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Michigan Surgical Quality Collaborative Presentation

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11-29-2016

Published in: Healthcare
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Michigan Surgical Quality Collaborative Presentation

  1. 1. Questions?
  2. 2. Establishing a Learning Health System for Surgical Improvement: The Michigan Surgical Quality Collaborative
  3. 3. Questions?
  4. 4. Agenda • Introduction • The MSQC Learning Health System Cycle • How it works • Future Direction & Grant • Questions
  5. 5. With Appreciation and Gratitude
  6. 6. MSQC Team
  7. 7. 73 Participating Hospitals
  8. 8. 73 surgeon champions 2,500 surgeons,1800 gynecologists 1,000 anesthesiologists 120 nurses (Surgical Clinical Quality Reviewer) Monthly surgeon conference calls, newsletter Quarterly meetings for 10 years 300-400 attendees per meeting By the numbers……
  9. 9. Agenda • Introduction • The MSQC Learning Health System Cycle • How it works • Future Direction & Grant • Questions
  10. 10. Collect Analyze Learn & Discern Translate & Disseminate Evaluate & Support Clinical Inquiry The MSQC Learning Health System Cycle
  11. 11. • Over 220 variables • Clinical variables (not billing or administrative) – Demographics/Insurance – Preoperative risk factors – Preoperative processes (ostomy marking/bowel prep) – Labs – Surgery factors (surgical approach, skin prep) – Perioperative/anesthesia care factors – Fluid volume balance – Medications – Postoperative outcomes – Discharge information Collect Analyze Learn & Discern Translate & Disseminate Evaluate & Support
  12. 12. Collect Analyze Learn & Discern Translate & Disseminate Evaluate & Support • Demo • 24/7 Analytics • Surgeon-specific reporting
  13. 13. Learn & Discern • Identify high performing sites • Site visits/meetings • Monitor data patterns • Validate data Collect Analyze Learn & Discern Translate & Disseminate Evaluate & Support
  14. 14. Success factors for the MSQC STRUCTURE • Financial support • Reliable data (doctors believe it) • Regional rather than national organization • Multidisciplinary & interdisciplinary • Nurses as data reviewers • Site visits CULTURE • High standards • Non-threatening • Non-competitive • Engagement • Exceptional customer service • Commitment to discovery and innovation What Makes MSQC’s Model Unique & Successful
  15. 15. Trust
  16. 16. Translate & Disseminate • Communicate • List serve/website • Toolkits • Learning Center • Schedule and conduct site visits • Meetings • Publish Collect Analyze Learn & Discern Translate & Disseminate Evaluate & Support
  17. 17. Evaluate and Support • Mentor • Coach • Train • Consult • Monitor data patterns • Identify areas for future improvement Collect Analyze Learn & Discern Translate & Disseminate Evaluate & Support
  18. 18. Agenda • Introduction • The MSQC Learning Health System Cycle • How it works • Future Direction & Grant • Questions
  19. 19. Big Data to the Bedside Reduce SSI ( infection) in colectomy patients
  20. 20. Colectomy • Commonly performed procedure • High incidence of SSI • 5,907 patients in 73 hospitals • 137 data elements/case • What did the data show? 22 Selected CPT codes
  21. 21. The Colectomy Bundle PACU Temp gt 96.8 deg F Bowel Prep w/Oral Abx LAPROSCOPIC Open Surgical Time gt 100 (min) PostOp Day 1 Glucose <140 SCIP 2 Compliant SCIP 1 Compliant
  22. 22. SSI Bundle Colectomy
  23. 23. How to prevent SSI in Michigan The Problem: Surgical site Infection Evidence Based Initiatives in 73 hospitals • Pre op shower • CHG skin prep • Glycemic control • Normothermia • Short duration surgery • Appropriate IV antibiotics • Oral antibiotics with bowel prep • Laparoscopic approach • Weight based dosing • Redosing for >3 hr cases • Wound protector • Prehabilitation • Enhanced Recovery Program SSI- A Major MSQC Initiative
  24. 24. The site visit fills an important gap • Team building! • Validate quantitative information- does it have “face value” • Identify barriers to implementation • Collect new qualitative info • Troy-Beaumont • Allegience • Genesys • Marquette • Hurley • Sparrow • St Joseph-AA • Oakwood
  25. 25. “Best Practice” Colectomy Panel
  26. 26. The Colectomy Bundle PACU Temp gt 96.8 deg F Bowel Prep w/Oral Abx LAPROSCOPIC Open Surgical Time gt 100 (min) PostOp Day 1 Glucose <140 SCIP 2 Compliant SCIP 1 Compliant
  27. 27. SSI Bundle Colectomy SSI Bundle (3-items) Trends
  28. 28. SSI Bundle Colectomy Antibiotic Choice Trends
  29. 29. SSI Bundle Colectomy Trends for SSI-Total and SSI Bundle (3-items)
  30. 30. SSI Bundle Colectomy SSI-Total by Terciles for Hospital Level Rates of SSI Bundle (3-items)
  31. 31. Results
  32. 32. 90 day episode cost vs Quality Composite BCBSM pays less as quality improves
  33. 33. Agenda • Introduction • The MSQC Learning Health System Cycle • A Case Study • Future Direction & Grant • Questions
  34. 34. 1. Leveraging technology 2. Patient-anchored care 3. Creating an epicenter for a Surgical Learning Health System
  35. 35. Leveraging Technology Data integration 30% 70% 30% 70%201 6 202 0 Electronic Manual Abstraction
  36. 36. Patient -Anchoring
  37. 37. Surgical Learning Health System
  38. 38. 1. Develop an eLearning ‘tool kit’ for Collaborative Quality Improvement start-up Tool kit development will be a ready-made solution to share knowledge from the MSQC embedded within the existing eLearning MSQC learning management platform (CourseMill). 2. Initiate infrastructure for a Consolidation Center at the University of Michigan. The Consolidation Center would function as a headquarters providing oversight, guidance and governance of the regional collaboratives. 3. Establish an inaugural Collaborative Quality Improvement (CQI) conference/workshop A conference will provide opportunity for sharing infrastructure, framework, data integrity, technology and expertise for a successful CQI-LHS. Expected Results
  39. 39. Agenda • Introduction • The MSQC Learning Health System Cycle • How it works • Future Direction & Grant • Questions
  40. 40. Questions? Questions?
  41. 41. • EXTRA SLIDES FOR QUESTIONS
  42. 42. • https://training.arbormetrix.com/Registry/client/msqc • • Username: msqcdemo • Password: 74deal8S (case sensitive)
  43. 43. Travel the Blue Highways Practice-Based Research—“Blue Highways” on the NIH Roadmap John M. Westfall, MD, MPH; James Mold, MD, MPH; Lyle Fagnan, MD JAMA. 297(4):403-6, 2007 Jan 24. NIH roadmap could benefit from “blue highway” or practice- based research that connects major academic centers to rural areas.
  44. 44. Be Deviant (Positively) 52 MSQC follows the principles of “positive deviance” as an approach to identify practices that improve healthcare quality. Research in action: Using positive deviance to improve quality of health care Elizabeth H Bradley, Leslie A Curry, Shoba Ramanadhan, Laura Rowe, Ingrid M Nembhard and Harlan M Krumholz Implementation Science. 4(25):1-11, 2009

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