December 12, 2008

Single Institution Experience of Initial Participation in a Statewide Multi-Institution Third Party Payer Sponsored Peripheral Vascular Intervention Quality Improvement Initiative

Paul G. Bove, MD, Steven Wang, MD, Terry Bowers, MD.
William Beaumont Hospital, Royal Oak, MI, USA.

OBJECTIVES: To review a single institution’s initial year experience of participation in a statewide multi-institution third party payer sponsored quality improvement initiative of peripheral vascular interventions.

METHODS: All aspects are reviewed involving the implementation of a multi-institution peripheral vascular intervention quality improvement initiative at a large tertiary care hospital that provides comprehensive multidisciplinary vascular care.

RESULTS: The first multidisciplinary PVI quality initiative within our institution was created in 2005 to look at complications and credentialing issues. In October of 2007, our institution began participation in a third party payer sponsored peripheral vascular intervention quality improvement initiative. This initiative allowed for participation in a robust database that captures comprehensive patient demographic information, as well as patient comorbidities, preprocedural, intraprocedural and post procedural treatments as well as post procedural outcome. In addition, antiplatelet therapy, statin, beta blockade and ace inhibitor use as well as intraprocedural heparin use are monitored. Quarterly review of aggregate and institutional data regarding benchmarks is performed. To facilitate the initiative, institutions are reimbursed to fund nursing staff to obtain patient consent, input data and perform patient follow up.
To date, approximately 1200 procedures have been input into the database. Two internal quality initiatives have begun. Efforts have involved an educational initiative to improve physician and nursing staff documentation and concurrently to promote pre and post procedural use of antiplatelet and statin therapy, and beta blockade and ace inhibition, as well as weight based heparin use monitored by ACT’s. Monthly multidisciplinary institutional meetings are held to review cases and address credentialing. Quarterly statewide meetings are held.
CONCLUSIONS: The implementation of a multi-institution statewide quality improvement initiative can be readily established and facilitated by third party payer support, resulting in the rapid dissemination of benchmark standards.

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