Quality Committee

Meeting

February 27, 2023

10:00am - 11:00am Eastern Time

Announcements

Measure Review: TOC-03 Dr. Alvin Stewart,

University of Arkansas

New Measure Proposal: Sugammadex Dosing -

Dr. Megan Anders, University of Maryland

Measure Updates:

● CARD 04/05

● GLU 01

Agenda

Meeting Minutes

January 2023

Roll Call – via Zoom or

Announcements

● Welcome UAB!

● Registration for MSQC/ASPIRE

meeting is open

● VBR measurement period updated:

12/1/2022 - 9/30/2023

● OB Subcommittee Update

Welcome to the

University of

Alabama

Birmingham

Chair: Dr. Dan Berkowitz

Quality Champion & PI: Dr. Philip McArdle

IT Champion: Dr. Dale Parks

Friday, April 21, 2023

MSQC/ASPIRE Collaborative Meeting

Michigan Union, Ann Arbor, Michigan

Registration Now Open!

See MPOG Website for

information and registration

2023 Meetings

Friday, July 14, 2023

ASPIRE Collaborative Meeting

Henry Executive Center, Lansing, Michigan

Friday, September 15, 2023

ACQR Retreat

DoubleTree Hotel, Ann Arbor, Michigan

Friday, October 13, 2023

MPOG Retreat

San Francisco, California

VBR Update - Michigan Sites

Due to BCBSM reporting timelines for 2024 VBR, the

measurement time period for this year has been updated to

December 1, 2022 - September 30, 2023.

This time period update applies to both standard and smoking

cessation VBR measures.

Please contact Kate with questions: kjbucrek@med.umich.edu

SUS-03 Released (Beta)

Subcommittee

Updates

OB Subcommittee Update

● Last meeting held on February 15th

○ QI Story: Dr. Robert Nicholson (Bronson-Kalamazoo)

○ Research Overview: Dr. Mike Mathis (MPOG)

● Call for Measure Reviewers!

○ ABX-01 & TEMP-05

● Next Meeting: May 24th @ 1pm EST

○ BMI Stratification

○ Second line uterine tone medications

● Please contact Nicole Barrios (Nicbarri@med.umich.edu) if interested in attending

future meetings.

Cardiac Subcommittee Update

● The Cardiac Subcommittee met in December with more than 20 participants in

attendance

● Included an unblinded performance review of TEMP-06 & TEMP-07: Avoiding Hypo

& Hyperthermia in Open Cardiac Surgery

● Seeking cardiac anesthesiologists to participate as peer reviewers in a

NHLBI-funded R01 study

● Contact Subcommittee Chair, Allison Janda (ajanda@med.umich.edu) if interested in

joining the committee or becoming a peer reviewer.

Next Meeting: April 5, 1-2pm EST

Measure

Review:

TOC 03

Alvin Stewart

University of Arkansas

Transfer of Care - ICU Vote

1 vote/ site

Continue as is/ modify/ retire

Need > 50% to retire measure

Coordinating center will review all votes after

meeting to ensure no duplication

Measure

Proposal:

Sugammadex

dosing

Megan Anders

University of Maryland

Low-dose Sugammadex

Measure Proposal

Megan Graybill Anders, MD, MS (she/her)

Associate Professor of Anesthesiology

Vice Chair for Safety and Quality

Department of Anesthesiology

University of Maryland School of Medicine

Measure Background

• Sugammadex FDA approved in 2015

• A STRONGER argument for use (thanks, MPOG!)

• In a multicenter observational matched cohort study of noncardiac surgery,

sugammadex administration was associated with:

• 30% reduced risk of pulmonary complications

• 47% reduced risk of pneumonia

• 55% reduced risk of respiratory failure

• 2023 ASA guideline endorses sugammadex over neostigmine for

reversal of deep, moderate, shallow blockade

Kheterpal S, et al. Sugammadex versus Neostigmine for Reversal of Neuromuscular Blockade and Postoperative Pulmonary Complications (STRONGER): A Multicenter Matched Cohort Analysis. Anesthesiology.

2020

Background – cost containment

• Strategies for cost-containment are an area of interest

• Formulary restrictions

• Lower-dosing strategies (0.5 or 1mg/kg)

• Dosing at "adjusted" body weight instead of actual body weight

• IWB + 0.4(Actual – IBW)

• Decision support and email feedback for dosage guideline

• A timely measure – groups may be engaging in discussion of

loosening formulary restrictions given ASA guideline

Pregnall AM, et al. Use of provider education, intra-operative decision support, and an email-feedback system in improving compliance with sugammadex dosage guideline and reducing drug expenditures. J Clin

Anesth. 2022

Measure Specification/Rationale

• Percentage of cases with sugammadex administration where cumulative

sugammadex dose < 200mg OR ≤ 3mg/kg

• Fixed cost of 200mg vial

• Acknowledges dose rounding given small injection volumes

• Encourages judicious use of NMBD to end with at least TOF = 2

• Compliant with FDA approved dosing and ASA 2023 guideline

• Threshold – 90%

• Acknowledges CICV, unexpected discontinuation of surgery, safety margin for

individualized dosing

Pregnall et al (Vanderbilt)

Anesth. 2022

Measure Specification - Detail

• Time Period: Anes start to Anes stop/end

• Inclusion:

• Is valid case

• Sugammadex administered

• Adult patients?

• Exclusion: No weight documented, ASA 6

• Attribution options

• Provider(s) signed into case at time of last sugammadex administration

• Provider signed into case at time of last NMBD administration

• Only include case if a and b are the same

Sugammadex Dosing Vote

1 vote/ site

Build as is, Build with modification, Do not build

Plurality wins

Coordinating center will review all votes after

meeting to ensure no duplication

Measure Updates

CARD 04 and CARD 05 - replacing CARD 02 and 03

Reviewed by Dr. Andrea Reidy - Washington University, 2021

Plan

● CARD 04 - outcome measure that identifies patients that had elevated troponin levels (>99th percentile upper reference limit) within 72

hours postoperatively.

● CARD 05 Percentage of high cardiac risk cases with significantly elevated postoperative troponin levels (> 99th percentile URL)

● Sites must submit upper and lower reference limits for each cardiac troponin assay used by their site in order to participate with this

measure.

● Reference limit data can be submitted to the MPOG Coordinating Center as part of the standard lab extract. For sites that are unable to add

to the extract, MPOG will distribute a survey to collect the upper and lower reference limits on an annual basis.

Reality

● Unable to modify the extract to reliably incorporate reference limits.

● Unable to develop process to reliably obtain reference limits manually

Pausing work on these until we can reliably get reference information using automated methods

Hyperglycemia Measure Updates Released!

GLU 01:

- Assigned a ‘pass’ criteria for cases that were administered insulin SQ within 120

minutes before the high glucose value (this change was already applied to GLU 03/05)

- Added exclusion for cases with measure duration ≤ 30 minutes

- Score changes were significant at some sites: >15% improvement!

GLU 03 & GLU 05:

- Added exclusion for cases with measure duration ≤ 30 minutes

- Score changes were minimal: +/-1%

Thank You!