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Study objective: Large-scale quality and performance measurement across unaffiliated hospitals is an important strategy to drive practice change. The Michigan Emergency Department Improvement Collaborative (MEDIC), established in 2015, has baseline performance data to identify practice variation across 15 diverse emergency departments (EDs) on key emergency care quality indicators.Methods: MEDIC is a unique physician-led partnership supported by a major third-party payer. Member sites contribute electronic health record data and trained abstractors add supplementary data for eligible cases. Quality measures include computed tomography (CT) appropriateness for minor head injury, using the Canadian CT Head Rule for adults and Pediatric Emergency Care Applied Network rules for children; chest radiograph use for children with asthma, bronchiolitis, and croup; and diagnostic yield of CTs for suspected pulmonary embolism. Baseline performance was established with statistical process control charts.

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appropriate care, such as not prescribing antibiotics in uncomplicated sinusitis. We determined the rates of following the CW guidelines for sinusitis among DTC telemedicine, Urgent Care (UC), and the emergency department (ED).Methods: Within our DTC telemedicine health records, we searched for chief complaints for the terms cough, sinusitis, upper respiratory infection, cold, sore throat, and congestion (Sept 2015 thru Feb 2016) (82 cases). We matched on date and chief complaints 82 cases from our UC and EM services (246 cases total). Two trained abstractors then used a standardized form to determine adherence to the CW recommendations.Results: Patients were 35 +/-17 years old, 57% female. Overall, the rates of antibiotic prescription were 59% for DTC telemedicine, 76% urgent care, and 65% in the ED (p<0.05). Rates of following CW guidelines for sinusitis were 73% in DTC telemedicine, 62% in urgent care, and 69% in the ED (p¼0.41).Conclusions: DTC telemedicine had the lowest rate of antibiotic prescriptions and the highest rate of Choosing Wisely guideline adherence for sinusitis.