Evaluating the impact of a collaborative quality initiative on surgical disparities: a retrospective analysis of surgical outcomes.

Abstract

Collaborative quality initiatives (CQIs), such as the Michigan Surgical Quality Collaborative (MSQC), have invested significant resources to improve surgical outcomes over time. This study aimed to assess whether CQI efforts translated to equitable improvements for vulnerable and non-vulnerable patients alike. We performed a retrospective observational study of patients who underwent an operation at one of 73 MSQC hospitals between 2014 and 2023. The coprimary exposures were the Distressed Communities Index (DCI), race and payer. DCI is a community index at the zip code level ranging from prosperous to distressed based on socioeconomic variables. Outcomes included 30-day complications, emergency department (ED) visits and readmissions, estimated using a logistic regression model adjusting for patient and hospital characteristics. Among 344 135 patients, the mean age (SD) was 54.7 (17.6) years and 50.7% were female. From 2014 to 2023, 30-day complications decreased for all groups stratified by DCI, race and payer. There was a disparity in complications between public versus privately insured patients (11.4% vs 9.2%, p<0.001) that significantly narrowed by the end of the study period (7.3% vs 6.6%, p=0.01). ED visits demonstrated baseline disparities by DCI (10.5% vs 7.5%, p<0.001), payer (11.1% vs 6.7%, p<0.001) and race (11.0% vs 8.2%, p<0.001). The disparity significantly narrowed by payer only (9.5% vs 6.4%, p<0.001). Readmissions decreased for all groups stratified by DCI, race and payer, but there were no significant changes in the disparities over time. Our study examining surgical outcomes for a statewide CQI found that disparities in outcomes narrowed over time. Quality collaboratives may effectively improve equity in surgical outcomes, but specific attention to persistent disparities is needed to close remaining gaps.