1. The Use of Data to Promote Physician Learning: Cholecystectomy Conversion Rates for the Province of Alberta
Dianne Johnson1, Brock Setchell1, Dereck Mok2, Noah Switzer2, Chris de Gara 2, Paul Childs2, Ingrid de Kock2, Khurram Jahangir1
1Physician Learning Program, Lifelong Learning (L3™) Portfolio, Faculty of Medicine & Dentistry, University of Alberta 2University of Alberta
SUMMARY OF WORK
Aggregate, anonymized practice data for Alberta was collected and analyzed by the PLP team as guided by surgical experts. This was made available to all general surgeons in Alberta. Surgeons interested provided informed consent and received their individualized data which was compared to that of their anonymized peers. A feedback session was offered to those who were interested. Participating surgeons completed a post-project survey. One year later, the consenting surgeons were sent a second data report and a subsequent survey to help them undertake impact assessment on their practice. Intended outcomes: Document conversion rate variance, provide individual general surgeons of Alberta (n=100) with their own cholecystectomy conversion rate as compared with anonymized data of their colleagues and institution, observe for practice change in individual surgeons once they have been provided with their own version rate data.
BACKGROUND
In the 2013/14 fiscal year, 8,216 cholecystectomies were performed in Alberta: 3,119 emergent and 5,097 elective. In general, this surgery is performed using a laparoscopic technique but this may, on occasion, be abandoned in favor of the traditional open approach (usually in an emergency). Intra- operative factors, such as excessive inflammation, would potentially make it unsafe to proceed laparoscopically. Inevitably, this is a surgeon’s judgment call and variance exists between surgeons as to their comfort proceeding laparoscopically or converting to an open procedure. An open cholecystectomy, because of the much larger incision, is associated with a more prolonged length of stay and higher rate of wound and chest infection.
This project examined the laparoscopic cholecystectomy conversion rates in Alberta.  The project was proposed by a general surgeon based on the needs assessment survey of his colleagues. The surgeons were interested in learning about practice variance surrounding conversion rates of emergency and elective laparoscopic cholecystectomies. A review, by a panel of general surgeons, of the aggregate provincial data results and current literature will be used to determine if any unperceived learning needs can be addressed through knowledge translation activities.
Provincial cholecystectomy data were made available at the annual Alberta Association of General Surgeons meeting in February 2014 and 2015.
Twenty-one general surgeons, with their written consent, were provided with their personal elective and emergent conversion data as compared with the aggregate.
The consenting general surgeons were surveyed for their opinions as to the process and value of the data provided.
CONCLUSION
Through data analysis, we hope to demonstrate that providing physicians with their individualized practice-based data can be a valuable learning tool. In the final survey, 72% of participants “Agreed” or “Strongly Agreed” that “PLP’s provision of this data was useful.”  Surveys can positively contribute in assessing the impact of knowledge translation activities.
IMPACT: IMPROVED PATIENT CARE AND STANDARDIZED PHYSICIAN PRACTICE.
FINAL OUTCOMES
ALBERTA PHYSICIAN LEARNING PROGRAM (PLP)
ALIGNING PHYSICIANS LIFELONG LEARNING FOR QUALITY IN ALBERTA
The Physician Learning Program (PLP) is a quality improvement program addressing physician learning needs by exploring physicians’ clinical questions using data from local EMRs and provincial databases. It is a collaboration between the University of Calgary, the University of Alberta and the Alberta Medical Association that aims to facilitate and create opportunities for physicians to understand individualized and group practice patterns. Ultimately, the PLP program helps physicians improve practice and patient outcomes.