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Value in Participation

Quality Improvement Can Lead to a Reduction in Cost

 

reduce-the-cost-of-healthcareLearn more below about:
  • How the VSGNE reduced their LOS for Carotid Endarterectomy from 2.5 days to 1.2 days
  • How the VQI’s National Quality Project to reduce SSI can help your center
  • How Regional Quality Groups are the key to improving patient care and reducing costs on a local level
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The VSGNE’s Quality Projects

The Vascular Study Group of New England (VSGNE), which the VQI is modeled after, has successfully impacted the quality of patient care in their region since 2003. The following are examples of quality improvements initiatives across their region:

CEA LOS Graph

  • To reduce operative risk, preoperative medications of known benefit have been prescribed (beta-blockers increased from 68% to 88% and statins from 53% to 89%)
  • Use of protamine to significantly diminish reoperation for bleeding during Carotid Endarterectomy. without increasing thrombotic risk
  • Patching during Carotid Endarterectomy has increased from 84% to 100%, which has eliminated recurrent carotid stenosis at one year follow-up
  • Use of less invasive procedures reduced to 24%

Quality improvements such as these should translate directly into hospital cost reduction. The VSGNE and Carolinas regional groups have demonstrated cost savings per admission, estimated by LOS reductions for Lower Extremity Bypass, Carotid Endarterectomy (shown above), and Open AAA Repair procedures.
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 National Quality Projects

The Quality Committees of the SVS Patient Safety Organization (SVS PSO) analyze VQI data to aid participating centers and physicians in their efforts to improve the quality and safety of patient care. Through the data analyses, the committees provide VQI participants with opportunities for improvement. In 2012, the SVS PSO Arterial Quality Committee initiated the VQI’s first national quality improvement project, focusing on surgical site infection (SSI) after infra-inguinal bypass. The committee analyzed data across all VQI centers to identify risk factors associated with in-hospital SSI after infra-inguinal bypass. Using a multivariable logistic model, significant variation was found, with the following variables identified as independent predictors of SSI:

Patients with Ankle-Brachial Index (ABI) less than 0.35 had a higher risk of SSI.
Operative skin preparation using chlorhexidine (instead of iodine) was associated with a lower risk of SSI, especially in patients with tissue loss.
Patients receiving 3 or more units transfusion during their admission had a higher risk of SSI.
Surgery time of more than 220 minutes was associated with a higher risk of SSI.

COPI Report

Based on these identified risk factors, the committee provided participants a Center Opportunity Profile for Improvement (COPI) report specific to the procedures they have entered into the database, to identify their best opportunity to reduce SSI.
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Value of Regional Quality Groups

Regional quality groups are the cornerstone of the Vascular Quality Initiative’s success. These groups provide a vehicle for collaboration between peers to identify and share best practices for improving patient care and reducing costs at the local level. Through regular meetings, participants analyze their regional data to identify variation in processes of care or outcomes that suggests opportunities for improvement.

At the regional meetings, risk-adjusted benchmarked reports of key quality measures are provided to participating centers and physicians, comparing their center to others in the region. They also receive risk-adjusted reports that compare their regional group’s performance to other regional groups of the VQI. These reports provide insight for regions and centers to launch quality initiatives that focus on practice changes to impact patient care and decrease costs.

RQG chart for CEA LOS

An example risk-adjusted length of stay benchmarked report comparing VQI regional groups is shown above.

 

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I am interested in collecting data for:
Carotid Artery StentCarotid EndarterectomyEndovascular AAA RepairOpen AAA RepairHemodialysis AccessInfra-Inguinal BypassSupra-Inguinal BypassPeripheral Vascular InterventionThoracic and Complex EVARIVC Filter (February 2013)Lower-Extremity AmputationVaricose Veins

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