Partners in Innovation | ACC’s Chapters are increasingly taking an active role in the promotion of tracking and improving quality through wider adoption of NCDR’s hospital and outpatient registries. Most recently, ACC’s Virginia Chapter was invited by the Virginia Cardiac Services Quality Initiative (VCSQI) to partner on changing its focus from measuring surgical outcomes to measuring overall quality. As part of this effort, which launched this summer, data from ACC’s CathPCI Registry are being merged with data from The Society of Thoracic Surgeons (STS) – a move intended to provide glimpses of patient care beyond the inpatient stay. Robert A. Shor, MD, FACC, chair of ACC’s Board of Governors and a practicing physician in Virginia, spoke with Cardiology to further explain the components of VCSQI and plans for the future.

Can you explain the layout of the VCSQI? What are the defining factors?

VCSQI is a multifaceted voluntary consortium of 18 hospitals and 14 cardiac surgical practices in the Commonwealth of Virginia. The program integrates NCDR data with the STS National Database and ARMUS – a tool that extracts cost data from hospitalization – to look at quality and cost across a wide spectrum of cardiovascular diseases throughout the Commonwealth of Virginia. The collaborative model consists of a process for convening leaders, use of technology for regional information sharing, educational programs to replicate best practices, and systems change to improve care processes. The objective is to effectively redesign clinical processes and modify provider behavior using the best evidence available.

VCSQI is the first program of its kind in Virginia – what makes it unique? In what ways does it differ from previous quality initiatives?

VCSQI is not only the first program of its kind in Virginia, but also the first of its kind in the country. There have been other regional STS and NCDR joint projects, but none statewide. The integration of ARMUS is also unique, as it creates the opportunity to compare cost differentials between hospitals.

Another component of the program is a voluntary random external review of 5 percent of percutaneous coronary intervention (PCI) cases by institutions to assess lesion stenosis – a surrogate for appropriateness (in addition to appropriate use criteria from NCDR). This differs from the unfunded, mandated reviews employed in other states.

VCSQI zeroes in on the best practices of hospitals with favorable outcomes. When those best practices have been pinpointed, we then encourage other hospitals to consider aligning their methods with those of more successful institutions.

What do you hope to gain from VCSQI, both on a large and small scale?

We hope to be able to help understand and manage population health by looking at quality and cost in real-world experiences. We also hope to determine and share best practices, teach fellows in training about registry data, and provide them with experience on how to use the data as a research tool.

What current problem areas will the program help to resolve?

We hope to reassure the public, institutions and providers that we are providing appropriate care. If problems are found, we intend for there to be prompt corrective action. The review of the NCDR and STS National Database data may yield unexpected information. We don’t know what it is we don’t know, and we won’t be able to anticipate every possible problem until we start reviewing the data.

Why should other states adapt similar programs?

I think it would be great if this type of program could expand to other states, as I believe it can aid in the transformation of care, in addition to growing the understanding and management of population health and restoring the public trust. We were able to do this on the back of the previous Virginia Cardiac Surgery Quality Initiative, but with the recent addition of other branches of the cardiology community, the expanded VCSQI could and should be even more successful in these endeavors.

Keywords: Virginia, Registries, Patient Care, Inpatients, Outpatients

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