Lessons Learned from MI-COVID19 Initiative Influence Care & Treatment Protocols Statewide

By: Debbie Reinheimer

Patient wth pulse oximeter

As patients became seriously ill with COVID19 in the spring of 2020, emergency departments and hospitals around the state were quickly filling up. Yet, at the time, much was unknown about this virus and how to treat it.

Fortunately, in Michigan, the Collaborative Quality Initiative structure offered a foundational process that quickly enabled hospitals statewide to collect meaningful patient data and share information on treatment protocols. Within a month of Michigan’s first positive case, 20 Michigan hospitals were contributing data, rising to 40 hospitals about a month later.

By the end of January 2021, data on more than 3,500 COVID19-positive patients had been abstracted and analyzed. In addition to sharing best practices in more than 30 webinars, four peer-reviewed papers have been published, with another seven currently under review.

“This has been a journey that we have taken together over the last year,” said Scott Flanders, M.D., the initiative’s program director and chief clinical strategy officer at Michigan Medicine. “A large group of health professionals shared crucial information, which significantly improved the outcomes of our patients here in Michigan.”

In June 2021, the MI-COVID19 registry leaders presented a webinar to Michigan hospitals,  physicians and other healthcare leaders on the lessons learned during the COVID19 pandemic. They shared the following key insights:

  • Early on, about one in five patients presented with nausea, vomiting and diarrhea. The collaborative was able to inform hospitals and ER staff statewide, so COVID tests, which were limited at the time, could be appropriately administered to patients with these symptoms.
  • A review of antibiotic use in hospitalized patients identified the situations in which someone should or should not be given antibiotics when hospitalized with COVID19.
  • One in 10 patients who survived an ICU stay died within 60 days of leaving the hospital. With this knowledge, providers could target the ICU patients to plan post-discharge care more carefully.
  • A large portion of patients who were hospitalized with COVID19 experienced severe physical, mental and financial challenges in the 60 days following hospital discharge. This finding helped hospitals develop important follow up programs to connect patients to needed health, mental health and social services.
  • Preventive anticoagulation therapy during hospitalization is associated with lower mortality. MI-COVID19 participants significantly decreased the percentage of hospitalized patients who missed two or more doses of prophylactic anticoagulation.

“This rate of change in clinical care is unprecedented in my time practicing medicine,” said Dr. Flanders. “We continue to look at the registry and at our learnings on COVID19 to develop additional best practices that lead to better patient outcomes.”

For example, initiative leaders have developed a mortality risk assessment model, which enables providers to assess a patient’s risk of death at the time of admission. This allows providers to use appropriate treatment protocols more quickly.

“All of us can be proud of the important work we were able to accomplish in coordinating resources to best treat COVID-19,” said Amy McKenzie, M.D., associate chief medical officer, Blue Cross Blue Shield of Michigan and one of the MI-COVID19 CQI steering committee members. “We were able to get the CQI up and running and collecting data within a month and determine notable variations in care and arrive at best practices within a relatively short period of time.  All this helped provide our hospitalized COVID patients across Michigan access to cutting edge care.”

More information on the MI-COVID19 initiative can be found here.