January 15, 2015

Quality Improvement at Core of Hernia Center’s Agenda

Collaboration means improved outcomes, lower costs


Collaboration and teamwork are the hallmarks of the leadership agenda of Michael J. Rosen, MD, FACS, who recently began his new role as Director of Cleveland Clinic’s Hernia Center, the first comprehensive center of its type in Northeast Ohio and one of only a handful of such centers across the country. Dr. Rosen says the greatest opportunity for advancement in the field of hernia surgery is Cleveland Clinic’s effort to become the first in the world to standardize approaches to disease while improving quality and reducing costs.


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At Two Helms

Dr. Rosen is also anticipating his new role as medical director of the Americas Hernia Society Quality Collaborative (AHSQC), a comprehensive national quality improvement effort providing real-time surgical outcomes data. He will assume the AHSQC presidency in 2015. “Nationally, it’s about changing the culture and getting people to become part of a team,” Dr. Rosen says. “In surgery, that is more of a struggle.”

With almost 16,000 ways to fix a hernia, there are large variations in practice that account for hundreds of millions of dollars’ worth of cost differences and likely produce varying outcomes. The national collaborative is bringing surgeons together to identify best practices, share those in real time and educate the group in a more rapid fashion. And the Cleveland Clinic Hernia Center is leading the charge.

It Takes a Village

“We have a group of clinicians willing to plant a seed and be part of something big,” says Dr. Rosen. “We’ll be one of the first places in the world where the entire hospital enterprise is going to come together and work as a team. This goes beyond just the surgeons and has the potential for supply chain and other groups to work together. This has almost never been done in general surgery in an organized fashion.”


The AHSQC has 80 surgeons across the country at 42 sites actively following more than 2,000 patients. Dr. Rosen is using his knowledge of AHSQC’s work to ensure the same quality of care for hernia disease throughout the entire Cleveland Clinic health system.

The AHSQC quality initiative feeds into active plans to establish the Hernia Center as a training site for surgeons already in practice. Along with advanced reconstruction techniques, surgeons from around the world will learn about quality improvement that leads to reduced costs.

Abdominal Wall Investigations

On the research front, Dr. Rosen is championing a multidisciplinary collaboration with Digestive Disease Institute experts for successful abdominal wall reconstruction. Dr. Rosen and his colleagues are about to begin a pivotal FDA investigational device exemption trial evaluating biologic versus synthetic mesh for contaminated ventral hernia repair. The results of this study could provide a cost-effective solution to contaminated abdominal wall reconstruction, potentially saving millions of dollars through improved outcomes.


Dr. Rosen is also working with Kathleen A. Derwin, PhD, of Cleveland Clinic Lerner Research Institute to develop a fiber-reinforced biologic mesh to reduce recurrence rates in complex ventral hernia repairs. This pioneering, clinically translational research is designed to improve patient outcomes through collaborative efforts across the Cleveland Clinic enterprise.

To refer a patient to Cleveland Clinic’s Hernia Center, call 855.REFER.123. Dr. Rosen can be reached at 216.445.3441 or rosenm@ccf.org.

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