WELCOME
ASPIRE and MSQC Members and Friends
Questions and Comments?
Join%your%@MSQCPSO%and%
@MPOGASPIRE%colleagues%
in%conversation%
using%the%hashtag%
#MIValuePartnerships
ENJOY THE MEETING!
TODAY’S AGENDA
A unique privilege and partnership
MSQC Executive Committee
Surgical Video Review
Partnering with Primary Care
ASPIRE-MSQC Morning Session
CQI Specific Afternoon Breakout Sessions
MSQC Thanks You!!!
Connie Bruski, RN
Munson Medical Center
Betty Riegel, BSN
St. John Hospital and Medical Center
Pati Ciofu-Smith
Beaumont Hospital -Dearborn
ASPIRE'Updates
April'20
th
2018
1st Group of
Sites - 2015
19 Current Sites
2 New Sites
Recruitment'2018
Committed
Anesthesiology
Team
Anesthesia
Information
System
IT Resources
Hospital
Leadership
What'you'have'told'us…
• CQIs%Need%to%Work%Together%More
• CQIs%Need%to%Work%Together%Better
• ASPIRE%and%MSQC%have%Areas%of%Overlappin g%Interest
• ASPIRE%and%MSQC%have%Common%Sites
Matching'Algor ithm'– match'MSQC'and'ASPIRE'patients'without'PHI
Hospital Age Gender
Date of
Surgery
CPT
ASA
Number of Matched
Cases
Number of
Cases
Percentage of
Cases
1 ASPIRE: 1 MSQC
41,888
92.5 %
2 ASPIRE: 1 MSQC
2,557
5.7 %
3 ASPIRE: 1 MSQC
636
1.4 %
4 ASPIRE: 1 MSQC
143
0.3 %
5 ASPIRE: 1 MSQC
39
0.1 %
6+ ASPIRE: 1 MSQC
6
0.0 %
Institution Name
Beaumont Dearborn
Beaumont Farmington Hills
Beaumont Grosse Pointe
Beaumont Royal Oak
Beaumont Taylor
Beaumont Troy
Bronson Healthcare Group
Henry Ford Health System
– Detroit
Henry Ford Health System
– West Bloomfield
Holland Hospital
Sparrow Health System
Trinity
- Mercy Health Muskegon
Trinity
- St. Joseph Mercy Ann Arbor
Trinity
- St. Joseph Oakland
Trinity
- St. Mary Mercy Livonia
University of Michigan Health System
Is'there'variability'in'intraoperative'opioids'delivered?
How'ASPIRE/MSQC'sites'pe r form'with'processes'of'care'that'reduce'complications?'
Baseline
~ 2015
Intermediate
~ 2016
Current
~ 2017
70%
75%
80%
85%
90%
95%
100%
Baseline Intermediate Current
Lung Protective Ventilation
_______
MSQC/ASPIRE Hospitals
_ _ _ _
Non- MI ASPIRE Hospitals
Is'there'variability'in'post-operative'pain'scores?
Does'intraoperative'opioid'administration'correlate'with'post-op'opioids?
OME Quartile
Hysterectomy Major Vascular Colorectal
Quartile
1 (0 – 30) 14% 37% 50%
Quartile
2 (> 30 – 60) 22% 44% 47%
Quartile
3 (> 60 to < 90) 48% 42% 66%
Quartile
4 (90 +) 35% 39% 51%
Percent of Patients Requiring Postop IM/IV Narcotics
What'we'need'from'you….
Your ideas for how
this data can
improve quality
across Michigan
PROSPER
• Prospective%Study%on%Perioperative%
Experience%and%Recovery
• Study%that%uses%surveys%and%passively%
collected%information%(activity/%location)%from%
smartphones%to%track%a%patient’s%experience%
throughout%perioperative%period
• No%active%recruiting!%%Just%posters%in%clinics/%
clinic%rooms
We'need'your'h elp!
Think that
understanding
how quality of life
changes before
and after surgery
is important
Able to display
posters and
make flyers
available to
patients in
surgical and
preoperative
clinics
PROSPER team
will create flyers
and posters and
send to your
clinic
If interested, we
can also send
you data on
patients from
your institution
that enrolled
mpog-prosper@med.umich.edu
Thank'you!
!"#$%&'
Please%do%the%MSQC%UTI%Survey
MSQC Colectomy Bundle
Recommendations
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Data%Abstra c tion%and%Integration
Overdose#related#organ#donors#in#Michigan
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4/1/17 - 6/30/17 7/1/17 - 9/30/17
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New prescribing
recommendations
based on patient
consumption
Reductions in
opioid prescribing
Reductions in
patient opioid
consumption
Monitor
Satisfaction,
Patient Outcomes
PROCEDURE
H
YDROCODONE (NORCO
)
5 mg tablets
OXYCODONE
5 mg tablets
CODEINE (TYLENOL #3)
30 mg tablets
TRAMADOL
50 mg tablets
Laparoscopic
Cholecystectomy 15 10
Laparoscopic
Appendectomy 15 10
Inguinal/Femoral Hernia Repair (open
/laparoscopic) 15 10
Open Incisional
Hernia Repair 40 25
Laparoscopic
Colectomy 35 25
Open Colectomy
40 25
Hysterectomy
Vaginal 20 15
Laparoscopic & Robotic 30 20
Abdominal 40 25
Wide Local Excision
± Sentinel Lymph Node Biopsy 30 20
Simple Mastectomy
± Sentinel Lymph Node Biopsy 30 20
Lumpectomy
± Sentinel Lymph Node Biopsy 15 10
Breast Biopsy or Sentinel Lymph Node Biopsy
15 10
Laparoscopic Cholecystectomy 75 75 -
Howard[1], Hill[2]
Laparoscopic Appendectomy 75 75 -
None. Analogy to lap chole.
Inguinal/Femoral Hernia Repair
(open/laparoscopic)
75 75 -
Hill[2], Howard "spillover"
data
Open Incisional Hernia Repair 200 150 -25%
New MSQC data(75th
percentile)
Laparoscopic Colectomy 185 145 -22%
New MSQC data(75th
percentile)
Open Colectomy 200 150 -25%
New MSQC data(75th
percentile)
Ileostomy/Colostomy Creation, Re-siting, or
Closure
- 200 -
New MSQC data(75th
percentile)
Open Small Bowel Resection or Enterolysis - 150 -
New MSQC data(75th
percentile)
Thyroidectomy - 50 -
New MSQC data(75th
percentile)
Hysterectomy
Vaginal 125 100 -20%
New MSQC data(75th
percentile)
Laparoscopic & Robotic 175 125 -29%
New MSQC data(75th
percentile)
Abdominal 220 185 -16%
New MSQC data(75th
percentile)
Wide Local Excision ± Sentinel Lymph Node
Biopsy
150 150 -
Michigan Medicine
institutional guideline
Simple Mastectomy ± Sentinel Lymph Node Biopsy 150 150 -
Michigan Medicine
institutional guideline
Lumpectomy ± Sentinel Lymph Node Biopsy 75 75 -
Hill[2]
Breast Biopsy 75 37.5 -50%
Hill[2]
Sentinel Lymph Node Biopsy Alone - 75 -
Michigan Medicine
institutional guideline
Procedure
Old
Recs
New
Recs
%
Change
Data for
Recommendation
#Rx Summit www.NationalRxDrugAbuseSummit.org
BCBSM#Payment#for#Pain#Optimization#Pathway#
following#Surgery
§ Enhanced%surgical%fees%for%surgery%not%associated%with%a%post-
operative%opioid%prescription%via%modifier%-22
- Laparoscopic%Cholecystectomy
- Thyroidectomy
- Inguinal%Hernia%Repair
- Sinus%Surgery
- Bariatric%Surgery
- Prostatectomy
900 lbs
of pills
17,500
opioid pills collected
1984
oldest opioid collected
Surgery
most common reason for opioid
Michigan OPEN September 2017 Medication Take Back Event
Michigan OPEN April 28
th
, 2018 Medication Take Back
Event Sites
Ann Arbor
Battle Creek
Chelsea
Clinton
Commerce
Dearborn
Flat Rock
Flint
Jackson
Kalamazoo
Copper Harbor
Lapeer
Livonia
Macomb
Mattawan
Monroe
Ottawa County
Pinckney
Pontiac
Roseville
Royal Oak
Saginaw
South Haven
Wayne
Wixom
Ypsilanti
ww w.michigan-open.org
https://opioidprescribing.info
Join%your%@MSQCPSO%and%
@MPOGASPIRE%colleagues%
in%conversation%
using%the%hashtag%
#MIValuePartnerships
Appendix
Population'Demographics
• 41,888%cases%from%19%hospitals
• Case%from%January%2008%to%October%2017
Procedure Type Case Count Percent
Hysterectomy
7,008
17%
Open Major Vascular
617
1%
Colorectal
5394
13%
Other
28,869
69%
Anesthetic'Characteristics'– Fluid'Balan ce 'by'Institution
70%
75%
80%
85%
90%
95%
100%
Baseline Intermediate Current
Administration of Reversal
72%
74%
76%
78%
80%
82%
84%
Baseline Intermediate Current
Transfusion Outcome
Surgical'Characteristics'– Postop'Pain'by'Pr ocedure
OME Quart ile'and'Postop'Pain'by'Procedure