Celebrating a decade of advancing joint replacement care in Michigan

The Michigan Arthroplasty Registry Collaborative Quality Initiative and its partners across the state are celebrating a decade of improving care and lowering risks for patients undergoing hip and knee replacement surgery. MARCQI’s achievements stem from a distinct, data-driven collaboration that connects care providers and health systems and which is rooted in continuous quality improvement engagement. The development of high-value tools for physicians and patients has also contributed to its success.

Throughout its first decade, from 2012 through 2022, MARCQI continually set new benchmarks for better care. Major milestones include:

• Reducing blood transfusions for hip and knee replacements by 85%
• Lowering post-procedure opioid usage by more than 45%
• Developing a statewide, patient-reported outcomes program that allows physicians to review patient feedback and recovery progress, then adapt care accordingly

The MARCQI team credits the collaborative approach for its ability to identify quality improvement opportunities. For example, MARCQI data revealed significant variation between participating hospitals in the rate of primary joint replacement patients being discharged to extended care facilities, ranging from 4% up to 40% — despite widespread evidence showing ECF patients have a higher risk of complications and readmission. After a focused effort, MARCQI reduced ECF discharges across the state by more than 60%.

MARCQI’s collaborative meetings also facilitate regular occasions for clinical champions to openly share effective strategies and best practices for patient education to promote the implementation of proven changes in hospitals.

During the height of the COVID-19 pandemic, MARCQI partnered with the Michigan Hospital Medicine Safety Consortium  and 10 other Collaborative Quality Initiatives to launch the Mi-COVID19 Initiative, a registry focused on improving care for patients with COVID-19.

At the same time, MARCQI increased engagement by using the infrastructure of its value-based reimbursement program. While in-person meetings paused, MARCQI asked providers to download their individual, surgeon-level reports and review them with two other surgeons, so collaborative work could continue.

Another way MARCQI adapted to the needs of the pandemic was by digitizing many processes and resources to increase ease of access to its tools.

A hallmark of MARCQI’s efforts to promote shared decision-making and patient optimization is the Infection Risk Calculator. Surgeons can use this tool with patients to help them understand their post-surgical risks and learn about opportunities to lower these and improve their outcomes. It can also be used as a guide to understand the potential for infections, which can help patients decide if surgery is the right choice. The tool has been vital in improving patient outcomes and satisfaction throughout Michigan by helping to establish a dialogue with candidates for surgery.

The next 10 years

In October 2022, MARCQI met to set its priorities for the next decade. MARCQI’s team says the next 10 years will include expanding its provider toolkit and ensuring that patient care in Michigan continues to improve. MARCQI also plans to leverage the momentum generated by its first quality summit to have robust conversations focused on current challenges and to share practical problem-solving success stories. MARCQI will use its patient-reported outcomes infrastructure for quality improvement efforts and follow key policy changes as cases shift towards outpatient facilities. Finally, building improved interactive reporting structures and systems that enable surgeons to analyze their data will be a main focus for MARCQI’s team as they start the CQI’s second decade.

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.