MAVSG Mid-America Vascular Study Group (MAVSG)

September 11th, 2019 Data Manager's Meeting: 9:00 - 9:50 am

Central DuPage Hospital, 25 N Winfield Rd, Winfield, IL 60190 Data Managers Meeting Agenda Overview

Welcome Attendance by hospital / clinic list Review of minutes from Data Managers call – 8.15.2019 Celebrate our regional LTFU improvement!!! Tracy Campin, BSN, RN – “Vascular Discharge Medication Project” Questions/ discussion Current hospitals and clinics in MAVSG!

Barnes Jewish Hospital UnityPoint Health Des Moines Carle Foundation Hospital University of Chicago Medical Center Columbia Surgical Services, Inc. University of Kansas Hospital Authority Flint Hills Heart, Vascular, Vein Clinic, LLC University of Missouri Medical Center Gilvydis Vein Clinic Weiss Memorial Hospital Iowa Heart Center at Mercy Medical Center University of Iowa Hospitals and Clinics Mercy Hospital Springfield Memorial Hospital of Carbondale Mercy Hospital St. Louis St. Luke's Methodist Hospital Nebraska Medicine Alexian Brothers Medical Center NorthShore Hospital Loyola University Medical Center Central DuPage Hospital Advocate Good Samaritan Hospital Northwestern Memorial Hospital Saint Francis Medical Center OSF Saint Anthony Medical Center Kansas Heart Hospital OSF Saint Francis Medical Center Bryan Medical Center OSF St. Joseph Medical Center Nebraska Methodist Hospital Saint Luke's Hospital of Kansas City AMITA Health Adventist Medical Center La Grange Southern University School of Medicine Decatur Memorial Hospital SSM DePaul Health Center Loyola MacNeal Hospital SSM Saint Louis University Hospital Loyola Gottlieb Memorial Hospital SSM St. Clare Health Center The Methodist Medical Center of Illinois SSM St. Joseph Health Center Menorah Medical Center SSM St. Mary's Health Center Newest – MercyOne Siouxland Medical Center St. Anthony's Medical Center Saint Luke's Episcopal Presbyterian Hospital Minutes from August Data Manager Call

Welcome MercyOne Siouxland Medical Center Welcome new AQC chair - Trissa Babrowski, MD Corrected Regional report – make sure you have the right one! As always – please keep your data managers section current, make Drs and or staff active/inactive in the registry. Spring Regional Reports - Reminder - cases thru 12.31.2019 and entered by 1.31.2020. Long Term Follow-up (LTFU)-LTFU Spring reports will cover 1.1.2017 thru 12.31.2017, entered by 1.31.2020. Cheryl gave highlights from the National meeting in June and encouraged everyone to come to next years meeting. HICN to MBI – a few rules to know-(slides) Discussion and clarification on coding discharge status-(slides) Lets Celebrate some success!!!!

8 centers over 85% !!!!

6 7 HICN to MBI – 2018 CMS Change

O will not be used - only zero I will not be used - only 1

8 Question was raised -

How to capture - Nursing home vs. Rehab Unit “Why is my percentage of nursing home patients so high?” “Am I abstracting differently?” Questions abstracting?

First place to turn is the Data Variable Dictionary and Help Text in Resources. Discharge status from Variable Dictionary V.2.26 Feedback: Skilled Nursing vs. Rehab? 13 LET’S START AT THE VERY BEGINNING….

▪ Nebraska Medicine joined VQI in 2016

▪ NMC participates in 7 of 12 VQI modules: ▪ Carotid Artery Stent ▪ Carotid Endarterectomy ▪ Endovascular AAA ▪ Open AAA ▪ Infra-Inguinal Bypass ▪ Peripheral Vascular Intervention ▪ Thoracic and Complex EVAR BASELINE COMPLIANCE NEBRASKA MEDICINE 7/1/16 – 5/31/17

Compliance across each module fell below the national goal of 100%

Total Compliance All Modules = 80% ANALYSIS • Outlined Current Process • Worked with vascular team to determine root causes leading to low compliance • Developed solutions • Created chart to summarize process, issues, solutions, timelines, and follow- ups • Categorized critical issues with appropriate solution START WITH A CHARTER KEY METRIC: INCREASE AWARENESS

1. Met with hospitalists to review initiative goal and plan 2. Communication to PCP via email or phone call if patient started on an antiplatelet and/or statin 3. Created a letter outlining the initiative and sent to all referring and primary providers (example below) KEY METRIC: MED ACKNOWLEDGEMENT WITHIN EMR

1. Smarttext created in progress note template within Epic

2. Added Antiplatelet and Statin medications to vascular post-op order sets KEY METRIC: GLOBAL RECOGNITION OF VASCULAR PATIENT

➢ Flag vascular patients in Epic who have a diagnosis of PAD, PVD, or AAA and trigger smarttext to address antiplatelet and statin medications. ANTIPLATELET AND STATIN THERAPY AT DISCHARGE *EXCLUDES PTS WITH A CONTRAINDICATION OR NON-COMPLIANCE

1/1/2016 – 6/30/2019

Discharge Medications

120%

97.5% 98.0% 100.0% 99.5% 96.0% 100%

82.0% 88.0% 80.0% 80%

60%

40%

% OF PTS RECEIVING RECEIVING ANTIPLATELET+STATIN %PTS OF 20%

0% 2016 2017 Qtr 1 2018 Qtr 2 2018 Qtr 3 2018 Qtr 4 2018 Qtr 1 2019 Qtr 2 2019

Interventions • Added smarttext in progress note template – added on 5/1/17 • Communication of the initiative sent to primary care providers and hospitalist team - sent out 10/20/17 • Modify vascular order sets to include antiplatelet and statin use – Went into production 6/7/18 CONTROL PLAN

Fallouts = Patients who were discharged by a service other than vascular.

Problem = Other services are not aware to continue medications started in the hospital

Solution = Implement vascular discharge summary smarttext

Educate non-vascular providers SUSTAINING IMPROVEMENTS

❖ Continue to monitor discharge medication compliance Track on Spreadsheet, note fallouts, and report quarterly

❖ Documentation compliance Query added to EMR and sent to provider when an antiplatelet/statin is not prescribed SUSTAINING IMPROVEMENTS

❖ Continue to promote initiative awareness Quality article featured in hospital campus newsletter

Discharge Medication Poster presented at the local State of the Art Nursing Conference For further details or questions, contact Tracy Campin at [email protected] End of Data Managers Meeting

• Questions? • Comments?? • Discussions???

26 Mid-America Vascular Study Group (MAVSG)

September 11th, 2019 Data Manager's Meeting: 9:00 - 9:50 AM Main Meeting 10:00 AM - 3:00 PM

Central DuPage Hospital, 25 N Winfield Rd, Winfield, IL 60190 Let us take a moment to remember ….. Thank you for Hosting!!!!

Dr. Joe Schneider, MD et al and Barbara Johnson and Heidi Terry – our awesome event planners at Central DuPage!

Thank you again! 30 MAVSG Meeting Agenda

Welcome and Introduction David Chew, MD Old Business / Approve Spring 2019 Minutes David Chew MD National VQI Update Carrie Bosela, SVS PSO AQC Update Trissa Babrowski, MD VQC Update Ravi Hasanadka, MD RAC Update Nick Nolte, MD GC Committee Update David Chew, MD Regional Data Review David Chew, MD Lunch Break – 12:30 ish Afternoon Presentations: “BMI and Fluoroscopy Time in PVI” Nick Nolte, MD “Using the VQI to Improve Transfusion Practices in Lower Extremity Arterial Bypass” Dr Matt Chia MD “Visceral and Peripheral Interventions for Malperfusion after TEVAR for Type B Dissection” Dr Rhami Khorfan MD MS “Effect of Abdominal Aortic Aneurysm Size on Endoleak, Secondary Intervention and Survival Following EVAR Dr Benjamin Ferrel DO Discharge Statin and Antiplatelet Lorraine Zacarias, RTR, CI, VI New Business / Meeting Evaluation / Next meetings David Chew, MD

Adjourn! Safe travels home and thank you for attending!! Welcome and Introductions

Barnes Jewish Hospital UnityPoint Health Des Moines Carle Foundation Hospital University of Chicago Medical Center Columbia Surgical Services, Inc. University of Kansas Hospital Authority Flint Hills Heart, Vascular, Vein Clinic, LLC University of Missouri Medical Center Gilvydis Vein Clinic Weiss Memorial Hospital Iowa Heart Center at Mercy Medical Center University of Iowa Hospitals and Clinics Mercy Hospital Springfield Memorial Hospital of Carbondale Mercy Hospital St. Louis St. Luke's Methodist Hospital Nebraska Medicine Alexian Brothers Medical Center NorthShore Hospital Loyola University Medical Center Central DuPage Hospital Advocate Good Samaritan Hospital Northwestern Memorial Hospital Saint Francis Medical Center OSF Saint Anthony Medical Center Kansas Heart Hospital OSF Saint Francis Medical Center Bryan Medical Center OSF St. Joseph Medical Center Nebraska Methodist Hospital Saint Luke's Hospital of Kansas City AMITA Health Adventist Medical Center La Grange Southern Illinois University School of Medicine Decatur Memorial Hospital SSM DePaul Health Center Loyola MacNeal Hospital SSM Saint Louis University Hospital Loyola Gottlieb Memorial Hospital SSM St. Clare Health Center The Methodist Medical Center of Illinois SSM St. Joseph Health Center Menorah Medical Center SSM St. Mary's Health Center St. Anthony's Medical Center Saint Luke's Episcopal Presbyterian Hospital Old Business

Changes to the By-laws discussed at our spring meeting and our spring meeting minutes were posted to our regional web site. No objections or corrections were received Any old business for discussion? Motion to approve the spring minutes ? Second ?

33 National VQI Update:

Carrie Bosela, SVS PSO Welcome – Newest Center to MAVSG

MercyOne Siouxland Medical Center Dr. Chad Laurich Chad.laurich@.com 18 Regional Quality Groups Number of Participating Centers Location of VQI Participating Centers

600 Total VQI

500 Procedures: now 625,251

400

300

VQI

200 602 VQI Centers 100 601 centers in North America- 46 States and Canada

0 1 center in Singapore

Jul-10 Jul-11 Jul-12 Jul-13 Jul-14 Jul-15 Jul-16 Jul-17 Jul-18 Jul-19

Jan-10 Jan-11 Jan-12 Jan-13 Jan-14 Jan-15 Jan-16 Jan-17 Jan-18 Jan-19 Total Procedures Captured 625,251 VQI Total Procedure Volume (as of 9/1/2019) 700,000 Peripheral Vascular Intervention 200,124 600,000 Carotid Endarterectomy 126,825

Infra-Inguinal Bypass 55,222 500,000 Endovascular AAA Repair 51,218 400,000 Hemodialysis Access 50,379

Carotid Artery Stent 33,621 300,000 Varicose Vein 32,823 200,000 Supra-Inguinal Bypass 18,361 Thoracic and Complex EVAR 15,646 100,000 Lower Extremity Amputations 15,379 0

IVC Filter 12,938

Jun-14 Jun-15 Jun-16 Jun-17 Jun-18 Jun-19

Oct-14 Oct-15 Oct-16 Oct-17 Oct-18

Apr-15 Apr-14 Apr-16 Apr-17 Apr-18 Apr-19

Feb-14 Feb-15 Feb-16 Feb-17 Feb-18 Feb-19

Dec-16 Dec-14 Dec-15 Dec-17 Dec-18

Aug-15 Aug-16 Aug-17 Aug-18 Aug-19 Open AAA Repair 12,715 Aug-14 Total Procedure Volume tab reflects net procedures added to the registry for the month Potential New Sites SVS PSO Staffing Update:

Kristopher Huffman has been hired as the new Director of Analytics Kristopher comes to us from ACS NSQIP Kristopher will start on September 3rd Dan Neal will continue on as a part-time employee of the PSO Actively Recruiting for Clinical Operations Associate Position will report to Carrie Bosela Position will assist with data audits, responding to clinical questions and updating and maintaining the registries Position will be the lead interface with regional data managers Position will attend regional and national meetings SVS PSO Staffing Update:

SVS PSO will be hiring an Associate Medical Director A RFA will be issued by the end of August and the position will be filled by March 2020 Position will report to the PSO’s Medical Director, Dr. Jens Eldrup-Jorgensen The initial focus will be to assist the SVS PSO Medical Director and SVS PSO staff, with guidance and oversight its clinical operations.  There will be a specific emphasis placed on attaining a deep understanding of the construct of the variables in each SVS VQI registry and then assisting with the development and maintenance of the registries and associated reporting and analytics. VQI@VAM Highlights:

Expanded Concurrent Abstraction Sessions – Consider adding Data Managers as presenters – Add more structured Q&A – Need more detailed Op Notes

Continued Growth of Poster/Networking Session – People commented on not only the increased number of posters, but the diversity and quality of topics – More time allotted for QI presentations – Will hold QI presentations to given timeframes, going forward

New Topics/Presentations Received High Praise – Opioid Crisis/ERAS Expert Panel – Limb Amputation/Preservation – Registry Operations Support VQI@VAM 2019

Attendance 161

60/40 split – Data Manager/Physician

3.24/4.00 Meeting Evaluation Rating

Who attended?

Feedback? How do we improve? Mid-America Papers & Posters

Nick Nolte, MD (OSF ST. Francis Peoria) “BMI and Fluoroscopy in PVI” Joe Schneider “Results of Carotid Endarterectomy in Patients with Contralateral Internal Carotid Artery Occlusion” From The Mid-America Vascular Study Group and The Society for Vascular Surgery Vascular Quality Initiative David Chew “The Effect of Abdominal Aortic Aneurysm Size on Endoleak, I Secondary Intervention and Survival following EVAR” Quality Improvement Activities Quality Improvement Webinars:

2019 Quarterly Webinars February 2019 “Starting a QI project” May 2019 “Code Rupture: Establishing A Protocol for the Patient With a Ruptured Aneurysm” September 2019 Educational – Methodology, QI tools Case studies from participants November 2019 Wrapping up a QI project, 2020 Participation Award Information Recap of 2018 QI Projects

Putting Data into Action See what your colleagues are doing with QI Twenty five posters were presented at the 2019 VQI@VAM Eight charters were featured in the poster presentations Three charters became podium presenters Ten poster presenters were podium presenters Four posters were based on the national VQI initiatives: D/C Medications and EVAR Imaging LTFU Quality Improvement Details: Charter Information

1. Activity Documentation Score

1. QI Project Initiation Attestation to include: 2 points • QI Project Title • Problem Statement Can be submitted at • Project Leader anytime • Clinical Sponsor • Expected start date

Form can be accessed at https://www.vqi.org/vqi- resource-library/quality-improvement/

• Project charters should be emailed to [email protected] or [email protected] Charters

Charter participants become part of focused group calls Interactive discussion sharing barriers and successes Sharing of charters Networking Checking in – where are you in the process Celebrating success

One on one calls, if requested Newsletters

The VQI News Distributed every other month Provides updates on regulatory issues, technical updates, and crossover news from the SVS and SVN VQI Quality Improvement Newsletter Distributed every other month Focusing on QI processes, tools, and definitions Quality Improvement Details for 2019 Participation Awards:

6-point maximum credit for QI even though additional points can be acquired Each VQI center submits one QI project per center for the Participation Award Reminder: Eligibility requirement - Participation in VQI for at least 12 months Final scoring completed: January 31, 2020 Star Ratings communicated in March 2020 Participation Awards: 2019

Scoring LTFU (40%) Regional Meeting attendance (30%) QI Project (20%) Registry subscriptions (10%)

Participation Committee is in the process of reviewing criteria for 2020 awards Participation Awards:

3 Star recipients received certificates at the Spring Regional and National Meeting

View pictures on your region’s website at www.vqi.org 3 Star Award Recipients

OSF Saint Francis Medical Center 3 Star Award Recipients

• Vascular Surgeons at Iowa Heart Center National QI project details

For general inquiries about the Participation Awards, please contact Cheryl Jackson at [email protected] or Jim Wadzinski at [email protected].

Submit Project Charters and supporting documentation for presentations and posters to [email protected] or [email protected].

Visit the VQI Members Only Website for webinars and presentations on VQI Quality Improvement Projects. www.vqi.org 2019 Reports:

Quarter 1: – Spring Regional Reports, – QI Update: EVAR LTFU Imaging Update/Risk Calculator – Performance Awards Quarter 2: – QI Initiative Updates – DC meds and EVAR LTFU imaging – Center and System Dashboards Quarter 3: – Fall Regional Reports – QI Initiative Updates – DC meds and EVAR LTFU imaging – Center and System Dashboards Quarter 4: – QI Initiative Updates – DC meds and EVAR LTFU imaging Registry Updates:

Hemodialysis Access: In development and will be released in Q3 2019 Venous Stent Registry: Specifications finalized, to be released in Q3 2019 Varicose Vein: Specifications finalized, to be released in Q4 2019 Vascular Medicine Registry: Specifications finalized, to be released in Q4 2019 Research Advisory Council

Nick Nolte, MD [email protected] Change in RAC Policies!

Policy on RAC Requests Related to Industry Studies Policy on Device Identification for approved RAC Requests Conflict of Interest Policies Revised based on these new Policies All posted on the VQI Web Site National Research Process

Proposal Submissions

October 2019 Call for Proposals: August 13, 2019 Due Date: September 16, 2019 Meeting: October 7, 2019 Notification Sent: October 8, 2019 RAC Update - Reminder

No Restriction of data release based on similar projects; collaboration is encouraged Only 1 refresh of data within 24 months of initial approval Industry related projects need to collaborate with the steering committee/s (i.e. TCAR) – Review policy and industry charters on the web Device Identification Policy: review on the web before submitting proposal National Research Process

Check Approved Project List https://www.vqi.org/data-analysis/rac- approved-project-search/

To submit a proposal to be considered for the National RAC, please follow the link below: http://abstracts123.com/svs1/meetinglogin Arterial Quality Council:

Trissa Babrowski, MD [email protected] AQC:

 Opioid Workgroup is formed and charged with putting forth recommendations on how the VQI can be used to track, monitor and benchmark opioid utilization.

 Continued refinement to Global Unique Device Identification Database (GUDID) integration in PVI, with planed expansion to other registries.

 Initiating Future Registry Updates – Harmonizing Demographics and Meds across all registries – Updating Infra/Supra Registries – Updating OAAA

 Provided Education and Clarification on recording “Other Devices” and IDEs Venous Quality Council:

Ravi Hasanadka, MD

[email protected] [email protected] Venous Quality Council

Council and Committee Transition – Dr. Almeida is in his last year as Chair of VQC – Succession needed for VV Registry committee chair

 Potential for Formation of a separate RAC for Venous

 Continued Interest from United Healthcare on collaborating on Appropriateness for Ablations. Could eliminate the need for pre-authorizations.

67 Resigning from the VQC?

Dr. Ravi Hasanadka has changed hospitals to Heart of Mary Medical Center, a OSF center in Urbana which is not currently a SVS VQI participant. Given there will be a gap before they join the MAVSG, and his three year term is over this fall 2019, he feels it will be best to resign. With sadness & gratitude -we will accept nominations, for a vote, for a new VQC chair for our region.

Thank you Dr. Hasanadka for your excellent leadership and participation

the68 past 3 years! Governing Council:

David Chew, MD [email protected]

James Ebaugh, MD [email protected] GC meeting at VAM

Vote on new Executive Committee Member – Dr. Yazan Duwayri, Emory University

 Presentation on Potential New Cost Project – Expanding upon the EVAR Cost Pilot Project

 Need for New RAC Policies – Revised Data Use Agreements – Non-VQI members cannot have access to VQI BDS – How to handle center id in Regional Data Sets Regional Reports: Fall 2019 David Chew, MD and James Ebaugh, MD

Notes: 1) In all reports, regional data are not shown for regions with <3 centers participating in the applicable registry.

2) In “by Center” bar charts, unless noted, data are not shown for centers with <10 cases.

3) In all graphics, “*" indicates a p-value<.05.

4) This report includes all data that had been entered into the71 VQI as of June 30, 2018. Dashboard

76

Lets Celebrate our Improvement!!!

FLASHBACK: 2013 overall dropped to 60%!! (Dr Schneider will remember this all to well)

To now… And now… nine centers at 85% or better! 80

86

89

92

95

98

101

104

107

110

113

118

123

126 Lunch Break! Afternoon Presentations: Dr Nick Nolte MD – “BMI and Fluoroscopy Time in PVI” Dr Andrew Hoel MD/ Dr. Ashley Vavra MD / Dr Matt Chia MD – “Using the VQI to Improve Transfusion Practices in Lower Extremity Arterial Bypass” Dr Mark Eskandari MD / Rhami Khorfan MD– “Visceral and Peripheral Interventions for Malperfusion after TEVAR for Type B Dissection” Dr David Chew MD / Dr Benjamin Ferrel DO – “The “Effect of Abdominal Aortic Aneurysm Size on Endoleak, Secondary Intervention and Survival following EVAR” Lorraine Zacarias RTR, CI, VI – Discharge Statin and Antiplatelet128 “BMI and Fluoroscopy Time in PVI”

Dr Ryan Nicholas Nolte MD Vascular Specialist OSF St Francis Vascular Institute “Using the Vascular Quality Initiative to Improve Transfusion Practices in Lower Extremity Arterial Bypass”

Matthew C Chia MD Resident Physician, Postdoctoral Research Fellow Division of Vascular Surgery, Feinberg School of Medicine, “Visceral and Peripheral Interventions for Malperfusion after TEVAR for Type B Dissection” Dr Rhami Khorfan MD MS Resident Research Fellow Department of Vascular Surgery/ Surgical Outcomes and Quality Improvement Center Northwestern University

<#> 131 <#> 132 <#> 133 <#> 134 <#> 135 <#> 136 <#> 137 <#> 138 <#> 139 <#> 140 <#> 141 <#> 142 “The Effect of Abdominal Aortic Aneurysm Size on Endoleak, Secondary Intervention and Survival following EVAR”

Dr Benjamin Ferrel DO Resident Physician / Surgery MercyOne / Iowa Heart Center Des Moines, Iowa Discharge Statin and AP

Lorraine Zacarias RTR, CI, VI Clinical Data Coordinator Cardiovascular Institute OSF Healthcare, Peoria IL New Business

How often should Executive Council Meet? TCAR / CAS will be separate for Spring Regional 2020 reports! Region size and number of sites – any reason to change? CME credits for Regional meetings – cost? History of MAVSG Meeting sites: When and Where: Planning

Next MAVSG Regional Meeting:

Spring 2020 -- Nebraska Medical April 6th, 2020

Volunteers for Fall 2020????? And beyond? Note: the 2020 Midwest Vascular will be in Minneapolis- outside our region - so where would we like our fall meeting? Thank you!!! Cook and Gore

Because our region has elected not to collect dues / fees, we are completely at the mercy of vendors to provide educational grants we can use to pay for food, meeting room space, AV / IT support, and even parking. Please take the time to thank your local vendors for their generous educational grants to support our regional meetings! Cook and Gore provided support for this mtg Meeting Evaluation:

Its your meeting………. What did you like about this meeting?  What can we do better? Suggestions/comments always welcome! We are Adjourned! THANK YOU!!