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

Current Collaborations

• Anesthesiology

  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.

• Bariatric surgery

  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.

  Results

  • 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)

• Blood clot prevention

  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.

  Results

  • 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.

• Cardiothoracic surgery

  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

  Results

  • 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)

• Cardiovascular

  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.

  Results

  PCI:

  • 20% reduction in risk adjusted mortality (2010 – 2017)
  • 37% reduction in risk adjusted acute kidney injury (2010 – 2017)
  • 54% reduction in transfusion (2010 – 2017)

  Vascular Surgery:

  • 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)

  TAVR:

  • 23% decrease in Contrast Induced Nephropathy (Q3 2017 – Q2 2018)
  • 46% decrease in transfusion (2015 – 2018)

• Care Transitions

  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.

• Emergency Medicine

  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.

  Website:  medicqi.org

• General surgery

  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.

  Results

  • 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)

• Hospital medicine

  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

  Results

  • 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).

• 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 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.

• Obstetrics Initiative

  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

• 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 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

• Radiation oncology

  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.

  Results

  • 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.

• 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.  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.

  Results

  • 20% reduction in surgical site infection
  • 20% reduction in urinary retention

• 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.For more information, go to mtqip.org.

   Results

  • 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)

• 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 seven patient advocates who serve as the moral compass for all the collaborative’s QI activities.

  MUSIC has several areas of focus:

  1. Prostate cancer care.
  2. Kidney stone care.
  3. Improving the quality of care for patients with small renal mass diagnoses.

  For more information, go to musicurology.com.

  Results

  • 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.

   

• Value collaborative

  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

  Results

  • 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