Sachin Kheterpal, MD, Professor of Anesthesiology at the University of Michigan and Executive Director of the Multicenter Perioperative Outcomes Group (MPOG), remains surprised by the amount of practice variation he sees while reviewing data as both a clinician and researcher. In fact, exposure to this data is one of his favorite parts of participation in MPOG.
“It’s amazing how much value there is when unnecessary practice variation is demonstrated and acted upon,” he shared. “It’s always surprising how open the clinical community is to share without judgment and investigate differences in processes of care and clinical outcomes.”
Using data to drive dialogue among anesthesiologists, nurse anesthetists, nurses, surgeons, quality improvement experts, computer programmers, statisticians, researchers, and administrators sums up MPOG. Participating hospitals use automated processes to extract institutional data that is validated by clinicians before submission to the coordinating center at the University of Michigan. The data is used for research, quality improvement, and education. Over the last decade, MPOG has built a perioperative patient registry of more than 22 million anesthetic cases integrated across more than 65 hospitals and health systems, representing a comprehensive and detailed global perioperative anesthesiology registry.
This “coalition of the willing” started auspiciously in 2008. MPOG cofounder Kevin Tremper, PhD, MD, who is Chair Emeritus of the Department of Anesthesiology at the University of Michigan, knew that different academic medical centers working to combine their data and collaborate on research projects was vital to investigating key issues in the field. Later, in 2014, the group added a quality improvement arm, given that the underlying data enabled the development of quality improvement measures.
Clinical trial opportunities
Across MPOG, there’s quite a bit of excitement about the upcoming THRIVE Trial. Led by Washington University (St. Louis, Missouri) and the University of Michigan, MPOG hospitals are participating in a pragmatic, comparative effectiveness, randomized controlled trial of 12,500 patients that will evaluate the patient experience of total intravenous anesthesia (TIVA) using propofol versus inhaled volatile anesthesia (INVA). The full-scale trial across more than a dozen U.S. hospitals builds upon a successful two-center, 300-patient feasibility trial. THRIVE will compare the effect of TIVA versus INVA on patients’ quality of recovery on postoperative day 1 and risk of intraoperative awareness with recall.
MPOG is also proud to participate in a National Institutes of Health (NIH) grant to implement and evaluate the effectiveness of “precision feedback” into the anesthesia quality improvement measure performance emails distributed monthly to nearly 8,000 anesthesia care professionals around the country. In 2024, the study team plans to launch a cluster randomized trial comparing precision feedback with the standard feedback that has been in place for several years.
Collaborations with other anesthesiology bodies
Much of MPOG’s mission may sound familiar to those familiar with the Anesthesia Quality Institute (AQI). The two organizations were founded in the same year and have a strong working relationship. MPOG and AQI review one another’s measures and attend each other’s meetings. “It is important for both of our organizations to ensure that, at a high level, our measures are aligned,” said Dr. Kheterpal. “This alignment allows participants of either organization to benefit.” While data doesn’t necessarily flow from one organization to the other, Dr. Kheterpal and Nirav Shah, MD, Quality Improvement Director at MPOG, attest to the “intellectual flow” between the two groups.
MPOG is particularly excited about their collaboration with the American Board of Anesthesiology. About five years ago, the two groups realized there was an opportunity to utilize MPOG’s quality improvement infrastructure to enable anesthesiologists to work on maintenance of certification. MPOG’s quality improvement program that sends provider feedback emails to anesthesiologists for case review and reflection can be used for MOCA® Part IV credit as well.
Drs. Kheterpal and Shah said that MPOG’s research mission enables early exposure for residents interested in research, and its QI mission allows them to incorporate problem-based learning projects as part of required resident education. Increasingly, residency directors are reporting that this interplay between MPOG’s QI platform and resident education is becoming an integral part of their programs.
“Participants are organically finding new uses for our program and we’re encouraging it,” noted Dr. Shah.
Membership in MPOG
Interested organizations must follow a specific process to join MPOG, including completing regulatory paperwork, implementing data extracts, mapping variables, and reviewing data quality, before sending data to the Coordinating Center. This rigorous process requires engagement from clinical, administrative, and technical leaders at each center.
Organizations can participate in MPOG’s research mission, QI mission, or both. Those interested in research join MPOG’s research committee meetings, vote on proposals, and, when ready, may submit their own research proposal for review and approval. Members interested in quality improvement join MPOG’s Quality Committee, discuss and develop new quality measures, and review performance measures and processes to improve care. Both missions make extensive use of the software and technical infrastructure developed by MPOG over the last 15 years.
Key components of MPOG’s QI mission included site-level dashboards that enable practice leaders to benchmark themselves against other MPOG sites and monthly provider feedback emails that enable anesthesia care professionals to review their individual performance and perform case review to enable the practice reflection needed to improve care.
While reliant on data, the “secret sauce” of MPOG is the culture of collaboration among its many sites and members. “The sites that get the most out of MPOG have not only passionate interests in research and/or QI, but also support from hospital and IT leadership. We are proud to have a culture of frank discussion and focus on improving care of patients undergoing anesthesia. MPOG’s innovation is not the data, it’s the collaborative spirit and sharing of best practices inspired by the data,” said Dr. Shah.