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Marc L. Schermerhorn - One of the best experts on this subject based on the ideXlab platform.
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Regional Variation in racial disparities among patients with peripheral artery disease.
Journal of vascular surgery, 2018Co-Authors: Thomas F. O'donnell, Chloe Powell, Sarah E. Deery, Jeremy D. Darling, Kakra Hughes, Kristina A. Giles, Grace J. Wang, Marc L. SchermerhornAbstract:Abstract Objective Prior studies identified significant racial disparities as well as Regional Variation in outcomes of patients with peripheral artery disease (PAD). We aimed to determine whether Regional Variation contributes to these racial disparities. Methods We identified all white or black patients who underwent infrainguinal revascularization or amputation in 15 deidentified regions of the Vascular Quality Initiative between 2003 and 2017. We excluded three regions with Results We identified 90,418 patients, 15,527 (17%) of whom were black. Patients underwent 31,263 bypasses, 52,462 endovascular interventions, and 6693 amputations. Black patients were younger and less likely to smoke, to have coronary artery disease, or to have chronic obstructive pulmonary disease, but they were more likely to have diabetes, limb-threatening ischemia, dialysis dependence, and hypertension and to be self-insured or on Medicaid (all P Conclusions Significant racial disparities exist in outcomes after lower extremity procedures in patients with PAD, with Regional Variation contributing to perioperative but not long-term outcome disparities. Underperforming regions should use these data to generate quality improvement projects, as understanding the etiology of these disparities is critical to improving the care of all patients with PAD.
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Regional Variation in patient selection and treatment for carotid artery disease in the vascular quality initiative
Journal of Vascular Surgery, 2017Co-Authors: Katie E Shean, Sarah E. Deery, Peter A Soden, Brian W Nolan, Joseph R Schneider, Caron Rockman, John Mccallum, Marc L. SchermerhornAbstract:Abstract Objective Previous studies involving large administrative data sets have revealed Regional Variation in the demographics of patients selected for carotid endarterectomy (CEA) and carotid artery stenting (CAS) but lacked clinical granularity. This study aimed to evaluate Regional Variation in patient selection and operative technique for carotid artery revascularization using a detailed clinical registry. Methods All patients who underwent CEA or CAS from 2009 to 2015 were identified in the Vascular Quality Initiative (VQI). Deidentified Regional groups were used to evaluate Variation in patient selection, operative technique, and perioperative management. χ 2 analysis was used to identify significant Variation across regions. Results A total of 57,555 carotid artery revascularization procedures were identified. Of these, 49,179 patients underwent CEA (asymptomatic: median, 56%; range, 46%-69%; P P P P P P P P P P P P P Conclusions Despite clinical benchmarks aimed at guiding management of carotid disease, wide Variation in clinical practice exists, including the proportion of asymptomatic patients being treated by CAS and preoperative medical management. Additional intraoperative variables, including the use of a patch and protamine during CEA and use of a protection device during CAS, displayed similar Variation in spite of clear guidelines. Quality improvement projects could be directed toward improved adherence to benchmarks in these areas.
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significant Regional Variation exists in morbidity and mortality after repair of abdominal aortic aneurysm
Journal of Vascular Surgery, 2017Co-Authors: Sara L Zettervall, Dominique B Buck, Peter A Soden, Jack L Cronenwett, Phillip Goodney, Mohammad H Eslami, Jason T Lee, Marc L. SchermerhornAbstract:Abstract Objective Limited data exist comparing perioperative morbidity and mortality after open and endovascular abdominal aortic aneurysm (AAA) repair (EVAR) among regions of the United States. This study evaluated the Regional Variation in mortality and perioperative outcomes after repair of AAAs. Methods The Vascular Quality Initiative (VQI) was used to identify patients undergoing open AAA repair and EVAR between 2009 and 2014. Ruptured and intact aneurysms were evaluated separately, and the analysis of intact aneurysms was limited to infrarenal AAAs. All 16 regions of the VQI were deidentified, and those with χ 2 and Fisher exact tests. Regional rates were compared against current quality benchmarks. Results Perioperative outcomes from 14 regions were compared. After open repair of intact aneurysms, no significant Variation was seen in 30-day or in-hospital mortality; however, multiple regions exceeded the Society for Vascular Surgery benchmark for in-hospital mortality after open repair of intact aneurysms of P = .55). After EVAR, all regions met the Society for Vascular Surgery benchmark of P = .75). Significant Variation in in-hospital mortality existed after open (14%-63%; P = .03) and endovascular (3%-32%; P = .03) repair of ruptured aneurysms across the VQI Regional groups. After repair of intact aneurysms, wide Variation was seen in prolonged length of stay (>7 days for open repair: 32%-53%, P = .54; >2 days for EVAR: 16-43%, P P P P P P P P = .04) and respiratory complications (6%-20%; P = .20) were variable across regions. The frequency of endoleak at completion of EVAR also had considerable Variation (15%-38%; P Conclusions Despite limited Variation, multiple regions do not meet current benchmarks for in-hospital mortality after open AAA repair for intact aneurysms. Significant Regional Variation exists in perioperative outcomes and length of stay, and mortality is widely variable after repair for rupture. These data identify important areas for quality improvement initiatives and clinical practice guidelines.
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Regional Variation exists in patient selection and treatment of abdominal aortic aneurysms
Journal of Vascular Surgery, 2016Co-Authors: Sara L Zettervall, Dominique B Buck, Peter A Soden, Jack L Cronenwett, Phillip Goodney, Mohammad H Eslami, Jason T Lee, Marc L. SchermerhornAbstract:Objective Significant Regional Variation in surgical rates has been identified following multiple surgical procedures. However, limited data have examined the Regional variability in patient selection and treatment of abdominal aortic aneurysms (AAAs). This study aimed to evaluate Regional Variation in patient selection, perioperative management, and operative approach for the repair of AAAs. Methods All patients undergoing open repair or endovascular aneurysm repair (EVAR) of an AAA in the Vascular Quality Initiative from 2009 to 2014 were identified. All Regional groups were deidentified, and those with fewer than 100 open repairs were combined into a single region. Results We identified 17,269 elective repairs (EVAR, 13,759; open, 3510) and 1462 ruptured AAAs (EVAR, 749; open, 713). There was significant Regional Variation in the use of EVAR for elective repair (range, 66%-88%; P P P P P P P P P P P = .01]) and the frequency of stress tests (EVAR, 33%-64% [ P P P P P Conclusions Significant Regional Variation exists in patient selection, perioperative management, and operative approach for the repair of AAA. Definitive evidence is lacking in many aspects of operative care, including the use of the retroperitoneal approach and renal protective strategies. However, this Variation emphasizes the importance of research to determine best practice in the areas of greatest Variation. Furthermore, where current clinical process measures exist and data are clear, such as the use of statin and antiplatelet agents, the high degree of Variation should serve as an impetus for Regional quality improvement projects.
Brent K. Hollenbeck - One of the best experts on this subject based on the ideXlab platform.
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Regional Variation in quality of prostate cancer care
The Journal of Urology, 2014Co-Authors: Florian R. Schroeck, Samuel R. Kaufman, Bruce L. Jacobs, Ted A. Skolarus, John M. Hollingsworth, Vahakn B. Shahinian, Brent K. HollenbeckAbstract:Purpose: Despite the endorsement of several quality measures for prostate cancer by the National Quality Forum and the Physician Consortium for Performance Improvement, how consistently physicians adhere to these measures has not been examined. We evaluated Regional Variation in adherence to these quality measures to identify targets for future quality improvement.Materials and Methods: For this retrospective cohort study we used SEER (Surveillance, Epidemiology, and End Results)-Medicare data for 2001 to 2007 to identify 53,614 patients with newly diagnosed prostate cancer. Patients were assigned to 661 regions (Hospital Service Areas). Hierarchical generalized linear models were used to examine reliability adjusted Regional adherence to the endorsed quality measures.Results: Adherence at the patient level was highly variable, ranging from 33% for treatment by a high volume provider to 76% for receipt of adjuvant androgen deprivation therapy while undergoing radiotherapy for high risk cancer. In addition...
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Regional Variation in Quality of Prostate Cancer Care
The Journal of urology, 2013Co-Authors: Florian R. Schroeck, Samuel R. Kaufman, Bruce L. Jacobs, Ted A. Skolarus, John M. Hollingsworth, Vahakn B. Shahinian, Brent K. HollenbeckAbstract:Despite the endorsement of several quality measures for prostate cancer by the National Quality Forum and the Physician Consortium for Performance Improvement, how consistently physicians adhere to these measures has not been examined. We evaluated Regional Variation in adherence to these quality measures to identify targets for future quality improvement. For this retrospective cohort study we used SEER (Surveillance, Epidemiology, and End Results)-Medicare data for 2001 to 2007 to identify 53,614 patients with newly diagnosed prostate cancer. Patients were assigned to 661 regions (Hospital Service Areas). Hierarchical generalized linear models were used to examine reliability adjusted Regional adherence to the endorsed quality measures. Adherence at the patient level was highly variable, ranging from 33% for treatment by a high volume provider to 76% for receipt of adjuvant androgen deprivation therapy while undergoing radiotherapy for high risk cancer. In addition, there was considerable Regional Variation in adherence to several measures, including pretreatment counseling by a urologist and radiation oncologist (range 9% to 89%, p <0.001), avoiding overuse of bone scans in low risk cancer (range 16% to 96%, p <0.001), treatment by a high volume provider (range 1% to 90%, p <0.001) and followup with radiation oncologists (range 14% to 86%, p <0.001). We found low adherence rates for most established prostate cancer quality of care measures. Within most measures Regional Variation in adherence was pronounced. Measures with low adherence and a large amount of Regional Variation may be important low hanging targets for quality improvement. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Florian R. Schroeck - One of the best experts on this subject based on the ideXlab platform.
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Regional Variation in quality of prostate cancer care
The Journal of Urology, 2014Co-Authors: Florian R. Schroeck, Samuel R. Kaufman, Bruce L. Jacobs, Ted A. Skolarus, John M. Hollingsworth, Vahakn B. Shahinian, Brent K. HollenbeckAbstract:Purpose: Despite the endorsement of several quality measures for prostate cancer by the National Quality Forum and the Physician Consortium for Performance Improvement, how consistently physicians adhere to these measures has not been examined. We evaluated Regional Variation in adherence to these quality measures to identify targets for future quality improvement.Materials and Methods: For this retrospective cohort study we used SEER (Surveillance, Epidemiology, and End Results)-Medicare data for 2001 to 2007 to identify 53,614 patients with newly diagnosed prostate cancer. Patients were assigned to 661 regions (Hospital Service Areas). Hierarchical generalized linear models were used to examine reliability adjusted Regional adherence to the endorsed quality measures.Results: Adherence at the patient level was highly variable, ranging from 33% for treatment by a high volume provider to 76% for receipt of adjuvant androgen deprivation therapy while undergoing radiotherapy for high risk cancer. In addition...
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Regional Variation in Quality of Prostate Cancer Care
The Journal of urology, 2013Co-Authors: Florian R. Schroeck, Samuel R. Kaufman, Bruce L. Jacobs, Ted A. Skolarus, John M. Hollingsworth, Vahakn B. Shahinian, Brent K. HollenbeckAbstract:Despite the endorsement of several quality measures for prostate cancer by the National Quality Forum and the Physician Consortium for Performance Improvement, how consistently physicians adhere to these measures has not been examined. We evaluated Regional Variation in adherence to these quality measures to identify targets for future quality improvement. For this retrospective cohort study we used SEER (Surveillance, Epidemiology, and End Results)-Medicare data for 2001 to 2007 to identify 53,614 patients with newly diagnosed prostate cancer. Patients were assigned to 661 regions (Hospital Service Areas). Hierarchical generalized linear models were used to examine reliability adjusted Regional adherence to the endorsed quality measures. Adherence at the patient level was highly variable, ranging from 33% for treatment by a high volume provider to 76% for receipt of adjuvant androgen deprivation therapy while undergoing radiotherapy for high risk cancer. In addition, there was considerable Regional Variation in adherence to several measures, including pretreatment counseling by a urologist and radiation oncologist (range 9% to 89%, p <0.001), avoiding overuse of bone scans in low risk cancer (range 16% to 96%, p <0.001), treatment by a high volume provider (range 1% to 90%, p <0.001) and followup with radiation oncologists (range 14% to 86%, p <0.001). We found low adherence rates for most established prostate cancer quality of care measures. Within most measures Regional Variation in adherence was pronounced. Measures with low adherence and a large amount of Regional Variation may be important low hanging targets for quality improvement. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Brian W Nolan - One of the best experts on this subject based on the ideXlab platform.
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Regional Variation in patient outcomes in carotid artery disease treatment in the vascular quality initiative
Journal of Vascular Surgery, 2018Co-Authors: Katie E Shean, Sarah E. Deery, Thomas F Odonnell, Alexander B Pothof, Joseph R Schneider, Caron Rockman, Brian W NolanAbstract:Abstract Objective Quality metrics were developed to improve outcomes after carotid artery revascularization; however, few studies have evaluated Regional differences in perioperative outcomes. This study aimed to evaluate Regional Variation in mortality and perioperative outcomes after carotid endarterectomy (CEA) and carotid artery stenting (CAS). Methods We identified all patients who underwent CEA or CAS from 2009 to 2016 in the Vascular Quality Initiative. Patients were analyzed on the basis of their symptom status. We assessed Variation in perioperative outcomes using χ 2 analysis, Fisher exact test, and t -test, where appropriate. Results A total of 78,467 carotid interventions were identified; 85% were CEAs, with 69% of those asymptomatic. Within CAS, 39% were asymptomatic. Perioperative stroke/death varied across regions within both CAS groups (asymptomatic, 0%-5.8% [ P = .03]; symptomatic, 2.4%-8.1% [ P = .1]), and several regions did not meet the American Heart Association (AHA) guidelines of 3% for asymptomatic patients and 6% for symptomatic patients, which persisted after risk adjustment. For CEA, the stroke/death rates fell within the standards set by the AHA guidelines in all regions for both the unadjusted and risk-adjusted models; however, there was significant Regional Variation in the cohorts (asymptomatic, 0.9%-3.1% [ P P P = .2], CAS, 0%-2.4% [ P = .2]; symptomatic: CEA, 0%-1.8% [ P P = .01]). Rates of in-hospital stroke, postoperative myocardial infarction, prolonged length of stay (>2 days), and use of intravenous blood pressure medications all varied significantly across the regions. After CEA, there was significant Variation in the rates of cranial nerve injuries (asymptomatic, 0.9%-4.9% [ P P P P = .02]), and discharge on antiplatelet and statin (asymptomatic, 75%-87% [ P P P P P P Conclusions Unwarranted Regional Variation exists in outcomes after carotid artery revascularization across the regions of the VQI. Significant Variation was seen in a number of outcomes for which quality metrics currently exist, such as length of stay and discharge medications. In addition, after CAS, several regions failed to meet the AHA guidelines for stroke and death. Given these results, quality improvement projects should be targeted to improve adherence to current guidelines to promote best practices.
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Regional Variation in patient selection and treatment for carotid artery disease in the vascular quality initiative
Journal of Vascular Surgery, 2017Co-Authors: Katie E Shean, Sarah E. Deery, Peter A Soden, Brian W Nolan, Joseph R Schneider, Caron Rockman, John Mccallum, Marc L. SchermerhornAbstract:Abstract Objective Previous studies involving large administrative data sets have revealed Regional Variation in the demographics of patients selected for carotid endarterectomy (CEA) and carotid artery stenting (CAS) but lacked clinical granularity. This study aimed to evaluate Regional Variation in patient selection and operative technique for carotid artery revascularization using a detailed clinical registry. Methods All patients who underwent CEA or CAS from 2009 to 2015 were identified in the Vascular Quality Initiative (VQI). Deidentified Regional groups were used to evaluate Variation in patient selection, operative technique, and perioperative management. χ 2 analysis was used to identify significant Variation across regions. Results A total of 57,555 carotid artery revascularization procedures were identified. Of these, 49,179 patients underwent CEA (asymptomatic: median, 56%; range, 46%-69%; P P P P P P P P P P P P P Conclusions Despite clinical benchmarks aimed at guiding management of carotid disease, wide Variation in clinical practice exists, including the proportion of asymptomatic patients being treated by CAS and preoperative medical management. Additional intraoperative variables, including the use of a patch and protamine during CEA and use of a protection device during CAS, displayed similar Variation in spite of clear guidelines. Quality improvement projects could be directed toward improved adherence to benchmarks in these areas.
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national trends and Regional Variation of open and endovascular repair of thoracic and thoracoabdominal aneurysms in contemporary practice
Journal of Vascular Surgery, 2011Co-Authors: Salvatore T Scali, Philip P Goodney, Daniel B Walsh, Lori L Travis, Brian W Nolan, David C Goodman, Lee F Lucas, David H StoneAbstract:Objectives Successful surgical management of thoracic aortic aneurysms (TAA) and thoracoabdominal aortic aneurysms (TAAA) has historically relied upon open surgical repair (OSR). More recently, the advent and application of thoracic endovascular stent graft aneurysm repair (TEVAR) permutations have become increasingly performed in contemporary practice. To better determine the effect of TEVAR techniques on OSR, we examined national and Regional trends in treatment use. Methods All Medicare patients from 1998 through 2007 undergoing isolated TAA and TAAA repair were analyzed using a clinically validated algorithm using diagnostic International Classification of Disease 9th revision (ICD-9; 441.1, 441.2, 441.6, 441.7, 441.9) codes and procedural (ICD-9 OSR: 38.35, 38.45 and TEVAR: 39.73, 39.79) codes. Differential rates of OSR and TEVAR were compared across census tract regions during the study interval. Results Total complex aortic repairs increased by 60%, from 10.8 to 17.8/100,000, between 1998 and 2007 ( P P = NS). There was substantial Regional Variation for both OSR and TEVAR. This Regional Variation was greater in OSR (range, 8.8-16.7/100,000) than in TEVAR (range, 4.5-6.9/100,000). Conclusions Degenerative TAA and TAAA aneurysms are being repaired in the United States at an increasing rate. This reflects the rapid acceptance of TEVAR, which apparently supplements rather than supplants OSR. There appears to be greater Regional Variation in OSR compared with TEVAR. These data may have significant implications for those interested in the effect of new technologies on health care and cost containment.
Sara L Zettervall - One of the best experts on this subject based on the ideXlab platform.
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significant Regional Variation exists in morbidity and mortality after repair of abdominal aortic aneurysm
Journal of Vascular Surgery, 2017Co-Authors: Sara L Zettervall, Dominique B Buck, Peter A Soden, Jack L Cronenwett, Phillip Goodney, Mohammad H Eslami, Jason T Lee, Marc L. SchermerhornAbstract:Abstract Objective Limited data exist comparing perioperative morbidity and mortality after open and endovascular abdominal aortic aneurysm (AAA) repair (EVAR) among regions of the United States. This study evaluated the Regional Variation in mortality and perioperative outcomes after repair of AAAs. Methods The Vascular Quality Initiative (VQI) was used to identify patients undergoing open AAA repair and EVAR between 2009 and 2014. Ruptured and intact aneurysms were evaluated separately, and the analysis of intact aneurysms was limited to infrarenal AAAs. All 16 regions of the VQI were deidentified, and those with χ 2 and Fisher exact tests. Regional rates were compared against current quality benchmarks. Results Perioperative outcomes from 14 regions were compared. After open repair of intact aneurysms, no significant Variation was seen in 30-day or in-hospital mortality; however, multiple regions exceeded the Society for Vascular Surgery benchmark for in-hospital mortality after open repair of intact aneurysms of P = .55). After EVAR, all regions met the Society for Vascular Surgery benchmark of P = .75). Significant Variation in in-hospital mortality existed after open (14%-63%; P = .03) and endovascular (3%-32%; P = .03) repair of ruptured aneurysms across the VQI Regional groups. After repair of intact aneurysms, wide Variation was seen in prolonged length of stay (>7 days for open repair: 32%-53%, P = .54; >2 days for EVAR: 16-43%, P P P P P P P P = .04) and respiratory complications (6%-20%; P = .20) were variable across regions. The frequency of endoleak at completion of EVAR also had considerable Variation (15%-38%; P Conclusions Despite limited Variation, multiple regions do not meet current benchmarks for in-hospital mortality after open AAA repair for intact aneurysms. Significant Regional Variation exists in perioperative outcomes and length of stay, and mortality is widely variable after repair for rupture. These data identify important areas for quality improvement initiatives and clinical practice guidelines.
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Regional Variation exists in patient selection and treatment of abdominal aortic aneurysms
Journal of Vascular Surgery, 2016Co-Authors: Sara L Zettervall, Dominique B Buck, Peter A Soden, Jack L Cronenwett, Phillip Goodney, Mohammad H Eslami, Jason T Lee, Marc L. SchermerhornAbstract:Objective Significant Regional Variation in surgical rates has been identified following multiple surgical procedures. However, limited data have examined the Regional variability in patient selection and treatment of abdominal aortic aneurysms (AAAs). This study aimed to evaluate Regional Variation in patient selection, perioperative management, and operative approach for the repair of AAAs. Methods All patients undergoing open repair or endovascular aneurysm repair (EVAR) of an AAA in the Vascular Quality Initiative from 2009 to 2014 were identified. All Regional groups were deidentified, and those with fewer than 100 open repairs were combined into a single region. Results We identified 17,269 elective repairs (EVAR, 13,759; open, 3510) and 1462 ruptured AAAs (EVAR, 749; open, 713). There was significant Regional Variation in the use of EVAR for elective repair (range, 66%-88%; P P P P P P P P P P P = .01]) and the frequency of stress tests (EVAR, 33%-64% [ P P P P P Conclusions Significant Regional Variation exists in patient selection, perioperative management, and operative approach for the repair of AAA. Definitive evidence is lacking in many aspects of operative care, including the use of the retroperitoneal approach and renal protective strategies. However, this Variation emphasizes the importance of research to determine best practice in the areas of greatest Variation. Furthermore, where current clinical process measures exist and data are clear, such as the use of statin and antiplatelet agents, the high degree of Variation should serve as an impetus for Regional quality improvement projects.
