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Original Investigation
October 11, 2017

Association of Quality Improvement Registry Participation With Appropriate Follow-up After Vascular Procedures

Author Affiliations
  • 1Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City
  • 2Division of Vascular Surgery and Endovascular Therapy, University of Alabama- Birmingham
  • 3Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 4The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire
  • 5Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
JAMA Surg. Published online October 11, 2017. doi:10.1001/jamasurg.2017.3942
Key Points

Question  Is hospital participation in the Vascular Quality Initiative associated with improved surveillance outcomes after vascular surgery over time?

Findings  In this quasi-experimental study, results of a difference-in-differences analysis using propensity scores to match Vascular Quality Initiative and non–Vascular Quality Initiative participating hospitals showed no significant increase in follow-up imaging within 3 years after joining the Vascular Quality Initiative. Nearly half of patients fail to receive any surveillance imaging in the first year after surgery, irrespective of whether their procedure occurred in a Vascular Quality Initiative participating hospital.

Meaning  Improving rates of surveillance imaging after vascular procedures represents an important opportunity for quality improvement, but using participation in surgical quality registries as a stand-alone strategy likely will not achieve this goal.

Abstract

Importance  Ensuring that patients undergo surveillance imaging after surgery is a key quality metric after many vascular procedures. It is unclear whether hospital participation in a national quality improvement registry such as the Vascular Quality Initiative (VQI) achieves this goal.

Objective  To determine if hospital participation in the VQI registry is associated with increased rates of surveillance imaging after vascular procedures.

Design, Setting, and Participants  A quasi-experimental study used Medicare claims to study 2174 US hospitals in which 1 530 102 patients had undergone an endovascular abdominal aortic aneurysm repair (EVAR), 1 403 067 patients had undergone a lower extremity bypass (LEB) or peripheral vascular intervention (PVI), and 294 942 patients had undergone carotid endarterectomy (CEA) and carotid artery stenting (CAS) procedures between January 1, 2007, and December 31, 2012. For each hospital, VQI participation was assessed, and a difference-in-differences analysis was used to measure the change in follow-up surveillance for VQI hospitals compared with control (non-VQI) hospitals selected after propensity score matching. The data were analyzed between January and August of 2016.

Main Outcomes and Measures  The proportion of patients who had imaging-based follow-up (computed tomography, duplex ultrasonography, or ankle-brachial index) within 1 year after their vascular procedure.

Results  A total of 1 830 928 patients (947 139 women and 883 789 men; mean [SD] age, 75.8 [7.1] years) were identified across 2174 hospitals. Of 3 228 111 total vascular procedures, 1 403 067 patients (43.5%) underwent LEB or PVI, 1 530 102 patients (47.4%) underwent EVAR, and 294 942 patients (9.1%) underwent CEA or CAS. During the 6-year period, follow-up imaging rates varied between 50% and 53% after EVAR, between 52% and 58% after LEB or PVI, and between 74% and 78% after CEA or CAS. A total of 68 VQI participating hospitals were propensity-matched to 68 hospitals, and 279 446 patients were studied across these 136 hospitals. In difference-in-differences analyses, there was no significant improvement in follow-up imaging after joining VQI during year 1 (relative risk, 0.99; 95% CI, 0.97-1.01), year 2 (relative risk, 0.98; 95% CI, 0.95-1.01), or year 3 (relative risk, 0.99; 95% CI, 0.96-1.03). This association was consistent for patients undergoing EVAR, LEB or PVI, and CEA or CAS procedures.

Conclusions and Relevance  Hospital participation in the VQI registry by itself does not increase rates of surveillance imaging after vascular procedures, suggesting that other strategies are needed to achieve this quality metric.

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