The Michigan Trauma Quality Improvement Program Virtual, MI May - PowerPoint PPT Presentation

The Michigan Trauma Quality Improvement Program Virtual, MI May 13, 2020

Meeting Logistics • Please mute all microphones • Discussion opportunities at section ends • Indicate in the chat if you’d like to contribute, we’ll call on you to share • You’ll unmute your own microphone

Meeting Logistics • Please sign the electronic confidentiality agreement to receive attendance points

Disclosures  Salary Support for MTQIP from BCBSM/BCN and MDHHS  Mark Hemmila  Judy Mikhail  Jill Jakubus  Anne Cain-Nielsen

Disclosures  Mark Hemmila Grants  Blue Cross Blue Shield of Michigan  Michigan Department of Health and Human Services  Ford Motor Company  Department of Defense  National Institutes of Health - NIGMS

No Photos Please

Evaluations  Link will be emailed to you following meeting  You have up to 7 days to submit  Please answer the evaluation questions  Physicians/Nurses/Advanced Practitioners:  No CME for this meeting

Data Submission  Data submitted February 7, 2020  This report  Data submitted April 3, 2020  Available on Web-site  Next data submission  June 5, 2020

Future Meetings  Spring (Registrar’s, MCR’s)  Tuesday June 2, 2020  Virtual  Fall  Tuesday October 13, 2020  Ypsilanti, EMU Marriott  Winter  Tuesday February 10, 2021  Ypsilanti, EMU Marriott

State of Michigan  FY 2020  19 Level 3 Hospitals  State and region reporting (Level 1,2,3)  Data Validation - 5 Hospitals pending  FY 2021  Proposal submitted

Emergency General Surgery  2019  7/1/2019  4 Hospitals  2020  Approval for 2 additional hospitals  Recruitment  Acute Care Surgery Model  Support  Abstractor

Program Update  BCBSM  No changes  Checks in June  Engagement network  Rapid dissemination of information and feedback  Value  Innovative and flexible  Window on the pulse  Avoid a collapse of the health care system

MTQIP Hospital Scoring Index Results Mark Hemmila, MD

#4 Timely LMWH VTE Prophylaxis in Trauma Service Admits  Venous Thromboembolism (VTE) Prophylaxis with LMWH Initiated Within 48 Hours of Arrival in Trauma Service Admits with > 2 Day Length of Stay (18 mo: 1/1/19-6/30/20)  ≥ 50% of patients (≤ 48 hr)  ≥ 45% of patients (≤ 48 hr)  ≥ 40% of patients (≤ 48 hr )  < 40% of patients (≤ 48 hr)

Metric #4 - VTE Prophylaxis LMWH Timeliness Cohort 2 - Admit to Trauma 1/1/19 - 1/31/20 30 27/34 Centers ≥ 50% 3 14 22 24 34 Mean 55.6% 25 13 21 35 8 2017 39% 12 Trauma Center 15 2018 50% 7 6 23 2019 55% 18 2 1 27 11 19 ■ ≥ 50% 16 26 29 ■ ≥ 45% 31 4 ■ ≥ 40% 9 28 10 ■ < 40% 5 20 32 17 33 0 20 40 60 80 100 % < 48 Hr of Arrival Pg. 3

VTE LMWH < 48 hours Cohort - TBI 50 40 30 % 20 10 0 33 23 29 30 32 34 10 28 9 17 5 13 11 20 1 4 15 19 8 2 25 18 24 31 7 27 6 16 35 14 3 12 22 26 21 Trauma Center Pg. 4

VTE LMWH < 48 hours Cohort - Spine Injury 80 60 40 % 20 0 3 7 4 1 9 0 0 0 2 8 4 2 5 1 3 9 7 1 4 5 5 7 2 9 4 6 1 8 3 6 3 8 5 2 6 3 1 2 1 2 3 3 2 3 3 2 2 1 1 1 3 2 1 2 2 2 1 1 1 2 1 Trauma Center Pg. 4

ACS TQIP Collaborative

ACS TQIP Collaborative

ACS TQIP Collaborative

ACS TQIP Collaborative

% 2008 0 1 2 3 4 5 2009 2010 2011 2012 VTE Event 2013 Year 2014 2015 2016 Unadjusted Adjusted 2017 2018 2019 1.19 % 1.21 %

#5 Timely Surgical Repair in Geriatric (Age ≥ 65) Isolated Hip Fracture  Time to surgical repair of isolated hip fracture in patients age 65 or older (12 mo: 7/1/19- 6/30/20)  ≥ 90% of patients (≤ 48 hr)  ≥ 85% of patients (≤ 48 hr)  ≥ 80% of patients (≤ 48 hr)  < 80% of patients (≤ 48 hr)

Metric #5 - Timely Surgical Hip Repair > 65 years Cohort 8 - Isolated Hip Fracture 7/1/19 - 1/31/20 27 12 21 17 19 3 7 35 34 29 9 8 Trauma Center 32 30 11 18 14 6 33 Mean 85.3% 20 16 2 13 31 26 5 22 25 24 1 10 23 4 28 15 0 20 40 60 80 100 % Pg. 5

Should we include non-operative patients?  Pro  Could represent surgeon bias  Con  These patients automatically count as > 48 hrs  What is the intent of the measure?  Timely operation  Reduce delays > better outcome  Avoid unnecessary testing

33 28 32 21 12 35 34 3 19 17 7 27 9 20 16 29 18 11 Mean 91.4% 8 6 1 30 2 31 14 25 13 26 5 22 24 23 10 4 15 Non-op excluded

exclude n hip_operati timely non-op timely traumactr 76 72 85.5 5.3 90.3 14 51 49 88.2 3.9 91.8 8 114 112 75.4 1.8 76.8 4 49 46 79.6 6.1 84.8 22 202 194 87.6 4.0 91.2 30 45 42 88.9 6.7 95.2 9 100 94 91.0 6.0 96.8 3 89 83 79.8 6.7 85.5 5 1 43 36 76.7 16.3 91.7 54 52 94.4 3.7 98.1 12 68 62 82.4 8.8 90.3 31 39 37 87.2 5.1 91.9 11 127 118 75.6 7.1 81.4 23 29 27 86.2 6.9 92.6 18 97 89 83.5 8.2 91.0 2 36 34 77.8 5.6 82.4 24 72 68 83.3 5.6 88.2 13 6 13 12 84.6 7.7 91.7 32 102 91 88.2 10.8 98.9 35 72 67 90.3 6.9 97.0 26 101 93 80.2 7.9 87.1 90 80 84.4 11.1 95.0 20 14 10 71.4 28.6 100.0 28 70 65 90.0 7.1 96.9 34 57 51 84.2 10.5 94.1 16 13 12 69.2 7.7 75.0 15 19 93 88 91.4 5.4 96.6 21 89 84 93.3 5.6 98.8 10 37 35 75.7 5.4 80.0 7 114 107 90.4 6.1 96.3 25 52 46 78.8 11.5 89.1 29 67 64 89.6 4.5 93.8 17 29 28 93.1 3.4 96.4 76 75 94.7 1.3 96.0 27 13 11 84.6 15.4 100.0 33 2393 2234 85.3 6.6 91.4

Differences operative vs. non-operative patients?  Operative  Younger  Female  SBP > 90  Less advanced directives (13 vs. 19%)  Less renal failure (1.8 vs. 2.9%)  Less CHF (12 vs. 17%)  Less dementia (26 vs. 35%)  Less functionally dependent health status (51 vs. 57%)

Discussion

#6 Red Blood Cell to Plasma Ratio  Red blood cell to plasma ratio (weighted mean points) of patients transfused ≥5 units in first 4 hours (18 Mo’s: 1/1/19-6/30/20)

Metric #6 - RBC to FFP Ratio - Mean Cohort 1 - MTQIP All 1/1/19 - 1/31/20 4 Ratio of RBC/FFP 3 2 1 0 3 5 8 4 6 1 8 6 7 0 3 5 5 1 3 2 8 9 7 9 1 0 3 2 4 9 5 2 6 2 7 1 0 4 4 3 3 1 1 1 2 1 3 1 2 1 1 1 2 2 1 3 1 2 2 2 2 3 2 3 2 Trauma Center Mean 1.56 - ↓1.71 Pg. 6

ACS TQIP Collaborative

#7 Serious Complications  Serious Complication Rate-Trauma Service Admits (3 years: 7/1/17-6/30/20)

Z-score  Measure of trend in outcome over time  Hospital specific  Compared to yourself  Standard deviation  > 1 getting worse  1 to -1 flat  < -1 getting better

Metric #7 - Z-score - Serious Complication Rate Cohort 2 - Admit to Trauma 7/1/17 - 1/31/20 2 1 Z-score 0 -1 -2 -3 3 8 0 1 4 2 1 9 8 7 6 3 5 7 6 1 5 7 0 4 9 3 2 5 1 0 4 8 9 2 2 5 6 4 3 1 3 2 3 2 2 2 2 1 2 1 1 1 1 1 3 3 3 2 1 2 2 1 1 3 2 Trauma Center Pg. 7

#7 Serious Complication Rate (Z- score) Metric #7 - Z-score - Serious Complication Rate Cohort 2 - Admit to Trauma 7/1/16 - 6/30/19 4 2 Z-score 0 -2 -4 -6 30 21 3 25 34 7 33 6 22 18 23 9 8 13 32 29 11 27 16 26 14 5 1 2 15 19 12 35 10 28 24 31 4 20 17 Trauma Center Pg. 8

#7 Serious Complication Rate (Z- score) Metric #7 - Z-score - Serious Complication Rate Cohort 2 - Admit to Trauma 7/1/17 - 1/31/20 2 1 Z-score 0 -1 -2 -3 3 18 30 1 24 32 21 29 8 27 26 13 25 7 16 11 5 17 10 4 19 33 2 35 31 20 14 28 9 22 12 15 6 34 23 Trauma Center Pg. 7

Collaborative Outcome Overview - Serious Cx Cohort 2 - Admit to Trauma 14 12 10 8 % 6 4 2 0 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Year Pg. 12

#8 Mortality  Mortality Rate-Trauma Service Admits (3 years: 7/1/17-6/30/20)

#8 Mortality Rate (Z- score) Metric #8 - Z-score - Mortality Rate Cohort 2 - Admit to Trauma 7/1/17 - 1/31/20 2 1 Z-score 0 -1 -2 -3 26 10 32 17 11 29 20 24 35 14 25 18 30 22 15 21 28 13 34 23 31 12 27 33 16 19 5 4 9 7 3 8 6 1 2 Trauma Center Pg. 7

#8 Mortality Rate (Z- score) Metric #8 - Z-score - Mortality Rate Cohort 2 - Admit to Trauma 7/1/16 - 6/30/19 2 1 Z-score 0 -1 -2 -3 30 11 1 3 14 24 22 31 29 9 7 12 5 21 34 27 19 23 6 33 16 28 25 26 20 4 13 35 2 32 18 17 10 8 15 Trauma Center Pg. 8

#8 Mortality Rate (Z- score) Metric #8 - Z-score - Mortality Rate Cohort 2 - Admit to Trauma 7/1/17 - 1/31/20 2 1 Z-score 0 -1 -2 -3 26 10 32 17 11 29 20 5 4 24 35 14 9 25 18 30 7 22 3 15 8 21 28 6 13 34 23 1 31 12 2 27 33 16 19 Trauma Center Pg. 7

Collaborative Outcome Overview - Mortality Cohort 2 - Admit to Trauma 6 5 4 % 3 2 1 0 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Year Pg. 12