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O'Neill SM, Fry BT, Weng W, Rubyan M, Howard RA, Ehlers AP, Englesbe MJ, Dimick JB, Telem DA. Use of statewide financial incentives to improve documentation of hernia and mesh characteristics in ventral hernia repair. Surg Endosc 2024; 38:414-418. [PMID: 37821560 DOI: 10.1007/s00464-023-10498-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/24/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Documentation of intraoperative details is critical for understanding and advancing hernia care, but is inconsistent in practice. Therefore, to improve data capture on a statewide level, we implemented a financial incentive targeting documentation of hernia defect size and mesh use. METHODS The Abdominal Hernia Care Pathway (AHCP), a voluntary pay for performance (P4P) initiative, was introduced in 2021 within the statewide Michigan Surgical Quality Collaborative (MSQC). This consisted of an organizational-level financial incentive for achieving 80% performance on eight specific process measures for ventral hernia surgery, including complete documentation of hernia defect size and location, as well as mesh characteristics and fixation technique. Comparisons were made between AHCP and non-AHCP sites in 2021. RESULTS Of 69 eligible sites, 47 participated in the AHCP in 2021. There were N = 5362 operations (4169 at AHCP sites; 1193 at non-AHCP sites). At AHCP sites, 69.8% of operations had complete hernia documentation, compared to 50.5% at non-AHCP sites (p < 0.0001). At AHCP sites, 91.4% of operations had complete mesh documentation, compared to 86.5% at non-AHCP sites (p < 0.0001). The site-level hernia documentation goal of 80% was reached by 14 of 47 sites (range 14-100%). The mesh documentation goal was reached by 41 of 47 sites (range 4-100%). CONCLUSIONS Addition of an organizational-level financial incentive produced marked gains in documentation of intra-operative details across a statewide surgical collaborative. The relatively large effect size-19.3% for hernia-is remarkable among P4P initiatives. This result may have been facilitated by surgeons' direct role in documenting hernia size and mesh use. These improvements in data capture will foster understanding of current hernia practices on a large scale and may serve as a model for improvement in collaboratives nationally.
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Affiliation(s)
- Sean M O'Neill
- Department of Surgery, Michigan Medicine, University of Michigan, Taubman Center, TC 2924B, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA.
| | - Brian T Fry
- Department of Surgery, Michigan Medicine, University of Michigan, Taubman Center, TC 2924B, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Wenjing Weng
- Michigan Surgical Quality Collaborative, Ann Arbor, MI, USA
| | - Michael Rubyan
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Ryan A Howard
- Department of Surgery, Michigan Medicine, University of Michigan, Taubman Center, TC 2924B, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Anne P Ehlers
- Department of Surgery, Michigan Medicine, University of Michigan, Taubman Center, TC 2924B, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Michael J Englesbe
- Department of Surgery, Michigan Medicine, University of Michigan, Taubman Center, TC 2924B, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Justin B Dimick
- Department of Surgery, Michigan Medicine, University of Michigan, Taubman Center, TC 2924B, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Dana A Telem
- Department of Surgery, Michigan Medicine, University of Michigan, Taubman Center, TC 2924B, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
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