Hospital participation in surgical quality program results in minimal improvements

Observational studies using large databases rarely get better than these two reports, which used sophisticated risk adjustments and achieved unusually rigorous matching of controls. But the studies by Osborne et al. and Etzioni et al. are not the final word on whether NSQIP can help improve the quality of surgical care.

The most likely explanation for the lack of improvement after feedback on surgical performance is that this information is necessary but not sufficient to effect change. The skills for improving processes and cultures do not yet pervade U.S. hospitals, to say the least. Proponents of NSQIP must link its information more energetically to the processes of learning, skill building, and change within participating hospitals.

David M. Berwick, M.D., is president emeritus and senior fellow at the Institute for Healthcare Improvement, Cambridge, Mass. He reported no relevant financial conflicts of interest. Dr. Berwick made these remarks in an editorial accompanying the two reports (JAMA 2015;313:469-70).