1. Translational and Personalized Medicine Initiative: Quality of Care Project Report Peripheral Revascularization Krista Mahoney, Postdoctoral Fellow October 8, 2015

2. Peripheral Revascularization - Summary Patients with suspected vascular disease > entry point = St. Clare’s Vascular Clinic > patients assessed, diagnosed and treated Data recorded in a database from 2007-present 3 possible assessments: 1.No vascular disease 2.Requires risk factor intervention 3.Requires revascularization Revascularization = restoration of blood flow to ischemic area (usually surgical) TPMI QoC Quarterly Report – Peripheral Revascularization

3. Peripheral Revascularization - Summary Primary outcomes of interest = amputation and death Research questions: 1)Are the outcomes of interest (limb loss and death) improving over time? Are intervention plans getting better? Can we optimize treatment plans using predictive data? 2)Are non-surgical interventions, like stenting, increasing over time? TPMI QoC Quarterly Report – Peripheral Revascularization

4. Peripheral Revascularization - Milestones Last 3 milestones TPMI QoC Quarterly Report – Peripheral Revascularization Ethics approval received March 2015 Data transferred from Eastern Health to CHIA Data de-identified April 2015 Data analyzed Patient demographics and clinic utilization patterns determined Sept 2015

5. Peripheral Revascularization - Progress Database data transferred to CHIA, de-identified, cleaned and analyzed. Currently, analysis is based upon patient demographics, baseline measures and clinic utilization patterns. Determining primary outcomes (amputation and death) will require future linkages with secondary usage data. TPMI QoC Quarterly Report – Peripheral Revascularization

6. Peripheral Revascularization – Baseline Measures TPMI QoC Quarterly Report – Peripheral Revascularization Number of patients 38 892 38 892 Patient Demographics Average age at diagnosis 70 70

7. Peripheral Revascularization - Utilization Patterns TPMI QoC Quarterly Report – Peripheral Revascularization Number of procedures entered 45 177 45 177 Clinic Utilization Patterns Average days of admission 7.5 7.5

8. Utilization Patterns BCSCAV = Duplex Study of Carotid Arteries Most common tests: AAP = Ankle/Arm Pressure SPWL = Segmental Pressure Measurements of Lower Extremity Peripheral Revascularization – Utilization Patterns 2007 2008 2009 2010 2011 2012 2013 2014 2015 YEAR

9. Utilization Patterns Stratification by Type of Exam Peripheral Revascularization – Utilization Patterns Limb Evaluations Carotid exams

10. Peripheral Revascularization – Utilization Patterns TPMI QoC Quarterly Report – Peripheral Revascularization Carotid Exams Stratification by Type of Exam Limb Evaluations Average age 71 Average age 73 Gender

11. Peripheral Revascularization – Geographic Distribution Map created by: Mark Squires, GIS Analyst, NLCHI

12. Peripheral Revascularization – Geographic Distribution Map created by: Mark Squires, GIS Analyst, NLCHI

13. Peripheral Revascularization – Challenges Challenges: 1.Timely Access - transferring the data from Eastern Health to CHIA 2.Lack of Data Dictionary - requires reverse coding of variables 3.Determining outcomes of interest – surgeries, stenting etc. not recorded in database (requires secondary uses linkages) TPMI QoC Quarterly Report – Peripheral Revascularization

14. Peripheral Revascularization – Next Objective Next steps 1.Link with secondary uses data 2.Determine patterns of outcomes 3.Hotspotting - Determine areas requiring improved intervention strategies (geographic or demographic) TPMI QoC Quarterly Report – Peripheral Revascularization

15. Peripheral Revascularization – Questions? TPMI QoC Quarterly Report – Peripheral Revascularization