1. ASPIRE Quality Committee Meeting 9/28/2015

2. Agenda Approve Minutes Items of Interest ASPIRE Annual meeting New ASPIRE Sites announced MPOG/ASPIRE Retreat ASA Meetings QCDR Update Roll Call Monitoring Gap measure Hypotension measure Preliminary ASPIRE Year 1 data

3. Approve Minutes

4. Items of Interest ASPIRE Annual Meeting New ASPIRE Sites announced MPOG/ASPIRE Retreat ASA Sessions QCDR Update

5. New ASPIRE Sites Announced – Year 2 Cohort Holland Hospital – Holland, MI Bronson Health System – Battle Creek and Kalamazoo, MI Botsford Hospital – Farmington Hills, MI (Beaumont – Farmington Hills) St. Mary Mercy – Livonia, MI St. Joseph Mercy – Oakland, MI Sparrow Health System – Lansing, MI

6. MPOG/ASPIRE Retreat Update

7. Session Title: QCDR Roundtable: Quality Measures That Matter –Reporting in 2016 Session Description: Join us for in-depth, small group discussions about the Physician Quality Reporting System, available reporting options for practices and how the ASA QCDR may be a viable option for quality reporting at your practice. Discussion topics will include: Available PQRS and ASA QCDR Measures Data Transfer from your system(s) to AQI Physician Quality Reporting System and Claims-Based Reporting Membership, Providers and Pricing Practices that are already participating in ASA QCDR will share their stories and take questions. Session Start/End Time: Sunday, Oct 25, 2015, 8:00 AM - 9:50 AM Session Title: Risk Adjustment for Performance Measurement: Friend or Foe? Session Track: Critical Care Medicine (CC) Session Description: This pro-con will examine the use of risk adjustment for outcome measurement in perioperative care. Using a pro/con format, the session will describe the theoretical basis for risk adjustment and current risk adjustment methodologies. Current implementations of risk adjustment in surgical care, implications for anesthesia quality, and unintended consequences will also be discussed. Session Start/End Time: Saturday, Oct 24, 2015, 1:10 PM - 2:10 PM Sessions at ASA Related to Quality Measurement

8. Session Title: My Patients Never Have Residual Paralysis in the PACU, or Do They? Session Track: Fundamentals of Anesthesiology (FA) Session Description: 1) Define residual neuromuscular blockade; 2) Explain fundamental concepts of recovery and reversal from neuromuscular blockade 3) Determine the important risk factors for residual paralysis; 4) Apply evidence-based practices related to neuromuscular management that are useful towards decreasing the incidence of residual neuromuscular blockade Session Start/End Time: Monday, Oct 26, 2015, 3:30 PM - 4:30 PM Session Title: How to Effectively Use Quality Data to Represent Your Practice and Improve Patient Outcomes Session Track: Professional Issues (PI) Session Description: Participants will be shown how to set up recurring reports that allow them to monitor outcomes and processes in their practice and how to utilize those reports to demonstrate value to stake holders and identify opportunities to improve care. Participants will be shown how to evaluate data using control chart analysis and confidence intervals. Participants will learn how to use demographic risk factors and benchmarks to refine focus of quality improvement initiatives. Session Start/End Time: Tuesday, Oct 27, 2015, 7:15 AM - 8:15 AM Sessions at ASA Related to Quality Measurement

9. Session Title: Perioperative Glucose Control: Creating a Shared Mental Model and Delivering Quality Patient Care Session Track: Fundamentals of Anesthesiology (FA) Session Description: This refresher course lecture will provide a brief summary of the scientific evidence underlying adverse outcomes associated with hyperglycemia in diabetics and those without the diagnosis of diabetes. Then we will review the set-up for a hospital system to deliver glycemic control based on American Diabetes Association and American Association of Clinical Endocrinologists guidelines. The creation of cognitive tools for the Perioperative Team to deliver on these guidelines will be emphasized. Session Start/End Time: Tuesday, Oct 27, 2015, 11:00 AM -12:00 PM Session Title: Perioperative Ventilatory Management: Strategies for Preventing Postoperative Pulmonary Complications Session Track: Fundamentals of Anesthesiology (FA) Session Description: Expanding on our understanding of ventilation strategies used in the critical care setting, recent work has shown that protective ventilatory management in the perioperative setting can influence subsequent risk for postoperative pulmonary complications (PPCs). This refresher course lecture will review preoperative risk stratification for patients at risk of PPCs, evolution of current ventilation strategies, strategies for avoiding complications of mechanical ventilation, and alternative modes of protective lung ventilation in the perioperative setting. Sessions at ASA Related to Quality Measurement

10. Session Title: Will Goal-Directed Transfusion Management Improve Quality of Care? Session Track: Fundamentals of Anesthesiology (FA) Session Description: Given the strong evidence collected over the past decade on the risks and potentially severe consequences of blood transfusions, this clinical forum will evaluate current and new strategies to avoid transfusions through preoperative optimization, minimizing intraoperative blood loss, and transfusion alternatives. Strategies of goal-directed transfusions in the perioperative period will also be examined. Session Start/End Time: Wednesday, Oct 28, 2015, 7:45 AM - 8:45 AM Session Title: Grading the Graders - How Do We Get to Better Performance Measures Session Track: Professional Issues (PI) Session Description: This panel will provide an overview of performance measurement, and will describe the strengths and limitations of process and outcomes measures. Topics will include the regulatory emphasis on outcome measurement and value-based purchasing, the ability of quality measures to truly capture quality, and the use of physician-specific vs. team-based performance measurement. Discussion will also include consideration of future directions in performance measurement. Session Start/End Time: Wednesday, Oct 28, 2015, 7:45 AM - 9:15 AM Sessions at ASA Related to Quality Measurement

11. QCDR Update Meeting at ASA HQ Quarterly Reports Due Continue for next year

12. Roll Call

13. Measure Feedback

14. Monitoring Gap Measure Measure performance in obtaining timely blood pressure readings with a maximum of 10 minute intervals between blood pressure measurements. A measurement gap will be identified for cases that have time duration greater than ten minutes between consecutive blood pressure readings. The measure will capture NIBP & arterial line measurements and will exclude artifact. Measurement period begins with the first blood pressure on arrival into the operating room until patient out of operating room. Feedback required for MRI cases Exclusions: Labor epidurals Responsible Provider: Provider signed in at 10 minute marks

15. Forum Summary Manual documentation of VS: 6 Device integration in MRI: 5 Explicit feedback to exclude MRI cases: 6 Other feedback and comments of interest Exclude all cases with manual data entry or paper records Noted hybrid state in MRI suites (manual and device integration, and vital signs are captured with variable quality Collect information on MRI gaps as an opportunity to learn

16. Hypotension Measure BP 01 will measure the cumulative time of Mean Arterial Pressure (MAP) <55mmHG. Cases that have a cumulative time of 20 minutes (1200 seconds) with a MAP< 55mmhg will be included as a failed case. BP 01 will include non-invasive and invasive blood pressure monitoring. Inclusions ≥ 18 years old All patients requiring anesthesia (general or local) Exclusions Patients <18 years old Baseline MAP<55mmHG or Major transfusion Cardiac procedures (CPT codes) Liver Transplant surgery (CPT codes) Lung Transplant surgery (CPT codes) Responsible Provider Provider who was signed in for the duration of hypotension Success described as: MAP 55mmHG throughout case length

17. Data across ASPIRE centers – last 12 months

19. 200

21. GLU 02 - Low Glucose Treated

26. PUL 01 - Tidal Volume less than 10 ml/kg