There is an interesting paper in the most recent Clinical Infectious Diseases on the Surgical Care Improvement Project (SCIP) and the Hospital Outpatient Measures Project (HOP). These are national QI projects intended to improve surgical care. The article lays out numerous problems with these projects, yet despite that, results from these projects will now begin to impact hospital reimbursement.

The authors note: "Measures are rolled out before their full impact is assessed, using live hospitals as the testing ground and relying on individuals trying to comply with these measures to troubleshoot. When issues do arise that require the measures to be changed, response times are invariably at least 6 months; meanwhile patients may be at risk, and measures are consistently failed."

It would be very interesting to know what these projects have cost hospitals. At my hospital, we have 1.5 nurse FTE just to abstract the data. Beyond that are thousands of hours of physician and nurse time spent trying to improve compliance with the metrics. And yet, there remains no compelling published data that outcomes have been improved.

Dale Bratzler, the brainchild of the projects, writes a response in the same issue of CID. At best, his response is tepid, and sheds little light on why these projects should be continued. His commentary ends like this: "The specific issues with SCIP performance metrics highlighted by Weston and colleagues are clearly a source of frustration for providers. However, the authors do not provide any evidence that harm has occurred because of implementation of SCIP." Ok, so we wasted millions of dollars, frustrated clinicians, and are about to punish hospitals financially, but we don't think any patients were harmed. Now that's exactly why much of QI is viewed as a joke!


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