BMC2 Vascular Presentation Health Care Facility

BMC2 VIC Registry Collaborative effort to assess and improve the quality and care outcomes of patients with peripheral vascular disease who undergo percutaneous arterial intervention

Process Patient is referred from PCP Baseline data collected Peripheral Arterial Questionnaire (PAQ) is completed by patient Pertains to lower extremity revascularization Consists of detailed inquiries about patients quality of life related to the disease process Patient has peripheral vascular intervention

Process Follow-up data collected 30 days post-intervention Medication compliance Lifestyle improvements (diet, exercise and smoking cessation Vital signs NIT ( non-invasive testing) such as ABI Any complications 6 months post-intervention Patient completes PAQ Data entered into registry

Coordinating Center Role During site visits: Ensures all cases included in registry Verifies data accuracy through chart reviews Provides Site visit reports Quarterly and annual quality reports Education for participating organizations Organizes collaborative meetings

Site Visit Reports Components: Completeness and timeliness of data Accuracy of data TIER 1 & 2 errors Meeting participation Clinician lead Data coordinator Quality indicators The organization receives a score for each component

Audit Criteria TIER 1 Significant data abstraction errors that affect quality improvement goals. Example: Abstractor fails to take credit on the website for a vascular complication documented in the patient’s medical record. TIER 2 Minor errors or discrepancies. Example: Data abstractor fails to document total contrast dose and the information is found in the patient’s medical record.

TIER 1 & 2 Scores A score is generated for TIER 1 & 2 Total number of errors in each TIER is divided by the number of cases audited TIER 1 findings can impact pay-for- performance A score of 0.3 or less is required for maximum payment TIER 2 findings do not affect pay for performance scores.

Audit Score Errors/ Omissions 38 Score3.8 RatingMeets Expectations Errors/ Omissions 5 Score0.5 RatingMeets Expectations TIER 2- September 2011TIER 1- September 2011 Errors/ Omissions 4 Score0.5 RatingMeets Expectations Errors/ Omissions 20 Score2.5 RatingExceeds Expectations TIER 1- June 2012TIER 2- June 2012

PAQ & FOLLOW-UP PERCENTAGES Exceeds Expectation

Meeting Participation September 2011 November 2012 Clinical Lead100% Data Coordinator: Conference Call Participation 100%

Attendance Compliance Annual Michigan ACC Conference American College of Cardiology Vascular Coordinator and Lead Clinician attended conference September 29 th to meet attendance criteria for the year.

BMC2 VIC Registry Goals PVI Physician Advisory Committee established goals & numerical targets in Goals: Vascular access complication <3% Post PVI transfusion <7% Contrast Induced Nephropathy <4% Medical Therapy ASA discharge: >90% Statin discharge: >75%

Vascular Access Complications YTD Q2 Outside expectations, Needs improvement

Post PVI Transfusions YTD Q2 Exceeds Expectation

Contrast Induced Nephropathy YTD Q2 Exceeds Expectation

Nephropathy Requiring Dialysis YTD Q2 Meets Expectation

Quality Indicators: Discharged on ASA Outside Expectation Needs Improvement

Quality Indicators: Discharged on Statins Goal: >75.00% Below Expectation

Strategy for Index Improvement Increased integration of patient management with PCP Interventionalist or Surgeon to order lipid panel and LFT at initial consult. Interventionalist or Surgeon will prescribe Statin unless contraindicated.