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 [email protected]

Awards and Recognition

Current Collaborations

• Anesthesiology

  The Anesthesiology Performance Improvement and Reporting Exchange is the quality arm of the Multicenter Perioperative Outcomes Group – a national consortium of hospitals focused on improving care for patients undergoing surgery.  Within Michigan, our 30+ member hospitals are committed to understanding variation in care and working together to reduce complications and improve outcomes.  For more information, go to mpog.org.

  Results:

  • 16% improvement in perioperative glucose management, reducing the risk of postoperative infections
  • 18% improvement in the utilization of non-opioid adjunct medications to effectively manage pain and improve outcomes after surgery
  • 19% reduction in high fresh gas flows that can contribute to increased environmental pollutants from anesthetic gases, reducing costs of greenhouse gas emissions without compromising patient care

• Back Pain

  The Michigan Back Collaborative (MIBAC) is a statewide, provider-led collaborative focused on better care for low back pain. The initial focus is on first-contact clinicians – primary care physicians and chiropractors.  Participants aim to achieve more effective care patterns, improved outcomes for patients, and greater satisfaction for both clinicians and patients. The three components within the MIBAC structure are: training, Patient Reported Outcomes (PRO), and the formation of a new registry for acute low back pain to identify best-practices in spine care. For more information, visit mibac.org.

• Bariatric surgery

  The Michigan Bariatric Surgery Collaborative aims to improve the quality of care for patients undergoing bariatric surgery in Michigan, by examining data, and designing and implementing changes in surgical care to improve outcomes. For more information, go to michiganbsc.org.

  Results

  • 62% decrease in length of stay beyond five days (2007 – 2021)
  • 60% decrease in post-surgical death rate (2008 – 2021)
  • 38% decrease in overall complications (2007-2021)
  • 1,400 patients avoided a hospital readmission following surgery (2006 – 2021)

• Blood clot prevention

  The Michigan Anticoagulation Quality Improvement Initiative aims to improve outcomes in patients requiring blood thinners for blood clot treatment and prevention.  Quality improvement activities are centered around reducing the risk of bleeding and clotting adverse events.  For more information, go to maqi2.org.

  Results

  • 86% increase in proportion of patients with optimal warfarin management
  • 58% reduction in serious bleeding events
  • 350,000 unnecessary lab tests prevented
  • 1,750 patients taken off dangerous drug combination
  • Member and provider toolkit developed to disseminate best practices learned by the collaborative

• Cardiothoracic surgery

  The Michigan Society of Thoracic and Cardiovascular Surgeons quality initiative aims to reduce the risk of complications and improve treatment for patients undergoing cardiothoracic surgery, general thoracic surgery and  perfusion treatment. For more information, go to mstcvs.org

  Results

  • 35 percent reduction in post-operative renal failure
  • 43 percent reduction in post-operative pneumonia
  • 45 percent reduction in use of extra blood (10% lower than national average)
  • 4,400 patients avoided unnecessary ventilation treatment

• Cardiovascular

  The Blue Cross Blue Shield of Michigan Cardiovascular Consortium, or BMC2, aims to improve quality of care, reduce complications, increase medication adherence, and reduce adverse outcomes for patients with cardiovascular disease. The consortium has a focus on the following areas:

  • Percutaneous Coronary Intervention – commonly known as angioplasty and stenting
  • Vascular Surgery for aneurysm repair, bypass surgery for peripheral arterial disease, carotid endarterectomy, and carotid stenting
  • Bypass surgery for peripheral artery disease and carotid endarterectomy
  • Transcatheter aortic and mitral valve replacement and repair

  For more information, go to bmc2.org.

  Results

  • 56% reduction in PCI patients receiving high dose radiation exposure during a PCI procedure
  • 43% of smokers quit 1 year after vascular surgery, translating to 6,310 life-years gained
  • 70,000 PCI patients referred for cardiac rehab, lowering risk of readmission and death
  • 59% increase in hospitals prescribing fewer than 10 post-surgical opioid pills following carotid endarterectomy

• Care Transitions

  Integrated Michigan Patient-centered Alliance in Care Transitions (I-MPACT) participants collect and share data to identify best practices to improve patient care transitions from hospital or skilled nursing facility (SNF) to home. In this initiative, hospitals and physician organizations work together to remove barriers to care, improve communication between organizations, and provide better coordinated care. For more information visit the I-MPACT website.

  Results: 

  • 1 in 10 CHF and SNF patients could likely avoid readmission when key transition of care information is included in the discharge summary
    • Transition of care fact sheet for providers sending patients to SNFs – includes discharge documentation items to consider when discharging a patient from the hospital to SNF

  • Over 18,000 I-MPACT care transition interventions provided:
    • Patient Education
    • Care Management
    • Medication Reconciliation
    • Consults and Referrals
    • Standardization of Discharge Processes

  • 8,700 additional follow-up appointments scheduled within seven days of discharge

  • Conversation guides for providers and patients to discuss the importance of seeing a doctor within 7 days of leaving the hospital:
    • Patient Conversation Guide – English
    • Patient Conversation Guide – Spanish 
    • Provider Conversation Guide 

• Emergency Medicine

  The Michigan Emergency Department Improvement Collaborative (MEDIC) catalyzes clinical practice change where there is strong evidence and opportunity to improve quality of care for children and adults visiting our state’s emergency departments.  Participants use the MEDIC data registry to collaborate to improve population health, increase health equity in emergency medicine, and address social determinants of health. For more information, please visit medicqi.org.

  Results & Initiatives:

  • Implemented clinical practice guidelines to reduce unnecessary diagnostic imaging:

  • • 11,000 chest CT scans avoided in adults with suspected pulmonary embolism
    • 8,000 head CT scans avoided in adults and children with minor head injury
    • 5,000 chest X-rays avoided in children with asthma, croup, or bronchiolitis

  • Catalyzed implementation of clinical practice guidelines to reduce unnecessary hospital admissions:

  • • Avoided 875 hospital admissions for adults with low-risk chest pain

• General surgery

  MSQC is a collaborative of 69 Michigan hospitals dedicated to overall surgical quality improvement, better patient care, and lower costs. Collaborative members provide the data and share best practices. The Coordinating Center hosts a robust statewide registry to analyze the data, identify best practices and areas for improvement, and disseminate them across the collaborative. For more information, go to msqc.org.

  Results

  • 23% reduction in surgical site infection for all procedures tracked by MSQC
  • 63% Reduction in post-operative opioid prescribing from 2017-2021
  • 11% reduction in readmissions for all procedures tracked by MSQC

• Health behaviors

  Healthy Behavior Optimization for Michigan (HBOM) is a partnering CQI that works collaboratively with existing CQIs to improve health behaviors within their patient populations.  The goal is to target health behaviors, such as smoking cessation, during teachable moments in health care including new diagnosis, surgery, hospitalization, and pregnancy.  By using evidence-based and CQI-determined best practices, HBOM is a cross-cutting entity aimed at changing behaviors across multiple populations. For more information visit hbomich.org

• Health disparities

  An effort between Michigan Medicine, Blue Cross Blue Shield of Michigan, and the Center for Health Research Transformation, the Michigan Social Health Interventions to Eliminate Disparities (MSHIELD) is a partnering CQI that addresses social health needs in patients across Michigan by linking healthcare and community partners to achieve equitable health outcomes for all. MSHIELD seeks to identify patients’ social health needs; connect patients with community-based and social service resources; and evaluate the effectiveness of social health interventions within hospitals/health systems, existing CQIs, and community regions. Participants also will work with existing CQIs to understand and address social needs and inequities in their patient populations, and with community and state efforts to improve upstream social determinants of health. For more information visit michiganshield.org

• Hospital medicine

  The Michigan Hospital Medicine Safety (HMS) Consortium is focused on evaluating and improving the care of hospitalized medical patients who are at risk for adverse events. For more information, go to mi-hms.org.

  Initiatives

  • Improving appropriate use of intravascular devices (Peripherally Inserted Central Catheter {PICC} & Midline)
  • Improving appropriate inpatient antimicrobial use for patients with pneumonia and positive urine cultures
  • Improving care of the hospitalized patient with sepsis (both on the medical wards and the intensive care unit)

  Results

  • 3,300 blood clots prevented
  • 870 central-line-associated bloodstream infections prevented
  • 32,000 days of unnecessary antibiotics avoided
  • 800+ antibiotic related adverse events avoided
  • 9,000 intravascular catheter occlusions prevented
  • Improved rates for VTE risk assessment, appropriate prophylaxis for high-risk patients, and prophylaxis avoided for low-risk patients

• Knee and hip replacement

  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.

  Results

  • Reduced blood transfusion rate by 88 percent for primary cases.
  • Implemented an infection prevention bundle, reducing the infection rate to 0.4 percent.
  • Achieved 53 percent fewer discharges to extended care facilities after knee or hip replacement surgery.

• Lung health

  INspiring Health Advances in Lung CarE (INHALE) seeks to improve asthma and COPD patient outcomes. Primary care and specialist providers collaborate to improve accuracy of asthma and COPD diagnosis and to assess the appropriate use of spirometry testing in clinical practice. Medication related initiatives will target overuse of both short acting beta agonists (SABA) and oral corticosteroids (OCS) by providing education on the risks of overuse and the importance of adherence to maintenance therapies.

• Obstetrics Initiative

  The Obstetrics Initiative (OBI) works to improve maternity care by supporting vaginal delivery and safely lowering the use of Cesarean sections among low-risk patients. Comprised of 75 participating Michigan maternity hospitals, participants work to identify and address variation through collaboration, rapid cycle data reporting, and quality improvement initiatives.

  OBI has several areas of focus:

  • Facilitate clinical culture change that promotes & supports vaginal birth.
  • Increase outpatient management of early labor.
  • Promote patent engagement and equity in care that is delivered in a respectful manner.
  • Promote physiologic labor and identify ways to respond to labor challenges.

  Visit the Obstetrics Initiative website at obstetricsinitiative.org

• Oncology

  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.

  Results

  • Improved prescribing of antiemetics with high emetic risk chemotherapy
  • Increase in complete assessment of family history of cancer in first- and second-degree relatives, which allows for early action in genetic diseases

• Radiation oncology

  The Michigan Radiation Oncology Quality Consortium (MROQC) aims to determine the most appropriate use of intensity modulated radiation therapy for breast and lung cancer patients. The group establishes and disseminates best practice guidelines that enable  practitioners to optimize the delivery of high quality, cost-effective care for breast, lung, & prostate cancers and bone metastases. For more information, go to mroqc.org.

  Results

  • 60 percent increase in the use of accelerated whole breast irradiation (2014-2019; in maintenance)
  • 10 percent decrease in the radiation dose given to the heart in lung patients (2018-2019; ongoing effort)
  • 96 percent of MROQC patients do not get more doses of radiation than needed in treating bone metastases (2018-2019; in maintenance)

• Spine surgery

  The Michigan Spine Surgery Improvement Collaborative (MSSIC) brings orthopedic surgeons and neurosurgeons together to study ways to improve spine surgery outcomes in Michigan.  Participants aim to improve the quality of care of spine surgery, reduce surgical complications, improve patient functional outcomes, reduce costs and episodes of care, and reduce the need for repeat surgeries. For more information, go to mssic.org.

  Results

  • 16% lower rate of hospital re-admissions within 90 days of discharge
  • 69% reduction in urinary retention
  • 152% improved ambulation within 8 hours of surgery for all spine surgery patients
  • 15% reduction in surgical site infection for lumbar spine surgeries

• Suicide prevention

  Michigan Mental health Innovation Network for clinical Design (MiMIND) works to engage psychiatrists, psychologists, and primary care physicians to improve suicide prevention and care across Michigan. The core program will begin by collaborating with provider organizations to determine and implement system-specific suicide prevention elements and use data to implement rapid cycle quality improvement processes.

• Trauma

  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. MTQIP comprises 35 Level I and II trauma centers in Michigan and over 300,000 patient admissions.

  In 2017, MTQIP began collaboration with the State of Michigan to create a regionalized, coordinated, and accountable trauma system in the state, including 23 Level III trauma centers. In 2019, Michigan Acute Care Surgery (MACS) was developed to improve the quality of care delivered to emergent general surgery patients at 10 hospitals. For more information, go to mtqip.org.

   Results

  • 28% decrease in major complications for trauma patients
  • 37% reduction in deep vein clots that can lead to a life-threatening event
  • 44,000 fewer hospital bed days per year for trauma patients across 35 hospitals

• Type 2 Diabetes

  The Michigan Collaborative for Type 2 Diabetes aims to prevent, slow and reverse the progression of type 2 diabetes using three strategies:
  1. increasing the prescribing of two newer classes of medications that control blood glucose levels
  2. supporting lower-carbohydrate diets
  3. expanding the use of new, lower-cost continuous glucose monitoring devices

  For more information, go to mct2d.org

   

• Urology

  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 14 patient advocates who serve as the moral compass for all the collaborative’s quality improvement activities. MUSIC has several areas of focus:

  1. Patients with, or at-risk for, prostate cancer
  2. Patients treated with kidney stone surgery
  3. Patients with a T1 renal mass diagnosis

  For more information, go to musicurology.com.

  Results

  • 50% 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.
  • Nearly doubled the proportion of low-risk prostate cancer patients avoiding unnecessary treatment
  • Established an electronic infrastructure for measuring and improving patient reported outcomes after prostate surgery.
  • Developed stent omission appropriateness guidelines for patients undergoing kidney stone surgery.
  • 65% reduction in opioid prescriptions following kidney stone surgery.
  • Statewide decrease in ED visits following kidney stone surgery.
  • Established chest imaging guidelines for the initial evaluation of patients with a renal mass diagnosis.
  • Doubled the renal mass complexity documentation by urologists.

   

• Value collaborative

  MVC represents a partnership between 100 Michigan hospitals and 40 physician organizations (POs) that helps members better understand their performance using high quality robust multi-payer data, customized analytics, and at-the-elbow support. MVC offers access to a data registry with information on over 40 different medical and surgical conditions, allowing members to benchmark their care utilization to the state, track changes over time, and identify areas of cost opportunity. MVC also fosters a collaborative learning environment to enable providers to learn from one another in a cooperative, non-competitive space. For more information, please visit michiganvalue.org.

  MVC Data Portfolio

  • Access to multi-payer data sources, including BCBSM PPO, BCBSM MA PPO, BCN, BCN MA HMO, Medicare FFS, and Michigan Medicaid
  • Over 40 different medical and surgical conditions available for member use on the MVC online registry
  • Approximately 8.4 million covered lives covered by MVC data sources
  • Around 84% of Michigan’s insured population accounted for by MVC’s data portfolio