Project Summary

This FCVC Innovation Challenge winning project is focused on improving the value of hypertension (HTN) referrals to the cardiology department by implementing a pre-appointment remote patient monitoring program. By bringing together partners from Cardiology, Patient Monitoring at Home (PMAH), and MPrOVE, we teamed up to solve the problem of long-wait times for patients to see a clinician to address their hypertension, as well as the lack of comprehensive, detailed data, for clinicians to make informed decisions on, to address hypertension concerns at the time of the appointment.

All eligible hypertension referrals undergo a 30-day monitoring period by PMAH, where patients are instructed to take their blood pressure at least once a day by a Bluetooth connected BP cuff (provided by PMAH), where the data is transmitted directly to the EHR. Nurses and APPs in the PMAH team directly monitor patient’s BP and have weekly virtual visits with patients to address concerns and make medication adjustments. After the initial 30-day period, patients are reassessed if their BP is controlled (<140/90), and if so, they are discharged from the program. If they are not controlled, they move on to the Cardiology Hypertension Clinic to undergo more rigorous evaluation and treatment.

Benefits of this program include:

• • Faster access to healthcare providers for addressing HTN concerns

  • More timely adjustments to hypertension treatments

  • Optimized cardiology referrals, ensuring patients receive appropriate care

  • Conversion of this service into a billable activity, which was not possible before

Team Members & Collaborative Partners

• Matthew Konerman, MD, MS, Cardiology

• Monika Leja, MD, Cardiology

• Jeff Kullgren, MD, MPH, MPrOVE Faculty & Internal Medicine

• Paul Schenk, MSN, RN, Cardiology 

• Val Mefford, MPH, MPrOVE

• Ibrahim Khan, MD Candidate

• Alexandra Geiger, MHSA, FCVC

Project Visual and Timeline

Project Summary

Restful sleep is a necessary yet often neglected part of medical care for hospitalized patients. Anecdotally, clinicians and patients report poor inpatient sleep conditions and outcomes, both nationally, and here at Michigan Medicine. There is a strong desire from Michigan Medicine health system leaders & clinicians to improve the inpatient sleeping experience. MPrOVE partnered with a team of clinicians to determine the drivers of poor patient sleep and develop an intervention to address those barriers.

Specifically, our team is working on: 

• Creating and piloting a patient-facing survey to rate patient sleep experience while in the hospital and identify interruptions to sleep

• Interviewing key staff (providers, nursing, etc.) to understand medical interventions and the impact on sleep

• Analyzing EHR data to quantify interruptions to sleep that patients typically experience

These learnings will culminate into an intervention that can be deployed in one pilot unit that will focus on prioritizing rest for the patient while maintaining patient safety.

Team Members & Collaborative Partners

• Geoff Barnes, MD, MPrOVE Co-Director & Cardiology 

• Stephanie Taylor, MD, Internal Medicine

• Jessica Wummel, MD, Internal Medicine

• Ruby Marr, MD, Internal Medicine

• Tony Cuttitta, MPH, MPrOVE

• Val Mefford, MPH, MPrOVE

• Kristen Hassett, MPH, MPrOVE

Project Visual and Timeline

Project Summary

The LVPT project seeks to reduce unnecessary preoperative testing for low-risk surgeries, aligning with long-standing recommendations from academic societies and clinical guidelines. Routine pre-op testing for these procedures contributes to wasteful spending, patient stress, and surgical delays without improving outcomes.

From 2022 to 2023, MPrOVE piloted a multi-component intervention within Michigan Medicine’s Minimally Invasive Surgery and Surgical Oncology divisions. This initiative combined evidence-based educational efforts and IT changes with strategic collaboration among key stakeholders—including the pre-op clinic, anesthesia, and surgical leadership—to improve adherence to clinical guidelines. The pilot yielded promising results, reducing unnecessary testing rates from 37% to 14% and increasing appropriateness of testing between both divisions.

Building upon the pilot’s success, MPrOVE launched an expansion in 2024, tailoring the intervention for additional surgical divisions within Michigan Medicine, starting with OB/GYN. By partnering with a surgeon champion, the team identified low-risk gynecologic procedures and refined intervention strategies. Moving forward, MPrOVE plans to implement the intervention within OB/GYN and continue exploring opportunities to expand across other surgical divisions, further advancing quality improvement efforts and reducing low-value care in the surgical sphere.

Team Members & Collaborative Partners

• Lesly Dossett, MD, MPH, MPrOVE Co-Director & Surgery

• Samira Rochotte, MPH, PMP, MPrOVE

• Val Mefford, MPH, MPrOVE

• Tony Cuttitta, MPH, MPrOVE

• Wendy Benedict, MPrOVE

• Nick Box, MPA, MPrOVE

• Erin Kim, MD Candidate

• Nabeel Obeid, MD, Surgery

• Bernard Jiang, MD, Anesthesiology

• Daniel Morgan, MD, OB/GYN & Urology

• Jillian Etcubanez, PA-C, Pre-Operative Clinic

• Shawna Lorch, MSA, CHES, Pre-Operative Clinic

Project Visual and Timeline

Project Summary

Patients who present to the emergency department (ED) with a pulmonary embolism (PE) can be safely discharged home if they are relatively low risk for other complications, yet most are still admitted despite the low value of admission. MPrOVE worked with ED leadership to provide a safe discharge pathway for patients and providers. This project aimed to increase the rate of low-risk discharges, expand the availability of hospital beds in the ED, and improve the patient experience.

There have been numerous studies, trials, meta-analyses, and guidelines demonstrating the safe outpatient management of low-risk PE. Per this literature, 20-50% of acute PE patients are candidates for discharge. However, only about 2% of Michigan Medicine PE patients are discharged from the ED. An internal case review and risk assessment of all PE patients in the ED revealed that at least 21% of these patients are very good candidates for discharge to home.

MPrOVE, in collaboration with ED clinical leaders and Health Information Technology & Services (HITS) staff, developed and implemented a safe discharge pathway specifically for low-risk patients with PE that includes:

• An automatic risk score calculation in the electronic health record (EHR) to calculate a patient's risk

• An EHR pop-up to alert providers of low-risk patients

• Comprehensive order set for discharging low-risk patients home including medication, patient instructions, and follow-up appointment

• Rapid access clinic appointment within 10 days of the ED visit (virtual appointments available to increase access)

• Medication voucher that provides coverage for up to 1 month of anticoagulant prescription costs

• Customized patient instructions with information about what to expect after PE diagnosis and when to return to the ED, if necessary

Team Members & Collaborative Partners

• Geoff Barnes, MD, MSc, MPrOVE Co-Director & Cardiology

• Colin Greineder, MD, PhD, Emergency Medicine

• Elizabeth Joyce, MD, Internal Medicine

• Tony Cuttitta, MPH, MPrOVE

• Val Mefford, MPH, MPrOVE

• Roger Lupton, HITS

• Stephanie Brooks, HITS

Project Visual and Timeline

Anticipated Outcomes

This low-risk PE discharge model:

• Increased the rate of low-risk PE discharges from 5% to more than 80%

• Reduced low-value admissions, expanding access to hospital beds

• Led to grant funding to spread the pathway across other Michigan EDs

Documents & Resources

• Low Risk PE Discharge website

• Qualitative Experience Implementing an Emergency Department-Based Outpatient Low-Risk Pulmonary Embolism Management Pathway

Project Summary

The MEDIC ALERT PE project is a stepped wedge cluster randomized implementation trial led through the Michigan Emergency Department Improvement Collaborative (MEDIC). It seeks to reduce unnecessary hospital admissions for patients with low-risk acute pulmonary embolism (PE) by implementing a multicomponent, theory-driven care pathway across diverse emergency departments. The project leverages strategies from behavioral economics—including clinician pre-commitment and point-of-care nudges—to shift heuristic-based decision-making and promote outpatient management where clinically appropriate. Ultimately, the project aims to improve patient outcomes, healthcare resource use, and system-wide quality of care. Project execution involves:

• Conducting implementation mapping at each site to identify barriers and tailor strategies

• Supporting site champions with coaching, tools, and feedback loops

• Monitoring data via the MEDIC ALERT PE dashboard and monthly updates from the Michigan Value Collaborative (MVC)

• Using structured communication channels for issue escalation and resolution

• Evaluating outcomes using mixed-methods and stakeholder-informed measures

Team Members & Collaborative Partners

• Principal Investigators: National experts in emergency care, implementation science, and PE care delivery

• Implementation Team: Site champions and clinical improvement leaders across 10 diverse hospital EDs

• Quantitative Analysts: Supporting real-time data monitoring from MEDIC and MVC sources

• MEDIC and MVC: Statewide collaborative infrastructure providing data, coordination, and local insight

• Stakeholders: Emergency physicians, patients, and quality improvement personnel

Project Visual and Timeline

• Year 1: Site onboarding, stakeholder interviews, tailoring of implementation strategies

• Year 2–3: Sequential site implementation with concurrent data collection

• Ongoing: Dashboard monitoring, fidelity checks, and site coaching

Project Summary

For heart failure patients with reduced ejection fraction (HFrEF), guideline-directed medical therapy (GDMT), a combination of four medications, significantly reduces readmissions and improves quality of life and survival. Among these, mineralocorticoid receptor antagonists (MRAs) stand out by reducing hospitalization or death rates by 37% within 30 days of admission. However, at Michigan Medicine, only ~25% of eligible HFrEF patients are prescribed MRAs, highlighting a critical gap in evidence-based care.

To address this, Dr. Cascino partnered with MPrOVE to enhance MRA utilization. Our collaborative efforts began in late 2023, leading to the launch of the stage 1 intervention in July 2024. This involved collaboration with Health Information Technology & Services (HITS), cardiologists, pharmacists, and residents to introduce a new MiChart-based OPA, encouraging prescribers to consider MRAs when clinically appropriate. We also created and distributed resident education to increase awareness of appropriate MRA utilization. 

Building on this foundation, we partnered with the Michigan Medicine Capacity Operations and Real‐time Engagement Center (M2C2) to implement stage 2 of the intervention. In April 2025, we launched a dedicated MRA node within M2C2’s heart failure pathway, the first of its kind--a node addressing GDMT. Early results are promising with a notable increase in appropriate MRA utilization.

Team Members & Collaborative Partners

• Tom Cascino, MD, MSc, MPrOVE Fellow & Cardiology

• Adam Stein, MD, Cardiology

• Sarah Adie, PharmD, Cardiology & Pharmacy

• Geoff Barnes, MD, MSc, MPrOVE Co-Director & Cardiology

• Zahera Farhan, MPH, MPrOVE

• Val Mefford, MPH, MPrOVE

• Niki Farquhar, MSE, M2C2 

• Chris Zimmerman, HITS

Project Visual and Timeline