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Michigan Surgical Quality Collaborative Presentation
The document discusses the Michigan Surgical Quality Collaborative (MSQC), which aims to establish a learning health system for improving surgical care in Michigan. It describes the MSQC learning health system cycle, which involves collecting data, analyzing it, learning from it, disseminating best practices, and evaluating and supporting continuous quality improvement. It provides details on how the MSQC works, including the data it collects, how sites are analyzed and monitored, and how knowledge is shared. It discusses the MSQC's focus on reducing surgical site infections in colectomy patients and the initiatives developed from analyzing the data. Finally, it outlines the MSQC's future plans to further leverage technology, anchor care around patients, and create an epicenter
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Michigan Surgical Quality Collaborative Presentation
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- 2. Establishing a LearningHealth System for Surgical Improvement: The Michigan Surgical Quality Collaborative
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- 4. Agenda • Introduction • TheMSQC Learning Health System Cycle • How it works • Future Direction & Grant • Questions
- 5. With Appreciation andGratitude
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- 8. 73 surgeon champions 2,500surgeons,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. Agenda • Introduction • TheMSQC Learning Health System Cycle • How it works • Future Direction & Grant • Questions
- 10. Collect Analyze Learn & Discern Translate& Disseminate Evaluate & Support Clinical Inquiry The MSQC Learning Health System Cycle
- 11. • Over 220variables • 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. Collect Analyze Learn & Discern Translate& Disseminate Evaluate & Support • Demo • 24/7 Analytics • Surgeon-specific reporting
- 15. Learn & Discern •Identify high performing sites • Site visits/meetings • Monitor data patterns • Validate data Collect Analyze Learn & Discern Translate & Disseminate Evaluate & Support
- 16. Success factors forthe 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
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- 18. Translate & Disseminate •Communicate • List serve/website • Toolkits • Learning Center • Schedule and conduct site visits • Meetings • Publish Collect Analyze Learn & Discern Translate & Disseminate Evaluate & Support
- 19. Evaluate and Support •Mentor • Coach • Train • Consult • Monitor data patterns • Identify areas for future improvement Collect Analyze Learn & Discern Translate & Disseminate Evaluate & Support
- 20. Agenda • Introduction • TheMSQC Learning Health System Cycle • How it works • Future Direction & Grant • Questions
- 21. Big Data tothe Bedside Reduce SSI ( infection) in colectomy patients
- 22. 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
- 25. The Colectomy Bundle PACUTemp 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
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- 28. How to preventSSI 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
- 30. The site visitfills 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
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- 32. The Colectomy Bundle PACUTemp 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
- 33. SSI Bundle Colectomy SSIBundle (3-items) Trends
- 34. SSI Bundle Colectomy AntibioticChoice Trends
- 35. SSI Bundle Colectomy Trendsfor SSI-Total and SSI Bundle (3-items)
- 36. SSI Bundle Colectomy SSI-Totalby Terciles for Hospital Level Rates of SSI Bundle (3-items)
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- 38. 90 day episodecost vs Quality Composite BCBSM pays less as quality improves
- 39. Agenda • Introduction • TheMSQC Learning Health System Cycle • A Case Study • Future Direction & Grant • Questions
- 40. 1. Leveraging technology 2.Patient-anchored care 3. Creating an epicenter for a Surgical Learning Health System
- 41. Leveraging Technology Data integration 30% 70%30% 70%201 6 202 0 Electronic Manual Abstraction
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- 44. Surgical Learning HealthSystem
- 45. 1. Develop aneLearning ‘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
- 46. Agenda • Introduction • TheMSQC Learning Health System Cycle • How it works • Future Direction & Grant • Questions
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- 48. • EXTRA SLIDESFOR QUESTIONS
- 50. • https://training.arbormetrix.com/Registry/client/msqc • • Username:msqcdemo • Password: 74deal8S (case sensitive)
- 51. Travel the BlueHighways 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.
- 52. Be Deviant (Positively) 52 MSQCfollows 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