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Use of statewide financial incentives to improve documentation of hernia and mesh characteristics in ventral hernia repair

  • 2023 SAGES Oral
  • Published:
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Abstract

Background

Documentation of intraoperative details is critical for understanding and advancing hernia care, but is inconsistent in practice. Therefore, to improve data capture on a statewide level, we implemented a financial incentive targeting documentation of hernia defect size and mesh use.

Methods

The Abdominal Hernia Care Pathway (AHCP), a voluntary pay for performance (P4P) initiative, was introduced in 2021 within the statewide Michigan Surgical Quality Collaborative (MSQC). This consisted of an organizational-level financial incentive for achieving 80% performance on eight specific process measures for ventral hernia surgery, including complete documentation of hernia defect size and location, as well as mesh characteristics and fixation technique. Comparisons were made between AHCP and non-AHCP sites in 2021.

Results

Of 69 eligible sites, 47 participated in the AHCP in 2021. There were N = 5362 operations (4169 at AHCP sites; 1193 at non-AHCP sites). At AHCP sites, 69.8% of operations had complete hernia documentation, compared to 50.5% at non-AHCP sites (p < 0.0001). At AHCP sites, 91.4% of operations had complete mesh documentation, compared to 86.5% at non-AHCP sites (p < 0.0001). The site-level hernia documentation goal of 80% was reached by 14 of 47 sites (range 14–100%). The mesh documentation goal was reached by 41 of 47 sites (range 4–100%).

Conclusions

Addition of an organizational-level financial incentive produced marked gains in documentation of intra-operative details across a statewide surgical collaborative. The relatively large effect size—19.3% for hernia—is remarkable among P4P initiatives. This result may have been facilitated by surgeons’ direct role in documenting hernia size and mesh use. These improvements in data capture will foster understanding of current hernia practices on a large scale and may serve as a model for improvement in collaboratives nationally.

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No funding was received for this study.

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Authors and Affiliations

  1. Department of Surgery, Michigan Medicine, University of Michigan, Taubman Center, TC 2924B, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA

    Sean M. O’Neill, Brian T. Fry, Ryan A. Howard, Anne P. Ehlers, Michael J. Englesbe, Justin B. Dimick & Dana A. Telem

  2. Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA

    Sean M. O’Neill, Brian T. Fry, Michael Rubyan, Ryan A. Howard, Anne P. Ehlers, Michael J. Englesbe, Justin B. Dimick & Dana A. Telem

  3. Michigan Surgical Quality Collaborative, Ann Arbor, MI, USA

    Wenjing Weng

  4. University of Michigan School of Public Health, Ann Arbor, MI, USA

    Michael Rubyan

Authors
  1. Sean M. O’Neill
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  2. Brian T. Fry
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Correspondence to Sean M. O’Neill.

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Sean O’Neill, Brian Fry, Wenjing Weng, Michael Rubyan, Ryan Howard, Anne Ehlers, Michael Engelsbe, Justin Dimick and Dana Telem have no conflicts of interest or financial ties to disclose.

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O’Neill, S.M., Fry, B.T., Weng, W. et al. Use of statewide financial incentives to improve documentation of hernia and mesh characteristics in ventral hernia repair. Surg Endosc 38, 414–418 (2024). https://doi.org/10.1007/s00464-023-10498-9

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