TY - JOUR
T1 - Best Practices in Data Use for Achieving Successful Implementation of Enhanced Recovery Pathway
AU - Hu, Q. Lina
AU - Liu, Jessica Y.
AU - Hobson, Deborah B.
AU - Cohen, Mark E.
AU - Hall, Bruce L.
AU - Wick, Elizabeth C.
AU - Ko, Clifford Y.
N1 - Funding Information:
Support: This project was funded under contract no. HHSP233201500020I from the Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services. Drs Hu, Liu, Ko, and Wick are supported by a grant from the AHRQ (HHSP233201500020I).
Publisher Copyright:
© 2019 American College of Surgeons
PY - 2019/12
Y1 - 2019/12
N2 - Background: Although enhanced recovery pathways (ERPs) have demonstrated promising results in published literature, their effectiveness has been inconsistent. The objective of this study was to identify the most important data use practices associated with successful implementation of ERPs. Study Design: As part of a national ERP implementation initiative, data regarding hospitals' previous ERP implementation experience were collected. Specifically, 4 data use practices (data collection, report generation, feedback to leadership, and feedback to frontline providers) and 2 data types (process measures and outcome measures) were correlated with ERP implementation outcomes (hospital-reported success and patient outcomes from the American College of Surgeons [ACS] NSQIP data). Results: Of 140 hospitals evaluated, 73 (52.1%) reported previous ERP implementation, with wide variations in data use practices. Of these, 33 (45.2%) reported successful implementation. Feedback of both process and outcome measure data was performed by only 15.1% of hospitals, but was associated with significantly higher likelihood of successful implementation when compared with no feedback (relative risk [RR] 2.45, 95% CI 1.69 to 3.56; p < 0.001) and feedback of only outcome measure data (RR 2.73, 95% CI 1.06 to 7.00; p = 0.037). Using ACS NSQIP data from 6,888 colorectal surgery patients from 52 hospitals with colorectal ERPs, hospital-reported success was associated with significantly lower surgical site infection rates (6.6% vs 8.1%; p = 0.011) and shorter length of stay (6.2 vs 7.0 days; p < 0.001). Conclusions: The most important data use practice associated with successful ERP implementation was data feedback to frontline providers of both process and outcome measures. However, this was rarely performed in a national cohort of hospitals and represents a substantial but straightforward opportunity for improvement.
AB - Background: Although enhanced recovery pathways (ERPs) have demonstrated promising results in published literature, their effectiveness has been inconsistent. The objective of this study was to identify the most important data use practices associated with successful implementation of ERPs. Study Design: As part of a national ERP implementation initiative, data regarding hospitals' previous ERP implementation experience were collected. Specifically, 4 data use practices (data collection, report generation, feedback to leadership, and feedback to frontline providers) and 2 data types (process measures and outcome measures) were correlated with ERP implementation outcomes (hospital-reported success and patient outcomes from the American College of Surgeons [ACS] NSQIP data). Results: Of 140 hospitals evaluated, 73 (52.1%) reported previous ERP implementation, with wide variations in data use practices. Of these, 33 (45.2%) reported successful implementation. Feedback of both process and outcome measure data was performed by only 15.1% of hospitals, but was associated with significantly higher likelihood of successful implementation when compared with no feedback (relative risk [RR] 2.45, 95% CI 1.69 to 3.56; p < 0.001) and feedback of only outcome measure data (RR 2.73, 95% CI 1.06 to 7.00; p = 0.037). Using ACS NSQIP data from 6,888 colorectal surgery patients from 52 hospitals with colorectal ERPs, hospital-reported success was associated with significantly lower surgical site infection rates (6.6% vs 8.1%; p = 0.011) and shorter length of stay (6.2 vs 7.0 days; p < 0.001). Conclusions: The most important data use practice associated with successful ERP implementation was data feedback to frontline providers of both process and outcome measures. However, this was rarely performed in a national cohort of hospitals and represents a substantial but straightforward opportunity for improvement.
UR - http://www.scopus.com/inward/record.url?scp=85075032638&partnerID=8YFLogxK
U2 - 10.1016/j.jamcollsurg.2019.08.1448
DO - 10.1016/j.jamcollsurg.2019.08.1448
M3 - Article
C2 - 31634564
AN - SCOPUS:85075032638
SN - 1072-7515
VL - 229
SP - 626-632.e1
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 6
ER -