Updates from the Quality Improvement folks
Objectives
• Keep most of you awake
• What we did last year
• Our plans for next year
Disclosures
• No personal consulting, financial, or board membership with any company
• I am a PI/Co-I on projects that receive grant funding from
– Blue Cross Blue Shield of Michigan (Anesthesia QI)
– Apple, Inc (wearabkes)
– NIH (induction dosing in elderly population)
– Edwards Lifesciences (intraoperative hypotension)
New sites or sites
that are interested
in joining
What is the
MPOG QI
Landscape
Across Our
Sites?
Duration of
participation
Existing QI
infrastructure
Relevance of
measures
Departmental
support
Emails/ no
emails
MOCA/ no
MOCA
New Measures
SUS 01
• Sustainability
• Is there an opportunity to deliver halogenated agents/ nitrous oxide more efficiently?
• Are your fresh gas flows ≤ 3 l/min between intubation and extubation?
BP 03
• Avoiding hypotension (MAP 65) for cumulative duration of 15 minutes or more
• Reflects current practice more accurately than BP 01
• Same inclusion/exclusion criteria as BP 01 (cardiac, liver txp, labor epidurals, etc)
PONV 03
• Percentage of patients, regardless of age, who undergo a procedure and have a documented
nausea/emesis occurrence postoperatively OR receive a rescue antiemetic in the immediate
postoperative period.
TOC 01
• Intraoperative Transfer of Care
• Percentage of cases in which a permanent intraoperative anesthesia staff change occurred,
that have a documented use of a checklist or protocol for the transfer of care from the
outgoing anesthesia provider to the incoming anesthesia practitioner
New Phenotypes – CPT Prediction
• Reminder: phenotypes are the data
building blocks by which we create
measures
• CPT Prediction phenotype generated
an anesthesia code based on procedure
text and ML algorithms
• Implemented this summer across all of
our measures
• Enables more accurate
inclusion/exclusions
• Replaced by submitted pro fee data
once that is submitted
Partnerships to extend the QI mission
MQUARK Audits
• Over 2000 PACU handoff audits across 20
hospitals
• 10/month/hospital
• Data on quality of handoffs
• Ready for new projects and analyses
New Toolkit - SSI
MOCA Part IV
• 350 providers
• Up to 25 points
• Click MOCA button on emails
• Review flagged cases
• Do it 12 times in 18 months
Our plans for next year
Our Measures
• Focus on measures that need to be
addressed on a systems level
• Evolve our attribution philosophy
from “failed” case to “flagged”
case
• Fully release ourselves from the
shackles of MIPS/QCDR
Existing domains where we can create additional depth
• Glycemic management
– Separate appropriate glucose checking and treatment into two measures
– Add preop and PACU data
• Transfusion management
– Extend into PACU
• Respiratory management
– Use respiratory complications phenotype
– Sugammadex usage
• Hypotension
– Add risk adjustment
• Sustainability
– Calculate global warming footprint of anesthetic gases
Current Dashboard
Dashboard 2.0
FLEXIBLE VISUALLY
INTERESTING
LINKS TO OTHER
MPOG APPS
Measure maintenance
• Every three years
• Review specifications
• Relevance
• Inclusion/Exclusions
• Make Recommendations
• Recruit Quality Champions
CaseViewer and DataDirect Upgrade
Renew Pediatric and Obstetric Anesthesiology subgroups
• Partner with specialty organizations
• Identify Pediatric and Obstetric
Champions
• Build measures/tools specific for
those subspecialties
• Recruit freestanding pediatric
hospitals
Emails
• Working with Dr. Zach Landis Lewis,
UM Learning Health Sciences
• Submitting grant to study
effectiveness of email design,
primarily focused on “tailored
messaging”
• Planning redesign, but not sure about
2020
Need to adapt and listen to stay relevant
• Need your
feedback
• Need to stay
nimble
• Need to take
calculated risks
• Need your new
ideas
Thank You
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