The Michigan Surgical and Health Optimization Program (MSHOP) has earned a $6.4 million Health Care Innovation Award from the Centers for Medicare and Medicaid for its work to lower surgery costs and help Michigan patients train for surgery.
Each year 45 million inpatient surgeries are performed in the U.S. Following a program to boost their physical ability and mindset, patients in MSHOP go home from the hospital sooner and the cost of their surgical care is less expensive than other patients.
MSHOP also arms doctors and patients with new technology to predict surgical complications and make better decisions about surgery.
The award project is led by Michael Englesbe, M.D., an associate professor of surgery, and co-principal investigators University of Michigan Chief Medical Officer Darrell A. Campbell Jr., M.D., and Stewart C. Wang, M.D., Ph.D., a U-M professor of surgery who pioneered the use of analytic morphomics in MSHOP's risk assessment tool.
"Awaiting major surgery is a difficult time for patients and their loved ones," says Englesbe, principal investigator of MSHOP. "MSHOP is designed to help patients in the State of Michigan use this time to prepare their body and mind for surgery."
MSHOP is a collaborative program between the Michigan Surgical Quality Collaborative (MSQC), Blue Cross and Blue Shield of Michigan (BCBSM) and the University of Michigan.
Support from BCBSM and Michael Mulholland, M.D., Ph.D., chair of the U-M Department of Surgery, has made it possible for MSHOP to examine why some patients have complications and do poorly following major surgery.
Compelling ideas to improve the nation's health
The Centers for Medicare & Medicaid Services provides up to $1 billion in Innovation Awards to support the most compelling new ideas to deliver better health, improve care and lower costs to consumers.
The surgical care model fostered by the U-M is poised to transform surgical care by improving the appropriateness of surgery, reducing surgical complications and empowering patients to improve the quality of their own care.
"Through this project, 12,500 patients will be enrolled; first at the University of Michigan Health System and then at 40 hospitals in Michigan," says Campbell, who directs the MSQC. "At this project's conclusion, a field-tested and optimized model will be available for implementation across the country."
The program aims to improve surgical outcomes in two ways:
- Improving health care delivery – A risk assessment tool, available on a smartphone app, helps physicians and patients determine if surgeries are appropriate, especially for elderly or frail patients. The smartphone app leverages technology already used by most physicians and smoothly integrates data into their fast-paced routines, says June Sullivan, MBA, technology director of MSHOP.
- Empowering patients – An established program that patients can follow at home focuses on walking, lung exercises, eating better, reducing stress and developing a care team of family and friends. "Patients welcome the opportunity to make an impact on their care outcome," says William Palazzolo, physician assistant and clinical director of MSHOP.
Based on the current program, the U-M has seen savings of $2,518 a case, and has reduced time in the hospital after surgery by 30 percent.
"Much as an athlete trains for competition, patients should train for surgery," says Englesbe, MSQC's associate director. "The program is designed to help surgeons and patients make better decisions about surgery, to identify high-risk patients and train these patients to improve their medical outcomes following surgery."
Predictive power for better outcomes
MSHOP will use patient X-rays and analytic morphomics to determine surgical risk and predict how well patients will do with major surgery. Patient-specific analytic morphomic data is created from the wealth of information that exists in a patient's diagnostic imaging, such as a CT scan or x-rays.
Morphomics has emerged as a predictor of surgical risk, measurement of overall health, and as a way to determine frailty and fragility beyond a patient's age.
The Morphomic Analysis Group at the UMHS is capable of semi-automated image processing that can identify thousands of data points from a single patient's scan, offering remarkable opportunities to understand a specific patient's risk.
"Analytic morphomics is an exciting new technology that has the power to provide critical data for a much more comprehensive, patient-specific, peri-operative risk assessment," says Wang, Director of Burn Surgery at the U-M and an injury prevention researcher.