General Surgical Outcomes Quality Improvement Database (UH-SOCRATES)
Condition: Colon Cancer; Diverticulitis; Colorectal Polyps; Crohn's Disease; Ulcerative Colitis; Rectal Cancer
MeSH terms: Crohn Disease; Diverticulitis
Study type: Observational

Summary: 
      A database has been established to track the outcomes of all cases performed in the
      University Hospitals Department of Surgery in an effort to improve quality of surgical
      performance and case management.

      Specifically, the purpose of the database will be used as a quality improvement tool for
      analyzing process and outcome measures and to accurately track cases performed by surgeons.
    

Detailed description: 
      Since the Institute of Medicine report, titled "To Err is Human", there has been an
      increasing trend to evaluate outcomes in healthcare. While optimal outcomes in delivery of
      healthcare are something that hospitals and their medical, nursing and administrative staff
      have always tried to achieve, this has often been attempted without having much information
      to assess the outcomes that actually occur.

      For this reason, programs such as NSQIP (the National Surgical Quality Improvement Project)
      have been brought from the VA system into private and academic healthcare systems, to sample
      surgical outcomes and provide hospitals with benchmarks that can be achieved, as well as
      informing them where they rank in the overall results. Unfortunately, systems such as NSQIP
      are based on sampling a percentage of cases performed each week, but do not track all cases
      or all providers. Many cases are therefore not tracked in any way.

      Certain centers have now established databases to track their own surgical outcomes. These
      are usually specific to certain surgical specialties, and provide an opportunity to perform
      quality improvement. These also have the added value of being useful tools for maintenance of
      certification and for clinical research.

      Primary goals of this study:

      We propose to further develop the General Surgical Outcomes Quality Improvement
      Database(GSOD)-subsequently renamed UH-SOCRATES-which will track all surgical, medical, and
      radiological encounters occurring at University Hospitals Case Medical Center(UHCMC)as well
      as at UH's Richmond and Geauga campuses. This database will have several goals:

        1. UH-SOCRATES will be used as a quality improvement tool for analyzing process and outcome
           measures, for example being able to evaluate patients with prolonged length of stay so
           that cases can be defined and evaluated for specific risk factors or in-hospital events.

        2. By using hospital coded CPT codes, UH-SOCRATES will be able to accurately track cases
           performed by surgeons for maintenance of certification purposes.

      All of these goals are related to quality improvement and assessment, and are considered "not
      human subjects research" under 45 CFR 46. In the future it is hoped that UH-SOCRATES will
      also be a powerful resource for formal research into surgical outcomes. Future IRB
      submissions will be submitted for this purpose. This IRB submission therefore only addresses
      the quality improvement perspective of the UH-SOCRATES.
    

Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        All patients receiving surgical, medical, or radiological services at University Hospitals
        Case Medical Center,Richmond,or Geauga campuses.