NCDR Update | Nearly 1 year after the launch of the ACC’s PVI Registry, CardioSource WorldNews: Interventions spoke with Steering Committee Chair Thomas T. Tsai, MD, MSc, about the how the registry is being used for quality improvement and what advancements are on the horizon. Dr. Tsai is an interventional cardiologist for Kaiser Permanente Colorado and director of the PVI program at Good Samaritan Medical Center in in Lafayette, CO.

CSWN: Interventions: The first round of outcome reports were provided to PVI Registry facilities in June. What value do these reports hold?

Thomas T. Tsai, MD, MSc: We are very excited to see what the data tell us. What procedures are being performed, for what indication, and how safely these procedures are performed? The field of peripheral vascular intervention evolves quickly and it will be illuminating to see what is occurring in contemporary practice. We will also be able to start understanding better the safety surrounding these procedures and the variability of our safety metrics across the country.

In addition to the hospital cardiac cath lab, the registry can be used in interventional radiology suites, hybrid operating rooms or outpatient vascular centers. Why is it important for these centers to belong to the registry as well?

These procedures are under increasing scrutiny whether they are performed in the hospital cath lab or an outpatient vascular center. Registries provide an infrastructure for collecting the data to ensure appropriate indications, procedural safety and outcomes in all the venues of care a patient might be treated in. Benchmarking to ensure high quality care in all these venues is the way to go.

What should participating sites do to get started using their data for QI?

First and foremost, participating sites should dive in and understand exactly what their hospital is doing in the peripheral space. What procedures for what indications? Then take a look at the important endpoints such as access and procedural complications, bleeding issues, medications at discharge and short-term follow-up complications. Then a site can compare their numbers with the benchmarked standards and take a deep dive into their data to try and identify areas for improvement and drill down to identify potential factors responsible for performance below their peers. Finally, hospitals or outpatient vascular centers can implement quality improvement projects to address problems and track progress via the registry. 

What role will be PVI Registry plan in Appropriate Use Criteria (AUC)?

Appropriate Use Criteria are coming to a theater near you soon. We need to be good stewards of our resources which starts by ensuring the procedures are being performed in those who are most likely to benefit. The PVI Registry is well positioned to map to the final AUC variables to categorize our patients into the AUC categories of “appropriate,” “may be appropriate” and “rarely appropriate.”  This will be an important aspect of the registry as reimbursement remains in the crosshairs of payers. The PVI Registry will put participants in a good position to address these issues. 

An executive summary dashboard is under development for the registry – what benefits will this bring?

Having the ability as a hospital administrator or cath lab director to efficiently review your data is a requisite perk now-a-days. One day you may be interested in your access site complications compared to other similar volume hospitals, another day the number of tibial interventions, and so on. Having the ability to change your “lenses” in which to view your data is powerful. 

What else is on the horizon for the registry?

We look forward to expanding the PVI Registry to include additional endovascular procedures and new open surgical procedures to cover a broader range of peripheral procedures patients might undergo. The registry will also emphasize the importance of short and long term follow-up date. Although the procedure-to-discharge piece is very important, how our patients do outside the hospital is an integral piece as well. Also, having the ability to assess quality of life over time is an important part of the registry’s mission. We are looking into ways to make this happen as well.

Keywords: CardioSource WorldNews Interventions, Quality Improvement, Radiology, Interventional, Registries, Benchmarking, Follow-Up Studies

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