Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE)

Quality Committee Meeting Notes – Monday, May 22, 2023

Attendance:

Abess, Alex (Dartmouth)

Liwo, Alvin (UAB)

Abou Nafeh, Nancy (AUB)

Loyd, Gary (Henry Ford)

Addo, Henrietta (MPOG)

Lewandowski, Kristyn (Corewell)

Agerson, Ashley (Spectrum)

Lopacki, Kayla (Mercy Health - Muskegon)

Armstrong-Browder, Lavonda (Henry Ford)

Lu-Boettcher, Eva (Wisconsin)

Barrios, Nicole (MPOG)

Mathis, Mike (MPOG)

Bauza, Diego (Weill Cornell)

Mack, Patricia (Weill Cornell)

Berndt, Brad (Bronson)

Malenfant, Tiffany (MPOG)

Biggs, Dan (Oklahoma)

McComb, Joe (Temple U)

Bollini, Mara (WUSTL)

McKinney, Mary (Corewell Dearborn / Taylor)

Bowman-Young, Cathlin (ASA)

McFarland, P (Tennessee)

Brennan, Alison (Maryland)

Mentz, Graciela (MPOG)

Buehler, Kate (MPOG)

Milliken, Christopher (Sparrow)

Chang, Joyce (Boston Children’s)

Nanamori, Masakatsu (Henry Ford Detroit)

Charette, Kristin (Dartmouth)

O’Conor, Katie (Johns Hopkins)

Clark, David (MPOG)

O’Dell, Diana (MPOG)

Cohen, Bryan (Henry Ford - West Bloomfield)

Owens, Wendy (MyMichigan - Midland)

Coleman, Rob (MPOG)

Pace, Nathan (Utah)

Collins, Kathleen (St. Mary Mercy)

Pardo, Nichole (Corewell)

Colquhoun, Douglas (MPOG)

Parks, Dale (UAB)

Corpus, Charity (Corewell Royal Oak)

Pimental, Marc Phillip (B&W)

Crump, Joyce (AUB)

Poindexter, Amy (Holland)

Cywinski, Jacek (Cleveland Clinic)

Quinn, Cheryl (St. Joseph Oakland)

Denchev, Krassimir (St Joseph Oakland)

Rozek, Sandy (MPOG)

Dewhirst, Bill (Dartmouth)

Ruiz, Joseph (MD Anderson)

Domino, Karen (Washington)

Saffary, Roya (Stanford)

Drennan, Emily (Utah)

Sakkab, Julie (AUB)

Finch, Kim (Henry Ford Detroit)

Schroeck, Hedi (Dartmouth)

Fisher, Garrett (MyMichigan)

Schwerin, Denise (Bronson)

Gibbons, Miranda (Maryland)

Scranton, Kathy (Trinity Health St. Mary’s)

Goatley, Jackie (Michigan)

Shah, Nirav (MPOG)

Goldblatt, Josh (Henry Ford Allegiance)

Smiatacz, Frances Guida (MPOG)

Hall, Meredith (Bronson Battle Creek)

Smith, Susan (Trinity Health St. Joseph)

Harwood, Tim (Wake Forest)

Spanakis, Spiro (U Mass)

Heiter, Jerri (St. Joseph A2)

Sprough, Donald (U Texas)

Henson, Patrick (Vanderbilt)

Stam, Benjamin (UMHS West)

Horton, Brandy (Anes Associates)

Stewart, Alvin (UAMS)

Johnson, Rebecca (Spectrum & UMHS West)

Toonstra, Rachel (Spectrum Health)

Joseph, Tom (U Penn)

Tyler, Pam (Corewell Farmington Hills)

Katta, Gaurav (Henry Ford)

Vallamkonda, Sushma (MPOG)

Khan, Meraj (Henry Ford)

Woodbury, Jennifer (UCSF)

Koltun, Ksenia (Corewell)

Vishneski, Susan (Wake Forest)

Kumar, Sathish (Michigan Medicine)

Andrew Zittleman (MPOG)

Karamchandani, Kunal (UT Southwestern)

Wedeven, Chris (Holland)

Lacca, Tory (MPOG)

Zacharyasz, Katherine (Cleveland Clinic)

LaGorio, John (Trinity Muskegon)

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 the Coordinating Center if they

are missing from the attendance record.

2. Minutes from February 27, 2023 meeting approved - minutes and recording posted on the website

for review

3. Announcements

○ Welcome Henrietta Addo! Quality Improvement Specialist at the MPOG Coordinating Center

○ Featured Members - MPOG Outcome Research Fellows: May & June

■ Clark Fisher, MD, PhD - Yale University

■ Sunny Lou, MD, PhD - Washington University

○ Welcome New Executive Board Members!

■ Dr. Dan Berkiwitz, University of Alabama - Birmingham

■ Dr. Hugh Hemmings, Jr. Weill Cornell

■ Dr. Peggy McNaull - University of Virginia

○ Congratulations to Cleveland Clinic for their Import Manager Conversion and addition of new

sites from Florida and Ohio Regional sites

■ IT Champion: Dr Ehab Farag

■ PI: Dr. Kenneth Cummings

■ Quality Champion: Dr Jacek Cywinski

■ Chair: Dr. Christopher A. Troianos

4. Upcoming 2023 Meetings

○ July 14: ASPIRE Collaborative Meeting, Henry Executive Center, Lansing, MI

○ September 15: ACQR Retreat, DoubleTree hotel in Ann Arbor, MI

○ October 13: MPOG Retreat in San Francisco, CA

○ May 24th 1pm EST: Obstetric Subcommittee Meeting

○ June 26, 4pm EST: Pediatric Subcommittee Meeting

5. Measure Selection Tool Pilot

○ New Measure Selection Application released to allow sites to update the measures included in

provider feedback emails & individual provider dashboards. Pilot phase only (Michigan sites) for

this month, will launch to all sites next month if pilot goes well

6. New Measures Released!:

○ GA-03-OB: Cesarean Delivery Cases where general anesthesia was administered after epidural

analgesia

○ GLU-06-CARD: Patients ≥18 years age & undergoing an open cardiac procedure requiring general

anesthesia, for whom any intraoperative blood glucose value did not exceed 180 mg/dL.

7. Measure Review: GLU-01/GLU-03/GLU-05: Hyperglycemia Management, Patrick Henson, MD -

Vanderbilt University

○ DISCUSSION:

■ See presentation slides for additional literature included as part of Dr. Henson’s review.

■ Dr. Henson’s Recommendations:

● Recommendation to retire GLU 01 due to reduced relevance.

● GLU 03: Redefine to recheck only & modify threshold to >180 rather than 200 mg/dL

● GLU 05: Modify threshold to >180 rather than 200 mg/dL per recent literature and

societal recommendations

■ Xan Abess (Dartmouth): Reasonable to go to 180 mg/dL; still some value in having separate

measures for GLU 01, GLU 03, and GLU 05 to allow for phasing in improvement locally. We

started with GLU 01 first to address intraop issues and then progressed to the perioperative

period

■ Guarav Katta (HF Allegiance): What is the rationale for retiring GLU 01 again?

● Patrick Henson (Vanderbilt): If I could only have one reported to me for my own practice,

I would think GLU 03 would be sufficient. To reduce overlap and redundancy of

measures.

● Gaurav Katta (HF Allegiance): I actually like the break out of the intraop vs. the periop

flagged cases for the separate measures but I do think we should update the threshold

to 180 mg/dL to align with evidence based recommendations.

■ Pam Tyler (Corewell East): Just a reminder that GLU 03 is a P4P measure for Michigan sites so

any change could impact this.

● Nirav Shah (MPOG Quality Director): We have a couple of options for how to deploy

this…we could replicate the measure and have a secondary measure for 180 mg/dL for

a period of time (similar to how we published PUL 02 after PUL 01) or we can modify the

existing measure

■ Patrick Henson (Vanderbilt): What about the modification to update GLU 03 to be a recheck

only measure?

● Nirav Shah (MPOG Quality Director): I think we have options for how to deploy this

change as well and would likely need to roll out a separate measure for recheck only

(separate from treatment).

○ GLU 01 VOTE:

○ GLU 03 VOTE:

○ GLU 05 VOTE:

○ Conclusion:

■ Update the threshold for GLU-01, GLU-03, and GLU-05 to 180mg/dL, and develop new

recheck measure

8. Measure Review: GLU-02/GLU-04: Hypoglycemia Management, Tim Harwood, MD - Wake Forest

University

○ Discussion:

■ See presentation slides for additional literature included as part of Dr. Harwood’s review.

■ Dr. Harwood’s Recommendations:

● Update threshold to 70 mg/dL, rather than 60

● Reduce timeframe for recheck 15 minutes

■ Sathish Kumar (Michigan Medicine): Agree that 90 minutes is too long. Think we should

recheck at 15 minutes and increase to 70mg/dL.

■ John Goldblatt (HF Allegiance): More of a technical question about the timestamp applied to

preop labs…I believe the timestamp applied is the time the sample was drawn, not the time

it was resulted.

● Nirav Shah (MPOG Quality Director): You bring up a great point. The lab value does

actually result 3 times: the time the sample was collected, the time the lab received the

sample, and the time the lab was resulted. I’m not sure which one is sent over to MPOG

most consistently but this is something sites will need to consider if we update the time

check to 15 minutes.

■ Kathleen Collins (Trinity- Livonia) via chat: Does lab report GLU<70 as a critical result at your

facility?

○ GLU 02 VOTE:

○ GLU 04 VOTE:

○ Conclusion:

■ Update GLU-02 and GLU-04 threshold to 70 mg/dL

■ GLU-02 and GLU-04: Reduce the time for recheck from 90 minutes to 15-30 minutes

Meeting concluded at 1101