SCOAP Community Speaks Up: VI-SCOAP

We were recently asked by colleagues at Northwest Hospital about an update on vascular intervention-SCOAP. How are surgeons, radiologists, and cardiologists participating in VI-SCOAP module, and what will the next 6 months look like for the program?

VI-SCOAP (Vascular Interventional Surgical Care and Outcomes Assessment Program) just completed its first year of data collection at 11 hospitals, representing 70% of the state’s vascular care. We are working to enroll 100% of the centers where vascular interventions and surgery are performed. If your hospital is not enrolled and you are interested in joining, please contact Rosa Johnson (rjohnson@qualityhealth.org).

Web-based reports based on our first 843 patients are now available. They represent care delivered by all three specialties and show the promise of VI-SCOAP (a demo version is available at http://cqi.armus.com/reports/SCOAP/Demo/DemoElectiveColon.xml, username “scoap” / password “demo”).  For more information on reports and how to access your hospital’s reports contact Rosa Johnson (rjohnson@qualityhealth.org).  Since October 2010, VI-SCOAP has benefitted from a $12 million grant from the Agency for Healthcare Reform and Quality (AHRQ) that partners VI-SCOAP hospitals and clinicians with Microsoft and leaders in health information technology to create more automated data flow in SCOAP and to reduce the burden on data abstractors. That collaboration will focus on the care of patients with claudication and will help VI-SCOAP expand its long term follow-up surveillance, as well as include a non-interventional comparator group.

Clinicians working with VI-SCOAP data reports have rolled up their sleeves to ask questions about “real world” outcomes and care variation that represent QI opportunities. VI-SCOAP reports highlight some things we do really well, such as delivering antibiotics on time and normothermia. It also shows us things we can do better. For example, 40 % of our patients are diabetic, but we only checked periprocedure glucoses 85% of the time. That’s 15% of patients who we missed an opportunity to have glycemic control and therefore reduce the risk of surgical site infection.  For our many patients on beta blockers, we only continue their use 89% of the time. That’s 11% of our patients who have a higher risk of heart attack after procedures because of a failure to continue these cardioprotective drugs. Metrics like these represent opportunities to impact the quality of care of patients receive, but it starts by knowing where you stand, and that’s what VI-SCOAP is all about.

Vascular care is a great arena for performance benchmarking.  There is significant variation in how the procedures are done, why they are done, and who does them.  For example, it’s interesting to see how the endovascular care is broken down in our state.  Forty-five percent of our patient population (carotid, aorta, and infrainguinal) underwent an endovascular procedure, with 18% of those being performed by cardiologists, 18% by Interventional Radiologists, and 61% by surgeons (see the figure included in this month’s newsletter). While this breakdown does not reflect all the cases performed by a specialty, it does represent a snapshot of our state’s robust endovascular landscape.  It highlights why we’ve built a level playing field for collaboration and why engagement of all specialties is so important.  VI-SCOAP is also important because we take care of some of the sickest patients out there. We see patients with DM (50%), coronary disease (80%) and symptomatic illnesses (75%) demanding high performing systems that to date have had very little in the way of performance monitoring.  These are also high complexity procedures with a risk of adverse events that must be monitored, understood and reduced.  Our early snapshot shows a rate of reintervention (percutaneous, endovascular, or open) in 2.8% of carotid procedures, 6.5% of aortic, and 6.0% of leg procedures. These all represent opportunities for QI, but it starts with knowing how we stand, and that’s what VI-SCOAP is all about.

Now we need you to get more involved. The VI-SCOAP advisory board is made up of interventional radiologists, interventional cardiologists, and vascular surgeons who meet quarterly to define and refine metrics for quality. That group is currently looking at variation in procedure-specific metrics like cerebral protection in carotid stenting and relevant outcome like stroke. They are also looking at an important feature of VI-SCOAP that is being enabled by the AHRQ grant – measurements of longer-term functional status for infrainguinal procedures. As we all know, having an open artery or stent is only important if it  improves functional status or healing. Tracking on this will help us all improve our selection of patients and show the value of our work.  These are just some of the metrics and outcomes that VI-SCOAP is currently addressing, and we invite you and your colleagues to participate in the process and direct future targets for performance monitoring.

Starting in 2011, VI-SCOAP – in concert with other SCOAP groups – will host a series of local, regional, and statewide meetings. You are encouraged to participate and be part of this process. This is an opportunity to direct the future of an exciting initiative-one that will change the scope of our practice and the way quality is defined for our field.

Thanks for all you do to make SCOAP and VI-SCOAP a success.

Ellen T. Farrokhi MD FACS , Associate Medical Director SCOAP
ellen@qualityhealth.org

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