July 14, 2004

Developing A Vascular Center That Works: The Importance Of Measuring The Right Outcomes

John W Hallett, Jr., Larry D Flanagan, Terry K Fournier
Eastern Maine Medical Center, Bangor, ME

Background: Recently, interest in creating hospital-based vascular centers has increased. However, how to measure success and how to predict future needs remains challenging.

Methods: In planning for a new multispecialty vascular center in a 480-bed nonprofit hospital serving a referral population of 500,000, three outcomes programs were incorporated: (1) service volumes tracked by outpatient visits, vascular lab exams, and outpatient/inpatient surgical and endovascular procedures, (2) patient satisfaction levels assessed by an independent national consultant, and (3) surgical outcomes monitored prospectively by the Northern New England Vascular Study Group. These outcomes were compared to volumes prior to opening the center, to patient satisfaction of the entire medical center, and to surgical outcomes of other regional hospitals. Payor mix was also monitored.

Results: In the first year of operation, outpatient evaluation/management visits increased 14% from 238 to 281 per month. Vascular lab volumes increased 189% (from 388 to 732 exams per month). Outpatient (353 per year) and inpatient (671 per year) procedures increased 27% and 19%, respectively, without increasing the number of surgeons. Patient satisfaction averaged 93.95% compared to an overal medical center rate of 91.48% (90th percentile). Surgical outcomes were comparable to or better than other regional centers. Payor mix was unchanged at 61% Medicare, 12% Medicaid, 23% commercial/Blue Cross, and 4% self pay/other.

Conclusions: Developing an integrated vascular center in a single hospital location increased both outpatient and inpatient evaluation/procedure volumes, created high patient satisfaction levels, and resulted in excellent surgical outcomes. These outcomes suggest that a new vascular center must plan for rapid growth within two years.