MARCQI Background

The MARCQI consortium consists of a Coordinating Center which is housed at the University of Michigan; the Data Management Center located at St Joseph Mercy Hospital in Ann Arbor and a current network of over 51 participating hospitals and ambulatory surgical centers in Michigan. MARCQI is led by Richard Hughes, PhD and Brian Hallstrom, MD from the Department of Orthopaedic Surgery at the University of Michigan. Dr. Hughes is an Associate Professor of Orthopaedic Surgery, Biomedical Engineering and Industrial and Operations Engineering at the University of Michigan. Dr. Hallstrom is a Clinical Assistant Professor who specializes in adult reconstructive surgery of the hip and knee.

Founded in 2011, MARCQI is one of the Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN) Collaborative Quality Initiatives (CQI’s). MARCQI is supported by Blue Cross and Blue Shield of Michigan as part of the BCBSM Value Partnerships program.

Rationale for MARCQI

As the need for arthroplasty increases, so does the cost. Projections of national total direct cost for primary and revision Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) exceed $23 and $50 billion, respectively, by 2015. In Michigan, 22,272 total hip and 29,158 total knee replacements were performed in 2012. Nationally, 719,000 TKA and 332,000 THA were done in 2010. In 2015, The American Academy of Orthopaedic Surgeons estimated that THA will increase by 174% and TKA by 673% by 2030.

Modern prosthetic system designs generally perform well over many years. The first surgery is termed the primary surgery. Reoperation to replace a total joint arthroplasty is termed revision. Revision is costly and has a higher rate of complication and failure than primary joint replacement. An unacceptably high percentage of primary joint replacements must be revised within 10 years. The percentage of total hip replacements in the US that were revisions averaged 15% in 2013; the percentage of repeated total knee replacements was approximately 4-8%.

Complications are also too frequent. Infection risk averages 0.5 % for hip and knee replacement, with major health and economic consequences. This variation in infection risk from hospital to hospital offers significant opportunity for determination of best practices and improvements over an entire group of hospitals.

The incidence of complications and revisions combined with the high cost of providing care for these problems makes total joint replacement an obvious opportunity to improve health care value by improving quality.