The VQI Team:

1. The VQI Team: How physicians and data managers partner to enhance data collection, reporting and analysis. • Camino, Lillian, MD, RPVI, RVT • Coordinator - CV Specialty Registries and Process Improvement, Indiana University Health • Regional Data CoManager, MVC • Lemmon, Gary, MD-FACS • Regional Medical Director, MVC

2. Notes: • No Disclosures • Number used in this presentation are for example only and do not represent the outcomes of any physician/institution

3. Audience Response Q1: • Does your institution perform “Process Improvement Meetings” with VQI Data? • No, not interested • No, but interested in implementing • Yes, Yearly/Biannually • Yes, Quarterly/Monthly • Yes, Weekly/Daily • Yes, Other

4. Audience Response Q2: • Have you implemented a “Process Improvement Project” in your institution based on VQI data? • No, not interested • No, but interested in implementing • Yes, I do

5. Our background • IU Health Methodist is a Level I Trauma Hospital in Indianapolis • Member of Midwest Vascular Collaborative

6. Science, Guidelines and Registries • Science tells us what we CAN do. • Guidelines tell us what we SHOULD do. • Registries tell us what we DO.

7. Why do process improvement? We want to have? • Patient Safety • Positive Outcomes • Cost Effective • Efficient Process Implementation How can we have it? • Aligning goals with quality objectives • Keeping team members engaged Better process will produce better outcomes.

8. Change Management • “Some of the best theorizing comes after collecting data because then you become aware of another reality.” • Robert J. Shiller, • Winner of the Nobel Prize in Economics Parts: • VQI Registry • Physician Champion • Data Coordinators • Engaged Teams • Process Improvement Meetings • Improvement Projects

9. Relationship between Physician Champion and Data Coordinator

10. Prepping for Success Meet prior to team meetings for in-depth analysis of data • Look at outliers in data • Determine what is significant • Look for patterns or relationship to other variables Good relationship and communication is key to success

11. Our Team Stakeholders Open forum, anyone can assist

12. Interdisciplinary Team • Members are in contact with day-to-day processes that can benefit from improvement. • VQI Data is the basis for this meeting…Meeting is as a forum to bring discussion and “idea-storming”. • Effective teams develop better solutions and greater buy-in for resulting changes

13. Process Improvement MeetingsHow members work together • Create subcommittees for specific projects • Majority of the work is done outside (information brought back to the next meeting) • Data can be requested for projects and monitoring FOCUS ON THE PROCESS Quality improvement revolves around PATTERNS of CARE

14. Statistical Presentation • Finding the best way to present data, ensures understanding of analysis and opens discussion on what can be done to improve outcomes. Note: For educational purpose only; do not reflect real outcome numbers

15. Deep Analysis • This requires help from your champion to determine what are good cut off points of variables • Helps in conveying elements of deep analysis to team • Using the Analytic & Reporting Engine Numerator Drill Down feature is a quick way to look at details of outliers Note: For educational purpose only; do not reflect real outcome numbers

16. Meeting minutes and action items • All stakeholders receive the slides with the components of the statistical analysis. • Meeting minutes with summary of discussions and action items • Results of action items discussed in next meeting

17. Guidelines Updates Meeting with stakeholders is an opportunity for education.

18. VQI Updates By meeting regularly we • Refresh definitions • Clarify questions that stakeholders may have Results: Improved documentation

19. Projects and Pilots:LTFU Improvement • Purpose: Getting physicians engaged in LTFU reporting. • Results: Reduced “Lost to Follow Up”

20. Tools:Physician Reference Cards Results: improved documentation Includes: • TASC criteria • Things to document (by type of intervention) • Ruptured AAA mortality Risk Assessment • CMS CAS documentation requirements • CAS: High Risk CEA Surgical criteria • Modified Rankin Scale Cards can be updated as needed

21. Tools:CMS CAS Documentation • Data that must be submitted to CMS CAS Recertification • Results: Decrease in extra communications & addendums

22. Tools:Vascular Surgical Huddle form • Coordination with anesthesia prior to intervention regarding: • Blood utilization • Clamp site • Prophylactic antibiotic Results: • Opened dialogue for care coordination

23. Tools:Abstraction Form: TEVAR • TEVAR and Complex abstraction form • Follows procedural flow and anatomical areas • Thoracic • Mesenteric • Renal • Iliac vessels • Purpose: assist in capturing complex data points

24. Tools:Abstraction Form: Open AAA • Purpose: assist in data collection • Results: Physicians improved their Op note documentations for OAAA

25. Projects and Pilots:Vascular Indications Conference Vascular Indication Conference • Weekly conference to present/discuss Patients needing Vascular Care • Ideally- Pre Treatment: Discuss Options including Open/Endo/Non-op Treatment • Consensus driven designed for Best Practice • Open to All Vascular Specialists: VS/CTS/IC/IR/Other • Can be used for support with complex cases. • Purpose: Analyze challenging cases among peers to determine best course of treatment • Results: Best course of action for individual case, therefor preventing unnecessary complications

26. Challenges and Lessons Challenges • Deficient documentation • Physician engagement • Data trusting • Multiple modules to focus • Multidisciplinary physicians Lessons • Keep it simple: Focus on few problems, for better analysis and implementation of processes to improve our outcomes • Once a good process has been stablished, then we can move to the next problem • Learn your tools

27. Good Resources • Your Physician Champion!!! • VQI Webinars • The Janet A. Brown Healthcare Quality Handbook: A Professional Resource and Study Guide Keep your knowledge updated

28. VQI Webinars • SVS VQI hosts educational webinars on a monthly basis • 2017 Topics Included: • February: National QI Projects: Discharge Medications: Reaching and Sustaining our Goal of 100% • March: PVI Cloning • March: CAS Registry (TCAR) • April: National QI Projects: Quality Improvement Process and Tools for EVAR LTFU Imaging • May: PVI – forum with users and developers • Webinars are archived and made available through Pathways and the VQI Members Only website

29. Take Away Points • Have Good Team • Present data in a friendly/digestible manner • Improve Documentation: • Better Documentation  Accurate Data  Reliable Analysis • Look at what your organization is doing with data • Revise impact of projects • KEEP IT SIMPLE!!!!

30. The End