As a physician, every day you enter a hospital you’re met with the question: Why did I enter the field of medicine? Throughout my 20 years in practice, the answer has always remained clear. I chose this path to help people, and there’s no doubt in my mind that my colleagues across Michigan would answer the same. As a cardiologist, I work to protect the core of a person’s health every day — their heart. One way I do this is by facilitating an effort among 33 hospitals across Michigan that improves care for patients who undergo angioplasty. The effort is funded by Blue Cross. The official name for this effort is the Blue Cross Blue Shield of Michigan Cardiovascular Consortium-Percutaneous Coronary Intervention (BMC2-PCI) Collaborative Quality Initiative, but in this article, I’ll just call it the angioplasty CQI. Angioplasty is a therapeutic procedure used to treat the narrowed arteries of the heart, restoring normal blood flow for many patients. With roughly 28,000 coronary angioplasties completed in the state every year, our medical community was searching for a way to make the procedure safer and more efficient than ever before. The angioplasty CQI collects data on these angioplasties and assesses complication rates such as kidney failure and heart attack, as well as the need for emergency open heart surgery. Using the data, the initiative developed guidelines to help physicians better manage patients at risk of serious complications. Recommendations from the angioplasty CQI contributed to dramatic decreases in emergency bypass surgeries and other complications. The angioplasty CQI launched in 1997 with just five Michigan hospitals. As we collected more and more data from patients across the state and shared our best practices, the complication rate of this surgery took a noticeable drop. This work was having an incredibly positive impact on patients and the Michigan medical community took notice, leading to the collaboration growing to roughly 33 hospitals participating in the CQI today. Now, every hospital in Michigan that performs angioplasties participates in this initiative. What does that mean for cardiologists like myself? We have developed an incredibly knowledgeable network of physicians and medical staff across the state who can give each other a call at a moment’s notice to ask, “What’s working best for you and your patients?” How does the angioplasty CQI benefit patients? For one thing, we’ve been able to reduce kidney damage caused by the dye used in angioplasties, called contrast-induced nephropathy. It’s an uncommon complication, so when doctors are looking at data from angioplasties done at just one site, the occurrences are so low it’s hard to notice any pattern or cause. Through the angioplasty CQI, data is gathered from procedures across the state, and participating physicians have a larger data picture to identify solutions. The CQI was able to identify the problem and recommend a change in contrast dye, resulting in a 32% reduction in contrast-induced nephropathy. The Blue Cross angioplasty CQI is also responsible for a 33% reduction in blood transfusions after angioplasty; a 52% reduction in vascular complications; and a 20% increase in referrals to cardiac rehabilitation. Every patient undergoing angioplasty in Michigan benefits from this CQI, since their risk of complications is much lower due to the sharing and implementation of best practices we’ve identified. It’s impossible to point to an individual patient who benefited since we will never know if they would have suffered from complications without it. But one thing we do know is that we have a lot more quiet days in the cath lab, because procedures are going smoothly. Physicians across the country have told me that this type of collaboration among competing hospitals and health systems is highly coveted. There are 22 Blue Cross CQIs, and each one brings together some of the brightest minds in Michigan. As a facilitator of the angioplasty CQI, I’m consistently impressed by what multiple doctors and hospitals can accomplish by working together. This effort is not just a collaboration between hospitals and physicians - Blue Cross’ contributions to the process have made it possible and ensured the durability and success of the initiative. It’s pretty amazing for such a large organization to do what Blue Cross does – they have taken a step back and allowed facilitators to independently collect and analyze data and act on it. Blue Cross leadership’s decision to let the medical community guide the initiative has been a key element to our success, and the results speak for themselves. Through this work, hospitals are improving – we’ve seen a reduction in angioplasty complications at all of our participating sites – and Blue Cross has allowed it to foster within the medical community. By trusting the physician community to do this, they have shown a level of maturity and confidence that a lot of states’ medical communities admire. We’re lucky that Blue Cross has shown this kind of support in this space and let us focus on continuously working to improve quality of care. Through this ongoing work, the Michigan medical community will continue to grow along with the successful care of cardiac patients across the state. This post is part of a storytelling series we call, “Beyond the Card.” These stories will feature Blue Cross Blue Shield of Michigan members, employees, and communities who are making meaningful differences throughout our state. We invite you to follow Beyond the Card stories here at MIBluesPerspectives.com and through the hashtag, #BeyondtheCard on our social channels. If you have a story you would like to share, please feel free to contact us at firstname.lastname@example.org. Photo credit: Dr. Hitinder Singh Gurm, MBBS
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