New England Registry for Vascular Quality Yields Results

BY MARK S. LESNEY

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A regional registry for quality assurance and improvement has already resulted in improvements in preoperative medication usage and should provide an appropriate vehicle and model for public and pay-for-performance reporting, according to Dr. Jack L. Cronenwett and colleagues who presented their results at the Vascular Annual Meeting.

The Vascular Study Group of Northern New England consists of 45 vascular surgeons from eight hospitals (range, 25-615 beds) in Maine, New Hampshire, and Vermont. The VSGNNE has prospectively recorded patient, procedure, and in-hospital data since 2003, he said in an interview.

"The regional cooperative data registry was designed to report outcomes of carotid endarterectomy, lower extremity bypass, and infrarenal abdominal aortic aneurysm repair--both open and [endovascular aneurysm repair]--in order to allow benchmarking among centers," said Dr. Cronenwett of the Dartmouth-Hitchcock Medical Center, Lebanon, N.H.

The VSGNNE registry compiles results plus 1-year follow-up data for these procedures, which are analyzed at a central site and reported anonymously to each center and surgeon at semiannual meetings where processes and regional benchmarks are discussed. A centralized audit validates both mortality and compliance with procedure entry by independently comparing these data with hospital administrative data.

In all, 6,144 of the selected vascular operations were entered into the registry through December 2006. The audit validation with administrative data showed that 94% of the appropriate operations were reported to the VSGNNE, and this audit led to the entry of the remaining 6%. The audit determined that mortality was accurately recorded in all patients, and that in-hospital and 1-year outcomes were similar to single-center reports, although variation among centers provided opportunity for improvement, Dr. Cronenwett said.

One of the most important accomplishments of the registry has been the success of process-improvement efforts, which were able to significantly increase preoperative ?-blockers from 72% to 88%, antiplatelet agents from 74% to 83%, and statins from 50% to 70% (P less than .001 for all).

"Key outcomes have been quite good when compared to other published results," said Dr. Cronenwett. "In-hospital stroke and death following carotid endarterectomy was 1.1%; major amputation or death following lower extremity bypass was 2.0%; and death following elective abdominal aortic aneurysm repair was 2.9% for open surgery and 0.4% for endovascular repair."

"This registry has proved durable for more than 3 years, and it is a model that could be adopted by other regions for improving patient outcomes and enabling pay-for-performance reporting." Dr. Cronenwett said in summary.

"The current and future efforts of the VSGNNE are to use the registry to focus on the analysis of risk-adjusted outcomes to better understand variation among centers and to improve patient selection," he said.

"This registry represents a grassroots effort by practicing vascular surgeons to learn more about their results and to compare them with others in a way that allows them to improve. Most surgeons do not have access to this level of information, [nor to] the underlying detail that could allow an understanding of cause and effect in order to improve outcome," he added.

"The Vascular Study Group of Northern New England has established a solid database which now provides useful information to participating surgeons in Maine, New Hampshire, and Vermont, and we are moving forward with risk-adjustment calculations to identify best practices that can further improve our results. These efforts are in line with public and payer expectations, and they represent the dedication of these practicing surgeons to improving their results," he concluded.

When asked to comment on this article, Dr. Mark D. Morasch, Northwestern University Feinberg School of Medicine, Chicago, stated: "By providing framework for continued Pay-for Performance initiatives in The Tax Relief and Health Care Act of 2006, Congress has mandated future quality measures be designed so that physician performance data can be submitted to CMS for payment through approved medical registries such as the STS database. The VSGNNE is a platform upon which Vascular Surgery can continue to take part in, and in fact lead, these initiatives." Dr. Morasch is an editorial advisor for Vascular Specialist.

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