{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T03:56:25Z","timestamp":1787889385097,"version":"build-2784847793"},"reference-count":25,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2021,3,29]],"date-time":"2021-03-29T00:00:00Z","timestamp":1616976000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Blue Cross\/Blue Shield of Michigan and Blue Care Network","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}]},{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"crossref","award":["1-R18-HS-025891-01"],"award-info":[{"award-number":["1-R18-HS-025891-01"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Qual Saf"],"accepted":{"date-parts":[[2021,3,13]]},"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) provides evidence-based criteria for peripherally inserted central catheter (PICC) use. Whether implementing MAGIC improves PICC appropriateness and reduces complications is unknown.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A quasiexperimental study design to implement MAGIC in 52 Michigan hospitals was used. Data were collected from medical records by trained abstractors. Hospital performance on three appropriateness criteria was measured: short-term PICC use (\u22645\u2009days), use of multilumen PICCs and PICC placement in patients with chronic kidney disease. PICC appropriateness and device complications preintervention (January 2013 to December 2016) versus postintervention (January 2017 to January 2020) were compared. Change-point analysis was used to evaluate the effect of the intervention on device appropriateness. Logistic regression and Poisson models were fit to assess the association between appropriateness and complications (composite of catheter occlusion, venous thromboembolism (VTE) and central line-associated bloodstream infection (CLABSI)).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 38 592 PICCs, median catheter dwell ranged from 8 to 56 days. During the preintervention period, the mean frequency of appropriate PICC use was 31.9% and the mean frequency of complications was 14.7%. Following the intervention, PICC appropriateness increased to 49.0% (absolute difference 17.1%, p&lt;0.001) while complications decreased to 10.7% (absolute difference 4.0%, p=0.001). Compared with patients with inappropriate PICC placement, appropriate PICC use was associated with a significantly lower odds of complications (OR 0.29, 95%\u2009CI 0.25 to 0.34), including decreases in occlusion (OR 0.25, 95%\u2009CI 0.21 to 0.29), CLABSI (OR 0.61, 95%\u2009CI 0.46 to 0.81) and VTE (OR 0.40, 95%\u2009CI 0.33 to 0.47, all p&lt;0.01). Patients with appropriate PICC placement had lower rate of complications than those with inappropriate PICC use (incidence rate ratio 0.987, 95%\u2009CI 0.98 to 0.99, p&lt;0.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Implementation of MAGIC in Michigan hospitals was associated with improved PICC appropriateness and fewer complications. These findings have important quality, safety and policy implications for hospitals, patients and payors.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjqs-2021-013015","type":"journal-article","created":{"date-parts":[[2021,3,29]],"date-time":"2021-03-29T13:29:33Z","timestamp":1617024573000},"page":"23-30","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":38,"title":["Improving peripherally inserted central catheter appropriateness and reducing device-related complications: a quasiexperimental study in 52 Michigan hospitals"],"prefix":"10.1136","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8670-9376","authenticated-orcid":false,"given":"Vineet","family":"Chopra","sequence":"first","affiliation":[{"name":"Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA"},{"name":"Medicine Service, Lieutenant Colonel Charles S. Kettles Department of Veterans Affairs Medical Center, Ann Arbor, Michigan, USA"},{"name":"Hospital Medicine Safety Consortium, University of Michigan Health System, Ann Arbor, MI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"O'Malley","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA"},{"name":"Hospital Medicine Safety Consortium, University of Michigan Health System, Ann Arbor, MI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Horowitz","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA"},{"name":"Hospital Medicine Safety Consortium, University of Michigan Health System, Ann Arbor, MI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qisu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA"},{"name":"Hospital Medicine Safety Consortium, University of Michigan Health System, Ann Arbor, MI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"McLaughlin","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA"},{"name":"Hospital Medicine Safety Consortium, University of Michigan Health System, Ann Arbor, MI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay","family":"Saint","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA"},{"name":"Medicine Service, Lieutenant Colonel Charles S. Kettles Department of Veterans Affairs Medical Center, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven J","family":"Bernstein","sequence":"additional","affiliation":[{"name":"Hospital Medicine Safety Consortium, University of Michigan Health System, Ann Arbor, MI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Flanders","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA"},{"name":"Hospital Medicine Safety Consortium, University of Michigan Health System, Ann Arbor, MI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,3,29]]},"reference":[{"key":"2025090410333003000_31.1.23.1","doi-asserted-by":"publisher","DOI":"10.1086\/502163"},{"key":"2025090410333003000_31.1.23.2","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1097\/NAN.0b013e31823bc8fd","article-title":"Developing an alternative workflow model for peripherally inserted central catheter placement","volume":"35","author":"Meyer","year":"2012","journal-title":"J Infus Nurs"},{"key":"2025090410333003000_31.1.23.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60592-9"},{"key":"2025090410333003000_31.1.23.4","doi-asserted-by":"publisher","DOI":"10.1086\/657942"},{"key":"2025090410333003000_31.1.23.5","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.12704"},{"key":"2025090410333003000_31.1.23.6","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1016\/j.amjmed.2015.03.028","article-title":"The association between PICC use and venous thromboembolism in upper and lower extremities","volume":"128","author":"Greene","year":"2015","journal-title":"Am J Med"},{"key":"2025090410333003000_31.1.23.7","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1001\/jamainternmed.2015.8402","article-title":"Variations in peripherally inserted central catheter use and outcomes in Michigan hospitals","volume":"176","author":"Chopra","year":"2016","journal-title":"JAMA Intern Med"},{"key":"2025090410333003000_31.1.23.8","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1016\/j.jvir.2017.02.005","article-title":"Patterns and predictors of peripherally inserted central catheter occlusion: the 3P-O study","volume":"28","author":"Smith","year":"2017","journal-title":"J Vasc Interv Radiol"},{"key":"2025090410333003000_31.1.23.9","doi-asserted-by":"publisher","DOI":"10.7326\/M15-0744"},{"key":"2025090410333003000_31.1.23.10","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2017-007342"},{"key":"2025090410333003000_31.1.23.11","unstructured":"Michigan Hospital Medicine Safety Consortium . Peripherally inserted central catheter initiative, 2020. Available: https:\/\/mi-hms.org\/quality-initiatives\/peripherally-inserted-central-catheter-picc-use-initiative"},{"key":"2025090410333003000_31.1.23.12","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.1111\/jth.13794","article-title":"The Michigan risk score to predict peripherally inserted central catheter-associated thrombosis","volume":"15","author":"Chopra","year":"2017","journal-title":"J Thromb Haemost"},{"key":"2025090410333003000_31.1.23.13","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2017.167"},{"key":"2025090410333003000_31.1.23.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2019.112513"},{"key":"2025090410333003000_31.1.23.15","unstructured":"Peripherally inserted central catheter (PICC) quality improvement toolkit, 2021. Michigan Hospital medicine safety Consortium. Available: https:\/\/www.improvepicc.com\/implementation.html [Accessed 25 Feb 2021]."},{"key":"2025090410333003000_31.1.23.16","unstructured":"Bloodstream infection event (central line-associated BloodstreamInfection and non-central line-associated bloodstream infection). CDC bloodstream infection\/device associated infection module, 2020. Available: https:\/\/www.cdc.gov\/nhsn\/pdfs\/pscmanual\/4psc_clabscurrent.pdf"},{"key":"2025090410333003000_31.1.23.17","unstructured":"Taylor WA . Change-Point analysis: a powerful new tool for detecting changes, 2010. Available: https:\/\/variation.com\/wp-content\/uploads\/change-point-analyzer\/change-point-analysis-a-powerful-new-tool-for-detecting-changes.pdf"},{"key":"2025090410333003000_31.1.23.18","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)14077-9"},{"key":"2025090410333003000_31.1.23.19","unstructured":"American College of Radiology ACR Appropriateness Criteria\u00ae . Radiologic management of central venous access, 2020. Available: https:\/\/acsearch.acr.org\/docs\/3094281\/Narrative\/"},{"key":"2025090410333003000_31.1.23.20","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2019-010463"},{"key":"2025090410333003000_31.1.23.21","article-title":"Effects of the magic guidelines on PICC placement volume: advanced practice provider and physician trends amongst Medicare beneficiaries from 2010-2018","author":"Lindquester","year":"2020","journal-title":"AJR Am J Roentgenol"},{"key":"2025090410333003000_31.1.23.22","unstructured":"Rogers M , Flanders S , McLaughlin E . Applying magic to improve PICC appropriateness in 42 Michigan hospitals. Abstract published at hospital medicine 2019, March 24-27, National harbor, MD. Abstract 10. 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