Questions?

Establishing a Learning Health System for Surgical Improvement:

The Michigan Surgical Quality Collaborative

Questions?

Agenda

• Introduction

• The MSQC Learning Health System Cycle

• How it works

• Future Direction & Grant

• Questions

With Appreciation and Gratitude

MSQC Team

73 Participating Hospitals

73 surgeon champions

2,500 surgeons,1800 gynecologists

1,000 anesthesiologists

120 nurses (Surgical Clinical Quality Reviewer)

Monthly surgeon conference calls, newsletter

Quarterly meetings for 10 years

300-400 attendees per meeting

By the numbers……

Agenda

• Introduction

• The MSQC Learning Health System Cycle

• How it works

• Future Direction & Grant

• Questions

Collect

Analyze

Learn & DiscernTranslate & Disseminate

Evaluate & Support

Clinical Inquiry

The MSQC Learning Health System Cycle

• Over 220 variables

• Clinical variables (not billing or administrative)– Demographics/Insurance

– Preoperative risk factors

– Preoperative processes (ostomy marking/bowel prep)

– Labs

– Surgery factors (surgical approach, skin prep)

– Perioperative/anesthesia care factors

– Fluid volume balance

– Medications

– Postoperative outcomes

– Discharge information

Collect

Analyze

Learn & DiscernTranslate & Disseminate

Evaluate & Support

Collect

Analyze

Learn & DiscernTranslate & Disseminate

Evaluate & Support

• Demo

• 24/7 Analytics

• Surgeon-specific reporting

Learn & Discern

• Identify high performing sites

• Site visits/meetings

• Monitor data patterns

• Validate data

Collect

Analyze

Learn & DiscernTranslate & Disseminate

Evaluate & Support

Success factors for the MSQC

STRUCTURE

• Financial support

• Reliable data (doctors believe it)

• Regional rather than national organization

• Multidisciplinary & interdisciplinary

• Nurses as data reviewers

• Site visits

CULTURE

• High standards

• Non-threatening

• Non-competitive

• Engagement

• Exceptional customer service

• Commitment to discovery and innovation

What Makes MSQC’s Model Unique & Successful

Trust

Translate & Disseminate

• Communicate

• List serve/website

• Toolkits

• Learning Center

• Schedule and conduct site visits

• Meetings

• Publish

Collect

Analyze

Learn & DiscernTranslate & Disseminate

Evaluate & Support

Evaluate and Support

• Mentor

• Coach

• Train

• Consult

• Monitor data patterns

• Identify areas for future improvement

Collect

Analyze

Learn & DiscernTranslate & Disseminate

Evaluate & Support

Agenda

• Introduction

• The MSQC Learning Health System Cycle

• How it works

• Future Direction & Grant

• Questions

Big Data to the Bedside

Reduce SSI ( infection) in colectomy patients

Colectomy

• Commonly performed procedure

• High incidence of SSI

• 5,907 patients in 73 hospitals

• 137 data elements/case

• What did the data show?

22 Selected CPT codes

The Colectomy Bundle

PACU Temp gt 96.8 deg F

Bowel Prep w/Oral Abx

LAPROSCOPIC

Open Surgical Time gt 100 (min)

PostOp Day 1 Glucose <140

SCIP 2 Compliant

SCIP 1 Compliant

SSI Bundle Colectomy

How to prevent SSI in Michigan

The Problem: Surgical site Infection Evidence Based Initiatives in 73 hospitals

• Pre op shower

• CHG skin prep

• Glycemic control

• Normothermia

• Short duration surgery

• Appropriate IV antibiotics

• Oral antibiotics with bowel prep

• Laparoscopic approach

• Weight based dosing

• Redosing for >3 hr cases

• Wound protector

• Prehabilitation

• Enhanced Recovery Program

SSI- A Major MSQC Initiative

The site visit fills an important gap

• Team building!

• Validate quantitative information- does it have “face value”

• Identify barriers to implementation

• Collect new qualitative info

• Troy-Beaumont

• Allegience

• Genesys

• Marquette

• Hurley

• Sparrow

• St Joseph-AA

• Oakwood

“Best Practice” Colectomy Panel

The Colectomy Bundle

PACU Temp gt 96.8 deg F

Bowel Prep w/Oral Abx

LAPROSCOPIC

Open Surgical Time gt 100 (min)

PostOp Day 1 Glucose <140

SCIP 2 Compliant

SCIP 1 Compliant

SSI Bundle Colectomy

SSI Bundle (3-items) Trends

SSI Bundle Colectomy

Antibiotic Choice Trends

SSI Bundle Colectomy

Trends for SSI-Total and SSI Bundle (3-items)

SSI Bundle Colectomy

SSI-Total by Terciles for Hospital Level Rates of SSI Bundle (3-items)

Results

90 day episode cost vs Quality Composite

BCBSM pays less as quality improves

Agenda

• Introduction

• The MSQC Learning Health System Cycle

• A Case Study

• Future Direction & Grant

• Questions

1. Leveraging technology

2. Patient-anchored care

3. Creating an epicenter for a Surgical Learning Health System

Leveraging Technology

Data integration

30%

70% 30%

70%2016

2020

Electronic Manual Abstraction

Patient -Anchoring

Surgical Learning Health System

1. Develop an eLearning ‘tool kit’ for Collaborative Quality Improvement start-upTool kit development will be a ready-made solution to share knowledge from the MSQC embedded within the existing eLearning MSQC learning management platform (CourseMill).

2. Initiate infrastructure for a Consolidation Center at the University of Michigan.The Consolidation Center would function as a headquarters providing oversight, guidance and governance of the regional collaboratives.

3. Establish an inaugural Collaborative Quality Improvement (CQI) conference/workshop A conference will provide opportunity for sharing infrastructure, framework, data integrity, technology and expertise for a successful CQI-LHS.

Expected Results

Agenda

• Introduction

• The MSQC Learning Health System Cycle

• How it works

• Future Direction & Grant

• Questions

Questions?

Questions?

• EXTRA SLIDES FOR QUESTIONS

• https://training.arbormetrix.com/Registry/client/msqc

•

• Username: msqcdemo

• Password: 74deal8S (case sensitive)

Travel the Blue Highways

Practice-Based Research—“Blue Highways” on the NIH Roadmap

John M. Westfall, MD, MPH; James Mold, MD, MPH; Lyle Fagnan, MD

JAMA. 297(4):403-6, 2007 Jan 24.

NIH roadmap could benefit from “blue highway” or practice-based research that connects major academic centers to rural areas.

Be Deviant (Positively)

52

MSQC follows the principles of “positive deviance” as an approach to identify practices that improve healthcare quality.

Research in action: Using positive deviance to improve quality of health careElizabeth H Bradley, Leslie A Curry, Shoba Ramanadhan, Laura Rowe, Ingrid M Nembhard and Harlan M KrumholzImplementation Science. 4(25):1-11, 2009