Hospital Referral Guidelines

Michigan Health and Safety Coalition Hospital Referral Guideline for Abdominal Aortic Aneurysm Repair*

• In collaboration with the Michigan Vascular Society, all Michigan surgeons and hospitals performing abdominal aortic aneurysm repair should collect risk-adjusted morbidity and mortality data and should participate in audits of data quality and accuracy as required. (See Appendix A for a list of codes.)

• All Michigan surgeons performing abdominal aortic aneurysm repair should work with the Michigan Vascular Society to actively participate in designing and implementing a process improvement strategy based on data. Active participation includes:

1. attending regularly scheduled meetings and developing processes by which data will be collected and data quality will be ensured;
2. convening a panel of vascular surgery experts who will develop hospital referral guidelines related to management of vascular disease that addresses endovascular techniques;
3. reviewing, analyzing, using and refining the vascular data;
4. examining and validating the relationship between health outcomes and abdominal aortic aneurysm;
5. identifying risk-adjusted morbidity and mortality indicators that reflect differences in quality of care (consider graft infection, renal failure, subsequent amputation, and leaks);
6. sharing information across surgical programs and learning from successful programs perhaps using the Northern New England Cardiovascular model of rounding by inter-hospital teams to identify best practices;
7. developing, implementing, evaluating, and periodically updating measurable evidence-based quality of care indicators, hospital and physician-specific standards and guidelines, best practices and clinical protocols;
8. evaluating hospital and physician-specific performance relative to agreed upon standards and guidelines;
9. educating physicians and hospitals about quality of care indicators, standards, guidelines, protocols and best practices as well as their hospital-specific patient outcomes;
10. sharing data and disseminating hospital and physician-specific performance information with physicians, hospitals, purchasers, consumers, and others in an appropriate manner that communicates the quality of Michigan vascular surgery programs and reassures purchasers and payers; and
11. identifying innovative models to cover the costs of data collection, analysis and use.

• Hospitals should collect additional quality of care indicator data such as total volume of abdominal aortic aneurysm repairs (open and closed endovascular repairs) performed by each physician, as well as ancillary staff experience and competence measures.

• Only hospitals with annual volumes of at least 20 should perform abdominal aortic aneurysm repairs using either open or closed (endovascular) techniques.

• Hospitals should require that their medical staff implement appropriateness criteria and use the criteria to perform clinical case review of abdominal aortic aneurysm repairs (open and endovascular).

Future direction of Coalition work related to the Abdominal Aortic Aneurysm Repair Guideline

The guideline should be reviewed and updated no later than December 31, 2003.

* This is meant to be a guideline and not a standard of care; this guideline represents the best of an evidence-based review at this time; the guideline is based on the principles of CQI and is not intended to be used in a punitive manner; this guideline needs to be taken as a whole, and not have selected parts be used without considering the entire content of the guideline.