Participating at the Iowa forum (from left): Philip R. Caropreso, MD, FACS, general surgeon, clinical professor of surgery, UICCM; Dr. Scott-Conner; Richard A. Sidwell, MD, FACS, Committee on Trauma State Provincial Chair, and Past-President, Iowa Chapter; Dr. Hoyt; Keith J. Mueller, PhD, Gerhard Hartman Professor and Chair, department of health management and policy, UI College of Public Health; Jennifer Vermeer, MPA, former Medicaid Director, Iowa Medicaid Enterprise; Timothy A. Breon, MD, FACS, general surgeon, Mahaska Health Partnership; Dr. Weigel; and K. John Hartman, MD, FACS, President, Iowa Chapter.
The American College of Surgeons (ACS) hosted the ACS Surgical Health Care Quality Forum Iowa, June 27, in Des Moines. This forum, part of the College’s Inspiring Quality (IQ) program, was the 19th in a series of community meetings that the College has presented across the U.S. since 2011 to highlight quality improvement programs that have set higher standards for surgical care, reduced costs, and improved patient outcomes at the state and national levels.
Issues in rural Iowa
A panel of health care leaders shared their insights into the unique issues that affect surgical care in rural areas, including workforce shortages, surgical education and training, and access to trauma care. Panelists discussed how Iowa’s trauma system, which was initiated in 2001, has evolved and how best practices are being used to improve patient outcomes and reduce health care costs in rural areas.
“The issues related to access to quality rural surgical care continue to burden many Iowa communities,” said forum co-host Ronald J. Weigel, MD, PhD, MBA, FACS. Dr. Weigel is associate vice-president for the University of Iowa (UI) Health Alliance; and the EA Crowell Jr. Professor and Chair of Surgery; professor of surgery, surgical oncology, and endocrine surgery; and professor of biochemistry, anatomy, and cell biology, UI Carver College of Medicine (UICCM), Iowa City.
“A big issue many of us are concerned about right now is workforce shortages and the impact that will have on the future of rural health care,” Dr. Weigel said. “Many general surgeons in rural areas are nearing retirement, and at the same time residents and younger surgeons are choosing to specialize. It will be important for our profession to focus on recruiting highly skilled and qualified general surgeons to the communities that need them most. Finding a way to fund graduate medical education is a serious problem facing our country and will affect this as well.”
Co-host Carol Scott-Conner, MD, PhD, MBA, FACS, professor of surgery, division of oncology and endocrine surgery, UICCM, added, “Quality can mean many different things for patient care, but for rural surgical care, it really boils down to having access to the right surgeon at the right time and for that surgeon to have the necessary resources to do the job well. It can be a real challenge, but having discussions like these and coming together as a network to share resources and best practices will make a big difference.”
Forum presenters discussed the start of Iowa’s trauma system in 2001 and how it has helped improve outcomes for trauma patients throughout the state. According to the Iowa Trauma System Ten-Year Report, released by the Iowa Department of Public Health in 2010, since the system was implemented, there has been a 49 percent decrease in traumatic brain injury, a 35 percent decrease in chest injury, and a 20 percent overall decrease in mortality among non-transfer patients.* In addition, the trauma system has enabled faster arrival to definitive care, faster and more appropriate resuscitation, patients to be seen by a trauma surgeon sooner, and more patients discharged home.
ACS activities
The forum also highlighted ACS programs and initiatives that support rural surgeons, including the creation of the ACS Advisory Council on Rural Surgery and the ACS rural listserv, a “hub” for approximately 1,000 rural surgeons across the country to use in sharing information. The listserv has proven to be a valued resource, already facilitating more than 5 million e-mail exchanges on a variety of topics and clinical questions affecting rural surgery practice.
“The Iowa Forum’s focus on rural quality couldn’t align more with ACS’ mission to ensure all patients have access to high-quality surgical care, wherever they are,” said David B. Hoyt, MD, FACS, ACS Executive Director. “From rural residency training programs to recruitment and retention support, continuing education and training, to trauma system verification, the College is committed to working with rural surgeons and hospitals to help identify and rectify the challenges that they face on a daily basis.”
Panelists also discussed the resources and metrics available to rural surgeons and hospitals to assess performance, including the ACS National Surgical Quality Improvement Program (ACS NSQIP®).
The full video of the Iowa forum is available at InspiringQuality.facs.org and on the College’s YouTube channel.
*Mellecker M, Torner J, Young T, Sparling K. Iowa Trauma System Ten Year Report. The University of Iowa Injury Prevention Research Center. Resources. Available at: http://www.public-health.uiowa.edu/iprc/resources/IA-Trauma-System_Ten-Year-Report.pdf. Accessed July 15, 2014.
