2015 VQI Annual Report - The Vascular Quality Initiative

201 5 A N N UA L R E P O RT
Vascular Quality Initiative
®
SVS PSO Governing Council Report
“Current Best Practice” announcement strongly
recommending that patients undergoing arterial
intervention be discharged home on a statin and
antiplatelet agent because we have shown that
these patients have 14% improved survival
after five years.
■ M
ake the VQI even more relevant and useful
Larry Kraiss MD, Chair
My predecessor, Dr. Richard Cambria, provided
exemplary leadership during the formative years of
the PSO, creating an organization with committed
physician participants, strong governance, stable
finances and excellent staff. Four years after
inception, the SVS PSO is no longer a start-up
operation. There are now 350 participating centers
and 2,500 participating physicians who have
contributed over 216,000 procedures to
the registries.
Coming into this job last June, I knew that we
needed a road map to take us to the next level of
maturity. To create that roadmap, we held our first
strategic planning session last fall. We identified
a number of areas for development.
■ P
rovide reports that inform day-to-day practice.
Three Center Opportunity Profile for Improvement (COPI) reports have been released: Surgical
Site Infection (SSI), Length of Stay after CEA,
Length of Stay after EVAR with many more in
development. The SSI COPI report facilitated
reduction in SSI among a number of centers
identified to have the greatest opportunity for
improvement. The VQI has also released a
for measuring the quality of vascular care. We
released a new Varicose Vein registry this year
with the American Venous Forum and are in the
early stages of working with the Society for
Vascular Medicine on a Registry for medical
management of PAD. We also are actively
exploring how to incorporate charge/cost data
into our registries.
■ B
roaden and deepen the infrastructure of the
VQI. As our PSO has grown and matured, we
recognize the need for more staff to work with
our highly-effective medical director, Dr. Jack
Cronenwett. In addition to Administrative
Director Carrie Bosela, three full time staff have
been recruited: Nadine Caputo as Quality
Director, Dan Neal as Analytic Director, and
Megan Mathy for administrative support in the SVS
Chicago office. This increase in permanent staff
will greatly accelerate new projects in our PSO.
■ I dentify distinct revenue streams to support VQI
development projects. We know that to continue
improving the VQI, we need to diversify our
revenue sources beyond participation fees. There
is great interest by vascular device
companies for using blinded VQI data to meet
regulatory requirements. Several of them have
contributed unrestricted grants to help fund VQI
development projects. We also anticipate income
from companies who want to “lease” the VQI
infrastructure to conduct their own studies.
We expect these arrangements will provide
opportunities for participating VQI centers to
defray the costs of participation.
■ S
trengthen our relationship with regulatory
agencies and other registries. Maturing as an
organization has meant gradually shifting away
from an exclusively internal focus to an external
focus. We are actively cultivating relationships
internationally with other vascular registries,
and in the US with the AHRQ, FDA and CMS.
These relationships are already bearing fruit,
increasing the stature of VQI as a voice for quality
and increasing the value of participation.
Finally, I am regularly reminded that VQI’s success
depends on the deep commitment to quality of its
members who go out of their way to participate.
I am honored to work with so many who generously
contribute their time in numerous capacities
to improve VQI.
Number of Participating Centers
Growth of Participating Centers
350
325
300
275
250
225
200
175
150
125
100
75
50
25
0
Research Advisory Committee Report
Philip Goodney MD, Chair
VQI members can request non-identifiable national
datasets for research and quality improvement
projects approved by their regional group. These
data do not identify patients, centers or providers,
but provide a rich source to analyze real world
practice and variation in process and outcomes.
Data requests are reviewed by the PSO Research
Advisory Committee (RAC) to be sure that they are
scientifically valid, that they are consistent with the
VQI mission, and that they do not overlap
existing projects.
The VQI RAC consists of 20 members with
broad scientific background and regional
representation. To date, the RAC has approved
45 proposals from 37 unique VQI investigators in
17 centers,representing diverse topics across
multiple procedures. (For details, see http://www.
vascularqualityinitiative.org/vqi-resource-library/).
lar
Quality
Initiative®
ruality
Quality
Initiative®
Initiative®
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RAC policies allow investigators to easily request
expansion of the scope of their initial project
when analyses suggest this. Progress of projects is
tracked by the RAC and investigators with similar
projects are encouraged to collaborate. With a
database of >200,000 procedures, VQI provides a
rich opportunity for research that often leads to
quality improvement projects based on new
scientific evidence.
VA S CUL A R QUA L IT Y I N I T I AT I V E 2 0 1 5 A N N UA L R E P O RT
Vascular Technology Council Report
Fred Weaver MD, Chair
Members of the VTC have met with the FDA and over two dozen manufacturers of arterial and venous devices
as well as companies that focus on the medical management of vascular disease.
Important progress to date:
■H
eld Corporate Roundtable discussions with
industry and FDA for longitudinal evaluation of
existing technology, which highlighted the value
of the existing VQI data and the benefit of
customized data elements and follow-up for
evaluation of device efficacy.
■ I dentified opportunities to use VQI registries to ob-
tain data needed to shorten the approval process
for expanded indications. The potential to leverage VQI as a platform for regulatory approval is a
critical focus of the VTC.
QUALITY CHAMPIONS
■ I nitiated two FDA-required post market surveil-
lance projects using VQI (highlighted below ),
establishing important efficiency advantages,
including rapid site recruitment without IRB costs
or individual site contracts, an established network
of sites already collecting much of the needed
data, and ease of customizing the registries for
new projects.
■E
stablished a mechanism for industry to support
new initiatives in the VQI, such as new registries
and reporting functionality. Corporate support
totaled $525,000 this year, provided by Quality
Champions and Quality Partners.
QUALITY PARTNERS
PQRS Reporting
with VQI and M2S
For the past 7 years, M2S has partnered
with VQI to allow VQI member physicians to
electronically report PQRS measures based
on VQI data submitted via M2S. This has
allowed 283 physicians to qualify for PQRS
reporting, initially obtaining a 2% bonus of all
their Medicare billings, but now transitioning
to avoid a 2% penalty for all Medicare billings.
This program has relied on 8 quality measures
developed by the SVS Quality Performance
Measures Committee (QPMC) that were
approved by the National Quality Forum
and CMS.
This year, M2S successfully applied to become
a Qualified Clinical Data Registry (QCDR) by
CMS. This allows VQI and QPMC to develop
new measures for more flexible PQRS
reporting by VQI members with less stringent
percent reporting criteria. As a result, 15 new
measures are available for PQRS reporting in
2015, across multiple procedures, including
PVI, Varicose Vein and IVC.
For more information see
www.vascularqualityinitiative.org
VQI External Projects
Jack Cronenwett MD, SVS PSO Medical Director
DEVICE POST-APPROVAL SURVEILLANCE
The TEVAR Dissection Surveilance project, begun
last year with FDA, Gore and Medtronic, is well
underway toward capture of 200 acute and 200
chronic Type B dissection procedures with 5-year
follow-up. In fact, 31 sites have already submitted
data for 174 cases in < 1 year, which is well ahead
of schedule, and demonstrates the efficiency of
using an existing data collection mechanism in an
established network of sites. The Lombard Aorfix®
Surveillance project, launched this year with FDA
and Lombard, includes core lab analysis of followup CT images, demonstrating another capability of
the VQI mechanism. Discussions are currently
underway regarding 6 additional projects in the
PVI and CAS areas, with FDA and industry,
underscoring the value of registry data to efficiently
serve multiple stakeholders who are interested in
quality improvement.
VQI Member Characteristics
HOSPITAL AFFILIATION, %
CREST-2 REGISTRY
Through a collaboration with CREST-2 investigators,
VQI members who use the CAS registry can
report their data in order to be certified as a
C-2 participant, and then use VQI CAS Registry to
meet the requirements of C-2 to report data for
non-randomized patients during this trial. This is
another example of the important use of VQI
data for multiple purposes.
INTERNATIONAL CONSORTIUM OF
VASCULAR REGISTRIES
The ICVR was organized this year by VQI and
European/Australasian members of VASCUNET
to allow international collaboration on vascular
quality improvement projects specifically focused
on total life cycle vascular device evaluation
worldwide. With support from the FDA and the
public-private partnership of the Medical Device
Epidemiology Network (MDEpiNet), this group has
held two meetings, solicited participation of 10
national registries, and selected an initial project
concerning devices used to treat para-renal AAA.
37%
32%
31%
Academic
Teaching
Community
BOARD CERTIFICATION, %
1%
5% 2%
11%
47%
17%
17%
Vascular Surgery
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Radiology
Cardiology
General Surgery
Cardiothoracic Surgery
Neurosurgery
Neurology
VA S CUL A R QUA L IT Y I N I T I AT I V E 2 0 1 5 A N N UA L R E P O RT
Regional Quality Group Activity
Carrie Bosela RN, Administrative Director
VQI has 18 regional vascular quality groups that meet semi-annually to review non-identified regional data provided by the PSO. Each region
discusses variation in processes of care, identifies regional opportunities for improvement and then initiates and conducts regional quality projects.
Many of these QI projects are now progressing rapidly, examples of which include:
■ I ncreasing
use of antiplatelet and statin use
pre-operatively and at discharge
■ D
ecreasing
myocardial infarction after major
arterial procedures
■ D
etermining
the role for non-autologous biological
grafts versus synthetic grafts for leg bypass
■ E
nhancing
recovery after lower extremity amputation
■ R
educing
length of stay after CEA, EVAR,
oAAA and LEB procedures
■ I mproving
■ R
educing
long term follow up of patients in VQI
preventable causes of readmissions
■ P
reventing
contrast-induced nephropathy
after peripheral arteriography
■ I ncreasing
smoking cessation after major
arterial procedures (highlighted below).
Regional Smoking Cessation Project
Philip Goodney MD
The VSGNE developed a QI project to improve smoking cessation after a 2013
VSGNE study by Dr. Andrew Hoel et al showed that the one year quit rate after
vascular surgery procedures varied from 28%-62% across centers. With input
from national experts and further analysis and discussion, we recognized the
opportunity for vascular physicians to improve patients’ smoking cessation by
providing (1) brief advice, (2) nicotine replacement and (3) referral to existing
smoking quit lines. This QI project was initiated in VSGNE and then led to an
SVS-funded multicenter randomized trial which has already enrolled 108 patients
across 8 centers. The trial is expected to demonstrate the potential for us to
improve smoking cessation with organized but minimal effort. This is an example
of how regional variation, identified through VQI data, can lead to an important
QI project and even a multi-centered clinical trial.
Quality Committee Reports
The Quality Committees have a representative from each of our 18 regional quality groups and have workgroups that oversee each registry.
Arterial Quality Committee, Adam Beck MD, Chair
Venous Quality Committee, Jose Almeida MD, Chair
REGISTRY REVISIONS. This year, the TEVAR and EVAR Registries were
substantially updated, including the ability to record device details and to
be used for physician-sponsored IDE studies. Currently, both the CAS and PVI
Registries are being updated, which will allow collaboration with the CREST-2
Study and future PVI projects.
VARICOSE VEIN REGISTRY. A workgroup comprised of PSO and American
Venous Forum members developed and released the new VVR in January, which
tracks treatment by radiofrequency, laser, chemical, embolic adhesive and surgical
ablation. Quality of life data are collected pre-treatment and at follow-up. Within
three months of launch, 21 centers entered data for 272 procedures. This registry
allows surgeons who restrict their practice to venous treatment to meet
maintenance of certification requirements of the American Board of Surgery and
will likely facilitate future requirements for vein center accreditation. Currently,
integration with vein-specific EMR vendors is being pursued by M2S to allow
transfer of VVR data from these EMR systems directly to M2S, to eliminate
double data entry.
LONG-TERM FOLLOW-UP. The importance of LTFU for assessing outcomes
in VQI has been reiterated by the AQC with a requirement for at least 80%
one-year follow-up reporting. Unfortunately, LTFU reporting has decreased as
VQI has grown, so a special committee has been tasked to improve this, with
discussions at all regional meetings this spring, leading to recommendations that
will include recognition of centers with best performance, and other incentives
to insure capture of LTFU data.
QUALITY PROJECTS. Work by AQC committees led to important scientific
contributions using national VQI data this year. Dr. Jeff Kalish et al reported that
chlorhexidine skin prep reduced surgical site infection after infrainguinal bypass.
Dr. Randy De Martino et al reported that antiplatelet agent and statin prescribed
at discharge after major arterial procedures improved 5 year survival by 14%.
Dr. Sal Scali et al found that prophylactic beta-blockers initiated before major
arterial operations did not reduce mortality or myocardial infarction rate, and
might be detrimental. This work has led to Current Best Practice announcements
by the AQC to VQI members which should improve patient outcomes.
IVC FILTER REGISTRY. Since its launch two years ago, 56 VQI centers have joined
the IVC registry, and have now contributed over 2500 procedures. This database
can now provide substantial information to drive quality improvement
research. Further, a project to facilitate tracking of patients who need filter
retrieval is now underway.
FUTURE PROJECTS. The VQC plans to develop a patient portal that will
allow QOL data to be collected long term after venous treatment. Quality
improvement projects will be driven by data collected in the VV and IVC
registries, and a potential future registry to track venous stenting is
being considered.
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VA S CUL A R QUA L IT Y I N I T I AT I V E 2 0 1 5 A N N UA L R E P O RT
350+ Participating VQI Centers by State
UAMS Medical Center (AR)
Carondelet Specialists Group (AZ )
Mayo Clinic Arizona (AZ)
The University of Arizona MC—
University Campus (AZ)
Cedars—Sinai MC (CA)
El Camino Hospital (CA)
Hoag Memorial Hospital
Presbyterian (CA)
Loma Linda University MC (CA)
Marin General Hospital (CA)
Palo Alto Medical Foundation (CA)
San Fernando Valley Vascular
Group (CA)
Sharp Chula Vista MC (CA)
Sharp Grossmont Hospital (CA)
Sharp Memorial Hospital (CA)
Stanford Hospital & Clinics (CA)
St. John’s Health Center (CA)
UC Davis Health System (CA)
UCLA—Harbor MC, Los Angeles
County (CA)
UCLA—Ronald Reagan MC (CA)
UCSD Medical Center (CA )
UCSF MC (CA)
USC Univ. Hospital—
Keck Hospital (CA )
Centura—Penrose St Francis
Health Services (CO )
Centura—Porter Adventist
Hospital (CO)
Exempla—Saint Joseph MC (CO)
Presbyterian St. Luke’s MC (CO)
UCHA—Memorial Hospital
Central (CO)
Univ. of Colorado, Denver (CO)
Danbury Hospital (CT)
Hartford Hospital (CT)
Midstate Medical Center (C)
The Hospital of Central
Connecticut (CT)
St. Francis Hospital & MC (CT)
Yale—New Haven Hospital (CT)
MedStar—Washington Hospital
Center (DC)
MFA—Medical Faculty
Assoc. Physician Group (DC)
Beebe Healthcare (DE )
Christiana Care Health System (DE)
Baptist Hospital of Miami (FL)
BayCare—St. Anthony’s
Hospital (FL )
Coastal Vascular & Interventional,
PLLC (FL)
Florida Hospital—Orlando (FL)
Mayo Clinic Florida (FL)
Memorial Regional Hospital (FL)
Miami Vein Center (FL)
Orlando Health—Dr. P. Phillips
Hospital (FL)
Orlando Health—Orlando Regional
MC (FL)
Orlando Health—South Seminole
Hospital (FL)
Palm Beach Gardens MC (FL)
Sarasota Memorial Hospital (FL)
South Miami Hospital (FL)
Tallahassee Memorial Hospital (FL)
Tampa Cardiovascular
Associates (FL)
Tampa General Hospital (FL)
The Vein &Vascular Institute of
Tampa Bay (FL)
UF Health—Shands Hospital (FL)
Albany Vascular Specialist
Center (GA)
Emory Healthcare (GA)
Floyd Med. Ctr. (GA)
Grady Memorial Hospital (GA)
Memorial Health University MC—
SHVI (GA)
Northside Hospital Atlanta (GA)
Northside Hospital Cherokee (GA)
Northside Hospital Forsyth (GA)
Piedmont Hospital Atlanta (GA)
Redmond Regional MC (GA)
Cardiovascular Medicine PC (IA)
Iowa Heart Center at Mercy MC (IA)
UnityPoint Health—Des Moines (IA)
St. Alphonsus Regional MC (ID)
St. Luke’s Healthcare—St. Luke’s Regional MC (ID)
Cardiovascular Medicine PC (IL)
Central DuPage Hospital (IL)
NorthShore University Health—
Skokie Hospital (IL)
Northwestern Memorial Hospital (IL)
OSF—St. Anthony MC (IL)
OSF—St. Francis MC (IL)
OSF—St. Joseph MC (IL)
Rockford Memorial Hospital (IL)
SIU School of Medicine,
Memorial MC (IL)
St. Mary’s Hospital—Decatur (IL)
The Practice of Stephen M. Ryan,
MD (IL)
UnityPoint Health—Methodist (IL)
UnityPoint Health—Proctor (IL)
Univ. of Chicago MC (IL)
Weiss Memorial Hospital (IL)
Community Hospital East (IN)
Community Hospital Heart &
Vascular (IN)
Community Hospital South (IN)
IU Health—Arnett Hospital (IN)
IU Health—Ball Memorial
Hospital (IN)
IU Health—Bloomington
Hospital (IN)
IU Health—Goshen Hospital (IN)
IU Health—Methodist Hospital (IN)
IU Health—Saxony Hospital (IN)
Memorial Hospital of South
Bend (IN)
St. Francis Heart Center (IN)
St. Joseph Regional MC (IN)
St. Vincent Heart Center of Indiana,
LLC (IN)
St. Vincent Hospital & Healthcare
Center (IN)
University of Kansas MC (KA)
Baptist Health Madisonville—
Jack L. Hamman Heart & Vascular
Center (KY)
KentuckyOne Health—Jewish
Hospital (KY)
King’s Daughters MC (KY)
Owensboro Health Regional
Hospital (KY)
LSU Health Science Center —
Shreveport (LA)
Ochsner MC (LA)
Baystate MC (MA)
Berkshire MC (MA)
Beth Israel Deaconess MC (MA)
Boston MC (MA)
Brigham and Women’s
Hospital (MA )
Hoenig Vascular Center (MA)
Massachusetts General
Hospital (MA)
Southcoast­—Charlton Memorial Hospital (MA)
Southcoast—St. Luke’s Hospital (MA)
St. Elizabeth’s MC (MA)
Tufts MC (MA)
University of Massachusetts
Memorial Hospital (MA)
Vascular Care of Metrowest,
P.C. (MA)
VCP—Vascular Care Partners (MA)
Carroll Hospital Center (MD)
Johns Hopkins Bayview MC (MD)
Maryland Vascular Specialist (MD)
Mercy MC—Baltimore (MD)
St. Agnes Healthcare (MD)
The Johns Hopkins Hospital (MD)
University of Maryland MC (MD)
Central Maine MC (ME)
Eastern Maine MC (ME)
Maine MC (ME)
MaineGeneral MC (ME)
Mercy Hospital (ME)
Beaumont Grosse Point
Hospital (MI)
Beaumont Royal Oak Hospital (MI)
Beaumont Troy Hospital (MI)
DMC Harper Univ. Hospital (MI)
Henry Ford Hospital (MI)
Henry Ford Hospital W.
Bloomfield (MI)
McLaren Flint (MI)
Michigan Vascular Center (MI)
Spectrum Health Hospital (MI)
University of Michigan (MI )
Vascular Center of Northern
Michigan (MI)
Allina—Abbott Northwestern
Hospital (MN)
Allina—Mercy Hospital (MN )
Allina—United Hospital (MN )
Allina—Unity Hospital (MN )
Fairview—Southdale Hospital (MN)
Fairview—Univ. of Minnesota
MC (MN)
Mayo Clinic (MN)
Mercy Hospital St. Louis (MO)
SSM DePaul Health Center (MO)
SSM St. Clare Health Center (MO)
SSM St. Joseph Health Center (MO)
SSM St. Mary’s Health Center (MO)
St. Luke’s Hospital (MO)
University of Missouri MC (MO )
The Practice of John F Lucas III,
M.D. (MS)
Univ. of Mississippi MC (MS)
St. Vincent Healthcare (MT)
Alamance Regional MC (NC)
Carolinas Healthcare System—
Sanger Heart & Vasc. Inst. (NC)
Cone Health Heart & Vascular
Center (NC)
Mission Hospital (NC)
Novant Health Forsyth MC (NC)
Novant Health Matthews MC (NC)
Novant Health Presbyterian MC (NC)
University of North Carolina
Hospitals (NC)
Vidant Medical Center (NC)
Wake Forest Baptist Health (NC)
Altru Hospital (ND)
Sanford MC Bismarck (ND)
CHI Health Nebraska Heart (NE)
Catholic Med. Center d/b/a
CTSA (NH)
Concord Hospital (NH)
Dartmouth Hitchcock MC (NH)
Elliot Hospital (NH)
Lakes Region General Hospital (NH)
Atlantic Health System (NJ)
Cooper University MC (NJ)
Kennedy University Hospital (NJ)
Meridian—Bayshore Community Hospital (NJ)
Meridian—Jersey Shore University
MC (NJ)
Meridian—Ocean MC (NJ)
Meridian—Riverview MC (NJ)
Meridian—Southern Ocean MC (NJ)
Overlook MC (NJ)
Heart Hospital of New Mexico at
Lovelace MC (NM)
Presbyterian Hospital (NM)
Carson Tahoe Regional Hospital (NV)
Catholic Health Kenmore Mercy
Hospital (NY)
Catholic Health Mercy Hospital
of Buffalo (NY)
Catholic Health Sister of Charity
Hospital (NY)
Catholic Health Sister of Charity,
St. Joseph Campus (NY)
Kaleida—Buffalo General
Hospital (NY)
Maimonides MC (NY)
Montefiore MC (NY)
Mount Sinai—Beth Israel
Hospital (NY)
Mount Sinai Health System (NY)
Mount Sinai—St.Luke’s Roosevelt Hospital Center (NY)
NSLIJ—Lenox Hill Hospital (NY)
NSLIJ—Long Island Jewish MC (NY)
NSLIJ—North Shore University Hospital (NY)
NSLIJ—Staten Island Hospital-North
Site (NY)
NYP/Weill Cornell Medical
College (NY)
Strong Memorial Hospital University of Rochester MC (NY)
SUNY Downstate—NYU Langone MC (NY)
SUNY Downstate—Stony Brook University MC (NY)
SUNY Upstate—University Hospital
MC (NY)
Westchester MC (NY)
Winthrop Univ. Hospital (NY)
Aultman Hospital (OH)
Cleveland Clinic, Heart and Vascular Insitute (OH)
Mercy MC (OH) (OH)
MetroHealth Medical Center (OH)
Mount Carmel East Hospital (OH)
Mount Carmel St Ann’s Hospital (OH )
Mount Carmel West Hospital (OH)
OhioHealth Doctors Hospital (OH)
OhioHealth Dublin Methodist
Hospital (OH)
OhioHealth Grady Memorial
Hospital (OH )
OhioHealth Grant MC (OH)
OhioHealth Marion General
Hospital (OH)
OhioHealth Riverside Methodist Hospital (OH)
ProMedica Toledo Hosp.,
Jobst Vascular (OH)
Summa Health System (OH)
The Ohio State Univ., Wexner
MC (OH)
University of Toledo MC (OH )
University Hospital Health
System (OH)
Inovia Vein Specialty Center (OR)
Oregon Health & Sciences
University (OR)
Abington Memorial Hospital (PA)
Geisinger Community MC (PA)
Geisinger MC (PA)
Geisinger Wyoming Valley MC (PA)
Guthrie Clinic (PA)
Penn State Milton S. Hershey MC (PA)
St. Luke’s Hospital & Health
Network (PA)
The Reading Hospital and MC (PA )
UPENN—University of
Pennsylvania (PA )
UPMC/ UPP Vascular Surgery (PA)
West Penn Hospital (PA)
West Penn—Allegheny General
Hospital (PA)
West Penn—Allegheny Valley
Hospital—Kiske MC (PA )
West Penn—Forbes Reg.
Hospital (PA )
West Penn—Jefferson Hospital (PA )
Lifespan—Rhode Island Hospital (RI)
Lifespan—The Miriam Hospital (RI)
Beaufort Memorial Hospital (SC)
McLeod Regional MC (SC)
Medical University of South
Carolina Hospital (SC)
Palmetto Health Richland (SC)
Regional MC of Orangeburg & Calhoun County (SC)
Roper St. Francis Hospital (SC)
Self Regional Healthcare (SC)
Spartanburg Reg. Health
Services District, Inc. (SC)
Trident MC (SC)
Rapid City Regional (SD)
Sanford Clinic Vascular
Associates (SD)
Baptist Memorial Hospital—
Memphis (TN)
Jackson Madison County General Hospital (TN )
Nashville Vascular & Vein
Institute (TN)
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Premier Surgical Associates,
PLLC (TN)
University of Tennessee MC (TN)
Baylor—Jack and Jane Hamilton
Heart and Vascular Hospital (TX)
Baylor—The Heart Hospital
Denton (TX)
Baylor—The Heart Hospital
Plano (TX)
CTVS—CardioThoracic Vascular
Surgeons (TX)
Hill Country Memorial Hospital (TX)
John Sealy Hospital, UTMB (TX)
Memorial Hermann Heart &
Vascular Institute—Texas MC (TX)
Memorial Hermann Southwest
Hospital (TX)
Peripheral Vascular Associates (TX)
Scott & White Memorial
Hospital (TX)
Texas Health Presbyterian Hospital Dallas (TX)
University of Texas Health Science Center, San Antonio (TX)
St. Mark’s Hospital (UT)
University of Utah Hospital and
Clinics (UT)
Augusta Health (VA)
Carilion Roanoke Memorial
Hospital (VA)
Charlotteville Radiology LTD/CRL Surgical (VA)
CJW Medical—Chippenham
Hospital (VA)
CJW Medical—Johnston-Willis Hospital (VA)
Inova Alexandria Hospital (VA)
Inova Fair Oaks Hospital (VA)
Inova Fairfax Hospital (VA)
Inova Gainesville Hospital (VA)
Inova Loudoun Hospital (VA)
Inova Mount Vernon Hospital (VA)
Mary Washington Hospital (VA )
Sentara Careplex Hospital (VA )
Sentara Leigh Hospital (VA)
Sentara Norfolk General
Hospital (VA)
Sentara Northern Virginia Medical
Center (VA)
Sentara Obici Hospital (VA)
Sentara Princess Anne Hospital (VA)
Sentara RMH MC (VA)
Sentara Williamsburg Regional
MC (VA)
University of Vermont MC (VT)
Harborview MC (WA)
Northwest Hospital & MC (WA)
Providence Health System
(WA – 19 sites, multi-state)
Univeristy of Washington MC (WA)
Aurora Baycare MC (WI)
Aurora Lakeland MC (WI)
Aurora MC in Kenosha (WI)
Aurora MC in Manitowoc
County (WI)
Aurora MC in Oshkosh (WI)
Aurora MC in Summit (WI)
Aurora MC in Washington
County (WI)
Aurora MC of Grafton (WI)
Aurora Memorial Hospital of
Burlington (WI)
Aurora Sheboygan Memorial
MC (WI)
Aurora Sinai MC (WI)
Aurora St. Luke’s MC (WI)
Aurora St. Luke’s South Shore (WI)
Aurora West Allis MC (WI)
Froedtert Memorial Lutheran
Hospital (WI)
ProHealth (Waukesha Memorial Hospital (WI)
Camden Clark MC (WV)
Charleston Area MC (WV)
St. Mary’s MC (WV)
St. Michael’s Hospital (CAN)
Toronto General Hospital (CAN)