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Disclosures . *No financial interests to disclose. . Background . Difficult to improve quality if we do not define ?quality." In order to do this we must:Measure our outcomesBenchmark our outcomes and compare to othersMinimize variation in the way we do things.. . Quality Impr
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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.