MPOG Pediatric
Subcommittee Meeting
October 6, 2020
Agenda
2:00 – 2:10 Roll Call/Announcements
2:10 - 2:15 Pediatric Quality Dashboard
2:15 - 2:30 Using MPOG Data for Pediatric Research
2:30 - 2:50 Pediatric Measure Updates
2:50 - 3:00 MPOG Peds Measure Review Schedule
July 2020 Meeting Summary
• Meeting Minutes from July 2020 have been posted to the website
• Pediatric Measure Performance Review
– TEMP-04
– Opioid Equivalency - Tonsil & Adenoidectomy (pediatric)
• Non-Opioid Adjunct Measure Discussion (PAIN-01)
– Initial measure proposal and discussion of non-opioid adjuncts to include
Announcements
• Annual MPOG Retreat held virtually last Friday 10/2. All
presentations available on our website.
– CMS perspectives on Quality Improvement
– Best of MPOG Abstracts
– MPOG Subcommittee updates
– Is Equity, Diversity and Inclusion important for
perioperative outcomes?
– Nathalia Jimenez, MD (Seattle Children’s)
– Integrating MPOG Data with Surgical Registries
• SPA Quality & Safety Meeting this Friday 10/9
– Update on the work of MPOG pediatric
subcommittee will be presented
Upcoming Meetings
• Pediatric Subcommittee Meetings
- December 15
• 2021 Schedule
- February 17
- May 19
- August 18
- October 9 (In person @ SPA)
- December 15
• MPOG Annual Retreat 2021
- October 8 (San Diego, CA)
NEW!
Pediatric QI Dashboard
MPOG Research Process
Overview
From Real-World Data to Actionable Knowledge
Michael Mathis, MD
Assistant Professor of Anesthesiology
Associate Research Director, MPOG
Shelley Vaughn, MPH
Department of Anesthesiology
Lead Research Facilitator, MPOG
– Descriptive Studies
– Operational Analyses
– Outcomes Studies
– MPOG Data
– MPOG + Surgical Registry
Types of Research Studies Leveraging MPOG
How many…
…pediatric patients <18
years…
…undergoing general
anesthesia with an
endotracheal tube…
…received albuterol
*AND* epinephrine during
surgery?
DataDirect: “Democratizing” data access
Fluids Labs Vitals
Meds Times
Diagnoses
Outputs Events
Outcomes
Standard MPOG
Concepts
MPOG Phenotypes
Cardiopulmonary Bypass Used
Anesthesia Technique: General
Oral Morphine Equivalents
Baseline Blood Pressure
….
Phenotypes: Structured Inferences from messy data
Developing a Research Study
PCRC Community of Peers
Data Visualization and Curation
Writing the Manuscript
MPOG Pediatric Publications
Writing the Manuscript
• Authorship protocol
– Byline authors – as per ICMJE guidelines
– Acknowledged collaborators – MPOG assists with tracking
• Registration of research protocol
– Protected version on MPOG website always
– Public access version on Open Science Framework discretion of PI
• iThenticate plagiarism checker
…so, where do I start?
Pediatric Measure
Performance Review
• Anesthesia Start → Anesthesia End
• Case Cohort – Patients < 18yo
– Procedures on cervical spine and cord
– not otherwise specified (CPT: 00600)
– patient in sitting position (CPT: 00604)
– Procedures on thoracic spine and cord
– not otherwise specified (CPT: 00620)
– via an anterior transthoracic approach; not utilizing 1 lung
ventilation (CPT: 00625); utilizing 1 lung ventilation (CPT: 00626)
– Procedures in lumbar region; not otherwise specified (CPT: 00630)
– Extensive spine and spinal cord procedures (CPT: 00670)
• Measure Specification
Opioid Equivalency - Spine (pediatrics)
Opioid Equivalency - Spine
Variation by Provider and Case Count (past12 mo.)
2
2
11
3
1
2
2
2
1
1
1
1
1
Opioid Equivalency by Case
PAIN-01
In Development
PAIN-01 Update
• Description: Percentage of patients < 18 years old who undergo a surgical or
therapeutic procedure and receive a non-opioid adjunct preoperatively and/or
intraoperatively.
• Success Criteria: At least one non-opioid adjunct medication was administered
to the patient during the preoperative or intraoperative period.
• Measure Time Period: Preop Start → Anesthesia End
• Exclusions
– ASA 5 and 6; Patients transferred directly to ICU
– Organ Harvest , Cardiac Surgery , Non-operative procedures and Radiology procedures
– Patients that were not extubated in the immediate postoperative period.
– Patients not given opioids or non-opioid adjuncts
• Responsible Provider: No individual attribution
Medications and Routes Considered
Routes
Intravenous (bolus and infusion)
Intramuscular (*Ketorolac only)
Oral
Nasal
Enteric Tube
NON-OPIOID ADJUNCTS
Acetaminophen
Aspirin
Ibuprofen
Naproxen
Celecoxib
Ketorolac
Ketamine
Lidocaine (IV Infusion only)
Dexmedetomidine
Gabapentin
Pregabalin
Clonidine
Esmolol
Magnesium
Additional Information Provided:
● Peripheral Nerve Block (Yes/No)
● Neuraxial (Yes/No)
● Spinal (Yes/No)
● Opioids Given in PACU
● Highest Pain score in PACU
MPOG Quality Measure
Review
Background
• Coordinating Center has created a review schedule
for all measures
– Quality measures should reflect the latest
evidence or may be“topped out” and worth
retiring if no longer relevant for QI
• MPOG subcommittee members have tremendous
experience and expertise that should be leveraged
to keep quality measures current and relevant to
pediatrics
• Request MPOG Pediatric Champions collaborate in
this review process with other quality committee
members
Plan
• Reviewers will make one of the following
recommendations (with supporting evidence)
1. Continue measure as is
2. Modify measure
3. Retire measure
• Considerations
– Reviewers will be de facto members of MPOG
Quality Improvement Measure Workgroup
– Coordinating Center will not assign more than 2
measures per Quality Champion
– Coordinating Center team will assist reviewers
as necessary to complete review process
Measures Review Schedule: Pediatrics
12/2020
• AKI 01 - Acute Kidney Injury → (Bishr Haydar)
• PUL 01 - Protective Tidal Volume, < 10mL/kg PBW → (Wes Templeton)
• PUL 02 - Protective Tidal Volume, < 8mL/kg PBW → (Wes Templeton)
• TEMP 03 - Postoperative Hypothermia → (Vikas O’Reilly-Shah)
03/2021
• CARD 02 - Myocardial Infarction → (Peds Reviewer?)
• PONV 02 - PONV Prophylaxis, Pediatrics → (Brad Taicher & Lisa Vitale)
Full Schedule
Next Steps...
• Publish PAIN-01
• Discuss 2021 Goals
– Call for Measure Survey will be sent out later this month
• Schedule meeting for December
Measure Build Status
Pediatric Temperature Management (TEMP-04) Complete!
OME Pediatric Cohort #1 - Tonsillectomy/Adenoidectomy Complete!
OME Pediatric Cohort #2 - Spine Complete!
Non-Opioid Adjunct (PAIN-01) December 2020
Thank you
