1. Next Steps for COAP and the Bree Collaborative: Phase of Care Mortality Analysis (POCMA) November 30 th, 2012 Chris Bryson, MD, MS – COAP Medical Director Kristin Sitcov – COAP Program Director

2.  Developed by the Michigan Society of Thoracic & Cardiovascular Surgery Quality Collaborative (MSTCVS - 33 cardiac surgery programs) – Frank Shannon, MD & colleagues.  Surgeons & team members were shown how to identify the seminal event (death trigger) that initiated deterioration resulting in death.  The surgeon & team complete a POCMA form for every mortality.  Each death is reviewed by the “Mortality Outcomes Review Group” (MORG), consisting of 16 cardiac surgeons from around the state with specific interest in quality improvement.  POCMA data is linked with STS data to facilitate ad hoc analysis to correlate risk factors & clinical variables with the POCMA assessment.  A death is judged avoidable if >50% likelihood that optimal care or absence of the clinical event would have resulted in survival.  Implementation has resulted in 50% reduction in overall mortality (from 2% to 1%).  Provides a structured platform for discussion, education, quality improvement and improved outcomes COAP Quality Improvement Efforts: Phase of Care Mortality Analysis (POCMA)

3. ARMUS Shannon, FL, et al. Ann Thorac Surg. 2011.07.057 COAP Quality Improvement Efforts: Phase of Care Mortality Analysis (POCMA)

4. ARMUS Shannon, FL, et al. Ann Thorac Surg. 2011.07.057 COAP Quality Improvement Efforts: Phase of Care Mortality Analysis (POCMA)

5. ARMUS Washington State POCMA Efforts:  May 2011 COAP Statewide Meeting – Frank Shannon, MD, William Beaumont Hospital, Troy, Michigan Overview of the Michigan experience with POCMA  May 2012 COAP Statewide Meeting – Pat Ryan, MD, Providence Regional Medical Center, Everett Eric Lehr, MD, Swedish Medical Center, Seattle Reviewed experiences with “internal” POCMA efforts Proposed collaborative approach in WA State  August 2012 COAP Management Committee – Approved secure online collaborative tool developed by Armus  November 2012 – Online tool ready for testing  January 2013 – Anticipate online tool will be ready for collaborative use by WA hospitals

6. ARMUS How the Bree Collaborative can support this effort:  Recognition of participation?  Promote incentives for participation?  Requirement based on mortality outcomes?  Other thoughts??