Track.

The CONSORT program will draw upon the Department of Surgery’s 30 years of experience in training surgical trainees in basic and translational surgical oncology research and the 15-year-old surgical oncology HSOR resident training collaboration between SOQIC, the Northwestern Institute for Comparative Effectiveness Research in Oncology (NICER-Onc), the HSOR Postdoctoral Fellowship at Northwestern, and the American College of Surgeons (ACS) Cancer Programs.