PubMed · 16052129
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Michael M Todd. 2005. A lesson learned.. https://doi.org/10.1097/00000542-200508000-00029
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We examined changes in practice patterns after the establishment of a varicose vein center (VVC) within two tertiary university vascular surgery practices and compared differences between urban (U) and rural (R) sites. Practice patterns for the treatment of VVs were compared 3 years before (period 1) and 3 years after (period 2) the formation of a U-VVC and an R-VVC in 2001. Both VVCs were part of similar-sized tertiary vascular surgery practices. Evaluation was specific to VVs, reticular veins, and telangiectasias. Prior to U-VVC, there were 338 office visits, six office procedures, and 114 hospital procedures. After U-VVC, there were 624, 120, and 312, respectively. Prior to R-VVC, there were 85 office visits, five office procedures, and 69 hospital procedures. After R-VVC, there were 528, 163, and 303, respectively. In period 1 for U-VVC and R-VVC, VVC relative value unit (RVU) generation as a percent of total practice RVUs was 1.0% and 0.7%, respectively. In period 2 for U-VVC and R-VVC, VVC RVU generation as a percent of total practice RVUs was 2.6% and 2.5%, respectively. In an effort to provide more coordinated treatment for patients with VVs, establishing a VVC within a tertiary academic vascular surgery practice can lead to rapid expansion of clinical volume by increased office visits, office procedures, and hospital procedures. Clinical demand for evaluation and treatment of VVs showed little variation between R-VVC and U-VVC.
OBJECTIVES: Due to the progress vascular medicine has made in conventional vascular surgery, endovascular procedures, and conservative therapy close, interdisciplinary cooperation is required. In order to assure the contextual and structural quality of vascular centers, the German Society for Vascular Surgery established a list of criteria for certification of each interdisciplinary vascular center. MATERIAL AND METHODS: Between July 2002 and December 2005, 77 centers have submitted a written application and have been audited by the commission for quality assurance of the German Society for Vascular Surgery, 59 vascular centers were certified for a period of 3 years with one center in each in Austria and in Switzerland, 13 centers were not certified (16.8%), and the applications of 5 centers are still pending. This analysis is based on 57 German certified vascular centers. RESULTS: Each center treats a median of 1149 inpatients (11% of these are emergency admissions) and 2,159 outpatients per year. Sixty percent of the patients treated have an arterial disease. All centers have vascular surgery and radiology departments. In 11 out of 57 centers, angiology services are offered in cooperation with affiliated physicians. Each vascular center has an average of 4.2 vascular surgeons, 3 radiologists and 1 angiologist. All centers offer radiological and ultrasound diagnostics (CT angiography in 100%, MRT in 95%, duplex sonography in 100%). Each clinic executes a median of 521 (233-1436) arterial operations and 263 (37-1055) arterial interventions. In addition, they execute varicose surgeries (n=217), shunt applications/revisions (n=58), minor amputations (n=57) and major amputations (n=42). They conduct 338 (92-3606) conservative therapies per year (POAD, diabetic foot, phlebothrombosis, chronic venous insufficiency). CONCLUSIONS: The certification of interdisciplinary vascular centers is a new approach to assure the contextual and structural quality of interdisciplinary vascular centers.
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