Cardiac Surgery Health Services Research & Quality

The Section of Health Services Research & Quality (HSRQ) within the U-M Medical School Department of Cardiac Surgery was established in 2012 under the leadership of Donald Likosky, PhD, a nationally recognized expert in understanding variation patterns in healthcare. HSRQ plays an important role within the department by investigating the quality and efficiency of cardiac surgical care at the institutional, regional, and national levels. The section dedicates its work to investigating healthcare delivery systems and developing strategies for their improvement, with specific focus on:

• Identifying the determinants and implications of variation in the surgical treatment of heart disease
• Assessing the impact of current health policies on the healthcare delivery system
• Developing and implementing best practices
• Evaluating traditional and novel therapies

Embracing a collaborative, data-driven approach, the Section of Health Services Research & Quality works diligently to advance patient care. The team systematically draws from both institutional and multi-institutional sources, including clinical registries, to inform best practices and improve outcomes. Their robust data infrastructure integrates both administrative and clinical information and links to the National Death Index for assessing long-term survival. Leveraging this comprehensive approach, one innovative project incorporates surgical case videos that simultaneously display patient physiologic responses to interventions alongside footage of the procedure itself. These visuals are linked to a clinical registry that tracks postoperative outcomes. This unique approach has resulted in an 80% reduction in cerebral emboli, the primary cause of stroke following cardiac surgery, ultimately leading to improved neurologic outcomes for open heart surgery patients.

Through a grant awarded by the Agency for Healthcare Research and Quality (AHRQ), our HSRQ team has collaborated with the Michigan Society of Thoracic and Cardiovascular Surgeons (MSTCVS) Quality Collaborative to investigate variability in blood utilization and post-operative hospital-acquired infections following Coronary Artery Bypass Grafting (CABG). With additional funding from the AHRQ, Dr. Likosky facilitated the creation of the National Cardiac Surgery Quality IMPROVEment (IMPROVE) Network, a consortium of regional cardiac surgical quality improvement collaboratives designed to enhance cardiovascular surgical care value through the development, evaluation, and dissemination of best practices across member organizations.

In partnership with clinical community members, Dr. Likosky's team also created the Perfusion Measures and Outcomes (PERForm) registry, which links surgical data with cardiovascular perfusion care processes and technology metrics. This registry serves as a foundation for participating centers to improve care and outcomes for cardiac surgery patients and has now been implemented at cardiac surgical programs nationwide.

To support continuous improvement in research endeavors, the Section of Health Services Research & Quality provides full-time data warehouse and biostatistical resources. Faculty receive real-time benchmarking reports and participate in monthly Research-in-Progress seminars to receive feedback and guidance on ongoing projects. These efforts foster a learning healthcare system model focused on high-quality, patient-centered care. In addition to its research focus, HSRQ contributes to the department’s educational mission. Medical students and surgical trainees actively participate in section-led projects, gaining hands-on experience in outcomes research and health services innovation.