Started in in 1996, VCSQI is a voluntary consortium that has grown to include 18 hospitals, 14 cardiac surgical practices, and in 2016 expanded to include the cardiology specialty with the goal of coordinating care and forming a statewide “Heart Team” approach to cardiac care. VCSQI members represent over 99% of all open-heart and 50% of interventional procedures in the Commonwealth of Virginia. VCSQI’s goal is to improve quality of care and contain costs in heart procedure programs of all sizes across the state.
The Virginia Cardiac Services Quality Initiative was awarded a federal government contract to serve as a Support and Alignment Network (SAN) 2.0 in October 2016. This contract requires the VCSQI SAN 2.0 to provide education and consultation to group practices that voluntarily seek assistance with improving outcomes, enhancing clinical experiences for their patients, and lowering costs. Through these efforts, clinicians will also be prepared for the new payment models already launched by the Centers for Medicare and Medicaid Services and for assessment for merit-based incentives.
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Learn What VCSQI is All About
VCSQI’s goal is to improve clinical quality in all cardiac service programs through outcomes analysis and process improvements. Additionally, VCSQI’s clinical/financial database helps reduce costs through reductions in complications and unnecessary resource utilization. The organization’s two main objectives are the following:
VCSQI focuses on improving outcomes through changes in processes of care and replication of best practices. The organization serves as a peer-to-peer value exchange whose work:
The objective is to help members find quality improvement opportunities to better utilize resources, contain costs, effectively redesign clinical processes and modify provider behavior using the best available evidence.
The organization provides value to its stakeholders by improving the quality of care through data analysis and implementing best practices protocols. VCSQI collaborates on quality by combining effective communications with solid evidence which translates into process-of-care changes. Benefits include lowered costs of care, enhanced clinical effectiveness, increased accountability, reduced regional variations, stronger alliances between heart team members and improved patient satisfaction. VCSQI achieves this through:
VCSQI’s Heart Team model of collaboration between cardiac surgery and cardiology practices helps to broaden its sphere of influence and is utilized as a means for setting priorities, synchronizing efforts, and managing data. VCSQI’s programs effectively convene leaders, use leading technology for regional information sharing, replicate best practices through educational programs and improve care processes through systems change. Additionally, this model tasks regional and local teams to review patient medical conditions, determine feasible treatment options and formulate reasonable strategies of patient care. These teams are situated within local provider organizations and in coordination externally with VCSQI.
VCSQI assumes an expanded role promoting a culture of continuous quality improvement for the entire cardiac services community. Participation is open, voluntary and equitable. The organization is a consortium of 18 cardiac surgical practices and 16 interventional cardiology sites and projects are led by the Board of Directors and developed by the Quality Committee and Research and Writing Committee.
VSCQI’s members perform over 99 percent of Virginia’s open-heart procedures.
VCSQI helped design and develop a global pricing demonstration with CMS and participated in the adoption of quality measures in cardiac surgery for the National Quality Forum in 2005.
The group has worked with CMS, the National Quality Forum, Wellpoint and STS in various initiatives. A protocol for reducing the incidence of post-operative atrial fibrillation has been in the field. Protocols for blood conservation and readmission reduction have also been researched and implemented.
VCSQI developed a quality dashboard tied to a pay-for-performance programs and gain-sharing models aligning incentives for physicians, hospitals, and payers. VCSQI is a working model for regional health information sharing, a grass-roots quality improvement organization and a patient safety collaborative.
VCSQI has officially taken the next step in incorporating interventional cardiology into our statewide collaborative. VCSQI board members agreed to change the group’s name to the Virginia Cardiac Services Quality Initiative.
Regional Collaboration as a Model for Fostering Accountability and Transforming Healthcare. Speir AM, Rich JB, Crosby IK, Fonner E. Seminars in Thoracic and Cardiovascular Surgery 21 (2009):12-19.
Additive Cost of Postoperative Complications for Isolated Coronary Artery Bypass Grafting Patients in Virginia. Speir AM, Kasirajan V, Barnett SD, Fonner E. Annals of Thoracic Surgery 88.1 (2009): 40-46. Presented at the 45th annual meeting of the Society of Thoracic Surgeons, San Francisco CA, January 2009.
Making a Business Case for Quality by Regional Information Sharing Involving Cardiothoracic Surgery. Rich, JB, Speir AM, Fonner E. The American Heart Hospital Journal, 4, no. 2 (Spring 2006): 142-147.
Preoperative Renal Function Predicts Hospital Costs and Length of Stay in Coronary Artery Bypass Grafting. LaPar DJ, Rich JB, Isbell JM, Brooks CH, Crosby IK, Yarboro LT, Ghanta RK, Kern JA, Brown M, Quader MA, Speir AM, Ailawadi G. Annals of Thoracic Surgery 101.2 (2016), 606-612.
Contemporary Costs Associated With Transcatheter Aortic Valve Replacement. Ailawadi G, LaPar DJ, Speir AM, Ghanta RK, Yarboro LT, Crosby IK, Lim DS, Quader MA, Rich JB. Annals of Thoracic Surgery 101.1 (2016), 154-161.
Cost, Quality, and Value in Coronary Artery Bypass Grafting. Osnabrugge RLJ, Speir AM, Head SJ, Jones PG, Ailawadi G, Fonner CE, Fonner E, Kappetein AP, Rich JB. Journal of Thoracic and Cardiovascular Surgery 148.6 (2014), 2729-2735.
Prediction of Costs and Length of Stay in Coronary Artery Bypass Grafting. Osnabrugge RLJ, Speir AM, Head SJ, Jones PG, Ailawadi G, Fonner CE, Fonner E, Kappetein AP, Rich JB. Annals of Thoracic Surgery 98.4 (2014): 1286-1293.
Costs for Surgical Aortic Valve Replacement According to Preoperative Risk Categories. Osnabrugge RLJ, Speir AM, Head SJ, Fonner CE, Fonner E, Ailawadi G, Kappetein AP, Rich JB. Annals of Thoracic Surgery 96.2 (2013): 500-506.
A Contemporary Cost Analysis of Postoperative Morbidity Following Coronary Artery Bypass Grafting With and Without Concomitant Aortic Valve Replacement to Improve Patient Quality and Cost Effective Care. LaPar DJ, Crosby IK, Rich JB, Fonner E, Kron IL, Ailawadi G, Speir AM. Annals of Thoracic Surgery 96.5 (2013): 1621-1627.
Postoperative Atrial Fibrillation Significantly Increases Mortality, Hospital Readmission, and Hospital Costs. LaPar DJ, Speir AM, Crosby IK, Fonner E, Brown M, Rich JB, Quader MA, Kern JA, Kron IL, Ailawadi G. Annals of Thoracic Surgery 98.2 (2014): 527-533. Presented at STSA 2013, Scottsdale, AZ.
Blood Product Conservation Is Associated with Improved Outcomes and Reduced Costs Following Cardiac Surgery. LaPar DJ, Crosby IK, Ailawadi G, Ad N, Choi E, Spiess BD, Rich JB, Kasirajan V, Fonner E, Kron IL, Speir AM. Journal of Thoracic and Cardiovascular Surgery 145.3 (2013): 796-804. Presented at AATS 2012, San Francisco, CA.
Delayed Sternal Closure after Left Ventricle Assist Device Implantation: Analysis of Risk Factors, Impact on Outcomes and Costs. Quader MA, LaPar DJ, Wolfe LG, Ailawadi G, Rich JB, Speir AM, Fonner CE, Kasirajan V. ASAIO Journal (American Society for Artificial Internal Organs: 1992) (2016).
Impact of Preoperative Statin Use on Ascending Aortic Aneurysm Repair Outcomes. Hawkins RB, Mehaffey JH, Guo A, Fonner CE, Speir AM, Rich JB, Yarboro LT, Ghanta RK, Ailawadi G. Circulation 134, no. Suppl 1 (2016): A17230-A17230.
Impact of Preoperative Glycemic Control on Long-Term Mechanical Circulatory Support Device Implantation. Downs EA, Johnston LE, LaPar DJ, Yarboro LT, Kern, JA, Kirby JL, Mazimba S, Speir AM, Rich JB, Quader MA, Ailawadi G. The Journal of Heart and Lung Transplantation 35, no. 4 (2016): S377.
Minimally Invasive Mitral Valve Surgery Provides Excellent Outcomes without Increased Cost: A Multi-Institutional Analysis. Downs EA, Johnston L, LaPar DJ, Ghanta RK, Kron IL, Speir AM, Fonner CE, Kern JA, Ailawadi G. Annals of Thoracic Surgery (2016).
Equivalent Mortality but Higher Morbidity in Patients Receiving Temporary Mechanical Support Prior to Permanent LVAD Implantation. Johnston LE, Ailawadi G, Downs EA, Rich JB, Speir AM, Quader AM, Kennedy JL, Yarboro LT, Kern JA, Mazimba S. The Journal of Heart and Lung Transplantation 35.4 (2016): S153.
Minimally Invasive Mitral Valve Surgery Has Superior Outcomes to Conventional Sternotomy Without Increased Costs. Downs EA, Johnston LE, LaPar DJ, Ghanta RK, Kron IL, Fonner CE, Kern J, Speir AM, Ailawadi G. Annals of Thoracic Surgery, (2016).
Institutional Variation in Mortality After Stroke After Cardiac Surgery: An Opportunity for Improvement. LaPar DJ, Quader MA, Rich JB, Kron IL, Crosby IK, Kern JA, Tribble CG, Speir AM, Ailawadi G. Annals of Thoracic Surgery (2015).
Blood Product Utilization With Left Ventricular Assist Device Implantation: A Decade of Statewide Data. Quader MA, Wolfe LG, Ailawadi G, Rich JB, Speir AM, LaPar DJ, Fonner CE, Kasirajan V. The Journal for Heart and Lung Transplantation 34.4 (2015): S14.
Bilateral IMA Use for Coronary Artery Bypass Grafting Remains Underutilized: A Propensity Matched Multi-Institution Analysis. LaPar DJ, Crosby IK, Rich JB, Quader MA, Speir AM, Kern JA, Tribble C, Kron IL, Ailawadi G. Annals of Thoracic Surgery 100.1 (2015): 8-15.
Multicenter Evaluation of High-Risk Mitral Valve Operations: Implications for Novel Transcatheter Valve Therapies. LaPar DJ, Isbell JM, Crosby IK, Kern J, Lim DS, Fonner E, Speir AM, Rich JB, Kron IL, Ailawadi G. Annals of Thoracic Surgery 98.6 (2014): 2032-2038.
Isolated Aortic Valve Replacement with Bio-Prostheses in Patients Age 50 to 65 Years: A Decade of Statewide Data on Cost and Patient Outcomes. Quader MA, Wolfe LG, Medina A, Fonner CE, Ailawadi G, Crosby IK, Speir AM, Rich JB, LaPar DJ, Kasirajan V. Journal of Cardiovascular Surgery, 2014 Sept. 12 [E-publication].
Performance of EuroSCORE II in a Large US Database: Implications for Transcatheter Aortic Valve Implantation. Osnabrugge RLJ, Speir AM, Head SJ, Fonner CE, Fonner E, Kappetein AP, Rich JB. European Journal of Cardio-Thoracic Surgery 46.3 (2014): 400-408.
Nonagenarians Undergoing Cardiac Surgery. Davis JP, LaPar DJ, Crosby IK, Kern JA, Lau CL, Kron IL, Ailawadi G. Journal of Cardiac Surgery 29.5 (2014): 600-604.
Hospital Variation in Mortality From Cardiac Arrest After Cardiac Surgery: An Opportunity for Improvement? LaPar DJ, Ghanta RK, Kern JA, Crosby IK, Rich JB, Speir AM, Kron IL, Ailawadi G. Annals of Thoracic Surgery 98.2 (2014): 534-540. Presented at STSA 2013, Scottsdale, AZ.
Predictors of Operative Mortality in Cardiac Surgical Patients with Prolonged Intensive Care Unit Duration. LaPar DJ, Gillen JR, Crosby IK, Sawyer RG, Lau CL, Kron IL, Ailawadi G. JACS 216(6): 1116-1123.
Preoperative Beta-Blocker Use Should Not Be a Quality Metric for Coronary Artery Bypass Grafting. LaPar DJ, Crosby IK, Kron IL, Kern JA, Fonner E, Rich JB, Speir AM, Ailawadi G. Annals of Thoracic Surgery 96.5 (2013): 1539-1545.
Concomitant Tricuspid Valve Operations Affect Outcomes Following Mitral Operations: A Multiinstitutional, Statewide Analysis. LaPar DJ, Mulloy DP, Stone M, Crosby I, Lau CL, Kron IL, Ailawadi G. Annals of Thoracic Surgery 94.1 (2012): 52-58. Presented at STSA 2011, San Antonio, TX.
Previous Percutaneous Coronary Intervention Increases Morbidity After Coronary Artery Bypass Grafting. Mehta GS, LaPar DJ, Bhamidipati CM, Kern JA, Kron IL, Upchurch GR, Ailawadi G. Surgery 152.1 (2012): 5-11.
Contemporary Outcomes for Surgical Mitral Valve Repair: A Benchmark for Evaluating Emerging Mitral Valve Technology. LaPar DJ, Mulloy DP, Crosby IK, Lim DS, Kern JA, Kron IL, Ailawadi G. Journal of Thoracic and Cardiovascular Surgery 143.4 (2012): S12-S16. Presented at AATS Mitral Conclave 2011, New York.
Small Prosthesis Size in Aortic Valve Replacement Does Not Affect Mortality. LaPar DJ, Ailawadi G, Bhamidipati CM, Stukenborg GJ, Crosby IK, Kern JA, Kron IL. Annals of Thoracic Surgery 92.3 (2011): 880-888.
Elective Thoracic Aortic Aneurysm Surgery: Better Outcomes from High-Volume Centers. Gazoni LM, Speir AM, Kron IL, Fonner CE, Crosby IK. JACS 210.5 (2010): 855-860.
Does urgent or emergent status influence choice in mitral valve operations? An analysis of outcomes from the Virginia Cardiac Surgery Quality Initiative. LaPar DJ, Hennessy S, Fonner CE, Kern JA, Kron IL, Ailawadi G. Annals of Thoracic Surgery 90.1 (2010): 153-160.
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