Presented at the 61st Annual Meeting of the Society for Vascular Surgery

Baltimore, Maryland, June 9, 2007

 

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

Jack L. Cronenwett, M.D (a), Donald S. Likosky, Ph.D (b), Margaret T. Russell, MBA, MS (a), Jens Eldrup-Jorgensen, M.D (c), Andrew C. Stanley, M.D (d) and Brian W. Nolan, M.D (a) for the VSG-NNE.

From the Sections of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (a); Maine Medical Center, Portland, ME (c); and the University of Vermont Medical Center, Burlington, VT (d), and the Departments of Surgery and Community and Family Medicine, Dartmouth Medical School, Hanover, NH (b).

Funded in part by a grant from the Center for Medicare and Medicaid Services.

Objective: To organize a regional cooperative data registry for carotid endarterectomy (CEA), lower extremity bypass (LEB) and infrarenal AAA repair (OPEN and EVAR) procedures in Northern New England in order to allow benchmarking among centers for quality assurance and improvement activities.
Methods: 48 vascular surgeons from 9 hospitals in ME, NH and VT (25-615 beds) prospectively recorded patient, procedure and in-hospital patient outcome data since January, 2003. Results plus 1-year follow-up data analyzed at a central site are reported anonymously to each center at semiannual meetings where care processes and regional benchmarks are discussed. Mortality and compliance with procedure entry were validated by independent comparison with hospital administrative data. Initial improvement efforts focused on optimizing preoperative medication usage.
Results: 6,143 operations were entered into the registry through December, 2006. In-hospital stroke or death following CEA was 1.0%, major amputation or death following LEB was 3.8% and mortality following elective OPEN and EVAR was 2.9% and 0.4%, respectively. Variation in results between centers and surgeons provides opportunity for further quality improvement. Any post-op complication increased median length of stay by > 3 days. Process improvement efforts initiated in 2004 increased preoperative beta-blocker administration from 72% to 91%; antiplatelet agents from 73% to 83%; and statins from 54% to 72% (all P<.001). Procedure volume and discharge status validation with administrative data led to 99% of appropriate operations being reported to the registry. Mortality was accurately reported to the data registry for all patients.
Conclusions: This validated regional data registry within a quality improvement initiative has been associated with improved preoperative 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 sustained for more than 4 years and is a model that could be adopted by other regions.