Quality Committee Meeting Minutes 9.23.2019

Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE)

Quality Committee Meeting Notes – Monday, September 23, 2019

Abdallah, Arbi (Wash U St. Louis)

Louzon, Kathryn (Beaumont Royal Oak/Troy)

Applefield, Daniel (St. Joseph Oakland)

Loyd, Gary (Henry Ford)

Angel, Alan (Bronson Battle Creek)

Lucier, Michelle (Henry Ford)

Bailey, Meridith (MPOG)

Mack, Patricia (Weill Cornell)

Biggs, Dan (Oklahoma)

Malenfant, Tiffany (Beaumont Trenton/Wayne)

Bledsoe, Amber (Univ of Utah)

McKinney, Mary (Beaumont Dearborn/Taylor)

Buehler, Katie (MPOG)

Miliken, Christopher (Sparrow)

Chang, Joyce (UCSF)

Nanamori, Masakatsu (Henry Ford Detroit)

Chen, Lee-Lynn (UCSF)

Obembe, Samson (Weill Cornell)

Clark, David (MPOG)

O’Reilly-Shah, Vikas (Emory)

Collins, Kathleen (St. Joseph)

Quinn, Cheryl (St. Joseph Oakland)

Cywinksi, Jacek (Cleveland Clinic)

Pardo, Nichole (Beaumont)

Davis, Quinten (Mercy Muskegon)

Poindexter, Amy (Holland)

Domino, Karen (Washington)

Poterek, Carol (Beaumont)

Egnatoski, Deborah (Beaumont Royal Oak)

Rensch, Robert (Beaumont Kalamazoo)

Forro, Jason (Sparrow)

Schmidt, Carol (Beaumont)

Gall, Glenn (St. Mary’s Livonia)

Schonberger, Rob (Yale)

Gray, Holly (Univ of Michigan)

Shah, Nirav (MPOG)

Harwood, Tim (Wake Forest)

Smith, Susan (Beaumont)

Heiter, Jerri (St. Joseph A2)

Studt, Lindsay (Beaumont)

Horton, Brandy (A4)

Tingle, Sarah (UAMS)

Jameson, Leslie (Colorado)

Turnbull, Zack (Weill Cornell)

Janda, Allison (MPOG)

Tyler, Pam (Beaumont Farmington Hills)

Johnson, Ray (Beaumont Wayne)

Yu, Shao Ping (Weill Cornell)

Jiang, Silis (Weill Cornell)

Vaughn, Shelley (MPOG)

Kaye, Toni (ASA)

Wood, Aaron

Koning-Randall, Kimberly (St. Joseph)

Lacca, Tory (MPOG)

Lins, Steve (Bronson)

Agenda & Notes

1. Minutes from June 24

, 2019 meeting approved- posted on the website for review.

Recording available as well.

2. Roll Call: Will contact QI Champions and ACQRs directly to inquire about participation status

if missing. Other participants can review meeting minutes and contact Coordinating Center if

missing from attendance record.

3. Announcements

a. ACQR Retreat occurred Friday September 22

in Ann Arbor, MI

i. Full day of collaboration between Michigan site ACQRs, ASPIRE QI coordinators,

physicians and programmers.

ii. Discussed measure updates, using MPOG data for research and round table

discussion with programmers and SSI toolkit feedback

b. MPOG Featured Member for September/October 2019: Dr. John Lagorio – St. Joseph

Mercy Muskegon. Read more at: https://mpog.org/featuredmembers/

4. Upcoming Events:

a. October 18, 2019 – MPOG Retreat

i. Orlando, Florida

ii. Registration is available on our website: https://mpog.org/mpogretreat2019/

b. Remaining Quality Committee meetings in 2019:

i. Monday, November 25, 2019 at 10:00 a.m. Eastern

5. Site Recruitment:

a. 5 New Michigan Sites Joining in 2020. Congratulations to:

i. Henry Ford Allegiance, Macomb, Wyandotte

ii. St. Mary’s Mercy Health (Grand Rapids, MI)

iii. Ascension Borgess (Kalamazoo, MI) - Tentative

6. Pediatric and OB subcommittee Reconvening

a. Planning a meeting for both subcommittees prior to 2020 to discuss creating specific

quality improvement metrics for pediatrics and OB.

b. If you would like to continue participating or join either subcommittee, please email the

coordinating center (mpog-admin@med.umich.edu

7. Ongoing Measure Review

a. Requesting help from Quality Champions via a new MPOG Measure Review Committee

i. Want to take advantage of the expertise that resides in our membership.

b. Purpose of Committee: Ensure measures stay current; reflect evidence and consensus of

the MPOG/ASPIRE Quality Committee.

c. Review Measures every 3 years

i. Recommendations on measure changes and whether they should be retired or

not.

ii. Coordinating Center will send out request to all Quality Champions with list of

measures.

8. What Happens when feedback emails are not sent?

a. Feedback emails are usually not sent due to a site data or extract issue

b. Current process is for Coordinating Center to notify Site Quality Champion and ACQR

c. Now, with many ASPIRE MOCA enrollees, more providers than ever “need” the emails to

get credit

d. Question: In the event feedback emails will not be sent, would sites like automated alerts

sent to providers from MPOG, or should this come from the site Quality Champion?

i. No comment. MPOG will continue to send email to QI Champion and ACQR when

feedback emails are not sent as scheduled.

9. Measure Discussion

a. PONV 01 Current

i. New – exclude patients who go to ICU directly (ie intubated)

ii. Largely follows MIPS measure

b. PONV 01 Future

i. Informed by PONV 03 (outcomes measure): identifies the percentage of patients

who undergo a surgical procedure and experience postoperative nausea/emesis

or receive an Anti-emetic in PACU.

ii. Initial data review shows most patients experiencing PONV in PACU are excluded

from PONV 01/02. We plan to revise PONV 01/02 exclusion criteria after release

of this measure to broaden our scope of patients included.

c. Outcome Measures displayed inversely on the dashboard

1. Included: CARD 02, CARD 03, AKI 01, MED 01

2. Question for Quality Committee: Should we display TRAN 02 and TEMP

03 as inverse measures?

a. Consensus was YES. Will move forward with this change.

d. BP 03: MAP < 65 is present for 15 minutes or less

1. BP 01 (<55 for 20 min) has topped out on performance for all sites. Most

current practice is consistent with keeping MAPs above 65.

2. BP 03 will have similar inclusion/exclusion criteria

a. Inclusions: All patients requiring general anesthesia or monitored

anesthesia care (MAC)

b. Analysis of current data for BP 03 is variable. All scores seem to

be high with still room for improvement

3. There was a hypotension measure submitted to CMS (and probably soon

NQF) that is similar to this proposal. That measure also includes risk

adjustment as well as based on age, BMI, sex, duration of surgery, and

ASA status.

4. Feedback

a. Dr. Karin Domino (University of Washington): in favor of BP-03.

Over half of their cases have hypotension with the BP 03

parameters and providers are seeing this clinically. Mathematica

data too preliminary to include risk adjustment as part of the

measure.

b. Dr. Patricia Mack (Weill-Cornell): Review exclusion criteria as

providers are noticing they are required to follow parameters

that think they should have been excluded.

c. Dr. Glen Gall and Kathleen Collins, CRNA (St. Mary Mercy

Livonia): Retire BP 01.

e. AKI 01: Cases With Low Creatinine

1. Current AKI Success Criteria: Percentage of cases that the baseline

creatinine increases more than 1.5 times within 7 postoperative days or

the baseline creatinine level increases by > .3 mg/dL within 48 hours

postoperatively

2. Failed case reviews have highlighted instances where baseline creatinine

started below normal. (i.e. baseline creatinine .3, and postop creatinine

.5)

a. Previously over included cases without billing codes - CPT

prediction tool will help with missing procedure data

3. Is this AKI? – it definitely could be…

a. Example: Frail or elderly population with a “sub normal” Cr due

to atrophied muscle mass

b. The Chronic Renal Insufficiency Cohort (CRIC) study group

assessed the variability between and within different

laboratories for creatinine values – variance observed (SD

creatinine 0.039 mg/dL)

c. Dr. Allison Janda (University of Michigan), reviewed cases across

ASPIRE that failed AKI with baseline Cr .2-.6 mg/dL

i. For cases where the Cr was between .3 and .6, we noted

that they had recent preoperative AKI, but excluding for

that is complicated and of debatable value.

d. AKI 01 Plan: Exclude adult patients with baseline creatinine <.3

mg/dL and pediatric patients with baseline < .2 mg/dL  Review

cases again to ensure that we optimize our inclusion/exclusions

e. Feedback:

i. Dr. Rob Schonberger (Yale): Do we have a percentage of

cases where we saw this? Sample seems diluted.

1. Dr. Alison Janda (University of Michigan): Do not

have an exact percentage but further review is

warranted

ii. Dr. Mike Mathis (University of Michigan): Using the data

we have available we can take this data pretty far. We

should never get to 100% and should consider these

cases are flagged for review.

Meeting concluded at 10:50am