He got his satisfaction from every operation that went well, and from seeing young surgeons launch their careers after learning at his side in the University of Michigan hospital鈥檚 operating rooms.
But the patients he takes care of these days don鈥檛 call or write. They don鈥檛 say hello in the hospital halls. They don鈥檛 even know his name.
And yet, his work touches tens of thousands of them a year, making their operations safer, their surgical teams more prepared, and their recoveries smoother.
That鈥檚 because Campbell has traded in his scalpel for Big Data. He leads one of the largest data-driven quality improvement efforts in all of surgery. Instead of operating on individual patients, he helps other surgical teams improve the way they care for their patients.
And just like any surgical team, it鈥檚 not a one-man show.
In Campbell鈥檚 case, he鈥檚 at the helm of a team of 2,000 surgeons, nurses, data experts and others from . Together, they鈥檝e created a massive cooperative effort with funding from the state鈥檚 largest insurer, Blue Cross Blue Shield of Michigan, and based out of the U-M Institute for Healthcare Policy and Innovation. They collect 137 different types of data about 50,000 operations performed at participating hospitals each year, from the patient鈥檚 weight to the exact drugs they got during the operation.
It鈥檚 called the , or MSQC. For the last decade, it has been the silent force behind a and better outcomes for patients across the state. The team鈥檚 publications about their achievements are causing a ripple effect on patients nationwide.
For instance, they鈥檝e from their efforts to reduce the number of patients who develop a surgical site infection after a common colon operation 鈥� the colectomy, or removal of part of the bowel. Not only did infections drop further the more often teams followed a 鈥渂undle鈥� of anti-infection protocols, but so did costs. And a new analysis shows that even though the rate of such infections dropped at hospitals nationwide during the time when MSQC was addressing them, the rate dropped faster in Michigan.
In , they show how complications from surgery more than doubled the cost of a patient鈥檚 care, and ate into a hospital鈥檚 profit margin.
鈥淚n my surgical career, we could really see a tangible benefit from what we did in virtually every patient,鈥� Campbell explains. 鈥淏ut in population health efforts like MSQC, no one knows that you鈥檝e helped them. They don鈥檛 know that they were spared getting an infection in the hospital, or that their operation was performed in a way that鈥檚 consistent with the same operation done on a patient a hundred miles away. But we鈥檙e able to make a difference for hundreds or thousands of patients at a time.鈥�
Campbell started down the road of improving surgery through shared data when he was chief medical officer of the U-M Health System, beginning in the late 1990s. He saw what the hospitals that serve America鈥檚 veterans were doing by looking at the data from their national electronic health record system, and acting on it.
Unlike the VA hospitals, though, he knew that most places where surgery takes place in the U.S. don鈥檛 have a way to share their records securely and electronically 鈥� and even if they could have, competitive pressures would stand in the way as they tried to stay afloat in Michigan鈥檚 downturned economy.
If things were going to get better for patients at non-VA hospitals, he realized, it would take a lot of trust, a lot of technology, and a lot of time.
Primary care doctors were already hard at work doing the same thing in their sphere. But they had so much to do to improve management of common chronic conditions that the surgeons weren鈥檛 yet on their radar.
And yet nearly half of American medical care is related to surgical procedures. So, Campbell first spearheaded U-M鈥檚 participation in a surgical quality improvement project that started with three hospitals and grew to hundreds nationwide that鈥檚 now run by the American College of Surgeons. The effort won him a n. But in 2005, the opportunity arose to harness BCBSM funding and launch a statewide effort involving a few dozen hospitals.
Because a statewide initiative can be nimbler than a large national one, Campbell calls MSQC a real 鈥渂oots on the ground鈥� approach. A key part of its success, he says, has been the culture of trust and familiarity that the MSQC team has cultivated through regular conference calls and meetings of all the participating teams. He also credits the responsive customer service from MSQC staff, who work directly with the nurses who spearhead data collection and reporting at each hospital.
鈥淲hat we rely on is a spirit of collaboration 鈥� that we鈥檙e not going to use the quality information to award trophies or put up billboards about who鈥檚 the 鈥榖est in the state,鈥� he adds. 鈥淚t鈥檚 measurement to improve, not measurement to judge. We treat the data confidentially, and share findings among our participants 鈥� including helping outliers understand how their practices or results differ from those around the state, and how they can change.鈥�
More hospitals have joined over the years, as MSQC attained a special status as a . The kinds of operations that MSQC focused on grew, from ones done by general surgeons to those done by vascular surgeons and now gynecological surgeons. Most recently, a bundle of interventions aimed at reducing inappropriate use of hysterectomy, and reducing infections among those who do opt for surgery, has rolled out for hospitals鈥� use.
More tellingly, no hospitals have dropped out. More will join in the coming year. And other states, from South Carolina to Tennessee to Illinois, have launched similar efforts with funding from their own Blue Cross Blue Shield insurers.
鈥淭he medical professions tend to be adversarial with big third-party payors, but we have the same goals of better quality and lower cost, and more appropriate use of care with fewer complications,鈥� says Campbell. 鈥淭hrough efforts like MSQC, we can work together productively with them.鈥�
The next challenge, he says, lies in connecting surgical quality improvement efforts with the care that patients receive before and after surgery, and linking up with quality improvement efforts going on in primary and non-surgical specialty disciplines. MSQC鈥檚 rich data set, with records from more than 420,000 operations, can help drive such programs.
For example, U-M has that can help surgical patients reduce their risk of complications by undergoing pre-surgery 鈥減rehabilitation鈥� that includes exercise, quitting smoking and emotional factors. Another effort draws on evidence from MSQC and other sources to fuel efforts to improve opioid painkiller prescribing after surgery.
Another challenge is to help hospitals improve the value of the care they provide to surgical patients - - not just by reducing cost, but by improving quality. Even if it costs more up front, higher-value care will ultimately mean fewer repeat hospital stays, and less time in nursing homes and the emergency room, Campbell feels. This drive is in line with the move by Medicare and other insurers to changing the way they pay for care to focus on value.
鈥淚t鈥檚 a fertile field, and there鈥檚 still a lot we can accomplish that can have a great impact on a lot of people,鈥� Campbell says. So even if MSQC doesn鈥檛 get Christmas cards from the patients its work touches, 鈥淲e are learning from our data, and acting on our data across a broad spectrum. For me, that brings a satisfaction of a different sort.鈥�
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