Welcome!
We will begin shortly…
ASPIRE Collaborative
Meeting
July 15th 2022
Post Meeting Information on our website
• Presentation slides, notes, and recordings
• CME Information
Please note, the Performance Review
information will not be recorded
THANK YOU!
Upcoming Events
ACQR Retreat
September 16, 2022
DoubleTree Hotel, Ann Arbor
MPOG Annual Retreat
October 21, 2022
New Orleans, LA
In person + virtual
Recruitment 2023
Our perspective
and plan
Have had steady recruitment last few
years (University of Michigan Health
West, Spectrum, MyMichigan, and
others)
About 35 sites now across the state
No plans for aggressive recruitment, but
understand that there are sites /
providers that are unable to join because
lack of hospital or IT support
Anticipate that there will be a few more
health system sites added over time
Health Equity and
ASPIRE
MSHIELD CQI (Michigan Social Health Interventions to Eliminate Disparities) is a
“partnering CQI”
MSHIELD has expertise in working with data involving social determinants of health
and health disparities
One of MSHIELD’s primary goals is to be a partner to all existing CQIs to help each
CQI achieve their quality improvement goals in a way that advances health equity
Their Mission and People
CQI Requirements
Identify a Health Equity Champion
Build your Health Equity Dashboard
Connect patients in need to community resources
PONV Toolkit is
complete!
Existing Toolkits
Web Caseviewer
Updated Version of Web Case Viewer - A new version of Web Case Viewer will be released by
August provider feedback emails
Web Case Viewer
Measure Details
The concepts used in the measure are
brought to the top above the notes section
for easy review
Web Case Viewer - H & P
Record Search and Administrative Sections
GLU 05 Update
GLU 05 Update
● Percentage of cases with a blood glucose >200 mg/dL with documentation
of insulin treatment
● Previously identified issue: Inappropriate flagging of cases where
subcutaneous insulin administered, glucose recheck > 200 mg/dL, but no
additional insulin sq given within 90 minutes because still within the 2-3
hour window of peak insulin effect
Updates
● Insulin administrations within 90 minutes after high glucose value -> PASS
● If not treated, measure will assess if insulin sq was administered within 180 minutes prior to high
glucose value
○ If yes, will ‘ignore’ that value
○ If no, then case will be flagged
● Only applies if MPOG is receiving insulin administration data at least 4 hours before anesthesia start
(ie preop holding)
● These updates will improve measure scores to reflect treatment of hyperglycemia. However, there
may still be gaps in which cases with poor glycemic control are now passed or excluded
● Also updated GLU to account for sq insulin administration
New Measure:
BP 05
New Measure: BP 05
Percentage of cases where severe hypotension during anesthesia induction (defined as MAP < 55 mmHg)
was avoided
Informational Measure Only
Measure Time Period: Induction Start
through Induction End
Inclusions: All patients requiring general anesthesia
Exclusions:
● Patients <18 years old
● ASA 6 cases
● Baseline MAP <60 mmHG
● Labor Epidurals / Obstetric Non-Operative Procedures
Success Criteria: MAP > 55 mmHG throughout induction time period
Sustainability
Sustainability
Bundle
SUS 01 - Low FGF (3 l/min) during anesthesia maintenance
SUS 02 - Global warming footprint of inhalational agents
(maintenance)
SUS 03 - Global warming footprint of inhalational agents
(induction)
SUS 04 - Low FGF (2 l/min) during anesthesia
maintenance
SUS 05 - Low FGF (weight based) during induction - PEDS
SUS 06 - Nitrous yes/no during induction - PEDS
SUS - 02
Efficient use of
inhalational agents
and nitrous oxide
during anesthesia
maintenance period
Description
Percentage of cases where carbon dioxide (CO
2
) equivalents normalized by
hour for cases receiving halogenated agents and/or nitrous oxide is less than
CO
2
equivalents of 2% sevoflurane at 2L FGF = 2.58 kg CO
2
/hr during the
maintenance period of anesthesia
Inclusions
Cases where halogenated hydrocarbons and/or nitrous oxide were
administered during the maintenance phase of anesthesia
Exclusions
Cases without automated FGF data (ie those that are manually entered)
Other Measure Details
Requires inspired agent concentrations
How are CO2 Equivalents Derived?
Number of minutes of
inhalational agent
administered.
● Convert agent % and FGF → mass of agent (mols/min)
● For Nitrous %
a. Convert Nitrous % and FGF → Nitrous Flows (L/min)
b. N2O flow → mass of agent (mols/min)
Agent Molecular
Weight
(g/mol)
Global
Warming
Potential
100
Atmospheric
Lifetime (years)
Isoflurane 184.5 565 3.2
Sevoflurane 200 144 1.1
Desflurane 169 2720 14
Nitrous Oxide 44 282* 114
⅀ [Inspired agent (%) × Fresh Gas Flow (L/min)]
1-n
x GWP
100
SUS - 03
Exploration of
environmental
footprint during
anesthesia
induction
Description
Carbon dioxide equivalents normalized by hour for cases
receiving halogenated agents and/or nitrous oxide during the
induction period of anesthesia
Informational measure only - no threshold
Inclusion and exclusion criteria same as SUS 02
SUS 04
Seeks to identify
high performing
sites
Similar to SUS 01 except lowers success criteria from 3 l/min
to 2 l/min
Most relevant for sites that have previously launched low FGF
projects in their institutions
Continues MPOG’s efforts to build best practice measures in
addition to “acceptable” practice
Timeline
Sustainability Bundle Development
04 02 03
End of
May
End of
June
Fall
Provider
Feedback
Update
A scalable service to improve healthcare quality through
precision audit and feedback
Zach Landis-Lewis, Allison Janda, Allen Flynn, Nirav Shah
NIH National Library of Medicine, Project #1R01LM013894-01
Proposal publication: https://www.researchprotocols.org/2022/5/e34990/
MPOG Precision feedback R01
45
Specific aims:
1. Systematically capture recipient requirements and
preferences for precision feedback messages
2. Implement and assess a demonstration precision
feedback service
3. Assess the effects of a precision feedback service on
care quality and engagement
Progress to date
46
Aim 1:
● 35 provider interviews, 3 design iterations of prototype messages
● Preference survey under development and coming soon
Aim 2:
● Software development, performance testing, and integration ongoing
Aim 3: Assess the effects of a precision feedback service
● Preparation for pilot study in 2023, cluster-randomised trial in 2024
Dear Alex,
Your performance dropped below the goal for the
measure:
TEMP-02: Thermoregulation Monitoring -
Core Temperature.
More information about the rationale for the
measure TEMP-02 and how it is calculated
is
available here
.
A case-by-case breakdown of your results are
available
at your clinical quality dashboard.
Below is your complete MPOG quality performance
report…
100%
80%
60%
40%
20%
0%
May
‘21
Jun
‘21
Jul
‘21
Aug
‘21
Sep
‘21
Oct
‘21
Nov
‘21
Dec
‘21
Jan
‘22
Feb
‘22
Mar
‘22
Apr
‘22
80%
(24/30)
You Top Performer Benchmark 90% Goal
88%
(21/24)
86%
(26/30)
Dear Alex,
You may have an opportunity to improve your
performance on measure
NMB-01: Train of Four
Taken
, which measures the percentage of cases
with a documented Train of Four (TOF) after last
dose of non-depolarizing neuromuscular blocker.
More information about the rationale for the
measure and how it is calculated is available here
.
Below is your complete MPOG quality performance
report…
100%
80%
60%
40%
20%
0%
89%
26/29
27/30
78%
25/32
87%
26/30
87%
27/31
96% 95% 96% 97%
Nov 2021 Dec 2021 Jan 2022 Feb 2022
You
Peer Average
90% Goal
Dear Alex,
In the last month there was a myocardial infarction within 72 hours after one of your operative cases.
Case details can be accessed by logging into your clinical quality dashboard
, and information about how this case was
identified is available
in this measure spec on the MPOG website.
Below is your complete MPOG quality performance report…
Subcommittee
Updates
July 20th
July 25th
August 17th
August 22nd
Thank You!