Good afternoon, my name is Jim Watzinski. I'm the Deputy Executive Director with the Society for Vascular Surgery Patient Safety Organization. Today I'll be presenting on the NCDR and SVS-VQI registry collaboration, how we provide data resources and peer-to-peer interactions to help improve quality of care. I'd like to thank the ACC for allowing me to present today. I have no disclosures. In this presentation, I'll be providing you an overview on the registry collaboration between the NCDR and the VQI, what's changed with the registries and information on how to join the SVS vascular quality initiative, a high-level overview of how the vascular quality initiative is structured, and then most importantly, the type of data that you get out of the registry and then how you look at that data to initiate quality improvement activities and the various resources and education materials that the VQI provides to assist with starting those initiatives. When the ACC and SVS first engaged in talks about a possible collaboration between the registries, we started out by looking at our missions. And probably no surprise to you is the missions are strikingly similar. The NCDR's is to improve patient care and heart health through trusted real-world evidence, and the VQI's is to improve the quality, safety, effectiveness, and cost of vascular health care by collecting and exchanging information. So it was with that in mind, we decided to continue the talks about how to collaborate, which led us to actually creating one singular registry. And it's really what we look back on as we continue operations of the now combined registry. So what exactly were we trying to achieve when the ACC and SVS came together to discuss a potential registry collaboration? Well, it was to address the main problem that there's just too many registries and too many registries in the cardiovascular space, whether it's NCDR, VQI, NISQIP, SIR. All of these are fine registries, but the fact is that they collect similar data on the same procedures in the vascular space. And this leads to difficult choices for hospitals that potentially lead to duplicate expense, duplicated effort in terms of data extraction and looking at data to initiate quality improvement efforts. And historically, some of these decisions have been rooted in the fact that each physician specialty tends to look to their own specialty society when making choices on which registry they're going to participate in. So as talks proceeded between the ACC and SVS, we really decided that we had to move beyond just talks about how do we harmonize data variables. That's well and fine if you just want to potentially enhance data analysis and research between the two societies, but that really doesn't address the main problem of too many registries in the cardiovascular space. So we decided that we really needed a unified approach to come together with the combined expertise of the ACC and SVS combined resources and have a unified solution that's focused on growth and not competition. The ACC and SVS also felt that the solution needed to be built on collaboration and trust. One where we learn from each other and leverage the strengths of both registries. One that offers a cost effective solution to the hospital and physician membership, but is also accepted by providers, government and payers. So after about a year and a half of discussion, the SVS VQI and NCDR PVI did decide to collaborate on a single registry, which is now known as the SVS VQI in collaboration with the NCDR. With the collaboration now in place, we believe that the SVS VQI in collaboration with NCDR is now the premier registry in the vascular space. It provides the richest data source for hospitals to initiate quality improvement projects and for industry and regulators to look at real world data to evaluate the safety and efficacy of devices used in vascular procedures. It also achieved the primary goal of providing a single data source for providers, thus eliminating the burden of duplicate expense for the cost of the registry and data abstraction. Again, this is an ongoing collaboration between SVS and ACC and ACC provides ongoing input based on participation on all of the SVS VQI committees and councils. Staff of the ACC, NCDR and the SVS VQI also continue to work together to transition NCDR PVI participants to the VQI. With the new registry collaboration going into effect as of January 1st, 2021, the NCDR PVI stopped accepting new cases into the NCDR PVI registry as of December 31st, 2020. That being said, access to historical data is still available through December of 2022 and final 2020 NCDR outcome reports were made available mid-year this year. As a reminder, as you're thinking about transitioning from NCDR PVI to the VQI, no historical data is transferred, but ACC, NCDR staff are working with SVS to help promote the registry and facilitate transition for PVI participants and we're happy to say that nearly half of the hospitals that formerly participated in the NCDR PVI registry are now subscribed to the VQI. For those of you who have yet to transition to the VQI, we wanted to provide some quick updated pricing for 2021. Currently, the price of a registry per year is $2,667. There is a one-time setup fee, so a first-year minimum is $7,667 and then with an ongoing annual fee of $2,667 per registry. The SVS VQI in collaboration with NCDR registry really is the perfect vehicle for your hospital or physician group to access data to drive quality at your institution. The registry provides the ability to collect evidence-based practice data for analysis. That data helps you drill down to the exact areas for improvement. De-identified anonymized data are provided to allow benchmarking comparisons with other hospitals and amongst physicians at regional and national levels. Your sites have the ability to access data for research and also you have the ability to participate in post-market surveillance studies. A bit of quick information on the organizational structure of the registry. The Vascular Quality Initiative in collaboration with NCDR is the formal name of the registry. It's run by the SVS Patient Safety Organization, which is a component of the Society for Vascular Surgery. We also have 18 regional quality groups that are part of the registry and will speak more to their benefit to registry operations. And then FIVOS, formerly M2S, is our technology partner, which is the web-based system for data entry and online reporting. Participation in the VQI is very strong with a very healthy growth rate. We now have 843 centers participating in the VQI. 842 of those centers are in the VQI. 842 of those centers are in North America with one center in Singapore. And the growth between 2020 and 21 is partly attributable to the collaboration between the ACC and SVS. So this shows that the VQI is a rich source of data with over 850,000 procedures in the registry. Of particular interest for the ACC audience would be the PVI registry as well as the CEA and CAS registry. PVI having over 285,000 cases, CEA having over 160,000 cases, and CAS having close to 60,000 cases. It's important to note that CAS is currently our fastest growing registry. Also of note, you'll see that we have two newer registries, the Vascular Medicine Consult Registry and the Vena Stent Registry, which were launched at the beginning of 2020. A bit of a slow uptake due to COVID, but we're now seeing enrollment in those registries. The Vascular Medicine Registry is of particular interest because it's our first non-operative registry and really is collecting data on medical management of vascular procedures and looking at the natural history of disease in the vascular space. I previously mentioned that the VQI is operated by the SVS Patient Safety Organization, and we believe that running the organization under the auspices of a PSO does provide some unique benefits to the registry participants, particularly in the areas of how data are kept, confidential processes around being able to collect data, as well as creating a culture of safety. First, the data are able to be collected without informed consent as long as they're being used for the purposes of quality improvement. That does extend to our post-market surveillance studies with industry. Data that are designated as patient safety work product are free from legal discovery, so this is a nice protection for hospitals and physicians, but it's also done to encourage honest reporting. Comparative data cannot be used for disciplinary purposes or competitive marketing, but anonymized data is allowable to be published as long as it's de-identified for a patient provider and hospital. Fivos, formerly M2S, is the technology provider for the VQI. The name of its technology platform is Pathways, and that's the system by which sites enter data into the registry. Fivos is currently the only vendor that the VQI works with, so all members are on the same version and platform of the registry at all times. It is a cloud-based system. It is HIPAA compliant, and there is also real-time reporting and analytics offered through Pathways. I'll now provide a quick review of features and benefits of the VQI registry. The registry does collect consecutive cases, which is different than some registries that sample, and we do audit for completeness by checking cases entered into the registry versus a institution's claims data, and that happens every three years. The registry does focus on one-year follow-up for key outcomes. We also do collect a 30-day follow-up, but really we focus on one-year follow-up. We also have the ability to link with Medicare claims data for longer-term follow-up data, and I will be speaking to that later in the presentation. We do believe that the registry is an ideal source of real-world data that academic centers, community centers can use for research purposes, and all centers have the ability to request access to data for research purposes, and that is part of the benefit of membership. The data are very granular with approximately 100 variables per procedure, in addition to the follow-up. We do have the ability to add customized variables to the database, so if there's data that you want to collect for a specific purpose that's not part of the standard form, you can add custom variables. Very important to note is the ability to participate in the Transcarotid Surveillance Project, and that is listed under an NCT number on clinicaltrials.org, and if you participate in that trial, you would be able to seek reimbursement for your high-risk transcarotid procedures. And then the last item I'll touch on is, again, we are organized in 18 regions for quality improvement efforts, and I will provide more detail a bit later in the presentation. Before we move on to the quality improvement portion of today's presentation, I wanted to highlight a couple of new additions to the VQI registries. First is the addition of patient-reported outcomes to the PVI registry. Previously, we only had patient-reported outcomes in our venous registries. Patient-reported outcomes are really of keen interest to the FDA, CMS industry, our providers and hospitals, as well as patients themselves, and we're hopeful that we can roll PROs out to all our registries in 2022. And then we also added COVID variables to the registry back in late 2020, and are continuing to update the registry with the additional information on vaccinations as that's now available. For the last half of today's presentation, I'm going to focus on quality improvement initiatives within the vascular quality initiative and the various tools, resources, and reports that are provided by the VQI to help sites initiate and sustain quality improvement efforts in their institutions. Given that the VQI is run under the auspices of a patient safety organization, we do feel compelled to really help member institutions use the VQI data to identify areas for improvement and then provide tools and resources to initiate and sustain quality improvement efforts at their institutions. And so this starts right from when you join onboarding with initial training, both in how to use the registry, and then right into quarterly sessions on continued education, on entering data into the registry, as well as quality improvement efforts on a quarterly basis. And then our semi-annual reporting that leads into our regional meetings, looking at benchmarking data to, again, identify areas of improvement for projects that can be done at an individual institution or on a regional or national basis. And then really the PSO helping gather and then disseminate that data to all the VQI members. And we do this either at our national meeting and through our members-only website. So a bit of a deeper dive into the 18 regional quality groups. As you can see by the map, they are organized by geography and the groups meet semi-annually. It used to be live before COVID, but now it's turned into remote, but we're starting to get back to some live or hybrid meetings. And really the crux to the meeting is each site does receive semi-annual reports and there's outcome reports and process measures and hospitals receive their own data and then their benchmark against their geographic regions and nationally and so then PSO staff work together with regional leadership to present that data to members and again have a active lively discussion about how hospitals in the region are doing and what can be done to improve and PSO staff are also there to share what's being done in other regions and ultimately at the end of the day we want to come up with some action items from each of these meetings where the region has identified quality improvement projects that they're going to attack for the next you know six to twelve months. In addition to looking at the the registry data you know for quality improvement there's also the ability for hospitals to present their quality improvement projects to report data based on research from the VQI or have other select presentations related to the VQI and quality improvement efforts. These are these these meetings are just part of participation in the VQI there's no added cost other than just cost of you know attending the meeting. As mentioned earlier in the presentation in the features and benefits section I did talk about a focus of the VQI being on one-year outcomes but it's also important to note that we do have the ability to link VQI procedure data with CMS claims data and this is a project called vision vascular implant surveillance and interventional outcomes network whereby we have a data use agreement with CMS to access CMS data claims data and then match that to VQI procedural data and the whole notion there is to get to longer-term outcome assessment and you know that's you know five years and even beyond and that's providing us with more complete and accurate information about each procedural encounter and then we're based on that we're able to provide additional reporting to centers looking at survival readmissions and surveillance. So this is a quick example of some of the vision based data that we're able to provide based on our linkage with CMS claims data and we just recently added the ability to report on CEA and CAS and so I thought it was important to provide this information on carotids to the ACC membership and from this you know you'll be able to see that we're able to provide those participating in the VQI carotid registries with you know five-year information on again survival reintervention and surveillance so each hospital that participates in the registry that we're able to you know link a lot you know claims data with for that period of time receives these reports in addition to their their normal quarterly dashboards and semi-annual reports. Another interesting and we think unique feature of VQI reporting is using the registry to check compliance with clinical practice guidelines. We started this in 2019 using the registry to check compliance with AAA guidelines and based on that we were able to look at each physician's level of compliance and then overall link that with how that compliance impacted outcomes. We've now expanded this work to look at our claudication guidelines and have now an ongoing process with our clinical guidelines writing committee to ensure that as guidelines are created any guidelines that are of high level of evidence are tracked in the VQI and then additionally that as the registry checks compliance and then looks at the impact on outcomes that data are fed back to the guidelines committee as they're doing reviews and updates of guidelines. I'll now provide you with some examples of the reporting that comes out of the VQI primarily for the semi-annual meetings that I mentioned those regional meetings so this is just an example of the high-level dashboard benchmarking that's received and this shows the various outcome and process measures that are included in a semi-annual report and then provides the regional and national benchmarks. In the middle this is de-identified but the individual center information would be in that blank column but we've just left that off for purposes of this example. So after the high-level dashboard then we get into the detailed outcomes reporting and this is really where the discussion happens up at the regional meetings in terms of identifying areas for improvement both as a region and the individual hospitals. So this is a process measure in PVI for ensuring that toe pressure is captured prior to procedure and you can see the upper right hand bar graph and all of those dark blue columns represent each hospital within that region. Every hospital knows who they are but they are de-identified for the full group but we encourage all hospitals to bring their own reports and then have an active discussion about the high outliers and low outliers and and potentially what's what's driving the the positive outcomes or the the need for improvement. And then the lower right bar graph each light blue bar represents an individual region and then the dark blue is the national benchmark. So this is where you can get into a discussion on the need for a regional quality improvement and you could see that there's some low outliers to the three on the left hand side and we'll have an active discussion of what's going on in that region and why there might be barriers or obstacles to performing on this measure and then talking about what can be done to improve and then even sharing what's been done in other regions to to help improve. So again we're not reinventing the wheel even though we are based as regional groups. It is a national initiative and we do as the PSO then share those learnings from other regions to help really jumpstart quality improvement projects. And this is just an example of physician level reporting that we provide to members. This particular example is on mortality risk for CEA and you know we feel this is beneficial because an individual physician can really do some self-examination on their practice relative to all of their peers in the VQI. The data are also broken down by by region as well so it provides an additional layer of granularity in terms of an individual physician being able to analyze their practice for various reporting measures. In addition to the online reporting and analytics quarterly dashboards and semi-annual reports, the PSO staff provides members with various tools and educational resources to help initiate and sustain quality improvement activities. Presented here is our QI project guide which is published annually and this is really a step-by-step toolkit to help members become familiar with various quality improvement tools that can be used in quality improvement project. You know whether it's PDSA, DMAIC, failure mode analysis or CQI lean, this guide not only presents a primer as to what those are but more importantly gives specific examples of how each tool are used specifically for a project that would be initiated based on VQI data. This slide shows a section of the QI project guide that has a tool that's been modified to show how it's used within the VQI. This is a project charter that's looking to improve the discharge of patients on anti-platelets and statins but it it takes a site through exactly what they need to do to you know create a problem statement to you know identify what their goals are, identify who the team is. So again the whole notion is how do you use the tool then more specifically how do you use that for a specific QI project that you'll encounter within the VQI. So in addition to sharing information at our semi-annual regional meetings, our annual meeting, our quarterly webinars and our monthly conference calls, we also have a very robust members-only website where all of this information is archived. And again this is this is a key of importance because what we want to be able to do is create a mechanism by which any hospital can look up in a topic of interest for improvement and then see how other institutions have initiated quality improvement projects to address that particular topic. In addition to being able to access case studies on specific areas of interest for quality improvement, the members-only website also acts as the repository for recordings for all quality improvement education produced by the VQI and that includes full recordings of every session for the last five years of the VQI annual meeting. Additionally every quarterly quality improvement webinar is recorded and stored on the website. These are all cataloged and categorized by registry and area of interest, so if you have any questions about a quality improvement project across the 14 registries, chances are that you're going to be able to find a presentation or case study on the topic in our members-only area. And the last report I'll show you is information that's provided around our national quality initiatives. The PSO is currently running two quality initiatives for the registries, the first being patients being discharged on appropriate medications, that being anti-platelets and statins, and the national quality initiative has done very well and improvement has been such that we're going to be able to move that quality initiative into a maintenance mode. What you're seeing here is a report on EVAR-SAC diameter reporting and wanting to make sure that each patient gets the appropriate imaging relative to their EVAR procedure, and you know it's important to note here that the you know each center gets granular detail on exactly for this compliance measure where they're at, where they're at nationally, and what they need to do to improve. So again when when we initiate any type of quality initiative we're also going to have very detailed reporting to help that institution be able to analyze their data and put an improvement plan into place. And I'll begin to wrap up this quality improvement section of the presentation by talking about an awards program that the VQI put in place in 2016, and this is really to recognize member institutions that are living up to the to the to the challenge of putting that registry data to use and improving care. And so this recognizes their performance in four domains, the first being their collection rate of long-term follow-up, and you've heard me mention the importance of long-term follow-up a couple of times in this presentation. Also attendance at those regional quality meetings, so on a semi-annual basis coming together to discuss individual outcomes and how you benchmark regionally and nationally, but then more important, you know, what are we going to do with that? So sharing stories of what our challenges are, you know, what's working, what's not working, and and how are we going to put plans in place to actually improve our performance. Individual quality improvement activities, so we we have a process by which hospitals submit quality improvement charters to the PSO so we can we can see what they're actively working on and then help them with that and then disseminate their results to the rest of the VQI community and celebrate their successes. And then lastly the the number of registries the institution participated in. And the the awards really have become a very large success and we celebrate these both at the regional quality meetings as well as at our annual meeting. And you know this is a I think a great way of recognizing the the hard work of an institution and gives the individuals who have done the hard work a way to display to their colleagues and administration that what they're doing with the registry data really makes a difference. And then I'll quickly mention one new program. The VQI is looking to start a trainee program in 2022 and the intent of this program is to really help trainees understand quality improvement through the use of registry data. And this has been a multidisciplinary approach much like this collaboration. We've included members of ACC, SCI, SIR on the committee as we've designed the program. And this will be a program that is 12 to 18 months, teaches trainees about the VQI and registry data, how the data are used to initiate quality improvement projects or research activities. And you know this is very important because residency programs have ACGME requirements that require quality improvement training as part of that curriculum. So we're hopeful that the VQI can be a part of that process. And we're really looking forward to engaging the next cohort of physicians in how to use registry data to improve care. And then lastly, I wanted to mention in addition to all of the education tools and resources we have around quality improvement, we don't neglect providing education around data entry itself. So on a quarterly basis, we are providing that type of education along with any additional needed information around updates to the registries on an annual basis prior to the annual meeting. There's separate sessions for each registry on data entry. And of course, all of the information is recorded and archived to the website. And then any small changes are pushed out via email and also included in the VQI monthly newsletter. Once again, I'd like to thank the ACC for allowing me to present today. I'd like to thank each and every one of you for attending today's session. If you have any questions, please visit our website at www.vqi.org or contact me directly. Thanks so much. Transcribed by https://otter.ai

SVS-VQI

data collection

quality improvement

cardiovascular registry

vascular procedures

registry participation

education