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2020 VQI Year in Review

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2020 VQI Year in Review YEAR IN REVIEW 2019/2020 Executive Summary 2019 and early 2020 have been an exciting time in the world of vascular surgery. It has been another successful year for the Society for Vascular Surgery’s Vascular Quality Initiative (SVS VQI). We are pleased to report SVS VQI has added 111 centers, bringing its total membership to 676 centers and over 4,700 physicians. More than 704,000 procedures have been captured in the SVS VQI’s 14 clinical registries. The big issue in 2020 is COVID-19. All of our personal and professional lives have been disrupted by this pandemic. COVID-19 will impact SVS VQI data collection for procedure, long-term follow-up and claims validation. SVS VQI is working with centers to minimize the impact as well as accommodate the disruptions in workflow. The SVS PSO has also formed a COVID taskforce and will be implementing COVID variables in the SVS VQI registries. All the Spring 2020 regional meetings were held as remote meetings with presentations and web attendance. Decisions regarding Fall 2020 regional meetings will be made by each region. Another significant issue in vascular surgery in 2019 was the Paclitaxel controversy. A meta-analysis by Katsanos et al reported an increase in Strategic Focus late mortality in patients being treated with devices using Paclitaxel During 2019/20, the Society for Vascular Surgery Patient Safety technology. This report initiated a flurry of investigations aimed at Organization (SVS PSO) has identified areas of strategic importance, determining the role of Paclitaxel devices in late mortality. As it turns including: out, SVS VQI is the only clinical registry that records device specific • EMR integration with Cerner and EPIC identification, i.e. a Paclitaxel drug coated balloon or Paclitaxel drug eluting stent. This granular clinical detail has allowed SVS VQI to • New reporting and analytics for SVS VQI members perform a detailed analysis that has contributed to the discussion on the • Long term claims-matched reports (EVAR first pilot) impact of Paclitaxel. We plan to continue to use SVS VQI data to further analyze this concerning relationship. • Standard operative notes (CEA first pilot) • Collaboration with SVS Clinical Practice Guidelines with SVS VQI data In 2019, SVS VQI began a process to integrate Data Extraction and Longitudinal Trend Analysis (DELTA) into our database. DELTA is an open • Source data audits source software application that is designed to detect early signal discernment. DELTA was developed by Frederic Resnic, an interventional cardiologist at Lahey Clinic, Boston, MA, and has been used to detect FIGURE 1 failure of ventricular pacemaker leads and vascular closure devices. We have used DELTA to analyse SVS VQI Paclitaxel patients (no adverse Growth in Participating Centers Jan-10 15 mortality was seen at 17 months) and plan further projects with more (as of April 2020) Jul-10 30 patients and longer follow-up. 700 Jan-11 60 SVS VQI has recentlyJul-11 released97 two new registries, Venous Stent released in October 2019Jan-12 and Vascular145 Medicine Consult registry released in 600 February 2020.Jul-12 The Venous184 Stent registry records patients who have undergone placementJan-13 of216 a venous stent for venous obstructive disease in the femoralJul-13 vein, iliac237 vein and inferior vena cava. 500 Jan-14 279 Jul-14 289 The Vascular Medicine Consult registry records patients with abdominal 400 aortic aneurysms,Jan-15 carotid320 stenosis, and lower extremity occlusive disease who Jul-15are being managed352 medically. This registry will help us Jan-16 377 learn about the natural history of these diseases as well as the outcome 300 of medical management.Jul-16 393 Other than vascular medicine specialists, we Jan-17 403 hope to have participation from medical colleagues in cardiology, May-17 422 internal medicine and other primary care specialties. 200 Aug-17 437 Nov-17 447 In 2019/20, 74 different primary SVS VQI investigators initiated 187 new Feb-18 458 100 research projects,May-18 and 129486 publications based on SVS VQI data appeared in peer-reviewedJul-18 journals.489 A selection of the best SVS VQI papers can be found on Oct-18the SVS VQI510 website, https://www.vqi.org/data-analysis/. 0 Mar-19 558 Oct-10 Oct-11 Oct-12 Oct-13 Oct-14 Oct-15 Oct-16 Oct-17 Oct-18 Oct-19 To further enhanceApr-19 the 565value of SVS VQI data to members, there are Apr-10 Apr-11 Apr-12 Apr-13 Apr-14 Apr-15 Apr-16 Apr-17 Apr-18 Apr-19 Apr-20 on-going qualityAug-19 improvement602 programs in several areas. SOURCE: M2S PATHWAYS Sep-19 612 Dec-19 649 VascularVApr-20ascular676 Quality Quality Initiative® Initiative® www.vqi.org 1 YEAR IN REVIEW 2019/2020 Current Registry Development/Revisions • Hemodialysis Access Revisions: Released Q4 2019 COVID-19 • NEW Venous Stent Registry: Released in Q4 2019 The COVID-19 pandemic is having a far-reaching global impact affecting geopolitical, financial and medical institutions worldwide. To paraphrase • Varicose Vein Revisions: Released in Q1 2020 the great physicist Richard Feynman, “we cannot understand what we • NEW Vascular Medicine Registry: Released in Q1 2020 cannot measure”. (collaboration with SVM and AHA) The SVS PSO has begun the process of measuring COVID-19’s impact on • 2020 Planned Revisions: Open AAA our patients through a survey of SVS VQI physicians and data managers. • NEW 2020 Addition of COVID variables Our goal is to incorporate COVID-19 variables into the registries. The following variables will be added for an undetermined amount of time. Launch of Venous Stent Registry Help text will be provided when released. The new Venous Stent Registry, launched in Quarter 4 2019, will collect data on percutaneous and open procedures that use a stent to treat patients with venous obstruction. This registry is designed to collect 0=Unknown, not tested; 1=Tested data on patient undergoing stent placement in the inferior vena cava, negative pre-op; 2=Tested positive Procedure COVID status at common iliac vein, external iliac vein, common femoral vein, deep time of procedure pre-op; 3=Tested negative pre-op femoral vein, femoral vein, and popliteal vein for obstruction due to but positive post-op thrombosis or compression. Launch of Vascular Medicine Consult Registry 1=Asymptomatic, The SVS PSO, in collaboration with the Society for Vascular Medicine Procedure COVID symptoms 2=Symptomatic, not intubated, (SVM) and the American Heart Association (AHA) introduced the pre-procedure 3=Symptomatic, intubated Vascular Medicine Consult registry (VMC) in Quarter 1 2020. INCLUSIONS New Outpatient Consults who are being treated medically for peripheral 0=None, 1= Delayed < 2 weeks, 2=Delayed 2-6 weeks, arterial disease due to atherosclerosis, atherosclerotic carotid artery Procedure Treatment delay occlusive disease, or abdominal aortic aneurysm. by pandemic 3=Delayed, > 6 weeks, 4=Uncertain EXCLUSIONS • Evaluation/diagnosis of pseudo or neurogenic claudication, 0=None-Mild worsening, peripheral arterial disease due to trauma, popliteal entrapment, Impact of delay medial adventitial cystic disease, chronic compartment syndrome 1=Moderate worsening, Procedure in treatment 2= Severe worsening, • Carotid disease due to dissection, infection, aneurysm, tumor, 3=Indeterminate Jan-10 15 isolated common carotid lesion not thought to involve the Jul-10 30 bifurcation, disease of the carotid bifurcation due solely to vasculitis, 700 Jan-11 60 Moyamoya disease, and fibromuscular dysplasia Jul-11 97 • Isolated aortic dissection without aneurysm 0=Tested negative, 30 Day COVID status 1=Tested positive, Jan-12 145 • Thoracic, thoraco-abdominal, and mycotic aneurysms 600 and LTFU after D/C 2=Unknown, not tested Jul-12 184 Jan-13 216 The registry will collect data on medications and dosages, risk factors Jul-13 237 500 and lifestyle modifications, and non-operative treatments to help to Jan-14 279 define the natural history of disease processes and the impact of Jul-14 289 medical management. Jan-15 320 400 Jul-15 352 Jan-16 377 300 Jul-16 393 Jan-17 403 May-17 422 200 Aug-17 437 Nov-17 447 Feb-18 458 100 May-18 486 Jul-18 489 Oct-18 510 0 Mar-19 558 Oct-10 Oct-11 Oct-12 Oct-13 Oct-14 Oct-15 Oct-16 Oct-17 Oct-18 Oct-19 Apr-19 565 Apr-10 Apr-11 Apr-12 Apr-13 Apr-14 Apr-15 Apr-16 Apr-17 Apr-18 Apr-19 Apr-20 Aug-19 602 Sep-19 612 Dec-19 649 Apr-20 676 www.vqi.org 2 YEAR IN REVIEW 2019/2020 SVS PSO Quality Councils and Committees Arterial Quality Council (AQC) Venous Quality Council (VQC) The mission of the AQC is to maximize the value of the data collected The mission of the VQC is to maximize the value of the data collected in the in the arterial registries. Members include a chair and vice chair, two venous registries. Members include a chair and vice chair, two representa- representatives from the Society for Vascular Surgery (SVS), one tives from SVS, one representative from the Society of Interventional representative from the Society of Interventional Radiology (SIR), two Radiology, two representatives from the Society for Vascular Medicine, two representatives from the Society for Vascular Ultrasound (SVU), two representatives from the Society for Vascular Ultrasound, plus representa- representatives from the Society for Vascular Medicine (SVM), plus tives from each regional vascular quality group. Three members including representatives from each regional vascular quality group. the chair are appointed by the American Venous Forum. AQC Update VQC Update • Opioid Workgroup formed and charged with putting forth • Council Transition: Dr. Marc Passman appointed as new Chair for 2020 recommendations on how the SVS VQI can be used to track, • Continued Interest from United Healthcare on collaborating on monitor and benchmark opioid utilization.
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