Quality Committee Minutes 10.26.20

Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE)

Quality Committee Meeting Notes – Monday October 26, 2020

Abess, Alex (Dartmouth)

Lacca, Tory (MPOG)

Angel, Alan (Bronson)

LaGorio, John (Mercy Muskegon)

Applefield, Daniel (St. Joseph Oakland)

Lewandowski, Kristyn (Beaumont)

Aziz, Mike (OHSU)

Lins, Steven (Bronson)

Bailey, Meridith (MPOG)

Lucier, Michelle (Henry Ford)

Berndt, Bradford (Bronson)

Malenfant, Tiffany (Beaumont Trenton/Wayne)

Biggs, Dan (Oklahoma)

Manders, Larry (Beaumont Taylor)

Bollini, Mara (Washington University)

Mathis, Mike (MPOG)

Boutin, Jimmy (Henry Ford)

McKinney, Mary (Beaumont Dearborn / Taylor)

Buehler, Kate (MPOG)

Milliken, Christopher (Sparrow)

Charette, Kristin (Dartmouth)

Moody, Rebecca

Chen, Lee-Lynn (UCSF)

Nanamori, Masakatsu (Henry Ford Detroit)

Coffman, Traci (St. Joseph Ann Arbor)

Obembe, Samson (Weill Cornell)

Cohen, Bryan (Henry Ford Detroit)

O’Reilly-Shah, Vikas (UW)

Collins, Kathleen (St. Mary Livonia)

Ostarello, Claire (Partners)

Coons, Denise (Bronson)

Overmyer, Colleen (University of Chicago)

Cuff, Germaine (NYU Langone)

Pace, Nathan (Utah)

Davies, Eric (HF Allegiance)

Pardo, Nichole (Beaumont)

Davis, Quinten (Mercy Muskegon)

Poindexter, Amy (Holland)

DePasquale, Will (NYU Langone)

Qazi, Aisha (Beaumont Troy)

Dewhirst, William (Dartmouth)

Quinn, Cheryl (St. Joseph Oakland)

Forro, Jason (St. Joseph)

Rubin, Daniel (University of Chicago)

Gall, Glenn (St. Mary Livonia)

Rutherford, Renee (Borgess Ascension)

Goatley, Jackie (Michigan Medicine)

Schroeder, Becky (Duke)

Hagan, Katherine (MD Anderson)

Scranton, Kathy (Mercy St. Mary)

Hall, Kathleen (Borgess)

Shah, Nirav (MPOG)

Heiter, Jerri (St. Joseph A2)

Smith, Susan (Beaumont)

Harwood, Timothy (Wake Forest)

Szymanski-Bogart, Brooke (MPOG)

Horton, Brandy (A4)

Trummel, John (Dartmouth)

Janda, Allison (MPOG)

Tyler, Pam (Beaumont Farmington Hills)

Jacobson, Cameron (Utah)

Vaughn, Shelley (MPOG)

Kaper, Jonathan( Beaumont Trenton)

Wood, Aaron (Beaumont Farmington Hills)

Khan, Meraj (Henry Ford Macomb)

Wren, Jessica (Henry Ford Wyandotte/Macomb)

Kheterpal, Sachin (MPOG)

Zeldes, Daniel (Beaumont Grosse Pointe)

Kileny, Joel (St. Joseph, Ann Arbor)

Konig-Randall, Kimberly (St. Joseph Ann Arbor)

Agenda & Notes

1) 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.

2) Minutes from August 24, 2020 meeting approved- minutes and recording posted on the website for

review

3) Announcements & Updates

a) COVID-19 study published in British Journal of Anesthesia (BJA) by Dr. Pirracchio and colleagues

at UCSF: Response of US hospitals to elective surgical cases in the COVID-19 pandemic

b) MPOG Featured Member: Amy Poindexter, BSN, RN from Holland Hospital in Michigan. ACQR

and vital

c) October 2020 Upgrade now available! Please contact support@mpog.zendesk.com

to receive

scripts to upgrade

4) Upcoming Events

a) MSQC/ASPIRE Collaborative Meeting: April 23, 2021

b) ASPIRE Collaborative Meeting: July 16, 2021

c) MPOG Retreat: October 8, 2021

d) Quality Committee Meetings via Zoom

i) Monday, January 25, 2021

ii) Monday, March 22, 2021

iii) Monday, May 24, 2021

iv) Monday, July 26, 2021

v) Monday, September 27, 2021

vi) Monday, November 22, 2021

5) MPOG Retreat Recap

a) Meeting Summary, Presentation Slides, and Videos available at mpog.org

b) Went well! Thanks to everyone for joining. Virtual meeting allows more folks to join than would

normally be able to travel to ASA location. Great attendance- over 160 attendees were able to

join for at least a portion of the meeting.

c) Thank you to our speakers!

i) Dr. Michelle Schreiber- Informing us that MIPS is not going away

ii) Dr. Nathalia Jimenez- Educating us on how DEI can influence perioperative outcomes

iii) Best of MPOG presenters:

(1) Dr. Sharon Reale (Brigham & Women’s)

(2) Dr. Tim Dubovoy (Michigan Medicine)

(3) Dr. Orestes Mavrothalassitis

iv) Subcommittee Leads:

(1) Cardiac Anesthesia Subcommittee: Dr. Allison Janda (Michigan Medicine)

(2) Obstetric Anesthesia Subcommittee: Dr. Rachel Kacmar (University of Colorado)

(3) Pediatric Anesthesia Subcommittee: Dr. Bishr Haydar (Michigan Medicine)

v) Breakout Sessions: Led by the MPOG Coordinating Center team

d) 2021 Plans

i) QI measures:

(1) GLU 05/06: Hyperglycemia Treatment & Appropriate Preop Glucose Check

(2) SUS 02: Global Warming F inhalational agents

(3) PUL 04: Respiratory bundle

(4) Peds/OB/Cardiac specific measures as recommended by the subcommittees

(5) Registry Outcomes to be added to QI reporting for sites that have merged data with

various registries: MSQC, NSQIP, STS, etc.

(6) More informational/best practice measures (ASPIRE 2.0)

(7) MPOG QI Stories/Measure Review at Quality Committee Meetings

ii) Development

(1) Emails 2.0

(2) Incremental Updates to DataDirect & QI Reporting

(3) App Suite: Location Mapping overhaul

(4) MQUARK: Generalize clinical trial software

(5) Infrastructure: More computed phenotypes

(6) Goal: Continue to build applications that work together and integrate data in a user-

friendly way

iii) Dashboard 2.0

(1) See Quality Committee slide deck for screenshots of new dashboard, including

subspecialty dashboards for OB, pediatric, and cardiac anesthesia – Now available in the

beta version of the dashboard

(2) Continue to provide feedback in the beta period: support@mpog.zendesk.org

(3) Next Steps:

(a) Bug fixes & usability enhancements

(b) Individual dashboard rollout

6) MOCA 2.0 Part 4

a) Visit MPOG website at https://mpog.org/moca

for more information on eligibility, fees, and

process to participate in the ASPIRE MOCA 2.0 program

7) Subcommittee Updates

a) Obstetric Anesthesia Subcommittee

1) Addition of informational row for severe pre-eclampsia in reports for AKI 01

2) Measures in development:

i) BP 04- Hypotension during Cesarean Deliveries: Flag cases with SBP <90 for >5

minutes between placement of spinal and delivery

ii) GA 01- General Anesthesia for Cesarean Deliveries

3) Continued development of “Obstetric Anesthesia Type” phenotype

a) Will replace current methods of excluding labor epidural or cesarean delivery cases in

most measures

4) 2021 Meetings

a) February 3rd, 1pm EST

b) May 5th, 1pm EST

c) August 4th, 1pm EST

d) November 3rd, 1pm EST

5) If interested in joining, please contact Brooke Szymanski-Bogart (bmiszy@med.umich.edu)

b) Pediatric Anesthesia Subcommittee

i) Pediatric Cases in MPOG Central as of October 2002: 1,647,619

ii) Now have 4 pediatric-specific quality measures

iii) 2 sites have integrated their NSQIP-peds data with MPOG

iv) 64 subcommittee members participating

v) 2020 Measures Complete

(1) TEMP 04

(2) OME-Tonsillectomy/Adenoidectomy

(3) OME-Spine

vi) Measure in Progress: PAIN 01 (Peds): Multimodal analgesia including regional blocks

vii) Next Meeting: December 16, 2020 1-2pm EST

viii) 2021 Meetings:

(1) February 17, 2021

(2) May 19, 2021

(3) August 18, 2021

(4) October 9, 2021 (in-person @SPA)

(5) December 15, 2021

ix) If interested in joining, please contact Meridith Bailey (meridith@med.umich.edu

)

c) Cardiac Anesthesia Subcommittee

i) Sites from 13 states now involved: see slide deck for participating sites

ii) Great subcommittee meeting held on October 9

(1) Goals: Develop cardiac-specific measures consistent with subspecialty guidelines and

consensus statements

(2) First cardiac-specific measure to develop: temperature management

(a) Post-bypass hypothermia avoidance

(b) On bypass hyperthermia avoidance

iii) To join, contact Allison Janda (ajanda@med.umich.edu)

8) AKI Measure Review and Vote

a) Measure Review Process:

i) MPOG QI measures need to be reviewed to stay current and relevant

ii) Should reflect latest evidence and consensus of the MPOG Quality Committee

iii) All MPOG measures should be reviewed every 3 years

iv) Quality Champions received an e-mail that outlined the process and included a link to a

Google spreadsheet that listed all the ASPIRE measures. Quality champions are assigned to

measures to assist with literature review and provide guidance to the Quality Committee

regarding measure changes/status. If you have not taken a look at the Google sheet, please

do so and let us know if you have any questions.

(1) If you want to change your assigned measure or have any questions, please contact the

Coordinating Center

(2) Coordinating Center will continue to reach out next month for those champions

assigned for any measure requiring review between now and December 2020.

v) Reviewers will make one of the following recommendations (with supporting information):

(1) Continue Measure as Is

(2) Modify Measure

(3) Retire Measure

b) First measure up for review: AKI 01

i) Initial rollout: 2016

ii) Last Review was performed in 2016 though updates have been made since then

iii) Assigned to the following reviewers:

(1) Dr. Michael Mathis, Michigan Medicine

(2) Dr. Michael Aziz, OHSU

(3) Dr. Bishr Haydar, Michigan Medicine

iv) Reviewed current AKI 01 measure specification: https://spec.mpog.org/Spec/Public/18

v) Risk adjustment is under review currently and will be revised by the end of the year –

Coordinating Center will add new methodology to spec once available

(1) Michael Mathis: Recommends threshold be re-evaluated once risk adjustment model is

updated

vi) KDIGO AKI definition used for this measure – still relevant in 2020

vii) Several references recommended to be added to the measure spec:

(1) Khwaja A: KDIGO Clinical Practice Guidelines for Acute Kidney Injury 2012; 120:pp c179–

(2) Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers

P, Van Lente F, Greene T, Coresh J, CKD-EPI (Chronic Kidney Disease Epidemiology

Collaboration): A new equation to estimate glomerular filtration rate. Ann Intern Med

2009; 150:604–12

(3) Gumbert SD, Kork F, Jackson ML, Vanga N, Ghebremichael SJ, Wang CY, Eltzschig HK:

Perioperative Acute Kidney Injury. Anesthesiology 2020; 132:180–204

(4) Turan A, Cohen B, Adegboye J, Makarova N, Liu L, Mascha EJ, Qiu Y, Irefin S, Wakefield

BJ, Ruetzler K, Sessler DI: Mild Acute Kidney Injury after Noncardiac Surgery Is

Associated with Long-term Renal Dysfunction: A Retrospective Cohort Study.

Anesthesiology 2020; 132:1053–61

(5) Meersch M, Schmidt C, Hoffmeier A, Van Aken H, Wempe C, Gerss J, Zarbock A:

Prevention of cardiac surgery-associated AKI by implementing the KDIGO guidelines in

high risk patients identified by biomarkers: the PrevAKI randomized controlled trial

2017; 43:pp 1551–61

(6) Futier E, Lefrant J-Y, Guinot P-G, Godet T, Lorne E, Cuvillon P, Bertran S, Leone M,

Pastene B, Piriou V, Molliex S, Albanese J, Julia J-M, Tavernier B, Imhoff E, Bazin J-E,

Constantin J-M, Pereira B, Jaber S, INPRESS Study Group: Effect of Individualized vs

Standard Blood Pressure Management Strategies on Postoperative Organ Dysfunction

Among High-Risk Patients Undergoing Major Surgery: A Randomized Clinical Trial. JAMA

2017; 318:1346–57

(7) Mathis MR, Naik BI, Freundlich RE, Shanks AM, Heung M, Kim M, Burns ML, Colquhoun

DA, Rangrass G, Janda A, Engoren MC, Saager L, Tremper KK, Kheterpal S, Aziz MF,

Coffman T, Durieux ME, Levy WJ, Schonberger RB, Soto R, Wilczak J, Berman MF, Berris

J, Biggs DA, Coles P, Craft RM, Cummings KC, Ellis TA 2nd, Fleishut PM, Helsten DL, et al.:

Preoperative Risk and the Association between Hypotension and Postoperative Acute

Kidney Injury. Anesthesiology 2020; 132:461–75

c) Reviewers recommendation (Mathis:

i) Recommendation: Continue the measure as-is (adding references and risk adjustment

methodology once updated)

(1) KDIGO still is most widely accepted way to define AKI

(2) Current evidence still suggests perioperative AKI is associated with long-term health

risks, hospital costs, and mortality

d) AKI 01 Measure Discussion:

i) Eric Davies (Henry Ford Allegiance): This measure relies on labs being obtained reliably after

surgery to assess for AKI. I think we need a measure that simply identifies the percentage of

cases that had a postop creatinine measured

(1) Michael Mathis (Michigan Medicine): Do not have a bullet-proof solution for this. Could

be transparent with reporting exclusions and reason for exclusion (i.e. lack of postop

creatinine) so we could better track this

(2) Nirav Shah (ASPIRE Director): Could create a demographic type measure on how many

patients had a creatinine measured and submitted to MPOG- could add this to the new

reporting dashboard for 2021

ii) Kate Hagan (MD Anderson): List of exclusions are arbitrary- why are only non-obstetric

procedures, pain procedures, and ECT are excluded?

(a) Michael Mathis (Michigan Medicine): These are the procedures that were excluded

for the MPOG study that specifically examined AKI and hypotension. This was just a

starting point.

(b) Nirav Shah (ASPIRE Director): Many other cases would be excluded by the 45-

minute exclusion or no postop creatinine measured. Thought we could cover most

appropriate procedure exclusions with that criterion.

endoscopy procedures with cancer diagnosis and therefore have preop/postop

creatinine values so they are included.

e) AKI 01 Vote: Via Webex

i) Continue Measure as is – 23/30 (77%)

ii) Modify measure – 2/30 (7%)

iii) Retire measure – 5/30 (16%)

f) Next measures due for review:

i) PUL 01/02: Protective Tidal Volume – Drs. Avery Tung (UChicago) & Douglas Colquhoun

(Michigan Medicine)

ii) TEMP 03: Perioperative Normothermia – Drs. Simon Tom (NYU) & Vikas O’Reilly-Shah

(University of Washington)

Meeting concluded at 11:02am