Postoperative Morbidity Clinical Trial
Official title:
Investigating Trends in Compliance With Quality Assurance Metrics
Verified date | April 2017 |
Source | University of Michigan |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Over 40 million major operative procedures are performed in the US annually and comprise
about 40% of healthcare expenditures. Despite decades of research, perioperative mortality
and morbidity remain a major healthcare system cost and detriment to long-term quality of
life. More than ten percent of patients experience a significant event such as surgical site
infection, reoperation, myocardial infarction, pulmonary embolus, or death. Nearly 100,000
patients die after surgery each year. National data demonstrate a 3-fold variation in risk
adjusted surgical morbidity and mortality, suggesting many opportunities for improvement in
perioperative care.
Anesthesiology care demonstrates wide variation in practice. Sometimes, this variation is
appropriate because the anesthesiologist is responding to patient comorbidities or procedure
specific events. However, even after controlling for patient specific factors, there is a
substantial amount of unexplained variation in fundamental elements of anesthesiology care.
The same procedure and patient can be performed using completely different anesthetic
techniques, hemodynamic management strategies, and medications. This variation in care can
lead to a variation in outcome.
The use of electronic health records (EHR) with detailed preoperative and intraoperative
data allows an automated system to be developed to notify clinicians their compliance to
both process of care metrics and outcome metrics. The Multicenter Perioperative Outcomes
Group (MPOG) quality improvement arm is known as Anesthesiology Performance Improvement
Reporting Exchange (ASPIRE). Like other Collaborative Quality Initiatives, the primary goal
of ASPIRE is to provide hospitals with risk-adjusted feedback on outcome and process of care
variation. In addition, ASPIRE creates an active best-practice sharing environment to enable
data to spur action. Recent literature has demonstrated that hospital-level feedback may not
be adequate to improve performance and clinical outcomes. In addition to hospital level data
and feedback, ASPIRE can disseminate provider-specific electronic feedback that may decrease
variation in care known to impact complications and cost.
The primary aim for this research study on ASPIRE's QI program is to determine if the
investigators can change behavior as measured by a provider's compliance to specific
performance metrics. The investigators believe that the start of individual provider
performance feedback reports to ASPIRE members presents a unique opportunity to research the
efficacy of these novel tools. The investigators propose to test the hypothesis that monthly
provider specific feedback emails on ASPIRE quality metrics over a period of 9 months
improves provider compliance as measured by a either a 10% improvement in the Total
Performance Score or by moving from below to above the 90% performance threshold in the
Total Performance Score Index.
Each provider type (faculty, CRNA, resident/fellow) within a hospital participating in
ASPIRE will be individually randomized to either receiving the electronic performance
improvement email or not for a total of nine months. No individual at the participating site
will see the individualized email compliance reports except for the specific provider. Only
an aggregate of the compliance across the entire hospital will be supplied to the
chairperson and the quality assurance directors. After the completion of the nine month
randomization period, all providers will receive monthly ASPIRE performance improvement
emails.
The University of Michigan is the coordinating center but also participating in this
research on QI project. De-identified patient data will be pulled in aggregate for each
provider using the MPOG database. The provider performance for each measure will then be
sent from ASPIRE to the randomized care provider via an email. The chairperson and quality
assurance directors will only see aggregate data on compliance rates and can NOT identify
individual compliance rates. Each participating site will obtain their own institutional IRB
to participate in this study.
Status | Completed |
Enrollment | 672 |
Est. completion date | January 2017 |
Est. primary completion date | January 2017 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | All |
Age group | N/A and older |
Eligibility |
Inclusion Criteria: - Hospitals currently participating in ASPIRE (https://www.aspirecqi.org/) - Quality assurance champion and chairperson have decided to participate in this quality assurance project. Exclusion Criteria: - Hospitals not currently participating in ASPIRE |
Country | Name | City | State |
---|---|---|---|
n/a |
Lead Sponsor | Collaborator |
---|---|
University of Michigan |
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Number of providers with improved compliance (where only one set of clinical providers) with Anesthesia Quality Measures using an email based provider specific feedback system | Investigating improved bundle compliance for all providers where only one anesthesia care provider group at the given institution were randomized to receive emails (attending/residents/CRNAs). | 9 months | |
Other | Number of providers with improved compliance for providers that already met the threshold compliance with Anesthesia Quality Measures using an email based provider specific feedback system | For all providers at baseline that already met bundle threshold compliance, we will investigate to determine if improved their performance during the study period. | 9 months | |
Other | Number of providers with improved compliance for all sites except the coordinating center with Anesthesia Quality Measures using an email based provider specific feedback system | Investigating improved bundle compliance for all providers expect those in the coordinating center to determine if they performance metrics have improved. | 9 months | |
Other | Number of patients with postoperative morbidity assigned to providers that did and did not receive quality metric emails. | Determine if patient postoperative morbidity are affected by a provider receiving metric emails for all cases, | 9 months | |
Other | Number of patients with postoperative morbidity assigned to only CRNA or Residents that did and did not receive quality metric emails. | Determine if patient postoperative morbidity are affected by a provider receiving metric emails but only for CRNAs, fellows and anesthesiology residents. | 9 months | |
Other | Number of patients with postoperative morbidity assigned to providers at all sites except the coordinating center that did and did not receive quality metric emails. | Determine if patient postoperative morbidity are affected by a provider receiving metric emails for cases done outside the coordinating center. | 9 months | |
Primary | Number of providers with improved compliance (for all clinical providers) with Anesthesia Quality Measures using an email based provider specific feedback system | Investigating improved bundle compliance for all providers where all anesthesia care providers at the given institution were randomized to receive emails (attending/residents/CRNAs). | 9 months |
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