A Checklist-Based intervention to improve surgical outcomes in Michigan evaluation of the keystone surgery program

Bradley N Reames, Robert W. Krell, Darrell A. Campbell, Justin B. Dimick

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Importance: Previous studies of checklist-based quality improvement interventions have reported mixed results. Objective: To evaluate whether implementation of a checklist-based quality improvement intervention-Keystone Surgery-was associated with improved outcomes in patients in a large statewide population undergoing general surgery. Design, Setting, and Exposures: A retrospective longitudinal study examined surgical outcomes in 64 891 Michigan patients in 29 hospitals using Michigan Surgical Quality Collaborative clinical registry data from 2006 through 2010. Multivariable logistic regression and difference-in-differences analytic approaches were used to evaluate whether Keystone Surgery program implementation was associated with improved surgical outcomes following general surgery procedures, apart from existing temporal trends toward improved outcomes during the study period. Main Outcomes And Measures: Risk-adjusted rates of superficial surgical site infection, wound complication, any complication, and 30-day mortality. Results: Implementation of Keystone Surgery in 14 participating centers was not associated with improvements in surgical outcomes during the study period. Adjusted rates of superficial surgical site infection (3.2%vs 3.2%, P = .91), wound complication (5.9%vs 6.5%, P = .30), any complication (12.4%vs 13.2%, P = .26), and 30-day mortality (2.1% vs 1.9%, P = .32) at participating hospitals were similar before and after implementation. Difference-in-differences analysis accounting for trends in 15 nonparticipating centers and sensitivity analysis excluding patients receiving surgery in the first 6 or 12 months after program implementation yielded similar results.

Original languageEnglish (US)
Pages (from-to)208-215
Number of pages8
JournalJAMA Surgery
Volume150
Issue number3
DOIs
StatePublished - Mar 1 2015

Fingerprint

Checklist
Surgical Wound Infection
Outcome Assessment (Health Care)
Quality Improvement
Mortality
Wounds and Injuries
Longitudinal Studies
Registries
Retrospective Studies
Logistic Models
Population

ASJC Scopus subject areas

  • Surgery

Cite this

A Checklist-Based intervention to improve surgical outcomes in Michigan evaluation of the keystone surgery program. / Reames, Bradley N; Krell, Robert W.; Campbell, Darrell A.; Dimick, Justin B.

In: JAMA Surgery, Vol. 150, No. 3, 01.03.2015, p. 208-215.

Research output: Contribution to journalArticle

Reames, Bradley N ; Krell, Robert W. ; Campbell, Darrell A. ; Dimick, Justin B. / A Checklist-Based intervention to improve surgical outcomes in Michigan evaluation of the keystone surgery program. In: JAMA Surgery. 2015 ; Vol. 150, No. 3. pp. 208-215.
@article{175bb314b85741bda2f64d2b41a47b03,
title = "A Checklist-Based intervention to improve surgical outcomes in Michigan evaluation of the keystone surgery program",
abstract = "Importance: Previous studies of checklist-based quality improvement interventions have reported mixed results. Objective: To evaluate whether implementation of a checklist-based quality improvement intervention-Keystone Surgery-was associated with improved outcomes in patients in a large statewide population undergoing general surgery. Design, Setting, and Exposures: A retrospective longitudinal study examined surgical outcomes in 64 891 Michigan patients in 29 hospitals using Michigan Surgical Quality Collaborative clinical registry data from 2006 through 2010. Multivariable logistic regression and difference-in-differences analytic approaches were used to evaluate whether Keystone Surgery program implementation was associated with improved surgical outcomes following general surgery procedures, apart from existing temporal trends toward improved outcomes during the study period. Main Outcomes And Measures: Risk-adjusted rates of superficial surgical site infection, wound complication, any complication, and 30-day mortality. Results: Implementation of Keystone Surgery in 14 participating centers was not associated with improvements in surgical outcomes during the study period. Adjusted rates of superficial surgical site infection (3.2{\%}vs 3.2{\%}, P = .91), wound complication (5.9{\%}vs 6.5{\%}, P = .30), any complication (12.4{\%}vs 13.2{\%}, P = .26), and 30-day mortality (2.1{\%} vs 1.9{\%}, P = .32) at participating hospitals were similar before and after implementation. Difference-in-differences analysis accounting for trends in 15 nonparticipating centers and sensitivity analysis excluding patients receiving surgery in the first 6 or 12 months after program implementation yielded similar results.",
author = "Reames, {Bradley N} and Krell, {Robert W.} and Campbell, {Darrell A.} and Dimick, {Justin B.}",
year = "2015",
month = "3",
day = "1",
doi = "10.1001/jamasurg.2014.2873",
language = "English (US)",
volume = "150",
pages = "208--215",
journal = "JAMA Surgery",
issn = "2168-6254",
publisher = "American Medical Association",
number = "3",

}

TY - JOUR

T1 - A Checklist-Based intervention to improve surgical outcomes in Michigan evaluation of the keystone surgery program

AU - Reames, Bradley N

AU - Krell, Robert W.

AU - Campbell, Darrell A.

AU - Dimick, Justin B.

PY - 2015/3/1

Y1 - 2015/3/1

N2 - Importance: Previous studies of checklist-based quality improvement interventions have reported mixed results. Objective: To evaluate whether implementation of a checklist-based quality improvement intervention-Keystone Surgery-was associated with improved outcomes in patients in a large statewide population undergoing general surgery. Design, Setting, and Exposures: A retrospective longitudinal study examined surgical outcomes in 64 891 Michigan patients in 29 hospitals using Michigan Surgical Quality Collaborative clinical registry data from 2006 through 2010. Multivariable logistic regression and difference-in-differences analytic approaches were used to evaluate whether Keystone Surgery program implementation was associated with improved surgical outcomes following general surgery procedures, apart from existing temporal trends toward improved outcomes during the study period. Main Outcomes And Measures: Risk-adjusted rates of superficial surgical site infection, wound complication, any complication, and 30-day mortality. Results: Implementation of Keystone Surgery in 14 participating centers was not associated with improvements in surgical outcomes during the study period. Adjusted rates of superficial surgical site infection (3.2%vs 3.2%, P = .91), wound complication (5.9%vs 6.5%, P = .30), any complication (12.4%vs 13.2%, P = .26), and 30-day mortality (2.1% vs 1.9%, P = .32) at participating hospitals were similar before and after implementation. Difference-in-differences analysis accounting for trends in 15 nonparticipating centers and sensitivity analysis excluding patients receiving surgery in the first 6 or 12 months after program implementation yielded similar results.

AB - Importance: Previous studies of checklist-based quality improvement interventions have reported mixed results. Objective: To evaluate whether implementation of a checklist-based quality improvement intervention-Keystone Surgery-was associated with improved outcomes in patients in a large statewide population undergoing general surgery. Design, Setting, and Exposures: A retrospective longitudinal study examined surgical outcomes in 64 891 Michigan patients in 29 hospitals using Michigan Surgical Quality Collaborative clinical registry data from 2006 through 2010. Multivariable logistic regression and difference-in-differences analytic approaches were used to evaluate whether Keystone Surgery program implementation was associated with improved surgical outcomes following general surgery procedures, apart from existing temporal trends toward improved outcomes during the study period. Main Outcomes And Measures: Risk-adjusted rates of superficial surgical site infection, wound complication, any complication, and 30-day mortality. Results: Implementation of Keystone Surgery in 14 participating centers was not associated with improvements in surgical outcomes during the study period. Adjusted rates of superficial surgical site infection (3.2%vs 3.2%, P = .91), wound complication (5.9%vs 6.5%, P = .30), any complication (12.4%vs 13.2%, P = .26), and 30-day mortality (2.1% vs 1.9%, P = .32) at participating hospitals were similar before and after implementation. Difference-in-differences analysis accounting for trends in 15 nonparticipating centers and sensitivity analysis excluding patients receiving surgery in the first 6 or 12 months after program implementation yielded similar results.

UR - http://www.scopus.com/inward/record.url?scp=84924957973&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84924957973&partnerID=8YFLogxK

U2 - 10.1001/jamasurg.2014.2873

DO - 10.1001/jamasurg.2014.2873

M3 - Article

VL - 150

SP - 208

EP - 215

JO - JAMA Surgery

JF - JAMA Surgery

SN - 2168-6254

IS - 3

ER -