Abdominal Core Health Quality Collaborative

Moving the Needle in Reducing Readmissions

The repair of inguinal hernias is one of the most common surgical procedures in the United States – with approximately 700,000 operations done each year.

“Although inguinal hernia repair is a common procedure, there are still many unanswered questions that rigorous assessment of real world data may address,” said Benjamin K. Poulose, M.D., M.P.H., Director for Quality and Outcomes, Abdominal Core Health Quality Collaborative (ACHQC) (formerly the Americas Hernia Society Quality Collaborative). “Incorporating the ACHQC into clinical practice has the potential to help improve efficiency and enhance care by analyzing some of these unknowns.”

ACHQC aims to improve the value in hernia care delivered to patients. Formed by hernia surgeons in private practice and academic settings, the ACHQC utilizes concepts of continuous quality improvement to improve outcomes and optimize costs. This is accomplished through a registry powered by ArborMetrix that delivers patient-centered data collection, ongoing performance feedback to clinicians, and analysis of collected data that supports research and collaborative learning.

To build and support a tailored registry, ACHQC leadership and ArborMetrix defined and configured specific measures, data models, and reports that bring together clinical data and patient reported outcomes for hernia repair in one easily accessible cloud-based system. The precise measures and models within the ACHQC registry provide clinical relevance and a clear picture of performance to participating surgeons.

By using the ArborMetrix analytics engine, and real-time measures and reports, the ACHQC is able to identify which processes are associated with the best outcome, and learn what can be done differently to improve standards of care. “ArborMetrix dynamically benchmarks performance in real-time, which is crucial for tracking the impact of quality improvement interventions,” Dr. Poulose said. “This has allowed ACHQC to improve the quality and cost-effectiveness of hernia repair by providing surgeons with immediate, risk-stratified metrics to determine the best procedure for an individual patient based on various factors.”

The actionable reports powered by ArborMetrix help ACHQC facilitate a process for continuous improvement at the society and individual surgeon level.

Ventral Hernia Decision Support Tool

Data from the ACHQC registry feeds the Ventral Hernia Support Tool, which predicts and displays complication rates and resource utilization in a manner that allows for efficient clinical trade-off decisions between open, laparoscopic and robotic surgical techniques. Specifically, the calculator predicts surgical site infections (30-day), readmission (30-day), hernia recurrence (one year), and hospital length of stay. Raw and post-analytics data are shared collaboratively among the society, surgeons, industry partners and the FDA in support of post-market surveillance initiatives to improve surgical hernia repair.
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Featured Results

ACHQC and its members have collectively achieved outstanding results and greatly enhanced care for their patients. A few highlights include:

• Identified alternative protocol to reduce length of stay and opioid dose requirements.
• Identified protocol to successfully reduce early readmissions after ventral hernia repair.
• Established collaborative engagements with the FDA and MDEpiNet.
• Regularly published peer-reviewed research in leading journals.
• Achieved MOC part IV recognition by American Board of Surgery.

Learn more about ACHQC at achqc.org/.
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Featured Research

1. Length of Stay and Opioid Dose Requirement with Transversus Abdominis Plane Block vs Epidural Analgesia for Ventral Hernia Repair. Journal of the American College of Surgeons. April 2019.
   Use of TAP block significantly reduces length of stay and decreases opioid dose requirements in the early postoperative period compared with epidural analgesia. (Warren JA, et al., JACS 2019).
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2. Reducing Early Readmissions after Ventral Hernia Repair with the Americas Hernia Society Quality Collaborative. Journal of the American College of Surgeons. May 2018.
   The AHSQC Early Readmission Reduction Initiative successfully reduced readmissions after VHRusing a structured questionnaire or early clinic visit implemented after discharge and before routine 30-day postoperative follow-up. (Poulose BK, et al., JACS 2018).
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3. Hybrid Robotic-assisted Transversus Abdominis Release vs. Open Transversus Abdominis Release: A Comparison of Short-Term Outcomes. Hernia. February 2019.
   Hybrid robotic transversus abdominis release (hrTAR) may be performed with significantly lower LOS, similar wound morbidity and complication profile compared to open TAR. This novel surgical technique provides a minimally invasive option for a challenging subset of patients. (Halka JT, et al., Hernia 2019).

References

1 ACHQC Newsletter, September 2016. https://www.achqc.org/uploads/general_images/AHSQC_Newsletter_FINAL.pdf

2 ACHQC Website, June 2017. https://www.achqc.org/news/news

3 ACHQC Press Release, February 2017. http://www.prweb.com/releases/2017/02/prweb14054179.htm