Shared Physician Learning Improves Vascular Care

Transcription

1 9 th Annual Meeting of PSOs April 26-27, 2017 Shared Physician Learning Improves Vascular Care Jens Eldrup-Jorgensen, MD, FACS Medical Director Society for Vascular Surgery PSO

2 Disclaimer The opinions expressed in this presentation are those of the presenter and do not reflect the official position of the Department of Health and Human Services (HHS), the Agency for Healthcare Research and Quality, or the Office for Civil Rights. 2

3 Society for Vascular Surgery Patient Safety Organization (SVS PSO) - Outline Today s Presentation SVS PSO Update PSO Success Story: Discharge Medications Making Shared Physician Learning Work Addressing Challenges to Physician Learning and Engagement Final Thoughts 3

4 SVS PSO Update: Centers in the Vascular Quality Initiative (VQI) Growth of VQI since 450 inception VQI Jan-11 May-11 Sep-11 Jan-12 May-12 Sep-12 Jan-13 May-13 Sep-13 Jan-14 May-14 Sep-14 Jan-15 May-15 Sep-15 Jan-16 May-16 Sep-16 Jan Centers, 46 States 4

5 SVS PSO Update: 2016 Vascular Procedure Volume 350, , , , , , , , , , ,000 75,000 50,000 25,000 0 VQI Total Procedure Volume Total Procedure Volume tab reflects net procedures added to the registry for the month 5

6 Specialty of Participating Physicians 6

7 Key Drivers of QI and Patient Safety: 17 Regional Groups AK HI 7

8 5 Year Survival By Discharge Medication Region 1 24% Improved 5 Year Survival of 15,000 Region 1 patients if Discharged after Surgery on Statin and Anti-platelet Agents 79% Both 74% Statin 72% Anti- Platelet 55% None SE<0.1 Log rank p<0.01 -De Martino et al,

9 15 Minutes Can Improve Survival 15% 9

10 AP/Statin Rate Hospital A 10

11 AP/Statin Rate Region 1 11

12 Making Shared Physician Learning Work 12 clinical registry workgroups: identify areas for improvement Findings and recommendations shared at semi-annual regional QI meetings Newly formed surgeon-led communications committee: findings into practice 2 nd annual QI meeting in May 2017: expanded program 12

13 AP/Statin Rate Region 2 13

14 AP/Statin Rate Region 3 14

15 Making Shared Physician Learning Work Sample physician specific reports Sample COPI reports Member only website and discussion board Newest component in development: Vascular dashboards 15

16 AP + Statin by Region, Center and Physician 16

17 % Patients Receiving AP + Statin by Year 17

18 Antiplatelet Rx (%) Hospital A CEA LEBPG EVAR OAAA

19 Statin Rx (%) Hospital A CEA LEBPG EVAR OAAA

20 Making Shared Physician Learning Work Physicians need to: Receive data Understand data See value of the data Data into action 20

21 % Patients Receiving AP + Statin by Center in Region 1 21

22 % Patients Receiving AP + Statin by Physician in Region 1 22

23 % Patients Receiving AP + Statin by Physician at Hospital A 23

24 Making Shared Physician Learning Work Customizing results for different hospital types Creative QI solutions for small/rural hospitals less reliance on advanced EMR, e.g., discharge medication reminder badges for providers Success of high touch solutions with use of nurse navigators to remind patients and providers 24

25 Want to Improve 5-Year Survival? Check the Meds Antiplatelet (AP) and statin medications are an important component to treatment, but a third of eligible post-op VQI patients leave the hospital without these medications. Those patients on AP and statins had a 14% absolute survival benefit and 40% adjusted improved survival. Survival by Discharge Medications No AP or statin AP & Statin For every 25 patients treated, discharge on an antiplatelet agent and statin medication is associated with 3.5 additional patients alive at 5 years! VQI participation is highly associated with improvement in medication use Conclusion: Medical management is associated with improved survival after a number of vascular procedures. Importantly, VQI participation improves the use of medical management, demonstrating that involvement in an organized quality effort can affect patient outcomes. Source: De Martino RR, Hoel AW, Beck AW, Eldrup-Jorgensen J, Hallett JW, Upchurch GR, Cronenwett JL, Goodney PP; Vascular Quality Initiative. J Vasc Surg Jan 15. pii: S (14) doi: /j.jvs

26 Making Shared Physician Learning Work: SVS PSO National QI Committee Process SVS PSO Identify high performing centers Input to/from regional meetings Educational resources COPI and physician reports Alignment with MIPS/MACRA Track successes Communications Committee Arterial Quality Committee Quality Improvement Workgroup Goals, measures, definitions, benchmarks Analysis of results QI bundles ( recommended clinical practices) Outcomes of interest to payers, administrators Recommended practices Messaging to key stakeholders (providers, patients, administrators) Oversight of articles, press releases Physician and hospital engagement QI implementation tools How-To presentations Expert guidance for user groups 26

27 National QI Initiative to Increase Statin Use 27

28 15 minutes can improve survival 15% 28

29 AP/Statin Rate-VQI Centers > 2 Years 29

30 AP/Statin Rate VQI Centers < 2 Years 30

31 Regional Participation Is Important P<

32 Addressing Challenges to Physician Learning and Engagement Outreach to different physician specialists: copresenters at regional meetings Passive members: more outreach, more strategies to encourage access to data and reports Multi-state regions Data entry burden, especially for smaller practices Time and cost 32

33 Addressing Challenges to Physician Learning and Engagement Cross regional visits/mentoring from more experienced leaders Growing trust among the learning group to discuss strategies for improvement in challenging areas Provide data of interest to hospital administrators, QI directors and hospital finance 33

34 Effect of Medications on 5 Yr Survival 81% Both 75% AP 68% Statin 55% None P<0.001 SE < 0.1 Years 34

35 Final Thoughts Sharing actions taken in a protected learning group (based on challenging areas within the aggregate performance data) improves vascular care. 35

36 Society for Vascular Surgery Patient Safety Organization (SVS PSO) Nadine Caputo, Quality Director Jim Wadzinski, General Manager Carrie Bosela, RN, Administrative Director Dan Neal, Director of Analytics 36

37 Shared Physician Learning Improves Vascular Care Thank you 37

38 Questions 38