Hospitals and physicians across Michigan are joining forces to put high-quality care into practice through regional improvement efforts, known as Collaborative Quality Initiatives (CQIs). Blue Cross and Blue Shield of Michigan/Blue Care Network began providing support for these efforts in 2005, and there are now 17 CQIs across the state.
Each represents a partnership between Blue Cross and hospitals around a certain area of care. Each CQI is led by a coordinating center staffed by a physician director, data analysts and quality improvement specialists. The coordinating center provides hospitals with data, identifies opportunities for improvement and supports interventions to reduce variation. Clinicians from across the CQI meet quarterly to discuss data, areas of focus and goals.
Scott Flanders, MD, Vice Chair, External Relations and Quality, in the Department of Medicine at the University of Michigan, is the physician lead for the Hospital Medicine Safety (HMS) Consortium CQI, which comprises 50 hospitals.
Efforts to improve hospital care include a focus on appropriate use of peripherally inserted central catheters, urinary catheters and inpatient antibiotic use, which align with Choosing Wisely recommendations from the Society of General Internal Medicine, Society of Hospital Medicine, American Society of Nephrology and Infectious Diseases Society of America.
“This work has been deemed important on a national stage,” Dr. Flanders said. “We can get buy-in from hospitals by showing that Choosing Wisely recommendations are created by professional societies.”
He credits reductions in inappropriate treatments across participating CQI hospitals on interventions that involve four key steps:
- Engage a physician champion
Dr. Flanders said that hospitals select a physician champion, but that other physicians who are experts in a certain area or are passionate about a project often emerge to advance improvement efforts.
- Identify population subgroups
Physicians work to identify a population of patients for which a certain test or procedure is not warranted. They can then set goals on reducing unneeded procedures among those patients by a certain percentage.
- Hardwire recommendations
Dr. Flanders noted that it is important to make it easy for clinicians to evaluate appropriateness, focus on evidence-based care and standardize workflow by building guidelines, which may reflect Choosing Wisely recommendations, into electronic health records.
- Provide support tools
The CQI coordinating center can further assist hospitals and clinicians with educational tools and strategies to assess certain situations. For example, HMS provides documents that address catheter care concerns, including clots, flushes and tip location.
Read more about the Michigan Hospital Medicine Safety Consortium and some of the promising results it has achieved.