4 www.mymsahq.org
PRESIDENT’S MESSAGE
Roy G. Soto, M.D.
President, Michigan Society of Anesthesiologists
ANESTHESIA QUALITY:
T
he leaders of the MSA and ASPIRE
are excited to announce a new
collaboration between the two
organizations. e goal is to improve
anesthesia quality in the state by
providing MSA members with education and
benchmarking that has not previously been
available to non-ASPIRE members.
WHAT IS HEALTHCARE QUALITY?
e Institute of Medicine denes health
care quality as "the degree to which health
care services for individuals and populations
increase the likelihood of desired health outcomes
and are consistent with current professional
knowledge."
As anesthesiologists, we have brief interactions
with our patients, and frequently aren’t aware of
their ultimate surgical outcome. Furthermore,
many of us don’t have a rm understanding of
how perioperative interventions aect broader
surgical outcomes. We all assume we are providing
quality care, but how do our assumptions align
with actual outcomes? And for that matter, what
outcomes are we interested in? Survival? PONV?
Pain? 30d mortality? Readmissions? Return to
baseline standard of living?
MSA/ASPIRE Collaboration to Improve
Michigan Patient Safety
Nirav Shah, M.D.
Quality Improvement Director,
Multicenter Perioperative Outcomes Group
If we want to track our performance, we have two
choices…measure the processes (e.g. how oen
are we prophylaxing against PONV) and measure
the outcomes (how oen do our patients develop
PONV). ese process and outcome measures
can be dicult to collect, analyze, and interpret,
and various organizations have taken dierent
approaches towards tackling this problem.
HISTORY OF QUALITY INITIATIVES
e Society of oracic Surgeons (STS) National
Database was established in 1989 as an initiative
for quality improvement and patient safety
among cardiothoracic surgeons. Today, any
patient can visit the STS website and nd data for
their particular procedure listed by hospital and/
or surgery group. Although an excellent example
of a quality reporting database, its applicability to
anesthesia is unclear. A heart operation tends to
be a somewhat standardized procedure in patients
with commonly similar comorbidities. An
anesthetic can involve a myriad of comorbidities,
techniques, medications, weights, and ages, and
teasing out anesthetic contributions to surgical
morbidity can be challenging, at best.
e Anesthesia Quality Institute (AQI)
was established by the American Society of
Anesthesiologists in October of 2008 to improve
quality through education and data feedback.
Summer/Fall 2018 5
AQI's vision is "to be the primary source of
information for quality improvement in the
clinical practice of anesthesiology.” Participating
groups and individuals can access compliance
with a variety of self-reported quality measures
and adjust performance accordingly.
HISTORY OF ASPIRE/MPOG
e Multicenter Perioperative Outcomes Group
(MPOG) was formed in Michigan in 2008 to enable
research and quality improvement. MPOG uses
electronic health data (vs. self-reported data)
to populate its registry, which now contains
approximately 10 million cases with 20 billion
physiologic observations. Since 2015, Blue Cross/
Blue Shield of Michigan has funded, quality
improvement eorts of MPOG for Michigan
hospitals. is eort, ASPIRE (Anesthesiology
Performance Improvement and Reporting
Exchange), has over 20 participating hospitals
THE DIFFERENCE BETWEEN ASPIRE AND
OTHERS
As with AQI, ASPIRE allows members to
view adherence to best practices and improve
quality for their patients. Unlike AQI, however,
ASPIRE data points are collected directly
from the anesthesia record allowing for rapid
benchmarking and reporting of performance.
ASPIRE calculates performance on over 20
measures, primarily focused on process of
care, including those governing ventilation
strategies, neuromuscular blockade, transfusion
management, PONV management, handovers,
and glycemic management (full list available at
https://mpog.org/quality/our-measures/)
ASPIRE, furthermore, allows for provider, group,
and hospital leader collaboration via web-based
meetings and quality summits, and performance
is shared with each of its member institutions and
the anesthesia providers who practice withinthese
institutions.
OUR PLAN GOING FORWARD
e infrastructure and collaborative nature of
ASPIRE has led to improved care in the state of
Michigan, particularly to participating providers,
groups, and institutions. It is time to apply the
lessons learned from ASPIRE to non-participating
anesthesiologists as well. Starting with our next
issue of the Ventilator, we will be providing
educational measure summaries, allowing non-
participating hospitals to improve their own
practices using ASPIRE data. We will augment
these articles with emails and website oerings
allowing any MSA member to improve their own
quality of care via ASPIRE benchmarking. It
is our pleasure to oer this new benet to our
membership, and to improve the quality and
safety of care oered in our state.
2018
October 12
MPOG RETREAT
SAN FRANCISCO
October 13-17
ANESTHESIOLOGY ANNUAL MEETING
SAN FRANCISCO
October 24-27
MSMS ANNUAL SCIENTIFIC MEETING
NOVI
November 17-18
ANESTHESIA QUALITY MEETING
SCHAUMBURG
CALENDAR OF EVENTS
