Download Data Elements - St. John Providence

Orthopedic Quality
Initiatives
Presenters:
Erica Lemons, RN
April Richmond, RN
What is MARCQI?
The Michigan Arthroplasty Registry Collaborative
Quality Initiative (MARCQI) is a group of orthopaedic
surgeons and medical professionals dedicated to
improving the quality of care for patients undergoing
hip and knee replacement procedures in Michigan.
More Than a Registry
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Collaborative
Non-competitive
Frequent Data Reporting
Quality focused
Sharing of Best Practices
Feasible – efficient use of data sources
Multi-year, longitudinal follow-up of cases
Includes events that occur at other hospitals
MARCQI Coordinating
Center Team
Co-Directors:
Dr. Brian Hallstrom
Dr. Richard Hughes
Project Manager:
Rochelle Igrisan
Biostatistician:
Dr. Bonita Singal
Site Coordinators/Data
Auditors:
April Richmond
Mary Gumtow
Sherri McPhail
Administrative Assistant:
Anne Kagay-Lidster
Providence’s MARCQI Team
Clinical Champion:
Dr. David Markel
Clinical Data Abstractors:
Erica Lemons
Stephanie Jenkins
www.marcqi.org
What is a Hospital CQI?
• Collaborative Quality Initiatives (CQI)
• Funded by Blue Cross Blue Shield of Michigan
• MARCQI is one of 20 CQI’s Sponsored by BCBSM
• Other CQI Program examples:
Angioplasty
General and vascular surgery
Bariatric surgery
Breast cancer treatment
Cardiac and thoracic surgery
BCBSM P4P Program:
http://www.bcbsm.com/provider/value_partnerships/hpp/index.shtml
BCBSM Sponsor
• CQI Participation Payment
• Pay-for-Performance Incentive Payment
Hospital Support
• Clinical Champion
• Clinical Data Abstractor(s)
• IT Support
• Quality Administration
• Infectious Disease
Performance
Index
10
MARCQI Participating Sites
2012: 12 Initial Sites
 Two pilot sites February 2012
 Gradual addition of ten more
2013: +17 additional sites joined
2014: +15 additional sites joined
2015: + 6 additional sites joined
50 MARCQI Sites to date
MARCQI Sites
Registered MARCQI Cases
Number of Cases
68137
55867
45986
37205
30048
0
934 3160
6158
22813
18784
9896 11839
Overview of Data Process
Participating
hospitals
collect and
submit clinical
data to the
MARCQI
Database
MARCQI links
data from
multiple
sources to track
pts over time
MARCQI
performs risk
adjustment and
data validation
and compiles
reports
Clinical
Champions and
Nurses come
together to
share data and
collaborate on
Quality
Improvement
efforts
Clinical
Champions and
Nurses share
collaborative
data and goals
at their hospital
to implement
change
Levels of Data
MARCQI Qualifying Cases
 Elective Primary Hip & Knee Arthroplasty
 Elective, Urgent, & Emergent Hip & Knee
Revisions
Levels of Data
Level 1 Data
Defines the procedure that starts a record
Who? - Patient, Surgeon
What? - Procedure, Implants
Where? - Hospital
When? - Procedure Date
Without this the patient is not in the registry
Levels of Data
Level 2 Data
Information about patient
Demographics
Co-morbidites
Complications and their treatments
Events of Interest
ER visits or readmissions
Reoperations or revision
Infection, blood clot, death
Levels of Data
Level 3 Data
Patient reported outcomes (PROS)
 Satisfaction & Health related quality of life
questions
 Patients self report how they feel pre-op and
again post-op
PROS Collection
• Pre-op
• Post-op at:
 3 months
 1 year
 2 years
 5 years
 10 Years
PROS Collection
MARCQI is currently performing a PROS
collection Pilot
• Goal of Pilot:
Electronic capture rate of 80% in clinic/office
• Surveys Utilized:
HOOS PS (short form) or KOOS PS (short form)
PROMIS 10 (10 questions)
• Maximum number of questions:
17
• Average completion time for electronic survey:
5 minutes
Make Michigan the best place in the
world to have a joint replacement.
Data Elements
Type of Data
Scheduled
MARCQI Cases
Data Source
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Surgery Schedule
OR Schedule
Possible
Contact
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•
Entry Method
Manual Entry/Case by
Case
-OrFBA
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•
OR Manager
Central
Scheduling
Registration
Office Managers
Performed
MARCQI cases
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•
Billing/Coding
OR Log
•
•
OR Manager
Billing Manager
FBA Only
Pre-Op Risk
Factors, Hospital
Data, Post-Op
events prior to
D/C
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Medical Records
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•
•
HIM Manager
Your Director
Infection Control
All Manual Entry/Case by
Case -OrCombination FBA &
Manual
Post-Op Events
after discharge
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Medical Records
Admitting/Registrati
on
Billing
Surgeons’ Office
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•
•
HIM Manager
Your Director
Surgeons’ Office
Managers
Infection Control
Manual Entry Only
Medical Record
OR Scanner
System
Orthopaedic News
Network (ONN) files
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•
•
HIM Manager
OR Manager
ONN
administrator
Manual Entry -OrFBA -OrBarcode Scanner in OR
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Implant Data
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Quality Improvement Cycle
MARCQI QI Projects
#1 Transfusions
 Reduce PRBC transfusions
#2 Readmissions
 What are the largest primary diagnosis reasons for
readmissions
?
#3 Infections
 Infection Prevention Bundle
#3 VTE
 Make recommendation
Why choose transfusion:
Wide range 6%-36%
Transfusion Guidelines
Red Cross Transfusion Guideline
post operative patients
Indicators for transfusion
Threshold of HGB < 8g/dl
Clinically Significant symptoms of anemia
 Unresponsive to fluid resuscitation
Clinical judgment in patients with HGB <
10g/dl and increased risk factors
Providence:
Then and Now
Transfusion Project
5/1/2012 –
11/5/2013
1/1/2014 –
9/30/2014
Received
Transfusion
13.9%
5.6%
Blood Transfusion
w/ post-op HGB > 8
33.3%
8.9%
Hips with
Transfusion
22.5%
10.7%
Knees with
Transfusion
10.0%
3.0%
MARCQI:
Then and Now
Transfusion Project
2/15/2012 –
11/5/2013
7/1/2013 –
6/30/2014
Received
transfusion
8.3%
6.4%
Blood Transfusion
w/ post-op HGB > 8
28.7%
21.6%
Hips with
Transfusion
11.7%
9.4%
Knees with
Transfusion
6.0%
4.5%
Estimates for 2014
676 Fewer patients transfused
1536 fewer transfusions given
$1,075,200 to $1,536,000 saved
Transfusion:
Going Forward
High transfusion rates at hospitals
Review recommendations and current
practices
Collaboration between hospitals
Visits from MARCQI Coordinating
Center Staff
Meeting with QI staff
Meeting with blood bank
Readmission Project
All sites are statistically the same
MIDB Readmissions
1/1/2013 – 12/31/2013
MARCQI
MIDB
30 Day
90 Day
3.3%
5.3%
3.3%
5.6%
Readmission Data
Looking at reasons for readmission
Risk adjustment for comparisons
Discharge dispositions
Barriers @ Providence
Manually abstracting discharge
disposition
Inconsistencies
Multiple people charting/ many
specialties
Where is the final dispo?
Infection Project
Why
Infection is devastating to patients and surgeons
Multiple admissions and operations
Rising resistant bacteria
Expensive
Infection Prevention Bundle
•Preoperative Methods
•Patient education of SSI
•Cleanse with CHG-containing product
•Screen for MRSA/MSSA and treat those
positive results
•Decolonize for MRSA/MSSA with Skin and
Nasal Antiseptic
•Intraoperative Methods
•Do not remove hair unless necessary
•Prep with an alcohol based agent
•SCIP- Administer ABX
•Minimize intraoperative foot traffic
•Postoperative Methods
•Apply sterile dressing
•SCIP- Discontinue ABX per protocol
Where does Providence Stand?
 < 0.2 % infection rate for 2014 (deep
infections)
Information shared with NHSN
Gathered by the Infectious Disease
team
 Goal < 0.5%
 We have implemented a decolonization
process for the orthopedic patients
qualifying for MARCQI
VTE Project
Collecting data phase
Not enough information to make
recommendations
Multiple protocols
 X surgeons
 50 + hospitals
 Many practices
Importance of Documentation
 Mechanical and Chemical
Educational Links
IHI Project Joints:
http://www.ihi.org/Engage/Initiatives/Completed/ProjectJOINTS/Page
s/default.aspx
AAOS:
http://www.aaos.org/
Ortho Bullets:
http://www.orthobullets.com/
HRSA Quality Improvement:
http://www.hrsa.gov/healthit/toolbox/HealthITAdoptiontoolbox/Quali
tyImprovement/whatisqi.html
Going Lean In Healthcare:
http://www.ihi.org/resources/Pages/IHIWhitePapers/GoingLeaninHea
lthCare.aspx
Questions ?