2018 Collaborative Quality Initiative Fact Sheet

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1 2018 Collaborative Quality Initiative Fact Sheet Blue Cross Blue Shield of Michigan Cardiovascular Consortium Overview The Blue Cross Blue Shield of Michigan Cardiovascular Consortium, commonly called BMC2, is a Collaborative Quality Initiative made up of three different registries: (1) percutaneous coronary intervention, (2) vascular surgery and (3) Michigan transcatheter aortic valve replacement. Established in 1997, the Blue Cross Blue Shield of Michigan Cardiovascular Consortium is a prospective, multicenter registry. In this regional collaborative, participants assess and improve quality of care and outcomes of patients who undergo an angioplasty procedure. Blue Cross established a vascular surgery initiative in 2012 as an additional registry and regional collaborative effort. Participants in this initiative assess quality of care and outcomes of patients who have peripheral vascular disease and undergo open abdominal aneurysm repair, endovascular abdominal aneurysm repair (EVAR), and open bypass procedures of both upper and lower extremities. In addition, the vascular surgery initiative collects data on carotid artery procedures, including carotid artery stenting and carotid endarterectomy. In 2015, the Michigan TAVR project was established as a collaboration between the Michigan Society of Thoracic and Cardiovascular Surgeons and the BMC2. Michigan TAVR is a quality improvement project designed to improve quality of care and patient outcomes in patients who undergo a percutaneous valve replacement procedure. Objectives Evaluate evidence-based disease management in patients undergoing PCI, vascular surgery, and carotid procedures Identify opportunities for quality improvement Implement quality improvement projects Decrease practice variation Develop risk assessment models and tools Goals o Reduce vascular access complications to a rate of 1.5 percent o Reduce the post-pci transfusion rate to 2.5 percent o Reduce the rate of contrast volume to glomerular filtration rate ratio 3 to 20 percent 1

2 o Increase the rate of cardiac rehabilitation referral to 90 percent o Reduce overall surgical site infection in non-emergent cases o Increase rate of use of chlorhexidine and alcohol skin prep to 90 percent o Increase rate of antibiotic re-dosing to 100 percent o Increase the rate of any antiplatelet prescribed at discharge to 95 percent o Increase the rate of statin prescribed at discharge to 80 percent o Increase the rate of post-procedure creatinine draws in high-risk endovascular aneurysm repair (EVAR) patients to 75 percent o Increase the rate of pre-procedure hydration in high-risk EVAR patients o Decrease the rate of post-operative myocardial infarction (MI) at 30 days to 3 percent o Decrease the rate of transfusion when asymptomatic with hemoglobin (HgB) 8 to 10 percent o Decrease the percentage of small/moderate sized elective EVAR patients NOT discharged by post-operative day 2 to < 10 percent o Decrease the percentage of asymptomatic CEA patients NOT discharged by post-operative day 3 to < 8 percent o Increase the rate of echocardiograms performed pre- and post-procedurally to 95 percent o Increase the rate of follow-up information obtained at 30 days and 1 year to 100 percent o Increase the rate of two surgeon evaluation source documentation to 100 percent o Reduce the rate of contrast induced nephropathy (CIN) to </= 5 percent o Reduce the rate of bleeding/vascular complications to </= 4 percent o Reduce the rate of transfusion to </= 14 percent Results o 10.5 percent reduction in CIN ( ) o 41.3 percent reduction in blood transfusions post-procedure ( ) o 48.1 percent reduction in vascular access complications ( ) o 15.4 percent increase in cardiac rehabilitation referral ( ) o 7 percent reduction in total number of procedures ( ) o 15.4 percent increase in use of pre-procedure aspirin ( ) o 24.7 percent reduction in surgical site infection in non-emergent cases ( ) o 26.4 percent increase in use of chlorhexidine & alcohol skin preparation ( ) 2

3 o 21.9 percent increase in prescription of any-antiplatelet at discharge ( ) o 18.3 percent increase in prescription of statins prescribed at discharge ( ) o 21.1 percent reduction in transfusions when asymptomatic with HgB 8 ( ) o 57.7 percent increase in pre-procedure hydration for high-risk EVAR patients ( ) o Created an agreed upon list of incremental risk percentages to add to the risk scores for TAVR o Distributed Clinical Pathways (Best Practices) for femoral, transaortic, and transapical procedures o Developed quarterly and year-to-date base reports and 30-day and 1-year follow-up reports Participants o 33 Michigan hospitals o 574 physicians o 35 Michigan hospitals o 237 physicians o 19 Michigan hospitals o 86 physicians Physician type(s) o Interventional cardiologists o Interventional cardiologists o Interventional radiologists o Vascular surgeons o General surgeons o Cardiothoracic surgeons o Neurosurgeons/neurologists Transcatheter aortic valve replacement o Interventional cardiologists 3

4 o Cardiothoracic surgeons Data Collection o All cases, all payer registry o 417,359 cases entered into the registry from 1997 through 2015 o Data registry: American College of Cardiology National Cardiovascular Data Registry Cath PCI (ACC NCDR) and BMC2 data collection platform o All cases, all payer registry o 18,930 cases entered into the registry from 2012 through 2015 o Data registry: BMC2 data collection platform o All cases o 1,734 cases entered into the registry from 2014 through 2015 o Data registry Society of Thoracic Surgeons/American College or Cardiologists Transcatheter Valve Therapy Registry Participation criteria : Michigan hospitals that perform PCI and have on-site open-heart surgery capability are eligible to participate in BMC2 PCI : Michigan hospitals that perform the procedures collected in the vascular surgery initiative are eligible to participate in BMC2 Vascular Surgery Michigan hospitals that perform TAVR procedures are eligible to participate in Michigan TAVR For additional information about this CQI, contact: David Bye, Health Care Analyst, Value Partnerships, Blue Cross, at dbye@bcbsm.com. About the BMC2 Coordinating Center Michigan Medicine (formerly University of Michigan Health System) serves as the Coordinating Center for BMC2 and is responsible for collecting and analyzing comprehensive clinical data from the participating hospitals. It uses these analyses to examine practice patterns, to generate new knowledge linking processes of care to outcomes, and to identify best practices and opportunities to 4

5 improve quality and efficiency. The center supports participants in establishing quality improvement goals and assists them in implementing best practices. Dr. Hitinder S. Gurm, MD, serves as project director of BMC2-PCI. He is associate chief of the Division of Cardiovascular Medicine, University of Michigan. In addition, he is chief of the Section of Cardiology, VA Ann Arbor Healthcare System. Dr. Gurm is a recipient of the Michigan Health & Hospital Association s Patient Safety & Quality Leadership Award and has been elected to the American Society for Clinical Investigation (ASCI). Dr. Peter K. Henke, MD, serves as project director of BMC2 Vascular Surgery. He is a Leland Ira Doan Research Professor of Vascular Surgery and Professor of Surgery, University of Michigan - operating at both, University of Michigan and VA Ann Arbor Healthcare System. Dr. Henke is associate chair of research, as well as the head of the Research Advisory Committee for the Department of Surgery, University of Michigan. Dr. P. Michael Grossman, MD, serves as a project co-director for BMC2 Michigan TAVR. He is an associate professor of Internal Medicine in the Division of Cardiovascular Medicine. In addition, Dr. Grossman is director of the Cardiac Catheterization Laboratory and a staff cardiologist, VA Ann Arbor Healthcare System. Dr. Stanley J. Chetcuti, MD, serves as a project co-director for BMC2 Michigan TAVR. He is an associate professor of Internal Medicine and the Eric J. Topol Collegiate Professor of Cardiovascular Medicine. Dr. Chetcuti serves as director of the Cardiac Catheterization Laboratory and the Interventional Cardiology Fellowship Program. Dr. Himanshu J. Patel, MD, serves as a project co-director for BMC2 Michigan TAVR. He is the Joe D. Morris Collegiate Professor of Cardiac Surgery, specializing in surgery for thoracic and thoracoabdominal aortic disease as well as surgery for valvular and aortic root disease. Dr. Patel served as chief of Cardiothoracic Surgery from 2004 to 2009, VA Ann Arbor Healthcare System. He has recently assumed the role as section head of Adult Cardiac Surgery, University of Michigan - Frankel Cardiovascular Center. Andrea Jensen, MA, MS, is research senior supervisor and project administrator for BMC2 PCI and vascular surgery. She was previously the site head of Research Quality Assurance at the Ann Arbor Site for Pfizer Global Research and Development. About the Collaborative Quality Initiative Program Sponsored by Blue Cross Blue Shield of Michigan and Blue Care Network, Collaborative Quality Initiatives bring together Michigan physicians and hospital partners to address some of the most 5

6 common and costly areas of surgical and medical care. Collaborative Quality Initiatives rely on comprehensive clinical registries that include data on patient risk factors, processes of care, and outcomes of care. As a result of the collection and analysis of procedural and outcomes data, the participants implement changes in practice, based on the knowledge acquired from the consortium. These changes in practices lead to increased efficiencies, improved outcomes, and enhanced value. Collaborative Quality Initiatives are contributing to Blue Cross achieving a lower growth in medical cost trends than the national average, which helps hold down health care costs for Blues customers statewide. About Value Partnerships Value Partnerships is a collection of clinically-oriented initiatives among Michigan physicians, hospitals and Blue Cross that are improving clinical quality, reducing complications, controlling cost trends, eliminating errors, and improving health outcomes throughout Michigan. For additional information about CQIs: Send an to cqiprograms@bcbsm.com. Visit our website at 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. 6

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