A Note from Leadership - Himanshu Patel
We are excited to announce that Henry Ford Health’s Dr. Raed Alnajjar has joined the leadership team at the MISHC Coordinating Center. The consortium’s expansion to collect data on mitral valve procedures made it an ideal time to grow our team and ensure we are well-positioned to meet the new challenges and opportunities we will encounter.
Dr. Alnajjar is devoted to collaboration and committed to searching for opportunities to create positive change and long-lasting impact. You can learn more about him in our Faculty Spotlight. Please join us in welcoming Dr. Alnajjar!
This issue of the newsletter is packed with helpful information and a celebration of the successes we achieve by working together. Thank you for all you do to improve quality of care and outcomes for structural heart patients in Michigan.
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Spotlight on Ascension St. Mary's
Ascension St. Mary’s is making great strides in improving patient safety and outcomes.
Aiming to reduce contrast usage during TAVR procedures and reduce the TAVR-related pacemaker rate, the group looked at an alternate technique for determining TAVR deployment. They also developed a collaborative project to establish a TAVR-related sedation protocol to safely and efficiently improve cath lab time and better-utilize cath lab and anesthesia staff.
In line with MISHC's mission of collaborating for improved quality of care and patient outcomes, Ascension St. Mary’s hopes to increase other sites’ awareness of the benefits of both projects. You can read about the steps they took, the challenges they met along the way, and how their work will help patients, on our blog.
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Dr. Raed M. Alnajjar Joins the MISHC Leadership Team
Dr. Raed M. Alnajjar of Henry Ford Health has joined Drs. Stanley Chetcuti, P. Michael Grossman, and Himanshu Patel as a MISHC Co-Program Director. “He brings a wealth of experience in cardiac surgery, with a focus on surgical and percutaneous management of mitral valve disease,” said Dr. Grossman.
As MISHC has grown to include both mitral valve procedures and TAVR procedures, it is an ideal time to expand leadership, particularly from a surgical perspective.
“MISHC’s mission of improving quality, safety, and patient outcomes motivates me,” said Dr. Alnajjar. “I look forward to being available to our structural heart sites as a resource.”
Read about Dr. Alnajjar's background, interests, and goals for MISHC's future, in this news article on our website.
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Staff Spotlight - Patty Theurer
Patty Theurer is the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative’s (MSTCVS QC) program manager and co-manager of MISHC.
She has been a member of both teams since their inception, MSTCVS QC in 2005 and MISHC in 2015, and has enjoyed watching them grow.
“I have met and had the opportunity to work with so many amazing people through the years here in Michigan, the country, and around the world,” Patty said. “I’m excited about bringing our state surgeons and interventional cardiologists together in a meaningful way to discuss ways to provide the best care for our patients with valve disease.”
Read more about Patty and her work on our blog.
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VBR Measure Performance YTD
We appreciate your commitment to improving quality of care and patient outcomes as we work together to meet our VBR goals. The graphs below represent performance as of 2022 Q3 YTD. Find more about MISHC VBR on our website.
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New Best Practice Protocols
The “MISHC TAVR Readmission Prevention Best Practice Protocol,” identifies evidence-based indicators that identify patients at increased risk for readmission and actions to consider in managing that risk. Visit our website to find this document which outlines pre-procedure assessment and actions for cardiac conduction disturbances and arrhythmias, heart failure, and frailty testing as well as guidelines for management intra- and post-procedure and post-discharge follow-up.
Thank you to the protocol authors, Michelle C. Brogdon RN, MSN, ACNP-BC; Michelle Crean MSN, RN-BC, ACCNS-AG; Annette Frugé RN, BSN, CV; Kimberly Simons, RN, BSN; Michelle Walker, RN, MSN, AGNP-BC; and Janet Fredal Wyman DNP, ACNS-BC, RN-CS, FACC
The Best Practice Protocol, “Antithrombotic Therapy Post-TAVR,” outlines risk factors and strategies for patients with and without concurrent indications for oral anticoagulants. The protocol includes a predictive model for bleed risk and questions and an illustration to help determine an antithrombotic regimen. You will find these best practice protocols, and others, on our website under “Quality Improvement.”
Thank you to lead author Dr. Mansoor Qureshi and support from the MISHC Best Practice Protocol Task Force.
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MISHC Publications
The MISHC paper, “The Relationship Between Hospital Stroke Center Designation and TVT Stroke: The Michigan TAVR Experience,” was published in JACC: Cardiovascular Interventions.
Reported MISHC TVT stroke rates were significantly higher at sites with Joint Hospital Commission Comprehensive Stroke Center designation status; however, other reported important clinical outcomes did not differ significantly based on this designation.
Comprehensive Stroke Center designation is a possible factor in stroke rate detection differences between TAVR institutions and might be a factor in the observed differences in stroke rates between TAVR trials and those reported in TVT. Additionally, these data suggest that comparison of hospitals based on post-TAVR stroke rates is potentially problematic.
The study authors are P. Michael Grossman, Devraj Sukul, Shelly C. Lall, Pedro A. Villablanca, Francis Shannon, Milan Seth, Stanley J. Chetcuti, Himanshu J. Patel, and G. Michael Deeb.
The publication garnered media attention and resulted in articles by Health Lab and TCTMD. You can learn more by reading those articles or at PubMed.
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TVT Updates
The STS/ACC NCDR TVT registry is planning a version upgrade for 2023 and has asked MISHC participants for input on potential improvements. At the MISHC Coordinator meeting in October, Joan Michaels, the TVT registry manager, asked coordinators to brainstorm ideas for website improvements.
Through the MISHC coordinator meeting, site visit exit interviews, and direct coordinator suggestions we have sent the list of potential updates, available on our website. Michigan is the only state where every site has an annual chart audit which puts us in a unique position to provide thoughtful feedback from each of the sites.
If you have any additional thoughts about potential website changes, don’t hesitate to contact Sheryl Fielding at sfields@med.umich.edu.
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MISHC Meeting Summaries
The MISHC Coordinator/Abstractor Meetings were held on Thursday, January 26th from 10 am – 11 am and Tuesday, March 14th from 2 pm – 3 pm. On January 26th, Annemarie Forrest and Sheryl Fielding presented an overview of how to implement and manage Quality Improvement Initiatives.
They introduced the MISHC Quality Improvement Project Plan & Summary. Use this form to track your project performance and activity over time. You will find it on our website under “Coordinator Resources” and then “General Resources.”
To choose a QI focus, your structural heart team can reference your fall 2022 snapshot report, your MISHC reports, or choose another area for improvement.
We will address progress on QI projects at the July MISHC coordinator meeting. Don’t hesitate to contact the Coordinating Center for assistance including direction in defining opportunities, initiating a project, or finding a site working on the same project or with the same EMR. QI Summaries will be submitted via email in December.
As always, sites that would like to present their projects at a coordinator meeting are welcomed and encouraged.
On March 14th, Sheryl Fielding welcomed Dr. Andrew Harris, of Michigan Medicine to present "Mitral Valve Echocardiographic Assessment for TEER and TMVR Procedures." You will find a video of his presentation on our YouTube channel. We encourage you to share this resource with your colleagues.
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Upcoming Meetings
The MiTVT2 Meeting for structural heart coordinators will be held on March 30th from 9 am – 10 am. The MISHC TAVR Readmission Prevention Best Practice Protocol will be presented and reviewed by two of the protocol’s authors, Annette Fruge and Dr. Janet Wyman. Click here to view the agenda.
MISHC Collaborative Webinars will be held on both Tuesday, April 18th, and Tuesday, June 20th, from 6 pm – 7:30 pm.
The MISHC Coordinator/Abstractor Meeting will be held on Friday, November 10th from 10 am – 3 pm. We are working to finalize a venue for this in-person meeting and will share details soon.
The MISHC Collaborative Meeting will be held in coordination with the MSTCVS Collaborative Meeting on Saturday, November 11th from 9 am – 12 pm in the VistaTech Center at Schoolcraft College.
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News from BMC2
The 2022 BMC2 Annual Report was released last month. This report provides a snapshot of the quality improvement achievements across BMC2 PCI, Vascular Surgery, MISHC, and the Michigan Cardiac Rehab Network (MiCR). We encourage you to browse the report for information including highlights from BMC2 publications and presentations, lists of Best Practice Protocols released in 2022, an overview of the work accomplished in collaboration with the PCI Patient Advisory Council (PAC), and a look at the future and the creation of the new database which will launch in the spring.
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Call for Participation
Do you have photographs of your teams in the cath lab or performing other tasks? We would love to feature you on our website! Send photos to the Coordinating Center at info.mishc@umich.edu.
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We Want to Hear From You!
Do you have something to share via our newsletter? We want to hear from you! Email Elizabeth Horn at ehorn@umich.edu.
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MISHC is a collaboration between the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Consortium (MSTCVS QC) and the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2.)
Support for MISHC is provided by Blue Cross and Blue Shield of Michigan and Blue Care Network as part of the BCBSM Value Partnerships program.
Although Blue Cross Blue Shield of Michigan and MISHC work collaboratively, the opinions, beliefs, and viewpoints expressed by the author do not necessarily reflect the opinions, beliefs, and viewpoints of BCBSM or any of its employees.
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