The Michigan Value Collaborative

Helping Michigan hospitals achieve their best possible patient outcomes at the lowest reasonable cost

Tag: care transitions (page 1 of 5)

BCBSM Collaborative Helps Improve Joint Replacement Initiatives and Patient Outcomes in Michigan

Rochelle Igrisan

Rochelle Igrisan, MBA, MSN, RN is MARCQI’s Senior Project Manager.

Established in 2012, The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI), essentially focuses on hip and knee procedures, such as joint replacements and revisions of those procedures. MARCQI currently works with 60 member hospitals using clinical data to track the progress of these hospitals in improving patient outcomes related to joint surgery. Several of the quality initiatives initiated by MARCQI and utilized at participating hospitals have proven to be valuable and successful at improving patient outcomes while also reducing costs.

Optimize Use of Blood Transfusions Post Joint Replacement

By disseminating data on usage, sharing and promoting the American Red Cross (ARC) Guidelines for blood transfusions, and reviewing best practices regarding the standard for blood transfusions after joint replacement surgery MARCQI recognized the use of transfusions as an area to address among their member hospitals. The ARC guidelines suggest:

  1. Providing blood transfusions post joint replacement (unilateral) if the patient’s hemoglobin level is less than eight; and
  2. Only transfusing one unit of blood at a time and then testing the patient’s hemoglobin levels again to assess further treatment.

Following implementation of these guidelines, MARCQI member hospitals the use of blood transfusions after joint replacement decreased from 9.8% to 2.6%. This best practice has not only helped improve patient care by providing an appropriate and necessary amount of care for the patient, but has also helped reduce costs for hospitals. It has also reduced blood utilization throughout the state of Michigan allowing this precious commodity to be available for other occasions.

Improving Patient Care and Self-Management Post Joint Replacement

A second initiative MARCQI participants worked on has been geared towards decreasing the inappropriate use of skilled nursing facilities after joint replacement surgery. The majority of joint replacement patients have better post-operative outcomes if they are sent home. Thus, hospitals provided patients with guidance on how to better self-manage their condition post joint replacement. Prior to implementation of this quality initiative, about 33 to 50 percent of patients went to a nursing home following joint replacement surgery. However, after working on this initiative, only about 15 percent of patients are sent to nursing homes post joint replacement.

Other initiatives MARCQI is working on are better understanding of pain management post joint replacement, and reducing surgical site infections in post joint replacement candidates. Overall, the different quality initiatives that MARCQI has worked on has helped improve patient outcomes and save hospitals millions of dollars. In 2014-2015, MARCQI member hospitals saw a shared cost savings of $3,453,424. This cost savings goes hand in hand with helping improve patient experience and quality of care related to joint replacement surgery.

To promote hospital and CQI collaboration, MVC and MARCQI work on a Joint Replacement Workgroup together. If you are interested in learning more about MARCQI or the Joint Replacement Workgroup, please contact Deby (, Abeer ( or Rochelle Igrisan from MARCQI (

McLaren- Lansing: Using Change as an Opportunity for Optimizing Palliative Care

Kim Hecksel

McLaren- Lansing Palliative Care nurses from left to right: Kim, RN, Paula, CNP and Carol, RN

Although the palliative care program at McLaren- Lansing has been around for about a decade, health care organizations are constantly changing and evolving to meet patient and family needs. The MVC Coordinating Center had the opportunity to speak to the team of case managers and nurses from McLaren- Lansing to hear about the different successes and barriers to palliative care at this facility. One distinct characteristic of this palliative care program is that patients and families are seen by and interact with consistent faces, rather than different clinicians, each time they visit. McLaren uses this consistency as leverage through transitions of care, especially at a time when clinician duties and health organizations are constantly changing.

The palliative care program at McLaren- Lansing also keeps up with the constant changes in health care by utilizing different online resources. One resource available to hospitals interested in palliative care programs is the Center to Advance Palliative Care (CAPC). CAPC offers a platform to help provide different health care organizations across the nation the tools and resources needed to advance palliative care programs in their respective institutions. For example, some CAPC resources help palliative care teams set up and develop a business plan for their respective palliative care programs. CAPC resources are helping guide the McLaren- Lansing team in creating a business model that illustrates the financial impact of a palliative care program on the health system. For more information on CAPC and the resources they can provide, visit

The palliative care team also looks at the big picture of the care provided to patients and consequently putting together different pieces of information to ultimately develop a course of treatment that best meets the needs of the patients and the family involved. One of the barriers McLaren- Lansing has with their palliative care program is working with patients, family members and other health care providers on understanding the value of palliative care and what it really offers. When met with this resistance, the palliative care team works in different ways on learning about and discussing the care plan and goal setting to find the right format for communication and understanding a diverse patient population. For example, the palliative care team engages with physicians one-on-one and attends presentations on the benefits of palliative care to better understand and work with patients and their families about their diagnosis and individualized care plan. Taking advantage of different resources available, such as CAPC, and instilling a strong support system among the palliative care team and liaising teams are factors that aid in instituting a successful palliative care program.

If you are interested in learning more about the palliative care program at McLaren- Lansing, please feel free to reach out to Deby ( or Abeer ( for more information and contact.

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