Download Variation and intensity of medical therapy in patients undergoing

Society for Vascular Surgery/Vascular Quality Initiative Research Application
Research Project Title:
Variation and intensity of medical therapy in patients undergoing vascular surgery
procedures
Principal Investigator:
Randall R. DeMartino, M.D., M.S.
Co-Investigators:
Philip P. Goodney, MD, MS
Jack L. Cronenwett, MD
Yuanyuan Zhao, MS
Specific Aims:
Peripheral arterial disease (PAD) affects millions worldwide, approaching 20% of those over 70 years of
1
age. Additionally, abdominal aortic aneurysms (AAA) are present in nearly 7% of older men.2 Both PAD and
AAA patients have a high prevalence of concomitant cardiovascular disease and approximately 75% of patients
with PAD will ultimately die of cardiovascular causes.1, 3 Despite the benefits and recommendations for use of
antiplatelet, statin, and beta blocker medications for patients with PAD and coronary artery disease (CAD),1, 4-6
these patients remains undertreated. Up to half of patients with PAD are not on antiplatelet or statin
medication.7, 8 Given that vascular surgery practice centers around treatment for symptomatic PAD and
aneurysmal disease, vascular surgeons are situated to ensure proper medical care is provided to these patients.
This proposal will seek to understand the variation of appropriate medical care among patients undergoing
vascular procedures, seek to understand the determinants to medical care, and to identify the effect of
medication on peri-operative and long term outcomes for patients with PAD and AAA.
Specific Aim 1. To describe of the variation of medication utilization among providers of vascular care
-Using the Vascular Quality Initiative (VQI) dataset, I will analyze the utilization of medications including
aspirin, statins and beta blockers among patients undergoing vascular surgical procedures within centers in the
VQI. The intensity of vascular care will be measured in two ways. 1) The proportion of patients on aspirin and
statins and beta blockers on the procedural level. 2) The proportion of patients in aspirin, statin and beta blocker
on the center and regional level.
Hypothesis: There is wide variation within the number of patients on appropriate cardiovascular medications
surrounding and following their vascular procedures
Specific Aim 2. To explore the determinates of medication treatment intensity during vascular surgical
procedures
-Using the VQI dataset, I will determine the characteristics of patients receiving appropriate medical
management. Covariates that will be explored will include age, gender, race, and comorbidities. Additionally,
systems-level covariates, including provider, hospital, and region, will be included to understand the influence
of system factors on medical treatment.
Hypothesis: In addition to specific patient characteristics, systems-based factors such as provider and center
will have an impact on medication utilization
Specific Aim 3. To demonstrate the association of medication utilization and intensity with both short
and long term outcomes following vascular surgical procedures.
-Using the VQI dataset with long term follow up data and mortality status from the SSDI, I will demonstrate the
association of medication utilization with both post-operative outcomes as well as long term survival.
Hypothesis: Increased systems-based utilization of cardiovascular medications will correlate with improved
post-operative outcomes as well as long term survival.
Significance:
Peripheral arterial disease (PAD) includes atherosclerotic occlusive disease of the cerebral, visceral, and
lower extremity arterial vascular beds. PAD affects millions worldwide, approaching 20% of those over 70
years of age.1 In addition, abdominal aortic aneurysms (AAA) remain a prevalent disease present in nearly 7%
of older men undergoing population based screening.2 Both PAD and AAA patients have a high rate of
associated cardiovascular disease. In fact, only 8% of patients undergoing major vascular surgical procedures
may have normal coronary.9 This is translated into a high incidence of clinical coronary and cerebrovascular
disease burdens among those with PAD and AAA.1, 10 A recent epidemiological study has also shown that
patients with AAA have a two-fold higher risk of heart attack and 1.8-fold higher risk of stroke compared with
population based controls.11 Lastly, cardiovascular comorbidities remain a long term complication, where
approximately 75% of those with PAD will ultimately die from cardiovascular causes.1, 3
The most commonly recognized medical treatment for patients with PAD and coronary artery disease
(CAD) is acetylsalicylic acid (aspirin). Numerous studies have consistently demonstrated the benefit of aspirin
in high risk cohorts. In a meta-analysis of 195 randomized studies of antiplatelet therapy versus placebo, there is
a 25% reduction in cardiovascular events, including stroke, among those with PAD on aspirin therapy. This has
lead multiple organizations to recommend aspirin therapy to patients with symptomatic PAD.1, 3, 5, 12 In addition,
the CAPRIE trial demonstrated that clopidogrel is as effective as aspirin in patients with PAD in reducing
cardiovascular events.13 Due to its effect on patient with cerebrovascular disease,13, 14 antiplatelet therapy is also
recommended for all patients with extracranial cerebrovascular disease. This has lead to a National Quality
Forum measure for antiplatelet use surrounding carotid revascularization.15 Although no specific
recommendations for aspirin therapy in patients with AAA exist at present, epidemiologic data demonstrate
patients with AAA are at elevated risk for cardiovascular events and carry high rates of cardiac comorbidities.11
Aspirin is widely accepted as basic medical therapy for those with CAD.6
In addition to aspirin therapy, the use of HGM-CoA reductase inhibitors (statins) is standard practice for
patients with PAD16, 17 and those undergoing major vascular surgery.18 The POISE III trial demonstrated a 9%
absolute risk reduction and 55% relative risk reduction in myocardial ischemic events with a similar effect on
all cardiovascular death after AAA repair, carotid endarterectomy, and arterial reconstruction for occlusive
disease.18 For this reason, statin usage is recommended for symptomatic PAD patients and those with coronary
disease by multiple guidelines.1, 3, 4, 6 Despite these benefits, some evidence has suggested statin use is
associated with insulin resistance and risk of diabetes. However, the benefit of statins on cardiac events far
outweighs the risks of diabetes.19
Beta-blocker therapy has been shown to be effective in reducing cardiac related morbidity among patient
undergoing non-cardiac and vascular surgery.20, 21 However, this has been meet with conflicting results, making
the net benefit of beta-blocker therapy a topic of debate.22, 23 Despite this, beta-blocker therapy remains a
prominent measure of care quality and it is recommended for patients at intermediate to high cardiac risk, or
known stress induced ischemia in the peri-operative period.24, 25 Although work within the Vascular Study
Group of New England has shown that overall increases in beta blocker usage did not decrease cardiac
morbidity, we have also increased out ability to better risk stratify patients at high cardiac risk.26, 27 Thus, the
opportunity exists to understand and describe the variation in beta blocker usage and its relation to high risk
vascular surgery patients and their outcomes.
Many patients with PAD remain undertreated. Of all PAD patients, 40-60% of patients are not on
antiplatelet agents and 40-70% are not on statins.7, 8 This is correlated with increased risk of mortality, even in
those with no known associated CAD.7 This has prompted the Department of Health and Humans Services to
initiate the Million Hearts Campaign to promote proper medical management to prevent strokes and death from
cardiovascular causes.28
Date from the VSGNE has shown similar trends of
medication use. We have recently studied the use of antiplatelet
medication and statin use among patients undergoing carotid
interventions (CAS and CEA), infra and suprainguinal bypass, and
aneurysm repair (open and EVAR). Within New England, many
patients on not on antiplatelet (AP) and statin medication in the perioperative period who should be treated (Figure 1, unpublished data).
From 2005 to 2012, we have improved the number of patients on
both AP and statin medications at pre-op and discharge (54% in
2005 to 67% in 2012, p<0.001). However our overall rate of AP and
statin use pre-op and discharge has not improved over the past few
years, averaging 65-70% of eligible patients.
Despite this modest improvement, the ability to place patients
on AP and statin medications before their operation and at discharge
varies significantly by center and by procedure (Figure 2,
unpublished data). This demonstrates that there are likely center
effects that relate to the ability to ensure that patients are placed on
appropriate therapy. This may be due to surgeon preference or
processes of care within each center.
Finally, our analysis has shown that optimal AP and
statin therapy has a significant effect on per-operative and longterm mortality. Pre-operative AP and statin use was associated
with lower 30-day mortality (0.97 vs 1.58%, RR 0.61, p<0.01).
This remained significant after adjustment for patient factors
(OR 0.66, 95% CI 0.5-0.9, p=0.01). Additionally, optimal
medical therapy with AP and statin was also associated with
improved 5-year survival, with the effect additive for both AP
and statin use (Figure 3, unpublished data). This effect remained
significant after adjustment for patient characteristics.
Figure 1. Proportion of patients on Antiplatelet, Statin
or Beta-blocker within the VSGNE by Procedure
Pre-operative
Discharge
Intolerant and missing excluded
Innovation:
As discussed, despite their benefits, many patients remain on suboptimal medical regimens. This results
from complex interactions between providers, patients and the systems of care that they interact within.
Understanding these dynamic forces can help to improve the quality of care delivered, as well as improve
outcomes. In this effort, the Society for Vascular Surgery Patient Safety Organization (SVS-PSO) and the
Vascular Quality Initiative (VQI) were established.29 Based on regional quality efforts in New England, the
VQI has established itself as a national, multi-institutional collaborative to improve the care of patients with
vascular disease.
The VQI is uniquely detailed to study the association of medical management surrounding vascular
operations in ways not possible by other means. First, the VQI records aspirin use. Apart from chart review,
tracking aspirin use is difficult, given its over-the-counter availability. Administrative databases, Medicare Part
D, or other databases are unable to correctly track its use. This makes the VQI valuable to understanding its use
surrounding vascular surgical procedures across centers. Second, the VQI tracks the use of aspirin, statin, and
beta-blocker usage pre-operatively, at discharge, and at one year follow up. This permits the ability to study
how effective medications are utilized during the peri-operative period and if they are maintained long term.
Finally, by linking with the Social Security Death Index (SSDI), we can establish vital status of post-operative
patients. Since the vast majority of PAD patients will die of cardiovascular causes, this is an ideal outcome for
assessment since these medications are known to prevent cardiovascular events.
This analysis establishes a novel approach to analyzing medication utilization. While our group has
confirmed that many patients remain undertreated, understanding the overall effect on suboptimal medical care
following vascular operations remains unknown. In addition, little is know about the contributing factors, such
as regional variation and other determinants of optimal medical care. Once the drivers for suboptimal care are
identified, quality improvement initiatives can be focused to improve these measures and improve the medical
care provided. Work within the Vascular Study Group of New England has shown that use of these data can be
used to augment physician practice for process improvement, making this analysis a step towards providing
better medical care.26
Research Strategy
Methods
Overall approach: To conduct our analysis, we will utilize the Vascular Quality Initiative (VQI) national
dataset from inception to present. We will analyze all elective procedures, including patients undergoing carotid
endarterectomy, carotid artery stenting, infra-inguinal bypass, supra-inguinal bypass, peripheral vascular
interventions, and open and endovascular aneurysm repair (infrarenal and thoracic). Only patients with CAD or
PAD history who underwent aneurysm repair will be included, as aortic aneurysmal disease alone carries no
endorsed medication recommendations. Patients will be censored after their first operation into the VQI dataset.
Thus, patients cannot be analyzed twice if they undergo a second operation in the dataset. This will help
understand the processes of care present within each center and region for all patients at their initial
presentation. Patients undergoing multiple procedures may have medication changes not reflective of the
standard practice, potentially due to complications or procedural failures. This may bias the findings in ways not
easily accounted for within the dataset. Fortunately, our group has extensive experience with the VQI dataset
from the Vascular Study Group of New England.26, 30-33
Aim 1. To describe of the variation of medication utilization among providers of vascular care.
First, to understand the variation present in medication utilization, I will characterize the centers present within
the VQI. As noted above, I will create my study population, a cohort based on patients undergoing their first
procedure within the VQI. The unit of analysis will be the patient, aggregated at the center and regional level.
The main outcome measure will be the intensity of medical treatment surrounding the patient’s procedure.
Intensity will be characterized in three ways. 1) The number of patients on antiplatelet medications (defined as
aspirin or clopidogrel), statin, or beta blockers before their surgery, at discharge, and at the most recent long
term follow up. 2) Higher intensity care will be defined as at least antiplatelet and statin usage at pre-operatively
and discharge for those undergoing operations for PAD, carotid revascularization or aneurysm repair with
cardiovascular risk factors (defined as those with any coronary disease, prior coronary revascularization, prior
bypass or stenting or prior carotid endarterectomy). 3) Beta blocker usage will be assessed as proportion of high
cardiac risk patients27 on chronic or pre-operative beta-blocker therapy undergoing major vascular surgery
procedures (open AAA, lower extremity bypass). Data will be aggregated at the center level into tertiles on
intensity of care. This will be utilized for further analysis on outcomes to ensure the anonymity of any one
center.
Potential Problems with Aim 1: One potential problem will be centers with low case volumes. Centers with only
a few cases will increase the potential for measurement error in understanding their practice patterns for medical
management. I will limit my center analyses to only those centers with >100 cases to limit this problem.
Another potential problem will involve medication intolerance. In my analysis, I will exclude patients that are
intolerant of both medications. For composite endpoints (such as being on AP and statin), patients will be
credited for optimal therapy if they are one medication, but intolerant of the other medication. This will ensure
centers and providers are credited for proper “intention to treat” with respect to optimal medical management. I
will also run my analysis with all patients who have medication intolerance removed to see how this affects our
findings.
Aim 2. To explore the determinates of medication treatment intensity during vascular surgical
procedures
To understand the determinates in the intensity medical management surrounding vascular surgical procedures,
I will use available data within the VQI dataset to associate specific variables with medical treatment. For this,
the unit of analysis will be the patient and the outcome of interest (dependent variable) will be pre-operative and
discharge antiplatelet and statin medication usage following carotid interventions, procedures for PAD and
aneurysm repair. Beta blocker usage will be assessed on pre-operative and discharge for high risk procedures as
noted above. The exposure (independent variables) will include medical co-morbidities, race, gender, age,
surgeon, center and region. The later two will remain anonymous. I will look to understand and identify
potential interactions among surgeon and center, as these may be related by system factors. I will use
multivariable logistic regression analyses to explore the relationships between my exposures and the intensity of
medical treatment.
Potential Problems with Aim 2: There may be missing data for patients within the VQI. Since at this time, we
do not understand if these data are missing at random, all logistical analyses will be based on patients with no
missing data for significant variables. Additionally, to ensure that medication use is recorded correctly, we will
perform site specific random audits to verify the VQI medication data.
Aim 3. To demonstrate the association of medication utilization and intensity with both short and long
term outcomes following vascular surgical procedures.
Once terciles of medication intensity are created, they can then be applied to understand what effect both
center level contextual variables and patient level medication use have on outcomes. Three outcomes will be
identified. 1) First, strata of medication intensity use will be evaluated on thirty-day mortality following each
operation. Thirty day or in hospital death will be defined as a combination of a discharge status of death within
the VQI and by death <30 days following a patient’s operation by SSDI (the outcome). I will explore patient
demographics, center, and medication use (exposures) on 30-day mortality while adjustments are done for
patient covariates using logistic regression techniques. This will include hierarchical modeling techniques
(center level terciles medication intensity) to understand what effect center intensity of care has on outcomes. 2)
Similar techniques will be employed to understand the effect of optimal medication usage on cardiovascular
morbidity, defined as post-operative death, myocardial infarction, dysrhythmia, or congestive heart failure. 3)
Finally, the effect of medication utilization on long term mortality (outcome) will be analyzed. Using life table
methods with Cox proportional hazards techniques, the association of patient demographics, optimal medication
utilization, and center intensity of care (exposures) will be described.
Potential Problems with Aim 3: As in Aim 2, there may be missing data for patients within the VQI. For logistic
and survival analyses, I will limit the multivariate models to patients without missing data on significant
variables.
Timeline:
Data Management
Data Analysis
Presentation of Findings
Publication of Findings
1-3 months
X
X
3-6 months
6-12 months
X
X
Budget:
Analyst Support: $2,000
Presentation and Dissemination of findings at Regional/National Academic Vascular Meeting: $1,000
Funds for the above budget will be provided by grant support for Philip Goodney, MD, via support from exiting
grant funding mechanisms.
References:
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Smith SC, Jr., Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, et al. AHA/ACCF
Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic
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Pande RL, Perlstein TS, Beckman JA, Creager MA. Secondary prevention and mortality in peripheral
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Subherwal S, Patel MR, Kober L, Peterson ED, Jones WS, Gislason GH, et al. Missed opportunities:
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Hertzer NR, Beven EG, Young JR, O'Hara PJ, Ruschhaupt WF, 3rd, Graor RA, et al. Coronary artery
disease in peripheral vascular patients. A classification of 1000 coronary angiograms and results of surgical
management. Ann Surg. 1984;199(2):223-33.
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Hirsch AT, Criqui MH, Treat-Jacobson D, Regensteiner JG, Creager MA, Olin JW, et al. Peripheral
arterial disease detection, awareness, and treatment in primary care. Jama. 2001;286(11):1317-24.
11.
Eldrup N, Budtz-Lilly J, Laustsen J, Bibby BM, Paaske WP. Long-term incidence of myocardial infarct,
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Sobel M, Verhaeghe R. Antithrombotic therapy for peripheral artery occlusive disease: American
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Suppl):815S-43S.
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A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events
(CAPRIE). CAPRIE Steering Committee. Lancet. 1996;348(9038):1329-39.
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Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death,
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15.
NQF Measure 0465-Perioperative Anti-platelet Therapy for Patients undergoing Carotid
Endarterectomy. [November 26, 2012]; Available from: http://www.qualityforum.org.
16.
Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, Bhala N, et al. Efficacy and safety of more
intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised
trials. Lancet. 2010;376(9753):1670-81.
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Schouten O, Boersma E, Hoeks SE, Benner R, van Urk H, van Sambeek MR, et al. Fluvastatin and
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19.
Sattar N, Preiss D, Murray HM, Welsh P, Buckley BM, de Craen AJ, et al. Statins and risk of incident
diabetes: a collaborative meta-analysis of randomised statin trials. Lancet. 2010;375(9716):735-42.
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Poldermans D, Boersma E, Bax JJ, Thomson IR, van de Ven LL, Blankensteijn JD, et al. The effect of
bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular
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Engl J Med. 1999;341(24):1789-94.
21.
Lindenauer PK, Pekow P, Wang K, Mamidi DK, Gutierrez B, Benjamin EM. Perioperative beta-blocker
therapy and mortality after major noncardiac surgery. N Engl J Med. 2005;353(4):349-61.
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Brady AR, Gibbs JS, Greenhalgh RM, Powell JT, Sydes MR. Perioperative beta-blockade (POBBLE)
for patients undergoing infrarenal vascular surgery: results of a randomized double-blind controlled trial. J Vasc
Surg. 2005;41(4):602-9.
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Devereaux PJ, Yang H, Yusuf S, Guyatt G, Leslie K, Villar JC, et al. Effects of extended-release
metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial.
Lancet. 2008;371(9627):1839-47.
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Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof E, Fleischmann KE, et al. ACC/AHA 2007
guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American
College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to
Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery): developed in
collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart
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perioperative cardiac care: a summary of implications for elective vascular surgery patients. Eur J Vasc
Endovasc Surg. 2010;39(1):1-4.
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quality improvement effort to increase beta blocker administration before vascular surgery. J Vasc Surg.
2011;53(5):1316-28 e1; discussion 27-8.
27.
Bertges DJ, Goodney PP, Zhao Y, Schanzer A, Nolan BW, Likosky DS, et al. The Vascular Study
Group of New England Cardiac Risk Index (VSG-CRI) predicts cardiac complications more accurately than the
Revised Cardiac Risk Index in vascular surgery patients. J Vasc Surg. 2010;52(3):674-83, 83 e1-83 e3.
28.
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29.
Cronenwett JL, Kraiss LW, Cambria RP. The Society for Vascular Surgery Vascular Quality Initiative. J
Vasc Surg. 2012;55(5):1529-37.
30.
De Martino RR, Nolan BW, Goodney PP, Chang CK, Schanzer A, Cambria R, et al. Outcomes of
symptomatic abdominal aortic aneurysm repair. J Vasc Surg. 2010;52(1):5-12 e1.
31.
Nolan BW, De Martino RR, Goodney PP, Schanzer A, Stone DH, Butzel D, et al. Comparison of carotid
endarterectomy and stenting in real world practice using a regional quality improvement registry. J Vasc Surg.
2012;56(4):990-6.
32.
Goodney PP, Likosky DS, Cronenwett JL. Factors associated with stroke or death after carotid
endarterectomy in Northern New England. J Vasc Surg. 2008;48(5):1139-45.
33.
Beck AW, Goodney PP, Nolan BW, Likosky DS, Eldrup-Jorgensen J, Cronenwett JL. Predicting 1-year
mortality after elective abdominal aortic aneurysm repair. J Vasc Surg. 2009;49(4):838-43; discussion 43-4.
BIOGRAPHICAL SKETCH
Provide the following information for the key personnel and other significant contributors in the order listed on Form Page 2.
Follow this format for each person. DO NOT EXCEED FOUR PAGES.
NAME
POSITION TITLE
Randall De Martino
Chief Resident
Section of Vascular Surgery
Dartmouth-Hitchcock Medical Center
eRA COMMONS USER NAME (credential, e.g., agency login)
EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training.)
DEGREE
(if applicable)
YEAR(s)
University of Richmond
Virginia Commonwealth Univ. School of Med.
BS
MD
2003
2007
Dartmouth College
MS
2011
-
2007-P
INSTITUTION AND LOCATION
Dartmouth-Hitchcock Medical Center
FIELD OF STUDY
Biology
Medicine
Clinical & Health
Services Research
Vascular Surgery
A: Personal Statement
I am a vascular surgery resident at Dartmouth-Hitchcock Medical Center. I am also a health services researcher
interested in comparative effectiveness and quality of care. In addition to my surgical training, I completed a
Master's degree in Clinical and Health Services Research at The Dartmouth Institute. My prior work with the
Vascular Study Group of New England has focused on improving patient selection and has enabled me to
become facile with the Vascular Quality Initiative dataset. The aim of this proposal is to understand the variation
and effect of medication utilization across centers within the Vascular Quality Initiative. In addition, this proposal
is well aligned with my long-term research goal, which is to better characterize the effect of quality vascular care
and understand the barriers to providing such care in an effort to improve outcomes.
B. Positions
Vascular Surgery Resident
Dartmouth-Hitchcock Medical Center
(Mark F. Fillinger, M.D.)
2007 - 2013
Masters Degree Clinical and Health Services Research
The Dartmouth Institute, Dartmouth College
(Philip P Goodney, MD, MS)
2010 - 2011
Honors:
Joint Surgical Advocacy Conference Scholarship, Society for Vascular Surgery
Chairman’s Scholarship, Dartmouth-Hitchcock Medical Center
Gold Foundation Humanism and Excellence in Teaching Award
Society for Vascular Surgery Annual Meeting Scholarship Society for Vascular Surgery
Dean’s Merit Scholarship Award, VCU School of Medicine
Willie M. Reams Award in Biology, University of Richmond
University of Richmond Summer Research Fellowship, University of Richmond
Merck/AAAS Fellowship for Biochemical Research, University of Richmond
2011
2010
2010
2007
2003-2007
2003
2001-2003
2001-2002
B: Peer-Reviewed Publications
1. Gillespie SR, De Martino RR, Zhu J, Chong HJ, Ramirez C, Shelburne CP, Bouton LA, Bailey DP, Gharse A,
Mirmonsef P, Odom S, Gomez G, Rivera J, Fischer-Stenger K, and Ryan JJ. IL-10 Inhibits Fc epsilon RI
Expression in Mouse Mast Cells. J. Immunol. Mar 2004; 172: 3181 - 3188. PMID 14978125.
2. De Martino RR, Stone DH. Repair of Multiple Right Renal Artery Aneurysms with Associated
Fibromuscular Dysplasia in a Solitary Kidney. J Vasc Surg. 2009; 49:497. PMID 19216969.
3. De Martino RR, Stone DH, Beck AW, Walsh DW. Thoracic Outlet Syndrome Associated With a Large
Cervical Rib. Vasc Endovascular Surg. 2009;43:393-4. PMID 19556226.
4. De Martino RR, Nolan BW, Powell RP, Walsh DW, Stone DH. Stent Graft Repair of Iatrogenic Femoral
Arteriovenous Fistula; A Useful Therapeutic Approach in a Hostile Groin. Vasc Endovascular Surg.
2010;44:40-3. PMID 19917562.
5. Beck AW, Nolan BW, De Martino RR, Tanski W, Stone DH, Walsh DB, Powell RP. Predicting Blood
Pressure Response after Renal Artery Stenting. J Vasc Surg. 2010;51:380-5. PMID 19939607.
6. Scali ST, Beck AW, De Martino RR, Duxbury A, Walsh DB. Endovascular Management of Congenital
Atresia of the Infrarenal IVC. Vasc Endovascular Surg. 2010;44:234-6. PMID 20308176.
7. De Martino RR, Nolan BW, Goodney PP, Chang CK, Schanzer A, Cambria R, Bertges DJ, Cronenwett LJ.
Outcomes of Symptomatic Abdominal Aortic Aneurysm Repair. J Vasc Surg. 2010;52:5-12. PMID 20471771.
8. Goodney PP, Schanzer A, De Martino RR, Nolan BW, Hevelone ND, Conte MS, Powell RJ, Cronenwett JL.
Validation of the Society for Vascular Surgery’s Objective Performance Goals (OPGs) for Critical Limb
Ischemia in Everyday Vascular Surgery Practice. J Vasc Surg. 2011;54:100-8. PMID 21334173.
9. Brewster LP, Glass C, De Martino RR, Hall H, Kauvar DS, Kokkosis AA, Kreishman P, Boros M, Kalata E,
Farber A. The Formal Response of Vascular Surgery Trainees to ACGME Recommendations. 2010.
Published in Vascularweb.org. Accessed October 2010.
10. Nolan BW, De Martino RR, Beck AW, Schanzer A, Goodney PP, Walsh DW, Cronenwett JL. Prior Failed
Ipsilateral Percutaneous Vascular Intervention (PVI) in Patients with Critical Limb Ischemia Predicts Poor
Outcome after Lower Extremity Bypass. J Vasc Surg. 2011;54(3):730-5. PMID 21802888.
11. Scali ST, Beck AW, Nolan BW, De Martino RR, Rzucidlo E, Walsh DB. Completion Duplex Ultrasound
Predicts Graft Performance after Crural Bypass. J Vasc Surg. 2011;54:1006-10. PMID 21820833.
12. Ashe KM, Chiu W, Khalifa AM, Nicolas AN, Brown BL, De Martino RR, Alexander CP, Waggener CT, FischerStenger K, Stewart JK. Vesicular Monoamine Transporter-1 (VMAT-1) mRNA and Immunoreactive Proteins
in Mouse Brain. Neuro Endocrinol Lett. 2011;32(3):253-8. PMID 21712771.
13. De Martino RR, Brewster LP, Kokkosis AA, Class C, Boros M, Kreishman P, Kauver DS, Farber A. The
Perspective of the Vascular Surgery Trainee on New ACGME Regulations, Fatigue, Resident Training and
Patient Safety. Vasc Endovascular Surg. 2011;45(8):697-702. PMID 22262113.
14. De Martino RR, Wallaert JB, Rossi A, Zbehlik A, Suckow B, Walsh DW. A Meta-Analysis of Anticoagulation
for Calf Deep Venous Thrombosis. J Vasc Surg. 2012;56(1):228-37. PMID 22209612.
15. De Martino RR, Goodney PP, Spangler EL, Wallaert JB, Corriere M, Rzucidlo EM, Walsh DB, Stone DH.
Variation in Thromboembolic Complications Among Patients Undergoing Commonly Performed Cancer
Operations. J Vasc Surg. 2012;55(4):1035-41. PMID 22409858.
16. Wallaert JB, De Martino RR, Finlayson SR, Walsh DB, Corriere M, Edwards M, Stone DH, Goodney PP.
Carotid Endarterectomy in Asymptomatic Patients with Limited Life Expectancy. Stroke. 2012;43:17811787. PMID 22550053.
17. Brooke BS, De Martino RR, Girotti M, Dimick JB, Goodney PP. Developing Strategies for Predicting and
Preventing Readmissions in Vascular Surgery. J Vasc Surg. 2012;56(2):556-62. PMID 22743022.
18. Nolan BW, De Martino RR, Goodney PP, Butzel D, Schanzer A, Stone DH, Kwolek CJ, Powell RJ, Cronenwett
JL. Comparison of Carotid Endarterectomy and Stenting in Real World Practice Using A Regional Quality
Improvement Registry. J Vasc Surg. 2012;56(4):990-6. PMID 22579135.
19. De Martino RR, Edwards MS, Corriere M, Beck AW, Stone DH, Finlayson SR, Cronenwett JL, Goodney PP.
Impact of Screening versus Symptomatic Measurement of Deep Venous Thrombosis in a National Quality
Improvement Registry. J Vasc Surg. 2012;56(4):1045-51. PMID 22832263.
20. Wallaert JB, De Martino RR, Marsicovetere PS, Goodney PP, Finlayson SR, Murray JJ, Holubar SD. Venous
Thromboembolism after Surgery for Inflammatory Bowel Disease: Are There Modifiable Risk Factors?
Data from ACS-NSQIP. Dis Colon Rectum. 2012;55(11):1138-44. PMID 23044674.
21. Wallaert JB, Cronenwett JL, Bertges DJ, Schanzer A, De Martino RR, Nolan BW, Eldrup-Jorgensen, Goodney
PP. Optimal selection of asymptomatic patients for carotid endarterectomy based on predicted 5-year
survival. J Vasc Surg. Accepted.
BIOGRAPHICAL SKETCH
Provide the following information for the key personnel and other significant contributors in the order listed on Form Page 2.
Follow this format for each person. DO NOT EXCEED FOUR PAGES.
NAME
POSITION TITLE
Philip Goodney
Assistant Professor
Section of Vascular Surgery
Dartmouth-Hitchcock Medical Center
eRA COMMONS USER NAME (credential, e.g., agency login)
PGOODNEY
EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training.)
DEGREE
(if applicable)
YEAR(s)
University of Connecticut
University of Connecticut School of Medicine
BS
MD
1995
1999
Dartmouth Medical School
MS
2003
-
2006
2008
INSTITUTION AND LOCATION
Dartmouth-Hitchcock Medical Center
Dartmouth-Hitchcock Medical Center
FIELD OF STUDY
Chemistry
Medicine
Evaluative Clinical
Science
General Surgery
Vascular Surgery
A: Personal Statement
I am a vascular surgeon and health services researcher at Dartmouth. During surgical training, I completed a
Master's degree in Evaluative Clinical Sciences during a two-year research fellowship at The Dartmouth
Institute. After joining the faculty at Dartmouth in 2008, I received a Career Development Award from the
NHLBI in 2010, as well as the Lifeline Research Award from the Society for Vascular Surgery in 2011. In my
research, I've enjoyed studying ways to determine which patients are most likely to benefit from surgical
treatments (References 3, 4, 5-8, and 14), and examining variation in the use and effectiveness of
revascularization for peripheral arterial disease (PAD) (References 1, 2, 6, and 13). The aim of this proposal is
to understand variation and effectiveness of medication utilization within the Vascular Quality Initiative. My
innovative research approaches have combined administrative claims with granular detail about patients,
procedures, and prevention, and advanced analytic tools such as hierarchical and econometric models. We will
utilize some of these methods for this proposal. Our results will impact the quality of care for patients
undergoing vascular surgery, by informing patients and physicians of the relative importance of medical
management. This proposal is well aligned with my long-term research goal, which is to better inform, patients,
physicians, and policymakers about quality of care in vascular surgery.
B. Positions
General Surgery Residency
1999 - 2001
Dartmouth-Hitchcock Medical Center
(Richard W. Dow, M.D.)
2003 - 2006
VA Special Fellowship in Outcomes Research
VA Outcomes Group, White River Junction, Vermont
(John D. Birkmeyer, M.D.)
2001 - 2003
Masters Degree in Evaluative Clinical Sciences
Center for Evaluative Clinical Sciences, Dartmouth
(Elliott S. Fisher, MD, MPH)
2001 - 2003
Vascular Surgery Fellowship
Dartmouth-Hitchcock Medical Center
(Jack L. Cronenwett, M.D.)
2006 - 2008
Assistant Professor, Section of Vascular Surgery
Dartmouth-Hitchcock Medical Center
Lebanon, NH
2008-current
Assistant Professor
The Dartmouth Institute for Health Policy and Clinical Practice
2008-current
Director (Interim), Surgical Outcomes Research
The Department of Surgery
Dartmouth Hitchcock Medical Center
2012-current
Honors:
Distinguished Fellow, Society for Vascular Surgery
NIH Loan Repayment Program
Faculty Loan Repayment Award, DHHS
Harmes Research Award, Department of Surgery, DHMC
Darling Award, New England Society for Vascular Surgery
Thomas P. Almy Housestaff Teaching Award
Jobst Award, Frederick A. Coller Surgical Society
Peripheral Vascular Surgery Society Academic Award
Dartmouth Medical School Class of 2007 Teaching Award
2012
2010
2009
2009
2008
2006
2007
2007
2007
B: Selected Peer-Reviewed Publications (of a total of 80)
Most Relevant to Current Proposal
1.
Goodney PP, Travis LA, Lucas FL, Cronenwett JL, Goodman DC. Variation in the use of vascular procedures
in the year prior to amputation. Circulation: Cardiovascular Quality and Outcomes 2012 Jan; 5(1): 94-102. PMID
22147886.
2.
Goodney PP, Holman KL, Travis LA, Henke PS, Birkmeyer JD, Cronenwett JL, Fisher ES. Regional use of
revascularization and amputation rates. J. Vasc Surg (in press), Sept . 2012.
3.
Goodney PP, Travis LA, Lucas FL, Cronenwett JL, Goodman DC, Stone DH. Survival following open and
endovascular thoracic aneurysm repair in the Medicare population Circulation 2011 Dec 13; 124 (24): 2661-9. PMID
22104552.
4.
Goldberg J, Baker FB, Cronenwett, JL, Goodney PP. The effect of risk and race on lower extremity
amputation among Medicare diabetics. J Vasc Surg 2012 Sept 7(epub ahead of print) PMID 22963815.
5.
Nallamothu BK, Gurm HS, Ting HH, Goodney PP, Rogers MA, Curtis JP, Dimick JB, Bates ER, Krumholz HM,
Birkmeyer JD. Operator experience and outcomes with carotid stenting in Medicare beneficiaries. JAMA 2011 Sept
28; 306 (12) 1338-43 PMID 21954477.
Additional Publications of Importance
6.
Goodney PP, Travis LL, Malenka D, Bronner KK, Lucas FL, Cronenwett JL, Goodman DC, Fisher ES.
Regional variation in carotid artery stenting and endarterectomy in the Medicare population. Circulation:
Cardiovascular Quality and Outcomes 2010 (3): 15-24. PMID 20123667.
7.
Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP et al. Surgeon volume and operative mortality in
the United States. New England Journal of Medicine. Nov 27 2003;349(22):2117-2127. PMID: 14645640.
8.
Goodney PP, Lucas FL, Birkmeyer JD. Should volume standards for cardiovascular surgery focus only
on high-risk patients? Circulation. Jan 28 2003;107(3):384-387. PMID: 12551859.
9.
Goodney PP, O'Connor GT, Wennberg DE, et al. Do hospitals with low mortality rates in coronary
artery bypass also perform well in valve replacement? Annals of Thoracic Surgery. Oct 2003;76(4):1131-1136;
discussion 1136-1137. PMID: 14529999.
10.
Goodney PP, Stukel TA, Lucas FL, et al. Hospital volume, length of stay, and readmission rates in
high-risk surgery. Annals of Surgery. Aug 2003;238(2):161-167. PMID: 12894006.
11.
Birkmeyer NJO, Goodney PP, Stukel TA, et al. Do cancer centers designated by the National Cancer
Institute have better surgical outcomes? Cancer. Feb 1 2005;103(3):435-441. PMID: 15622523.
12.
Goodney PP, Lucas FL, Stukel TA, et al. Surgeon specialty and operative mortality with lung resection.
Annals of Surgery. Jan 2005;241(1):179-184. PMID: 15622006.
13.
Goodney PP, A Dartmouth Atlas Report: Trends and regional variation in the use of carotid
revascularization. Dartmouth College Publishing, The Dartmouth Atlas (www.dartmouthatlas.org).
14.
Goodney PP, Likosky DS, Cronenwett JL, et al. Factors associated with amputation or graft occlusion
after lower extremity bypass in Northern New England. Annals of Vascular Surgery 2009. Sept 10 (Epub ahead
of print) PMID: 19748222.
15.
Goodney PP, Lucas FL, Travis LL, Fisher ES. Changes in the use of carotid revascularization among
the medicare population.Archives of Surgery. Feb 2008;143(2):170-173. PMID: 18283142.
C: Research Support
Current:
Dartmouth SYNERGY Award: Toward Understanding the Cost and
Cost-Effectiveness of Carotid Stenting and Endarterectomy.
Principal Investigator
$50,000
2012-2014
NHLBI K08 Career Development Award (1K08HL05676-01)
Understanding Regional Variation in Treatment Intensity with PAD
Principal Investigator (Mentor = Elliott S. Fisher, MD, MPH)
$699,570
2010-2015
American Vascular Association / American College of Surgeons Lifeline Award
Supplemental Funding Award. Understanding Regional Variation in
Treatment Intensity with PAD.
$250,000
2011-2015
Department of Health and Human Services Faculty Loan Repayment Award
Regional Variation in Treatment Intensity with Lower Extremity PAD
Principal Investigator
$35,451
2010-2012
National Institutes of Health Loan Repayment Award
Understanding Regional Variation in Treatment Intensity with PAD
$34,576
2011-2013
Peripheral Vascular Surgery Society Academic Award
Development of a disease-specific quality of life measure for patients
2011-2012
with critical limb ischemia (Co-Investigator with Bjoern Suckow, MD)
$14,500
Hitchcock Foundation Seed Grant
Development of a Glucose Management Service for Vascular Surgery
Patients Co-Investigator with Jessica Wallaert, MD
$10,500
2011-2012
Completed
Peripheral Vascular Surgery Society Academic Award (Goodney, PI)
2007-2008
Peripheral Vascular Surgery Society Risk Prediction Model for Complications
Following Lower Extremity Revascularization
Using data from the Vascular Study Group of Northern New England, this project entails constructing a risk
prediction model to allow surgeons to select optimal candidates for lower extremity revascularization.
$14,500
Society for Vascular Surgery Clinical Seed Grant (Goodney, PI)
2007-2008
Society for Vascular Surgery
Development of a Risk Prediction Model for Complications and Functional Outcomes
Following Lower Extremity Revascularization Using a Prospective Regional Database
Using data from the Vascular Study Group of Northern New England, this project entails constructing a risk
prediction model to identify and examine the incidence of functional outcomes after lower extremity
revascularization.
$15,000
Hitchcock Foundation Grant (Goodney, PI)
Hitchcock Foundation, Dartmouth-Hitchcock Medical Center
Has Carotid Stenting Affected the Incidence of Carotid Endarterectomy?
This project examined the utilization of carotid revascularization in Medicare
patients, and examines regional variation in this procedure as well as its effect
on outcomes.
$10,000
2006-2007
Quality Research Grant Program (Chang, Goodney, PIs)
Hitchcock Foundation, Dartmouth-Hitchcock Medical Center
Percutaneous arterial closure – Can we decrease morbidity?
In this quality improvement project we designed, implemented, and measured the
effects of a clinical pathway used to obtain hemostasis after percutaneous
endovascular procedures.
$8,000
2006-2007
Abbott Vascular, Inc. (Cronenwett, Goodney, PIs)
Standardizing Arterial Closure Technique following Percutaneous Arterial Intervention:
A Feasibility Study
This project was an industry-sponsored study examining the indications, use and
results of different methods of obtaining arterial closure following endovascular
procedures.
$6,000
2006-2008
BIOGRAPHICAL SKETCH
Provide the following information for the key personnel and other significant contributors in the order listed
on Form Page 2.
Follow this format for each person. DO NOT EXCEED FOUR PAGES.
NAME
Jack L. Cronenwett, M.D.
POSITION TITLE
Professor, Department of Surgery, Community and
Family Medicine and The Dartmouth Institute for
Health Policy and Clinical Practice
eRA COMMONS USER NAME
JCronenwett
INSTITUTION AND LOCATION
University of Michigan, Ann Arbor, MI
Stanford University Medical School, Stanford, CA
University of Michigan, Ann Arbor, MI
University of Michigan, Ann Arbor, MI
University of Michigan
University of Tennessee
A.
DEGREE
(if
applicable)
B.S.
M.D.
Residency
Fellowship
Residency
Fellowship
YEAR(s)
1965-1969
1969-1973
1973-1975
1975-1977
1977-1979
1979-1980
FIELD OF STUDY
Medicine
General Surgery
Vascular Research
General Surgery
Vascular Surgery
Personal Statement.
I strongly support Dr. De Martino’s application to understand variation and the effectiveness of medical
management surrounding vascular surgery. This has high probability of improving care as well as reducing
variation and cardiovascular complications following vascular surgical operations. I am in a unique position
to support this activity as a co-investigator. During the past 10 years, I founded and serve as Medical
Director of the Vascular Study Group of New England (VSGNE). This effort has demonstrated improvement
in processes and outcomes associated with vascular procedures, and has directly led to the current national
Vascular Quality Initiative (VQI) of the Society for Vascular Surgery (SVS). I led the development of the SVS
Patient Safety Organization (SVS PSO), and now serve as the Medical Director of this effort, which began
this year, and already involves > 100 hospitals in 30 states. I am appropriately positioned to work with Dr.
De Martino in understanding variation in medical management. This project is in alignment with efforts by
the Vascular Quality Initiative to reduce variation and improve the quality of care provided to improve
outcomes.
B.
Positions and Honors.
Academic Appointments:
1980 - 1983 Research Associate, Veterans Administration, Medical Center, Ann Arbor, Michigan
1980 - 1984 Assistant Professor, Department of Surgery, University of Michigan, Ann Arbor, Michigan
1984 - 1989 Associate Professor, Department of Surgery, Dartmouth Medical School, Hanover, NH
1989 Professor, Department of Surgery, Dartmouth Medical School, Hanover, NH
2002 Professor, Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH
2009 Professor, The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
Professional Positions:
1980 - 1984 Director, Vascular Diagnostic Unit, Veterans Administration, Medical Center, Ann Arbor, Michigan
1980 - 1984 Attending Surgeon, University of Michigan Hospitals
1980 - 1984 Staff Surgeon, Veterans Administration, Medical Center, Ann Arbor, Michigan
1984 - 1987 Director, Vascular Laboratory, Dartmouth-Hitchcock Medical Center
1984 - 2007 Chair, Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center
1988 - 2007
1996 - 2002
1997 - 1998
2000 - 2002
2002 - 2003
2003 - 2011
2003 - 2008
2002 2011 -
Program Director, Vascular Surgery Residency, Dartmouth-Hitchcock Medical Center
Residency Review Committee for Surgery, Member
President, New England Society for Vascular Surgery
President, Association of Program Directors in Vascular Surgery
President, Society for Vascular Surgery
Senior Examiner, Vascular Surgery, American Board of Surgery
Editor-in-Chief, Journal of Vascular Surgery
Medical Director, Vascular Study Group of New England
Medical Director, Society for Vascular Surgery Patient Safety Organization
Honors:
1973
1977
1977
1977
1987 - 2011
1991
1994 - 2011
1994 - 2011
1996 - 2011
1998
2001 - 2011
2002
2003
2010
Senior Surgical Award, Stanford Medical School
Frederick A. Coller Award for Research by Surgical Residents
Conrad Jobst Award for outstanding contributions in vascular research
Resident Research Award, Association for Academic Surgery
48 Visiting professorships
Traveling Fellow, Australia and New Zealand Chapter of the ACS
27 Honorary lectures
Listed in "The Best Doctors in America”
Listed in "Who's Who in America," Marquis
The Chairman's Award, Department of Surgery, Dartmouth Medical School
Listed in Castle Connolly "America’s Top Doctors"
Honorary Member, Canadian Society for Vascular Surgery
Honorary Member, Southern Association for Vascular Surgery
Julius H. Jacobson Physician Excellence Award, Vascular Disease Foundation
C. Selected peer-reviewed publications (from a total of 180):
Most Relevant to Current Proposal
1.
Cronenwett JL, Birkmeyer JD, Nackman GB, Fillinger MF, Bech FR, Zwolak RM, Walsh DB. Costeffectiveness of carotid endarterectomy in asymptomatic patients. J Vasc Surg 1997;25:298-309; discussion
10-1, 9052564.
2.
Cronenwett JL, Likosky DS, Russell MT, Eldrup-Jorgensen J, Stanley AC, Nolan BW. A regional
registry for quality assurance and improvement: the Vascular Study Group of Northern New England
(VSGNNE). J Vasc Surg 2007;46:1093-101; discussion 101-2, 17950568.
3.
Goodney PP, Likosky DS, Cronenwett JL. Factors associated with stroke or death after carotid
endarterectomy in Northern New England. J Vasc Surg 2008;48:1139-45, 18586446.
4.
Beck AW, Goodney PP, Nolan BW, Likosky DS, Eldrup-Jorgensen J, Cronenwett JL. Predicting 1-year
mortality after elective abdominal aortic aneurysm repair. J Vasc Surg 2009;49:838-43; discussion 43-4,
19341875.
5.
Stone DH, Nolan BW, Schanzer A, Goodney PP, Cambria RA, Likosky DS, Walsh DB, Cronenwett JL.
Protamine reduces bleeding complications associated with carotid endarterectomy without increasing the risk
of stroke. J Vasc Surg 2010;51:559-64, 64 e1, 20045609.
6.
Goodney PP, Travis LL, Malenka D, Bronner KK, Lucas FL, Cronenwett JL, Goodman DC, Fisher ES.
Regional variation in carotid artery stenting and endarterectomy in the Medicare population. Circ Cardiovasc
Qual Outcomes 2010;3:15-24, 20123667.
7.
Goodney PP, Nolan BW, Eldrup-Jorgensen J, Likosky DS, Cronenwett JL. Restenosis after carotid
endarterectomy in a multicenter regional registry. J Vasc Surg 2010;52:897-904, 5 e1-2; discussion -5,
20620001.
8.
Wallaert JB, Goodney PP, Vignati JJ, Stone DH, Nolan BW, Bertges DJ, Walsh DB, Cronenwett JL.
Completion imaging after carotid endarterectomy in the Vascular Study Group of New England. J Vasc Surg
2011;54:376-85, 85 e1-3, 21458209.
Additional Publications of Importance (in chronological order)
9.
Cronenwett JL, Johnston W. Rutherford’s Vascular Surgery. 7th ed: Saunders; 2010.
10.
Schanzer A, Goodney PP, Li Y, Eslami M, Cronenwett J, Messina L, Conte MS. Validation of the PIII
CLI risk score for the prediction of amputation-free survival in patients undergoing infrainguinal autogenous
vein bypass for critical limb ischemia. J Vasc Surg 2009;50:769-75; discussion 75, 19628361.
11.
Goodney PP, Likosky DS, Cronenwett JL. Predicting ambulation status one year after lower extremity
bypass. J Vasc Surg 2009;49:1431-9 e1, 19497502.
12.
Goodney PP, Nolan BW, Schanzer A, Eldrup-Jorgensen J, Bertges DJ, Stanley AC, Stone DH, Walsh
DB, Powell RJ, Likosky DS, Cronenwett JL. Factors associated with amputation or graft occlusion one year
after lower extremity bypass in northern New England. Ann Vasc Surg 2010;24:57-68, 19748222.
13.
Goodney PP, Nolan BW, Schanzer A, Eldrup-Jorgensen J, Stanley AC, Stone DH, Likosky DS,
Cronenwett JL. Factors associated with death 1 year after lower extremity bypass in Northern New England. J
Vasc Surg 2010;51:71-8, 19939615.
14.
Bertges DJ, Goodney PP, Zhao Y, Schanzer A, Nolan BW, Likosky DS, Eldrup-Jorgensen J,
Cronenwett JL. The Vascular Study Group of New England Cardiac Risk Index (VSG-CRI) predicts cardiac
complications more accurately than the Revised Cardiac Risk Index in vascular surgery patients. J Vasc Surg
2010;52:674-83, 83 e1-83 e3, 20570467.
15.
Goodney PP, Eldrup-Jorgensen J, Nolan BW, Bertges DJ, Likosky DS, Cronenwett JL. A regional
quality improvement effort to increase beta blocker administration before vascular surgery. J Vasc Surg
2011;53:1316-28 e1; discussion 27-8, 21334166.
D. Research Support:
Ongoing Research Support:
Vascular Study Group of New England Cronenwett (PI)
2009 This is an ongoing quality improvement project funded by a consortium of 28 hospitals in New England to
generate benchmarked, risk-adjusted outcomes reports, with derivative quality research designed to improve
clinical care.
Completed Research Support
Centers for Medicare and Medicaid Cronenwett (PI)
2001 - 2009
"Northern New England Vascular Surgery Quality Improvement Initiative"
This is a regional quality improvement initiative comprised of 13 hospitals in 3 states collecting data about
vascular surgery procedures in order to identify process induced variation and improve outcomes. I am the PI
of this project.
Centers for Medicare and Medicaid Cronenwett (PI)
“Aortic Aneurysm Screening in Medicare Beneficiaries”
2001- 2003
This was a study to determine the prevalence of AAAs in Medicare patients in 3 sites to calculate the costeffectiveness of screening in the general population. I was the PI in this multicenter study.
Society for Vascular Surgery Cronenwett (PI)
1998 - 2000
"Dartmouth Atlas of Vascular Healthcare"
This was a study of all vascular surgical procedures performed in the US based on small area analysis to
identify variation in provider type, rates of intervention, and variation in outcome by hospital referral region. I
was the PI.
National Institutes of Health, NHLBI (R01-HL35102) Cronenwett (PI)
"Pharmacologic modification of vascular graft patency."
This was one of multiple basic research studies performed in my early career.
1985 - 1988
BIOGRAPHICAL SKETCH
Provide the following information for the Senior/key personnel and other significant contributors in the order listed on Form Page 2.
Follow this format for each person. DO NOT EXCEED FOUR PAGES.
NAME
POSITION TITLE
Yuanyuan Zhao
Statistical Research Analyst
Section of Vascular Surgery
Dartmouth-Hitchcock Medical Center
eRA COMMONS USER NAME (credential, e.g., agency login)
EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, include postdoctoral training and
residency training if applicable.)
DEGREE
INSTITUTION AND LOCATION
MM/YY
FIELD OF STUDY
(if applicable)
A.
Eastern Michigan University, Ypsilanti, MI
MA
09/04-12/06
Tianjin Institute of Technology, Tianjin, China
BE
09/93-07/97
Math Department,
Applied Statistics
Telecommunications
Engineering
Personal Statement
I am a Statistical Research Analyst at Section of Vascular Surgery, DHMC. I have a strong background in
statistical theory and excellent experiences in medical data analysis. As a Statistical Research Analyst at Section
of Vascular Surgery, I conduct statistical analysis in clinical research in Section of Vascular Surgery and
Vascular Study Group of New England (VSGNE); assist data cleaning and management; coauthor research
paper published and abstracts presented in academic conferences; review manuscript and abstracts before
submission. I have rich experiences in multivariate linear regression analysis, categorical data analysis, survival
analysis and longitudinal data analysis in medical and health science and programming in SAS 9.2. In the past I
have demonstrated the ability to collaborate with colleagues in all kinds of projects. My expertise and
experience have prepared me to participating in this proposed project.
B.
Positions and Honors
Positions and Employment
01/2009-present
Statistical Research Analyst
Section of Vascular Surgery, Dartmouth- Hitchcock Medical Center, NH
07/2006-08/2006 Statistical Data Analyst
Tobacco Research Center, University of Minnesota, Minneapolis, MN
01/2005-12/2006 Computing Consultant and Graduate Assistant
Eastern Michigan University, Ypsilanti, MI
04/1998-07/2001 Senior Electrical Engineer
Personal Communication Sector (PCS), Motorola (China) Electronics Ltd., Tianjin, China
07/1997-04/1998 Electrical Engineer
Samsung Optical Electronics Ltd., Tianjin, China
Honors
2005-2006 Outstanding Graduate Assistant, Eastern Michigan University, MI
1999-2001 Excellent Performance Award, Motorola (China) Electronics Ltd.
1993-1994 Distinguished Student Fellowship, Tianjin Institute of Technology, China
C.
Selected Peer-reviewed Publications
1. The Vascular Study Group of New England Cardiac Risk Index (VSG-CRI) Predicts Cardiac Complications
More Accurately Than the Revised Cardiac Risk Index in Vascular Surgery Patients,
Daniel J. Bertges, Philip P. Goodney, Yuanyuan Zhao, Andres Schanzer, Brian W. Nolan, Donald S.
Likosky, Jens Eldrup-Jorgensen, Jack L. Cronenwett, Journal of Vascular Surgery, 2010 Sep; 52(3):674-83
2. Variation in smoking cessation after vascular operations,
Andrew W. Hoel, Brian W. Nolan, Philip P. Goodney, Yuanyuan Zhao, Andres Schanzer, Andrew C.
Stanley, Jens Eldrup-Jorgensen, Jack L. Cronenwett, Vascular Study Group of New England, Journal of
Vascular Surgery, 2013 Jan 30