Improving Care for Adults and Children in the Wolverine State
The Hospital Medicine Safety (HMS) Consortium CQI and the Michigan Emergency Department Improvement Collaborative (MEDIC) are among 17 statewide Collaborative Quality Initiatives (CQIs) in Michigan that focus on bringing together hospitals to improve care in a specific area.
The team at MEDIC—the newest CQI, having joined in 2015—has recruited over a dozen hospitals to join the collaborative. The MEDIC coordinating center identifies opportunities for improvement and supports interventions to reduce low-value care within each hospital.
“We have a broad range of sites involved including, large, academic centers, community and rural hospitals to children’s hospitals,” said Keith Kocher, MD, Director of MEDIC. “All together, they represent more than one million emergency department visits – about a third of the state total.”
This is the first time a CQI will include a focus on both pediatric and adult care. To do so, participating MEDIC organizations agreed to focus some quality improvement targets on recommendations found on Choosing Wisely lists from the American College of Emergency Physicians and American Academy of Pediatrics, including CT scans for minor head injuries.
“One reason we felt strongly about including kids was due to an important reality of emergency department care,” said Michele Nypaver, MD, co-director of MEDIC. “Most children visit emergency departments at non-pediatric hospitals. In order to drive change in pediatric emergency care delivery, one has to consider the providers in both children’s and general emergency departments. MEDIC is an innovative model that reflects the broad age spectrum of emergency medical practice.”
MEDIC also aims to provide evidence to support practice change and close performance gaps.
“We prioritize initiatives that are within the control of clinicians,” said Dr. Kocher. “That is a fundamental principle when looking to get buy-in and engagement. We also have to be able to measure it effectively, and the measurement has to be actionable so clinicians can use the information to improve their practice.”
Dr. Nypaver said since Choosing Wisely is widely known and endorsed by specialty societies, it is easy to get clinicians on the front lines into the conversation about evidence-based care.
“I look at these campaign measures as scaffolding for the work we do,” she said. “It helps us focus on something that is scientifically robust and reliably measurable so clinicians can understand what they are doing now and make changes when necessary. The MEDIC platform brings the data to clinicians to allow them to see their specific performance, compare it to their local group and entire collaborative. Physicians inherently want to make the best decisions for patients but did not have access to data like this before. This is a powerful new tool that MEDIC physicians can use to implement change and reduce variability in practice.”
MEDIC has built a registry, collected baseline data and is now engaged in helping each site with its quality improvement efforts. In recognition of the variation in emergency department structures, each organization will work on different projects and will come together to share what they learn in order to adopt best practices to reduce unnecessary care.