The Blue Cross and Blue Shield of Michigan Vascular Interventions Collaborative (BMC2 VIC)

The Blue Cross and Blue Shield of Michigan Vascular Interventions Collaborative (BMC2 VIC)

The Blue Cross Blue Shield of Michigan Vascular Interventions Collaborative is comprised of two integrated components, one for peripheral vascular interventions and one for vascular surgeries.  VIC combines the BMC2 Peripheral Vascular Collaborative (BMC2PVI – in place since 2003) to include vascular surgical procedures and the specialties that perform these procedures. Both are multi-specialty and include all consecutive cases performed by all specialties within a hospital that perform vascular procedures.

BMC2 VIC Goals:

  • Establish a trusting collaborative structure
  • Support collection, analysis and distribution of patient characteristics, procedural information and outcomes
  • Facilitate collaborative, hospital and physician level
  • Benchmarking
  • Identification of best practices and opportunities for quality improvement
  • Eventually comparative effectiveness analysis for open and endovascular procedures

 

BMC2 PVI and Vascular Surgery (VIC):

  • Designed to improve quality of care and outcomes and reduce practice variation across the specialties that perform these procedures
  • Overcomes the barriers of traditional market and academic competition
  • Collects, audits, and organizes data – reports procedural variables and outcomes to individual operators and institutions
  • Computed using R to facilitate the inclusion of statistical parameters – includes graphics
  • Formatted using LaTeX
  • Report specifications –available on the website - detail all parameters and calculations
  • Report types:
    • Quarterly/TYD - Collaborative, hospital and physician reports- discharges
    • Morbidity and Mortality Report – Quarterly for each hospital, physician
    • 30 Day Follow-up Report – Quarterly and YTD (6 mo and 1 year)
    • PAQ report
    • Carotid Reports

 

Data collected:

  • Patient Information
  • Labs
  • History
  • Presenting Symptoms
  • Prior Surgical procedures
  • Prior Vascular Intervention
  • Medications
  • Procedural information
  • Outcomes
  • In Lab
  • Prior to Discharge
  • Peripheral Arterial Questionnaire (PAQ)
  • Baseline – Pre-procedure
  • 6 Months/1 Year
  • Follow-up/Status, Meds, Complications
  • 30 day
  • 1 year (PVI 6 months)

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BMC2 PVI part of VIC:

A quality improvement registry funded by Blue Cross Blue Shield of Michigan in October, 2007.

A multi-center, multi-disciplinary outcomes registry and the first of its kind in the United States.

  • Multi-specialty initiative that includes:
    • Interventional Radiologists
    • Vascular Surgeons
    • Interventional Cardiologists
  • Scope of PVI procedure types:  Radial, brachial, axillary, subclavian, renal, celiac, mesenteric, distal aorta and all arteries in the lower extremity
    • Percutaneous trans luminal angioplasty and stenting
    • Atherectomy
    • CTO Device Use
    • Any balloon or stent inserted during a surgical procedure
    • All cases where an attempt was made to cross a peripheral lesion
    • Fistulas and dialysis grafts, or LE aneurysm excluded

 

BMC2 PVI numeric goals:

  • ASA at discharge > 90%
  • Statin at discharge > 75%
  • Vascular complications < 3% (lowered from 4% to 3% in 2011)
  • Post PVI transfusion < 7%
  • Contrast induced nephropathy < 4% (lowered from 7% to 4% in 2011)

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BMC2 Vascular surgery part of VIC:

  • A quality improvement registry funded by Blue Cross Blue Shield of Michigan in October, 2007
  • A regional collaborative effort
  • A multi-center, multi-disciplinary outcomes registry and the first of its kind in the United States
  • Multi-specialty initiative that includes:
    • Vascular surgeons
    • Cardio-thoracic surgeons
    • General Surgeons

 

Vascular surgery procedure types:

  • Open Abdominal Aneurysm Repair
  • Endovascular Abdominal Aneurysm Repair (EVAR), Infrarenal, Suprarenal and Juxtarenal Repairs
  • Endovascular Repair of Abdominal Aortic Stenosis
  • Open Bypass Procedures, Upper and Lower Extremity
  • Carotid Stenting
  • Carotid Endarterectomy

BMC2 VIC Participating Hospitals

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PVI Quality Improvement Results to date: