Clin Colon Rectal Surg 2019; 32(01): 016-024
DOI: 10.1055/s-0038-1673350
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Statewide Clinic Registries: The Michigan Surgical Quality Collaborative

Vahagn C. Nikolian
1   Department of Surgery, University of Michigan, Ann Arbor, Michigan
Scott E. Regenbogen
1   Department of Surgery, University of Michigan, Ann Arbor, Michigan
› Author Affiliations
Further Information

Publication History

Publication Date:
08 January 2019 (online)


Regional clinical registries provide a unique opportunity for shared learning and population-based analyses of the quality of surgical care. Through the “Michigan Model” of pay for participation in strategic Value Partnerships, exemplified by the Michigan Surgical Quality Collaborative (MSQC), the state's dominant private insurer, Blue Cross Blue Shield of Michigan, has sponsored 20 statewide clinical quality improvement collaboratives. MSQC represents a partnership among 73 Michigan hospitals with a robust data infrastructure and flexible platform for the promulgation of best practices in surgical quality improvement. This article will describe the organizational structure of the MSQC, the contributions the registry has made to quality improvement in colorectal surgery, and how future work will align to improve the reliability of improvement-relevant registry data.

  • References

  • 1 Birkmeyer JD. Strategies for improving surgical quality--checklists and beyond. N Engl J Med 2010; 363 (20) 1963-1965
  • 2 Healy MA, Mullard AJ, Campbell Jr DA, Dimick JB. Hospital and payer costs associated with surgical complications. JAMA Surg 2016; 151 (09) 823-830
  • 3 Dimick JB, Weeks WB, Karia RJ, Das S, Campbell Jr DA. Who pays for poor surgical quality? Building a business case for quality improvement. J Am Coll Surg 2006; 202 (06) 933-937
  • 4 Birkmeyer JD, Gust C, Dimick JB, Birkmeyer NJ, Skinner JS. Hospital quality and the cost of inpatient surgery in the United States. Ann Surg 2012; 255 (01) 1-5
  • 5 Regenbogen SE, Veenstra CM, Hawley ST. , et al. The personal financial burden of complications after colorectal cancer surgery. Cancer 2014; 120 (19) 3074-3081
  • 6 Share DA, Campbell DA, Birkmeyer N. , et al. How a regional collaborative of hospitals and physicians in Michigan cut costs and improved the quality of care. Health Aff (Millwood) 2011; 30 (04) 636-645
  • 7 Campbell Jr DA, Kubus JJ, Henke PK, Hutton M, Englesbe MJ. The Michigan Surgical Quality Collaborative. The Michigan Surgical Quality Collaborative: a legacy of Shukri Khuri. Am J Surg 2009; 198 (5, Suppl): S49-S55
  • 8 Dimick JB, Staiger DO, Birkmeyer JD. Ranking hospitals on surgical mortality: the importance of reliability adjustment. Health Serv Res 2010; 45 (6, Pt 1): 1614-1629
  • 9 Regenbogen SE, Osborne NH, Dimick JB. Hospital characteristics and participation in the National Surgical Quality Improvement Program. J Surg Res 2012; 172: 212
  • 10 Osborne NH, Nicholas LH, Ryan AM, Thumma JR, Dimick JB. Association of hospital participation in a quality reporting program with surgical outcomes and expenditures for Medicare beneficiaries. JAMA 2015; 313 (05) 496-504
  • 11 Etzioni DA, Wasif N, Dueck AC. , et al. Association of hospital participation in a surgical outcomes monitoring program with inpatient complications and mortality. JAMA 2015; 313 (05) 505-511
  • 12 Campbell Jr DA, Englesbe MJ, Kubus JJ. , et al. Accelerating the pace of surgical quality improvement: the power of hospital collaboration. Arch Surg 2010; 145 (10) 985-991
  • 13 Hendren S, McKeown E, Morris AM. , et al. Implementation of a hospital-based quality assessment program for rectal cancer. J Oncol Pract 2014; 10 (03) e120-e129
  • 14 Abdelsattar ZM, Wong SL, Birkmeyer NJ. , et al. Multi-institutional assessment of sphincter preservation for rectal cancer. Ann Surg Oncol 2014; 21 (13) 4075-4080
  • 15 Slim K, Vicaut E, Launay-Savary MV, Contant C, Chipponi J. Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg 2009; 249 (02) 203-209
  • 16 Englesbe MJ, Brooks L, Kubus J. , et al. A statewide assessment of surgical site infection following colectomy: the role of oral antibiotics. Ann Surg 2010; 252 (03) 514-519 , discussion 519–520
  • 17 Kim EK, Sheetz KH, Bonn J. , et al. A statewide colectomy experience: the role of full bowel preparation in preventing surgical site infection. Ann Surg 2014; 259 (02) 310-314
  • 18 Hendren S, Fritze D, Banerjee M. , et al. Antibiotic choice is independently associated with risk of surgical site infection after colectomy: a population-based cohort study. Ann Surg 2013; 257 (03) 469-475
  • 19 Stulberg JJ, Delaney CP, Neuhauser DV, Aron DC, Fu P, Koroukian SM. Adherence to surgical care improvement project measures and the association with postoperative infections. JAMA 2010; 303 (24) 2479-2485
  • 20 Hendren S, Englesbe MJ, Brooks L, Kubus J, Yin H, Campbell Jr DA. Prophylactic antibiotic practices for colectomy in Michigan. Am J Surg 2011; 201 (03) 290-293 , discussion 293–294
  • 21 Krapohl GL, Morris AM, Cai S. , et al. Preoperative risk factors for postoperative Clostridium difficile infection in colectomy patients. Am J Surg 2013; 205 (03) 343-347 , discussion 347–348
  • 22 Krapohl GL, Phillips LR, Campbell Jr DA. , et al. Bowel preparation for colectomy and risk of Clostridium difficile infection. Dis Colon Rectum 2011; 54 (07) 810-817
  • 23 Kaoutzanis C, Kavanagh CM, Leichtle SW. , et al. Chlorhexidine with isopropyl alcohol versus iodine povacrylex with isopropyl alcohol and alcohol- versus nonalcohol-based skin preparations: the incidence of and readmissions for surgical site infections after colorectal operations. Dis Colon Rectum 2015; 58 (06) 588-596
  • 24 Mohan S, Kaoutzanis C, Welch KB. , et al. Postoperative hyperglycemia and adverse outcomes in patients undergoing colorectal surgery: results from the Michigan surgical quality collaborative database. Int J Colorectal Dis 2015; 30 (11) 1515-1523
  • 25 Waits SA, Fritze D, Banerjee M. , et al. Developing an argument for bundled interventions to reduce surgical site infection in colorectal surgery. Surgery 2014; 155 (04) 602-606
  • 26 Leichtle SW, Mouawad NJ, Welch KB, Lampman RM, Cleary RK. Risk factors for anastomotic leakage after colectomy. Dis Colon Rectum 2012; 55 (05) 569-575
  • 27 Nikolian VC, Kamdar N, Regenbogen SE. , et al. Anastomotic leak after colorectal resection: a population-based study of risk factors and hospital variation. Dis Colon Rectum 2016; 59: e49-e400
  • 28 Ziegler MA, Catto JA, Riggs TW, Gates ER, Grodsky MB, Wasvary HJ. Risk factors for anastomotic leak and mortality in diabetic patients undergoing colectomy: analysis from a statewide surgical quality collaborative. Arch Surg 2012; 147 (07) 600-605
  • 29 Delaney CP, Weese JL, Hyman NH. , et al; Alvimopan Postoperative Ileus Study Group. Phase III trial of alvimopan, a novel, peripherally acting, mu opioid antagonist, for postoperative ileus after major abdominal surgery. Dis Colon Rectum 2005; 48 (06) 1114-1125 , discussion 1125–1126, author reply 1127–1129
  • 30 Poston S, Broder MS, Gibbons MM. , et al. Impact of alvimopan (Entereg) on hospital costs after bowel resection: results from a large inpatient database. P&T 2011; 36 (04) 209-220
  • 31 Absher RK, Gerkin TM, Banares LW. Alvimopan use in laparoscopic and open bowel resections: clinical results in a large community hospital system. Ann Pharmacother 2010; 44 (11) 1701-1708
  • 32 Obokhare ID, Champagne B, Stein SL, Krpata D, Delaney CP. The effect of alvimopan on recovery after laparoscopic segmental colectomy. Dis Colon Rectum 2011; 54 (06) 743-746
  • 33 Harbaugh CM, Al-Holou SN, Bander TS. , et al. A statewide, community-based assessment of alvimopan's effect on surgical outcomes. Ann Surg 2013; 257 (03) 427-432
  • 34 Regenbogen SE, Shah NJ, Stacey D, Hendren S, Englesbe MJ, Campbell Jr DA. Population-based assessment of intraoperative fluid administration practices across three surgical specialties. Ann Surg 2017; 265 (05) 930-940
  • 35 Guillou PJ, Quirke P, Thorpe H. , et al; MRC CLASICC trial group. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 2005; 365 (9472): 1718-1726
  • 36 Nelson H, Sargent DJ, Wieand HS. , et al; Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004; 350 (20) 2050-2059
  • 37 Tam MS, Kaoutzanis C, Mullard AJ. , et al. A population-based study comparing laparoscopic and robotic outcomes in colorectal surgery. Surg Endosc 2016; 30 (02) 455-463
  • 38 Bhama AR, Obias V, Welch KB, Vandewarker JF, Cleary RK. A comparison of laparoscopic and robotic colorectal surgery outcomes using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Surg Endosc 2016; 30 (04) 1576-1584
  • 39 Bhama AR, Wafa AM, Ferraro J. , et al. Comparison of risk factors for unplanned conversion from laparoscopic and robotic to open colorectal surgery using the Michigan Surgical Quality Collaborative (MSQC) database. J Gastrointest Surg 2016; 20 (06) 1223-1230
  • 40 Regenbogen SE, Mullard AJ, Peters N. , et al. Hospital analgesia practices and patient-reported pain after colorectal resection. Ann Surg 2016; 264 (06) 1044-1050
  • 41 Klein M, Gögenur I, Rosenberg J. Postoperative use of non-steroidal anti-inflammatory drugs in patients with anastomotic leakage requiring reoperation after colorectal resection: cohort study based on prospective data. BMJ 2012; 345: e6166
  • 42 Paulasir S, Kaoutzanis C, Welch KB. , et al. Nonsteroidal anti-inflammatory drugs: do they increase the risk of anastomotic leaks following colorectal operations?. Dis Colon Rectum 2015; 58 (09) 870-877
  • 43 Krell RW, Girotti ME, Fritze D, Campbell DA, Hendren S. Hospital readmissions after colectomy: a population-based study. J Am Coll Surg 2013; 217 (06) 1070-1079
  • 44 Hendren S, Morris AM, Zhang W, Dimick J. Early discharge and hospital readmission after colectomy for cancer. Dis Colon Rectum 2011; 54 (11) 1362-1367
  • 45 Martin RC, Brown R, Puffer L. , et al. Readmission rates after abdominal surgery: the role of surgeon, primary caregiver, home health, and subacute rehab. Ann Surg 2011; 254 (04) 591-597
  • 46 Kao LS, Ghaferi AA, Ko CY, Dimick JB. Reliability of superficial surgical site infections as a hospital quality measure. J Am Coll Surg 2011; 213 (02) 231-235
  • 47 Dimick JB, Staiger DO, Baser O, Birkmeyer JD. Composite measures for predicting surgical mortality in the hospital. Health Aff (Millwood) 2009; 28 (04) 1189-1198
  • 48 Shih T, Cole AI, Al-Attar PM. , et al. Reliability of surgeon-specific reporting of complications after colectomy. Ann Surg 2015; 261 (05) 920-925