MARCQI at Ten: A Decade of Advancing Joint Replacement Care

The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) and its partners across the state are celebrating a decade of improving care and lowering risks for patients undergoing hip and knee replacement surgery. The successes stem from a distinct, data-driven collaboration that connects care providers and health systems, and is rooted in continuous quality improvement engagement and the development of high-value tools for physicians and patients. 

Co-Director Dr. Brian Hallstrom welcomes MARCQI partners to a recent collaborative-wide meeting.
Dr. Hallstrom speaking at the collaborative wide meeting. 


Throughout its first decade (2012-2022), MARCQI continually set new benchmarks and improved care through: 

  • reducing blood transfusions for hip and knee replacements by 85%,
  • lowering post-procedure opioid usage by more than 45%,
  • developing a statewide patient-reported outcomes program that allows physicians to review patient feedback and recovery progress, and adapt care accordingly.

The MARCQI team credits the collaborative approach for identifying high-value opportunities for quality improvement, such as when MARCQI data revealed significant variation (4-40%) in primary joint replacement patients being discharged to extended care facilities (ECF) across participating hospitals, despite widespread evidence showing ECF patients have higher risks of complications and readmission. After a focused effort, MARCQI reduced ECF discharges across the state by more than 60 percent.  

Additionally, MARCQI’s collaborative meetings facilitate regular opportunities for clinical champions to openly share effective strategies and best practices for patient education and implementation changes in their hospitals. 


During the height of the COVID-19 pandemic, MARCQI partnered with the Michigan Hospital Medicine Safety Consortium (HMS) and ten other Michigan CQIs to launch the Mi-COVID19 Initiative, a registry focused on improving care for patients with COVID-19.  

At the same time, MARCQI increased collaborative engagement by utilizing the infrastructure of its value-based reimbursement program. While in-person meetings paused,  MARCQI asked providers to download their individual surgeon-level reports and review them with two other surgeons, so collaborative work could continue. Another way MARCQI adapted to the needs of the pandemic was by digitizing many processes and resources, increasing ease of access to its tools. 

Infection Risk Calculator

A hallmark of MARCQI’s efforts to promote shared decision-making and patient optimization is the Infection Risk Calculator. Surgeons can use the tool with patients to help them understand post-surgical risks and learn about opportunities to improve their own outcomes by showcasing actions the patient can take such as decreasing their body mass index (BMI), stopping smoking, and avoiding narcotics. The calculator can also be used as a guide to understanding the potential for infections, which can help patients decide if surgery is the right choice. Using this tool to establish a dialogue with candidates for surgery has been vital in MARCQI’s work improving patient outcomes and satisfaction throughout Michigan.

The next ten years

Dr. Hughes at the collaborative wide meeting.

MARCQI’s team says the next ten years will be dedicated to building on its progress by  expanding its provider toolkit and ensuring that patient care in Michigan continues to improve. MARCQI is ready to build on recent successes, such as its first quality summit. Held in 2022, the well-attended event featured the most speakers ever present at a MARCQI collaborative meeting and created engagement opportunities for attendees to have robust conversations focused on current challenges and sharing practical, problem-solving success stories.

During a collaborative-wide meeting in October, MARCQI set priorities for the statewide collaboration, including utilizing the patient reported outcomes infrastructure and responses for quality improvement efforts and understanding key changes in policy as cases shift towards outpatient facilities. Building improved interactive reporting structures and systems to enable surgeons to dive into their data and outcomes will also be a main focus for MARCQI’s team as they start the CQI’s next decade.