Outcomes of care of abdominal aortic aneurysm in Veterans Health Administration facilities: results from the National Surgical Quality Improvement Program

Bush, Ruth L.; DePalma, Ralph G.; Itani, Kamal M.F.; Henderson, William G.; Smith, Tracy; Gunnar, William

doi:10.1016/j.amjsurg.2009.08.005

Cited by 11 publications

(9 citation statements)

References 28 publications

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“…35 A recent review of outcomes of care in the VA for almost two decades (1991-2008) of vascular surgery demonstrated a progressive, significant reduction in mortality and morbidity for all non-cardiac surgery and improving trends in vascular surgery and AAA repair in particular. 29 Risk-adjusted mortality decreased from 1.2 to 0.7 during this period of observation. Aneurysm mortality for open procedures fell from 5.1% to 3.9%, while EVAR beginning in 2001, exhibited a mortality reduction from 3.2% to 0.8% as the number of EVARs performed rose from 125 cases in 2001 to 951 during 2008.…”

Section: Quality Assessment Concepts: Private and Publicmentioning

confidence: 95%

Evolution of quality and surgical risk assessment in the USA

DePalma

2011

Vascular

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As health-care reforms progress, quality and risk assessment in the health-care system of the USA surface as critical issues. This review considers past, present and possible future changes in quality assessment along with formal programs of complication reduction and pay for performance (PFP) as related to surgery and vascular interventions. Strategies for quality improvement include aggregate and risk-adjusted outcome measurement, process compliance with the Surgical Complication Improvement Program, oversight and PFP, now policies of the Centers for Medicare and Medicaid Services (CMS). Advantages, disadvantages and unintended consequences of these policies are discussed. While ongoing system changes will influence vascular surgical practice, unique opportunities and obligations exist for vascular surgeons to contribute to quality assessment of their interventions, to evaluate long-term outcomes and to devise strategies for comprehensive cost-effective care for the conditions affecting patients with vascular disease.

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Section: Quality Assessment Concepts: Private and Publicmentioning

confidence: 95%

Evolution of quality and surgical risk assessment in the USA

DePalma

2011

Vascular

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“…39 These data, by propensity analyses, demonstrate continual improvement not necessarily attributable to one quality measurement method or another, but rather to iterative data based on improved intervention strategies. The Veterans Affairs Open versus Endovascular Repair (OVER) randomized trial, at the same time, demonstrated equivalence of these two procedures within the VA integrated health care system and will continue to accumulate long-term data.…”

Section: Quality Assessment: Public and Privatementioning

confidence: 97%

Health care trends and vascular specialists: The good, the bad, and the ugly

DePalma

2011

Journal of Vascular Surgery

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Current health care trends include movements toward general health care reform and rapidly evolving changes affecting treatment of vascular disease. Government-sponsored programs and private coalitions increasingly influence practice management and patient care. Emerging organizational influences derive from public perceptions, policies, laws, and regulations intended to make health care safe, effective, patient centered, timely, efficient, and equitable. These trends energized methods of quality assessment, cost containment, and practice protocols over individual judgments and seek to exert increasing direction over clinical practice. Some evolving measures are good, some controversial, and some, without deliberate intent, may be harmful. This review considers evolving initiatives in the context of ethics of practice and practicalities of managing patients with vascular disease. Key issues include compliance with purely process-based measures, pay for performance, and assessment of quality outcomes. Strengths, weaknesses, opportunities, and potential threats to vascular practice are outlined.

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“…The database of AAA patients created from DSSs is a useful tool for identifying patients at risk for AAA by risk factor analysis [8] and a mechanism to assist clinicians in tracking their patients with a detected aneurysm using clinical reminders [29]. Should AAA patients require surgical repair, the VA National Surgical Quality Improvement Program (VASQIP, formerly NSQIP) tracks those patients nationwide and frequently reports to clinicians from a central VA database [5]. Each VA region has a designated VASQIP official to report AAA repair statistics, either locally or nationally, to vascular surgeons for quality assurance.…”

Section: The Veterans Affairs Aaa Screening Programmentioning

confidence: 99%