Section of Vascular Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; VA Quality Scholars Program, Veterans Health Association, White River Junction, Vt; VA Outcomes Group, Veterans Health Association, White River Junction, Vt; Geisel School of Medicine, Dartmouth College, Hanover, NH; Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH.
Section of Vascular Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; VA Quality Scholars Program, Veterans Health Association, White River Junction, Vt; VA Outcomes Group, Veterans Health Association, White River Junction, Vt; Geisel School of Medicine, Dartmouth College, Hanover, NH; Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH.
J Vasc Surg. 2019 Jan;69(1):74-79.e6. doi: 10.1016/j.jvs.2018.03.423. Epub 2018 Jun 15.
The accurate measurement of reintervention after endovascular aneurysm repair (EVAR) is critical during postoperative surveillance. The purpose of this study was to compare reintervention rates after EVAR from three different data sources: the Vascular Quality Initiative (VQI) alone, VQI linked to Medicare claims (VQI-Medicare), and a "gold standard" of clinical chart review supplemented with telephone interviews.
We reviewed the medical records of 729 patients who underwent EVAR at our institution between 2003 and 2013. We excluded patients without follow-up reported to the VQI (n = 68 [9%]) or without Medicare claims information (n = 114 [16%]). All patients in the final analytic cohort (n = 547) had follow-up information available from all three data sources (VQI alone, VQI linked to Medicare, and chart review). We then compared reintervention rates between the three data sources. Our primary end points were the agreement between the three data sources and the Kaplan-Meier estimated rate of reintervention at 1 year, 2 years, and 3 years after EVAR. For gold standard assessment, we supplemented chart review with telephone interview as necessary to assess reintervention.
VQI data alone identified 12 reintervention events in the first year after EVAR. Chart review confirmed all 12 events and identified 18 additional events not captured by the VQI. VQI-Medicare data successfully identified all 30 of these events within the first year. VQI-Medicare also documented four reinterventions in this time period that did not occur on the basis of patient interview (4/547 [0.7%]). The agreement between chart review and VQI-Medicare data at 1 year was excellent (κ = 0.93). At 3 years, there were 81 (18%) reinterventions detected by VQI-Medicare and 70 (16%) detected by chart review for a sensitivity of 92%, specificity of 96%, and κ of 0.80. Kaplan-Meier survival analysis demonstrated similar reintervention rates after 3 years between VQI-Medicare and chart review (log-rank, P = .59).
Chart review after EVAR demonstrated a 6% 1-year and 16% 3-year reintervention rate, and almost all (92%) of these events were accurately captured using VQI-Medicare data. Linking VQI data with Medicare claims allows an accurate assessment of reintervention rates after EVAR without labor-intensive physician chart review.
血管质量倡议（VQI）单独、VQI 链接到医疗保险索赔（VQI-医疗保险）和临床图表审查补充电话访谈的“黄金标准”这三种不同的数据来源对血管内动脉瘤修复（EVAR）后的再干预进行准确测量，这在术后监测中至关重要。本研究旨在比较三种数据来源（VQI 单独、VQI 链接到医疗保险和图表审查）后 EVAR 的再干预率。
我们回顾了 2003 年至 2013 年在我院接受 EVAR 治疗的 729 例患者的病历。我们排除了没有报告给 VQI 的随访患者（n=68[9%]）或没有医疗保险索赔信息的患者（n=114[16%]）。最终分析队列中的所有患者（n=547）均有来自所有三种数据来源（VQI 单独、VQI 链接到医疗保险和图表审查）的随访信息。然后，我们比较了三种数据来源之间的再干预率。我们的主要终点是三种数据来源之间的一致性以及 EVAR 后 1 年、2 年和 3 年的再干预估计 Kaplan-Meier 率。对于黄金标准评估，我们根据需要补充图表审查和电话访谈，以评估再干预。
VQI 数据单独在 EVAR 后第一年确定了 12 例再干预事件。图表审查确认了所有 12 例事件，并发现了 18 例 VQI 未捕获的额外事件。VQI-医疗保险数据在第一年成功地确定了这 30 例事件中的所有事件。VQI-医疗保险还记录了在此期间发生的四次基于患者访谈未发生的再干预（4/547[0.7%]）。图表审查与 VQI-医疗保险数据在第一年的一致性非常好（κ=0.93）。在 3 年时，VQI-医疗保险检测到 81 例（18%）再干预，图表审查检测到 70 例（16%）再干预，灵敏度为 92%，特异性为 96%，κ 值为 0.80。Kaplan-Meier 生存分析显示，VQI-医疗保险和图表审查后 3 年的再干预率相似（对数秩，P=0.59）。
EVAR 后进行图表审查显示，1 年时的再干预率为 6%，3 年时的再干预率为 16%，其中几乎所有（92%）事件都通过 VQI-医疗保险数据准确捕捉。将 VQI 数据与医疗保险索赔联系起来，可以在不进行繁琐的医生图表审查的情况下，准确评估 EVAR 后的再干预率。
