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The Michigan Trauma Quality Improvement Program: Results from a collaborative quality initiative

Hemmila, Mark Richard MD; Jakubus, Jill L. MS; Cain-Nielsen, Anne H. MS; Kepros, John P. MD; Vander Kolk, Wayne E. MD; Wahl, Wendy L. MD; Mikhail, Judy N. PhD

Journal of Trauma and Acute Care Surgery: May 2017 - Volume 82 - Issue 5 - p 867–876
doi: 10.1097/TA.0000000000001401
AAST 2016 Plenary Paper

BACKGROUND American College of Surgeons verified trauma centers and a third-party payer within the state of Michigan built a regional collaborative quality initiative (CQI). The Michigan Trauma Quality Improvement Program began as a pilot in 2008 and expanded to a formal program in 2011. Here, we examine the performance of the collaborative over time with regard to patient outcomes, resource utilization, and process measures.

METHODS Data from the initial 23 hospitals that joined the CQI in 2011 were analyzed. Performance trends from 2011 to 2015 were evaluated for outcomes, resource utilization, and process measures using univariate analysis. Risk-adjustment was performed to confirm results observed in the unadjusted data. To calculate the potential number of patients impacted by the CQI program, the maximum absolute change was multiplied by the number of trauma patients treated in the 23 hospitals during 2015.

RESULTS Membership in a CQI program significantly reduced serious complications (8.5 vs. 7.3%, p = 0.002), decreased resource utilization, and improved process measure execution in trauma patients over 5 years time. Similar results were obtained in unadjusted and risk-adjusted analyses. The CQI program potentially avoided inferior vena cava filter placement in 167 patients annually. Decreased venous thromboembolism rates mirrored increased compliance with venous thromboembolism pharmacologic prophylaxis.

CONCLUSION This study confirms our hypothesis that participation in a regional CQI improves patient outcomes and decreases resource utilization while promoting compliance with processes of care.

Level of Evidence Economic/therapeutic care, level V.

From the Department of Surgery (M.R.H., J.L.J., A.H.C-N., J.N.M.), University of Michigan, Ann Arbor; Department of Surgery (J.P.K.), Michigan State University College of Human Medicine, Lansing; Department of Surgery (W.E.V.K.), Mercy Health St. Mary’s, Grand Rapids; Department of Surgery (W.L.W.), St. Joseph Mercy Hospital, Ann Arbor, Michigan.

Submitted: August 29, 2016, Revised: December 28, 2016, Accepted: January 18, 2017, Published online: March 15, 2017.

This paper was presented at the 75th Annual Meeting of the American Association for the Surgery of Trauma, September 14–17, 2016, in Waikoloa, Hawaii.

Reprints will not be available from the authors.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Address for reprints: Mark R. Hemmila, MD, University of Michigan, North Campus Research Complex, Building 16, Room 139E, 2800, Plymouth Rd, Ann Arbor, MI 48109-2800; email:

© 2017 Lippincott Williams & Wilkins, Inc.