Opportunities to Work Across
Registries
Nirav Shah, MD
Douglas Colquhoun, MBChB
University of Michigan, Department of Anesthesiology
April 21
st
2023
Acknowledgements:
• Manal Saad, Medical Student/Fellow
• Michelle Romanowski, Developer
• Diana O’Dell, Research Facilitator
• Tiffany Malenfant, Clinical Informatics Specialist
• Kathy Bishop, Program Manager
• Jami Boyd, Clinical Site Coordinator
• Yuxuan Chen, Data Analyst
• Wenjing Weng, Statistician
Thinking Broadly About our Registries
Feature MSQC (or Surgical Registry) MPOG
Data Entry Trained Abstractor Reviewing
Patient Records
Automated Extract from EHR
Data Source Entire Record + Patient Contact Primarily Structured EHR data
Case Inclusion (Sampled) eligible cases All Anesthesia Records in EHR
Validation Cross Checking + Agreement Case Sample Verification,
Control Charts
Key Strength Rigorously Defined Outcomes Detailed Process of Care Data
Scalability Limited by Abstractors Extremely scalable after first
case
MPOG is a Non-Traditional Registry
• Every electronic charted episode of Anesthesia Care is
in MPOG
• The “denominator” of surgical activity in a hospital
• No insight into non-anesthesia cases (ie some L&D)
• MPOG does not contain direct identifiers by design
(except dates of service)
MPOG Cases
MSQC
MTQIP
MSTCVS
OBI
Linking Registries is “Best of Both”
• Each Brings a Key Strength:
• Great exposure information from MPOG
• Great outcome data from MSQC/Other Registry
• Opportunities for partnership:
• Quality
• Research
• Operations
• Seeking to do this at the Coordinating Centers, to minimize impact on sites
How can this be done?
• While ideal would be true matching on names/unique identifiers:
• This data isn’t available
• Incurs a different level of privacy consideration
• Not needed for the purposes of the match
• Commonly available case characteristics, in combination are quite identifying:
• Your institution may look after 100 surgical patients today
• Of those 6 cases might be bowel resection cases
• 4 may be female
• Only 2 might be in their 72 years old
• Only one was started at 7:45am
Using 2018-2019 Data To Develop Process:
• Looked at MSQC Cases from 2018-2019 from
institutions participating in MPOG and MSQC
• n = 21,942 (2018)
• n = 13,757 (2019)
• Cases were validated through manual review.
• Review process included the match parameters
and comparison of the MPOG “procedure text”
variable and the MSQC surgical CPT code
descriptions
• ~70% cases from 2019 were reviewed
State Of Michigan Hospitals
Participate in MSQC
Participate in MPOG
Method #1
Required:
• Age
• Sex
• Institution name
• Operation Date
Optional
• CPT Code
• ASA
Method #2
• Age
• Sex
• Institution name
• Procedure Start
date/time
AND
•In Room
date/time
OR
•Anesthesia Start
date/time
Method #3
• Age (+/- 1 year)
• Sex
• Institution name
• Procedure Start
date/time
AND
•In Room
date/time
OR
•Anesthesia Start
date/time
Method #4
• Age (+/- 1 year)
• Sex
• Institution name
• Procedure Start
date/time
AND
•In Room
date/time
(+/- 10 min)
OR
•Anesthesia Start
date/time
(+/- 10 min)
Method #5
• Age (+/- 1 year)
• Sex
• Institution name
• Procedure Start
date/time
AND
•In Room
date/time
(+/- 10 min)
OR
•Anesthesia Start
date/time
(+/- 10 min)
Ranked matching
Method #6
• Age (+/- 1 year)
• Sex
• Institution name
1. Procedure Start
date/time
AND
• In Room date/time
(+/- 10 min)
OR
• Anesthesia Start
date/time (+/- 10 min)
2. Procedure Start
date/time (+/- 1 min)
AND
• In Room date/time
OR
• Anesthesia Start
date/time
Ranked matching
Match Rate
92.81% (2019)
92.09% (2018)
# of Duplicates
17 (2019)
39 (2018)
Match Rate
97.48% (2019)
96.65% (2018)
# of Duplicates
0 (2019)
1 (2018)
Match Rate
97.74% (2019)
96.86% (2018)
# of Duplicates
3 (2019)
8 (2018)
Match Rate
99.19% (2019)
98.95% (2018)
# of Duplicates
36 (2019)
71 (2018)
Match Rate
99.19% (2019)
98.95% (2018)
# of Duplicates
0 (2019)
0 (2018)
Match Rate
99.26% (2019)
99.05% (2018)
# of Duplicates
0 (2019)
0 (2018)
Can you work with other registries?
• Ongoing collaborations with MTQIP
• Dependent on heterogeneity in included population:
• May not work well for OBI (example) given limited age and sex distribution
• High volume of cases may make this more difficult.
Specific Example Project: SSI
• Team lead by Amit
Bardia (MGH)
• AHRQ R01
• One aspect is to
associate detail of
antibiotic compliance
(MPOG) with SSI
outcomes
• Using surgical
registries of SSI
The overall adherence to guideline-based antibiotic administration was noted to improve over time.
The overall rates of adherence in the 4 domains were 80.4% for choice, 99.4% for timing, 82.9% for
dosing, and 73.2% for redosing.
Bardia A et al. JAMA Network Open. 2021;4(12):e2137296
On the horizon: Joint Quality Measures
• Glucose management?
• Non – opioid adjuncts?
• Surgical Site Infections?
Takeaway Points:
- Thank you for collaboration between organizations
- Joining these registries is the best of both worlds
- Achievable while maintaining privacy and culture of each organization
- Excellent opportunities for expanding quality and research horizons
Thank you
