A Note from Peter Henke
As we enter fall, we are celebrating many successes at BMC2. We have several new papers that have recently been published or are in the pipeline to be released soon. BMC2 data and quality projects have been shared, and recognized, at the ACC Quality Summit. Special events like the Michigan Bariatric Surgery Collaborative’s Obesity Management Summit and the Learning Health Sciences Collaboratory, have offered us a venue for sharing the BMC2 story and the impact that we make together as a consortium.
We have had the opportunity to join in person more frequently and value the connections that these events have fostered. We appreciate those of you who have shared your stories with us by presenting at BMC2 meetings and through our newsletter’s Site Spotlight.
We encourage you to read about these successes, and more, in this issue of our newsletter. The work that we do together has a broad reach, and we THANK YOU for the contributions you make each day.
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Site Spotlight - Spectrum Health Lakeland
At 70.9%, Spectrum Health Lakeland’s Q4 2021 performance for P2Y12 Duration Documentation was a little too close to the minimum performance goal requirement of ≥ 70% set by BMC2. During the site’s Cardiology meeting in January 2022, the team set the new performance goal of 92% for Q1 2022.
They asked the Interventionalists to make this a regular part of their documentation and began to manually track P2Y12 duration documentation in March 2022. At each Cardiology meeting thereafter, initiative leaders shared individual physician performance. The documentation improved, but was inconsistent, with 68% recorded in March, 82% in April, and 81% in May.
Then, the team went a step further. Visit our blog to learn about what they did next, and how it helped them reach their goal.
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Patient Spotlight - Crystal MrozDiagnosed with kidney disease at the age of 8, Crystal Mroz knew she would need health care for the rest of her life. As she grew, she focused on her education and securing a good job. This would enable her to support herself and have access to the care her condition would require over time. “I have always had this major health issue in the back of my mind,” Crystal explained. “I couldn’t really be a dreamer. I had to be a realist because my health was always in the balance.”
When she experienced a minor heart attack in September of 2013, the fact that she was a two-time kidney transplant patient impacted her care. Visit our blog to read about Crystal's experience as a patient and how it inspired her to join our BMC2 PCI Patient Advisory Council.
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BMC2 in the News
The article, “Improving the Quality of Health Care through 25 Years of Statewide Collaboration in Michigan” was published in NEJM Catalyst Innovations in Care Delivery. Authors Ryan Howard, James Grant, Thomas Leyden, and Michael Englesbe review Collaborative Quality Initiatives, how they work, and the positive outcomes for healthcare that they help achieve. A subscription to the journal is needed to read the article in its entirety but you can read a summary at the NEJM website.
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BMC2 Publications
“Assessment of Determinants of Value in Carotid Endarterectomy” was just published in Annals of Vascular Surgery. The study by Drs. Craig S. Brown, Nicholas H. Osborne, Ahmad Hider, Michael T. Kemp, Jeremy Albright, Caleb Scheidel, and Peter K Henke found that there is tremendous variation in both quality and payments across hospitals included for Carotid Endarterectomy (CEA.) Importantly, costs were higher at low-value hospitals independent of postoperative complication. There appears to be little to no relationship between total episode spending and surgical quality, suggesting that improvements in value may be possible by decreasing total episode cost without affecting surgical outcomes. Find the paper on pubmed.gov.
The paper, “Trends and outcomes of percutaneous coronary intervention during the COVID-19 pandemic in Michigan” has been published in PLOS ONE. Study authors, Lorenzo Azzalini MD, PhD, MSc; Milan Seth, MS; Devraj Sukul, MD, MSc; Javier A Valle MD, MSCS; Edouard Daher, MD; Brett Wanamaker, MD; Michael T Tucciarone, MD; Anwar Zaitoun, MD; Ryan D Madder, MD; and Hitinder S Gurm, MD investigated the influence of the COVID-19 pandemic on the temporal trends and outcomes of patients undergoing PCI in Michigan. Using BMC2 data, a pandemic cohort and a pre-pandemic cohort were compared. The study concluded that we observed a reduction in PCI volumes and higher risk-adjusted mortality during the pandemic. COVID-19-positive patients experienced significantly worse outcomes. Read the entire article on the PLOS ONE website.
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National Presentations
In September, consortium members presented BMC2 data at the ACC Quality Summit, Midwestern Vascular 2022, and TCT 2022. For more details, including study outcomes and to view posters, follow the links throughout or visit the news section of bmc2.org.
The ACC Quality Summit was held September 14th - 16th in Los Angeles. Kathleen M. Frazier, RN, BSN, presented “Using a Collaborative Quality Improvement Registry to Improve Radiation Dose Reporting and Reduction: The BMC2 PCI Experience in Michigan.” Study co-authors are Annemarie Forrest RN, MS, MPH; Milan Seth, MS; and John Sly.
The poster, “A Standardized Approach to Heparin Management During Cardiac Catheterization” won the award for 1st Place Poster during the ACC Quality Summit. Study authors are Stephanie Edwin, PharmD, BCPS-AQ Cardiology; Hussein Almadhoun, MD, RPH, MSc Clinical Pharm; Edouard Daher, MD, FACC; Anthony Gianino, RN, MA; Dawn Light, RN; John Surducan, RN of Ascension St. John Hospital, Detroit, MI. The study was presented by Dr. Almadhoun during the 1st Place Poster Presentation.
Midwestern Vascular 2022 was held in Grand Rapids, MI September 15th – 17th. Dr. Drew J. Braet presented “A Novel Risk Calculator to Identify Patients at Risk of Contrast Associated Acute Kidney Injury after Endovascular Abdominal Aortic Aneurysm Repair." Co-authors are Drs. Jeremy Albright, Nicholas H. Osborne, and Peter K. Henke.
The poster “Delays to Surgery Increase Mortality and Limb Loss in Patients with Acute Limb Ischemia Treated with Open Thrombectomy” was presented by Dr. Margaret Smith. Co-authors are Drs. Jeremy Albright, Jonathan Eliason, Loay Kabbani, M Ashraf Mansour, Nicholas H. Osborne, and Peter K. Henke.
Dr. Abdul Kader Natour presented “Utilization of Preoperative Vein Mapping in Patients Undergoing Infra-Inguinal Bypass is Associated with Increased Use of Venous Conduits.” Co-authors are Drs. Alexander Shepard, Timothy Nypaver, Robert Cuff, Nicolas J Mouawad, Mark Mattos, Peter Henke, and Loay Kabbani.
TCT 2022 was held in Boston from September 16th – 19th, 2022. Dr. M. Chadi Alraies presented the poster “Variation in the Utilization of Coronary Physiology Among Those Undergoing PCI in Michigan – Insights from the BMC2.” Co-authors are Milan Seth, Dr. Devraj Sukul, Dr. Ryan Madder, MD, and Dr. Hitinder Gurm.
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Peripheral Artery Disease National Action Plan
In December of 2018, a Peripheral Artery Disease (PAD) round table was held at the National Heart, Lung, and Blood Institute where representatives from the American Heart Association, along with 50 participants including health care professionals, governmental agencies, non-profit organizations, patient advocacy groups, and PAD patients, developed goals and tactics for PAD awareness, diagnosis, and treatment. A PAD Summit of experts in the field, including our Director of BMC2 Vascular Surgery, Dr. Peter Henke, convened in April of 2021 to write the PAD National Action Plan.
The plan outlines 6 goals – Public Awareness, Professional Education, Detection and Treatment, Public Health, Research, and Advocacy. You can visit our blog for access to the PAD National Action Plan and more information.
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Special Event - Obesity Management Summit
The Michigan Bariatric Surgery Collaborative (MBSC) held the 2022 Obesity Management Summit on September 23rd from 7 am – 4 pm at the Suburban Collection Showplace in Novi. This event, hosted by Blue Cross Blue Shield and Blue Care Network, featured expert speakers presenting on topics such as the latest and best practices for obesity management in behavior modification, diet, and pharmacological approaches. The goal of the Summit was to help participants foster better communication and collaboration between surgical care teams and primary care teams to help patients achieve long-term success in obesity management.
BMC2 shared a wide range of materials during the event's CQI forum including statistics on obesity among PCI and VS patients and links to our publications, best practices, and annual report. You can view the BMC2 Obesity Management Summit poster and learn more about the event on our blog.
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BMC2 Meeting Summaries
A PCI Coordinator Meeting was held on September 8th from 10 am – 3 pm at BCBSM Lyon Meadows, New Hudson, MI. It was a great day for learning and networking as we welcomed speakers Dr. Troy LaBounty and Dr. Brett Wanamaker, both of Michigan Medicine. Sarah Varitek from ABIOMED, Inc. led us through an Impella Device Family Overview and Beaumont Troy's Patti Ratka and Spectrum Health Lakeland’s Rebecca Dill shared projects from their sites. For information on the presentations, along with a link to Dr. LaBounty's presentation on our YouTube channel, visit our blog.
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News from MISHC
Our MISHC team was also active at the ACC Quality Summit this month. Consortium members Brittany Powell, BS and Michele Mullin, BSN, RN along with MISHC Clinical Quality Improvement Lead, Sheryl Fielding, BSN, RN presented the poster, “Improving Usability of the STS/ACC TVT Registry™ Data Extract Function Tool to Ensure Data Accuracy and Quality: A Collaborative Endeavor by University of Michigan Health Frankel Cardiovascular Center, Beaumont Health Spectrum Health System, Michigan Structural Heart Consortium, and STS/ACC TVT Registry”. Through thoughtful conversation, this multi-disciplinary team worked collaboratively to address the data extract formatting change in the STS/ACC TVT Registry version 3.0.
By including the “TVT Procedure Pathway” identifier on every spreadsheet in the extract, they reduced the potential misalignment of 743 data elements to 34. This ultimately adds value to all transcatheter valve programs participating in the STS/ACC TVT Registry by improving efficiency and accuracy of data analysis. In turn, this allows teams more time to focus on improvement projects and best practice implementation. Moving forward, their goal is to determine feasibility of aligning all data across the consecutive version data extracts. View their poster on mishc.org.
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Upcoming Meetings
The Vascular Surgery and MVS/SVS/VQI Collaborative Meeting will be held on Thursday November 3rd from 1 pm – 5:30 pm
The next PCI Physician Meeting will be held on Thursday, November 10th from 6 – 9 pm at Cantoro Italian Market in Plymouth, MI. Look for an agenda and invitation to register for this meeting coming soon!
The next PCI Coordinator Meeting will be held on December 8th from 10 am – 11 am
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Welcome New PCI Coordinator and Abstractor
New Coordinator – Jill Kwapis, BSN, RN Quality Coordinator, University of Michigan West
New Abstractor – Chelsea Wiler, RN Clinical Database Specialist, Spectrum Health, Meijer Heart
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Opportunities for Participation
Free 1-1 Counseling Offered by Michigan OPEN - To support appropriate prescribing for vascular surgery patients, Michigan OPEN is offering BMC2 vascular surgeons the opportunity to participate in tailored, one-on-one counseling sessions. Sessions provide unbiased, evidence-based information about medications and prescribing. Participants will be compensated for their time. Learn more on our blog.
Patient Advisory Council - We are seeking additional patients that represent the diversity of our state to join our BMC2 PCI Patient Advisory Council. We are particularly interested in adding a patient who experienced complications as well as a patient who had a routine PCI to our team. Can you recommend a patient to this group? There is no up-front commitment and patients will be compensated for their time.
Send the patient’s name and contact info to Annemarie Forrest, avassalo@umich.edu; or Pam Benci, plf@umich.edu. You can learn more about patient responsibilities and what we are looking for in a patient advisor by visiting our blog.
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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 Walker at ehorn@umich.edu.
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Support for BMC2 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 BMC2 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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