Computational Biology
Microarrays Prove Reliable in Cross-platform Tests
Immunology
T Cell Misfits May Spell Autoimmunity
Pathology
Prostate Tumor Chemistry
Reveals Early Disease
Medical Education
Dienstag Named Medical Education Dean
Student Research Takes Stage at Soma Weiss Day
Minorities Appear to Use CAM Less Than Whites
Blueprint Drawn for Ebola Infection
Director Appointed for Research Compliance at HMS
Abelardo Morell Photograph Donated
Stem Cell Institute Awards 12 Seed Grants
Connors Gift Renames MGH Building After Thiers
Zelen Award and Talk Announced
Rabkin Fellows Chosen for ’05–’06
Honors and Advances
In Memoriam
Surgery Center Joins Push for Quality Improvement
Surgery Center Joins Push for Quality Improvement
 Photo by Graham Ramsay Selwyn Rogers (left) and Michael Zinner led the development of the Center for Surgery and Public Health, a multi-institutional collaboration for quality assessment and improvement in surgery. |
Surgery and public health are not often considered in the same context, but recent developments in both fields and efforts under way at the national and local levels are bridging the gap between these disciplines, with an eye toward improving patient care.
After two years of planning, the Brigham and Women’s Hospital Center for Surgery and Public Health, a collaboration among BWH, HMS, and HSPH, was established in March to investigate quality of care, the availability of adequate surgical manpower, and the appropriate use of surgical resources internationally. Headed by Selwyn Rogers Jr., the center will bring together researchers from diverse backgrounds, including physicians, health services researchers, and health law and health policy experts, to set new quality standards in surgery, to better understand the policy implications of surgical workforce utilization in the United States and abroad, and to support multidisciplinary research in the areas of quality of surgical care, disparities in surgical care, and international health. Rogers is chief of the Division of Trauma, Burn and Surgical Critical Care at BWH and executive director of the center.
Quality Assessment
The movement to study outcomes in surgery is not new. Growing public demand
for near-perfect results has highlighted the need for high quality surgical
care. Research in the Veterans Health Administration (VHA) that assessed
predictors of surgical outcomes with an approach called the National Surgical
Quality
Improvement Program (NSQIP) catalyzed the movement in the United States.
NSQIP was instituted in 1994 to collect preoperative, intraoperative, and
30-day
outcome variables. With this data, the VHA was able to develop risk-adjustment
models for surgical outcomes and develop best practices. Between 2002 and
2004, 18 private-sector hospitals, including BWH and Massachusetts General
Hospital,
were included in the NSQIP, in a study funded by the Agency for Healthcare
Research and Quality (AHRQ). Beginning in 2005, the American College of
Surgeons began a private-sector expansion to make the NSQIP available to
all surgery
practices.
| “Residency training as currently conceived is woefully inadequate to train surgeons for the world they will enter.” |
Applying NSQIP is one of the major strategies of the Center for Surgery and Public Health, as is its cross-disciplinary, multi-institutional approach to quality assessment and improvement. “External reporting of outcomes has become public knowledge and the demand for transparency regarding quality of care has mandated a collaboration,” Rogers said. He credits Michael Zinner, chairman of the Department of Surgery at BWH and the Mosely professor of surgery at HMS, with envisioning the center.
Training Top Surgeons
The education and training of surgeons and the optimal level of manpower
and workforce diversification are important additional areas of research
for the
surgery center. Rogers believes that changing the paradigm for education,
beginning in medical school, is essential. “Residency training
as currently conceived is woefully inadequate to train surgeons for
the world they will enter,” he
said. He advocates greater use of information technology, including
online decision support, streamlining of the educational process to
suit particular
career paths, re-education for those who want to make career changes,
and re-certification focusing on competence, not testing.
Surgery residents and fellows will be an integral part of the center and will have the opportunity to study at HSPH during their fellowship training. One-on-one mentoring from senior researchers will be available as will funding for residents and fellows conducting patient-centered research. Caprice Christian, currently a chief surgical resident at BWH, has worked on outcomes research in the past and will continue her research during her upcoming fellowship in surgical oncology as a researcher affiliated with the center. The research portion of her fellowship will focus on quality of care in two different areas, patient safety and health-care utilization.
Christian believes that the field of outcomes research as applied to surgery has come to the fore in recent years not only because of the greater interest in quality from patients and physicians and pressure from public scrutiny, but attention from organizations such as the Leapfrog Group, a coalition of health care purchasers who have attempted to use their combined purchasing power to encourage quality improvement. “If we don’t regulate the quality of surgical care, others will,” she said. “We’re trying, in a scientifically rigorous way, to investigate what many physicians already know are problems and then to address them.”
The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.
Related Websites
Center for Surgery and Public Health:
www.brighamandwomens.org/centerforsurgeryandpublichealth
American
College of Surgeons National Surgical Quality Improvement Program:
www.nsqip.org
The
Leapfrog Group:
www.leapfroggroup.org