Keith Kocherworking to improve the performance of

emergency and acute care

Why?

Health

Advancing

Promoting

Supporting

Cultivating

(not health care)

How?

Health care

Culture

Science

Economics

Politics

How?performance varies

How?

𝑉𝑎𝑙𝑢𝑒=𝑄𝑢𝑎𝑙𝑖𝑡𝑦𝐶𝑜𝑠𝑡

TimelinessFunctional status MortalityRelief of suffering Communication

Provider work Ancillary staff work

Tests TreatmentsFacility

𝑉𝑎𝑙𝑢𝑒=𝑄𝑢𝑎𝑙𝑖𝑡𝑦𝐶𝑜𝑠𝑡

How?

What value did the patient

derive from the ED visit?

What value did the system (society)

derive from the ED visit?

How?

* Doesn’t mean

we can’tdo better

performance varies*

What?2 major research projects:

• Michigan Emergency Department Improvement Collaborative (MEDIC)

• Funded by Blue Cross Blue Shield of Michigan and Blue Care Network

• Started January 2015• www.medicqi.org

• Career Development Award (K08)• Funded by the Agency for Healthcare Research

and Quality (AHRQ)• Started August 2015

UM BEA

CWM HF CHM

HFHH

MM

MidMichigan Medical CenterMidlandJeff Allen, MD

MNM

McLaren Northern MichiganPetoskeyBrian Gelb, MD

Holland HospitalHollandBrian Holt, DO

University of Michigan HospitalAnn ArborBenjamin Bassin, MDDavid Somand, MD

UM

CW Mott Children’s HospitalAnn ArborNicole Sroufe, MD

CWM

Beaumont HospitalRoyal OakBlaine Dennis, MD

BEA

Children’s Hospital of MichiganDetroitPrashant Mahajan, MD, MPH, MBA

CHM

Henry Ford HospitalDetroitSeth Krupp, MDMichelle Slezak, MD

HF

Detroit Receiving HospitalDetroitBrian O’Neil, MD

DR

M EDI CMICHIGAN EMERGENCY DEPARTMENT

IMPROVEMENT COLLABORATIVE

&PARTICIPATING SITESCLINICAL CHAMPIONS

Adult Pediatric Both

MEDIC Coordinating Center Team

Keith KocherDirector

Executive Committee Chair

Michele NypaverCo-DirectorPediatric

Committee Chair

Brad UrenSite Relations Lead

Jim PribbleQuality Initiatives LeadData and Publications

Committee Chair

Jason HamAdult QI Consultant

Michelle MacyPediatric QI Consultant

Greg LevineProgram Manager

Sarah BellData Analyst

April ProudlockData Auditor

Andrew Livingston

Administrative Assistant

ArborMetrixData Registry

Vendor

MEDIC Vision & Values Advance Emergency Care

Work together to advance the delivery of emergency care

Learn & Collaborate Provide tools to help providers help each other get better

Improve Patient Outcomes Evaluate current patterns of care, guide quality

improvement efforts

Drive Performance Deliver accurate, statistically rigorous performance

feedback

MEDIC Quality Initiatives

1) CT use for minor head injuries in adults and children

2) CT use to evaluate for pulmonary embolism in adults

3) Chest x-rays use for the evaluation of bronchiolitis, croup, and asthma in children

4) Developing outpatient alternative pathways to hospitalization from the ED in adults and children

What?

1) To determine patient clinical and hospital factors associated with variability in ED hospitalizations

“Understanding the Causes and Consequences of Variation in Emergency Department Hospitalization

Practices Across the United States”

2) To determine how patient non-clinical factors influence variability in ED hospitalizations

3) To evaluate the effect of ED hospitalization patterns on outcomes and costs

Career Development Award:

Sepsis [2]

Acute myocardial infarction [100]

Acute renal failure [157]

Stroke [109]

Congestive heart failure [108]

Pneumonia [122]

Diabetes with complications [50]

Cardiac dysrhythmias [106]

Biliary tract disease [149]

Fluid and electrolyte disorders [55]

Urinary tract infection [159]

Chronic obstructive pulmonary disease [127]

Asthma [128]

Soft tissue infections [197]

Chest pain [102]

0 10 20 30 40 50 60 70 80 90 100

Admission Rate, %

Observed Variation for the Top 15 Most Commonly Admitted Medical and Surgical Conditions

Notes: Unadjusted admission rates presented. Conditions shown with their associated clinical classification software (CCS) code. Boxes correspond to interquartile range, with median marked. Whiskers denote 10th and 90th percentiles.

from: Sabbatini AK, Nallamothu BK, Kocher KE. Reducing variation in

hospital admissions from the emergency department for low-

mortality conditions may produce savings. Health Affairs, 2014;

33(9):1655-1663.

Questions?

MEDIC: Infrastructure

Participating EDs

MEDIC Coordinating

CenterBCBSM & BCN

• Offer neutral ground for collaboration• Program funding and incentive payment design• Clinical and administrative support to

Coordinating Centers

CQI

• Clinical Leadership – develop and executes the QI agenda• Project Management• Data transfer and collection• Explore links between process and outcomes• Analytic and QI support

Data Analysis

Data Reporting

Develop Best

Practices

Data collection

Continuous Quality

Improvement

Collaborative

• Contribute to All-Payer registry

• Share and learn best practices

• Implement quality Improvement opportunities

Arbor Metrix

• Centralized database• Support chart

abstraction process• Performance reporting

Sabbatini AK, Nallamothu BK, Kocher KE. Reducing variation in hospital admissions from the emergency department for low-mortality conditions may produce savings. Health Affairs, 2014; 33(9):1655-1663.