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 population health collaborative focused on better care for low back pain by first-contact clinicians – primary care physicians, chiropractors, emergency medicine and urgent care physicians, specialists, physical therapists, and advanced practice providers. Participants aim to achieve more effective care patterns, better outcomes for patients and increased satisfaction for clinicians and patients, with a focus on lowering the rate of transition from acute to chronic pain. The three components within the MIBAC structure are: training, Patient Reported Outcomes (PROs) 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

  • 66% increase in proportion of patients with optimal warfarin management
  • Over 700 fewer serious bleeds
  • Over 2,000 patients taken off dangerous drug combination
  • Direct Oral Anticoagulant (DOAC) dashboard successfully integrated into four participating hospital EMRs and actively being used to monitor for dangerous off-label DOAC dosing
  • 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 cardiac and thoracic surgery. For more information, go to mstcvs.org

  Results

  • 75% Increase in the number of Multiple Arterial Grafts​ used in coronary artery bypass operations; more than double the national average. Use of Multiple arteries leads to improved long-term survival.
  • 78% Increase since 2015 in the number of patients receiving 10 or more lymph nodes sampled at the time of lung cancer surgery, which helps guide appropriate treatment.
  • 30% Reduction in use of red blood cell transfusions in patients undergoing coronary artery bypass operations.
  • 96% Reduction in the number of patients requiring a ventilator for longer than 6 hours after coronary artery bypass operations since 2011

• 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 artery disease
  • Carotid endarterectomy and carotid stenting
  • Transcatheter aortic and mitral valve replacement and repair

  For more information, go to bmc2.org.

  Results

  • 250 fewer post-PCI readmissions annually, saving more than $5M per year
  • 65% increase in follow-up imaging after aneurysm repair identifies more at-risk patients, improving long-term outcomes
  • 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
  • 80% decrease in blood transfusions, or 2,275 transfusions avoided, preventing death and kidney injury after transcatheter valve procedures

• 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:
  -14,000 chest CT scans avoided in adults with suspected pulmonary embolism
  -13,900 head CT scans avoided in adults and children with minor head injury
  -9,200 chest X-rays avoided in children with asthma, croup, or bronchiolitis
  Catalyzed implementation of clinical practice guidelines to reduce unnecessary hospital admissions:
  -Avoided 2,300 hospital admissions for adults with low-risk chest pain
  Leveraged quality improvement partnerships to:
  -Build an initiative focused on ED distribution of naloxone to at-risk populations for opioid harm reduction
  -Establish a workflow in 13 EDs for smoking cessation counseling for patients with chronic obstructive pulmonary disease

• 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

  • 20% reduction in surgical site infection for all procedures tracked by MSQC
  • 65% Reduction in post-operative opioid prescribing from 2017-2021

• 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

  The Michigan Social Health Interventions to Eliminate Disparities (MSHIELD) CQI was founded in 2021 to promote awareness and integration of social determinants of health across the CQI portfolio. MSHIELD’s mission is to empower CQIs to lead the future of quality improvement which achieves whole health for all people by integrating social care and clinical care, using data to drive health equity, and fostering a culture of anti-racism.

  MSHIELD consists of 3 pillars that provide a foundation upon which we aim to achieve equitable health outcomes for all:

  • Data Strategy & Quality: Supporting CQIs to use their data to identify health inequities and develop equity-focused quality improvement goals.
  • Community-Clinical Partnerships: Collaborating with community and clinical partners to close the gap between healthcare and social service systems across the state.
  • Culture of Equity: Driving a culture of equity across the CQI community to raise awareness and promote anti-racist approaches to quality improvement.

  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 the care of the hospitalized patient with sepsis (both in the medical wards and the intensive care unit)

  For more information, go to mi-hms.org.

  Results

  • 3,300 blood clots prevented
  • 870 central-line-associated bloodstream infections prevented
  • 57,000 days of unnecessary antibiotics avoided
  • 1,000+ 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’s key focus areas include:

  • Safely lowering the Nulliparous Term Singleton Vertex (NTSV) cesarean rate
  • Reducing severe maternal morbidity and mortality
  • Promoting evidence-based management of pain after childbirth
  • Reducing inequities in maternity outcomes by promoting patient engagement and respectful, patient-centered care

  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

  • 70% Of patients that use tobacco receive cessation counseling or referral, compared to 33% when this initiative began in 2014
  • 33% Increase in hospice enrollment prior to death since 2020
  • 30% Increase in patients with complete family history documented since 2020

• Radiation oncology

  The Michigan Radiation Oncology Quality Consortium (MROQC) establishes and disseminates best practices that enable practitioners to optimize the delivery of patient-centered, appropriate, high quality, cost-effective care for breast, lung, & prostate cancers and bone metastases. For more information, go to mroqc.org.

  Results

  • 62 percent increase in the use of accelerated whole breast irradiation in accordance with ASTRO Choosing Wisely® campaign (2014-2021; in maintenance)
  • 11 percent decrease in the radiation dose given to the heart in lung patients–reducing the risk of heart complications (2018-2021; ongoing effort)
  • 96 percent of MROQC patients get appropriate, shorter course treatments for bone metastases as recommended by ASTRO Choosing Wisely® campaign (2018-2021; 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

  • 17% Reduction of lumbar surgical site infection
  • 29% Reduction of hospital readmissions within 90-days of discharge
  • 69% Reduction of urinary retention
  • 170% Improvement in ambulation within 8 hours of spine surgery
  • 27k Patients ambulated within 8 hours that previously would not have since 2020

• 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.

  Visit henryford.com/mimind for more information.

• 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

  Currently 28 of 40 physician organizations in Michigan participate in MCT2D, representing over 300 primary care practices and 30 specialty practices (nephrology and endocrinology). The MCT2D team prioritizes keeping the patient voice centered in the work that they are doing and the resources they create, and maintains a patient advisory board that meets bi-monthly to give input on patient focused tools and share their experiences of type 2 diabetes care.

  MCT2D is working with the Michigan Data Collaborative to build a statewide population health registry that will report clinical and claims data and will be the basis for tracking quality improvement efforts in the program.

  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
  • Nearly doubled the proportion of low-risk prostate cancer patients avoiding unnecessary treatment
  • 30% reduction in readmissions following prostate cancer surgery
  • Established an electronic infrastructure for measuring and improving patient reported outcomes after prostate and kidney stone surgery
  • Developed stent omission appropriateness guidelines for patients undergoing kidney stone surgery
  • 65% reduction in opioid prescriptions following kidney stone surgery
  • 34% reduction 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
  • Facilitates a Virtual Tumor Board (VTB) with nearly 50 urologists who regularly discuss complex patients with renal tumors to optimize treatment decisions
  • Developed Roadmap for the Management of T1 Renal Masses to improve treatment appropriateness and the quality of surveillance for patients with kidney tumor

• 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

  • Multi-payer administrative claims data, including claims from BCBSM PPO, BCBSM MA, BCN HMO, BCN MA, Medicare FFS, and Michigan Medicaid
  • Over 40 different medical, surgical, and ED-based conditions available for analysis and benchmarking
  • Limited patient-level Medicare data for authorized users of the MVC registry is available as a result of MVC’s CMS-certified status as a Qualified Entity
  • Approximately 8.4 million covered lives reflected on the MVC registry
  • Approximately 84% of Michigan’s insured population reflected in MVC’s data