A Note from Leadership
We are excited that we have recently rolled out the first set of mitral reports. We look forward to the ways that collecting and reporting on this data will help us develop new quality projects and improve patient outcomes and quality of care in the coming months and years.
Members of the consortium are consistently working on projects to improve the patient experience both here in Michigan, and in national efforts, lending their time and talents by providing feedback to national organizations and planning committees. Sara Babcock and her team at Spectrum Health in Grand Rapids contributed to this year’s ACC Quality Summit. Learn more in the Site Spotlight later in the newsletter.
We also continue to aid in educating members of the consortium by bringing in local and national speakers such as University of Minnesota’s Dr. Joao Cavalcante who will join us at our upcoming Collaborative Meeting. Dr. Cavalcante will present on CT planning to optimize aortic valve replacement strategies and implications for TAV in TAV and TAV in SAV.
The work that we do is possible because of you, your commitment to health care, and the desire to better the lives of patients, across the state, and ultimately the nation, and the world. Thank you for your partnership and collaboration.
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Spotlight on Spectrum Health Grand Rapids
“We’ve been tucked away for a long time,” reflects Sara Babcock, RN, MSN, the Quality, Safety, and Experience Clinical Database Lead at Spectrum Health Fred and Lena Meijer Heart Center in Grand Rapids. “The pandemic took so much from us. I don’t want it to take our quality care away from us. We gave quality care beforehand; we need to be giving quality care afterward.”
One of the ways that the team at Spectrum has worked to improve quality care and outcomes during the pandemic is to look at ways to reduce the rate of permanent pacemaker placement following transcatheter aortic valve replacement (TAVR.) Another is looking at alternatives to the KCCQ to measure patient satisfaction by way of Spectrum Health’s Registry Quality Program. Learn more about these projects, and how presenting projects at MISHC meetings and nationally has given staff an edge, by visiting our blog.
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Staff Spotlight - Mary Casey
MISHC’s new project manager, Mary Casey, works with members of the Coordinating Center, staff and physicians at hospitals, and other partners to manage special projects, optimize efficiency, and maintain key operational processes within the consortium.
Mary looks forward to building the online platform for the new coordinator orientation and training. She’s excited about it because the project is a combination of utilizing some of her existing skills while learning a completely new system. She also looks forward to partnering with MISHC and BMC2’s extremely knowledgeable nurse leads to develop the modules and design the system. Read more about Mary and what drew her to MISHC on our blog.
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New VBR Goals
We asked the consortium to help determine 2023 VBR goals and the results are in!
Upon final approval by BCBSM, 2023 VBR goals will include:
1. Rate of NYHA Heart Class documentation for TAVR at 30-day follow-up, goal ≥ 92%
2. Rate of cases with contrast dose ≥ 3 CrCl for TAVR, goal ≤ 5%
3. Increase TAVR KCCQ documentation at baseline and 30-day follow-up, goal ≥ 95%
We will notify you as soon as the goals are approved. Thank you for your partnership in this process and your commitment to achieving the established goals.
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New Best Practice Protocol - Timeout for TAVR
The new best practice protocol (BPP) for Timeout for TAVR is available on mishc.org. The document contains information on patient and pre-procedure details. It also outlines checks to be performed prior to anesthesia and access/incision and guidelines for debriefing post-procedure. You can view the complete BPP on our website. Thank you to our Best Practice Protocol Task Force for creating this document.
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MISHC 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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News from BMC2 - Announcing New Vascular Surgery Leadership
The BMC2 Coordinating Center is preparing for a transition in leadership as Dr. Peter Henke steps down from his role as the Director of BMC2 Vascular Surgery. For 10 years, Dr. Henke has been a champion for cardiovascular patients, greatly impacting the trajectory of improvements in quality of care and outcomes in vascular patients across the State of Michigan through his superb guidance and expertise. We are so very grateful for the years of service that Dr. Henke has provided to BMC2 and are lucky he will continue participating in BMC2 in an ex officio capacity.
We are excited to welcome Dr. Nicholas Osborne as our next Director of BMC2 Vascular Surgery, effective January 1st. Dr. Osborne has been an active and engaged member of BMC2 and we look forward to continuing our mission of improving quality of care and outcomes under his care. You can learn more about Dr. Osborne on the BMC2 blog.
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Other News of Note
U.S. News and World Report Releases Public Reporting on TAVR Procedures
The U.S. News and World Report rates qualifying TAVR sites for TAVR procedures and publishes results for most sites annually. Scores are based on claims data and are not star ratings, but an overall performance rating. You’ll find a list of these TAVR-specific ratings, released on July 26th, on the U.S. News and World Report hospital ratings page.
STS/ACC TVT Public Reporting for TVT Star Ratings Now Available
The Society of Thoracic Surgeons/American College of Cardiology (STS/ACC) star rating system rates the benchmarked outcomes of TAVR programs across the U.S. Known as one of the most sophisticated and highly regarded overall measures of quality in health care, the star rating is based on actual data submitted by sites to the TVT registry. This year’s reporting went live on September 1st and can be found on the STS/ACC TVT Public Reporting website.
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New Partnership With MSHIELD
We are pleased that MISHC is forming a new partnership with Michigan Social Health Interventions to Eliminate Disparities (MSHIELD), a new partnering CQI in the Value Partnership portfolio. MSHIELD addresses social health needs in patients across Michigan by linking healthcare and community partners to achieve equitable health outcomes for all. Our new project manager, Mary Casey, will serve as a liaison to MSHIELD and we will be developing projects and initiatives to improve disparities in health care. We are excited to collaborate with you through this new venture. For more information on MSHIELD, visit their website.
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Notable Publication
“Evaluating the Feasibility of a Statewide Collaboration to Improve Cardiac Rehabilitation Participation” was recently published in the Journal of Cardiopulmonary Rehabilitation and Prevention. This study by, Michael P. Thompson, PhD; Jessica M. Yaser, MPH; Annemarie Forrest, MS, MPH, RN; Steven J. Keteyian, PhD; and Devraj Sukul, MD, MS demonstrated the feasibility of creating a statewide collaboration of hospitals and CR facilities centered around the goal of equitably improving CR enrollment for all eligible patients in Michigan. The collaboration is supported by a multidisciplinary advisory group and performance benchmarking. Lessons learned in this study helped to result in the Michigan Cardiac Rehab (MiCR) Network. You can read more about this study at PubMed and learn more about MiCR on our website.
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National Presentation
The ACC Quality Summit was held September 14th – 16th in Los Angeles. 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” was presented by consortium members Brittany Powell, BS and Michele Mullin, BSN, RN along with MISHC Clinical Quality Improvement Lead, Sheryl Fielding, BSN, RN. 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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Special Event
The Michigan Bariatric Surgery Collaborative (MBSC) hosted 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.
There was also a CQI forum, where CQIs were invited to share information about their organization with attendees. MISHC attended and made a wide range of materials available to participants, including statistics on obesity among structural heart patients and links to our publications, best practices, and annual report. You can view MISHC's poster on our website.
Administrators, House Officers, Medical Students, Nurse Practitioners, Nurses, Physician Assistants, Physicians, Social Workers, and other healthcare professionals in the fields of endocrinology, general medicine, primary care, and surgery were in attendance.
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MISHC Meeting Summaries
Two MiTVT2 TAVR Readmission Prevention Meetings were held over the quarter on June 30th and September 1st both from 11 am – 12 pm. During the June meeting, topics such as conduction disturbance/arrythmia, heart failure, and process components that may impact readmission rates, were discussed with readmission high performers in MISHC sharing their site’s practice and processes. Presenters were Dr. Janet Wyman – Administrative Director, Structural Heart Disease Clinical Services, Henry Ford Health System, Ann Ostrander – Structural Heart Coordinator, Cardiovascular Program Administrator, Covenant Healthcare, and Annette Fruge – Cardiovascular Service Line Manager, MyMichigan Health. We look forward to continuing this discussion, sharing experiences to help improve patient quality of care and outcomes.
The MiTVT2 readmission prevention best practice workgroup is working to finalize a draft best practice that will be distributed for comment after the October collaborative meeting. During the September meeting, the team worked to identify areas that needed additional resources including pre-TAVR prehab, indicators for readmission, and frailty assessment. The final draft will be presented at the MISHC coordinator meeting on October 14th and distributed to all MISHC participants for feedback.
A MISHC Coordinator Meeting was held on Thursday, August 25th from 11 am – 12 pm. Dr. Andrew Harris of Michigan Medicine shared the presentation, “Echocardiographic Assessment of Echocardiographic Assessment of Aortic Stenosis and Post-TAVR.” You can view it on our YouTube channel. There was also a coordinator meeting on September 20th from 9 am – 10 pm. Information was shared by three members of the MISHC Coordinating Center. Jeremy Albright, PhD, shared information on risk adjustment methodology while Elizabeth Walker shared insight on MISHC communications and Annemarie Forrest presented on the Michigan Cardiac Rehab Network (MiCR.) Dr. Albright’s presentation can be found on our MISHC YouTube channel.
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Upcoming Meetings
The next MISHC Coordinator/Abstractor Annual Meeting is on Friday, October 14th from 1 pm – 5 pm at Frederik Meijer Gardens and Sculpture Park, Grand Rapids, MI. View the agenda on our website.
The next MISHC Collaborative Meeting is on Saturday, October 15th from 10 am – 3 pm at Frederik Meijer Gardens and Sculpture Park, Grand Rapids, MI. View the agenda on our website.
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Welcome Our New Coordinator
Christy Hignite, HIT
MyMichigan Health
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MISHC Website Tips
MISHC has a suite of resources available on our website that serve as tools for consortium members to support impactful quality improvement efforts at their hospitals. Visit mishc.org and click on “Coordinator Resources.” You will find drop-down menus for “General Resources” as well as TAVR and mitral resources. Use the displayed links to download resources such as access user forms, registry data entry deadlines, dictionaries, billing guides, and more.
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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 Walker at ehorn@umich.edu.
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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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