VQI Quality Initiative Update

Fall 2022


This report is patient safety work product generated within the SVS PSO, LLC, and is considered privileged and confidential.

About the Report

The Society for Vascular Surgery Patient Safety Organization (SVS PSO) conducts two VQI-wide quality improvement (QI) initiatives: Discharge Medications and Sac Diameter Reporting After EVAR. This report provides an update on your center's progress on these measures, but is not intended to present a 100% complete picture of your center's current rates for these initiatives. Instead, the report is designed to provide rapid data-feedback for centers to evaluate their data in preparation for the participation awards at the end of the year. As such, the following results should be regarded as only preliminary snapshots used to inform and drive quality improvement at your institution.

To quickly access a specific QI initiative, click on the name in the table of contents on the left. For data feedback and drill-down on your center's reviewed or excluded cases in each QI initiative, click on "VQI Case Appendix". All results are based on data entered into the VQI as of September 30, 2022. Only cases submitted as complete in the PATHWAYS platform are reflected in this report.


Introduction

Providing individual medical centers the ability to track their performance allows our members to use their data for successful QI initiatives. The 2022 Participation Awards will continue to incorporate both QI initiatives in the composite scoring, including bonus points for maintaining and/or improving your Discharge Medications and EVAR Sac Diameter Reporting rates as described below.

Our goal is to have 100% of our eligible patients (i.e. those without contraindications to these medications) discharged on these medications after their vascular procedures. Overall VQI rates for discharge medications have been steadily tracking upward - 82% in 2018, 84% in 2019, 85% in 2020 and 86% in 2021 - but we still have room for improvement in order to reach our goal.

Since EVAR sac diameter reporting is a long-term follow-up measure, rates are not calculated until two years after the surgery date in order to allow centers adequate time to capture and enter LTFU. Our baseline rate is 60% for cases performed in 2019. Historically, rates have held nearly constant: 62%, 62% and 62% in 2016-2018, respectively. The goal is for 100% of EVAR patients to have sac diameter reporting at one year.

Together, we can reach our goal for each of these initiatives.



Discharge Medications

2022 Procedures Through Quarter 3 (January 1, 2022 - September 30, 2022)

Includes CAS (TFEM CAS and TCAR), CEA, EVAR, INFRA, LEAMP, OAAA, PVI, SUPRA, and TEVAR procedures only. Antiplatelet is defined as ASA or P2Y12 inhibitor. Cases are excluded if (1) Discharge Statin = "No, for medical reason" OR (2) Both Discharge ASA = "No, for medical reason" AND Discharge P2Y12 inhibitor = "No, for medical reason" OR (3) An in-hospital death occurred.

For the 2022 Participation Awards, centers that are above the 2022 75th percentile for the rate of discharge antiplatelet+statin can receive bonus points toward their final award (as long as their rate is not significantly lower than their 2021 rate). Centers that are below the 75th percentile but show statistically significant improvement (p-value<.05) over their 2021 rate can also receive bonus points toward their final award.

The first two lines of the table below show your center's current antiplatelet+statin rate for 2022 cases. Other rows show the rate of discharge antiplatelet+statin that must be achieved among your expected number of remaining 2022 cases for your center to reach the 75th percentile for 2021, or to show statistically significant improvement over its 2021 rate.

Note that the 75th percentile for 2021 has been provided as a benchmark, but the 75th percentile for 2022 cases will likely be different than it was for 2021. Thus, reaching the 75th percentile for 2021 will not guarantee that your center is above the 75th percentile for 2022.


Results
Number of 2022 cases meeting inclusion criteria 582
N (%) of 2022 cases where patient received antiplatelet+statin 526 (90.4%)
75th percentile among VQI centers for 2021 96.9%
Your center's antiplatelet+statin rate for 2021 cases 89.6%
Estimated total number of cases your center will enter for 2022 * 822
Estimated number of cases remaining to be entered 240
Minimum rate among estimated remaining 2022 cases to stay above 75th percentile for 2021 NA (below 75th percentile)
Minimum rate among estimated remaining 2022 cases to reach 75th percentile for 2021 or show statistically significant improvement over your 2021 rate** 225/240 (93.8%)

*Extrapolated from your center's case volume for Jan-Sep 2022.

**Based on extrapolated case volumes. If your estimated remaining cases with discharge medications to reach the 2021 75th percentile is greater than your estimated remaining cases, and it is mathematically impossible for your center to show statistically significant improvement over your 2021 rate, 100% is given for your remaining minimum rate.


EVAR: Sac Diameter Reporting

2020 procedures

Includes Endovascular AAA Repair (EVAR) procedures only. Excludes patients who were converted to open or died within 21 months of surgery.

All EVAR patients should undergo annual imaging with sac diameter reporting to confirm success of the procedure and demonstrate absence of endoleak, which could lead to rupture.

For the 2022 Participation Awards, centers that are above the 2020 75th percentile for EVAR sac diameter reporting will receive a point toward their final award (as long as their rate is not significantly lower than their 2019 rate). Centers that are below the 75th percentile but show statistically significant improvement over their 2019 EVAR sac diameter reporting rate will also receive a point toward their final award.

The table below shows your center's current sac diameter reporting rate for 2020 cases and the percent of your center's 2020 cases without a reported sac diameter that would need a sac diameter reported for your center to reach the 75th percentile for 2019, or to show statistically significant improvement over its 2019 sac diameter reporting rate.

Note that the 75th percentile for 2019 has been provided as a benchmark because centers have had a full 21 months to enter follow-up for those cases, but the 75th percentile for 2020 cases will likely be different than it was for 2019. Thus, reaching the 75th percentile for 2019 will not guarantee that your center is above the 75th percentile for 2020.


Results
Number of 2020 procedures meeting inclusion criteria 63
N (%) of 2020 procedures with sac diameter reported between 9 and 21 months post-procedure 41 (65.1%)
75th percentile among VQI centers for 2019 77.8%
Your center's sac diameter reporting rate for 2019 cases 83.7%
Among 2020 cases without reported sac diameter, % with reported sac diameter required to reach 2019 75th percentile or show statistically significant improvement over your 2019 rate 8/22 (36.4%)



VQI Case Appendix

Fall 2022


The VQI Case Appendix provides embedded drill-down and data feedback for each report. Using the appendix, centers can easily identify and download cases that were included or excluded from each report, as well as cases with each noted outcome.

The interactive tables below give your center's cases (both included and excluded) entered for the procedure timeframe of each report (as of September 30, 2022). Each row references a particular case and each case is referenced by PRIMPROCID, a unique case identifier assigned to each procedure to protect patient identity. Additional data elements are included for each case to further facilitate quality improvement efforts, including procedure and patient characteristics, and other data elements related to report construction.

To download a .csv or .xlsx file containing your center's data, click on either the "CSV" or "Excel" buttons located above each interactive table.


Important Notes

  • The interactive tables can be sorted on a column by clicking on the column name.
  • Values of binary (yes/no) variables are represented as 1s and 0s, where 1 = "Yes" and 0 = "No".

  • Binary indicator variables for report inclusion/exclusion are provided where applicable.

  • The search function returns every row containing at least 1 cell satisfying the value entered in the search bar.

  • Many data elements given in the interactive tables are cleaned or constructed variables created by the SVS PSO, whereas other data elements are taken directly from the PATHWAYS platform. To reference PATHWAYS data elements not provided in the interactive tables, PRIMPROCID can be used to access the entire case record in PATHWAYS.



Discharge Medications

2022 Procedures Through Quarter 3 (January 1, 2022 - September 30, 2022)

Cases: 624

Cases Included: 582

For cases excluded from the report (Excluded = 1), 'N/A' is entered for the value of DC Meds Compliance.


EVAR: Sac Diameter Reporting

2020 procedures

EVAR Cases: 71

EVAR Sac Diameter Reporting Cases Included: 63

For cases where Death = 0 (No), -90000 is entered for Days to Death.



References


Previous work by De Martino et al (J Vasc Surg, 2014 Jun;59(6):1615-21) demonstrated that patients undergoing major arterial procedures have a 25% improvement in 5-year survival if they are discharged on an anti-platelet agent and a statin. This work, along with a growing body of literature demonstrating similar results, prompted the national VQI Quality Initiative to increase the appropriate use of statin and antiplatelet agents in our patients.

Long-term follow-up imaging and sac diameter reporting is essential after EVAR to determine the success of the procedure, defined by exclusion of the aneurysm without significant endoleak or continued sac enlargement. Therefore, the SVS PSO continues to focus on improvement in the area of EVAR sac diameter reporting.

To support these initiatives, the SVS PSO continues to provide webinars, newsletters, regional meetings, case studies, a QI Project Guide, and reports like this one to assist you, our members, in analyzing your data, defining your problem, developing a plan (charter), implementing a process, and evaluating your outcomes.

The SVS PSO has coordinated networking opportunities among centers with similar QI charters in order to facilitate an exchange of ideas and provided webinars on QI tools. The networking opportunities have included ways of overcoming barriers, sharing of worksheets, and processes used for successful QI projects at academic and community centers. In addition, numerous tools, resources and presentations on these two topics are available to assist a center with starting a QI project at their institution.