From the Illinois Surgical Quality Improvement Collaborative (ISQIC), Chicago, IL.
J Am Coll Surg. 2023 Jul 1;237(1):128-138. doi: 10.1097/XCS.0000000000000679. Epub 2023 Mar 15.
Surgical quality improvement collaboratives (QICs) aim to improve patient outcomes through coaching, benchmarked data reporting, and other activities. Although other regional QICs have formed organically over time, it is unknown whether a comprehensive quality improvement program implemented simultaneously across hospitals at the formation of a QIC would improve patient outcomes.
Patients undergoing surgery at 48 hospitals in the Illinois Surgical Quality Improvement Collaborative (ISQIC) were included. Risk-adjusted rates of postoperative morbidity and mortality were compared from baseline to year 3. Difference-in-differences analyses compared ISQIC hospitals with hospitals in the NSQIP Participant Use File (PUF), which served as a control.
There were 180,582 patients who underwent surgery at ISQIC-participating hospitals. Inpatient procedures comprised 100,219 (55.5%) cases. By year 3, risk-adjusted rates of death or serious morbidity decreased in both ISQIC (relative reduction 25.0%, p < 0.001) and PUF hospitals (7.8%, p < 0.001). Adjusted difference-in-differences analysis revealed that ISQIC participation was associated with a significantly greater reduction in death or serious morbidity (odds ratio 0.94, 95% CI 0.90 to 0.99, p = 0.01) compared with PUF hospitals. Relative reductions in risk-adjusted rates of other outcomes were also seen in both ISQIC and PUF hospitals (morbidity 22.4% vs 6.4%; venous thromboembolism 20.0% vs 5.0%; superficial surgical site infection 27.3% vs 7.7%, all p < 0.05), although these difference-in-differences did not reach statistical significance.
Although complication rates decreased at both ISQIC and PUF hospitals, participation in ISQIC was associated with a significantly greater improvement in death or serious morbidity. These results underscore the potential of QICs to improve patient outcomes.
外科质量改进合作组织（QIC）旨在通过辅导、基准数据报告和其他活动来改善患者的预后。尽管其他地区的 QIC 已经随着时间的推移自然形成，但尚不清楚在 QIC 成立时同时在多家医院实施全面的质量改进计划是否会改善患者的预后。
纳入在伊利诺伊州外科质量改进合作组织（ISQIC）的 48 家医院接受手术的患者。从基线到第 3 年，比较术后发病率和死亡率的风险调整率。差异分析比较了 ISQIC 医院和 NSQIP 参与者使用文件（PUF）医院，后者作为对照组。
在参与 ISQIC 的医院接受手术的患者有 180582 例。住院手术占 100219 例（55.5%）。到第 3 年，ISQIC（相对减少 25.0%，p<0.001）和 PUF 医院（7.8%，p<0.001）的死亡或严重发病率的风险调整率均降低。调整后的差异分析显示，与 PUF 医院相比，ISQIC 参与显著降低了死亡或严重发病率（比值比 0.94，95%CI 0.90 至 0.99，p=0.01）。ISQIC 和 PUF 医院的其他结局的风险调整率也出现了相对降低（发病率 22.4%对 6.4%；静脉血栓栓塞症 20.0%对 5.0%；浅表手术部位感染 27.3%对 7.7%，均 p<0.05），尽管这些差异没有达到统计学意义。
尽管 ISQIC 和 PUF 医院的并发症发生率均有所下降，但参与 ISQIC 显著改善了死亡或严重发病率。这些结果强调了 QIC 改善患者预后的潜力。
