Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) as a model for regional registries in the United States

Background: The United States has been a difficult environment in which to develop arthroplasty registries, largely because of the absence of a national health system. The purpose of this paper is to describe the development of a statewide registry-based quality improvement collaborative in Michigan. Methods: The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) was started in 2011 to improve the quality of care for total hip and knee replacement patients in Michigan. It is funded by Blue Cross and Blue Shield of Michigan/Blue Care Network as part of their Collaborative Quality Initiative (CQI) program. The CQI concept depends on capturing high-quality data (clinical status, process, and outcome), rigorously developing risk-adjustment models, and presenting risk-adjusted data to collaborative members at four face-to-face meetings a year. Results: MARCQI has grown to include 44 hospitals and 377 orthopedic surgeons. The registry contains 54,848 cases (18,421 hips and 36,427 knees). Four collaborative-wide quality improvement activities have been initiated: 1) transfusion reduction, 2) deep vein thrombosis and pulmonary emboli prevention, 3) infection prevention, and 4) readmission prevention. Conclusion: The CQI model developed by Blue Cross and Blue Shield of Michigan/Blue Care Network can be adapted to hip and knee arthroplasty, which demonstrates that private payers can play a role in the development and promotion of arthroplasty registries in the United States.