Michigan Anticoagulation Quality Improvement Initiative (MAQI2)

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Michigan Anticoagulation Quality Improvement Initiative (MAQI2) is a multi-center, collaborative quality initiative sponsored by Blue Cross Blue Shield of Michigan. Data is collected on patients taking oral anticoagulants from several participating Michigan health systems and entered into a data registry managed by the MAQI2 Coordinating Center located within MCORRP. Data collected include patient demographics, medications, co-morbidities, time in therapeutic range (TTR), and frequency of adverse events. Information on each site’s protocols and processes are also collected in an effort to link outcomes with variations in clinic operations and practice. Data from over 23,000 patients has been entered into the registry along with over 700,000 follow-ups.

Opportunities for improvement have been identified, best practices have been shared, and quality improvement interventions have been completed or are underway. Current initiatives include reducing unnecessary lab testing, inappropriate aspirin use, and off-label dosing. Improving patient knowledge of anticoagulation is an ongoing initiative. In 2021, MAQI2 developed an EMR based dashboard which screens an entire health system for patients on inappropriate doses of anticoagulants. The dashboard is currently implemented at 4 participating hospitals. The aim of all quality improvement initiatives is to increase anticoagulation effectiveness and safety.

Efforts to improve patient care and safety have been recognized nationally. The American Society of Hematology has identified our efforts to reduce inappropriate aspirin as a "Choosing Wisely Champion" and the American Heart Association identified a MAQI2 paper as one of the most impactful papers related to heard disease and stroke from 2021. MAQI2 is working with the Anticoagulation Forum to implement interventions to reduce inappropriate aspirin across several other hospitals across the country.

In addition, the MAQI2 collaborative has developed the MAQI2 Anticoagulation Toolkit, which includes a downloadable collection of guidelines, protocols, and a mobile app to help providers manage anticoagulation patients more safely and effectively. The toolkit also includes patient education resources in multiple languages for patients to learn more about how to take anticoagulants safely. Information for the toolkit and mobile app can be found at: www.anticoagulationtoolkit.org. Thousands of providers and patients across the country are using the toolkit to improve anticoagulation safety and effectiveness.

MAQI2 Coordinating Center

• MAQI2 Twitter
• University of Michigan Frankel Cardiovascular Center
• Michigan Anticoagulation Quality Improvement Initiative
• University of Michigan Anticoagulation Clinic
• Anticoagulation Toolkit