A regional registry for quality assurance and improvement: the Vascular Study Group of Northern New England (VSGNNE).
OBJECTIVE
A regional cooperative data registry was organized for carotid endarterectomy (CEA), lower extremity bypass (LEB), and infrarenal abdominal aortic aneurysm (AAA) repair (open and endovascular) procedures in Northern New England to allow benchmarking among centers for quality assurance and improvement activities.


METHODS
Since January 2003, 48 vascular surgeons from nine hospitals in Maine, New Hampshire, and Vermont (25 to 615 beds) have prospectively recorded patient, procedure, and in-hospital patient outcome data. Results plus 1-year follow-up data analyzed at a central site are reported anonymously to each center at semiannual meetings where care processes and regional benchmarks are discussed. Mortality and compliance with procedure entry were validated by independent comparison with hospital administrative data. Initial improvement efforts focused on optimizing preoperative medication usage.


RESULTS
A total of 6143 operations were entered into the registry through December 2006. In-hospital stroke or death after CEA was 1.0%, major amputation or death after LEB was 3.8%, and mortality was 2.9% after elective open and 0.4% after endovascular repair. Variation in results between centers and surgeons provides opportunity for further quality improvement. Any postoperative complication increased median length of stay by > or =3 days. Process improvement efforts initiated in 2004 increased preoperative beta-blocker administration from 72% to 91%, antiplatelet agents from 73% to 83%, and statins from 54% to 72% (all P < .001). Procedure volume and discharge status validation with administrative data led to 99% of appropriate operations being reported to the registry. Mortality was accurately reported to the data registry for all patients.


CONCLUSIONS
This validated regional data registry within a quality improvement initiative has been associated with improved preoperative medication usage. It provides a potential vehicle for future public and pay-for-performance reporting and has the potential to improve patient outcomes. It has been sustained for >4 years and is a model that could be adopted by other regions.
Cronenwett
Jack L
JL
Sections of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. j.cronenwett@hitchcock.org
Likosky
Donald S
DS
Russell
Margaret T
MT
Eldrup-Jorgensen
Jens
J
Stanley
Andrew C
AC
Nolan
Brian W
BW
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D019985:Benchmarking; D003299:Cooperative Behavior; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007902:Length of Stay; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D009511:New England / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D016491:Peripheral Vascular Diseases / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011300:Preoperative Care; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality
D000319:Adrenergic beta-Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors