Greetings, I'm Jim Wodzinski, I'm the Executive Director for the Society for Vascular Surgery's Patient Safety Organization. I'd like to thank the American College of Cardiology for allowing me to speak today. My topic today is putting registry data into action, lessons learned from the Vascular Quality Initiative. I have no disclosures. In this presentation, I'll be covering the registry collaboration between the ACC and CDR and the SCS Vascular Quality Initiative, the different types of data that are available for quality improvement and research activities, the various tools and resources that the VQI provides to its members to implement quality improvement programs, and some sample case studies of the activities undertaken by VQI members. To provide context for this presentation, I want to remind the audience that as of January 1st, 2021, the NCDR PVI registry combined with the SVS VQI registry to create the SVS VQI in collaboration with NCDR. The foundation for the collaboration between the NCDR and the SVS VQI was that both registries had a very common mission, that of using real-world data to improve patient care. This partnership has allowed us to create the premier registry in the vascular space. This registry provides a richer data source for QI and industry projects and also consolidates the space for a singular data source for our hospital providers. This is an ongoing relationship where the ACC and CDR provides ongoing input to the registries through representations on all VQI committees and councils, and we meet regularly with the NCDR to work to transition the remaining NCDR PVI participants into the SVS VQI. The Society for Vascular Surgery became involved with the Vascular Quality Initiative in 2010 when the registry had just over 100 members. Now in 2022, we're nearing 1,000 members, and we're happy to report that over 100 of these members have come from the relationship between the NCDR and the SVS VQI. The SVS VQI is a collection of 14 different registries covering virtually all vascular procedures. We now have over a million cases across these 14 registries, so this is a very rich source for hospitals, both for QI and research, and hospitals have the flexibility of joining one or all 14 of the registries and really can tailor that based on hospital volumes and areas of concentration for quality improvement efforts. The SVS VQI offers its members a wide variety of reporting to help them track the quality of care they're offering to their vascular patients, from quarterly best practice dashboards to semi-annual regional quality reports, interim reports on national quality initiatives, as well as hospitals being able to access their own data and do ad hoc reporting. There's a plethora of data that can be used to benchmark performance and initiate quality improvement projects. The first set of reports that we'll talk about are the quarterly dashboards. Every VQI member receives a dashboard for each registry they participate in. These dashboards are based on procedural data that are entered into the registry. Your hospital's information will be benchmarked against the rest of the nation. We provide benchmarks that show your performance in terms of if you're in the top quartile or in the lower quartile. These are color-coded so you can easily identify your areas for quality improvement. In this more detailed view of the dashboard, you once again see that each site receives a report. Its data are then compared against hospitals in their region and the VQI overall. So in your center column, you can see the outcome rates, and I'll focus here on the post-op events. So for this procedure, PVI claudication, this site is doing very well with its outcome rates for MI, renal status, thrombosis, access site infection, and unplanned amputation. So doing very well on its own rates and compared against its region and the VQI overall. The items highlighted in choral embolization, lesion dissection, arterial perforation, and access site hematoma are all areas where they're performing in the bottom 25th percentile. And that should provide an indication that there is an opportunity for improvement and the potential for a quality improvement plan to be enacted based on this data. One of the unique features of the VQI is its 18 regional quality groups. We've already seen in the quarterly dashboard reporting that benchmarking is done not only on a site's data against national data, but also against regional data. So when I mentioned that that site's data is compared against hospitals in its region, these are how those regions are broken up and hospitals in those regions provide that benchmark data. And it's the next reports, the semi-annual regional quality reports that are discussed at regional quality meetings. So prior to each of these semi-annual regional meetings, each site receives its data on about 30 outcome or process measures that will be discussed at the meeting. Each site is asked to look at their data, look at how they compare against their region, look how they compare against the nation, and be prepared to discuss these outcomes at the upcoming meeting. So data for each outcome or process measure will be broken down not only by the site, but then you'll have blinded aggregated data that shows benchmarking against the individual hospitals in the region, and then how that region's comparing against other regions throughout the VQI. This again helps lead to discussions at the regional meetings about why there's variation at specific hospitals within the region, and why there might be variation across the regions. The whole point of the meeting and this data and discussions is to provide a safe environment where you can really discuss what's going on in a specific area. What are your challenges? What are you having problems with in terms of implementing a QI plan? And querying your peers from hospitals in your region about what they've implemented, what's working well, and how did they overcome challenges? And it's from here where a lot of our quality initiatives, both at a local hospital level and at a regional level, are initiated. Another unique feature of the VQI relates to follow-up data. Most registries are focusing on 30-day follow-up data, and while the VQI does collect 30-day follow-up data, our information really focuses on one-year follow-up data, as that's the standard practice of care for most vascular procedures. Other procedures within vascular also really need to go beyond one year and really extend to three to five years. And we do recognize that even collecting one-year follow-up data is a challenge. So the way the VQI has navigated this is, one, we do allow hospitals who have the ability to collect data beyond one year to put additional follow-ups, as many as they want, into the registry, and then they can get reporting on that. We also are providing dashboard data for all the follow-up data entered into the registry, and hospitals can simply go into our system and run reports for each registry and their long-term follow-up data. And I think one of the unique things that we've managed to do is match Medicare claims data with the VQI data to be able to provide five-year reporting data on most of our registries. So these graphs show a detailed example of the type of reporting that's been provided to centers on Medicare claims match data since 2019 and then every year after. So this is an example of our endovascular abdominal aortic aneurysm repair registry information. And in these reports, each center gets to see, for a five-year period, their performance in the areas of freedom from reintervention, freedom from imaging surveillance failure, and five-year freedom for death. So in each of these graphs, the dotted line represents the center's information, and then the solid gold line represents all centers in the VQI. So again, for procedures, especially like EVAR, which really is something where you almost want to follow the patient for life, especially because of things like device failure, device migration, it really provides the center and individual physicians, because there's a physician-level companion report for this, a lot of information they couldn't otherwise get out of the registry, again, based on the difficulty of entering that long-term data. So again, the ability to match our clinical data with claims data from CMS has been very valuable not only for quality improvement purposes and for patient care, but also for research. So to wrap up this section on reporting and data, I did want to touch a little bit more on research, as I just mentioned in the last slide. The quarterly dashboard reports, the semi-annual regional reports, and even that five-year survival reintervention and surveillance report, those really are primarily used for the main mission of quality improvement in looking at the care that's provided to our vascular patients. But having over a million cases in the registry and the ability to match that data with Medicare claims, we really have a very rich asset that can be leveraged for research and can be leveraged for device evaluation. And this is also a member benefit. So every center that participates in the VQI has the ability to submit abstracts and request blinded data sets for research purposes. Those data are, there's a formal process by which abstracts are sent every other month. There's a formal research advisory council that evaluates all of the abstracts that are submitted, grades those proposals, and then either approves or declines requests. And then based on those approvals, a fully de-identified blinded data set will then be sent to the hospital for analysis. These data sets are provided at no additional cost. We do ask that each data set, there'll be a data use agreement signed so that data can only be used for a very specific project. We allow a two-year period for the data to be used to be then published and presented. It's also important to note that those requests can include requests for the data sets to be mapped with the Medicare claims data and then be made available. So the vascular quality initiative run by the Society for Vascular Surgery is run as a patient safety organization. So the SVS patient safety organization really is the entity that manages the registry. And as such, we feel that it's incumbent upon us to make sure that hospitals have the tools and resources, again, to put that registry data into action and use that data to monitor their performance and implement quality improvement programs. The patient safety organization provides additional safeguards around security of the data, data not being used for punitive measures against caregivers, and it also safeguards the data against discovery. So to make good on our commitment to help our VQI members use registry data to improve quality of care, the VQI offers a plethora of tools, resources, education, and meeting. We've already talked about the semi-annual meetings, but that means that VQI staff not only are producing the reports for those meetings, but are helping coordinate and run these 36 regional meetings. We also have our annual national meeting, the VQI at VAM, that takes place each June, and that's a day and a half of registry education with about half of that focusing on quality improvement, case studies, best practices, and education. In the interim between the semi-annual regional meetings and the VQI annual meeting, we have quarterly webinars highlighting case studies, best practices, and additional registry training. We also push information out through a VQI monthly newsletter. We have a whole QI toolkit that looks at general QI tools, whether it be quality charters, PDSA, DMAIC, but looks at it through the lens of vascular surgery and the VQI. So what we do is we take standard tools but then tailor them for the VQI and provide practical examples of how you would use a tool for a specific quality improvement project out of the VQI. We also have resources on our members-only website, so that would be replays of the webinars, replays of all of the sessions from the vascular annual meeting, posting all of our case studies, abstracts, posters. So there's hundreds of case studies from the VQI community that you can get to in the members-only section of our website. So again, you're not starting a project from scratch. That's, again, the whole notion of how we're organized as regions and then as a nation, so we can share at the local level and share at the national level. So chances are, if you have an issue at your hospital and you're trying to initiate a specific quality improvement project, there's probably another site that's already started that or has already gone through it, and you can learn from what another site has already done. So again, you don't have to reinvent the wheel. And then we also have national quality improvement projects that the VQI really holds out as something we want all sites to be able to participate in. So it kind of sets it up as an easy way for any site to participate in a quality improvement project. So I'd like to take a couple of minutes to talk more about our quality improvement webinars, because they've been really critical to the proliferation of all the quality improvement projects that we have within the VQI. Betsy Weimer, our Director of Quality Improvement, leads these webinars. The first are the focus charter webinars, and this is where she gathers folks that are working on like projects, so they can come together and discuss the initiation of the projects and then challenges and successes they're having along the way. We also invite all members of VQI to attend these, so you don't have to actively be working on a charter. You can see how people are using the data for the implementation of quality improvement projects. So we're learning together as a family. Again, it's not reinventing the wheel. Again, these have been really successful. We've gone from, you know, at the start having around 20 folks on the calls to now having over 70 on each call. And then the other thing we do is offer webinars that are more of the finished product. So these are the case studies. We get guest speakers from VQI members that talk about the projects they've completed, talk about their successes, talk about how they sustain those projects, the different tools and resources that they had to acquire from within their institution to make them happen. And again incredibly successful. When we first started these we had about 30 folks who attended and now there's well over 150 people on each call. And all of these again are recorded and archived on the VQI website. So if you're not able to make the live call you can always refer to the recordings. So in addition to the data and reporting one thing you've heard me talk about a lot throughout this presentation are the quality improvement charters. Again it goes back to the toolkit and helping educate folks on how to just start a quality improvement project. From defining what your problem is, what your goals are, what your team needs to be, what resources you need, and ultimately reporting your success and your challenges along the way. And we found that this sort of structured format to help people think through their projects has been very beneficial. And the VQI takes an active role in that we actually collect and kind of monitor the progress of all of these projects that are going on across the VQI. And you can see the first year 2018 that we instituted this we had 55, a slight dip, and these are submitted at the end of the year. So that 2019 I think was just you know when late 2019 was when COVID was hitting. So we think there was some COVID impact late 2019 but then you can see a bump up in 2020. And currently we're sitting at 87 charters and fully expect that we'll get into triple digits. So you can see that and there's a lot of hospitals in the VQI family that are actively using the data to improve quality of care. And then all of these projects in some form or fashion are either talked about within the hospital, talked about at regional meetings, or at our national meeting. So we have hundreds and hundreds of case studies at our fingertips that we can share with the VQI family. So in addition to the quality improvement projects that are initiated through the charter process, whether it be by an individual hospital or a region, the VQI itself has put forth some national quality improvement projects. The first of these being prescribing antiplatelets and statins at discharge. So this really is a process measure but this was born out of a research study based on VQI data done by Dr. Randy Di Martino at the Mayo Clinic. So he used that process that I talked about earlier of putting in an abstract requesting a blinded data set to do a research study but then was able to show that patient had improved survival rates, long-term survival rates, if they were discharged on platelets and statins. Another project we have, this harkens back to what I was talking about earlier as well about long-term follow-up, is making sure that we have the appropriate imaging for EVAR procedures. Again, it's part of that importance of that long-term surveillance of looking at the images and the device, if there's device migration. So very important that we have that follow-up and the imaging in the registry, so you're checking up on your patient. And last is a new national quality initiative that will launch in 2023 and that will be aimed at smoking cessation. So now we'll take just a bit of a deeper dive into one of the national quality initiatives and that's discharge medications. And so we've been tracking the progress of how hospitals are doing with compliance with discharging patients on their anti-platelets and statins. And this analysis shows 121 centers that were part of the VQI in 2012 and continue to be in the VQI through 2021. And you can see the dramatic impact in the compliance with this process measure over time. So in 2012, on an aggregate basis, these centers were at about 72, 73% compliance. And by 2021, we're close to 90%. And we think that's due to the VQI having a focus and providing continued feedback to these centers. But then the hard work that's done by each institution to really pay attention to their own performance at a center level, at an individual physician level, at a regional level, and then put into place the appropriate QI processes to really drive those number up. And this has been a really nice success story for the society. So this is a bit of a deeper dive into some of the data that's provided to the hospitals on this National Quality Initiative of Discharge Medications. This comes from our regional report. So again, done semi-annually. And while each center, again, receives their own information and it's benchmarked, their own information is benchmarked against the regional rates as well as the national rates. We find that the regions themselves are competitive as well. And we'll look at this and say, if you're on the far right and you're the Southeast region and your compliance rate's only 80%, you're like, well, how is the Carolinas at 91%? And how do we get first up to the VQI national average of that 87%, but ultimately to a higher rate of compliance? And again, this will be a discussion at the regional meetings and physicians and data managers will challenge each other as a region. We need to do better. There is that sense of healthy competition amongst physicians and data managers to make sure that we're doing the best we can because it does have a profound impact for our patients. It goes back to the research that has come out of the VQI data and showing that while this is a process measure, it's an important factor to increase the longevity of life's post vascular surgery. So again, a big part of our shared learning tools and resources is our annual meeting, the VQI at VAM that's held every June. And really a highlight of the meeting is our quality poster reception, which takes place on the first evening. And we have somewhere between 25 and 30 posters on an annual basis. And I'm really proud of this session because initially this was set up to be just more of a networking opportunity. But then we really turned it into more of a quality improvement learning opportunity. And so every site that submits a poster, they're actually at the poster having active dialogue with all the other members at the annual meeting. It's very well attended and is always one of the highest rated sessions at our annual meeting. Most of these presentations are based on quality charters that have been submitted in previous years. The projects come to fruition and then people want to share their results. And again, it's that continuous learning and that learning across the VQI from individual institution to region, to the national level. We need to, again, share our processes, share our successes. So we're not reinventing the wheel. And then we just don't stop at just the poster session. We then take the best of the best from the poster session and make sure that we give people time on the podium at the annual meeting to go deeper into their projects and ensure that everybody who might not have been able to make the poster session is able to really benefit from the hard work of the success stories of each of these quality improvement projects. So another thing we do at the VQI to ensure that all of the work from the quality improvement posters and case studies continue to have a life after the annual meeting is that we've created a compendium on an annual basis of all of the posters, abstracts and podium presentations so that anybody who wasn't able to attend the annual meeting or might not even have been in the VQI during that year can go back and look at all this great work. There's well over 100 case studies that people can learn from and, again, take a look at their data and figure out, all right, if I have an area of opportunity, what did someone else do to improve in this area? I can go look at their poster, look at the whole workflow, get a charter, see the abstract, and then see the challenges and the successes. So, again, I'm repeating myself, but it's not reinventing that wheel. It's learning from the community and taking those tools and resources and applying it to my data and my center. So I'm going to end the presentation and briefly talk about two specific quality improvement projects from VQI membership. I think this first one is really kind of unique and exciting. The VQI has worked with the society to be able to use the registry to check compliance with the society's surgical guidelines. Most societies have guidelines they give to their membership, but I can't say that all societies are really great at tracking if their membership is in compliance with the guidelines they're putting out there. So we've started the process of ensuring that our registry first captures data elements that can be tied back to high evidence guidelines. And then as that data are entered, we provide feedback reports to centers so they can see how they're doing relative to the society guidelines. So this particular project is looking at the guideline that relates to elective EVARs, and the guidelines state that there are certain aneurysm sizes before those interventions should happen. The Cleveland Clinic, prior to taking on this initiative, was only at a 86 percent compliance rate, and they felt that they needed a higher level of compliance. So they initiated a quality improvement strategy. They did use the SVS charter process, and at the end of the day, their results got up to almost a 95 percent compliance rate, so a full nine percent improvement in the compliance with the society guidelines. And they don't think that's good enough, so they're still putting in plans to continue this project and drive that 95 percent up even higher. Another interesting thing out of this project is that as this information was shared at regional and national meetings, and this feedback data is shared on a regular basis in terms of, again, compliance with guidelines, again, centers, physicians get this benchmark data, this caused multiple regions to come together and create a project that is looking at compliance with the EVAR guidelines over three regions. And so this is, again, a very exciting example of, again, how the VQI is working with the society to track compliance with the guidelines, how feedback data is going to individual centers and surgeons so they can benchmark their performance, and then people are seeing that, okay, my practice, you know, might be deviating from the norm, so let's examine that and then put in improvement plans to drive compliance up. But then it's getting the attention of others in the VQI family, and we're seeing that then these processes to improve are being replicated not only in other hospitals, but across multiple regions. So a really great success story, not only for the Cleveland Clinic, but for many other regions within the VQI. And then the last case study I'll touch on here is from Stanford HealthCare, Stanford University, and their project was looking at how they can improve their long-term follow-up. And this isn't necessarily just about the data. The data are important. The data provide feedback that can help us analyze the quality of care that we're giving to our patient. But as Stanford said it themselves and their lessons learned, this is about sustaining the continuum of care with the patients. And that's very important for ensuring that patients are recovering properly and that devices are acting properly, and we're just continuing to provide the care that's needed to the patients. So based on the feedback reports provided to Stanford in 2013, their follow-up rate was only at 69%. And we'd really like to see all hospitals be at that 80% range with their long-term follow-up. And so they had undertaken a pretty intensive quality improvement project, looking at many factors in the process from personnel, communication, technology, all the different ways that they can look at how to improve those follow-up rates. And with that work, they were able to steadily increase their follow-up rates over time from 69% in 2013, steadily increasing all the way to 92% in 2017. So some very impressive results. And again, shared regionally, shared nationally, and we've had a lot of folks reach out to Stanford to see what they're doing to improve long-term care and have had people adopt their quality improvement plan. So with that, I'll end my presentation. I'll thank all of you for listening. And if you have any questions about joining the VQI, or even if you're in the VQI, how you obtain and leverage these various resources, please feel free to contact me, Jim Wodzinski, at the Society of Vascular Surgery, or Betsy Weimer. And thank you for your time and attention.

Vascular Quality Initiative

Registry collaboration

Real-world data

Quality improvement

Long-term follow-up

Surgical guidelines

Vascular patients