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

SLIDE 1

The Michigan Trauma Quality Improvement Program

Virtual, MI May 13, 2020

SLIDE 2

Meeting Logistics

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SLIDE 3

Meeting Logistics

Please sign the electronic confidentiality

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SLIDE 4

Disclosures

 Salary Support for MTQIP from BCBSM/BCN

and MDHHS

 Mark Hemmila  Judy Mikhail  Jill Jakubus  Anne Cain-Nielsen

SLIDE 5

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

SLIDE 6

No Photos Please

SLIDE 7

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

SLIDE 8

Data Submission

 Data submitted February 7, 2020

 This report

 Data submitted April 3, 2020

 Available on Web-site

 Next data submission

 June 5, 2020

SLIDE 9

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

SLIDE 10

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

SLIDE 11

Emergency General Surgery

 2019

 7/1/2019  4 Hospitals

 2020

 Approval for 2 additional hospitals  Recruitment  Acute Care Surgery Model

 Support

 Abstractor

SLIDE 12

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

SLIDE 13

MTQIP Hospital Scoring Index Results

Mark Hemmila, MD

SLIDE 14

#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

f 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)

SLIDE 15

Pg. 3

27/34 Centers ≥ 50% ■ ≥ 50% ■ ≥ 45% ■ ≥ 40% ■ < 40% Mean 55.6% 2017 39% 2018 50% 2019 55%

20 40 60 80 100

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

% < 48 Hr of Arrival Trauma Center

Metric #4 - VTE Prophylaxis LMWH Timeliness Cohort 2 - Admit to Trauma 1/1/19 - 1/31/20

SLIDE 16

Pg. 4

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

10 20 30 40 50

VTE LMWH < 48 hours Cohort - TBI

Trauma Center %

SLIDE 17

Pg. 4

3 3 1 7 4 1 2 9 1 2 3 3 2 2 8 3 4 2 5 3 1 2 3 9 2 7 1 1 1 4 1 5 3 5 7 2 2 1 9 2 4 2 6 2 1 8 3 1 6 1 3 1 8 2 5 1 2 6

20 40 60 80

VTE LMWH < 48 hours Cohort - Spine Injury

Trauma Center %

SLIDE 18

ACS TQIP Collaborative

SLIDE 19

ACS TQIP Collaborative

SLIDE 20

ACS TQIP Collaborative

SLIDE 21

ACS TQIP Collaborative

SLIDE 22

VTE Event

Year %

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 1 2 3 4 5

Adjusted Unadjusted

1.21 % 1.19 %

SLIDE 23

#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)

SLIDE 24

Pg. 5

Mean 85.3%

20 40 60 80 100

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

Metric #5 - Timely Surgical Hip Repair > 65 years Cohort 8 - Isolated Hip Fracture 7/1/19 - 1/31/20

% Trauma Center

SLIDE 25

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

SLIDE 26

Non-op excluded Mean 91.4%

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

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

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

SLIDE 28

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%)

SLIDE 29

Discussion

SLIDE 30

#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)

SLIDE 31

Pg. 6

Mean 1.56 - ↓1.71

3 3 3 5 1 8 1 4 1 6 2 1 8 6 1 7 3 1 3 2 5 1 5 1 1 3 1 2 2 8 9 2 7 1 9 3 1 1 2 3 2 4 2 9 5 2 2 2 6 3 2 7 1 2 3 4 2 4

1 2 3 4

Trauma Center Ratio of RBC/FFP

Metric #6 - RBC to FFP Ratio - Mean Cohort 1 - MTQIP All 1/1/19 - 1/31/20

SLIDE 32

ACS TQIP Collaborative

SLIDE 33

#7 Serious Complications

 Serious Complication Rate-Trauma Service

Admits (3 years: 7/1/17-6/30/20)

SLIDE 34

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

SLIDE 35

Pg. 7

3 1 8 3 1 2 4 3 2 2 1 2 9 8 2 7 2 6 1 3 2 5 7 1 6 1 1 5 1 7 1 4 1 9 3 3 2 3 5 3 1 2 1 4 2 8 9 2 2 1 2 1 5 6 3 4 2 3

3
2
1

1 2

Z-score

Metric #7 - Z-score - Serious Complication Rate Cohort 2 - Admit to Trauma 7/1/17 - 1/31/20

Trauma Center

SLIDE 36

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

6
4
2

2 4

Z-score

Metric #7 - Z-score - Serious Complication Rate Cohort 2 - Admit to Trauma 7/1/16 - 6/30/19

Trauma Center

#7 Serious Complication Rate (Z-score)

Pg. 8

SLIDE 37

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

3
2
1

1 2

Z-score

Metric #7 - Z-score - Serious Complication Rate Cohort 2 - Admit to Trauma 7/1/17 - 1/31/20

Trauma Center

#7 Serious Complication Rate (Z-score)

Pg. 7

SLIDE 38

Pg. 12

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2 4 6 8 10 12 14

Collaborative Outcome Overview - Serious Cx Cohort 2 - Admit to Trauma

Year %

SLIDE 39

#8 Mortality

 Mortality Rate-Trauma Service Admits (3

years: 7/1/17-6/30/20)

SLIDE 40

#8 Mortality Rate (Z-score)

Pg. 7

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

3
2
1

1 2

Z-score

Metric #8 - Z-score - Mortality Rate Cohort 2 - Admit to Trauma 7/1/17 - 1/31/20

Trauma Center

SLIDE 41

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

3
2
1

1 2

Z-score

Metric #8 - Z-score - Mortality Rate Cohort 2 - Admit to Trauma 7/1/16 - 6/30/19

Trauma Center

#8 Mortality Rate (Z-score)

Pg. 8

SLIDE 42

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

3
2
1

1 2

Z-score

Metric #8 - Z-score - Mortality Rate Cohort 2 - Admit to Trauma 7/1/17 - 1/31/20

Trauma Center

#8 Mortality Rate (Z-score)

Pg. 7

SLIDE 43

Pg. 12

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 1 2 3 4 5 6

Collaborative Outcome Overview - Mortality Cohort 2 - Admit to Trauma

Year %

SLIDE 44

#9 Timely Head CT in TBI Patients on Anticoagulation Pre-Injury

 Head CT date and time from procedures  Presence of prehospital anticoagulation  TBI (AIS Head, excluding NFS, scalp, neck, hypoxia)  Cohort1, Blunt mechanism  Exclude direct admissions and transfer in  No Signs of Life = Exclude DOAs  Transfers Out = Include Transfers Out  Time Period = 7/1/19 to 6/30/20

SLIDE 45

#9 Head CT

 Measure = % of patients with Head CT, date,

and time

 Timing

 ≥ 90% patients (≤ 120 min)  ≥ 80% patients (≤ 120 min)  ≥ 70% patients (≤ 120 min)  < 70% patients (≤ 120 min)

SLIDE 46

19/34 Centers ≥ 90% (+10) Mean 87.3%

Pg. 8

Metric #9 - ED Head CT < 120 min Cohort 1 - MTQIP All, TBI on Anticoagulant (Excluding ASA) 7/1/19 - 1/31/20

Trauma Center

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

25 50 75 100

%

SLIDE 47

9/34 Centers ≥ 90% Mean 84.1%

2020 Metric #10 - ED Head CT < 120 min Cohort 1 - MTQIP All, TBI on Anticoagulant (Excluding ASA) 7/1/18 - 6/30/19

Trauma Center

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

25 50 75 100

%

SLIDE 48

Effect of excluding platelets

 Anticoagulation = 279 patients

 87% CT within 120 min

 Anticoagulation or Antiplatelet = 915 patients

 83% CT within 120 min

SLIDE 49

#10 Timely Antibiotic in Femur/Tibia Open Fractures - Collaborative Wide Measure

 Type of antibiotic administered along with date

and time for open fracture of femur or tibia

 Presence of acute open femur or tibia fracture

based on AIS or ICD10 codes (See list)

 Cohort = Cohort 1 (All)  Exclude direct admissions and transfer in  No Signs of Life = Exclude DOAs  Transfers Out = Include Transfers Out  Time Period = 7/1/19 to 6/30/20

SLIDE 50

#10 Open Fracture Antibiotic Usage

 Measure = % of patients with antibiotic type,

date, time recorded ≤ 120 minutes

 ≥ 85% patients (≤ 120 min) > 10 points  All or nothing

 ACS-COT Orange Book – VRC resources

 Administration within 60 minutes

 ACS OTA Ortho Update  ACS TQIP Best Practices Orthopedics

SLIDE 51

Collaborative Mean = 82.4%

16/34 Centers ≥ 90% (-1)

Pg. 10

354 patients April 7-10 patients more

25 50 75 100

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

%

Metric #10 - Open Fracture - Time to Abx ≤ 120 min Cohort 1 - MTQIP All 7/1/19 - 1/31/20

Trauma Center

SLIDE 52

6/34 Centers ≥ 85%

Collaborative Mean = 71%

Pg. 9

Open Fracture - Time to Abx ≤ 60 min Cohort 1 - MTQIP All 7/1/19 - 1/31/20

Trauma Center

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

25 50 75 100

%

SLIDE 53

 Push report

 Metric #10

 Check your data

SLIDE 54

16 5 6 31 29 34 22 9 12 8 24 4 27 35 20 15 21 11 10 18 3 7 25 30 19 14 32 13 26 1 2 35 17 28

SLIDE 55

MTQIP Program Manager Data Update

Jill Jakubus, PA-C

SLIDE 56

Topics Remote Validation Migration AIS 2015 Updated Validation Variables ArborMetrix IHF Time to Operation ArborMetrix New Variables Research in Progress

SLIDE 57

Remote Validation Migration

3/20/20 Stay at Home Order Current Travel Limits Future Uncertainty

SLIDE 58

Remote Validation Migration

Pro-Active Approach EmailNotification 4 Centers

SLIDE 59

Remote Validation Migration

All centers transitioned to remote

validation to earn 2020 points forward

All centers sign same agreement (RAA)

SLIDE 60

Remote Validation Migration

SLIDE 61

Topics Remote Validation Migration AIS 2015 Updated Validation Variables ArborMetrix IHF Time to Operation ArborMetrix New Variables Research in Progress

SLIDE 62

AIS 2015 Request uniform timing of adoption by the collaborative

SLIDE 63

AIS 2015 Consistent model calibration and discrimination Collaborative Benchmarking

SLIDE 64

AIS 2015 AIS 2015 mapped back to AIS 05/08 (page 2/102) National Benchmarking

SLIDE 65

AIS 2015

Projected Q4 Pending On-Going Registry Integration Licensing Fees Education

SLIDE 66

AIS 2015

SLIDE 67

Topics Remote Validation Migration AIS 2015 Updated Validation Variables ArborMetrix IHF Time to Operation ArborMetrix New Variables Research in Progress

SLIDE 68

Updated Validation Variables

Review Jan - May Collaborate June Implement Jan 2021

SLIDE 69

Updated Validation Variables

Hospital Discharge Date/Time
Pregnancy
Delirium
Whole Blood Units
Patient Name
Patient MRN
Head CT Date/Time
IHF Date/Time

Preliminary Additions

SLIDE 70

Updated Validation Variables

Not used in modeling
Not used in performance index
Error rate < 1%

Preliminary Deletions

SLIDE 71

Updated Validation Variables

SLIDE 72

Topics Remote Validation Migration AIS 2015 Updated Validation Variables ArborMetrix IHF Time to Operation ArborMetrix New Variables Research in Progress

SLIDE 73

SLIDE 74

ArborMetrix IHF Time to Operation

Currently in testing environment
Promote after collaborative decision

regarding IHF case managed non-op

Projected July
Email reports

SLIDE 75

Topics Remote Validation Migration AIS 2015 Updated Validation Variables ArborMetrix IHF Time to Operation ArborMetrix New Variables Research in Progress

SLIDE 76

ArborMetrix New Variables

PHI variables
Facilitate drilling in with your EMR
Projected July/Aug

SLIDE 77

Topics Remote Validation Migration AIS 2015 Updated Validation Variables ArborMetrix Time to Operation ArborMetrix New Variables Research in Progress

SLIDE 78

Research in Progress

Center PI Topic Phase Detroit Receiving Oliphant The accuracy of orthopaedic data in a trauma registry. Traumatic injury and associated costs. Analysis Henry Ford Johnson EMS vs. private car effect on outcomes Analysis Michigan Medicine Hemmila Pedestrian protection Analysis Michigan Medicine Wang Injury prevention in vunerable populations Analysis Michigan Medicine Ward Clinical decision support tools Analysis Providence Hospital, Spectrum Health, St. Joseph Mercy, Michigan Medicine Iskander, Lopez, Jakubus, Wahl Optimal timing head CT for geriatric falls Analysis Spectrum Health Chapman Outcomes in operative fixation of rib fractures Analysis

St. Joseph Mercy Ann Arbor

Hoesel Rib fractures in the elderly Agreement execution University of Minnesota Tignanelli Redefining the Trauma Triage Matrix: the Role of Emergent Interventions Published Journal of Surgical Research 3/10/20

SLIDE 79

Topics Remote Validation Migration AIS 2015 Updated Validation Variables ArborMetrix Time to Operation ArborMetrix New Variables Research in Progress

SLIDE 80

Summary

All centers migrating to remote data
validation. Please sign/return the

agreement.

New validation variables, metrics, an
nline functionality coming this

summer.

SLIDE 81

MTQIP Program Manager Update

Judy Mikhail, PhD MBA RN

SLIDE 82

Title

Subtitle

The information contained herein is the proprietary information of BCBSM. Any use or disclosure of such information without the prior written consent of BCBSM is prohibited.

BCBSM CQI Survey Conducted Feb 2020 (for 2019) 35 Questions Every Other Year Evaluation of MTQIP

82

Thank You For Your Participating!

SLIDE 83

MTQIP Total Score Comparison 2017 2017 to 2019 2019

4.4 4.5 4.68 4.68 TPM/MCR/REG SURGEONS

2017 2019

SLIDE 84

Survey Sections Summary

4.78 4.71 4.66 4.59 4.68 4.68 4.71 4.69 4.65 4.68

MTQIP Staff Meetings Data/Reports TC Support Overall Avg

TPM/MCR/REG SURGEONS

5/17 6/17 1/17 6/17 4/17 2*/17 8/17 SURG Ranking STAFF Ranking 4/17 8/17 4/17

SLIDE 85

Additional Questions: TPM/MCR/REG

Question Result

1. Do you also abstract for another CQI?

Yes = 13 No = 68

2. Is quality of abstraction being compromised? Yes = 17

No = 63 Not sure = 11

17% 19%

SLIDE 86

Conclusion

 Thank you for attending  Evaluations

 Fill out and turn in

 Questions?  See you in October?

SLIDE 87

Meeting Logistics

Please sign the electronic confidentiality