In response to the global COVID-19 pandemic, a joint CQI venture, Mi-COVID19, formed under the leadership of Dr. Scott Flanders, Chief Clinical Strategy Officer at the University of Michigan and the Michigan Hospital Medicine Safety (HMS) Program Director, and Elizabeth McLaughlin, HMS Program Manager. The initiative brought together teams spanning several Blue Cross Blue Shield of Michigan (BCBSM) Collaborative Quality Initiative’s (CQI’s). Dr. Hallie Prescott, an International leader in Sepsis and a Critical Care Physician/Intensivist, with feedback from Infectious Diseases and Hospitalist leaders, developed a data collection strategy aimed at understanding clinical characteristics and care practices for patients with COVID-19. By early April 2020, the Mi-COVID19 Registry was built just 3 weeks after the first case of COVID-19 in Michigan. By the end of April 2020, just weeks after launch, over 40 hospitals across Michigan and multiple CQI’s had helped collect and share data on thousands of patients hospitalized with COVID-19. The goals of the Mi-COVID19 registry are:
- Identify factors associated with critical illness/severe course and outcomes;
- Identify patient characteristics, care practices, and treatment regimens associated with improved outcomes;
- Understand the long-term complications for hospitalized patients including subsequent rates of readmission, mortality, and return-to-normal activities;
- Evaluate variability of care processes across Mi-COVID19 hospitals and identify processes associated with improved outcomes;
- Utilizing established CQI models, facilitate improvement in care across Michigan hospitals.
At the close of 2020, the data registry included over 3,500 patients with COVID-19. As a result of being one of the largest COVID-19 data sets containing detailed clinical data, several key findings were identified and published in peer-reviewed literature or shared via webinar. These include:
- 60-day outcomes of patients with COVID-19- Patients with COVID-19 who survived hospitalization had significant ongoing morbidity, including the inability to return to normal activities, physical and emotional symptoms, and financial loss;
- Empiric antibiotic therapy and community-onset bacterial co-infection in patients hospitalized with COVID-19 - Despite the low prevalence of community-onset bacterial co-infections, patients hospitalized with COVID-19 often received early empiric antibiotic therapy;
- Impact of early use of steroids in preventing clinical deterioration;
- Mental health in discharged patients during the COVID-19 pandemic;
- Racial and ethnic variation in COVID-19 care, treatment, and outcomes (in hospital and 60 days);
- Venous thromboembolism prophylaxis and treatment in patients hospitalized with COVID-19;
- Variation in COVID-19 characteristics, treatment, and outcomes in Michigan;
- COVID-19 outcome prediction model/severity score for risk-adjustment;
- Accessing healthcare following COVID-19 diagnosis;
- Epidemiology/variation of ICU treatments and outcomes;
- Characterization of new opioid prescriptions during and after COVID-19 admission.
In addition to understanding care practices for patients with COVID-19, the Mi-COVID19 initiative has been facilitating collaboration across Michigan hospitals to share best practices and improve care for hospitalized patients with COVID-19. To date, the Mi-COVID19 initiative has conducted 12+ webinars focused on clinical topics including best practices and protocols for critically ill patients with COVID-19, COVID-19 therapeutic, vaccine strategies, managing COVID-19 at critical access and rural hospitals, use of monoclonal antibodies, and provider wellness. As a result of this novel initiative and partnership across hospitals and payers, the care for patients with COVID-19 across Michigan has dramatically improved.