The SVS Vascular Quality Initiative and The Florida Vascular Study Group

1. The SVS Vascular Quality Initiative andThe Florida Vascular Study Group

2. Disclosures *No financial interests to disclose It is difficult to improve quality if we do not define what quality is. In order to do that, we must measure our outcomes, benchmark them, and compare our results to other surgeons. And we must minimize the variation in the way we do things. It is difficult to improve quality if we do not define what quality is. In order to do that, we must measure our outcomes, benchmark them, and compare our results to other surgeons. And we must minimize the variation in the way we do things.

3. Background Difficult to improve quality if we do not define “quality.” In order to do this we must: Measure our outcomes Benchmark our outcomes and compare to others Minimize variation in the way we do things. It is difficult to improve quality if we do not define what quality is. In order to do that, we must measure our outcomes, benchmark them, and compare our results to other surgeons. And we must minimize the variation in the way we do things. It is difficult to improve quality if we do not define what quality is. In order to do that, we must measure our outcomes, benchmark them, and compare our results to other surgeons. And we must minimize the variation in the way we do things.

4. Quality Improvement in Practice Most practitioners do not track outcomes. Benchmarks with others not available. Unfortunately, most practitioners do not track their outcomes, and therefore benchmarks with others are not available. Unfortunately, most practitioners do not track their outcomes, and therefore benchmarks with others are not available.

5. Quality Improvement in Practice Most practitioners don’t track outcomes. Benchmarks with others not available. Difficult for individual practitioner to recognize variation or improve quality. Small number of adverse events prevents recognition of patterns that could be improved. Isolated nature of practice prevents practitioners from learning from each other. It is inherently difficult for an individual practitioner to recognize variation in care or to improve quality performed to the small numbers of adverse events preventing recognition of patterns and the isolated nature of practice which prevents practitioners from learning from one another.It is inherently difficult for an individual practitioner to recognize variation in care or to improve quality performed to the small numbers of adverse events preventing recognition of patterns and the isolated nature of practice which prevents practitioners from learning from one another.

6. Quality Improvement in Practice Most practitioners don’t track outcomes. Benchmarks with others not available. Difficult for individual practitioner to recognize variation or improve quality. Small number of adverse events prevents recognition of patterns that could be improved. Isolated nature of practice prevents practitioners from learning from each other. Potential value of shared data registry. Thus there is a lot of potential value in a shared registry.Thus there is a lot of potential value in a shared registry.

7. How Can Physicians Improve Quality? By assuming responsibility for all structure and process variables that affect outcome By aggregating data across surgeons and centers to reveal variation in process and outcome that can be analyzed to select best practice By acting on data to reduce variation

8. Regional Vascular Quality Groups Regional groups forming in Florida, Michigan, Georgia and Ontario, CanadaRegional groups forming in Florida, Michigan, Georgia and Ontario, Canada

9. Vision: Regional groups for local control, data ownership and responsibility National network of regional quality improvement groups to collect common data elements and pool information to improve patient care

10. Patient Safety Organizations(PSO) The Patient Safety Act of 2009 established a framework by which hospitals and providers may voluntarily report information to Patient Safety Organizations (PSOs), on a privileged and confidential basis, for the aggregation and analysis of patient safety events Protects comparative data from discovery Eliminates need for informed patient consent and IRB approval Allows patient identifiers to be included Only de-identified data can be released Benchmarking, risk adjustment and merging with other identified data sets done within the PSO QI research requires approval of PSO committee; analytic data sets are de-identified

11. SVS PSO Approved by AHRQ in February 2011 Assists in the creation of regional study groups Analyzes data to initiate innovative quality improvement efforts on a regional and national level Regional representatives to the PSO regulate data sharing and use Data cannot be used for comparative marketing Partners with M2S, Inc. to provide a secure, web-based data collection and analysis system Initiated by the very successful Vascular Study Group of New England (VSGNE)

12. Society for Vascular Surgery Patient Safety Organization (PSO) The mission of the Society for Vascular Surgery® Patient Safety Organization (SVS PSO) is to improve patient safety and the quality of health care delivery by providing web-based collection, aggregation, and analysis of clinical data submitted in registry format. The SVS PSO strives for its outcome analysis to be an integral component of each participating health care provider’s quality improvement efforts, including the implementation of recommendations, protocols and best practices developed by the SVS PSO.

13. SVS PSO Data Collection and Analysis Pre-operative risk factors, post-operative outcomes, and one-year follow-up data collected Participants must agree to enter 100% of procedures (audited against claims data) Aggregated data used to recognize patterns of outcome events and their associated causes Anonymous, risk-adjusted reports for comparison and assessment of key outcomes compared to other physicians and centers. Each center owns their data and can decide with whom to benchmark

14. Benefits of Benchmarking Identify factors/processes of care that reduce complications ? reduced costs Inform internal quality and M&M meetings Demonstration of institution’s commitment to improving patient care Assess quality of care through comparison with similar institutions Detection of specific areas for quality improvement Regional study group example follows

15. Regional Group Examples Vascular Study Group of New England (VSGNE) established 2002 Today there are 24 centers participating – both academic and community hospitals The group has published over 15 peer-reviewed articles and given more than 20 presentations at national and regional meetings Look at slide 27 and 30 Look at slide 27 and 30

16. VSGNE ..

17. Focus on Quality Improvement Track key procedures CEA, CAS, TEVAR, EVAR, Open AAA, infra- and supra-inguinal bypass and peripheral vascular intervention Key procedures provide overall insight Recording all procedures is unrealistic Semi-annual Meetings Critical to success, durability of group Stimulate cooperative quality projects Overcome insular nature of practice with granular conversations about quality

18. >14,000 Operations Reported

20. Beta Blocker Usage Results

21. Beta Blocker Usage Increases

24. Length of Stay for Open AAA – by region

25. Length of Stay for Lower Extremity Bypass – By region

26. Length of Stay for Open AAA – By Medical Center 26

27. Length of Stay for Lower Extremity Bypass – By Medical Center 27

28. Established 2005 10 Medical Centers Carolinas Group

30. Risk Factor Modification Project

32. So Dr. Beck’s vision was to start the vascular study group here at the University of FL, participating with the VSGNE and benchmarking our data against theirs. So Dr. Beck’s vision was to start the vascular study group here at the University of FL, participating with the VSGNE and benchmarking our data against theirs.

34. Additional Benefits of Participation Maintenance of Certification with ABS Participation in regional benchmarking meets part 4 requirement to evaluate performance Collection of all required data for Carotid Artery Stent Facility Recertification through the Centers for Medicare and Medicaid Services (CMS) Physician Quality Reporting System (PQRS) Possible 1% reimbursement to participating MDs for all CMS payments

35. SVS PSO’s partnership with M2S M2S’s secure, web-based data collection and analysis system, Clinical Data Pathways, provides real-time benchmarked reports for major outcomes and complication per surgeon and center permits centers to continuously assess themselves compared to a blinded group of peers on key performance measures Built-in error checking and incomplete record monitoring for optimal data quality Ad-hoc reports to review trends within data and determine future research initiatives Facilitates detection of specific areas for quality improvement and identification of best practices Platform for regional and national benchmarking

36. Clinical Data Pathways Vascular Module Eight procedures and associated follow-up forms Open AAA Repair, Endovascular AAA Repair, TEVAR, Carotid Artery Stent, Carotid Endarterectomy, Infra-Inguinal Bypass, Supra-Inguinal Bypass and Peripheral Vascular Intervention Reports include: data management reports, query capabilities, longitudinal benchmarking, major outcomes and complication reports for surgeon and center and pre- and post-operative medication usage Ability to integrate with your EMR/clinical system Export data into a spreadsheet Customized forms and reports available Flexible platform can be adapted to fit unique workflows Also, now provides tools to collect all required data for Carotid Artery Stent Facility Recertification through the Centers for Medicare and Medicaid Services (CMS) PQRI participation for up to a 2% reimbursement Forms to come in early 2011 include TEVAR, dialysis access and AmputationAlso, now provides tools to collect all required data for Carotid Artery Stent Facility Recertification through the Centers for Medicare and Medicaid Services (CMS) PQRI participation for up to a 2% reimbursement Forms to come in early 2011 include TEVAR, dialysis access and Amputation

37. Workflow Integration Pathways allows multiple users to enter data Multiple successful approaches for data entry into the Pathways system RNs, NPs, PAs, surgeons or a combination Pathways does not require an FTE for data entry Data entry commitment estimates: High volume institution (750 cases entered/year) 10-15 hours per week Medium volume institution (250 cases entered/year) 5 hours per week Small volume institution (110 cases entered/year) 1-2 hours per week

38. General Information– Office Staff

39. Demographics/History– Midlevel Provider

40. Procedural Data– Surgeon

41. Procedural Data – Surgeon

42. Post-operative Data– Nurse or Midlevel Provider

43. Available Reports

44. Pricing Annual subscription fee, based on surgical volume (table below) Annual SVS PSO fee Maximum of $4,000 One-time setup fee: $5,000 Additional services EMR/clinical systemintegration Data import Customization

45. Summary SVS PSO, through regional study groups, promotes quality improvement initiatives while maintaining local control and ownership Allows assessment hospital’s performance against others in your region and across the nation Demonstration of institution’s commitment to improving patient care Supports internal quality improvement monitoring Aids surgeons in meeting surgical board certifications

46. For additional information or for administrative references contact M2S, sales@m2s.com or (603) 298-5509

47. VSGNE Example Meeting Agenda AV access and TEVAR working groups report CLI treatment preference survey results Panel: Lower extremity bypass: Techniques that work VSG CRI cardiac risk online prediction tool Predicting respiratory failure after elective OAAA repair Carotid patch and re-stenosis update Intensive glucose management in LEB patients Outcomes of LEB after previous interventional treatment MI rates in diabetics after LEB Clinical improvement vs. graft patency in LEB Impact of increased beta blocker usage Statin use working group report New QI projects and clinical uses for registry Variation in complication rates by center and procedure

49. So Dr. Beck’s vision was to start the vascular study group here at the University of FL, participating with the VSGNE and benchmarking our data against theirs. So Dr. Beck’s vision was to start the vascular study group here at the University of FL, participating with the VSGNE and benchmarking our data against theirs.