MPOG Brain Health/Geriatric Workgroup
Date: August 21, 2023 3-4p T
Via Zoom
Agenda
● Introductions
● Meeting Goals
● Recap of geriatric/brain health progress
● Proposed Measures (midazolam use)
Participants
Jeff Jacobs, MD – Cleveland Clinic Florida Linda Liu, MD – UCSF
Stacie Deiner, MS, MD – Dartmouth-Hitchcock Medical Center Liz Whitlock, MD – UCSF
Xan Abess, MD – Dartmouth-Hitchcock Medical Center Phil Vlisides, MD – Univ. of Michigan
Miles Berger, MD – Duke University Mark Neuman, MD – University of Pennsylvania
Gary Loyd, MD – Henry Ford Health System Rob Schonberger, MD – Yale/MPOG Associate Research Director
Lucy Everett, MD – Massachusetts General Hospital Mike Mathis, MD – MPOG Research Director
Germaine Cuff, BSN, PhD – NYU Langone Health Nirav Shah, MD – MPOG Quality Director
Simon Tom, MD – NYU Langone Health Rebecca Pantis, M.S. – MPOG
Anne Donovan, MD - UCSF Tony Edelman, MD – MPOG Associate QI Director
Lee-Lynn Chen, MD – UCSF Sachin Kheterpal, MD – MPOG Executive Director
Goals of this meeting
● Ensure all attendees are caught up on conversations and progress over
the last couple of years
● Obtain feedback on developing a new measure that demonstrates
variation in care with administration of midazolam in the geriatric
population
● Determine next steps for this workgroup
○ Continue with ad hoc meetings with correspondence over email
○ Create Basecamp forum to host conversations between meetings?
What is MPOG?
★ Formed in 2008
★ > 63 hospitals including private practices
and academic institutions
★ Data at the coordinating center is
transformed for use in education,
research, and quality improvement
★ We currently have 76 quality measures
Recap of Progress Thus Far…
● Email conversation initiated in August 2020 with interest in studying periop
delirium
● Identified variables present in EHR across MPOG sites -> developed MPOG
Concepts to capture preop cognitive assessments & postop delirium screening
● Met several times from Fall 2020 - Winter 2021
● Presented update at July 2021 Quality Committee meeting
● PCRC 0170 approved in 07/2022, study team led by Xan Abess (Dartmouth) in -
Pragmatic perioperative brain health screening in older surgical patients
MPOG Data
● Between 01/01/2018 - 7/31/2023:
○ 22,545,381 total cases from 71
institutions
○ 6,813,186 cases with patient age >65
across 70 institutions
● More than 60 brain health MPOG
concepts now available!
MPOG Delirium Concepts
(See Browser for complete list)
Institutions Occurrences
Cognition Assessment
17 2,162,398
Clock-Drawing Test – Score
9 23,469
Montreal Cognitive Assessment (MoCA) - Score
6 45,920
Cognitive Screening: MoCA Total Score
2 207,151
Confusion Assessment Method (CAM) - Overall
CAM-ICU Score
4 58,063
Confusion Assessment Method (CAM) Score
26 2,067,098
AD8 – Total score
0 0
4AT – Total Score
0 0
Hopkins Frailty- Score
2 2,663
Recommendations for Variable Mapping
Preop
● Cog screening: AD8, MMSE, MOCA, MiniCog
● Frailty screening: Clinical Frailty Scale, Frail Scale, CSHA Frailty Index
PostOp
● Delirium screening: 4AT, CAM, CAM-ICU
*MPOG only captures data 4 hours before anes start through PACU or 6 hours after anesthesia end.
Measures of interest
● % of patients age >X undergoing non-cardiac GA who received a midazolam intraoperatively
● % of patients age >65 without preoperative hypotension undergoing GA for non-cardiac surgery who
had episode of MAP <55 mmHg within 15 minutes of induction (adaptation of BP-05)
● % of patients screened preoperatively for cog impairment
● % of patients screened preoperatively for frailty
● % of patients screened postoperatively for delirium
● % of patients age >X undergoing GA with ETT who received more that 1.5mg/kg of single propofol
dose for induction
● % of patients requiring sugammadex for rescue following full reversal by neostigmine/glycopyrrolate
Proposed midazolam measure
❖ Midazolam use in patients in geriatric population
❖ Informational only (no threshold)
MED-03
❖ Description: Percentage of geriatric patients who (do not) receive a
benzodiazepine
❖ Threshold: Not applicable - Informational only
❖ Measure time period: Pre-op start time - Anesthesia End
MED-03
❖ Inclusion:
➢ Geriatric patients who undergo procedures requiring general anesthesia
❖ Exclusions:
➢ ASA 5 & 6 cases
➢ Patients <65 y/o?
➢ Others?
MED-03
❖ Success Criteria:
➢ No midazolam / benzodiazepine administered
❖ Provider Attribution:
➢ All anesthesia providers signed in at Anesthesia Start?
➢ All anesthesia providers signed in at Anesthesia End?
➢ Providers signed in when midazolam administered?
Ving questions
❖ Should MPOG build a measure for midazolam administration in the geriatric population?
➢ Yes
➢ No
❖ Which age range among the geriatric population should be included?
➢ > 65
➢ > 70
➢ >75
➢ <80
Ne Questions and Steps
● Should we recommend specific assessments for preoperative frailty / cognition, or
postoperative delirium in the PACU?
● Should we build a measure that tracks rates of PACU delirium screening in the
PACU, knowing that it's going to be low?
● Are there experts in addition to this group that we want to hear more from at
MPOG meetings?
● Continue progress on PCRC 0170
● Consider additional research projects
● Continue to recommend sites to map Brain Health concepts
