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J Am Coll Surg. 2018 Jan;226(1):91-99. doi: 10.1016/j.jamcollsurg.2017.10.013. Epub 2017 Oct 28.

Evidence that a Regional Surgical Collaborative Can Transform Care: Surgical Site Infection Prevention Practices for Colectomy in Michigan.

Author information

1
Department of Surgery, University of Michigan, Ann Arbor, MI.
2
Michigan Surgical Quality Collaborative, University of Michigan, Ann Arbor, MI.
3
Department of Surgery, University of Michigan, Ann Arbor, MI; Michigan Surgical Quality Collaborative, University of Michigan, Ann Arbor, MI.
4
Michigan Surgical Quality Collaborative, University of Michigan, Ann Arbor, MI. Electronic address: krapohlg@med.umich.edu.

Abstract

BACKGROUND:

Surgical site infections (SSI) after colectomy are associated with increased morbidity and health care use. Since 2012, the Michigan Surgical Quality Collaborative (MSQC) has promoted a "bundle" of care processes associated with lower SSI risk, using an audit-and-feedback system for adherence, face-to-face meetings, and support for quality improvement projects at participating hospitals. The purpose of this study was to determine whether practices changed over time.

STUDY DESIGN:

We previously found 6 processes of care independently associated with SSI in colectomy. From 2012 to 2016, we promoted a bundle of 3 care measures (cefazolin/metronidazole, oral antibiotics after mechanical bowel preparation, and normoglycemia) in 52 hospitals. Primary outcome was change in use of the 3-item SSI bundle. We also used a hierarchical logistic regression model to assess the association between 6-item compliance and SSI rate, morbidity, and health care use.

RESULTS:

The use of cefazolin/metronidazole increased from 18.6% to 32.3% (p < 0.001), oral antibiotic preparation increased from 42.9% to 62.0% (p < 0.001). The increase in normoglycemia was not significant. Concurrently, the SSI rate fell from 6.7% to 3.9% in the 52 hospitals (p = 0.012). Patients receiving more bundle measures had decreased rates of SSI, sepsis, and pneumonia. Morbidity and health care use significantly decreased with increased bundle compliance.

CONCLUSIONS:

These data show a significant increase in use of process measures promoted by a regional quality improvement collaborative, and an associated decrease in SSI after elective colectomy. These results highlight the promise of regional collaboratives to accelerate practice change and improve outcomes.

[Indexed for MEDLINE]

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