Quality Projects
Many of our research projects start out as quality initiatives, designed to improve patient care and postoperative outcomes. These initiatives allow us to identify areas for improvement, implement evidence-based solutions, and measure the impact on patient health and satisfaction.
Patient-Reported Outcome Measures (PROMs) Collection
MaineHealth has made significant strides in ensuring the highest quality of care through the expansion of pre-operative PROM collection for orthopedic surgeries across all its sites. This initiative aligns with the CMS mandate, effective July 2024, which requires the collection of pre-operative and one-year post-operative PROMs for Medicare inpatient total hip and knee arthroplasties. Since 2021, MMP Ortho JR has been collecting PROMs in our electronic health records system, but prior to 2024, most sites had a 0% collection rate or used methods that were difficult to extract. Starting in April 2024, MaineHealth implemented a centralized and consistent PROMs collection process across all sites.
This system not only meets CMS requirements but also ensures that MaineHealth is well-prepared for any future expansions of these requirements. The data collected is already proving valuable for research and quality improvement efforts, demonstrating MaineHealth's commitment to delivering excellent patient outcomes.
Measuring Patient Improvement Through Substantial Clinical Benefit
Patients undergo joint replacement surgeries to improve their mobility and reduce pain in daily activities. One of the ways MaineHealth measures this improvement is through patient reported outcome questionnaires pre and postoperatively. In 2024, Center for Medicare and Medicaid Services (CMS), set a benchmark for improvement from joint replacement surgeries, indicating that the surgery had a substantial clinical benefit if patients improved at least 20 points for a knee or 22 points for a hip replacement. The national goal is for 60% of patients to reach substantial clinical benefit.
Hip Fractures
In 2024, Maine Health Orthopedics completed a two-year long quality project at Maine Medical Center Portland that worked to reduce the time to surgery for hip fracture patients. Hip fracture surgery is one of the most common orthopedic trauma surgeries in Maine, with about one a day done at MMC Portland. This project stemmed from a multi-center collaborative study with Stanford. Delayed surgery (>24-48 hours) for hip fracture patients is associated with higher morbidity, mortality, and overall cost, but determinants of delayed surgery are varied and context dependent. As such, improvement strategies are ideally specific to the identified driver of delay in a given context.
Working with Stanford staff, semi-structured interviews were completed with stakeholders involved in all aspects of hip fracture care to identify determinants affecting time to surgery for hip fracture patients. Then, working with leaders from Emergency Medicine, Internal Medicine, Anesthesia and many more, Dr. Camuso’s team worked to address these determinants. Overall, the project was successful, reporting a decreased time to surgery for hip fracture patients.
