Ethical, legal, and health policy challenges in contemporary cardiothoracic surgery
Cardiac Surgeons and the Quality Movement: the Michigan Experience

https://doi.org/10.1053/j.semtcvs.2009.03.008Get rights and content

The Michigan Society of Thoracic and Cardiovascular Surgeons created a voluntary quality collaborative with all the cardiac surgeons in the state and all hospitals doing adult cardiac surgery. Utilizing this collaborative over the last 3 years and creating a unique relationship with a payor, an approach to processes and outcomes has produced improvements in the quality of care for cardiac patients in the state of Michigan.

Section snippets

Historical Introduction

The Michigan Society of Thoracic and Cardiovascular Surgeons (MSTCVS) was founded in 1965 during an era when many national, regional, and state speciality societies were beginning. The first meeting of what was initially called the Michigan Society of Thoracic Surgeons was held on September 21, 1965 in Detroit in conjunction with the Michigan State Medical Society (personal communication, Allen Silbergleit, MD, PhD, Historian, Michigan Society of Thoracic and Cardiovascular Surgeons, August

Partnering with a Payer

In 1996, the Blue Cross/Blue Shield of Michigan Centers of Excellence Project asked Michigan hospitals involved with interventional cardiologic approaches to coronary artery disease to consider participating in a voluntary registry. Nine hospitals agreed and a data registry of interventional procedures and outcomes was initiated in December 1997 known as the Blue Cross/Blue Shield of Michigan Cardiovascular Consortium (BMC2).1 This voluntary consortium involved physicians, administrators, and

Quality Collaborative

Prior to creation of the cooperative agreement with Blue Cross/Blue Shield of Michigan, all adult cardiac surgical sites in Michigan began participating in the MSTCVS quality collaborative. With the agreement, funding was provided to each site for a portion of the data manager's salary and the STS data submission fee and the STS-DCRI quarterly Michigan data reports. With additional budgetary monies, two experienced nurses were hired full time, one as the MSTCVS quality initiative specialist and

Improvement Initiatives

The initial phases of our State Society's quality initiative, even before partial payer funding, targeted process and outcome variables for focused review. These included the following:

  • 1

    Internal mammary artery (IMA) usage

  • 2

    Preoperative intra aorta balloon pump usage

  • 3

    Prolonged ventilation

  • 4

    Postoperative atrial fibrillation

  • 5

    Coronary artery bypass crude and risk adjusted mortality

Other areas reviewed included postoperative renal failure and postoperative cerebral vascular accident. As the collaborative

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