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A Regional Registry for Quality Assurance and Improvement: The Vascular Study Group of Northern New England (VSG-NNE)

Jack L Cronenwett¹, Margaret T Russel^l1, Donald S Likosky¹, Jens Eldrup-Jorgenson², Andrew C Stanley³, Brian W Nolan¹, Robert E Hawkins.^2
1Dartmouth-Hitchcock Medical Center, Lebanon, NH; ²Maine Medical Center, Portland, ME; ³University of Vermont, Burlington, VT.

OBJECTIVES: To organize a regional cooperative data registry to report outcomes of carotid endarterectomy (CEA), lower extremity bypass (LEB) and infrarenal AAA repair (OPEN and EVAR) in order to allow benchmarking among centers, to improve processes of care and ultimately to improve patient outcomes. Initial improvement efforts focused on optimizing preoperative medication usage.

METHODS: 45 vascular surgeons from 8 hospitals in ME, NH and VT (137 - 615 beds) have prospectively recorded patient, procedure and in-hospital outcome data since 2003. Results plus 1-year follow-up data analyzed at a central site are reported anonymously to each center at semiannual meetings where processes and regional benchmarks are discussed. Mortality and compliance with procedure entry are validated by independent comparison with hospital administrative data through a centralized audit.

RESULTS: 5,097 of the above operations were entered into the registry as of June, 2006. Validation with administrative data showed that 94% of operations had been reported to VSG-NNE, and led to entry of the remaining 6%. Mortality was accurately recorded in all but 1 patient. In-hospital and 1-year outcomes are similar to single center reports but variation among centers provides opportunity for future improvement (Table: Range). Any post-op complication (Cx) increased median length of stay by >3 days. Process improvement efforts have increased preoperative beta-blockers from 72% to 88%; antiplatelet agents from 74% to 83%; and statins from 50% to 70% (all P<.001).

CONCLUSIONS: This validated regional data registry within a quality improvement initiative has resulted in improvements in pre-operative medication usage. It provides an appropriate vehicle for public and pay-for-performance reporting and has the potential to improve patient outcomes. It has been durable for > 3 years and is a model that could be adopted by other regions. Current/future efforts focus on analyzing risk-adjusted outcomes to better understand variation among centers and improve patient selection.

*Complications: stroke, bleeding, MI, CHF, resp, renal, ischemia, infection, re-operation