VCSQI | Virginia Cardiac Services Quality Initiative …

Members volunteer their time going above and beyond their professional responsibilities

Participants combine the latest in clinical quality measurements with cutting-edge analytics and technological solutions

VCSQI teams connect as a multi-disciplinary consortium of clinical specialties across many provider networks

VCSQIs goal is to improve clinical quality in all cardiac service programs through outcomes analysis and process improvements. Additionally, VCSQIs clinical/financial database helps reduce costs through reductions in complications and unnecessary resource utilization. The organizations two main objectives are the following:

VCSQI members collaborate to analyze hospital processes, work to identify opportunities for improvement and help implement relevant best practice protocols. Members believe that by improving quality and patient care costs can be contained. Through the use of its clinical/financial database VCSQI improves the quality of care for cardiology and cardiac surgery patients, reduces complications, better coordinates care across both specialties to improve efficiencies in cardiac services care and ultimately reduces costs.

VCSQI is positioned as a reliable statewide source of information. VCSQI serves as the interface to communicate process of care information between member sites, eliminates decision making in silos and connects clinical teams. It augments its regional peer-to- peer interactions with more structured educational media and remote/online technologies.

VCSQI focuses on improving outcomes through changes in processes of care and replication of best practices. The organization serves as a peer-to-peer value exchange whose work:

The objective is to help members find quality improvement opportunities to better utilize resources, contain costs, effectively redesign clinical processes and modify provider behavior using the best available evidence.

The organization provides value to its stakeholders by improving the quality of care through data analysis and implementing best practices protocols. VCSQI collaborates on quality by combining effective communications with solid evidence which translates into process-of-care changes. Benefits include lowered costs of care, enhanced clinical effectiveness, increased accountability, reduced regional variations, stronger alliances between heart team members and improved patient satisfaction. VCSQI achieves this through:

VCSQI members research, identify, and replicate best practices with the goal of improving the quality of patient care. Pilot programs and other proof-of-concept steps are used to develop and lead initiatives for cardiac surgery sites. Best practices and evidence-based guidelines are researched and validated before adoption.

VCSQI applies its benchmarking function on: selecting and defining new quality indicators, establishing baseline data, designing scorecards, maintaining privacy and confidentiality and improving onsite feedback and documentation to better understand trends and variations. Data managers convene regularly to standardize coding practices allowing for timely, sound and accurate interpretations of cardiac service performance reports. Engaging data managers is critical to ensure comparable, defensible metrics.

A process is in place for sampling, scanning, and uploading pertinent films and records for blinded peer review and scoring. To achieve 95% confidence, 5% of Percutaneous Coronary Intervention (PCI) cases will be randomly selected from each site and sent to the Accreditation for Cardiovascular Excellence (ACE) or an equivalent external vendor for review. Each participant is responsible for local operations in coordination with VCSQIs statewide panel. Individual results of the review process will be shared with each institution, and the actions taken as a result of the reviews will be at the discretion of the institution. De-identified data will be presented on a statewide level to assess the overall level of agreement between imaging and treatment.

The approach being espoused by VCSQI is founded on vibrant working relations (a) among clinician colleagues and administration at the practice and hospital level, and (b) regionally with our body of collaborating organizations. VCSQI will coordinate with and connect all participating cardiac surgical and interventional cardiology providers.

VCSQI under the direction of the VCACC/VCSQI Oversight Committee will use a peer-to-peer review process to operationalize AUC for PCI procedures. As capacity and effectiveness increase, the review model will be extended to CABG procedures, TAVR/SAVR, and post-operative events.

VCSQIs unique database links clinical factors and financial outcomes with qualitative, process-level information in order to identify change, monitor and drive quality improvements and enhance patient care while reducing costs. Data and analytics will guide decision-making and improve the organizations evidence base. Data from the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database and the American College of Cardiology (ACC) National Cardiovascular Data Registry (NCDR)will be submitted quarterly to a secure web-based system. Cardiac surgical and NCDR data will be mapped with financial data from standardized hospital files. An annual report, online report library, National Quality Forum (NQF) reporting, and internal rankings will be used to compare performance of member institutions. Reporting will include procedure volume, demographics, risk factors, complications, mortality, resource use, costs, and data quality checks.

VCSQI forms and coordinates regional/local, peer-to-peer review panels to monitor and optimize patient selection. An underlying data model will augment the review process with accurate benchmarks and AUC algorithms.

A data quality assurance process assesses inter-rater reliability of captured data and quantifies errors and inconsistencies. This is an iterative process of measuring, educating and improving data quality. Establishing comparable data from one time period to the next, across facilities and between different data sets; as well as, accurately capturing and reliably reporting clinical performance indicators is the cornerstone to VCSQIs quality improvement infrastructure.

VCSQI adjusts its efforts to improve participants chances for success by implementing models to evaluate hospital performance. Progress is communicated to key audiences in the cardiac surgery and cardiology community and other external organizations.

Performance Indicator Review and Development: VCSQI develops, refines and uses selected clinical quality indicators to measure performance. The organization prioritizes using a set of clinically relevant indicators tied to care processes that can be easily and quickly modified.

VCSQI focuses on high-risk patients and high-cost procedures to uncover performance variations in outcomes and resource use. Risk-adjustment provides accurate comparisons and helps with development of protocol formulation, consensus, adoption and tracking.

Participants interests are represented in an open and focused manner. VCSQI is led by the Board of Directors who develop a governance structure, set dues and adopt bylaws. Member bylaws and committee decisions guide the groups priorities, synchronizing efforts to regularly refine the management of data. Additionally, an Executive Director works with the Board of Directors and other members to facilitate development, set agendas, encourage participation, focus discussion on key issues, help the group reach consensus and solve problems.

Work plans, time lines, milestones and funding help define VCSQIs course of action and operations. A coordinator facilitates development, fosters discussion on key issues, helps reach consensus and solves problems.

Since every participant has its own relative strengths and weaknesses, VCSQI ensures that providers priorities are addressed. A regional Priority Matrix and Quality Improvement Prospectus are drafted to coordinate initiatives.

VCSQIs Heart Team model of collaboration between cardiac surgery and cardiology practices helps to broaden its sphere of influence and is utilized as a means for setting priorities, synchronizing efforts, and managing data. VCSQIs programs effectively convene leaders, use leading technology for regional information sharing, replicate best practices through educational programs and improve care processes through systems change. Additionally, this model tasks regional and local teams to review patient medical conditions, determine feasible treatment options and formulate reasonable strategies of patient care. These teams are situated within local provider organizations and in coordination externally with VCSQI.

VCSQI assumes an expanded role promoting a culture of continuous quality improvement for the entire cardiac services community. Participation is open, voluntary and equitable. The organization is a consortium of 18 cardiac surgical practices and 16 interventional cardiology sites and projects are led by the Board of Directors and developed by the Quality Committee and Research and Writing Committee.

Regional Collaboration as a Model for Fostering Accountability and Transforming Healthcare. Speir AM, Rich JB, Crosby IK, Fonner E. Seminars in Thoracic and Cardiovascular Surgery 21 (2009):12-19.

Additive Cost of Postoperative Complications for Isolated Coronary Artery Bypass Grafting Patients in Virginia. Speir AM, Kasirajan V, Barnett SD, Fonner E. Annals of Thoracic Surgery 88.1 (2009): 40-46. Presented at the 45th annual meeting of the Society of Thoracic Surgeons, San Francisco CA, January 2009.

Making a Business Case for Quality by Regional Information Sharing Involving Cardiothoracic Surgery. Rich, JB, Speir AM, Fonner E. The American Heart Hospital Journal, 4, no. 2 (Spring 2006): 142-147.

Preoperative Renal Function Predicts Hospital Costs and Length of Stay in Coronary Artery Bypass Grafting. LaPar DJ, Rich JB, Isbell JM, Brooks CH, Crosby IK, Yarboro LT, Ghanta RK, Kern JA, Brown M, Quader MA, Speir AM, Ailawadi G. Annals of Thoracic Surgery 101.2 (2016), 606-612.

Contemporary Costs Associated With Transcatheter Aortic Valve Replacement. Ailawadi G, LaPar DJ, Speir AM, Ghanta RK, Yarboro LT, Crosby IK, Lim DS, Quader MA, Rich JB. Annals of Thoracic Surgery 101.1 (2016), 154-161.

Cost, Quality, and Value in Coronary Artery Bypass Grafting. Osnabrugge RLJ, Speir AM, Head SJ, Jones PG, Ailawadi G, Fonner CE, Fonner E, Kappetein AP, Rich JB. Journal of Thoracic and Cardiovascular Surgery 148.6 (2014), 2729-2735.

Prediction of Costs and Length of Stay in Coronary Artery Bypass Grafting. Osnabrugge RLJ, Speir AM, Head SJ, Jones PG, Ailawadi G, Fonner CE, Fonner E, Kappetein AP, Rich JB. Annals of Thoracic Surgery 98.4 (2014): 1286-1293.

Costs for Surgical Aortic Valve Replacement According to Preoperative Risk Categories. Osnabrugge RLJ, Speir AM, Head SJ, Fonner CE, Fonner E, Ailawadi G, Kappetein AP, Rich JB. Annals of Thoracic Surgery 96.2 (2013): 500-506.

A Contemporary Cost Analysis of Postoperative Morbidity Following Coronary Artery Bypass Grafting With and Without Concomitant Aortic Valve Replacement to Improve Patient Quality and Cost Effective Care. LaPar DJ, Crosby IK, Rich JB, Fonner E, Kron IL, Ailawadi G, Speir AM. Annals of Thoracic Surgery 96.5 (2013): 1621-1627.

Postoperative Atrial Fibrillation Significantly Increases Mortality, Hospital Readmission, and Hospital Costs. LaPar DJ, Speir AM, Crosby IK, Fonner E, Brown M, Rich JB, Quader MA, Kern JA, Kron IL, Ailawadi G. Annals of Thoracic Surgery 98.2 (2014): 527-533. Presented at STSA 2013, Scottsdale, AZ.

Blood Product Conservation Is Associated with Improved Outcomes and Reduced Costs Following Cardiac Surgery. LaPar DJ, Crosby IK, Ailawadi G, Ad N, Choi E, Spiess BD, Rich JB, Kasirajan V, Fonner E, Kron IL, Speir AM. Journal of Thoracic and Cardiovascular Surgery 145.3 (2013): 796-804. Presented at AATS 2012, San Francisco, CA.

Delayed Sternal Closure after Left Ventricle Assist Device Implantation: Analysis of Risk Factors, Impact on Outcomes and Costs. Quader MA, LaPar DJ, Wolfe LG, Ailawadi G, Rich JB, Speir AM, Fonner CE, Kasirajan V. ASAIO Journal (American Society for Artificial Internal Organs: 1992) (2016).

Impact of Preoperative Statin Use on Ascending Aortic Aneurysm Repair Outcomes. Hawkins RB, Mehaffey JH, Guo A, Fonner CE, Speir AM, Rich JB, Yarboro LT, Ghanta RK, Ailawadi G. Circulation 134, no. Suppl 1 (2016): A17230-A17230.

Impact of Preoperative Glycemic Control on Long-Term Mechanical Circulatory Support Device Implantation. Downs EA, Johnston LE, LaPar DJ, Yarboro LT, Kern, JA, Kirby JL, Mazimba S, Speir AM, Rich JB, Quader MA, Ailawadi G. The Journal of Heart and Lung Transplantation 35, no. 4 (2016): S377.

Minimally Invasive Mitral Valve Surgery Provides Excellent Outcomes without Increased Cost: A Multi-Institutional Analysis. Downs EA, Johnston L, LaPar DJ, Ghanta RK, Kron IL, Speir AM, Fonner CE, Kern JA, Ailawadi G. Annals of Thoracic Surgery (2016).

Equivalent Mortality but Higher Morbidity in Patients Receiving Temporary Mechanical Support Prior to Permanent LVAD Implantation. Johnston LE, Ailawadi G, Downs EA, Rich JB, Speir AM, Quader AM, Kennedy JL, Yarboro LT, Kern JA, Mazimba S. The Journal of Heart and Lung Transplantation 35.4 (2016): S153.

Minimally Invasive Mitral Valve Surgery Has Superior Outcomes to Conventional Sternotomy Without Increased Costs. Downs EA, Johnston LE, LaPar DJ, Ghanta RK, Kron IL, Fonner CE, Kern J, Speir AM, Ailawadi G. Annals of Thoracic Surgery, (2016).

Institutional Variation in Mortality After Stroke After Cardiac Surgery: An Opportunity for Improvement. LaPar DJ, Quader MA, Rich JB, Kron IL, Crosby IK, Kern JA, Tribble CG, Speir AM, Ailawadi G. Annals of Thoracic Surgery (2015).

Blood Product Utilization With Left Ventricular Assist Device Implantation: A Decade of Statewide Data. Quader MA, Wolfe LG, Ailawadi G, Rich JB, Speir AM, LaPar DJ, Fonner CE, Kasirajan V. The Journal for Heart and Lung Transplantation 34.4 (2015): S14.

Bilateral IMA Use for Coronary Artery Bypass Grafting Remains Underutilized: A Propensity Matched Multi-Institution Analysis. LaPar DJ, Crosby IK, Rich JB, Quader MA, Speir AM, Kern JA, Tribble C, Kron IL, Ailawadi G. Annals of Thoracic Surgery 100.1 (2015): 8-15.

Multicenter Evaluation of High-Risk Mitral Valve Operations: Implications for Novel Transcatheter Valve Therapies. LaPar DJ, Isbell JM, Crosby IK, Kern J, Lim DS, Fonner E, Speir AM, Rich JB, Kron IL, Ailawadi G. Annals of Thoracic Surgery 98.6 (2014): 2032-2038.

Isolated Aortic Valve Replacement with Bio-Prostheses in Patients Age 50 to 65 Years: A Decade of Statewide Data on Cost and Patient Outcomes. Quader MA, Wolfe LG, Medina A, Fonner CE, Ailawadi G, Crosby IK, Speir AM, Rich JB, LaPar DJ, Kasirajan V. Journal of Cardiovascular Surgery, 2014 Sept. 12 [E-publication].

Performance of EuroSCORE II in a Large US Database: Implications for Transcatheter Aortic Valve Implantation. Osnabrugge RLJ, Speir AM, Head SJ, Fonner CE, Fonner E, Kappetein AP, Rich JB. European Journal of Cardio-Thoracic Surgery 46.3 (2014): 400-408.

Nonagenarians Undergoing Cardiac Surgery. Davis JP, LaPar DJ, Crosby IK, Kern JA, Lau CL, Kron IL, Ailawadi G. Journal of Cardiac Surgery 29.5 (2014): 600-604.

Hospital Variation in Mortality From Cardiac Arrest After Cardiac Surgery: An Opportunity for Improvement? LaPar DJ, Ghanta RK, Kern JA, Crosby IK, Rich JB, Speir AM, Kron IL, Ailawadi G. Annals of Thoracic Surgery 98.2 (2014): 534-540. Presented at STSA 2013, Scottsdale, AZ.

Predictors of Operative Mortality in Cardiac Surgical Patients with Prolonged Intensive Care Unit Duration. LaPar DJ, Gillen JR, Crosby IK, Sawyer RG, Lau CL, Kron IL, Ailawadi G. JACS 216(6): 1116-1123.

Preoperative Beta-Blocker Use Should Not Be a Quality Metric for Coronary Artery Bypass Grafting. LaPar DJ, Crosby IK, Kron IL, Kern JA, Fonner E, Rich JB, Speir AM, Ailawadi G. Annals of Thoracic Surgery 96.5 (2013): 1539-1545.

Concomitant Tricuspid Valve Operations Affect Outcomes Following Mitral Operations: A Multiinstitutional, Statewide Analysis. LaPar DJ, Mulloy DP, Stone M, Crosby I, Lau CL, Kron IL, Ailawadi G. Annals of Thoracic Surgery 94.1 (2012): 52-58. Presented at STSA 2011, San Antonio, TX.

Previous Percutaneous Coronary Intervention Increases Morbidity After Coronary Artery Bypass Grafting. Mehta GS, LaPar DJ, Bhamidipati CM, Kern JA, Kron IL, Upchurch GR, Ailawadi G. Surgery 152.1 (2012): 5-11.

Contemporary Outcomes for Surgical Mitral Valve Repair: A Benchmark for Evaluating Emerging Mitral Valve Technology. LaPar DJ, Mulloy DP, Crosby IK, Lim DS, Kern JA, Kron IL, Ailawadi G. Journal of Thoracic and Cardiovascular Surgery 143.4 (2012): S12-S16. Presented at AATS Mitral Conclave 2011, New York.

Small Prosthesis Size in Aortic Valve Replacement Does Not Affect Mortality. LaPar DJ, Ailawadi G, Bhamidipati CM, Stukenborg GJ, Crosby IK, Kern JA, Kron IL. Annals of Thoracic Surgery 92.3 (2011): 880-888.

Elective Thoracic Aortic Aneurysm Surgery: Better Outcomes from High-Volume Centers. Gazoni LM, Speir AM, Kron IL, Fonner CE, Crosby IK. JACS 210.5 (2010): 855-860.

Does urgent or emergent status influence choice in mitral valve operations? An analysis of outcomes from the Virginia Cardiac Surgery Quality Initiative. LaPar DJ, Hennessy S, Fonner CE, Kern JA, Kron IL, Ailawadi G. Annals of Thoracic Surgery 90.1 (2010): 153-160.

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VCSQI | Virginia Cardiac Services Quality Initiative ...