PROGRAMS Collaborative Quality Initiatives
Collaborative Quality Initiatives address many of the most common and costly areas of surgical and medical care in Michigan. In each CQI, hospitals and physicians across the state collect, share and analyze data on patient risk factors, processes of care and outcomes of care, then design and implement changes to improve patient care.
It’s working. A subset of the CQIs have saved an estimated $1.4 billion in statewide health care costs, due to decreased complications and improved patient outcomes. Much of the success comes from the three-part approach to each initiative:
- Funding from the Blues enables hospitals and physicians to work in a collaborative environment, providing resources for data collection and analysis along with administrative oversight.
- A separate coordinating center serves as a data warehouse, conducts data audits, performs data analyses, generates comparative performance reports, and convenes participant meetings.
- Participants work together by sharing data and developing and implementing best practices to improve patient care throughout the state of Michigan.
This award-winning model is the first of its kind, nationally, and is internationally recognized as an innovative approach to improving health care quality and value. The CQI program has been profiled in presentations in over 30 countries on five continents.
For more information about participating in a Collaborative Quality Initiative, please contact the CQI Administration Team at CQIPrograms@bcbsm.com.
Awards and Recognition
eValue8 Health Plan Innovation Award
National Business Coalition on Health
'06, '11, '12, '15
Best of Blue Award
Blue Cross and Blue Shield Association, for collaborative efforts in excellence and innovation
Cancer Center Innovator Award
Foley & Lardner, LLP, for innovative payment reform for and improvement in oncology treatment
Accelerator Award by Clinical Innovation + Technology Magazine
Institute for Healthcare Policy and Innovation (IHPI) Impact Accelerator Award
Dorland health Platinum Award
For Health Information Technology Systems/Quality Reporting Systems
MHA Keystone Center Patient Safety & Quality Leadership Award
Physician Leadership Award given to Hitinder S. Gurm, MD, associate professor of internal medicine, University of Michigan Health System, for his leadership of the Blue Cross Blue Shield Cardiovascular Consortium - PCI Collaborative Quality Initiative
2011, 2014, 2015
Spirit of Collaboration Award
Michigan Cancer Consortium, for contributing to the improvement of cancer care in Michigan
Best Published Paper in Robotic Surgery
Best Paper in Robotic Surgery Published in European Urology in 2016
The Anesthesiology Performance Improvement and Reporting Exchange is a collaborative among hospitals across Michigan to improve anesthesiology practices, reduce anesthesiology-related complications and improve patient outcomes.For more information, go to aspirecqi.org.
The Michigan Bariatric Surgery Collaborative improves the quality of care for patients undergoing bariatric surgery in Michigan. This collaboration includes 41 Michigan hospitals and one hospital in California. For more information, go to michiganbsc.org.
- Decreased blood clot rates by 39 percent (2007-2015)
- Decreased post-surgical death rates by 50 percent (2007-2015)
- Decreased readmissions by 38 percent (2007 – 2015)
The Michigan Anticoagulation Quality Improvement Initiative aims to improve outcomes and safety for patients who receive medication therapy to prevent blood clot formation. Findings from this initiative have influenced standard protocols for managing patients. For more information, go to maqi2.org.
- 41% decrease in ER visits for minor bleeds
- 100,000 unnecessary lab tests prevented
- Development of member and provider toolkits to disseminate best practices learned by the collaborative.
The Michigan Society of Thoracic and Cardiovascular Surgeons quality initiative aims to reduce the risk of complications and improve treatment methods for cardiothoracic surgery. Every Michigan hospital with an adult cardiac surgery program participates in this initiative.For more information, go to mstcvs.org
- 55 percent reduction in post-operative renal failure (2008-Q2 2016)
- 38 percent reduction in post-operative pneumonia (2008-Q2 2016)
- 45 percent reduction in use of extra blood (2008-Q2 2016)
The Blue Cross Blue Shield of Michigan Cardiovascular Consortium, or BMC2, is a prospective, multicenter, collaborative effort to assess and improve quality of care and outcomes for patients with coronary disease, with a focus on the following three areas:
- Percutaneous Coronary Intervention – commonly known as angioplasty.
- Vascular Surgery – patients with peripheral vascular disease who are undergoing open abdominal aneurysm repair, endovascular abdominal aneurysm repair and open bypass procedures of upper and lower extremities. The project also collects data on carotid artery stenting and carotid endarterectomy.
- TAVR (Transcatheter Aortic Valve Replacement) – percutaneous valve replacement procedures
For more information, go to bmc2.org.
- 20% reduction in risk adjusted mortality (2010 – 2017)
- 37% reduction in risk adjusted acute kidney injury (2010 – 2017)
- 54% reduction in transfusion (2010 – 2017)
- 20% reduction in surgical site infection (2014 – 2017)
- 62% decrease in transfusions when HgB>8 (2014 – 2017)
- 127% increase in pre-procedure hydration for high risk EVAR (2012- 2017)
- 23% decrease in Contrast Induced Nephropathy (Q3 2017 – Q2 2018)
- 46% decrease in transfusion (2015 – 2018)
The Integrated Michigan Patient-centered Alliance on Care Transitions aims to reduce hospital re-admissions and improve post-discharge care coordination in five target populations- congestive heart failure patients, pneumonia patients, acute myocardial infarction patients, chronic obstructive pulmonary disease patients, and patients transitioning to a skilled nursing facility.
Participants collect and share data to identify best practices that will improve patient care before, during and after transition from the hospital setting.Visit the I-MPACT website here.
The Michigan Emergency Department Improvement Collaborative (MEDIC)collects and analyzes data on adult and pediatric patients receiving common and costly procedures during emergency department visits. This work includes three broad categories, all with potential cost savings available:
- Diagnostic testing. For example, decision-making around advanced imaging such as computed tomography (CT) scans, magnetic resonance imaging (MRI) and ultrasound.
- Treatment and processes of care. For example, ensuring prompt door-to-balloon time in ST-elevation myocardial infarction, timely initiation of appropriate antibiotics in septic shock, and provision of thrombolytics in acute ischemic stroke.
- Transitions of care. For example, choosing appropriate patients for hospitalization and ensuring quality transitions for those patients discharged for follow up with outpatient providers.
The goal of the Michigan Surgical Quality Collaborative is to evaluate and improve the quality of general and vascular surgery while reducing health care costs. The initiative is outperforming national initiatives in surgical outcomes, including reduction in complications and in surgical site infections.
For more information, go to msqc.org.
- Colectomy Procedures (2012-2016)
- Reduction of 34% in surgical site infection rate
- Greater than 36% increase on adherence to 3 colectomy bundle elements:
- Colon Cancer (2014-2016)
- Rate for positive margins has decreased (improved) 8.27%
- Rectal Cancer (2014-2016)
- The rate for 12 or more lymph nodes examined increased 4.4%
- Hysterectomy (2012-2014)
- Identified the increased cost of robotic hysterectomy for benign disease ($3,200 per case)
- Colectomy Procedures (2012-2016)
The Hospital Medicine Safety Consortium is focused on evaluating and improving the care of hospitalized medical patients who are at risk for hospital-associated infections or blood clots. For more information, go to mi-hms.org
- Improved rates for VTE risk assessment, appropriate prophylaxis for high-risk patients, and prophylaxis avoided for low-risk patients.
- Increase in use of single lumen PICCs, decrease in short term PICC use, and decrease in PICC use for patients with chronic kidney disease (eGFR <45).
The Michigan Arthroplasty Registry Collaborative Quality Initiative is a statewide quality initiative that improves the quality of hip and knee joint replacement surgery procedures and reduces unnecessary costs of this care in the state of Michigan.For more information, go to marcqi.org.
- Reduced blood transfusion rate to less than 2.0 percent for primary cases.
- Implemented an infection prevention bundle, reducing the infection rate to 0.4 percent.
- Reduced discharges to extended care facilities after knee or hip replacement surgery to 10 percent compared to a national average of over 25 percent.
The Obstetric Initiative (OBI) is an interdisciplinary quality initiative led by healthcare providers dedicated to improving women’s health. OBI’s first objective is to support vaginal delivery and safely lower the Cesarean delivery rate among low-risk patients in Michigan hospitals.
Participants are initially collecting data from Blue Cross, Blue Care Network, all 81 Michigan maternity hospitals, and patient medical records, and sharing data insights to improve safe delivery practices statewide.Visit the Obstetrics Initiative website at obstetricsinitiative.org
The Michigan Oncology Quality Consortium aims to promote high-quality, effective, and cost-efficient care for medical and gynecological cancer patients, using quality improvement guidelines facilitated by the American Society of Clinical Oncology’s Quality Oncology Practice Initiative (QOPI®).
For more information, go to moqc.org.
- Improved appropriate pain management in patients’ first two office visits for cancer care from 73% in 2015 to > 90% in 2018
- Increased appropriate pain management in patients’ last two visits beforedeath from 77% in 2015 to > 90% in 2018
The Michigan Radiation Oncology Quality Consortium (MROQC) investigates the most appropriate use of intensity modulated radiation therapy for breast and lung cancer patients. The goal is to minimize side effects and determine the types of patients who would be most likely to benefit from this technology.For more information, go to mroqc.org.
- An increase in the use of accelerated whole breast irradiation in eligible patients from 36 percent to 85 percent since 2014.
- An increase in the use of motion assessment in lung cancer patients from 53 percent to 86 percent since 2014.
The Michigan Spine Surgery Improvement Collaborative (MSSIC) brings orthopedic surgeons and neurosurgeons together to study ways to improve spine surgery outcomes in Michigan. By collecting and sharing data and discussing observations, physicians in participating hospitals are developing best practices to reduce surgical complications, improve patients’ function following spine surgery, and reduce the need for subsequent surgeries.For more information, go to mssic.org.
- 20% reduction in surgical site infection
- 20% reduction in urinary retention
The Michigan Trauma Quality Improvement Program aims to address inconsistencies and variations in patient outcomes related to trauma-based care. It focuses on quality improvement in high-impact areas such as blood clot prevention and bleeding control.For more information, go to mtqip.org.
- Decreased blood clotrate from 2.5 percent (2008-2010) to 1.24 percent (2017)
- Increased pharmacologic blood clotprophylaxis timeliness from 34 percent (2012) to 58 percent (2017)
- Hemorrhage control: Increased the percent of patients receiving a ratio of blood to plasma ≤ 2.5 in the first 4 hours of a massive transfusion event from 28 percent (2011) to 82 percent (2017)
The Michigan Urological Surgery Improvement Collaborative works to improve the quality of urologic care for patients in Michigan. Ninety percent of the urologists in the state participate, as well as seven patient advocates who serve as the moral compass for all the collaborative’s QI activities.
MUSIC has several areas of focus:
- Prostate cancer care.
- Kidney stone care.
- Improving the quality of care for patients with small renal mass diagnoses.
For more information, go to musicurology.com.
- 50 percent reduction in transrectal ultrasound guided prostate biopsy-related hospitalizations
- Statewide decrease in the utilization of both bone scans and CT scans for men with low-risk prostate cancer.
- Established a tri-annual robotic prostatectomy skills workshop program that allows for peer-to-peer video review and mentorship.
The Michigan Value Collaborative uses claims data to help hospitals understand variation in healthcare use, identify best practices, and lead interventions for improving care before, during, and after hospitalization.
Member hospitals access the MVC data registry to evaluate trends in care utilization, re-admissions and post-acute care around 32 medical and surgical conditions. Hospitals can benchmark their utilization compared to other participating hospitals.For more information, go to michiganvalue.org
- Reduced Skilled Nursing Facility usage by 10.2% in MVC hospitals in conjunction with the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARQCI)
- Developed a Heart Failure Readmissions Toolkit to reduce readmissions for CHF patients