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 aims to improve the quality of care and outcomes for patients receiving anesthesia. ASPIRE is the founding member of the Multicenter Perioperative Outcomes Group, a national consortium of 50 hospitals across 18 states and 2 countries seeking to improve patient care using electronic healthcare data. For more information, go to aspirecqi.org.

  Results:

  11 percent improvement in using protective lung ventilation processes, proven to reduce risk of lung complications (2018-19)
  15 percent improvement in monitoring of neuromuscular blockade (medications used to induce paralysis during surgery)
  17 percent increase in restrictive blood transfusion management, resulting in fewer unnecessary blood transfusions (2017-19)

• 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

  • 54 percent decrease in length of hospital stay beyond five days (2007-2019)
  • 56 percent decrease in post-surgical death rate (2008-2019)
  • 35 percent decrease in overall complications (2007-2019)
  • 1,100 patients avoided a hospital readmission following surgery (2006-2019)

• 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, and to improve quality of care for patients being treated for bleeding disorders. Findings from this initiative have influenced standard protocols for managing patients. For more information, go to maqi2.org.

  Results

  • 23 percent increased patient time in therapeutic range
  • 56 percent decrease ER visits for minor bleeds
  • 175,000 unnecessary lab tests prevented
  • 1,700 patients taken off dangerous drug combination
  • 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 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 coronary disease. The consortium has a focus on the following areas:

  • Percutaneous Coronary Intervention – commonly known as angioplasty.
  • Vascular Surgery for aneurysm repair
  • Bypass surgery for peripheral artery disease and carotid endarterectomy
  • Minimally invasive TAVR (Transcatheter Aortic Valve Replacement)

  For more information, go to bmc2.org.

  Results

  • 2.,700 patients avoided complications including stroke and days in hospital.
  • 25 percent reduction in surgical site infection in non-emergency vascular surgery cases
  • 13,000 PCI patients referred for cardiac rehab, to lower risk of readmits and deaths
  • 51 percent reduction in bleeding and vascular complications

• Care Transitions

  Integrated Michigan Patient-centered Alliance on Care Transitions (I-MPACT) participants collect and share data to identify best practices that will improve patient care during and after transition from the hospital setting.  In this initiative, hospitals and physician organizations work together, which helps remove barriers, improves communication between organizations and contributes to better coordinated care. Visit the I-MPACT website here.

• 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. This work falls into three broad categories, all with the potential to improve quality and reduce costs:

  • Diagnostic imaging. For example, decision-making around testing with computed tomography (CT) scans, magnetic resonance imaging (MRI) and X-ray.
  • Safe discharge from the emergency department. For example, identifying low-risk chest pain patients who are safe to send home with appropriate and timely follow-up care.
  • Shared decision-making. For example, incorporating tools and frameworks to ensure patient and family engagement in testing and treatment decisions in the emergency department.”

  Website:  medicqi.org

• General surgery

  The Michigan Surgical Quality Collaborative is a collaborative of Michigan hospitals focused on improving the quality and cost-effectiveness of general and vascular surgery. The group aims to make Michigan the best place for surgery in the United States.

  For more information, go to msqc.org.

  Results

  • 23 percent reduction in surgical site infection for all procedures tracked by MSQC
  • 38,000 fewer days in the hospital
  • 11 percent reduction in readmissions for all procedures tracked by MSQC

• 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

  • Reduction in unnecessary days of antibiotics for asymptomatic urinary tract infection, and increased treatment for pneumonia
  • 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 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.

• Obstetrics Initiative

  The Obstetric Initiative (OBI) is an interdisciplinary quality initiative 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  from 73 Michigan maternity hospitals identify and address variation in obstetric care in the state through collaboration, rapid cycle data reporting, best practice sharing, and quality improvement initiatives.

  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 2019
  • Increased appropriate pain management in patients’ last two visits beforedeath from 77% in 2015 to > 90% in 2019

• 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

  • 9 percent lower rate of hospital re-admissions within 90-days of discharge
  • 39 percent reduction in urinary retention
  • 35 percent improved early ambulation for lumbar surgical patients

• 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

  • 23 percent decrease in hospital mortality for trauma patients
  • 36 percent reduction in vein clots (life-threatening blood clots that can form in injured/bedridden patients)
  • More than 4,000 trauma patients have avoided a serious complication or death

• 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 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 small renal mass diagnosis

  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.
  • 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.
  • Established chest imaging guidelines for the initial evaluation of patients with a renal mass diagnosis.

   

• Value collaborative

  The Michigan Value Collaborative collects and shared meaningful, benchmarked performance data from a variety of payers for 37 different medical and surgical conditions. Participating hospitals and physician organizations can then compare their care utilization to the state to identify possible areas of cost opportunity. Additional activities facilitate the sharing of best practices among participants.  For more information, go to michiganvalue.org