MPOG Bylaws February 2024

Multicenter Perioperative Outcomes Group (MPOG) Bylaws

I. Name

a. The name of the group is the Multicenter Perioperative Outcomes Group (MPOG)

II. Purpose

a. The purpose of MPOG is to allow multi-institutional collaboration for the purpose of

accelerating outcomes research and quality improvement in perioperative medicine.

III. Code of Conduct

a. The successes of MPOG depend upon a cooperative model of information exchange.

Member institutions and representatives are expected to:

i. Respect the intellectual property presented and the comments made by

presenters and discussants.

ii. Disclose competing interests or obligations that may conflict with new or

existing projects.

iii. Refrain from using or sharing privileged information without the consent of the

MPOG Executive Board.

iv. All provider-identifying and institution-identifying elements must be removed

prior to public disclosure of any data.

v. No data gained from analysis of MPOG data for research or quality

improvement purposes will be used for competitive or marketing purposes.

vi. Failure to adhere to the code of conduct or any other bylaw is grounds for

dismissal from MPOG and removal of any funding support.

IV. Goals/Objectives

a. MPOG Research

i. Develop a structure for multi-institutional collaboration and data sharing.

ii. Develop the information technology infrastructure to pool a wide variety of

perioperative data.

iii. Develop/enlist the statistical infrastructure to analyze the data.

iv. Provide an academic collaborative where faculty from multiple institutions will

be able to collaborate in outcomes research.

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b. MPOG QI (also referred to as ASPIRE – Anesthesiology Performance

Improvement and Reporting Exchange)

i. Develop a structure for institutions to use real-world data and collective

experience to assess variation in practice.

ii. Develop the information technology infrastructure to measure variation in

quality.

iii. Develop quality measures to represent both process-of-care and clinical

outcomes.

iv. Develop/enlist the statistical infrastructure to analyze the data.

v. Provide a collaborative venue where physicians are able to collaborate to

improve quality.

vi. Build a collaborative relationship among surgeons, anesthesiologists, and CRNAs

across hospitals.

V. Members

a. MPOG

i. Any anesthesiology department or practice can apply for membership in MPOG.

Membership only requires that the institution have a perioperative information

system and that the anesthesiology department chair or head of practice and

faculty support the project through their willingness to submit their limited

dataset into the central MPOG database.

ii. There are three types of member institutions:

1. Provisional members are member institutions that have yet to

contribute the minimum dataset but have already begun the regulatory

and technical processes required to contribute data. These members

cannot submit research proposals or conduct research using shared

MPOG data until they meet the data requirements of active

membership or receive aggregated quality improvement data.

Provisional members may participate in Quality Committee meetings

and contribute feedback on quality improvement activities. They do not

have voting rights.

2. Active members are member institutions that have submitted at least i)

10,000 cases over 6 consecutive months or ii) 12 consecutive months

into the central MPOG database and have submitted complete monthly

data within 12 months. Active members must validate 5 cases per

month prior to upload to the MPOG Coordinating Center. Active

Members have equal access to the MPOG database and can submit

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research proposals and manuscripts to be evaluated by the

Perioperative Clinical Research Committee (PCRC). These members may

be represented on the Executive Board and may vote during the

Executive Board election. They may submit measures to be evaluated by

the MPOG Quality Committee.

3. Inactive members are member institutions that were previously active

members but have not submitted additional monthly data in greater

than 12 months. These members cannot serve as lead institution, first

author, or senior author on a PCRC proposal or submit measures to be

evaluated by the MPOG Quality Committee. These members may

continue to be represented on the Executive Board by a previously

elected chairperson but may not vote for Executive Board members.

Inactive members may become active members by submitting new

perioperative data, totaling at least i) 10,000 cases over 6 consecutive

or ii) 12 consecutive months’ cases, into the MPOG database.

b. MPOG QI (ASPIRE)

i. MPOG QI (ASPIRE) utilizes the existing MPOG data infrastructure. Hospitals

within the state of Michigan may be funded by BCBSM to join MPOG for the

purpose of participating in MPOG QI (ASPIRE).

ii. The MPOG coordinating center is the University of Michigan

VI. Executive Board

a. The Executive Board serves without pay and is comprised of:

i. 9 elected anesthesiology department chairs or head of practice of Active

member institutions

ii. Executive Director ex-officio

iii. Research Director ex-officio

iv. Quality Improvement Director ex-officio

v. Chairperson of the University of Michigan Department of Anesthesiology (in its

role as the MPOG Coordinating Center) ex-officio

vi. In addition, Dr. Kevin Tremper serves as a non-voting Executive Board Member

in his capacity as Founding Executive Director.

vii. Executive Board members serve on the Executive Board for a three-year term.

viii. If an elected Board member leaves their departmental position for any reason,

the vacated position will be voted upon at the next election cycle. If three or

more positions are prematurely vacated between election cycles, an election

will be held for these vacated position within 8 weeks

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ix. Each year, at least three positions on the Board will be open for election.

b. Executive Board Elections

i. Executive Board members are elected via a first-past-the-post process.

ii. In the case of a tie for a position, a run-off system will be used

iii. Nominees for Executive Board elections are solicited each year for the three

open positions. Nominees will have a minimum of two weeks to submit their

nominations. Nominees must include a short biography and photo. Self-

nomination is encouraged.

iv. Each Active member institution may place one vote for each open position on

the Executive Board.

v. Voting by proxy is permitted. Proxy voting allows transfer of voting rights from

one institution to another with voting rights to vote for that institution in its

absence.

c. The Executive Board is responsible for

i. approving the participation of each active member

ii. annual reviewing and approval of MPOG coordinating center budget

iii. guiding MPOG coordinating center and member site processes

iv. reviewing all proposed revisions to the MPOG bylaws (Section XV).

v. addressing ad hoc issues (e.g. data requests outside of the research and QI

purview, MPOG partnerships and relationships, etc.)

d. Other officers will be determined by the Executive Board as they are deemed necessary.

e. The usual (Robert’s) parliamentary rules governing deliberative bodies will govern the

Executive Board meetings.

f. Executive Board Voting

i. Matters requiring Executive Board review and approval will be performed at an

Executive Board Meeting.

ii. A simple majority (i.e. one more than half) of Executive Board members or their

designated constitutes a quorum. Presence is defined via either physical or

electronic means.

iii. In absence of a quorum, no formal action will be taken except to postpone the

Executive Board vote to a subsequent date.

iv. Passage of motions requires a simple majority (i.e. one more than half) of the

Executive Board members or their designated appointee present at the

meeting. Presence is defined as either via physical or electronic means. hllo

VII. MPOG Task Force

a. From time to time, MPOG may convene an ad hoc task force.

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b. Members of this task force are elected by the Executive Board by simple majority or

selected by the MPOG coordinating center

c. The task force will meet at a frequency determined by the Executive Board or

Coordinating Center to discuss current perioperative research needs and the ability of

MPOG to address those needs, and to provide recommendations to the Executive Board

or Coordinating Center

VIII. Committees

a. Perioperative Clinical Research Committee (PCRC)

i. The PCRC is comprised of individuals identified from their institutions as the

Research Champion/Principal Investigator (PI).

ii. For any proposal involving the use of surgical registry data (NSQIP, MSQC, STS,

etc), the surgical champion of the relevant surgical registry from each site must

also be represented at a PCRC meeting or PCRC vote.

iii. The PCRC serves as the publication committee of MPOG and is responsible for

reviewing, refining, and modifying any research proposals and manuscripts

created by researchers at active/contributing institutions. All proposed research

studies using data from the central MPOG database must pass a peer-review

process by the PCRC prior to submission for publication.

iv. The PCRC is to meet electronically on a monthly basis to discuss and evaluate

submitted research proposals and manuscripts.

v. The PCRC approves research proposals and manuscripts using a simple majority

(i.e. one more than half) of the members present at the meeting. The senior

statistical consultant is to serve as the tie-breaking vote, in the event of a tie.

vi. The PCRC will make every reasonable effort to review all research proposals and

manuscripts within 30 days of the research proposals’ or manuscripts’

submission dates.

b. MPOG Quality Committee

i. The MPOG Quality Committee is comprised of anesthesiologists, CRNAs\ CAAs,

Anesthesia Clinical Quality Reviewers (ACQRs), and QI managers. MPOGQuality

Committee membership is not limited to active MPOG members and can

include quality improvement representatives from provisional, active, and

inactive sites.

ii. The MPOG Quality Committee meets electronically to discuss items of interest,

including quality measure criteria, meeting agendas, best practices, data

validation issues, etc.

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iii. Voting rights for decisions faced by the ASPIRE Quality Committee will be

limited to Quality Champions or their designees from Active MPOG sites only (1

vote per site).

iv. New measures proposed by the MPOG Quality Committee will be determined

by a simple majority vote of the voting committee members.

c. The Executive Board may appoint other standing and ad hoc committees as needed.

IX. Meetings

a. An annual MPOG membership meeting will be held to provide updates on the current

status of MPOG activities and allow members to provide feedback on MPOG activities.

b. Special meetings may be called by the Executive Board provided that at least thirty (30)

days’ notice of such meeting is sent to all members.

X. Funding

a. MPOG coordinating center activities will be funded through MPOG site fees, sponsored

QI funding, coordinating center self-funding, foundation, grant, and industry-sponsored

research. All funding received will be documented and submitted annually to the

Executive Board for review. All funded research projects will be reviewed by the existing

PCRC review process.

i. All research efforts will involve three costs (forms of value):

1. Principal investigator (PI) center cost varies for hypothesis development,

data cleaning, analysis, and manuscript preparation.

2. MPOG coordinating center (University of Michigan) cost varies for

hypothesis refinement, data extraction and cleaning.

3. MPOG data ‘intellectual property’ (shared across MPOG contributors)

for the high quality data itself

ii. Types of funding

1. MPOG Fees to be collected from active sites to offset staff and

administrative costs at the coordinating center.

2. Foundation and government sponsored research: MPOG data and

collaborative infrastructure can and has been used for competitive

proposal submissions for foundation grants. In this context, there are

clear mechanisms in place (budget request) for compensation. In

accordance with the external sponsor mechanisms in place, an MPOG

site would request effort allocation for each of the local individuals

involved in the project. Prior to proposal submission, the PI would

contact MPOG to receive a letter of support indicating data availability

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and develop a budget estimate for central MPOG costs. The University

of Michigan will serve as a subcontractor on the proposal.

3. Industry sponsored research: Vendors have identified the value of

MPOG data and its value to drive market creation, product refinement

and effectiveness analyses. A single MPOG site would serve as the

primary contractor. The budget will include their negotiated costs as

well all research effort costs. Any active MPOG member may develop

an industry-funded research proposal.

4. Sponsored QI funding

a. State specific and payer-specific rules regarding funding will be

contained in the statement of work for each payer relationship

iii. Any data access fees collected by the coordinating center will be distributed as

follows

1. Until the annual coordinating center operating cost of MPOG is held in

reserve, 100% of the data access fees will be held coordinating center

2. Once the annual operating costs are held in reserve, 50% of the data

access fees will be distributed to the coordinating center and 50% of the

fees will be distributed to the centers contributing data to the study in a

manner proportional to the number of patients included in the study or

in the form of rebates for active site fees.

3. Any center not contributing data to the study will not receive any

portion of the data access fees

4. The coordinating center reserve fund will be reviewed by the Executive

Board annually and the ledger statement of the funds will be distributed

to the Executive Board on an annual basis

XI. Data Ownership

a. Each institution continues to retain sole rights to the data they contribute to the central

MPOG database. Institutions may choose to withdraw their data from the central MPOG

database at any time. Upon receipt of a written request, either physical or electronic,

from a member institution, their data is to be removed from the central database within

seven business days. In the event that this data has already been extracted for research

and/or publication purposes, all reasonable effort will be made to ensure that it is

excluded from use for any study that is not yet in the data analysis phase.

b. MPOG does not own the data stored in the central MPOG database, does not have

responsibility for ensuring the validity of the data, cannot forward or transfer data

without written expressed consent by each contributing institution, or use data without

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following the data sharing rules described below unless approved explicitly for that

purpose by the PCRC, Quality Committee, or Executive Board.

XII. Data Sharing

a. Protected health information (PHI) except date of service will be removed by the

institution contributing the data before submission to MPOG. MPOG will provide

software to sites to enable removal of PHI.

b. After achieving Active member status, the amount of data contributed does not

determine priority in authorship. All Active member institutions have equal access to

data stored in the central MPOG database.

c. All Active member institutions may submit research proposals and manuscripts to be

reviewed and evaluated by the PCRC.

d. The primary author of a research proposal must be from an institution that contributes

the data elements requested and has submitted them within 12 months.

e. Once a research proposal is approved by the PCRC, the MPOG programming team will

extract the approved data elements for the specific research study. The primary author

or co-author of the proposal who had institutional IRB approval to do the study is

provided access to these data. If the author determines they need additional data from

the MPOG database more than 1 year after the initial PCRC approval, they must

resubmit their proposal to obtain the new data. If between 1-2 years after PCRC

approval, electronic voting by current PCRC members is accepted. If >=2 years after

PCRC approval, the proposal must be re-presented in full and voted upon at a PCRC

meeting.

f. The author can only use this limited dataset to answer the specific research question

posed in the proposal and may not use this data for other research purposes. The

primary author has nine months from receipt of data to submit a completed manuscript

to the PCRC for review. The PCRC will confirm that the primary author has followed the

proposed research methods and followed the intent outlined in their original proposal.

If they fail to follow their original methods or research intent, they are prohibited from

using the specific dataset for purposes of publication of the manuscript.

g. Once a manuscript is approved by the PCRC, the primary author may submit the

manuscript to the peer-reviewed journal of their choice.

h. The PCRC will strive to review all research proposals and manuscripts within 30 days of

the research proposals’ or manuscripts’ submission dates.

i. All conflicts in authorship are to be resolved by the involved parties.

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XIII. Exclusivity

a. Participation or contribution of data into the central MPOG database does not confer

exclusivity. Each institution may continue to use their own data for their individual

research studies and/or contribute that data to other research studies.

XIV. Conflict of Interest

a. Personal interests, whether or not considered a conflict of interest, should be disclosed

annually. These interests include consulting relationships, equity relationships, financial

relationships, familial relationships, and speaker’s fees.

b. Any member of MPOG who has a financial, personal, or official interest in, or conflict (or

appearance of a conflict) with any matter pending before the group of such nature that

it prevents or may prevent that member from acting on the matter in an impartial

manner, will offer to voluntarily excuse themselves and refrain from discussion and

voting on said item.

c. PCRC members and all principal investigators must disclose any conflicts of interest

during the submission of each research proposal.

XV. Amendment

a. The Executive Board is responsible for reviewing and voting on all proposed revisions to

the MPOG bylaws. Bylaw changes require a two-third majority of Executive Board

members or their designated appointee present at the meeting.

XVI. Dissolution

a. Participation in the MPOG is entirely voluntary. If the Executive Board decides, via a

two-thirds majority, that the MPOG should dissolve, all data should be removed from

the central database within seven days. Existing research and publications already under

consideration for submission may continue. Signees to this agreement affirm that they

will not use shared data to initiate new research in the event that the MPOG is

dissolved.

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Multicenter Perioperative Outcomes Group (MPOG)

Terms of Membership Participation Agreement

Institution Name: _____________________________________________________________

I have read the MPOG bylaws. Please note, while this is not a legally binding document, reviewing

and signing this document is required for all MPOG sites.

______________________________ ______________________________

Print Name: Department Chair and/or Print Name: Anesthesiology Champion/PI

Head of Practice/Sponsor

Signature:_______________________ Signature:_______________________

Date: __________________________ Date: __________________________