Hoel Andrew W, Faerber Adrienne E, Moore Kayla O, Ramkumar Niveditta, Brooke Benjamin S, Scali Salvatore T, Sedrakyan Art, Goodney Philip P
Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.
The Dartmouth Institute, Lebanon, NH.
J Vasc Surg. 2017 Sep;66(3):751-759.e1. doi: 10.1016/j.jvs.2016.12.100. Epub 2017 Feb 17.
Accurate and complete long-term postoperative outcome data are critical to improving value in health care delivery. The Society for Vascular Surgery Vascular Quality Initiative (VQI) is an important tool to achieve this goal in vascular surgery. To improve on the capture of long-term outcomes after vascular surgery procedures for patients in the VQI, we sought to match VQI data to Medicare claims for comprehensive capture of major clinical outcomes in the first several years after vascular procedures.
Patient and procedure characteristics for abdominal aortic aneurysm procedures captured in the Society for Vascular Surgery VQI between January 1, 2002, and December 31, 2013, were matched to Medicare claims data using an indirect identifier methodology. Late outcomes captured in the VQI and in Medicare claims were compared.
Matching procedures yielded 9895 endovascular aneurysm repair (EVAR) patients (82.4% of eligible VQI patients) and 3405 open aneurysm repair (OAR) patients (74.4% of eligible). Comparison of patients who did and did not match to a Medicare claim demonstrated similar patient and procedure characteristics. Evaluation of late outcomes revealed good patient-level agreement on mortality for both EVAR (κ, 0.64) and OAR (κ, 0.82). Postoperative reintervention rates demonstrated lower agreement for both EVAR (κ, 0.26) and OAR (κ, 0.16).
This work demonstrates the feasibility of an algorithm using indirect identifiers to match VQI patients and procedures to Medicare claims data. The refinement of this strategy will focus on establishing and improving algorithms related to identifying and categorizing late events after EVAR and may serve as a mechanism to ensure that the best quality follow-up information is achieved within the VQI.
准确完整的术后长期结局数据对于提高医疗保健服务的价值至关重要。血管外科学会血管质量倡议（VQI）是在血管外科实现这一目标的重要工具。为了改进VQI中血管手术患者术后长期结局的收集情况，我们试图将VQI数据与医疗保险理赔数据进行匹配，以全面收集血管手术后最初几年的主要临床结局。
使用间接标识符方法，将2002年1月1日至2013年12月31日期间血管外科学会VQI中记录的腹主动脉瘤手术的患者和手术特征与医疗保险理赔数据进行匹配。比较VQI和医疗保险理赔中记录的晚期结局。
匹配的手术产生了9895例血管内动脉瘤修复（EVAR）患者（占符合条件的VQI患者的82.4%）和3405例开放性动脉瘤修复（OAR）患者（占符合条件的74.4%）。与医疗保险理赔匹配和未匹配的患者比较显示，患者和手术特征相似。对晚期结局的评估显示，EVAR（κ，0.64）和OAR（κ，0.82）在患者层面的死亡率一致性良好。术后再次干预率在EVAR（κ，0.26）和OAR（κ，0.16）中显示出较低的一致性。
这项工作证明了使用间接标识符将VQI患者和手术与医疗保险理赔数据进行匹配的算法的可行性。该策略的完善将集中于建立和改进与识别和分类EVAR后晚期事件相关的算法，并可作为一种机制，以确保在VQI内获得最佳质量的随访信息。
