Implementation and Practice Change

Faculty Lead: Dr. Michael Englesbe, MD

Michigan Opioid Prescribing Engagement Network (Michigan OPEN)

Leadership: Dr. Chad Brummett, MD, Dr. Michael Englesbe, MD, and Dr. Jennifer Waljee, MD, MPH, MS

Visit the Michigan OPEN website

The Michigan Opioid Prescribing Engagement Network (Michigan OPEN) is an effort to develop a preventive approach to the opioid epidemic in the state of Michigan by tailoring postoperative and acute care opioid prescribing. We know that one of the most common reasons for opioid prescribing is surgical care and recovery and yet there are no guidelines to direct postoperative opioid prescribing. The lack of evidence-based guidelines for postoperative and acute care opioid prescribing has contributed to a surplus of opioid pills within patients’ homes and communities, increasing the potential for diversion and nonmedical use. 

Through a partnership with Michigan’s network of clinician-led Collaborative Quality Initiative (CQI) programs, Michigan OPEN is working with 72 hospitals across the state to 1) increase prescription opioid awareness among patients and providers, 2) obtain detailed data, and 3) identify and disseminate best practices in postoperative and acute care opioid prescribing.  

Michigan Surgical & Health Optimization Program (MSHOP)

Principal Investigator: Dr. Michael Englesbe, MD
Co-Investigators: Dr. Darrell "Skip" Campbell, MD and Dr. Stewart Wang, MD

Surgery is an expensive aspect of healthcare.  For perspective, an office visit costs about $100.  Inpatient surgery without complication averages $20,000, while surgical care when complications arise becomes two to three times more expensive. Annually in the US, 45 million inpatient surgeries are performed, and one in five involves a complication. This project targets these surgical complications and aims to reduce healthcare expenditures by millions of dollars, while improving the health and outcomes of patients. The Michigan Surgical and Health Optimization Program (MSHOP) integrates several key innovations.  First, using novel pre-operative risk assessment tools, individuals deemed to have remediable risk will participate in an evidence-based optimization program that empowers patients to train for surgery by doing basic walking exercises. Further, these risk assessment tools will be used by surgeons to inform decision-making discussions with patients. Excessively high risk and futile surgical procedures may be reduced.  MSHOP is a collaborative program between the Michigan Surgical Quality Collaborative, Blue Cross and Blue Shield of Michigan, and the University of Michigan. 

Project Goals:

  • Improving health care delivery by creating technologies to provide efficient, patient-centered surgical risk stratification and best practice recommendations to the bedside for surgeons and physicians, leading to improved clinical decisions. This will facilitate shared decision-making, encourage patients to affect their own surgical outcomes, and improve care of at-risk patients, especially elderly and frail members of society.
  • Improving health by using major surgery as a motivating event to encourage patients in poor health to improve their surgical outcomes by participating in an innovative program of preventive care, peri-operative physical activity and behavior modification.  MSHOP leverages proven clinical engagement tools to support patients as well as their care providers. 
  • Reducing costs by improving the appropriateness of surgery, reducing surgical complications, and reducing length of inpatient stay.

Results and Resources:

The key components of MSHOP – real time risk stratification and peri-operative optimization through prehabilitation – will improve surgical outcomes in two ways:

  1. Real time risk stratification will improve the appropriateness of surgery; in certain high-risk cases, patients and surgeons will avoid prohibitively high-risk surgical care, focusing on medical and palliative management. 
  2. This program will teach patients to train for surgery, in order to improve their physiology and mindset.  Based on results at UMHS, a reduction in inpatient costs of care (payments to hospitals) of approximately $2,518 per case should result.

Dissemination:

In 2014 MSHOP received a $6.4 M grant from the Centers for Medicare and Medicaid Services, in order to conduct a demonstration project which will establish whether reductions in cost and length of stay achieved by the University of Michigan Health System can be similarly gained when the program is implemented in other systems. This project will enable the development and implementation of novel care technologies and a payment model that are well suited  to transform surgical care in Michigan.  Over three years, 12,500 patients will be enrolled; first at Michigan Medicine and then at 40 surgical practices affiliated with hospitals across the state of Michigan. At this project’s conclusion, a field-tested and optimized product will be available for rapid national adoption.