2526 Utilizing Quality and Value Metrics to Improve Patient Outcomes Through the Kaiser Permanente Minimally Invasive Hysterectomy Initiative

Abstract

Study Objective We present a case study in improving quality metrics with the Kaiser Permanente Minimally Invasive Hysterectomy Initiative to address the high rates of abdominal hysterectomies. Design Quality Improvement Project. Setting Route of hysterectomy (abdominal, laparoscopic, vaginal, robotic). Patients or Participants 31,385 patients who underwent surgical hysterectomy at Kaiser Permanente Northern California between 2008-2015. Interventions We initiated a four-pronged quality improvement program to increase the rate of minimally invasive hysterectomies, including: 1) Leadership engagement to set goals and achievable targets; 2) Surgeon education and training; 3) Utilization of targeted medical data to track outcomes and drive performance; and 4) Delineation of Obstetrics and Gynecology surgical teams and establishment of criterion-based credentialing. Measurements and Main Results Total abdominal hysterectomy percentages decreased from 50.5% to 6.9%, and total laparoscopic hysterectomy percentages increased from 21.9% to 61.9%. Robotic hysterectomy percentages only increased from 0.1% to 7.8%, and total vaginal hysterectomy percentages were maintained. Conclusion Our experience indicates that a quality improvement program to reduce abdominal hysterectomies while improving patient care can be successfully instituted on a large scale with limited reliance on less cost-effective robotic technology. The core aspects of the strategy should be highly incentivized under programs like Medicare Access and CHIP Reauthorization Act (MACRA). Moreover, this model can be used to address other quality issues in gynecologic surgery. It is our hope that the future of gynecologic surgery moves towards such a model that prioritizes optimal patient care. Please note that this abstract includes information that was presented in the paper, “Measuring Quality in Minimally Invasive Gynecologic Surgery: What, How, and Why?” by Abel et. al. in JMIG February 2019.