2021 TABLE OF CONTENTS

1. Executive Summary: The Value of Participation in the SVS VQI 1 2. 10th Anniversary Timeline 2 3. Introduction to the SVS VQI 3 4. Impact of COVID-19 4 5. SVS VQI Members Profile 5 6. Launch of VQI Trainee Program 6 7. Data Quality Dashboards 7-8 8. Regional Quality Groups 9 9. Quality Improvement Methods: Learning from the Data 10 10. National Quality Improvement Initiatives 11 11. SVS VQI Data Analysis 12 12. SVS Guidelines and the SVS VQI 12 13. Collaboration with Societies 13-14 14. MYPAD PILOT FOR PATIENT REPORTED OUTCOMES 14 15. Using SVS VQI Data for Collaborative Projects with FDA & Industry 15 16. Corporate Support 15 17. Registry Assessment of Peripheral Interventional Devices (RAPID) Update 16 18. International Consortium of Vascular Registries (ICVR) Update 17 19. The SVS VQI and Compliance with the EUMDR 17 20. Technology & Registry Developments 18 21. Future Developments 18

APPENDICES

A. Participating Sites 20 B. SVS Patient Safety Organization Structure 23 C. FIVOS (FORMERLY MEDSTREAMING/M2S) Technology Partner 23

SVS VQI 2021 Annual Report 1. EXECUTIVE SUMMARY - THE VALUE OF PARTICIPATION IN THE SOCIETY FOR VASCULAR SURGERY (SVS) VASCULAR QUALITY INITIATIVE (VQI)

The mission of VQI is to improve the quality of vascular aware of their performance and comparison to care using a data driven approach but sometimes regional and national benchmarks. things happen. In 2020, COVID-19 got in the way and then didn’t go away. VQI had to learn how to Each center receives quarterly dashboards and continue operations in the face of multiple obstacles regular performance reports to allow them to do and we had to learn about the impact of COVID-19 meaningful quality assurance and focus their quality on vascular patients. As has been said, in adversity improvement initiatives. Biannual regional meetings there is opportunity. Many VQI centers learned that allow physicians, nurses, data managers, quality important follow up could be done by telemedicine officers, and others to meet, share information and accurately and efficiently. COVID-19 variables were ideas, and learn from each other in a positive and added to the registries so that we could see the supportive environment. Members have used SVS influence on vascular procedures and determine VQI data to significantly improve the delivery of the incidence of conversion while hospitalized. VQI vascular care at a local and national level thereby also learned that virtual or remote regional meetings reducing complications and expenses. had many advantages. Attendance was markedly increased due to the lack of necessity for travel Investigators have used SVS VQI data for – reducing the time commitment and expense. risk stratification, outcomes analysis, quality Regional medical directors adapted to the virtual improvement, defining best clinical practices, format encouraging participation and interaction comparative effectiveness research and reducing with online attendees. The virtual meetings were resource utilization. This work has resulted in more considered to be an unqualified success. VQI plans than 429 scientific publications in peer-reviewed to continue to offer remote attendance as we journals since 2011. SVS VQI membership also (hopefully) return to in-person meetings in the future. facilitates participation in clinical trials and other One downside was the inopportune time to offer medical device evaluation projects. new registries. In 2020, the Medical Consult Registry and the Venous Stent registry were released. Due The SVS VQI collaborates with multiple other to the pandemic, hospital resources and attention organizations, including the American Venous has been directed elsewhere and uptake in the new Forum (AVF), American Heart Association (AHA), registries has been disappointing. Society for Vascular Medicine (SVM), Vascular Access Society of the Americas (VASA), Society for January 2021 marked the official start of the Vascular Ultrasound (SVU), governmental regulatory American College of Cardiology (ACC) National agencies, device manufacturers, and payers. The Cardiovascular Data Registry (NCDR) Peripheral Registry Assessment of Peripheral Interventional Vascular Intervention (PVI) registry merger with Devices (RAPID) is a public/ private partnership the SVS VQI. The collaboration of the two premier which uses the strength of different societies (SVS, vascular registries joins the forces and expertise of ACC, and SIR) and their registries to enhance device both. Many of the NCDR PVI sites have already joined evaluation and to develop objective performance VQI and more are in the process. We welcome our criteria for the endovascular treatment of lower- NCDR PVI colleagues and look forward to working extremity arterial occlusive disease. SVS VQI also with them. works with industry to provide clinically detailed data for device performance, post-market surveillance, The VQI registries continue to have strong growth and label expansion. SVS VQI has partnered with in participation by new centers and providers. SVS vascular registries from Europe and Asia to form the VQI’s 14 registries contain demographic, clinical, International Consortium of Vascular Registries (ICVR) procedural and outcomes data from more than to bring a global perspective to improving vascular 800,000 vascular procedures performed nationwide care and device evaluation. and in Canada, Puerto Rico and Singapore. Each record includes information from the patient’s initial We feel strongly that the best is yet to come. treatment and one- year follow-up. Over 10,000 new procedures are added monthly. The wealth of data Dr. Jens Jorgensen in the registry allows centers and providers to be SVS PSO Medical Director 1 www.VQI.org 2. 10TH ANNIVERSARY TIMELINE

• Formation of Vascular Quality Initiative with Society for 2011 Vascular Surgery based on the Vascular Study Group of • Expansion to 8 VQI New England Regional Vascular Study • Establishment of SVS Patient Group 2012 Safety Organization, LLC • Analytics and Reporting Platform for regional/ national benchmarking • Collaboration with American Venous Forum (AVF) 2013 • Launch IVC Filter Registry • First Post-Approval Study • Launch of Lower Extremity TEVAR Dissection Project Amputation Registry • Inaugural meeting ICVR (International Consortium 2014 • Collaboration with Registry of Vascular Registries) • Launch of Varicose Vein Assessment of Peripheral Registry Vascular Devices (RAPID) • Launch of Vascular Implant Surveillance and 2015 Interventional Outcomes • Integrated Global Unique Device Identification Network (VISION) in Database (GUDID) in PVI collaboration with Medical Registry Device Epidemiology • Initiated TransCarotid 2016 Network ( MDEpiNet ) Arterial Revascularization Epidemiology Network) Surveillance Project (TSP) in collaboration with CMS • Inaugural VQI@VAM 2017 meeting • Implementation of Source • Participation Awards and Data Audits Star Recognition • Implementation of Quality • 8 Regional Groups formed, Improvement Project including Canada Charters 2018 • 500 Participating Sites, 500,00 Procedures and 3000 Participating • Collaboration with SVS 2019 Clinical Practice Guidelines and VQI data • Data Extraction and Longitudinal Trend Analysis (DELTA) • Merger of ACC NCDR with Paclitaxel Analysis 2020 VQI • Publication of VQI • Launch of Patient Report Paclitaxel Data Outcomes (MyPAD) in PVI • Launch of Vascular Registry Medicine Consult Registry • Publication VQI COVID Data • Launch of Venous Stent 2021 • Publication Objective Registry Performance Goals (OPG) • Integration of COVID Superficial Femoral-Popliteal variables into the registries Evidence Development (SPEED) • Development of Trainee Program

2 SVS VQI 2021 Annual Report 3. INTRODUCTION TO THE SVS VASCULAR QUALITY INITIATIVE POTENTIAL BENEFITS OF VQI FOR KEY STAKEHOLDERS The SVS VQI is a collaboration of the SVS Patient Safety Organization (PSO), 18 regional quality improvement groups, and Fivos (Formerly Medstreaming/M2S), its For Patients commercial technology partner. The mission of SVS VQI •Improve care based on SVS VQI data and is to improve the quality, safety, effectiveness, and cost quality initiatives of vascular healthcare. •Use best practices to reduce length of stay •Improve long-term outcomes through The SVS PSO is a wholly owned subsidiary of the Society emphasis on follow-up and secondary for Vascular Surgery, with headquarters in Chicago. The prevention SVS PSO governs all functions of SVS VQI, including the specification of data elements captured in each registry, For Physicians/Providers the standard reports made available to regional groups, •Adopt best practices through SVS VQI data member hospitals and physicians, and SVS VQI national analysis quality improvement projects. •Improve care through quality initiatives and charters The SVS PSO is supported by over 250 physician volunteers who dedicate their time and effort in support of SVS •Monitor performance by comparison with VQI mission. These physicians provide content expertise, regional and national benchmarks advice, clinical support to all the registries and data •Improve patient selection using SVS VQI risk analyses and ad-hoc support in areas such as industry assessment calculators partnerships and communications. In addition, each center and region have lead physicians and regional For Hospitals and Quality Officers medical directors to provide guidance, identify best •Improve care by quality initiatives and practices and develop regional initiatives. projects •Regional and national benchmarks for QA The SVS PSO operations are funded by annual registry and QI efforts subscription fees from participating hospitals or physician •Reduce expenses by addressing resource groups. Enhancements, upgrades and new projects are utilization and length of stay funded by contributions from corporate supporters. For Policymakers •Better data to inform decision making on policy development •Monitor safety and efficacy using real world evidence •Work collaboratively with the SVS to develop quality measures

For Payers •Adopt best practices to provide better care and reduce complications and expenses •Inform population health approaches through use of comparative data •Reduce expenses due to decreased length of stay and resource utilization

For Industry Enhance efficiency for label expansion using registry data •Utilize registry-based trials for pre-market approval and post-market surveillance •High quality, large scale, real world data for evaluation of device performance

3 www.VQI.org 4. IMPACT OF COVID-19 THE SVS VQI REGISTRIES There was an abrupt shutdown nationally of routine elective vascular surgery procedures by March 15, 2020, As of June 1, 2021, there are 14 SVS VQI registries following a plea from the US Surgeon General to help that contain 831,524 vascular procedures. From ‘Flatten the Curve’. As a result, volume in the SVS VQI June 1, 2020 through June 1, 2021, there were dropped 7-fold for arterial procedures and 5-fold for over 119,000 procedures added to the registries. venous procedures during mid-March to end of May in 2020 when compared to the same period in 2019. To monitor COVID-19 impact on vascular procedures, Total Procedures the SVS PSO incorporated new variables in all of the 831,524 procedural registries as of September 2020: Captured as of 6/1/2021

• COVID-19 testing availability at time of procedure • COVID-19 symptoms at time of procedure Peripheral Vascular Intervention 276,534 • Determination if COVID-19 delayed procedure or evaluation prior to procedure Carotid Endarterectomy 158,738 • Judgement by clinician if delay affected patient care adversely Infra-Inguinal Bypass 68,247 • For LTFU: If patient has experienced COVID-19 infection since the time of the procedure and Endovascular AAA Repair 64,382 symptom status Hemodialysis Access 64,233 Collaborations/Publications/Presentations this past year: Carotid Artery Stent 56,793

• Seminars in Vascular Surgery publication: The Varicose Vein 46,726 Impact of COVID-19 Pandemic on Registries and Clinical Trials Supra-Inguinal Bypass 21,940 • Two JVS Publications (JVS & JVSVL) on registry volumes Thoracic & Complex EVAR 21,445 • AHRQ PSO Presentation on VQI Response • Collaboration with Vascular Surgery COVID-19 Lower Extremity Amputations 21,364 Collaborative (VASCC) IVC Filter 15,952 Review of primary outcomes in VQI Registry Data since insertion of COVID variables (Sept 2020 through Open AAA Repair 14,147 Feb 21) yielded the following results: Vascular Medicine Consult 118 • Overall, > 97% of variable inclusion rate for COVID status in all registries Venous Stent 43 • Only 1.2% of patients tested positive for COVID- 19 restrictive practices in place and/or patient hesitation/reluctance to seek treatment during pandemic VQI Procedure Volume Growth • Baseline overall mortality across registries of 1.4% rose to 1.6% during time interval while baseline mortality for elective patients who 900,000 were asymptomatic and COVID (Test negative) remained unchanged 800,000 • Patients having a COVID (Test positive) yet 700,000 Asymptomatic had mortality > twice that of negative COVID test patients (odds ratio 2.4) 600,000 • Presence of any COVID symptom (aggregate) 500,000 had mortality of ~4.6 times that of an Asymptomatic and (Test negative) patient (odd 400,000

ratio 5) 300,000 • Mortality of Symptomatic and Intubated patient exceeded 33% across registries 200,000 • There was minimal difference in mortality across geographic regions 100,000 • Further evaluation will be done on secondary 0 procedure outcomes such as MI, CHF, respiratory Nov-14 Nov-15 Nov-16 Nov-17 Nov-18 Nov-19 Nov-20 failure, graft failure etc. May-14 May-15 May-16 May-17 May-18 May-19 May-20 May-21 • LTFU analysis of COVID variable data will require waiting until Sept 2023 for completeness 4 SVS VQI 2021 Annual Report 5. SVS VQI MEMBERS PROFILE

Participation in SVS VQI continues with steady growth reaching over 800 centers including office-based laboratories by the end of May 2021 (Figure 5.1). There is a broad distribution of different practice types – 29% academic institutions, 29% teaching hospitals and 42% community hospitals (Figure 5.2). There is also broad distribution of physician specialties – less than half vascular surgeons, 15% interventional cardiology, 14% interventional radiology, 6% general surgery, 4% cardiothoracic surgery and 4% neurosurgery (Figure 5.3).

Growth of VQI Centers 900

800

700

600

500

400

300

200

100

0 Jul-15 Jan-12 Jan-19 Jun-11 Jun-18 Oct-13 Oct-20 Apr-10 Feb-16 Apr-17 Sep-16 Dec-14 Aug-12 Aug-19 Nov-10 Nov-17 Mar-13 Mar-20 May-14 May-21

Source: M2S PATHWAYS Data, June 2021 Types of Affilia�on,Figure 5.1: Growth VQI of Centers SVS VQI Centers (as of June, 1, 2021)

4% 3% 29% 4%

6%

42% 7% 47%

15%

14%

29% Vascular Surgery Radiology Cardiology Other General Surgery Cardiothoracic Surgery Community Academic Teaching Neurosurgery None

Source: PATHWAYS data, June 2021 Source: PATHWAYS Data, June 2021 Figure 5.2: SVS VQI Participating Hospital Types Figure 5.3: Distribution of SVS VQI Physician Specialties

5 www.VQI.org • Mentor directed FIT involvement of Regional 6. LAUNCH OF VQI TRAINEE Study groups with both passive and active PROGRAM participation within meeting structure (prep calls, present comparative data, new QA/QI VQI wants to help medical students, residents projects, local quality charters,etc) and fellows learn about quality improvement! • Minimum program duration of one year with goal of generating work product focused on Purpose: quality improvement at local/regional/national To foster understanding of quality process and level metrics among Vascular Surgery Residents, • Potential selection of FIT work product (after GC Fellow and Medical Students (‘trainees’) through review) for presentation at VQI@VAM mentorship in the Vascular Quality Initiative (VQI) • Scholarship awarded to those Tier 1 Applicants in collaboration with the Association of Program (limited number) to advance to Tier 2 level Directors in Vascular Surgery (APDVS). which increases engagement with PSO staff and committee meetings Proposal: • Communication back to FIT program of their The SVS/PSO proposes a mentorship program involvement/participation in VQI and PSO to for trainees to learn about surgical quality help fulfil educational requirements of training improvement and research with a focus on vascular disease. Selection of FITs would come from application to the Society for Vascular Surgery (SVS) Patient Safety Organization (PSO) VQI. FITs will be assigned a mentor(s) within one of eighteen VQI Regional Quality Groups as directed by the SVS PSO Governing Council and staff. Any active VQI member meeting requirements can volunteer to serve as a mentor in the program. Regional or Associate Medical Directors are strongly encouraged to take a leadership role in this initiative.

Vascular Trainee Work Group established in July 2021 to formalize program: Introducing Audible Bleeding • Governing Council directed and monitored program for matching resident or fellow in Another great resource for trainees and practicing training (FIT) with approved VQI mentor to vascular surgeons (especially those who are early increase knowledge and familiarity with VQI in their careers) is Audible Bleeding - a vascular and the PSO surgery focused podcast that is now an official • FIT Application and selection process for publication of SVS! residents and fellows in vascular surgery/ cardiology/vascular medicine programs; listed In July 2021, the Getting Started Using the VQI for as Tier 1 applicant Research episode featured a panel discussion with Drs. Leila Mureebe, Jeff Siracuse, and Philip Goodney. Click here to listen to the podcast: https://www.audiblebleeding.com/vqi-research- intro/

In April 2021, Dr. Jack Cronenwett participated in a podcast titled History of the APDVS, the vascular integrated residency, and the VQI. Click here to listen to this podcast: https://www.audiblebleeding.com/2021/04/12/ apdvs-lifetime-achievement-in-education- award-winner-dr-jack-cronenwett-history-of-the- apdvs-the-vascular-integrated-residency-and- the-VQI/

For a complete list of Audible Bleeding pocasts, click here: https://www.audiblebleeding.com/episodes-1/ 6 SVS VQI 2021 Annual Report 7. DATA QUALITY DASHBOARDS & REGIONAL REPORTS

The SVS PSO Best Practice Dashboards allow centers to review their performance and compare to regional and national benchmarks. The SVS PSO registry committees select outcome measures to be reported in the dashboards, which are distributed quarterly to SVS VQI members. The dashboards provide each center their individual results, along with results for their region and SVS VQI overall. Results that are in the “top” 25th percentile are highlighted blue and those in the “bottom” 25th percentile are highlighted coral.

PVI CLAUDICATION

7 www.VQI.org PVI CHRONIC LIMB THREATENING ISCHEMIA

8 SVS VQI 2021 Annual Report 8. REGIONAL QUALITY GROUPS

SVS VQI has 18 regional quality groups based on geographic proximity (Figure 8.1). Regional quality group meetings are in important aspect of SVS VQI and a key component to successful quality improvement. Regional groups distinguish SVS VQI from almost all other registries. Each of the 18 groups hold biannual meetings that provide a forum for discussion on outcomes analysis and work on quality improvement.

Figure 8.1: SVS VQI Regional Group Map

During each region’s bi-annual meeting, data are reviewed and discussed by the members present. Many groups identify an area for improvement and launch region-wide efforts to improve care. Topics that have been addressed include:

• Recording of hemodynamic data (ABI/Toe Pressure) prior to peripheral intervention • Measuring aneurysm sac diameter one year following EVAR and TEVAR • Increasing rates of IVC filter retrieval • Reducing LOS for CEA and EVAR Increasing LTFU rates • Increasing statins and antiplatelet prescriptions at discharge • In hospital Stroke/Death for CEA, TFEM CAS, and TCAR • Compliance with SVS EVAR sac size guidelines • Compliance with SVS Cell-saver guidelines

Some regions have also used “hashtags” to collect unique data for quality improvement: • Factors contributing to renal failure • Frailty of Vascular Patients • Patient Reported Outcomes • Smoking Cessation • Causes of Delirium with Vascular Patients • EVAR SAC diameter size compliance with SVS Guidelines 9 www.VQI.org 9. QUALITY IMPROVEMENT PROJECTS: LEARNING FROM THE DATA

The SVS PSO offers a variety of resources for Participating centers can earn up to three stars participating centers to improve care utilizing SVS based on the following criteria: VQI data. The SVS PSO encourages participating centers to submit quality improvement (QI) charters • The completeness of long-term, follow-up on projects using their own center data. This process reporting (LTFU) based on the percentage of has helped the SVS PSO identify groups working on patients for whom they have at least nine months similar initiatives and facilitate collaboration and of follow-up data networking opportunities. • Attendance at semi-annual meetings of a regional quality group and VQI@VAM Quality Improvement Projects • Initiation of quality improvement activities based SVS VQI centers work on quality improvement on VQI data projects which may be selected for presentation • The number of vascular registries in which the at the VQI Annual Meeting in June. These projects center participates are often related to the National QI Initiatives on Discharge Medications or Endovascular AAA SVS VQI centers work on quality improvement Long Term Follow-Up Imaging but can address any charter projects throughout the year. These projects vascular topic supported by VQI data. The SVS PSO are often related to the National QI Initiatives of provides resources to assist SVS VQI centers with Discharge Medications or Endovascular AAA Long their QI projects. Term Follow-Up Imaging, but can address any vascular topic supported by VQI data. Quality Improvement Tools The SVS PSO, together with M2S, develops quality improvement tools to assist VQI members, vascular nurses, quality improvement staff and hospital administrators with their own vascular quality programs.

These tools include: • Presentations • Webinars/Events • VQI Annual Meeting (presentations and videos available for attendees only) • QI Project Guide (for VQI members only) • Video/audio • Case studies

Participation Awards The SVS PSO encourages provider and center engagement through a program of annual Table 9.1 – Quality Improvement Projects to Date Participation Awards. Participation Awards are given on the basis of long-term follow-up rates, regional meeting participation, quality improvement initiatives and registry participation. The Participation Awards program encourages active involvement in the registries and QI activities. Certificates are distributed to centers receiving the maximum award level at the regional and national meetings.

10 SVS VQI 2021 Annual Report 10. NATIONAL QUALITY educational tutorials for staff. They continue to increase their LTFU compliance rate today. This is IMPROVEMENT INITIATIVES— an exemplary demonstration of using VQI data to OPTIMAL DISCHARGE improve care.

MEDICATIONS AND EVAR Optimal Discharge Medications for Vascular Patients LONG-TERM FOLLOW-UP The SVS VQI’s first national QI initiative is the IMAGING prescribing of an antiplatelet agent and statin at discharge to improve patients’ long-term health. Experienced SVS VQI centers have applied registry Discharge medications was selected because there data and implemented innovative approaches is strong evidence that antiplatelet agents and to improve success rates for the current national statins increase patient survival following a vascular quality initiatives on Endovascular AAA Long-term procedure. SVS VQI data have shown that patients Follow-Up Imaging and Discharge Medications. undergoing arterial procedures who received a discharge prescription of antiplatelet medications EVAR Long Term Follow-Up (LTFU) Imaging and a statin have significantly better 5-year survival. Endovascular Aortic Aneurysm Repair (EVAR) It is a process measure that affects most vascular requires long-term monitoring to ensure the durability surgery patients and is readily actionable. of repair. EVAR patients are susceptible to the late development of endoleaks, which can occur in up A 2020 Quality Charter on DC medications reviewed to 20% of patients and may result in rupture. Recent why a facility was below the VQI 25th percentile studies have demonstrated low compliance rates for antiplatelet and statin medications prescribed with long-term follow-up imaging after EVAR. To at discharge. The facility goal was to become ensure that patients achieve successful outcomes 100% compliant. Using VQI data, the facility was after EVAR, long-term follow-up imaging is essential. able to develop improvement strategies including education, workflow processes, electronic medical Our regional meetings have focused on “moving record templates, multidisciplinary collaborations, the needle” - meaning to improve reporting of EVAR and monthly data review with communication to sac diameter. There has been a wide variation in stakeholders. In the fall of 2018, DC medication compliance with a VQI mean of 58.6% (22-89%) compliance was 72.9%. The current facility with little improvement since the inception of the compliance moved to 97.23% in 2020 and is now national quality initiative in 2016. Barriers identified 100% in 2021. include patient factors, patient lost to follow up, imaging unavailable, and generic dictation such https://www.vqi.org/about/quality-improve- as “sac size unchanged.” ment/national-qi-initiatives/

“It is the obligation of the operating surgeon to stress the need for lifelong surveillance and integrate discussions about LTFU into all stages of AAA EVAR care to ensure that their patients achieve optimal outcomes.” – Salvatore Scali, MD, Professor of Surgery, University of Florida.

A 2021 Quality Charter on LTFU care shared the challenges on scheduling patients requiring 9 to 21 month follow up post EVAR procedure. Using VQI data, this site was able to “move the needle” by increasing their follow up rate from 69% in 2013 to 92% in 2017. They developed a patient-centered scheduling system, utilized telehealth follow up, Figure 10:1: Discharge Medications and Statin Rate for 119 sent patient reminder correspondence, obtained SVS VQI Hospitals (2012 to Date) appropriate EVAR imaging, and developed SOURCE: SVSVQI 11 www.VQI.org 11. SVS VQI DATA ANALYSIS 12. SVS GUIDELINES AND THE SVS VQI physicians may request de-identified SVS VQI datasets from each registry for analysis. The SVS PSO Research Advisory Council reviews and evaluates requests for datasets by investigators, who provide The SVS Document Oversight Committee the RAC a description of their proposed project. As approached the SVS VQI to see if the registries of the end of May 2021, the RAC has approved 810 could be used to document compliance with SVS projects, and of those, 439 have been published AAA guidelines and monitor adoption over time. in peer-reviewed journals. This year, the SVS PSO In addition, we looked to define the impact of Executive Committee, the RAC and the Venous guideline compliance on outcomes. Compliance Quality Council agreed to create a new SVS PSO with recommendations was associated with Venous RAC to facilitate the growth of venous improved outcomes and should be encouraged data analyses and research, particularly in light of for providers. Participation in the SVS VQI registry the new Venous Stent Registry. provides an objective assessment of performance and compliance with the SVS guidelines. SVS VQI The SVS VQI Vascular Implant Surveillance and provider and center reports may be used as a focus Interventional Outcomes Network (VISION) is a for quality improvement efforts. Vascular Quality partnership between the SVS VQI and the Medical Initiative assessment of compliance with Society for Device Epidemiology Network (MDEpiNet) that Vascular Surgery clinical practice guidelines on the directly supports the mission of the SVS VQI. VISION care of patients with abdominal aortic aneurysm links SVS VQI registry data to Medicare claims to was published in the September 2020 issue of the generate novel registry-claims linked datasets. The JVS. https://pubmed.ncbi.nlm.nih.gov/31973949/ datasets combine the granular clinical detail from the SVS VQI with discrete long-term outcomes A similar project is underway looking at the SVS derived from Medicare claims. VISION data is used clinical practice guidelines on the treatment to generate center-specific feedback reports of claudication. 1A Guidelines state that a called, Survival, Reintervention and Surveillance patient should be on an Antiplatelet, Statin, and (SRS). Each report shows each center’s long- NOT smoking (Optimal Medical Therapy) while term performance when compared to the VQI undergoing PVI for claudication due to lower for Medicare patients undergoing the following extremity arterial occlusive disease. Initial analysis procedures: shows that less than half of the patients undergoing endovascular treatment for claudication are • Endovascular abdominal aortic aneurysm compliant with “optimal medical therapy” (Figure repairs (EVAR) 12.1 ). • Elective abdominal aortic aneurysm repair (EVAR + Open AAA) • Carotid endarterectomy for asymptomatic stenosis • Carotid artery stent procedures (TCAR and transfemoral procedures) for asymptomatic stenosis

Use of the data is governed by a Data Use Agreement (DUA) between Weill Cornell Medical College and the Center for Medicaid and Medicare Services (CMS). VISION replaces the previous Medicare-Match data process.

Visit https://www.vqi.org/data-analysis/ for everything you need to learn about blinded dataset Figure 12.1 Optimal Medical Rx Compliance request policies and procedures, view already approved projects for possible collaboration, and more.

12 SVS VQI 2021 Annual Report a rich source of data for academicians, the FDA and 13. COLLABORATION WITH industry looking to answer scientific questions about SOCIETIES patient characteristics and outcomes and the use and effectiveness of different treatments.

Although VQI was begun by vascular surgeons, The ACC holds seats on SVS PSO committees and less than 50% of the current membership in SVS councils, and collaborates with the PSO on Quality VQI are vascular surgeons. There is a broad multi- Improvement education. disciplinary participation in the SVS VQI, which includes physicians from Cardiology, Radiology, Over 60 former NCDR PVI sites now participate in VQI. General Surgery, Cardiothoracic Surgery, Participants who have not yet joined the SVS VQI, Neurology, Neurosurgery and other specialties. may contact the SVS VQI account team by emailing Recognizing this fact, the SVS VQI has fostered [email protected], or by calling 603-298-6717, to begin working relationships with many of the societies enrollment. that represent these various specialties to help inform and promote the registries. The SVS VQI’s governing council and registry committees also include volunteers from these different disciplines. The SVS VQI would like to recognize and thanks the following Societies for their ongoing involvement with the SVS VQI. The expertise and guidance provided by our colleagues has been instrumental to the success of VQI: AMERICAN HEART ASSOCIATION and SOCIETY FOR VASCULAR MEDICINE • American College of Cardiology The SVS VQI and the Society for Vascular Medicine • American Heart Association (SVM), in collaboration with the American Heart • American Venous Forum Association® (AHA) created and released the Vascular • Society for Vascular Medicine Medicine Consult Registry (VMC) in early 2020. Dr. Josh • Society for Vascular Nursing Beckman, Dr. Marc Bonaca, and former Association • Society for Vascular Ultrasound president Dr. Mark Creager are among those • Vascular Access Society of the Americas members serving on the VMC Steering Committee to provide scientific expertise and oversight. Dr. Randall DeMartino, MD and Dr. Michael R. Jaff, from the SVS serve as co-chairs of the VMC Steering Committee. The Registry targets new patients who are being treated medically for Atherosclerotic Carotid Artery Occlusive Disease, Abdominal Aortic Aneurysm, and Peripheral Lower Extremity Arterial Disease due to atherosclerosis. Medication details and dosages, risk factor and lifestyle modifications, non-operative AMERICAN COLLEGE OF CARDIOLOGY (ACC)/NCDR treatments and counseling will be the emphasis of the The American College of Cardiology and Society for VMC. The Registry also helps define the natural history Vascular Surgery have moved to a single vascular of disease and the impact of medical management. registry to harness the strengths of both organizations Features include a web-based platform with real-time in improving care and outcomes of patients with reporting. vascular disease. The American Heart Association, a global force for Effective January 1, 2021, the ACC NCDR Peripheral longer, healthier lives, has a longstanding commitment Vascular Intervention (PVI) registry is now operated to improving systems of care through its quality by SVS, creating a co-branded VQI program that is a improvement programs such as its flagship Get unique and comprehensive resource for measuring With The Guidelines® (GWTG) program, promoting and improving the care provided to a growing consistent adherence to evidence-based guidelines population of patients with vascular diseases. The in hospital and healthcare settings across the U.S. This ACC’s PVI Registry will not enroll new hospitals for 2021, team effort represents an opportunity to leverage but will now be managed by SVS. the strengths of both organizations to improve care delivered to patients with vascular disease in the The new registry collaboration provides greater outpatient populations as well. opportunities to evaluate new and emerging technologies, pharmacologic therapies, and medical and lifestyle management. It also provides 13 www.VQI.org 14. MYPAD PILOT FOR PATIENT REPORTED OUTCOMES

The SVS VQI has created My PAD, a pilot program for the collection of patient-reported outcomes (PRO) on patients undergoing endovascular AMERICAN VENOUS FORUM treatment for peripheral arterial disease (PAD). The Society for Vascular Surgery® Vascular Quality Initiative® (SVS VQI) and the American Venous Forum (AVF) are pleased to collaborate in the treatment of venous disease.

With more than 20 percent of the adult population suffering from chronic venous diseases, AVF is committed to expanding its efforts through the VQI Traditional clinical outcomes such as patency and to assess the efficacy of various treatments for patients reintervention may not fully capture the quality with venous disease. AVF and SVS have positioned of care or the experience of PAD patients. It is themselves as leaders in vascular quality improvement important to learn and measure from the patient’s by providing a platform for their members to analyze perspective. outcomes, determine best practices, and collaborate on quality improvement efforts across regions. VQI launched the My PAD pilot in April. It includes several SVS VQI centers that participate in the The VQI and AVF worked together to launch the Peripheral Vascular Intervention (PVI) Registry. The Varicose Vein Registry in 2014 and the Venous Stent pilot will collect center workflow data and seeks to Registry in late 2019. As part their collaboration with optimize PRO collection in the least burdensome VQI, AVF thought leaders serve as volunteers on the and patient-centered manner by leveraging committee that worked on creating and enhancing technology, such as smart phones and tablets. both registries, including participation on the Venous Research Advisory Committee (RAC). Additionally, The SVS VQI will enroll a variety of practice types the VQI participates in registry education sessions at ranging from university to community-based the AVF annual meeting. practices in rural and urban settings. MyPAD will serve as a foundation for future SVS VQI patient- The Varicose Vein Registry captures procedures reported outcome programs. performed in vein centers, office-based practices, and ambulatory or inpatient settings and includes The data will be collected from patients undergoing therapies such as thermal radiofrequency ablation, peripheral vascular interventions for claudication or thermal laser ablation, mechanochemical ablation, chronic limb-threatening ischemia. Centers will use chemical ablation, embolic adhesive ablation, and the VascuQoL-6 and EuroQol 5D-5L questionnaires surgical ablation (including high ligation, stripping, (estimated completion time is less than 10 to 15 and phlebectomy). The Venous Stent Registry treats minutes) to collect data at three time points, pre- patients with symptomatic venous obstructions due to procedure and at one month and one-year post- chronic thrombosis and/or some venous compression procedure. disorders. VQI is exploring the introduction of Patient Advisor groups this fall to further understand the patient’s perspective on their PAD treatment.

14 SVS VQI 2021 Annual Report of TCAR in comparison with CEA as performed 15. USING SVS VQI DATA FOR by centers participating in the Vascular Quality COLLABORATIVE PROJECTS Initiative (VQI). The TCAR Surveillance Project was evaluated by the US Food and Drug Administration WITH FDA AND INDUSTRY (FDA) and found to be scientifically valid and clinically relevant. Based on this, reimbursement Medical devices are an integral component for TCAR procedures performed by centers of vascular healthcare. SVS VQI collects participating in the VQI TCAR Surveillance Project clinical data to help better understand device was approved on Sept. 1, 2016, by the Centers performance. Data may be used to meet for Medicare and Medicaid Services (CMS) under regulatory requirements, support post-approval the current National Coverage Determination. surveillance or expand existing indications for use For centers or providers to be reimbursed for (IFU). performance of TCAR, they must participate and enter data in the VQI Carotid Artery Stent Registry. Post-Approval Surveillance Projects The TCAR Surveillance Project is directed by an SVS The use of SVS VQI data for post-approval PSO Steering Committee that will make periodic surveillance is consistent with the FDA vision of analyses of outcomes collected in the VQI CAS registry-based evaluation throughout the total and CEA Registries. product lifecycle. Initial projects have leveraged existing SVS VQI infrastructure and reduced For more information on the TCAR Surveillance recruitment time and expenses. For example, Project, please see Clinical Trials.gov: the recruitment for the Thoracic EndoVascular Aortic Dissection (TEVAR) project (see below) was SVS VQI TransCarotid Revascularization completed in half the time initially estimated by Surveillance Project industry sponsors, Medtronic and Gore. https://clinicaltrials.gov/ct2/show/NCT02850588 SVS VQI has partnered with several device manufacturers to provide aggregate data for product development, creation of performance 16. CORPORATE SUPPORT standards, and expansion of device indications: The operations of the SVS PSO are financed by TEVAR Post-Approval Surveillance Projects fees paid by participating sites. New project - Initiated in October 2014, this project has development, including addition of new registries, demonstrated the value of expanding quality reports, and improved functionality in SVS surveillance to real-world device evidence with VQI has been made possible through generous faster than expected enrollment while meeting unrestricted contributions by Quality Champion, FDA requirements. In partnership with Gore and Quality Partner and Quality Associate-level Medtronic, the SVS PSO and M2S has completed corporations. Corporate sponsors of the SVS PSO enrollment of the one- year and five-year cohorts. are listed below: The SVS PSO is excited to announce the continuation of the TEVAR Dissection Surveillance Project to evaluate the Cook Zenith Dissection Quality Champions Endovascular System. FDA approval was granted for this device after safety and effectiveness were demonstrated in pre-market studies of complicated dissection with the proviso that the efficacy of TEVAR treatment of descending aortic dissection would be more fully analyzed through post-market surveillance, as is done through VQI for the W. L. Gore and Medtronic devices after their approval.

For more information, please contact: [email protected] Quality Partners Transcarotid Artery Revascularization (TCAR) Surveillance Project The TCAR Surveillance Project is designed to obtain more data about real-world outcomes 15 www.VQI.org hazard ratio (HR)= 0.79, 95% confidence interval 17. REGISTRY ASSESSMENT OF (CI) 0.72-0.87, P= 0.004). The manuscript “Vascular PERIPHERAL INTERVENTIONAL Quality Initiative Surveillance of Femoral-popliteal Artery Paclitaxel Devices Shows Improved Two- DEVICES (RAPID) UPDATE year Survival” was accepted for publication in Journal of the American College of Cardiology RAPID is a public private partnership between Cardiovascular Interventions. Second, a VQI professional society registries (Society for Vascular analysis linked to Medicare claims was performed Surgery, American College of Cardiology and by the VISION team at Weill Cornell Medical Center Society for Interventional Radiology), academia, led by Dr. Art Sedrakyan and Dr. Philip Goodney of industry and federal regulators including CMS Dartmouth Medical Center. In this large, claims- and FDA. The FDA, through the Medical Device linked, VQI based analysis, there was no increase Epidemiology Network (MDEpiNet), has promoted in patient mortality or major amputation after PVI the concept of CRNs to generate real-world with paclitaxel vs non-paclitaxel devices. The study evidence about medical device performance. is being submitted for peer review. The goal of RAPID is to promote the evaluation of peripheral vascular devices throughout the total 4. Randomized controlled trials nested in registries product lifecycle. Over the next year, RAPID will focus on promoting the use of registries for randomized trials. A virtual think Updates on RAPID related VQI activities tank “Registry-supported Prospective Trials: What Are We Missing?” is scheduled for Friday, September 1. Objective performance goals (OPG) 9th from 12-5pm. The five-hour session will bring Objective performance goals for femoral-popliteal together the major stakeholders to discuss why the peripheral vascular interventions were published in concept has not been successfully adopted and the Journal for Vascular Surgery in the fall of 2020. consider strategies to promote clinical trials within The Superficial Femoral Artery-Popliteal EvidencE registries. The meeting will include discussion of Development (SPEED) OPGs were derived from past and current proposals and a brainstorming VQI PVI data. The publication generated discussion session with industry and federal regulators on new about the future of objective performance goals. use cases. Those interested in participating may Two commentaries will be published in the JVS in contact Rebecca Wilgus at rebecca.warlick@duke. 2021. The first is titled, “A critical appraisal of registry- edu. based objective performance goals in peripheral arterial disease.” A counter is titled, “Toward a Reference better system for the sustainable development Bertges DJ, White R, Cheng YC, Sun T, Ramkumar N, Goodney P, of objective performance goals for peripheral Wilgus R, Lottes A, Samle J, Drozda J, Raska M, Heise T, Schuyler-Jones W, Tcheng J, Eldrup-Jorgensen J, Sedrakyan A, Malone M, Marinac- vascular interventions.” Both viewpoints illustrate Dabi D, Thatcher R, Morales P, Krucoff M and Cronenwet J. Registry a pathway forward for OPG development. Assessment of Peripheral Interventional Devices Objective Performance Goals for Superficial Femoral and Popliteal Artery Peripheral Vascular Interventions. J Vasc Surg. 2020 Oct 17;S0741-5214(20)32202-3. PMID: 2. Lean Case Report Form for PVI 33080324 The RAPID LEAN working group led by James Black, MD and Donna Buckley, MD has developed a “lean” case report form (CRF) for peripheral vascular interventions. The form was developed FDA Notifications after considering the lessons learned from the paclitaxel experience. The lean CRF released for As a Patient Safety Organization, we share comment by the RAPID community and submitted Safety Notifications with VQI Members: for peer review. In the future, the CRF may be used as a template for peripheral device trials. • FDA will contact the SVS PSO with Safety Notifications it wants us to communicate 3. Paclitaxel (PTX) studies • Safety Notifications will appear in both the Two VQI projects on the safety of paclitaxel PSO and SVS newsletters devices in the treatment of femoral-popliteal • All Safety Notifications are posted to the disease have progressed over the past year. First, VQI and SVS Websites VQI has continued surveillance of mortality in the • https://www.vqi.org/resources/fda- after PTX treatment through DELTA (Data Extraction communication/ and Longitudinal Trend Analysis). In this analysis performed in collaboration with Dr. Fred Resnic and the Lahey Hospital and Medical Center, treatment with any PTX vs. non-PTX devices was associated with increased two-year survival (89.5% vs. 86.7%; 16 SVS VQI 2021 Annual Report 18. INTERNATIONAL 19. THE SVS VQI AND CONSORTIUM OF VASCULAR COMPLIANCE WITH THE REGISTRIES (ICVR) UPDATE EUMDR

The ICVR was launched in November 2014 at The European Medical Device Regulation (EU MDR) Cornell University as a partnership of VQI, VASCUNET was introduced in 2017 to ensure high standards of and other registries that include over 12 national quality and safety for medical devices being used registries, the FDA, manufacturers, and other in Europe. It establishes a framework for medical stakeholders. The mission of the International device monitoring to ensure a high level of health Consortium of Vascular Registries (ICVR) is to and safety while supporting innovation. While provide a collaborative platform through which the new European MDR includes pre-approval registries and other stakeholders around the world evaluation for medical device manufacturing, it can share data to improve vascular health care. adds a new total life-cycle reporting requirement In order to create this collaborative platform, to medical device regulation. the ICVR is leveraging existing national registries, including the Society for Vascular Surgery Vascular One of the most important but most challenging Quality Initiative (VQI) and Vascunet, a vascular requirements of EU MDR is the active Post-Market registry collaboration within the European Society Clinical Follow-up required to establish safety of Vascular Surgery which involves national and and performance during the total lifecycle of a regional vascular registries from Europe, Australia device. Manufacturers must report such data to and New Zealand. maintain their CE mark for each device by May 2020. Medstreaming/M2S and the Society for The ICVR is proud to announce that in 2021 it formally Vascular Surgery Vascular Quality Initiative (SVS launched a project entitled “ICVR Evaluation of VQI) recognize the importance of supporting EVAR Treatment of Ruptured AAA”. The aim of this manufacturers and regulators, both domestic project is to evaluate the safety and effectiveness and international, to evaluate the safety and of EVAR devices used to treat rAAA (compared performance of vascular devices currently being to open rAAA repair) in the ICVR registries, and to used in daily practice. SVS VQI collects much provide manufacturers of current EVAR devices with relevant data to provide the real-world evidence individual data about their device. The design of needed to meet the new EU MDR. “Manufacturers the study will include collection of data from 13 face significant challenges in collecting real-world different countries participating in ICVR. clinical follow-up data about ALL their devices,” said Jack Cronenwett, MD, CMO Medstreaming/M2S. The central purpose of this project is to evaluate “In fact, some companies are now considering the in-hospital mortality after EVAR for ruptured AAA in need to remove some currently CE-marked devices a multinational registry collaboration using mortality from the European market if they cannot obtain associated with standard open repair to establish needed data. We are pleased to have supplied a benchmark. The hypothesis is that EVAR for rAAA data from the SVS VQI to several manufacturers to is associated with in-hospital survival that meets a help them successfully meet EU MDR requirements. performance goal derived from open rAAA repair. Going forward, we believe that the SVS VQI registry Given that untreated rAAA carries a mortality will be a primary data source to address current approaching 100%, the intent of this project is to and future regulatory challenges faced by device focus specifically on survival to discharge. Further, manufacturers world-wide.” the long term safety and effectiveness of these EVAR devices has been extensively studied and established for elective AAA repair. The key to improving outcome after rAAA repair is improving initial survival, which is the major endpoint for this project.

17 www.VQI.org 20. TECHNOLOGY & REGISTRY 21. FUTURE DEVELOPMENTS DEVELOPMENTS In 2021-2022, the SVS VQI plans to support improved care and promote patient safety in the Technology Highlights: following areas:

Move Record – Move procedure data to the • Infra-Inguinal and Supra-Inguinal registries will correct patient when duplicate/miskeyed patient be revised in late 2021 records have been identified. • Open AAA Registry and Lower Extremity Amputation Registry will be revised in 2022 Audit Info – View record details including creator • Addition of Vaccination details to all Registries and created date, last user to update and date to continue to analyze the affect of COVID-19 updated, and form validation submission status. Enhanced Long Term follow up reporting ● • capabilities for all registries will be released Recent Records – Quickly return to your recently accessed procedure and follow up records. over time, beginning with EVAR, CAS, CEA ● and PVI in 2021 Release Notes - Go to the Support Tab to • Infra-Inguinal Bypass pilot of variables to access historical release announcements to help better manage the usage of Opioids in review recent updates. Vascular procedures ● • Expand Patient Reported Outcomes to all PVI Reporting Tab – This new tab will be home to users Fall 2021 and other registries in 2022 future new data analysis reporting including the • Collection of details about level of residency current analytics engine. will be added to the registries

Registry Highlights: • Across-registry revision to add COVID-19 variables • TEVAR Revision to align with SVS/STS guidelines • Vascular Ultrasound Registry (VUR) major revision • Varicose Vein Registry (VVR) revision for New CEAP Clinical Classification • Venous Stent Registry (VSR) revision for New CEAP Clinical Classification • Vascular Medicine Consult (VMC) registry revision to add new drug category and update CAD • VQI PRO collection for PVI

Upcoming Registry Highlights: • Minor revision to CEA, CAS, and VMC to add stenosis and contralateral events • Add Opioid variables to INFRA • Follow-up Outcomes reports for CAS, CEA and EVAR using new reporting technology • New Device Assistant feature to streamline device search and selection • Minor revision to TEVAR to update dependencies for Entry Flow and Dissection Date/Type • Minor revision across registries to change Gender to Sex, add COVID Vaccination variables, and add medical resident variables • Minor revision to IVC Filter manufacturer options SVS VQI 2021 Annual Report APPENDICES

www.VQI.org APPENDIX A— VQI SITES LISTED IN ALPHABETICAL ORDER (AS OF 6/1/2021)

CENTER NAME Baystate Medical Center (MA) DLP Conemaugh Memorial Medical Center, LLC (PA) Abington Memorial Hospital (PA) Beaufort Memorial Hospital (SC) DMC Harper University Hospital (MI) Abrazo Arizona Heart Hospital (AZ) Beebe Healthcare (DE) Doctors Hospital at Renaissance (TX) Abrazo Arrowhead Campus (AZ) Berkshire Medical Center (MA) Doylestown Hospital (PA) AdventHealth Celebration (FL) Beth Israel Deaconess Medical Center (MA) Dr. Ricardo Vasquez, MD (IN) AdventHealth Orlando (FL) Beth Israel Medical Center (NY) Duke Raleigh Hospital (NC) AdventHealth Tampa (FL) Bethesda North Hospital (TriHealth, Inc.) (OH) Duke Regional Hospital (NC) Advocate Good Samaritan Hospital (IL) Birmingham St. Vincent’s East Hospital (AL) Duke University Medical Center (NC) Advocate South Suburban Hospital (IL) Bloomington Hospital (IN) East Alabama Medical Center (AB) AHS SouthCrest Hospital, LLC dba Hillcrest Hospital South (OK) Bon Secours DePaul Medical Center (VA) East Jefferson General Hospital (LA) Alamance Regional Medical Center (NC) Bon Secours Maryview Medical Center (VA) Edward Hospital (IL) Albany Medical Center (NY) Bon Secours Memorial Regional Medical Center (VA) Einstein Medical Center Montgomery (PA) Albany Vascular Specialist Center (GA) Bon Secours St. Francis Medical Center (VA) Eisenhower Medical Center (CA) Alex Westerband, MD, PLLC dba VVAS - Varicose Vein and Bon Secours St. Mary’s Hospital (VA) El Camino Hospital (CA) Aesthetic Solutions (AZ) Boston Medical Center (MA) Elkhart General Hospital (IN) Alexian Brothers Medical Center (IL) Bridgeport Hospital (CT) Elliot Hospital (NH) Allegheny Health Network - Allegheny Clinic Brigham and Women’s Hospital (MA) Elmhurst Memorial Hospital (IL) Vascular Surgery (PA) Bronson Battle Creek Hospital (MI) Emanate Health Medical Center dba Emanate Health Allina- Abbott Northwestern Hospital (MN) Bronson Methodist Hospital (MI) Inter-Community Hospital (CA) Allina- Mercy Hospital (MN) Brookwood Baptist Medical Center (AL) Emanate Health Medical Center dba emanate Health Queen of Allina- United Hospital (MN) Brookwood Baptist Health System - Princeton Baptist Medical the Valley Hospital (CA) Allina- Unity Hospital (MN) Center (LA) Emanuel Medical Center (CA) Altru Health System (ND) Brookwood Baptist Health System - Shelby Baptist Medical Emory Healthcare (GA) AMITA Health Adventist Medical Center LaGrange (IL) Center (LA) Emory St. Joseph’s Hospital (GA) AnMed Health Medical Center (AnMed Health) (SC) Bryan Medical Center (NE) Englewood Hospital and Medical Center (NJ) Arizona Endovascular Center (AZ) BSA Hospital (TX) Evansville Surgical Associates (IN) Arizona Vascular Specialists (AZ) Camden Clark Medical Center (WV) Excela Health (PA) Arnett Hospital (IN) Cape Canaveral Hospital (FL) Fairlawn Surgery Center (VA) Arnot Health (NY) Cape Cod Hospital (MA) Fairview Southdale Hospital (MN) Artery and Vein Institute (PA) Capital Health Medical Center - Hopewell (NJ) Fairview St. John’s Hospital (MN) Asante Rogue Regional Medical Center (Asante Capital Health Regional Medical Center (NJ) Fairview St. Joseph’s Hospital (MN) Health System) (OR) Capital Regional Medical Center (FL) Flagstaff Medical Center (AZ) Ascension Borgess Hospital (MI) Cardiothoracic and Vascular Surgical Associates (FL) Flint Hills Heart, Vascular, and Vein Clinic, LLC (KS) Ascension Health - St. Mary’s Saginaw (MI) Carilion Roanoke Memorial Hospital (VA) Florida Hospital Memorial Medical Center (FL) Ascension Providence Hospital, Novi Campus (MI) Carle Foundation Hospital (IL) Florida Hospital Zephyrhills, Inc. (FL) Ascension Providence Hospital, Southfield CarolinaEast Medical Center (NC) Floyd Medical Center (GA) Campus (MI) Carson Tahoe Regional Hospital (NV) Forrest General Hospital Vascular Services (MS) Ascension Sacred Heart Hospital Bay (FL) Catawba Valley Medical Center (NC) Fort Hamilton Hospital - Kettering Adventist Healthcare dba Ascension Seton Medical Center Austin (TX) Catholic Health Mercy Hospital of Buffalo (NY) Kettering Health Network (OH) Ascension St. John (OK) Catholic Health Sister of Charity Hospital (NY) Fort Sanders Regional Medical Center (TN) Ascension St. John Hospital (MI) Cedars-Sinai Medical Center (CA) Fox Valley Surgical Associates Ltd. (WI) Ascension Via Christi Hospitals Wichita Hospital (KS) Centerpoint Medical Center (MO) Franciscan Health Lafayette East (IN) Aspirus Wausau Hospital, Inc. (WI) Centra Health (Lynchburg General Hospital) (VA) Froedtert Memorial Lutheran Hospital (WI) Associates in Vascular Care (NJ) Central Florida Regional Hospital (FL) Geisinger Community Medical Center (PA) AtlantiCare Regional Medical Center (AtlantiCare Central Maine Medical Center (ME) Geisinger Medical Center (PA) Health System) (NJ) CGH Medical Center (IL) Geisinger Wyoming Valley Medical Center (PA) Atrium Health Carrabus (NC) Charleston Area Medical Center (WV) Genesis Hospital (OH) Atrium Health Pineville (NC) CHCA Conroe, LP dba HCA Houston Healthcare Conroe (TX) Genesis Medical Center, Davenport (IA) Atrium Health Union (NC) Chester County Hospital (PA) Gilvydis Vein Clinic (IL) AU Medical Center, Inc. (GA) Cheyenne Regional Medical Center (WY) Glens Falls Hospital (NY) Aultman Hospital (OH) Christiana Care Health System (DE) Global Neurosciences Institute, LLC (Crozer-Chester Medical Aurora Baycare Medical Center (WI) Christus Highland Medical Center (LA) Center) (PA) Aurora Lakeland Medical Center (WI) Christus St. John Hospital (TX) Good Samaritan Hospital (TriHealth, Inc.) (OH) Aurora Medical Center in Kenosha (WI) Christus St. Michael Hospital (TX) Good Samaritan Hospital of Suffern (NY) Aurora Medical Center in Manitowoc County (WI) CHUM (Canada) Goshen Hospital (IN) Aurora Medical Center in Oshkosh (WI) CISSSO (Canada) Gottlieb Memorial Hospital (Loyola University Aurora Medical Center in Summit (WI) CJW Medical - Chippenham Hospital (VA) Health System) (IL) Aurora Medical Center in Washington County (WI) CJW Medical - Johnston-Willis Hospital (VA) Grady Memorial Hospital (GA) Aurora Medical Center of Grafton (WI) Cleveland Clinic, Heart and Vascular Institute (OH) Great River Medical Center (IA) Aurora Memorial Hospital of Burlington (WI) Clinton Memorial Hospital (OH) Griffin Health (CT) Aurora Sheboygan Memorial Medical Center (WI) Coastal Heart Medical Group (CA) Guthrie Clinic (PA) Aurora Sinai Medical Center (WI) Coastal Vascular & Interventional, PLLC (FL) Hackensack Meridian- Bayshore Community Aurora St. Luke’s Medical Center (WI) Coastal Vein and Vascular Specialists (FL) Hospital (NJ) Aurora St. Luke’s South Shore (WI) Cobb Hospital, Inc. (WellStar Health System, Inc.) (GA) Hackensack Meridian- Hackensack University Aurora West Allis Medical Center (WI) Columbia St. Mary’s Hospital Milwaukee, Inc. (WI) Medical Center (NJ) Avera Heart Hospital of South Dakota (SD) Columbia St. Mary’s Hospital Ozaukee, Inc. (WI) Hackensack Meridian- Jersey Shore University Avera McKennan Hospital (SD) Columbia Surgical Services, Inc. (MO) Medical Center (NJ) Backus Hospital (CT) Columbia University Irving Medical Center (NY) Hackensack Meridian Health - JFK Medical Center (NJ) Bakersfield Memorial Hospital (CA) Columbus Regional Hospital (IN) Hackensack Meridian- Ocean Medical Center (NJ) Ball Memorial Hospital (IN) Community Hospital East (IN) Hackensack Meridian- Riverview Medical Center (NJ) Baltimore Washington Medical Center (MD) Community Hospital Heart & Vascular (IN) Hackensack Meridian- Southern Ocean Medical Banner Desert Medical Center (AZ) Community Hospital South (IN) Center (NJ) Banner Heart Hospital (AZ) Concord Hospital (NH) Halifax Hospital Medical Center (FL) Banner--University Medical Center Phoenix (Banner Cone Health Heart & Vascular Center (NC) Harborview Medical Center (WA) Health) (AZ) Confluence Health (WA) Harlingen Medical Center (TX) Banner--University Medical Center Tucson (AZ) Cookeville Regional Medical Center (TN) Harrison Medical Center (CHI Franciscan Health) (WA) Baptist Health Louisville (KY) Cooper University Medical Center (NJ) Hartford Hospital (CT) Baptist Health Madisonville- Jack L. Hamman Heart Covenant Health - Grey Nuns Hospital (Canada) Health Park Medical Center (Lee Memorial Health & Vascular Center (KY) Covenant Healthcare (MI) System) (FL) Baptist Health Paducah (KY) Cox Medical Center South (MO) HealthPartners, Inc. (MN) Baptist Hospital of Miami (FL) CTSA (NH) Heart & Surgical Hospital (CA) Baptist Memorial Hospital- Memphis (TN) CTVS- CardioThoracic Vascular Surgeons (TX) Heart Care Consultants, LLC (PA) Barnes Jewish Hospital (MO) Danbury Hospital (CT) Heart Hospital of Lafayette (LA) Bartow Regional Medical Center (FL) Dartmouth Hitchcock Medical Center (NH) Heart Hospital of New Mexico at Lovelace Baton Rouge General Medical Center (LA) Dayton Osteopathic Hospital dba Grandview Medical Center Medical - Center (NM) Bayfront Health Seven Rivers (FL) Kettering Adventist Healthcare (Kettering Health Network(OH) Henrico Doctors’ Hospital (VA) Bayhealth Medical Center (DE) Deaconess Midtown Hospital (IN) Henry Ford Allegiance Health (MI) Baylor All Saints Medical Center (TX) Deborah Heart and Lung Center (NJ) Henry Ford Hospital, Detroit (MI) Baylor- Jack and Jane Hamilton Heart and Decatur Memorial Hospital (IL) Henry Ford Hospital, West Bloomfield (MI) Vascular Hospital (TX) Dell Seton Medical Center at the University of Texas (TX) Henry Ford Macomb (MI) Baylor Scott & White Medical Center - Irving (TX) Delray Medical Center, Inc. (FL) Heritage Valley Beaver - Heritage Valley Health System (PA) Baylor Scott & White Medical Center - McKinney (TX) Diagnostic Imaging of Milford (CT) Hoenig Vascular Center (MA) Baylor Scott & White Medical Center -- Round Dignity Health - St John’s Regional Medical Center (CA) Holmes Regional Medical Center (FL) Rock (TX) Dignity Health - St Joseph’s Hospital and Medical Center (CA) Holy Spirit - Geisinger Affiliate (PA) Baylor- The Heart Hospital Denton (TX) Dignity Health dba St. Bernardine Medical Center (CA) HonorHealth Deer Valley Medical Center (AZ) Baylor- The Heart Hospital Plano (TX) Dignity Health Dominican Hospital (CA) HonorHealth Scottsdale Osborn Medical Center (AZ) Baylor University Medical Center (TX) Dixie Regional Medical Center (UT) HonorHealth Scottsdale Thompson Peak Medical Center (AZ) 20 SVS VQI 2021 Annual Report APPENDIX A— VQI SITES LISTED IN ALPHABETICAL ORDER (AS OF 6/1/2021) Horizon Vascular Specialists (MD) MedStar Franklin Square Medical Center (MD) Nova Scotia Health Authority (Canada) Hospital of Central Connecticut (CT) MedStar Georgetown University Hospital (DC) Novant Health Forsyth Medical Center (NC) Hospital of the University of Pennsylvania (PA) MedStar Good Samaritan Hospital (MD) Novant Health Matthews Medical Center (NC) Houston Methodist Baytown Hospital (TX) MedStar Harbor Hospital (MD) Novant Health Presbyterian Medical Center (NC) Houston Methodist Clear Lake Hospital (TX) MedStar Montgomery Medical Center (MD) NSLIJ- Lenox Hill Hospital (NY) Houston Methodist Sugar Land Hospital (TX) MedStar Southern Maryland Hospital Center (MD) NSLIJ- Long Island Jewish Medical Center (NY) Houston Methodist The Woodlands Hospital (TX) MedStar Union Memorial Hospital (MD) NSLIJ- North Shore University Hospital (NY) Houston Methodist West Hospital (TX) MedStar Washington Hospital Center (DC) NSLIJ- Staten Island Hospital- North Site (NY) Houston Methodist Willowbrook Hospital (TX) Memorial Health University Medical Center (GA) NSLIJ-Southside Hospital (NY) Huntington Hospital (CA) Memorial Hermann Greater Heights Hospital (TX) NYU Langone Medical Center (NY) Huntsville Hospital (Huntsville Hospital Health Memorial Hermann Heart & Vascular Institute- NYU Winthrop Hospital (NY) System) (AL) Texas Medical Center (TX) Ocala Regional Medical Center (FL) Inova Alexandria Hospital (VA) Memorial Hermann Katy Hospital (TX) Ochsner Medical Center (LA) Inova Fair Oaks Hospital (VA) Memorial Hermann Memorial City Medical Center(TX) OhioHealth Doctors Hospital (OH) Inova Fairfax Hospital (VA) Memorial Hermann Northeast Hospital (TX) OhioHealth Dublin Methodist Hospital (OH) Inova Gainesville Hospital (VA) Memorial Hermann Southeast Hospital (TX) OhioHealth Grady Memorial Hospital (OH) Inova Loudoun Hospital (VA) Memorial Hermann Southwest Hospital (TX) OhioHealth Grant Medical Center (OH) Inova Mount Vernon Hospital (VA) Memorial Hermann Sugar Land (TX) OhioHealth Mansfield Hospital (OH) Integris Baptist Medical Center, Inc. (OK) Memorial Hermann The Woodlands Hospital (TX) OhioHealth Marion General Hospital (OH) Intermountain Medical Center (UT) Memorial Hospital at Gulfport (MS) OhioHealth Riverside Methodist Hospital (OH) Javon Bea Hospital--Riverside Campus (IL) Memorial Hospital Belleville (IL) Oklahoma Heart Hospital South, LLC (OK) John Sealy Hospital, UTMB (TX) Memorial Hospital of South Bend (IN) Oklahoma Heart Hospital, LLC (OK) Johns Hopkins Bayview Medical Center (MD) Memorial Hospital Pembroke (FL) Oklahoma Heart Institute at Hillcrest Medical Kadlec (Providence) (WA) Memorial Hospital West (FL) Center (OK) Kaleida- Buffalo General Hospital (NY) Memorial Medical Center (IL) Orange Regional Medical Center (NY) Kansas Heart Hospital (KS) Memorial Regional Hospital (FL) Oregon Health & Sciences University (OR) Kennedy University Hospital (NJ) Memorialcare Long Beach Medical Center (CA) Oregon Vascular Specialists, LLC (OR) Kennestone Hospital, Inc. (WellStar Health System, Memorialcare Orange Coast Medical Center (CA) Orlando Health, Inc. Dr. P. Phillips Hospital (FL) Inc.) (GA) Memorialcare Saddleback Medical Center (CA) Orlando Health, Inc. Health Central Hospital (FL) Kent Hospital (RI) Menorah Medical Center (KS) Orlando Health, Inc. Orlando Regional Medical KentuckyOne Health- Jewish East (KY) Mercy Hospital Springfield (MO) Center (FL) KentuckyOne Health- Jewish Hospital (KY) Mercy Hospital St. Louis (MO) Orlando Health, Inc - South Lake Hospital (FL) Kettering Medical Center - Kettering Adventist Healthcare dba Mercy Medical Center- Baltimore (MD) Orlando Health, Inc. South Seminole Hospital (FL) Kettering Health Network (OH) MercyOne Des Moines Medical Center (IA) OSF- Saint Anthony Medical Center (IL) King’s Daughters Medical Center (KY) MercyOne Siouxland Medical Center (IA) OSF- Saint Francis Medical Center (IL) Kootenai Health (ID) Meritus Medical Center (MD) OSF- St. Joseph Medical Center (IL) Lake Health - West Medical Center (OH) Methodist Dallas Medical Center (TX) OU Medical Center (OK) Lakeland Regional Medical Center (FL) Methodist Le Bonheur, Germantown (TN) Our Lady of Lourdes Regional Medical Center, Inc. (LA) Lakes Region General Hospital (NH) Methodist Le Bonheur, University Medical Center (TN) Our Lady of the Lake (LA) Lakeview Regional Medical Center (LA) Methodist Hospital (IN) Overlake Hospital and Medical Center (WA) Lancaster General Hospital (PA) Methodist Richardson Medical Center (TX) Overlook Hospital (Atlantic Health System) (NJ) Lawrence + Memorial Hospital (CT) Miami Vein Center (FL) Owensboro Health Regional Hospital (KY) Lee Memorial Health System (Gulf Coast Medical Michigan Vascular Center (MI) Palm Beach Gardens Medical Center - Cleveland Clinic Foun- Center) (FL) Middlesex Hospital (Middlesex Health System) (CT) dation (FL) Legacy Health (OR) MidHudson Regional Hospital (NY) Palmetto Health Richland (SC) Lehigh Valley Hospital (PA) Midland Memorial Hospital (TX) Palo Alto Medical Foundation (CA) Lifespan- Rhode Island Hospital (RI) MidMichigan Health - Midland (MI) Parkview Hospital, Inc (Parkview Regional Medical Center) (IN) Lifespan- The Miriam Hospital (RI) MidState Medical Center (CT) Parkview Medical Center (CO) Loma Linda University Medical Center (CA) Midwest Institute Minimally Invasive Therapies (IL) Parkwest Medical Center (TN) Los Robles Hospital & Medical Center (CA) Midwest Physician Alliance (Heart Care Center of PeaceHealth Sacred Heart Medical Center - Loyola University Medical Center (IL) Illinois - Premier Vascular, LLC) (IL) Riverbend (OR) Lutheran Medical Center (CO) Mission Hospital (NC) PeaceHealth Southwest Medical Center (WA) Lyerly Baptist Neurosurgery (FL) Mission Hospital - Providence Health (CA) PeaceHealth St. Joseph Medical Center (WA) MacNeal Hospital (Loyola University Health Mississippi Baptist Medical Center (MS) Penn Presbyterian Medical Center (PA) System) (IL) Mobile Infirmary (AL) Penn State Health St Joseph’s Medical Center (PA) Maimonides Medical Center (NY) Mon Health Medical Center (WV) Penn State Milton S. Hershey Medical Center (PA) Main Line Hospitals, Inc. - Bryn Mawr Hospital (PA) Montefiore Medical Center (NY) Pennsylvania Hospital (PA) Main Line Hospitals, Inc. - Lankenau Medical Monument Health - Rapid City Hospital, Inc (SD) Penrose St. Francis Health Services (Centura Health Center (PA) Morton Plant Hospital (FL) Corporation) (CO) Main Line Hospitals, Inc. - Paoli Hospital (PA) Morton Plant North Bay (FL) Peripheral Vascular Associates (TX) Main Line Hospitals, Inc. - Riddle Hospital (PA) Mosaic Life Care (MO) PHT Jackson Memorial Hospital (FL) Maine Medical Center (ME) Mount Sinai Hospital (NY) Piedmont Athens Regional Medical Center, Inc. (GA) MaineGeneral Medical Center (ME) Mount Sinai Medical Center (FL) Piedmont Hospital Atlanta (GA) Manatee Memorial Hospital (FL) MultiCare Deaconess Hospital (WA) Pima Vascular (Southern Arizona Vascular Institute) (AZ) Marietta Memorial Hospital (OH) MultiCare Good Samaritan Hospital (WA) PineHurst Surgical (NC) Marin General Hospital (CA) MultiCare Tacoma General Hospital (WA) Porter Adventist Hospital (Centura Health Marshfield Clinic Health System, Inc. (WI) Munson Medical Center (MI) Corporation) (CO) Martin Medical Center (FL) Nashville Vascular & Vein Institute (TN) Portsmouth Regional Hospital (NH) Mary Washington Hospital (VA) Nebraska Medical Center (NE) Presbyterian Hospital (NM) Massachusetts General Hospital (MA) Nebraska Methodist Hospital (NE) Presbyterian St. Luke’s Medical Center (CO) Maury Regional Medical Center (TN) New Hanover Regional Medical Center (NC) ProHealth Care (Waukesha Memorial Hospital) (WI) Mayo Clinic Arizona (AZ) New York-Presbyterian/Brooklyn Methodist (NY) ProMedica Toledo Hospital, Jobst Vascular (OH) Mayo Clinic Florida (FL) New York-Presbyterian/Queens (NY) Providence Alaska Medical Center (AK) Mayo Clinic Health System - Franciscan Health Newark Beth Isreal Medical Center (Barnabas Providence Holy Cross Medical Center (CA) care, Inc. (La Crosse) (WI) Health) (NJ) Providence Holy Family Hospital (WA) Mayo Clinic Health System - Northwest Wisconsin Newtown-Wellesley Hospital (MA) Providence Hospital (AL) Region, Inc. (WI) North Florida Regional Medical Center (FL) Providence Little Company of Mary, Torrance (CA) Mayo Clinic Hospital - Rochester (MN) North Memorial Health Hospital (MN) Providence Medford Medical Center (OR) McKay-Dee Hospital (UT) North Mississippi Medical Center (MS) Providence Portland Medical Center (OR) McKenzie-Willamette Medical Center (OR) North Okaloosa Medical Center (FL) Providence Regional Medical Center (WA) McLaren Bay Region (MI) Northeast Georgia Medical Center (GA) Providence Sacred Heart Medical Center (WA) McLaren Flint (MI) Northeast Methodist Hospital (TX) Providence Saint Joseph Medical Center (CA) McLaren Greater Lansing (MI) NorthShore University Health- NorthShore Skokie Providence St. Mary Medical Center (WA) McLaren Macomb (MI) Hospital (IL) Providence St. Peter Hospital (WA) McLaren Northern Michigan (MI) Northside Hospital Atlanta (GA) Providence St. Vincent Medical Center (OR) McLaren Port Huron (MI) Northside Hospital Cherokee (GA) Providence Tarzana Medical Center (CA) McLeod Regional Medical Center (SC) Northside Hospital Forsyth (GA) Radiology Associates - Fox Valley (WI) Mease Countryside Hospital (FL) Northside Hospital Gwinnett (GA) Rapides Healthcare System (Rapides Regional Medical Center) (LA) Mease Dunedin Hospital (FL) Northwest Community Hospital (IL) RCHP-Florence - North Alabama Medical (AL) Medical Center Hospital (TX) Northwestern Medicine Central DuPage Hospital (IL) Redmond Regional Medical Center (GA) Medical City Dallas (TX) Northwestern Medicine Lake Forest Hospital (IL) Regents of the University of New Mexico (NM) Medical City Denton (TX) Northwestern Memorial Hospital (IL) Regional Medical Center of Orangeburg & Medical City Fort Worth (TX) Norton Healthcare, Inc. - Norton - Audubon (KY) Calhoun Co (SC) Medical City Plano (TX) Norton Healthcare, Inc. - Norton - Brownsboro (KY) Reid Health (IN) Medical Faculty Associates, Inc. (DC) Norton Healthcare, Inc. - Norton - Downtown (KY) Rex Hospital, Inc. (NC) Medical University of South Carolina Hospital (SC) Norton Healthcare, Inc. - NWCH - St. Matthews (KY) Riverside Regional Medical Center (VA) MedStar Cardiology Associates (MD) Norwalk Hospital (CT) Rockledge Regional Medical Center (FL) 21 www.VQI.org APPENDIX A— VQI SITES LISTED IN ALPHABETICAL ORDER (AS OF 6/1/2021)

Roper St. Francis Hospital (SC) St. Joseph’s Medical Center of Stockton (Dignity UCSF Medical Center (CA) Rose Medical Center (CO) Health) (CA) UF Health- Shands Hospital (FL) Royal Oak (William Beaumont Hospital) (MI) St. Luke’s Campus (Mohawk Valley Health System) (NY) UNC Hospitals (NC) Rush Foundation Hospital (MS) St. Luke’s Healthcare- St. Luke’s Regional Medical United Health Services Hospitals, Inc. (NY) Russell C. Lam MD PA (TX) Center (ID) United Hospital Center (WV) Rutgers Robert Wood Johnson Medical School (NJ) St. Luke’s Hospital - Allentown Campus (PA) UnityPoint Health- Des Moines (IA) Sacred Heart Hospital of the Hospital Sisters of the St. Luke’s Hospital - Anderson Campus (PA) UnityPoint Health- Meriter Hospital (WI) Third Order of St. Francis (WI) St. Luke’s Hospital - Bethlehem Campus (PA) Univeristy of Washington Medical Center Saint Alphonsus Regional Medical Center (ID) St. Luke’s Hospital - Monroe Campus (PA) (Montlake Campus) (WA) Saint Barnabas Medical Center (Barnabas Health) (NJ) St. Luke’s Hospital - Quakertown Campus (PA) University Hospitals Ahuja Medical Center (OH) Saint Francis Hospital and Medical Center (CT) St. Luke’s Hospital - Warren Campus (NJ) University Hospitals Cleveland Medical Center (OH) Saint Joseph Health System, Inc d/b/a CHI St. Joseph HealthSt. Luke’s Hospital (MN) University of Alabama (AL) London (KY) St. Luke’s Hospital (MO) University of Arkansas Medical Sciences (AR) Saint Joseph Hospital (CO) St. Luke’s Methodist Hospital (IA) University of Chicago Medical Center (IL) Saint Joseph Hospital (KY) St. Luke’s Roosevelt Hospital Center (NY) University of Cincinnati Medical Center (OH) Saint Joseph Regional Medical Center (IN) St. Mary Corwin Medical Center (Centura Health University of Colorado - Denver (CO) Saint Joseph’s Hospital (GA) Corporation) (CO) University of Colorado - North Vascular Services (CO) Saint Luke’s Hospital of Kansas City (MO) St Mary Medical Center (CA) University of Connecticut Health Center (CT) Saint Luke’s Memorial Hospital, Inc. (PR) St. Mary Medical Center (PA) University of Iowa (IA) Saint Thomas Midtown Hospital (TN) St. Mary’s Hospital (CO) University of Kansas Medical Center (KA) Saint Thomas Rutherford Hospital (TN) St. Mary’s Hospital (WI) University of Kentucky (KY) Saint Thomas West Hospital (TN) St. Mary’s Medical Center (WV) University of Maryland Medical Center (MD) Salem Health (OR) St. Patrick Hospital (Providence) (MT) University of Massachusetts Memorial Hospital (MA) San Diego Vascular Associates (CA) St. Peter’s Hospital (St. Peter’s Health Partners) (NY) University of Michigan (MI) Sanford Bemidji Medical Center (SD) St. Vincent Healthcare (MT) University of Minnesota Medical Center (UMMC) (MN) Sanford Clinic Vascular Associates (SD) St. Vincent Heart Center of Indiana, LLC (IN) University of Mississippi Medical Center (MS) Sanford Medical Center Fargo (SD) St. Vincent Hospital and Health Care Center, Inc. (IN) University of Missouri Medical Center (MO) Sanger Heart and Vascular Institute (NC) St. Vincent Hospital of the Hospital Sisters of the University of Oklahoma School of Community Santa Rosa Memorial - Providence Health (CA) Third Order of St. Francis (WI) Medicine (OK) Santa Rosa Memorial (CA) St. Vincent’s Medical Center (CT) University of Tennessee Medical Center (TN) Sarasota Memorial Hospital (FL) Stamford Hospital (CT) University of Texas Health Science Center, Saxony Hospital (IN) Stanford Hospital and Clinics (CA) San Antonio (TX) Scott & White Memorial Hospital (TX) Steward Good Samaritan Medical Center, Inc. (MA) University of Utah Hospital and Clinics (UT) Scripps Green Hospital (Scripps Health) (CA) Steward St. Anne’s Hospital Corporation (MA) University of Vermont Medical Center (VT) Scripps Memorial Hospital Encinitas (CA) Steward Trumbull Memorial Hospital, Inc. (OH) University of Washington Medical Center Scripps Memorial Hospital La Jolla (Scripps Health) (CA) Stockton Cardiothoracic Surgical Medical Group (CA) (Northwest Campus) (WA) Seattle Vascular Surgery (WA) Stony Brook University Medical Center (NY) University of Wisconsin Hospitals and Clinics Self Regional Healthcare (SC) Straub Medical Center (HI) Authority (WI) Sentara Careplex Hospital (VA) Strong Memorial Hospital, University of Rochester University Surgical Associates (TN) Sentara Leigh Hospital (VA) Medical Center (NY) UPMC Altoona (PA) Sentara Martha Jefferson (VA) Suburban Hospital (MD) UPMC/UPP Vascular Surgery (PA) Sentara Norfolk General Hospital (VA) Summa Health System (OH) UPMC/Hamot Hospital (PA) Sentara Northern Virginia (VA) Sunnybrook Health Sciences Centre (Canada) UPMC Pinnacle Hanover (PA) Sentara Obici Hospital (VA) SUNY Upstate- University Hospital Medical Center (NY) UPMC Pinnacle Harrisburg (PA) Sentara Princess Anne Hospital (VA) Superior Vein Care, PLLP (ID) UPMC Pinnacle Memorial (PA) Sentara RMH Medical Center (VA) Surgical Specialists of Central Florida (FL) UPMC Pinnacle West Shore (PA) Sentara Virginia Beach General Hospital (VA) SwedishAmerican Hospital (IL) UPMC Susquehanna - UPMC Williamsport (PA) Sentara Williamsburg Regional Medical Center (VA) Swedish Cherry Hill (Providence) (WA) UPMC Western Maryland (MD) Sequoia Hospital (Dignity Health) (CA) Swedish Edmonds (Providence) (WA) Utah Valley Hospital (UT) Shannon Medical Center (TX) Swedish First Hill (Providence) (WA) UVA Medical Center (UVA Health System) (VA) Sharp Grossmont Hospital (CA) Tallahassee Memorial HealthCare, Inc. (FL) ValleyCare (CA) Sharp Memorial Hospital (CA) Tampa General Hospital (FL) Vanderbilt University Medical Center (TN) SIH - Memorial Hospital of Carbondale (IL) Tenet Florida Physicians Services, LLC (FL) Vanguard Vascular & Vein (TX) Singapore General Hospital Pte Ltd (Singapore) Texas Health Harris Methodist Fort Worth (TX) Vascular & General Surgical Specialists of SWFL (FL) SIU School of Medicine, Memorial Medical Center (IL) Texas Health Presbyterian Hospital (TX) Vascular Institute of Chattanooga (TN) Slidell Memorial Hospital (LA) The Christ Hospital (OH) Vascular Institute of Michigan (MI) South Florida Baptist (FL) The Hospital Authority of Valdosta and lowndes County Georgia Vascular Surgery Associates (FL) South Miami Hospital (FL) (GA) Venice Regional Bayfront Hospital (FL) Southcoast- Charlton Memorial Hospital (MA) The Johns Hopkins Hospital (MD) Verde Valley Medical Center (AZ) Southcoast- St. Luke’s Hospital (MA) The Medical Center of Aurora (CO) Vidant Medical Center (NC) Southwest Healthcare System (CA) The Medical Center, Navicent Health (The Medical Virginia Commonwealth University Hospital Space Coast Vascular (FL) Center of Central Georgia, Inc.) (GA) Authority (VA) Spartanburg Regional Health Services District, Inc. (SC) The Methodist Hospital (TX) Virginia Mason (WA) Spectrum Health Hospital (MI) The Methodist Medical Center of Illinois (IL) Wadley Regional Medical Center (TX) SSM DePaul Health Center (MO) The MetroHealth System (OH) Wake Forest Baptist Health (NC) SSM Health - Good Samaritan (IL) The Ohio State University, Wexner Medical Center (OH) WakeMed Health & Hospitals -- Cary Campus (NC) SSM Health - St Agnes (WI) The Practice of John F Lucas III, M.D. (MS) WakeMed Health & Hospitals -- Raleigh Campus (NC) SSM Health St. Louis University Hospital (MO) The Reading Hospital and Medical Center (PA) Washington Hospital Health System (CA) SSM St. Anthony Hospital (OK) The University of Arizona Medical Center- University Wayne UNC Health Care (NC) SSM St. Clare Health Center (MO) Campus (AZ) Weill Cornell Medical College (NY) SSM St. Joseph Health Center (MO) The University of California Irvine Medical Center (CA) Weiss Memorial Hospital (IL) SSM St. Mary’s Health Center (MO) The University of Southern California on Well Span Surgery Center (Good Samaritan) (PA) St. Anthony Lakewood (Centura Health behalf of its Keck Medicine of USC (CA) WellSpan York Hospital (PA) Corporation) (CO) The University of Texas M.D. Anderson Cancer West Hospital (IN) St. Anthony Community Hospital, Warwick (NY) Center (TX) West Jefferson Medical Center (LA) St. Anthony Medical Center (CHI Franciscan The University of Texas Southwestern Medical West Tennessee Heart and Vascular Center (TN) Health) (WA) Center (TX) West Virginia University Hospitals, Inc. (WV) St. Anthony’s Hospital (FL) The Valley Hospital (NJ) Westchester Medical Center (NY) St. Anthony’s Medical Center (MO) The Vein and Vascular Institute of Tampa Bay (FL) White Plains Hospital (NY) St. Charles Health System, Inc. (OR) Thomas Jefferson University Hospitals, Inc. (PA) White Square Vascular Surgery (MD) St. Clair Hospital (PA) Thunder Bay Regional Health Sciences Centre Willis-Knighton North (LA) St. Dominic’s Memorial Hospital and Medical (Canada) Winchester Medical Center (VA) Associates (MS) Tift Regional Medical Center (GA) Winter Haven Hospital (FL) St. Elizabeth’s Medical Center (MA) Toronto General Hospital (Canada) Yale New Haven Hospital (CT) St. Francis Heart Center (IN) Tradition Medical Center (Martin Memorial Yavapai Regional Medical Center (AZ) St. Francis Medical Center (CHI Franciscan Health) (WA) Medical Center, Inc.) (FL) Yuma Regional Medical Center (AZ) St. John’s Health Center (Providence) (CA) Trident Medical Center (SC) St. John’s Hospital (IL) TriStar Centennial Medical Center (TN) St. Joseph Medical Center (MO) TriStar Summit Medical Center (TN) St. Joseph Medical Center (CHI Franciscan Health) (WA) Tucson Medical Center (AZ) St. Joseph Mercy Health System (MI) Tufts Medical Center (MA) St Joseph (Orange) - Providence Health (CA) Turkey Creek Medical Center (TN) St. Joseph Hospital (Eureka) (CA) UC Davis Health System (CA) St. Joseph’s Hospital (FL) UCHA- Memorial Hospital Central (CO) St. Joseph’s Hospital North (FL) UCLA- Ronald Reagan Medical Center (CA) St. Joseph’s Hospital South (FL) UCSD Medical Center (CA) 22 SVS VQI 2021 Annual Report APPENDIX B— SOCIETY FOR APPENDIX C—FIVOS (FORMERLY VASCULAR SOCIETY PATIENT MEDSTREAMING/M2S) CLINICAL SAFETY ORGANIZATION (SVS PSO) PLATFORM The Patient Safety and Quality Improvement Act The SVS Vascular Quality Initiative is built on Fivos of 2005 authorized the creation of Patient Safety PATHWAYS® clinical registry platform, allowing Organizations (PSO) to improve the quality and users to track, measure, and analyze clinical safety of health care by the collection and analysis information, promote collaboration, objectively of patient data. It protects any comparative drive decisions, and optimize performance. outcome analyses or other aggregated reports that is generated by a PSO from discovery in state PATHWAYS is a secure, cloud-based solution that and federal court. These analyses and reports, enables physicians, institutions, clinical data called Patient Safety Work Products (PSWP) can managers, and researchers to collect, manage, be used for quality improvement but not for analyze, and disseminate their clinical data to disciplinary action against a provider. It allows achieve optimal outcomes. Accessible by any patient identifiers to be collected, without specific computer with a compatible browser, PATHWAYS IRB or patient approval. This permits a PSO to match is designed to easily integrate into a variety of patients with other data sources, such as the Social workflows by allowing multiple users to access Security Death Index or Medicare claims data to and enter data on a single procedure form, evaluate long-term effectiveness of procedures in and to spread the responsibilities of data entry terms of mortality or complications. The identity of to more than one individual. Authentication patients, hospitals, providers and other protected identifies users’ roles and permissions to ensure health information cannot be disclosed by a PSO, appropriate access to content within PATHWAYS. although non-identifiable data can be published Real-time data validation through error-trapping for quality improvement research, adhering to both and alerts ensure that only high-quality data PSO and HIPAA requirements. SVS VQI embraced is populated into the system. PATHWAYS has the use of a PSO to house its activities, because it been designed to support large-scale quality provides substantially more security and protection improvement and research projects as dynamic than most registries.data can be published for content within registries can easily be added quality improvement research, adhering to both and/or modified. PSO and HIPAA requirements. SVS VQI embraced the use of a PSO to house its activities, because it About Fivos provides substantially more security and protection Fivos was formed in 2021 by the planned than most registries. combination of two highly complementary businesses, Medstreaming and M2S. Fivos offers VQI SUPPORTING SOCIETIES specialty-based workflow reporting applications American College of Cardiology* for providers, registry solutions and support for American Venous Forum* medical societies, and custom data sets for Canadian Society for Vascular Surgery device manufacturers that advance innovation. Eastern Vascular Society Florida Vascular Society At Fivos, we believe in healthcare IT innovation Georgia Vascular Society that enables proactive patient care and Michigan Vascular Society improves the quality of healthcare. Combining Midwestern Vascular Surgical Society decades of industry experience, a thorough New England Society for Vascular Surgery understanding of data science, and a large dose New York Society for Vascular Surgery of curiosity, we are committed to empowering Peripheral Vascular Surgery Society healthcare organizations to leverage data to Rocky Mountain Vascular Society create efficiencies, manage costs, and improve Society for Clinical Vascular Surgery outcomes. For more information, visit www. Society for Vascular Medicine* fivoshealth.com. Society for Vascular Ultrasound* Southern Association for Vascular Surgery Southern California Vascular Surgical Society The American Heart Association* Vascular Access Society of America* Western Vascular Society

*Members of SVS PSO Governing Council

23 www.VQI.org 2019 Detailed Annual Report

© Society for Vascular Surgery Patient Safety Organization, 2019. All rights reserved.