Who comprises MPOG, and what are its goals?
The Multicenter Perioperative Outcomes Group is an international consortium of over 50 anesthesiology and surgical departments of institutions with perioperative information systems. The goals of MPOG are to accelerate outcomes research and investigate perioperative clinical practices to advance knowledge and improve patient care.
What data elements are tracked within MPOG?
The MPOG database contains high-quality data relevant to perioperative patient care. These include minute-to-minute physiologic data as recorded within the intraoperative record, as well as minute-to-minute patient care interventions including medication administration, fluid/blood product administration, ventilator settings, and procedure times.
In addition to intraoperative anesthesia record information, the MPOG database records:
- Patient diagnoses – available by discharge diagnoses, professional fee data, and the Anesthesia History & Physical
- Laboratory values – 365 days before and after surgery date, as available within the electronic health record
- Outcome measures – including in-hospital mortality, and diagnosis/laboratory based outcomes (e.g. acute kidney injury, myocardial infarction, postoperative pneumonia
For ease of use and to promote research and quality improvement efforts, all database elements tracked within MPOG can be found within using our Concept Browser search tool.
What is the goal of surgery registry integration?
Through tracking perioperative care practices, the MPOG consortium has been able to drive research and quality improvement efforts leading to multiple publications and quality reporting tools. Similar accomplishments have been made with surgery registries. Through database integration, however, there is great potential for new lines of research and cross-departmental collaboration leveraging the strengths within each database.
MPOG strives to build these promising new lines of research, and invites surgeons as collaborators on MPOG-initiated projects as well as supports surgeons on projects of their own.
What regulatory framework has MPOG established for responsible conduct of research?
The MPOG consortium has two types of IRB approvals used to conduct research. At the coordinating center, an IRB is maintained which enables the collection of a limited dataset to be stored in a secure MPOG database. At each participating center (“performance site”), a second institution-specific IRB is maintained in order to send each institution’s limited clinical dataset to the central MPOG database. If interested in adding surgical registry (e.g. STS or NSQIP) data to your MPOG dataset, you will need to add specific language to the IRB document to ensure that each registry is listed. In the case of the STS Database, we recommend an amendment which describes the ‘Society of Thoracic Surgeons National Database’ rather than individual components (e.g. STS-Adult Cardiac Surgical Database, aka “STS-Cardiac”, STS-General Thoracic Surgical Database, aka “STS-Thoracic”) to preclude requiring additional amendments if additional datasets are added in the future.
What methods are used to ensure security of Protected Health Information (PHI) within the MPOG database?
No patient identifiers are extracted as part of the data aggregation process. Because date of surgery is being extracted, the date of surgery is considered a limited data set and a Data Use Agreement (DUA) between MPOG and each participating research center will need to be established. For more information on DUA processes, please contact MPOG coordinating center admin Tory Lacca.
All data uploaded to the MPOG central database are stored within a high-security data center owned by the University of Michigan. Building access is strictly controlled and servers are maintained by University of Michigan IT staff. Further information regarding measures to ensure patient privacy can be found here.
Who has access to the MPOG database?
The MPOG database is maintained on a secure central server, with access to limited datasets granted on a project-specific basis to active members. Projects may be presented by MPOG contributing members, and are reviewed during research and quality improvement meetings as described below.
What are the sources of funding for MPOG?
MPOG is maintained through three funding sources: anesthesia departmental support (both coordinating center and participating sites), nonprofit healthcare organization support via Blue Cross Blue Shield, and industry support for performing industry-sponsored clinical trials.
How can I learn more about MPOG?
A full description of MPOG membership, infrastructure, goals, research publications, and quality improvement projects are available at the MPOG website: www.mpog.org
What institutions have currently been involved with surgery registry integration?
Current surgery registries establishing integration with MPOG include the National Surgical Quality Improvement Program (NSQIP) database as well as the Society of Thoracic Surgeons (STS) database. Multiple MPOG sites are actively integrating NSQIP and STS data currently; a current list of active sites is available upon request.
I am interested in a collaboration with MPOG, and I already have some ideas for research or quality improvement projects. How can I work with MPOG to drive these ideas forward?
The MPOG team is absolutely committed to your research and quality improvement interests, and seeks cross-departmental collaboration!
The MPOG consortium has an established Perioperative Clinical Research Committee (PCRC) to coordinate research and quality improvement efforts within the group. It accomplishes this goal by reviewing research proposals submitted, and periodically reviewing progress of all ongoing research projects.
The purpose of the committee is not to limit or provide obstacles to successful research programs, but to ensure appropriateness of clinical research and allocate research resources to complete projects. Our formalized steps for proposal can be found here.
Are there any examples of research publications achieved through surgery registry integration with MPOG?
Multiple research projects are currently being pursued by surgery and anesthesiology faculty at participating sites. An example of a completed publication utilizing elements from the MPOG and STS databases can be found here:
- STS Thoracic: https://www.ncbi.nlm.nih.gov/pubmed/27011307
- STS Cardiac: https://www.ncbi.nlm.nih.gov/pubmed/31403976
What is the time commitment required for the Surgical Registry Database Manager to import surgical registry data into the MPOG local database?
Time commitment is minimal, and expedited by the use of a surgical registry-specific important tool (e.g. STS Import Tool; NSQIP Import Tool). Usually less than one hour per upload is required. Uploads can be performed on the same intervals as when curated surgical registry “harvest files” are submitted to surgical-registry specific coordinating centers (usually quarterly or bi-annually), or less frequently (e.g. annually) as time permits.
The first time using the surgical registry-specific Import Tool to integrate MPOG data with surgical registry “harvest file” data may take longer as your Surgical Registry Database Manager becomes familiar with the Import Tool and develops a process workflow for integration at regular intervals.
Are surgeon names included in the surgical data uploaded to MPOG Central?
During the Surgical Registry integration process which is performed locally at your institution using the Import Tools within the MPOG Application Suite, surgeon names are removed and replaced with anonymized IDs. Additionally, protected health information with the exception of dates of service, which remain covered in MPOG DUAs already established at MPOG active sites, are also removed via the Import Tool. This integrated LimitedDataset with the above identifiers removed, is what is transferred to the secure MPOG Central database.
Are Protected Health Information (PHI) included in surgical registries uploaded to MPOG?
Though medical record numbers or social security numbers are required to locally match MPOG data to surgical registry data (e.g. STS or NSQIP), those elements remain stored locally and are not uploaded to the MPOG Central database.
Can I be more selective in choosing modules to avoid taking days to upload?
Yes – You can choose to upload registry data only
Only NSQIP records that matched a patient will be uploaded, but with each NSQIP import an attempt will be made to match all NSQIP cases to the respective MPOG patients, not just the new NSQIP entries. Given that, there’s a possibility more historical records will be patient matched in the future. However the best chance to get the most number of records is to do the historical MPOG backfill.
The NSQIP import tool does automatically flag matched cases/patients for upload, so make sure to use the “cases awaiting upload” option, NOT the “all cases” option. The second option reuploads every case which is not necessary here