Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE)

Quality Committee Meeting Notes – Monday, July 24, 2023

Attendance:

Abou Nafeh, Nancy (AUB)

Loyd, Gary (Henry Ford)

Agerson, Ashley (Spectrum)

Lewandowski, Kristyn (Corewell)

Barrios, Nicole (MPOG)

Lopacki, Kayla (Mercy Health - Muskegon)

Bollini, Mara (WUSTL)

Milliken, Christopher (Sparrow)

Boutin, Jim (Henry Ford - Wyandotte)

Nanamori, Masakatsu (Henry Ford Detroit)

Bowman-Young, Cathlin (ASA)

Nurani, Shafeena (Corewell Troy)

Buehler, Kate (MPOG)

O’Conor, Katie (Johns Hopkins)

Charette, Kristin (Dartmouth)

O’Dell, Diana (MPOG)

Clark, David (MPOG)

Owens, Wendy (MyMichigan - Midland)

Cohen, Bryan (Henry Ford - West Bloomfield)

Pace, Nathan (Utah)

Coleman, Rob (MPOG)

Pantis, Rebecca (MPOG)

Collins, Kathleen (St. Mary Mercy)

Pardo, Nichole (Corewell)

Corpus, Charity (Corewell Royal Oak)

Parks, Dale (UAB)

Esmail, Tariq (Toronto)

Sakkab, Julie (AUB)

Finch, Kim (Henry Ford Detroit)

Schwerin, Denise (Bronson)

Goatley, Jackie (Michigan)

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

Goldblatt, Josh (Henry Ford Allegiance)

Shah, Nirav (MPOG)

Hall, Meredith (Bronson Battle Creek)

Smiatacz, Frances Guida (MPOG)

Harrison, Kelly (UAMS)

Spanakis, Spiro (U Mass)

Harwood, Tim (Wake Forest)

Stam, Benjamin (UMHS West)

Heiter, Jerri (St. Joseph A2)

Stewart, Alvin (UAMS)

Hubbert, Kate (Holland Hospital)

Tallarico, Roberta (UCSF)

Lacca, Tory (MPOG)

Woodbury, Jennifer (UCSF)

LaGorio, John (Trinity Muskegon)

Wade, Meredith (MPOG)

Langnas, Erica (UCSF)

Wedeven, Chris (Holland)

Lalonde, Heather (Trinity Health)

Zittleman, Andrew (MPOG)

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 May 22, 2023 meeting approved - minutes and recording posted on the website for

4. Upcoming 2023 Meetings

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

■ Thank you to all our speakers

■ Post Meeting Wrap-up on website – slides, presentation recording and CME information

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

○ October 13: MPOG Retreat in San Francisco, CA

5. Welcome UMASS Memorial Health!

○ Chair: Dr. Matthias Walz

○ Aim 1: 35 provider interviews, 3 design iterations of prototype messages

■ Preference survey completed

○ Aim 2: Software development, performance testing, and integration of Precision Feedback

Service nearing completion

○ Aim 3: Assess the effects of a precision feedback service

■ Preparation for pilot study in 2023, cluster-randomized trial in 2024

7. Subcommittee Updates

○ Cardiac Subcommittee

■ Next meeting: September, date TBD

○ Obstetric Subcommittee

○ Next meeting: November 8th, 1pm ET

■ Measure Review: BP-04

■ ABX-03-OB: Azithromycin administration for cesarean delivery

8. Brain Health/Geriatric Workgroup

○ Interested group of MPOG participants have met virtually on an ad hoc basis over the last

couple of years

○ Focus on both brain health (delirium / cognition) & geriatric measures

○ Email discussions re: midazolam use in geriatric population

○ Releases scheduled periodically over the coming months

○ Starting with quirks (bug fixes), then moving to new features

○ Release notes will be available on the website as changes are pushed to Production.

○ Performance scores will not be impacted.

○ Thanks to everyone for their feedback over the last couple of years!

■ Now available on ‘All Measure’ & ‘Sustainability’ dashboards - if interested in adding to

Provider Feedback Emails - available in new Measure Selection Tool

○ New Glycemic Management Measures

■ Per Quality Committee approval at the May meeting, new glycemic management measures

are now available:

■ GLU 09: Hyperglycemia Management, Intraop

o updates GLU 01 with new threshold of 180 mg/dL

■ GLU 10: Hyperglycemia Management, Periop

o updates GLU 03 with new threshold of 180 mg/dL

■ GLU 11: Hyperglycemia Treatment, Periop

minutes

■ Quality Committee also requested a ‘recheck only’ measure as part of the measure review

discussion. Peds Subcommittee also in favor of recheck only measure.

■ Next Steps

o Specify and build new recheck measure (convene a small workgroup)

o Once recheck measure(s) are built, consider retiring GLU 09 and 10

o Recheck related to hyperglycemia only?

o How to deal with recheck in preop / PACU?

o How to account for insulin treatment?

○ DISCUSSION:

Let me or Nicole know if you need help accessing the new measure selection app!

■ Tim Harwood (Wake Forest): I understand the technical difficulties of getting the glucose

labs in the system within 15 minutes but believe the Level 2 (BG<54) values should be

rechecked within 15 minutes for the measure. Level 1 rechecks within 30 minutes is

reasonable but would like to hear other members’ thoughts on the Level 2 recheck

as a column.

o Nirav Shah (MPOG): We decided to include formal labs for now to allow sites the

opportunity to review those cases and determine what structural issues may need to be

addressed to allow providers to be notified timely when formal labs are resulted to

allow for proper treatment. Can revisit this as necessary after the measure is in

production and sites have had a chance to do some review.

11. Multicenter QI Measure Proposal

○ Situation

■ A site recently proposed a project to examine compartment syndrome related to patient

■ Includes PCRC proposal and approval, data access, and dissemination protocols

○ Assessment:

■ There may be demand from sites to access MPOG Registry data for QI purposes (rare

diseases or complications, or areas outside of current MPOG coordinating center focus).

■ Coordinating Center should develop a process for sites to analyze registry data for QI

purposes

○ Recommendation:

■ Site completes QI proposal based on MPOG template

■ After presentation to MPOG Quality Committee and approval, coordinating center

generates dataset and stores at MPOG Central

○ DISCUSSION:

■ Tariq Esmail (University Health Network- Toronto): Great proposal but by definition, when

we talk about rare cases, even if deidentified, the cases would be deidentified but would the

institutions be deidentified also?

○ Nirav Shah (MPOG): Great question. It would deidentified by both patient and

typically pre-post intervention. I can't picture a case where we would need data from other

sites. Can you give an example?

○ Nirav Shah (MPOG) - Site example was interested in looking at compartment

■ Silis Jiang (Weill Cornell): Any thoughts on requiring an IRB non-human subjects

determination?

○ Nirav Shah (MPOG): As most QI work is usually exempt by IRB standards, I think this

▪ Dan Biggs (University of Oklahoma) - If you identify an event that is rare enough, would that

allow us to identify the place?

▪ Nirav Shah (MPOG) - One of the ways we would want this approved is through quality

committee to discuss and manage that risk

▪ Kathleen Collins (Trinity Health – Livonia) - This might allow sites to check the frequency of

supposed/assumed rare cases or outliers. Some might be more frequent than we expect

o Tariq Esmail (University Health Network- Toronto): It sounds like this discussion is

o Nirav Shah (MPOG): Yes correct. At the coordinating center we would want to know

o Sachin Kheterpal (MPOG): What we’re discussing today is whether or not we should

▪ Shreyas Bhavsar (MD Anderson) – Thank you for bringing this forward. We originally were

info would live. Then you have to worry about discoverability

o Sachin Kheterpal (MPOG) - this would only include data within MPOG, therefore,

Meeting concluded at 1057